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Mixing medicines and supplements could be harmful

Many patients do not readily disclose their supplement use to healthcare providers, as they perceive these products to be safe. But this gap in doctor-patient communication can be dangerous as some combinations of prescription medication and supplements could have detrimental side effects.

A recent Changi General Hospital study found that over 90 per cent of the 55 elderly patients studied suffered from at least three chronic conditions and almost all of them were taking multiple medications during their hospital stay. At home, the patients took an average of nine types of medications. Photo: Reuters

A recent Changi General Hospital study found that over 90 per cent of the 55 elderly patients studied suffered from at least three chronic conditions and almost all of them were taking multiple medications during their hospital stay. At home, the patients took an average of nine types of medications. Photo: Reuters

SINGAPORE — A pill for a nerve problem, two for a sluggish thyroid and three different drugs for a lung condition are just some of the medications 82-year-old Martin Fong takes daily for several chronic conditions. And it is not unusual for the average senior in Singapore to pop multiple pills each day just as Mr Fong does.

A recent Changi General Hospital study found that over 90 per cent of the 55 elderly patients studied suffered from at least three chronic conditions and almost all of them were taking multiple medications during their hospital stay. At home, the patients took an average of nine types of medications.

But prescription drugs are not the only pills chronic-disease sufferers take; vitamins and other supplements are likely found in their pillboxes too.

For instance, in addition to his various daily medications, Mr Fong takes Vitamin B12 for a nerve ailment. He also recently started taking calcium supplements after he fractured his leg.

Health supplements are widely consumed in Singapore.

The Health Supplements Industry Association of Singapore estimated that Singaporeans spent almost S$6 million on supplements in 2015, a figure that is expected to increase by 8 to 10 per cent annually.

Although there are currently no formal data on the number of patients with chronic diseases who take supplements, it is not uncommon for pharmacists to see walk-in patients and their relatives inquiring about dietary supplements as a complement to their medications, said Ms Serena Kon, a pharmacist at the Singapore General Hospital (SGH).

What is of concern, she said, is that many patients do not readily disclose their supplement use to healthcare providers, as they perceive these over-the-counter products to be safe.

But this gap in doctor-patient communication can be dangerous as some combinations of prescription medication and supplements could have detrimental side effects.

In particular, those on multiple medications face a higher chance of medication-supplement interactions, said Ms Kon.

An example is omega-3 fish oil, which is often marketed as heart-healthy, but could spell trouble for people on the blood thinner warfarin, a medication commonly used to prevent heart attacks, stroke and blood clots.

“Warfarin is one of the most notorious medications known to interact with various supplements. It can interact with supplements such as omega-3 fish oils, ginkgo biloba, Vitamin K and St John’s Wort, leading to a potential risk of bleeding or clotting,” said Ms Kon.

Other examples of dangerous medication-supplement interaction include calcium and iron supplements, which can lower absorption of certain antibiotics and potentially cause treatment of an infection to fail, Ms Kon pointed out.

Some supplements are also not suitable for people with certain chronic diseases. For instance, potassium supplements should be dispensed with caution to chronic kidney disease patients, added Ms Kon.

FILLING IN NUTRITION GAPS WHILE ON LONG-TERM MEDICATION

But this does not mean that chronic disease sufferers should totally steer clear of supplements. In fact, those on certain long-term medication may benefit from supplements, said complementary medicine expert Dr Lesley Braun, director of Blackmores Institute in Australia.

At the 2017 Blackmores Institute Symposium last month, where she shared her views on integrating complementary medicine into pharmacy practice, Dr Braun said there is growing evidence to suggest that complementary medicine can be safely used with conventional treatments.

When taken appropriately, they can benefit people whose long-term prescription medication use may put them at risk of nutritional deficiencies.

“For example, research has shown that people on long-term medication for Type 2 diabetes like metformin are at risk of B12 deficiency.

“Blood pressure medication, when taken long-term, can induce zinc deficiency,” said Dr Braun, who is also an adjunct associate professor at the National Institute of Complementary Medicines (Western Sydney University).

“It would make sense for pharmacists to ask patients on these medications for signs of these nutritional deficiencies and check whether they are taking enough in their diets. If they aren’t, perhaps they should look into a supplement,” she added.

The right supplements can also help the elderly meet their energy, protein, vitamin and mineral requirements, when they do not eat well due to various reasons such as changes in lifestyle, dental issues or poor digestion and appetite, said Ms Lynette Goh, senior dietitian at National Healthcare Group Polyclinics. These supplements may come in the form of nutritional drinks and shakes, and are usually prescribed by a dietitian, said Ms Goh.

LOWERING SUPPLEMENT-MEDICATION INTERACTION RISK

While supplements can be easily bought over the counter, the experts stressed that people with chronic diseases and who are on multiple medications should never take matters into their own hands.

Ask your doctor and pharmacist when and how much of the supplement to take and find out about potential interactions with food or medication, said Ms Goh.

“The doctor should also know what you are currently taking so that he or she can monitor for any side effects or any interactions between conventional medicine and supplements or herbal medicines,” said Ms Goh.

In some cases, taking medications and supplements at separate timings might not prevent undesirable effects.

“Patients need to be aware that there are many pathways through which these interactions can take place.

“Simply taking the dietary supplement several hours from a dose of medication may not necessarily avoid the interaction,” warned Ms Kon.

Consulting a pharmacist would help you find the right formulation when choosing a supplement, said Dr Braun. “Men, women, children and teenagers have different requirements. The person’s lifestyle should be taken into consideration, too.

“For example, we know that smokers would benefit from Vitamin C supplementation because smoking destroys this vitamin,” she said.

While supplements might offer some people a nutrition boost, the experts said that every individual still has to work on getting his diet right first. When considering a supplement, decide what you really need that cannot be obtained by diet, advised Ms Goh.

“It’s easy to get a little lazy and think you can get everything from a supplement but it is important for us to realise that we can never fully replace what’s in a really good diet,” said Dr Braun.

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