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What you need to know about dietary supplements
1. What You Need to Know
About Dietary Supplements
Lyndsey N. Hogg, PharmD, BCACP
Clinical Pharmacy Specialist, Ambulatory Care
Via Christi Clinic, P.A.1 July 8th, 2014
2. 2
Introductions and Disclosures
About the Speaker
Clinical Pharmacist at Via Christi Clinic
Doctor of Pharmacy (PharmD)
Board Certified Ambulatory Care Specialist (BCACP)
Disclosures
Dr. Hogg has nothing to disclose concerning possible financial or personal relationships with
pharmaceutical manufacturers that may have a direct or indirect interest in the subject matter of this
presentation
Via Christi Health and Dr. Hogg do not endorse any specific medications or indications which may be
discussed during today’s presentation.
Always discuss with your health care provider(s) before starting, stopping, or changing any medications or
dietary supplements.
3. 3
Today’s Goals
1) Provide you with knowledge to safely
utilize dietary supplements
2) Guide you to reliable resources
3) Inform you on questions to ask about
dietary supplements & medications
4. 4
Interesting Facts
More than 50% of Americans use dietary
supplements on a regular basis
Regulated as foods, not drugs
5. 5
Key Points
Do not self-diagnose any health condition
Check with your health care providers
before starting any supplements
Supplements should not replace
prescribed medications or a healthy diet
Do your research- use reliable sources
7. Dietary Supplements
Dietary supplements
include:
Vitamins
Minerals
Herbals & botanicals
Amino acids
Enzymes
Many other products
Variety of forms:
Tablets
Capsules
Powders
Drinks
Energy bars
7
8. 8
Who Regulates Supplements?
U.S. Food & Drug Administration (FDA)
Different set of regulations compared to
“conventional” foods & drug products
9. 9
Supplements: How are they
different from drugs?
Research studies to prove safety are
not required
FDA cannot take action against manufacturer until
after product is marketed
Proven efficacy is not required
All claims must be followed by statement:
This statement has not been evaluated
by the Food and Drug Administration.
This product is not intended to diagnose,
treat, cure, or prevent any disease
10. 10
Which Products Do I Buy?
“Seals of Approval”
U.S. Pharmacopeia
NSF International
Consumerlab.com
Seal of approval does NOT mean “safe & effective”.
Rather provides assurance the product:
Was properly manufactured
Contains listed ingredients
Does not contain harmful levels of contaminants
12. 12
RDA vs. DV
RDA: Recommended Daily Allowance
Food & Nutrition Board at the Institute of Medicine of
the National Academies
Vary by age, gender and pregnancy status
Recommended intake amount of nutrient per day
DV: Daily Value
Food & Drug Administration
Do NOT vary by age or gender
(one DV for anyone >4 years old)
Suggest how much nutrient per serving
Often match or exceed RDA for most people
13. 13
Reading a Supplement Label
Serving Size
varies among
products
% DV
Not the RDA
Supplement
Components
Fillers,
binders,
flavors, etc.
Adapted from FDA’s “Dietary Supplement Labeling Guide”
14. Dietary Supplements
Don’t replace variety of foods important to a
healthy diet
Dietary Guidelines for Americans
Choose MyPlate
Natural does NOT
mean safe
14
16. 16
Calcium
Use
Osteoporosis (prevention & treatment)
Evidence
Well-documented: adequate intake is important for
keeping bones strong & reducing bone loss
Regular weight-bearing & muscle-strengthening
exercises are also important
17. 17
How Much Calcium Should I Take?
