Tag Archives: drug interactions

6 Things To Know About Your Over-the-Counter Medications

By Emily Shearer
JustCareUSA

Over-the-counter medications are drugs you can buy without a prescription to treat common problems. However, you should still use them with caution. A number of recent studies have revealed worrisome side effects from incorrect use of OTC medicines. Here are six things you should know about over-the-counter medications (OTC) to keep you and your loved ones safe.

To minimize the risk of harmful drug interactions, always keep a list of all the drugs you are taking in your wallet (both prescription drugs and OTC drugs) and share the list with your doctors and the people you most trust. If you are getting headaches, diarrhea, constipation, or have a dry mouth, it might be a minor side effect of the drugs you’re taking; some side effects can be life-threatening, including severe bleeding or liver or kidney damage.

  1. Just because medicines are OTC does not make them risk-free. Do not assume that because you do not need a prescription for OTC medications that they are always safe to use. Depending upon the other medications you are already taking and your health condition, OTC drugs may be dangerous and can be toxic if overused. While it is generally okay to take the correct dose of an OTC drug for a specific problem (for example, taking ibuprofen to help relieve a headache), all medications carry different risks and benefits. If you have a complex health condition or simply have concerns about an OTC medication, check with your doctor before taking it. People with very bad symptoms, who do not know what is wrong with them, or with long-term medical problems also should check with their doctor before taking an OTC medication.
  2. Our knowledge about the risks and benefits of different OTC drugs is continuously changing. As with other areas of medicine, researchers are constantly learning new things about OTC drugs that change the way they should be used. For example, after receiving numerous reports of severe liver damage associated with the use of acetaminophen (the active ingredient in Tylenol), in 2011 the FDA changed the maximum amount of acetaminophen that could be contained in single OTC dosage to 325 mg. And the risks may differ depending upon your age, weight and medical condition.
  3. OTC drugs may interact with other medications you are taking. Just as two or more prescription medications can interact with one another, creating adverse or unintended side effects, OTC drugs can also change the way a prescribed medication works in your body. If you are taking prescription medications, including opioids, check with your doctor before combining them with an OTC medicine.
  4. OTC drugs may interact with diet or lifestyle factors. OTC medications can be harmful if they interact with alcohol in your system or certain foods in your diet. They can also affect other health conditions. Check with your doctor if you have specific medical or lifestyle considerations that may need to be taken into account when starting an OTC medication. As a general rule, you should not consume alcohol when taking any type of medication, unless your doctor gives you permission to do so.
  5. OTC drugs may affect older people differently. While everyone should be careful when taking medications, older people need to take extra caution. The body changes how it absorbs food and drugs as it ages; and, older people generally take more medications than younger people, putting them at higher risk for adverse interactions.
  6. Your doctor may decide to provide you with different treatments based on the OTC medications you take. Always report your OTC medications to your doctor, whether at check-ups or during hospital visits. Always let healthcare providers know about any medications you are currently taking, including OTC medicines.

Many people take vitamin and herbal supplements to feel better. As a general rule, eating a healthy diet of foods with different vitamins is the best way to make sure you have the vitamins you need. Like over-the-counter drugs, vitamin supplements are not risk-free. Watch John Oliver explain the issues with vitamin supplements. You can learn more from about vitamin supplements on JustCareUSA from Dr. Salomeh Keyhani, including vitamin C supplements, vitamin E supplements, vitamin B6 supplements, and vitamin B12 supplements.

Dr. Keyhani’s evidence comes largely from Cochrane.org, which is an independent group that analyzes a range of studies and summarizes the best evidence from research. Also keep in mind that vitamin supplements you buy at the drugstore or other retail stores are not regulated by the FDA, and so they may not be what they appear to be, as the New York Attorney General’s office found.

Emily Shearer is a student at Stanford University School of Medicine with a background in health policy. 

This article originally appeared on JustCareUSA. Republished with permission.

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Is Your Child on Multiple Meds? He May Be at Increased Risk for Adverse Events

When we think of drug interactions and adverse effects, we worry more about adults — and particularly seniors — who are often on a cocktail of drugs. But new research shows that children and teens are also at risk for adverse effects – some quite serious – from being on multiple drugs.

