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When drugs collide: Seniors at risk for dangerous interactions with supplements, prescription drugs
Supplement use in America Story by Jennifer Graham - photo by Jennifer Graham
Americas medicine cabinets are bulging with over-the-counter pain relievers, prescription drugs, and vitamins and supplements that promise to improve health. But pills can collide to disastrous effect, and 1 in 6 American seniors risk life-threatening conditions from interactions between drugs and supplements, a new report says.

Researchers at the University of Chicago analyzed prescription drug use among senior citizens in 2006 and again in 2011. They found the number of seniors who took more than five prescription drugs had significantly increased, as had the number of seniors taking nutritional supplements, which, when combined with some drugs, can lead to renal failure and hemorrhage.

Of particular concern is an increase in use of statins (drugs that lower cholesterol levels) and antiplatelets (used to treat heart disease) at the same time that use of omega-3 fish oil more than tripled.

Such pairings can actually worsen heart conditions, said Dr. Caleb Alexander, a co-author of the study and co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health.

The fact that we see substantial increases of risk of major adverse events over five or six years is of great concern, he said.

Americans, however, love their supplements. According to the Council for Responsible Nutrition, an industry trade group, 68 percent of American adults take at least one supplement, with more than three-quarters of supplement users taking a multivitamin and nearly 20 percent taking omega-3 fatty acids.

Year after year, our consumer survey demonstrates that the majority of Americans take dietary supplements, and with high confidence, said Andrea Wong, the councils vice president for scientific and regulatory affairs.

Something fishy

Alexander and his colleagues surveyed 2,351 seniors in 2005-06 and 2,206 in 2010-11. Participants were between 62 and 85 years old, and were interviewed in their homes where their medications and supplements could be inspected.

They found that 1 in 3 seniors use five or more prescription medications, and two-thirds use prescription medication along with over-the-counter medication or dietary supplements, a rate that has doubled since 2005. Together, these comprise a trend the researchers call "a growing public health problem."

"Despite no evidence of any clinical benefits, dietary supplement use is increasingly common among older adults, with almost a 50 percent increase in the use of multiple supplements. The almost four-fold increase in the use of omega-3 fish oils over a five-year period is particularly noteworthy considering their limited cardiovascular benefits," the report said.

"We also identified an almost three-fold increase in the use of vitamin D, which may be due to increased reports supporting possible cognitive benefits in older adults."

That corresponds with findings from the Council for Responsible Nutrition, which says vitamin D, taken by nearly one-third of supplement users, is second only to multivitamins in popularity, and surpasses both vitamin C and calcium in sales.

"Government data show that Americans are not getting enough of the nutrients they need from diet alone, and so consumers, with the help of their doctor or other health care practitioner, can consider dietary supplements as a smart and affordable way to help fill those nutrient gaps," Wong said.

While Alexander says that, for some people, supplements offer minimal benefit but carry major risk, he and his colleagues agree that patients and health care professionals need to talk more about what happens when supplements and drugs collide.

"These efforts may include incorporation of the interaction effects of commonly used medications, including OTC medications and dietary supplements, in treatment guidelines," the report said.

The researchers limited their analysis to the 20 most commonly used medications and the 20 most commonly used supplements. Among them, 15 interactions carried the risk of major or life-threatening severity.

Shared responsibility

About 15 percent of Americans of all ages take five or more prescription drugs. Among older Americans, that figure rises to 40 percent. Judy Carleton of Cleveland is among them.

Carleton, a retiree who is 69 years old, takes eight prescription pills and two capsules every day, along with an aspirin and multiple injections. Although she takes no supplements, she said her doctor has never discussed possible drug interactions with her in her treatment for diabetes, high cholesterol and a heart condition.

While Carleton has suffered no complications, she has a friend who went to the hospital with breathing problems after taking two pills for different conditions at the same time. Her friend had not been told this was something she shouldn't do, Carleton said.

Her friend's emergency illustrated a problem that Alexander noted: Too often, doctors and pharmacists fail to ask, and patients fail to mention, what they are taking beyond what is being prescribed at the time.

Doctors, pharmacists and patients themselves all share a responsibility that the patients treatment programs are sensible and lean. And this includes not just prescription medicine, but over-the-counter treatments and supplements, Alexander said.

Millions of Americans take supplements and many are convinced of the health benefits of these products, and yet they are loosely regulated and theres little to no high-quality evidence of their effectiveness, he said.

While he concedes that many Americans believe they are getting benefits from fish oil or mega doses of vitamin C, Alexander says a placebo effect may often be at work, noting, "30 percent of people get better with a sugar pill."

There are websites where people can check potential interaction issues with their drugs and supplements, including those at Medscape, and AARP. The sites note, however, that their tools are for information only and should not be a substitute for advice from a medical professional, and Alexander says its important for people to have these conversations with their doctors and pharmacists.
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