Age RDA for Men1 RDA for Women1
19-50 1,000 1,000 mg
51-70 1,000 mg 1,200 mg
71+ 1,200 mg 1,200 mg
1
1
300
200
750
Estimating your daily calcium intake:
Table & Recommended Daily Allowances (RDA) obtained from National Osteoporosis Foundation:
Clinician’s Guide to Prevention and Treatment of Osteoporosis (2014 Issue, Version 1)
18. 18
Forms of Calcium
Carbonate
Most common (inexpensive & convenient)
Take with food for best absorption
Tends to cause more side effects (bloating,
constipation)
Citrate
Take with or without food
Other forms: gluconate, lactate, phosphate
19. 19
Tips on Taking Calcium
Optimizing your calcium intake
No more than 500 mg per dose (your body can’t
absorb more than this at one meal)
Take at separate time from multivitamin
Calcium can decrease absorption of:
Certain antibiotics (Levaquin, tetracycline)
Bisphosphonates (Fosamax, Boniva, etc)
Levothyroxine (Synthroid)
Phenytoin (Dilantin)
20. 20
Vitamin D
Use
Bone health
Helps with calcium absorption
Daily requirements
National Osteoporosis Foundation
• <50 years: 400-800 IU/day
• 50 years & older: 800-1000 IU/day
Institutes of Medicine Dietary Reference Intake
• <70 years: 600 IU/day
• 71 & older: 800 IU/day
Most people with osteoporosis need >1000 IU/day
21. 21
Folate (Folic Acid)
Critical for women of child-bearing potential
prevention of certain birth defects (spina bifida
and anecephaly)
Recommended intake
Childbearing potential: 400 mcg/day
Pregnant: 600 mcg/day
Most women will not obtain sufficient amounts
through their diet alone
22. 22
Black Cohosh
Reported Uses:
Menopausal symptoms
Evidence
Preliminary evidence encouraging but not sufficient
(use < 6 months)
Side Effects
Few reported (stomach upset, headaches)
Long-term safety data unavailable
Who should not take it:
Pregnant women
Breast cancer
Liver disorders
23. 23
Cranberry
Reported Uses:
urinary track infections
Evidence
Prevention- preliminary evidence not definitive
Treatment- not effective
Side effects
Stomach upset or diarrhea (when used in excess)
Who should not take it:
Those taking warfarin (Coumadin)
Possibly those on medications which affect the liver
24. 24
Vitamin C
Reported Uses:
Common cold
Evidence
Prevention: data does not support
Duration/severity: no effect to mild
effect
Foods Containing Vit C† Amount of Vit C†
Citrus fruits Medium orange = 70 mg
Red & green peppers ½ cup red pepper = 96 mg
Other fruits & veggies
(broccoli, strawberries,
cantaloupe, tomatoes, etc)
½ cup broccoli = 39 mg
½ cup strawberries = 40mg
Medium tomato = 17 mg
Fortified foods & beverages
Recommended Amount†
Adult women 75 mg
Pregnant
women
85 mg
Breastfeeding
women
120 mg
Smokers add 35 mg
† National Institutes of Health Office of Dietary Supplements- “Vitamin C Quick Facts”
25. 25
Fish Oil & Omega-3 Fatty Acids
Side effects
Bad breath, belching, heartburn, nausea, loose stools
Who should not take it:
Fish or seafood allergy
Liver disease
Possibly those at high bleeding risk
Reported Uses† Evidence†
Heart disease Reduces all-cause mortality
High cholesterol May lower triglycerides
(dose-dependent)
Cognitive function (memory) Inadequate evidence
Asthma No conclusions possible
† National Institutes of Health Office of Dietary Supplements- “Summary of AHRQ Report on Omega-3”
26. 26
Glucosamine/Chondroitin
Reported Uses
Osteoarthritis
Evidence
Does not slow joint destruction or relieve pain†
Pregnancy
Use caution
Who should not take it:
Allergy to shellfish (glucosamine)
† National Institutes of Health Office of Dietary Supplements- “Summary of GAIT Study”
27. 27
Coenzyme Q-10
Reported Uses:
Heart disease
Drug-induced muscle weakness (e.g. statins)
Reproductive disorders
Cancer
Evidence varies among uses
Side effects
No serious effects reported
Insomnia, rash, nausea, dizziness, headache
Use during pregnancy or breastfeeding- NO
35. 35
Other Reliable Sources
NIH fact sheets
Nutrient recommendations (NIH)
PubMed Dietary Supplement Subset
MedlinePlus (National Library of Medicine)
Food & Drug Administration
Federal Trade Commission
36. 36
Tips on Searching the Web for
Information on Supplements
Questions to think about:
Who operates the website?