The study, published in September in the journal Pediatrics, found that one in five children is on regular prescription medication, and one in twelve is potentially at risk for serious side effects from two or more drugs interacting with each other. In particular, teen girls have a higher risk than boys.

In many cases, this happens when a child is on a chronic long-term medication, such as an antidepressant, birth control or an ADHD (attention-deficit/hyperactivity disorder) stimulant. He or she falls ill and is given an antibiotic, a short-term medication. At that point, there is the potential for those two drugs to interact and cause adverse effects.

The Risks of Using Multiple Drugs in Children

About 200,000 children (age 17 and younger) go to the ER each year as a result of an adverse drug event, according to the CDC. What wasn’t known before was how many children and teens were on prescription drugs, and how many were taking two or more at the same time — called concurrent use — and the risk from drug-to-drug interaction.

The researchers found that boys age six to 12 years old had the highest use of concurrent prescription drugs at 12%, followed by teen boys and girls at 10%.

Significantly, the risk of drug-to-drug interactions for teen girls on antidepressants was much higher at 18%, than for boys at almost 7%, because more teen girls were given antibiotics for infections.

The most common side effect seen with drug-drug interactions in the study was abnormal heart rhythm, with a risk of its leading to sudden death. It also found that the most commonly used combinations of drugs were associated with effects such as suicidal tendencies or depressive symptoms. These combinations include taking an antidepressant with at least one other psychotropic medication or a birth control pill.

What Parents Need to Know

Over-the-counter (OTC) pain and fever medicines and antacids can also potentially interact with antidepressants and other chronic drugs, the study authors pointed out.

“Parents need to be aware of these adverse effects, which are not typical but could happen for many reasons,” said Dima Qato, PharmD, MPH, PhD, associate professor of pharmacy at the University of Illinois, Chicago, and lead study author. “They need to be aware of the drugs that can cause it, which are not limited to prescription medicines, but can also be [OTC] analgesics and acid reflux drugs used to treat heartburn.”

If children see more than one doctor and they’re given different prescription drugs by different providers, parents need to inform their physicians and pharmacists about all drugs they’re on.

About 200,000 children (age 17 and younger) go to the ER each year as a result of an adverse drug event.

Sudden cardiac deaths are under-reported in children, but are more common among those who are athletes, have asthma or are on antidepressants.

“It’s a concern that children are taking medications that expose them to higher risk,” Qato cautioned. “We may not know, as physicians, pharmacists and school nurses, that this could happen.”

“We hope people will be more vigilant about giving children multiple medications, particularly teen girls,” she added.

Communication Key to Avoid Risk

“The study brings up some really good points,” said Siyi Yung, MD, a pediatrician and attending physician at the University of California, Los Angeles Mattel Children’s Hospital. “It shows how many kids are at risk for drug interactions. It’s definitely a problem, even if it’s not as prevalent as in elderly people. We need to be aware of it because of how often children go to the emergency room for adverse effects.”

But she cautioned that the study looked at potential interactions, not actual events that took place and were reported. These potential adverse effects are not common, but could happen.

“The potential is high, but in pediatrics, when we prescribe for a chronic period of time, we usually follow them very closely, especially if it’s an antidepressant, via phone or in-person,” Yung said. “When patients are already on chronic medication, and we are the ones prescribing an antibiotic, that is when it gets trickier.”

When an outside prescriber such as a psychiatrist writes up a prescription for an antidepressant, and communication between the doctor, the parents and the pediatrician is not clear, this can lead to gaps in knowledge which can complicate things, especially when the child is put on two or more drugs. Intake forms at clinics and hospitals always ask about current medications, but patients and caregivers can slip up and forget to list them all.

“Someone could come in for a urinary tract infection, forget to tell the doctor they’re also on antidepressants, and get antibiotics for their UTI, which could lead to a drug interaction,” Yung explained. “For many patients, their parents give us an oral report, but often can’t remember the name of the medicine, its potency, etc.”

System Improvements Needed

Part of the problem also lies with unnecessary prescriptions for antibiotics, which Yung said are often doled out when children are brought to the ER or urgent care, and seen by unfamiliar doctors. Antibiotics are only effective for bacteria-based infections. More than 60,000 children end up at the ER as a result of an adverse drug event from an antibiotic each year, according to the CDC.

“I think it drives home the need to improve our healthcare system so patients are not forced to go to the ER when they could be served by their normal clinic or primary care provider,” Yung said.

