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Chapter 107 Dietary Supplements Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Dietary Supplements FDA definition: “vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites” intended to supplement the diet Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 2 Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 3 Regulation of Dietary Supplements The Dietary Supplement Health and Education Act (DSHEA) of 1994 Package labeling Adverse effects Impurities, adulterants, and variability National Center for Complementary and Alternative Medicine Promotional materials Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 4 Regulation of Dietary Supplements Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006 FDA Current Good Manufacturing Practices (CGMPs) ruling, 2007 Quality certification programs Standardization of dietary supplements Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 5 Common Herbal Remedies Black cohosh Coenzyme Q-10 Cranberry juice Echinacea Feverfew Flaxseed Garlic Ginger root Ginkgo biloba Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 6 Common Herbal Remedies Glucosamine Green tea Probiotics Saw palmetto Soy St. John’s wort Valerian Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 7 Harmful Supplements to Avoid Comfrey Kava Ma huang (ephedra) Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 8 Black Cohosh Cimicifuga racemosa Used to treat symptoms of menopause MOA unknown Effectiveness Some studies have shown it to be as effective as estrogen Has not been evaluated for long-term use Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 9 Black Cohosh Drug interactions May potentiate antihypertensives and the hypoglycemic effect of oral agents and insulin Adverse effects Safe for routine use GI are most common side effects Also rash, headache, dizziness, weight gain, and cramps Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 10 Coenzyme Q-10 Potent antioxidant in the body; participates in production of ATP at the mitochondrial level Therapeutic uses Mitochondrial encephalomyopathies, CHF, and myopathies due to HMG-CoA reductase inhibitors (statins) Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 11 Coenzyme Q-10 Adverse effects Well tolerated, may have GI symptoms Drug interactions CoQ-10 is structurally similar to vitamin K2 and may antagonize the effects of warfarin Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 12 Cranberry Juice Therapeutic use Effectiveness Prevents UTI The proanthocyanidins it contains interfere with bacterial adhesion to the urinary tract Daily intake helps prevent UTIs in women in their teens or 20s and elderly women – not older adults or young girls Contradictory evidence that cranberry juice may increase INR of warfarin patients Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 13 Echinacea Echinacea angustifolia, E. purpurea, E. pallida Used orally and topically Produces antiviral, anti-inflammatory, and immunostimulant effects Widely taken, but effectiveness is highly questionable Interactions May interfere with immunosuppressant drugs Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 14 Feverfew Used primarily for prophylaxis of migraine MOA not well understood Has shown to be effective Adverse effects Well tolerated, no serious effects Mild GI reactions Long-term safety studies are lacking Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 15 Flaxseed Used to treat dyslipidemia and constipation Soluble plant fiber Seems to decrease total cholesterol and LDL, similar to other fiber products Adverse effects are GI-related (bloating, cramping, etc.) Should be taken 1 hour before or 2 hours after other medications Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 16 Garlic Used primarily for cardiovascular system effects To reduce levels of TG and LDL and raise HDL Also used to reduce blood pressure, suppress platelet aggregation, increase arterial elasticity, and decrease formation of atherosclerotic plaque; antimicrobial and anticancer effects Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 17 Garlic Can have favorable effects on blood pressure and plasma lipids Must be raw, not cooked (allicin and allinase) 1-2 cloves twice daily for effect Only 5 of 18 common garlic products contain allicin in effective amounts Generally well tolerated except for unpleasant taste and bad breath Has significant antiplatelet effects Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 18 Ginger Root Primary uses To treat vertigo To suppress nausea and vomiting caused by motion sickness or morning sickness; to suppress post-op nausea and vomiting For cancer chemotherapy Can suppress platelet aggregation Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 19 Additional Supplements Ginkgo Glucosamine Generally well tolerated Use with caution in patients with shellfish allergy Increased risk for bleeding Green tea Overconsumption leads to caffeine overdose Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 20 Additional Supplements Probiotics Saw palmetto Generally well tolerated – some GI effects Conflicting results in treatment of BPH May have antiplatelet effects Soy Should not be used with antiestrogenic medications (tamoxifen) Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 21 St. John’s Wort Widely used to treat depression Limited clinical studies show St. John’s wort is useful for mild to moderate depression – not severe depression No prescription needed in United States Interacts adversely with many drugs Induction of cytochrome P450 enzymes Induction of P-glycoprotein Intensification of serotonin effects Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 22 Additional Supplements Valerian Generally well tolerated Does not seem to potentiate CNS depressant effects of alcohol, but this may occur Used as a tranquilizer in World War II Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 23 Harmful Supplements Comfrey Kava Contains pyrrolizidine alkaloids that are associated with veno-occlusive disease Can result in severe hepatic damage Ma huang (ephedra) Can elevate BP and stimulate the heart and CNS Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. 24