What is the purpose of the website?
• Educate the public vs sell a product
What is the source of the information & is it
referenced?
• Reputable peer-reviewed journals
Is the information current?
How reliable is the internet or e-mail solicitations?
• UPPERCASE LETTERS & LOTS OF !!!!!!!!!!!!
Questions adapted from FDA.gov
37. 37
More Tips
Ask yourself: Does it sound too good to be true?
Think twice about chasing the latest headline
Contact manufacturer for more information
Check your assumptions:
“Even if a product may not help me, it at least won’t
hurt me.”
“When I see the term ‘natural’, it means that a product
is healthful and safe.”
“A product is safe when there is no cautionary
information on the product label.”
Questions adapted from FDA.gov
40. 40
Questions?
Who Should I Ask?
Your doctor or other provider
Your pharmacist
When should I ask?
New medication started
Medication stopped
Medication dose change
Significant change in diet
41. 41
General Questions to Ask
What is the name of my medicine?
Why am I taking this medicine?
How much do I take and how often?
What side effects are possible?
What should I do if they occur?
What should I do if I miss a dose or double
the dose?
Is there anything I should avoid while taking
this medicine?
42. 42
Questions About Interactions
Is the interaction something my doctor can
monitor for or should the medication/food
be stopped?
If I take them at different times, will this prevent
the interaction?
What side effects should I watch for? What
should I do if they occur?
44. 44
Key Points
Dietary supplements do not replace necessary
medications
Do your research- utilize reliable resources
Natural ≠ safe
Some dietary supplements can interact with
prescription medications
Notify all providers of your current medications
ALWAYS ask your pharmacist or provider before
starting (or stopping) dietary supplements
49. 49
Tips from a Pharmacist
Keep a list of ALL your medications
This includes vitamins & supplements!
Keep copies in your wallet & at your house
Take to all provider appointments
Track any changes
Update after each provider appointment
Take medications exactly as prescribed
50. 50
Tips from a Pharmacist
Use ONE pharmacy
Check medications before leaving the pharmacy
All necessary refills present?
Any medications that were stopped?
When a medication is stopped:
Cancel automatic refills
Update medication list
53. What You Need to Know
About Dietary Supplements
Lyndsey N. Hogg, PharmD, BCACP
Clinical Pharmacy Specialist, Ambulatory Care
Via Christi Clinic, P.A.53 July 8th, 2014
Editor's Notes
Picture from
https://myds.nih.gov/en/content/background-information-botanical-dietary-supplements
In the United States, the U.S. Food and Drug Administration (FDA) has regulatory responsibility for dietary supplements. FDA regulates dietary supplements under a different set of regulations than those covering “conventional” foods and drug products (prescription and over-the-counter). Under the Dietary Supplement Health and Education Act of 1994, the dietary supplement manufacturer is responsible for ensuring that a dietary supplement is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market.
Manufacturers must make sure that product label information is truthful and not misleading. FDA’s post-marketing responsibilities include monitoring safety, e.g. voluntary dietary supplement adverse event reporting, and product information, such as labeling, claims, package inserts, and accompanying literature.
Research studies in people to prove that a dietary supplement is safe are not required before the supplement is marketed, unlike for drugs. It is the responsibility of dietary supplement manufacturers/distributors to ensure that their products are safe and that their label claims are accurate and truthful. If the FDA finds a supplement to be unsafe once it is on the market, only then can it take action against the manufacturer and/or distributor, such as by issuing a warning or requiring the product to be removed from the marketplace.
The manufacturer does not have to prove that the supplement is effective, unlike for drugs. The manufacturer can say that the product addresses a nutrient deficiency, supports health, or reduces the risk of developing a health problem, if that is true. If the manufacturer does make a claim, it must be followed by the statement…
In addition, there are a few independent organizations that offer “seals of approval” that may be displayed on certain dietary supplement products. These indicate that the product has passed the organization’s quality tests for things such as potency and contaminants. These “seals of approval” do not mean that the product is safe or effective; they provide assurance that the product was properly manufactured, that it contains the ingredients listed on the label and that it does not contain harmful levels of contaminants.