Similarly, for ADHD, when a parent raises concerns, there may be an explanation for a child’s behavior when physicians investigate, and maybe even contact the teachers, before prescribing drugs.

Parents also often start a child on OTC medicines without being aware of how they might interact with the chronic drugs the child is on, so it’s important to ask the doctor what medicines and supplements (including vitamins) should be avoided every time you meet with the doctor about the chronic drug, she said.

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Can Artificial Intelligence Predict Drug Side Effects?

Marinka Zitnik is a postdoctoral computer science researcher at Stanford University with an interest in how artificial intelligence (AI) can help in the field of medicine. When she came across statistics about how taking multiple medications can lead to experiencing many side effects, she decided to do something about it.

She wondered if an AI system could mine information about these drug combinations and predict their potential side effects, which could then be used by prescribers as a tool to evaluate the risks of prescribing a particular cocktail of drugs.

The more drugs someone is taking, the more likely the risk of drug-drug interactions. Physicians prescribing the drugs cannot predict all the possible side effects that could occur because there is so much that is unknown about potential adverse effects from combining drugs.

The Problem of Polypharmacy

In the US, studies show that about 40% of adults over the age of 65 take five or more medicines, up from about 13% back in the late 1980s. Called polypharmacy, it’s most common among seniors, but is also prevalent among adults with intellectual disability and, increasingly, even among children and teens with certain conditions.

Zitnik learned that it’s difficult to perform experiments on a large scale to get reliable information on potential side effects from drug combinations, given there are more than 5,000 drugs on the US market, which makes it impossible to test different combinations of all these drugs.

Zitnik and her Stanford colleagues say that there are 1,000 known drug side effects, meaning there are 125 billion possible side effects if all potential drug pairs are considered.

“We don’t know much about how they interact, and we spend nearly $200 billion on treating the side effects,” she said, quoting a Journal of Pharmacy study.

When Zitnik and her colleagues embarked on this project, they found there was no existing model that could test for polypharmacy side effects. So they took data from the FDA Adverse Event Reporting System (FAERS) database and used it to develop algorithms. Their AI system, Decagon, first learns about side effects, becoming familiar with them. It then can predict them by studying how the drugs interact with the body’s 19,000 proteins.

“We get the adverse effects data, then training [of the system] happens in several rounds. In every round, the model makes predictions, we look at errors in the predictions and we change” information about the drugs and side effects “so that in the next round the predictions are more accurate,” Zitnik explained. “This is repeated many times until the model learns…well and can accurately predict side effects.”

It currently has about 80% accuracy in predicting side effects, which it ranks according to the top 50 possible drug interactions. The researchers’ goal at this stage is to clinically validate the predictions made by Decagon, by looking for real-life patient experiences that are comparable. The next step will be refining the system and making it user friendly for prescribers.

AI’s Potential Impact on Reducing Side Effects

“I don’t see how most prescribers can even begin to scratch the surface in understanding the potential for drug interactions,” said Dave Walker, RPh, a pharmacy veteran in Oregon who used to manage pharmacies for hospitals and grocery chains and owned his own store. “Deprescribing needs to happen, because less is better. I’ve seen people taking 18, even 27 medications from multiple prescribers.”

He said the Decagon system could have a significant impact on predicting and reducing adverse effects, for one main reason.

“In pharmacology and pharmacy, they don’t have the resources or time to analyze this for every patient. If we have an automated system doing this, I see a lot of good coming from it,” Walker, who also serves on MedShadow’s Medical Advisory Board, said.

Jeannene Strianse, PharmD, director of pharmacy at Stony Brook University Hospital in New York, finds Decagon to be an interesting approach to a critical problem.

“The older you get, the more drugs you are on, for various reasons,” Strianse said. “When we look at patients that are on multiple drugs, patients 65 and older tend to be on an average of 10 drugs each.”

Stony Brook Hospital has three pharmacists review drugs a patient is taking to see if any can be taken out of the mix. They also look at databases for drug-drug interactions to see if changes are necessary. In this way, they can stop using secondary drugs that are often used to treat the side effects from particular drug combinations.

“Drugs seem to be the quick answer to things,” she pointed out. “The AI system can help patients and physicians make informed decisions in starting a new drug, but they need to be careful because it’s an idea of what might potentially happen — which may not happen.”

She cautioned that side effects often occur only in a small number of people, depending on genetic and other factors, so in a doctor-patient discussion, it needs to be discussed as “it may happen, but probably won’t happen.”

Strianse said that the system can have a lot of potential to improve care once it’s further validated, and will be one more tool in the physician’s tool box to determine what the risk is in prescribing a specific drug to a patient.

“This system will be able to say, based on how two drugs interact, that it could cause liver failure, but it can’t say if that will happen to you, me or someone else,” Strianse said. “It can just tell you there’s a potential risk, so that’s what the physician and patient need to understand — that it can’t predict exact risk, but it’s still more information than they had before.”

What’s Next for Decagon

Zitnik’s team is now collaborating with medical schools at Columbia University and Stanford to improve the model and test it so it’s accurate enough to be used in the real world.

The medical schools will look at electronic health records to see what drugs patients are on, the side effects they experience, and how that coincides with Decagon’s predictions.

“If Decagon predicts that a blood pressure lowering drug and another drug could lead to tachycardia [rapid heartbeat], they will see if there are patients who have experienced this, which then validates our system,” Zitnik said.

What she hopes to achieve with Decagon is to create user-friendly tools that provide guidance for doctors to help them make better decisions in prescribing drug combinations. Patients should also be able to enter the drug combinations they’re taking so Decagon can predict the side effects they should watch out for. Zitnik also wants to make it useful for clinical researchers, so they can develop drug therapies that have fewer side effects.

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‘It’s a Gamble:’ St. John’s Wort, Depression and Drug Interactions

In my 20s, I wasn’t much for traditional medicine. For one thing, navigating our labyrinthine health care system seemed like a lot of unnecessary work. For another, I was broke. Plus, I used henna to dye my hair. I wanted something natural.

That meant that when I felt down in the winter and was quick to worry and anxiety, I didn’t go to the doctor. I went to the drug store and got myself a bottle of St. John’s wort (Hypericum perforatum).

By the time I started taking St. John’s wort around 2003, the plant had been used to rid the environment of evil spirits in ancient Greece and medicinally to menstrual cramps, heal wounds, and treat kidney conditions in later centuries. Today, it’s primarily used to treat depression.

What those early practitioners didn’t know and what I didn’t, either, was that St. John’s wort can interact with prescription medicines in ways that can be serious. With everything from hormonal contraception to organ-transplant drugs interacting with the supplement, the more you know about the interactions, the better off you are.

Powerful or Placebo

In 1998, St. John’s wort was the second most popular supplement in the US, according to the nonprofit supplement industry group the American Botanical Council.

That’s when I first heard about it. But what I didn’t know was that, 4 years earlier, passage of the Dietary Supplement Health and Education Act created the category of dietary supplements and prevented the FDA from requiring supplement companies to prove their products were safe, certify levels of active ingredient or produce evidence that they work.

So, I was working with spotty knowledge. I wasn’t the only one.

Research on St. John’s wort was positive early on, but over the years, the findings have been more muddy, said D. Craig Hopp, PhD, deputy director of the Division of Extramural Research, National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health (NIH) . St. John’s wort seems to be associated with a “strong” reduction in depressive symptoms, including lack of interest in once-pleasurable activities, sleep or eating changes, hostility, irritability, and feelings of guilt, worthlessness or helplessness.

“But you get the same response from the placebo,” he said. “It’s not real clear whether it has [any] benefit.”

A 2002 NCCIH-funded study found that neither St. John’s wort nor the antidepressant tested was any more powerful than placebo for major depression. Another study found the same for mild depression.

On the other hand, a 2008 Cochrane review of 29 studies on the herb found that St. John’s wort is as effective as antidepressants in ameliorating mild to moderate depressive symptoms. But there was a catch: In countries where supplements are regulated and prescribed, the results were more positive. Studies conducted in the US had less positive results.

In any case, Hopp added, “St. John’s wort by itself is safe. But when taken in combination with something else, it dramatically influences how well those medicines work.”

Multiple Interactions

That’s because when you’re taking a whole-herb supplement, you aren’t just getting whatever the active ingredient of the herb is — you’re getting everything else that comes with it, too.