The following is a list of several organizations offering these programs:
Consumerlab.com approved quality product seal
NSF International dietary supplement certification
U.S. Pharmacopeia dietary supplement verification program
From NIH ODS (http://ods.od.nih.gov/Health_Information/ODS_Frequently_Asked_Questions.aspx#Information)
Q. What is the difference between the RDA and DV for a vitamin or mineral?
Many terms are used when referring to either the amount of a particular nutrient (such as calcium or vitamin D) you should get or the amount in a food or dietary supplement. The two most common are the Recommended Dietary Allowance (RDA) and the Daily Value (DV). These terms can be confusing.
RDAs are recommended daily intakes of a nutrient for healthy people. They tell you how much of that nutrient you should get on average each day. RDAs are developed by the Food and Nutrition Board at the Institute of Medicine of the National Academies. They vary by age, gender and whether a woman is pregnant or breastfeeding; so there are many different RDAs for each nutrient.
DVs, established by the U.S. Food and Drug Administration (FDA), are used on food and dietary supplement labels. For each nutrient, there is one DV for all people ages 4 years and older. Therefore, DVs aren’t recommended intakes, but suggest how much of a nutrient a serving of the food or supplement provides in the context of a total daily diet. DVs often match or exceed the RDAs for most people, but not in all cases.
DVs are presented on food and supplement labels as a percentage. They help you compare one product with another. As an example, the %DV for calcium on a food label might say 20%. This means it has 200 mg (milligrams) of calcium in one serving because the DV for calcium is 1,000 mg/day. If another food has 40% of the DV for calcium, it’s easy to see that it provides much more calcium than the first food.
The FDA has a Web page that lists the DVs for all nutrients and provides additional details.
Sample label from FDA’s “Dietary Supplement Labeling Guide: Chapter IV. Nutrition Labeling” (published April 2005)
http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/DietarySupplements/ucm070597.htm
(website accessed 7/6/14)
Even some vitamins and minerals, when taken in inappropriate amounts, can cause problems. For example, too much vitamin A can reduce bone mineral density, cause birth defects, and lead to liver damage, according to the National Academy of Sciences
MyPlate
By the U.S. Department of Agriculture
Includes “healthy eating on a budget”
From WebMD article “’Natural’ Dietary Supplements” (accessed 7/6/14)
http://www.webmd.com/fitness-exercise/naturual-dietary-supplements?page=2
“Many natural products can affect your body in ways that can potentially lead to serious illness, even death.
Androstenedione. A steroid precursor used by St. Louis Cardinals slugger Mark McGwire and others, claims to enhance athletic performance and boost testosterone levels. The FDA and many amateur and professional athletic organizations have banned androstenedione. But the supplement is still for sale through the Internet and other countries and many athletes use it, putting their health at risk.
Not only does androstenedione boost the concentration of estrogen (a female hormone), which can lead to breast development and impotence in men, it may cause abnormal periods, deepening of the voice and increased facial hair in women. It can also lead to serious liver disease and blood clots.”
Other examples in the article: ephedra (in wt loss products) & creatine (used by some athletes)
Scientific evidence shows that some dietary supplements are beneficial for overall health and for managing some health conditions. For example, calcium and vitamin D are important for keeping bones strong and reducing bone loss; folic acid decreases the risk of certain birth defects; and omega-3 fatty acids from fish oils might help some people with heart disease.
http://ods.od.nih.gov/factsheets/list-all/Calcium/
99% of body’s calcium supply is in the bones; when exogenous supply is inadequate, bone tissue from the skeleton is reabsorbed in order to maintain a constant calcium level
Intakes in excess of 1,200 to 1,500 mg per day may increase the risk of developing kidney stones, cardiovascular disease and stroke.
Scientific evidence shows that some dietary supplements are beneficial for overall health and for managing some health conditions. For example, calcium and vitamin D are important for keeping bones strong and reducing bone loss;
***separate Ca from fluoroquinolones (Levaquin) & tetracyclines, bisphosphonates, levothyroxine, & phenytoin- as Ca decreased absorption of these drugs
Calcium absorption
As amt increases, % absorption decreases
Absorption highest in doses <500 mg
***separate Ca from fluoroquinolones (Levaquin) & tetracyclines, bisphosphonates, levothyroxine, & phenytoin- as Ca decreased absorption of these drugs
Calcium absorption
As amt increases, % absorption decreases
Absorption highest in doses <500 mg
NOF guidelines:
Chief dietary sources of vitamin D include vitamin D-fortified milk (400 IU per quart, although certain products such as soy milk are not always supplemented with vitamin D) and cereals (40 to 50 IU per serving or more), salt-water fish and liver. Some calcium supplements and most multivitamin tablets also contain vitamin D. Supplementation with vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol) may be used. Vitamin D2 is derived from plant sources and may be used by individuals on a strict vegetarian diet.
Many older patients are at high risk for vitamin D deficiency, including patients with malabsorption (e.g., celiac disease) or other intestinal diseases, chronic renal insufficiency, patients on medications that increase the breakdown of vitamin D (e.g. some antiseizure drugs), housebound patients, chronically ill patients and others with limited sun exposure, individuals with very dark skin, and obese individuals. There is also a high prevalence of vitamin D deficiency in patients with osteoporosis, especially those with hip fractures, even in patients taking osteoporosis medications. 35, 36
Since vitamin D intakes required to correct vitamin D deficiency are so variable among individuals, serum 25(OH)D levels should be measured in patients at risk of deficiency. Vitamin D supplements should be recommended in amounts sufficient to bring the serum 25(OH)D level to approximately 30 ng/ml (75 nmol/L) and a maintenance dose recommended to maintain this level, particularly for individuals with osteoporosis. Many patients with osteoporosis will need more than the general recommendation of 800-1,000 IU per day. The safe upper limit for vitamin D intake for the general adult population was increased to 4,000 IU per day in 2010.30
Scientific evidence shows that some dietary supplements are beneficial for overall health and for managing some health conditions. For example, folic acid decreases the risk of certain birth defects (neural tube defects such as spina bifida & anecephaly)
http://ods.od.nih.gov/factsheets/list-all/BlackCohosh/
http://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/
Herb
Evidence- preliminary evidence encouraging but not sufficient to support recommendation for use
NCCAM at NIH funding rigorous scientific study
Amer. College of Obstetrians & Gynecologists- may be helpful short term (6 month) for women w/ vasomotor sx (consensus & expert opinion)
http://ods.od.nih.gov/factsheets/list-all/Cranberry/
National Center for Complementary & Alternative Medicine (NCCAM)
http://nccam.nih.gov/health/cranberry
Future studies
NCCAM funding studies to better understand effects on UTIs
National Institute on Aging funding study of potential anti-aging effects
http://ods.od.nih.gov/factsheets/list-all/VitaminC/
http://ods.od.nih.gov/factsheets/VitaminC-QuickFacts/
Amount needed/day
Most people get enough through diet. Those who may not include:
Smokers (or those exposed to 2nd hand smoke): more needed for repairing damage from free radicals
Infants fed evaporated or cow’s milk
Those who eat limited variety of food
Certain dzs such as severe malabsorption, some types of cancer, & kidney damage requiring hemodialysis
http://ods.od.nih.gov/factsheets/list-all/FishOil/
http://ods.od.nih.gov/factsheets/list-all/Omega3/
Numerous uses:
Asthma
No conclusions could be drawn about the value of omega-3 fatty acid supplements in the prevention or treatment of asthma for adults or children other than the fact that they have an acceptable safety profile.
Cancer
CV & heart dz
Impact on cardiovascular disease: According to both primary and secondary prevention studies, consumption of omega-3 fatty acids, fish, and fish oil reduces all-cause mortality and various CVD outcomes such as sudden death, cardiac death, and myocardial infarction. The evidence is strongest for fish and fish oil supplements.