It’s unclear what St. John’s wort’s active ingredient is, though researchers have studied 2 components, hyperforin and hypericin. What researchers do know is that St. John’s wort also delivers significant doses of enzymes that help the body break down medications.

Any drug that is broken down by these particular enzymes breaks down a lot faster than it would otherwise. Drugs include the heart medication digoxin, the opioid oxycodone, some HIV medications, cancer drugs like irinotecan, cyclosporine for organ transplants, and the anticoagulant warfarin. That means that the medication exits the body more rapidly.

In the case of HIV medications, that could mean that the virus mutates and develops resistance to the drug so it never works as well again. In the case of heart medicines, it can increase the risk of a cardiac event.

And in the case of organ transplants, it can be fatal.

“Studies have shown that St. John’s wort would clear immunosuppressive medicines 10 times faster,” Hopp said, “That could cause organ rejection and organ failure.”

Plus, because St. John’s wort is unregulated, you don’t know exactly how much active ingredient you’re getting. That limits doctors’ ability to adjust dosages to accommodate St. John’s wort use, said Austin De La Cruz, PharmD, BCPP, a clinical pharmacist who treats mental health disorders. In addition, he teaches psychiatric treatment and over-the-counter medications at the University of Houston College of Pharmacy.

“It is definitely a gamble,” he said. “If you’re taking St. John’s wort with digoxin and switch to a different St. John’s wort brand that has lower amounts of active ingredient, that can lead to significant toxicity with digoxin.”

Birth Control and St. John’s Wort

Notably, since the majority of people reporting depressive symptoms are women, St. John’s wort seems to break down the contraceptive hormone ethinyl estradiol, a component of most estrogen-containing birth control, about twice as fast as when it is taken alone.

“There were also a number of unintended pregnancies because women taking oral birth control were not getting effective doses,” Hopp said of studies on the topic. “This isn’t fatal [the way organ failure is] but it is still a serious adverse event.”

Treating Accurately

For De La Cruz, all of this makes it hard for him to recommend St. John’s wort. He also pointed to a ban on sale of St. John’s wort in France and Ireland, and careful regulation in other countries as evidence of concern.

If people are interested in non-pharmacological approaches to depression, he recommends therapy. Cognitive behavioral therapy has been found to be more effective than antidepressants alone, he said, and carries no risk of side effects.

Then he’ll make sure patients are trying everything that drugs can’t address — like exercise, food and sleep habits — and light therapy lamps if the depression is seasonal.

“It’s important to identify if the depression can be managed by self-care,” De La Cruz said. For instance, a patient may only come in when they feel depressed, but they may also have bouts of mania. Using only St. John’s wort or an antidepressant could exacerbate manic episodes in bipolar disorder.

Besides, he said, 800,000 people die by suicide related to depression every year.

“Depression is a serious illness,” he said. “I have a hard time recommending St. John’s wort.”

NCCIH’s Hopp was less absolute. If you don’t take any of the medications that interact with St. John’s wort, its risk is essentially zero. But because it interacts with so many medications, people should tell their doctors they are taking it.

“It’s not that you can’t take St. John’s wort,” he said. “But it warrants a high level of extra care.”

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Quick Hits: Guidelines Could Boost Use of Hypertension Meds, Using AI to Predict Drug Interactions & More

If new guidelines on high blood pressure are adopted, many more people would likely be put on hypertension drugs, a new study argues. Last year, the American College of Cardiology (ACC) and the American Heart Association (AHA) released proposed updated guidelines that would lower the values for determining high blood pressure, which would label millions more people as having hypertension. Researchers from the Yale School of Medicine examined adults aged 45 to 75 years from the US and China who would have a diagnosis of hypertension and be candidates for treatment based on the updated ACC/AHA guidelines, compared with current guidelines. The results indicated that the number of people labeled as having hypertension would increase by 26.8% in the US and 45.1% in China. Researchers also calculated that 7.5 million people in the US and 55 million people in China would be advised to start drug treatment, while 14 million in the US and 30 million in China would be advised to receive more intensive drug treatment. Posted July 11, 2018. Via BMJ.

Artificial intelligence may be able to predict potential side effects of drug interactions. A new system called Decagon, developed by computer scientists at Stanford University, could aid doctors in making more informed decisions about which drugs to prescribe and help researchers find better combinations of drugs to treat complex diseases. Currently, there is no real way of knowing potential interactions for most drug combinations. “There are about 1,000 different known side effects and 5,000 drugs on the market, making for nearly 125 billion possible side effects between all possible pairs of drugs,” according to a Stanford news release. “Most of these have never been prescribed together, let alone systematically studied.” Researchers found a way around this problem by developing a system (Decagon) that is designed to deduce patterns about drug interaction side effects and predict previously unseen consequences from taking 2 drugs together. In many cases, the predicted side effects, which were based on the patterns detected, came true. To date, Decagon only considers side effects associated with pairs of drugs. In the future, scientists hope to further develop the system to incorporate more complex regimens. Posted July 10, 2018. Via Stanford News.

The FDA has approved the first topical treatment for excessive underarm sweating. The new medicated wipe — known as Qbrexza — was approved for the treatment of primary axillary hyperhidrosis (excessive underarm sweating) in patients 9 years of age and older. It works by blocking sweat production and can be applied once a day. The most common side effects observed during the use of Qbrexza in trials were dry mouth, dilated pupils, sore throat, headache, urinary hesitation, blurred vision, dry nose, dry throat, dry eye, dry skin and constipation. The most common local skin reactions were erythema, burning/stinging and pruritus. Posted June 29, 2018. Via Dermira.

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Next Avenue: Is This Newer Class of Antibiotics Really Safe?

MedShadow Foundation recently ran a news story about antibiotics causing “rare” damages to people. We’ve received very passionate responses — more than 75 and counting — from people who all claimed to be harmed by a particular type of antibiotics called fluoroquinolones also known as floxins. In fact, more than 60,000 people have complained to the Food and Drug Administration (FDA) about this class of drugs. Read the article by Su Robotti, founder/president, MedShadow here. 

 

McKnight’s Senior Living: 6 Meds To Handle With Care

Older adults taking five or more medications per week, plus an aging body system, equals problems for home and senior living caregivers. Polypharmacy can leave senior residents uniquely vulnerable to side effects and adverse events. That leaves caregivers worried and frustrated because there is little they can do. However, in the daily care of your clients, you can be aware of those drugs that are most likely to lead to potential health issues and be ready. Read here. 

FDA Speeds Up Availability of New Drug Safety Information

The FDA has sped up how quickly new safety information that arises on prescription drugs can get to people.

Before, the FDA would update a database based on self-reported side effects and drug interactions from doctors and patients. That database is a part of the Drug Safety Labeling Changes Program that used to include new information only once a month. Now the agency says its recent improvement “enables the FDA to post the latest safety information about a medicine almost at the same time we approve a change.”

Drug labeling is best explained as the small print details you get with your prescription when it is filled. It contains information such as what the drug is used for, side effects one may experience with it, drugs that may interact with it. In some cases, strong warnings if there have been adverse events reported during clinical trials and since the drug has hit the market are contained in a “black box” at the beginning of the labeling.

“Safety information can change multiple times over the lifetime of a drug as FDA learns about new risks, interactions with other medications and side effects,” Mary E. Kremzner, PharmD, MPH, U.S. Public Health Service and director of the Division of Drug Information in the FDA’s Center for Drug Evaluation and Research,” wrote in a blog post.

A drug’s labeling is usually changed at least several times while available on the market.

If you are concerned about a medication you are taking and want to see if labeling has been updated as a result of side effect issues to have been brought to the attention to the FDA, visit the agency’s searchable Drug Safety Labeling Changes database.

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Next Avenue: Food-Drug Combinations That Can Be Dangerous

You probably know that you shouldn’t mix certain medications because of the risk of dangerous drug interactions. And you’ve probably heard the common warnings to avoid taking some types of medication on an empty or full stomach or with alcohol. But you may not be aware of food-drug interactions, which can occur when a medication interacts with a food or beverage and causes undesirable effects. More here.

Dietary Supplement Ingredients To Avoid

Fifteen ingredients commonly found in dietary supplements should be avoided as they can potentially cause cancer, cardiac arrest, or even organ damage, according to a new analysis from Consumer Reports.

A panel of independent doctors and dietary researchers also found that many of the ingredients identified have the potential to interact with prescription drugs, such as statins, which are used to lower cholesterol, and over-the-counter medicines such as aspirin.

One of the ingredients cited in the report, yohimbe (also called johimbe), claims to treat low libido, erectile dysfunction, depression and obesity. However, the researchers found yohimbe is also associated with raising blood pressure, rapid heart rate, headaches, seizures, liver and kidney problems, heart problems and panic attacks.

Another ingredient on the list, green tea extract powder (also known as camellia sinensis), claims to promote weight loss. However, risks associated with the powder include dizziness, ringing in the ears and reduced absorption of iron; it can also worsen anemia and glaucoma, increase blood pressure and heart rate, and cause liver damage.

“Not only are the advertised ingredients of some supplements potentially dangerous, but because of the way they’re regulated, you often have no idea what you’re actually ingesting,” Pieter Cohen, MD, an assistant professor of medicine at Harvard Medical School, told Consumer Reports.

Many Americans are also under the false impression that because many supplements are derived from natural sources, they are safe. And many also believe that they are regulated and tested for efficacy and safety, based on a survey Consumer Reports conducted last year. That’s incorrect as well.

“Congress needs to step in,” Chuck Bell, programs director for the policy and mobilization arm of Consumer Reports, said. “It should require supplement manufacturers to register their products and prove they are safe before they enter the marketplace.”

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Herbal Supplements: 3 Risks for Women

Holistic health is big business in the US, in large part because it claims to promote health benefits.  And just like prescription drugs, herbal medications can be of particular concern to women, in part because more women take herbal remedies.

Herbal Supplements & Risks for Women

According to the National Health Interview Survey conducted by a division of the Centers for Disease Control and Prevention, approximately 33% of American adults used complementary health approaches in 2012. At the top of the list are natural products like herbal supplements in various forms.

The appeal of plant-based medicine in particular is not unfounded: “While some people may dismiss herbal remedies as quackery, the use of botanicals is well rooted in medical practice,” says Stacey Chillemi, an herbal educator and author of The Complete Herbal Guide and National Herbs for Common Conditions. “More than a quarter of all modern drugs used today contain active ingredients derived from plants.”

Still, natural does not automatically mean safe. These potions and remedies “can have significant, even fatal interactions with prescription drugs,” says Ian Musgrave, PhD, a molecular pharmacologist and researcher at the University of Adelaide in Australia. Women have adverse reactions to supplements “more often than men simply because more women use them over all,” he says.

A 2015 study that Musgrave co-authored found that women more frequently reported negative reactions to St. John’s Wort, a supplement that some research suggests may help ease depression.

Some risks of herbal supplements, however, have less to do with the popularity of them among women and more to do with female-specific reproductive issues, like the three below.

1. Birth Control

St. John’s Wort can interfere with the effectiveness of oral contraceptives, says Musgrove. Other herbs, including vitex, dong quai, black cohosh and red clover may help manage symptoms related to menstruation and menopause, for example, because they can influence levels of female hormones like estrogen, says Chillemi. For that same reason, they should generally be avoided by women using hormonal birth control methods because the herbs may make them less effective.

2. Pregnancy

“The FDA urges pregnant women not to take any herbal products without talking to their health care provider first,” says Chillemi, and they should also seek guidance from an experienced herbalist or other professional familiar with herbal medicine. “Herbs may contain substances that can cause miscarriage, premature birth, uterine contractions or injury to the fetus,” she says.

Certain culinary herbs, such as rosemary, garlic, sage, ginger and turmeric are safe to use in foods in the amounts normally used for cooking, but might be unsafe in large, concentrated doses during pregnancy. Sprinkling herbs in your cooking is still safe. Other herbs used medicinally, however, are likely to be unsafe to use during pregnancy or breastfeeding, or if at higher risk of hormone-related cancers: saw palmetto, dong quai and goldenseal (only a risk for pregnancy and breastfeeding)

3. Menopause

Herbs that influence hormones may also be helpful in managing problems related to menopause. “Black cohosh, red clover, chaste-tree berry, dong quai, evening primrose, ginkgo, ginseng and licorice are among the most popular herbs for women experiencing problems with menopause,” says Chillemi. But again, because of these effects, they could also interfere with hormone therapy. “Some of these herbs have powerful hormone-like effects, and women should not assume they are harmless,” she says. Make sure to alert your doctor if you are taking herbal supplements and you are discussing adding hormone therapy.

Herbal supplements can be helpful for a range of symptoms, but it is important for consumers to do their homework on the benefits and risks before taking them. “Very carefully check reliable sites for adverse effect information, as this is often omitted, highly abbreviated or hard to find on many seller websites,” advises Musgrave.

The National Center for Complementary and Integrative Health offers a comprehensive resource of safety information and other data on various supplements. “Always tell your medical practitioner of your herbal medicine use to ensure you are not taking them with drugs that could potentially interact, and so that side effects can be monitored,” he adds.

Further Reading

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Why Opioids Are More Dangerous for Seniors

One of the most fascinating aspects of learning about side effects of drugs has been to discover that many side effects are predictable based on how the a drug works in the body — what is called “method of action.”

Opioids, for example, work by slowing pain receptors and increasing dopamine, a chemical that controls the brain’s reward and pleasure center, which is an effective way of inhibiting the body’s ability to feel pain and makes you feel great.

This colorful and informative video explains how opioids work (there’s no sound).

However, opioids not only go to the brain but also move throughout the entire body affecting (and most often, slowing) all body systems. The most obviously inhibited one, after pain, is the digestive system. Hence the well-known problem of “opioid-induced constipation.”

And Then There’s Aging

Aging bodies add another dimension. Medicines accumulate more easily in a body (especially in the kidneys) where all systems are naturally slowing down from age. If you’re a senior, ask your doctors to give you the lowest effective dose of the lowest level of pain med, which is good advice at any age. The choice of pain killer should be very different for a healthy 40-year-old who plays squash weekly than for an 80-year-old with high blood pressure who walks a few blocks a day and has a delicate stomach.

Elderly adults taking opioid painkillers have 4 times as many bone fractures, are 68% more likely to be hospitalized and are 87% more likely to die as those taking over-the-counter pain medication.

Side effects from most drugs, and especially opioid drugs, are more pronounced in seniors. Falls, dizziness, headaches, sedation, worse constipation and slow reaction times are much more common when using opioids. (Should you be driving while using even a mild opioid?)

Elderly adults taking opioid painkillers have 4 times as many bone fractures, are 68% more likely to be hospitalized and are 87% more likely to die as those taking over-the-counter pain medication, according to the National Safety Council.

When Options Become Limited

Why take any opioid if you’re a senior who isn’t in end-of-life care? Your options become limited as your stomach becomes more sensitive, your kidneys and liver process more slowly and you take other medicines that might interact badly with some meds. Some of the less extreme painkillers, like Aleve or Tylenol, aren’t tolerated well. For example, aspirin and NSAIDs can upset stomachs. Note that some studies indicate that opioid drugs are just as upsetting to stomachs.

Weaker opioids like codeine don’t work for many people. The next step up, morphine, is hard on the kidneys, an organ that is commonly compromised in old age. Hydromorphine is easier on the kidneys but much more potent, stronger than might be needed with stronger side effects. Opioid choices get stronger and affect the body more from there.

What to do if your doctor recommends an opioid-based drug? Consider refusing them. They are NOT RECOMMENDED for headaches or migraines, and the benefits of using them for fibromyalgia or chronic back pain probably don’t outweigh their very significant risks, the AAN (American Academy of Neurology) states.

Work with your doctor on a multifaceted approach to pain management, as recommended by the AAN. Cognitive-behavioral therapy and activity coaching have been very successful not only at lowering pain but increasing the ability to function.

Fix the source of the pain and take opioids for the shortest time period possible. Do your best to make sure a temporary severe pain doesn’t turn into a chronic one.

Watch for Drug Interactions

If you’re a senior and taking drugs for high blood pressure, cardio issues, diabetes, etc., prescribing is complicated and risky. Drug-to-drug interactions are not only possible, they are likely. Assume any new symptom is a side effect and call your doctor before it becomes life threatening or limiting. This is one of the many reasons that we at MedShadow encourage you to discuss thoroughly your options for alternatives to drugs wherever possible — this way, when you need drugs your doctors have more options.

Opioids are known for being highly addictive. And as discussed in our recent article, 3 Steps from Pain Management to Heroin, seniors are not immune to addiction.

Whether you are a senior, care for a senior or expect to become a senior one day, it’s always important to discuss with your health care provider why you are taking a drug, how long you can expect to take it and what the effect of it will be on your entire body, not just the problem area.

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