Impact on CVD risk factors: Fish oils can lower blood triglyceride levels in a dose-dependent manner. Fish oils have a very small beneficial effect on blood pressure and possible beneficial effects on coronary artery restenosis after angioplasty and exercise capacity in patients with coronary atherosclerosis
Child & maternal health
Cognitive function
Diabetes, IBD, RA, renal dz, systemic lupus, osteoporosis
Omega-3 fatty acids can reduce joint tenderness and need for corticosteroid drugs in rheumatoid arthritis. Data are insufficient to support conclusions about the effects of omega-3 fatty acids on inflammatory bowel disease, renal disease, systemic lupus erythematosus, bone density, and diabetes.
Eye health
Mental health
The quantity and strength of evidence is inadequate to conclude that omega-3 fatty acids protect cognitive function with aging or the incidence or clinical progression of dementia (including Alzheimer’s disease), multiple sclerosis, and other neurological diseases.
Organ transplant
No conclusive evidence suggests specific benefits of omega-3 fatty acid supplementation on any outcome in any form of organ transplantation. However, available studies are small, have methodological problems, and may not fully apply to current transplantation procedures
http://ods.od.nih.gov/factsheets/list-all/Glucosamine/
Glucosamine- amino sugar produced by body & distributed in cartilage & other connective tissue
Chondroitin- complex carbohydrate that helps cartilage retain water
GAIT study
http://nccam.nih.gov/research/results/gait/qa.htm
For pts with mild pain- no difference for either agent alone or combo compared to placebo
For pts with moderate-severe pain- statistically significant pain relief compared to placebo (NOTE small group & thus only considered a preliminary finding, more studies needed)
http://ods.od.nih.gov/factsheets/list-all/CoenzymeQ10/
NIH- What you need to know:
http://nccam.nih.gov/health/supplements/coq10
Antioxidant necessary for cells to function properly
Used by cells to make energy they need to grow & stay healthy
Levels decrease as you age
Evidence
HF- associated w/ improved heart function & feeling better
Post bypass & heart valve surgery- CoQ10 plus other nutrients associated w/ quicker recovery
HTN- mixed results
Statin induced muscle weakness- mixed results (one study showed it helped ease myopathy but concluded results not definite; other study showed no better than placebo)
Reproductive health- some evidence to support improved semen quality & sperm count in infertile men but not know if this affects likelihood of conception
Cancer- no convincing evidence it treats or prevents cancer (although women w/ breast cancer have been show to have abnormal CoQ10 levels)
Interactions
Can make warfarin less effective
Side effects
most common side effects: insomnia, increased liver enzymes, rashes, nausea, upper abdominal pain, dizziness, sensitivity to light, irritability, headaches, heartburn, and fatigue
NIH sponsoring studies investigating effects on statin-induced muscle pain, fertility in older women & breast cancer treatments
can cause serious bleeding if combined with blood thinners such as warfarin
Warfarin
Decreased w/ vit K rich foods
Increased with cranberry juice
Calcium prevents antibiotic absorption (separate dosing time)
Levaquin & Cipro
NIH ODS
“Dietary Supplement Fact Sheets”- Available for many vitamins, herbals & supplements
DSLD (database from the NIH- launched June 2013)
17,000 products included initially, will grow to >55,000 products
The DSLD is a collaborative project of the Office of Dietary Supplements (ODS) and the National Library of Medicine (NLM) at NIH, with input from many federal stakeholders including most NIH institutes and centers, the U.S. Department of Agriculture’s Agricultural Research Service, the Centers for Disease Control and Prevention’s National Center for Health Statistics Division of Health and Nutrition Examination Surveys, and the U.S. Food and Drug Administration’s Center for Food Safety and Applied Nutrition.
NIH fact sheets
Includes links to helpful resources and information on many dietary supplements
Nutrient recommendations
Includes recommended daily allowance (RDA), adequate intake (AI), & tolerable upper intake level (UL)
PubMed Dietary Supplement Subset
Searchable database of articles on dietary supplements
Linked with Medline database
MedlinePlus
Searchable website which includes reliable information on health topics, drugs & supplements
Federal Trade Commission- info on how to evaluate claims for products related to your health (avoiding fraudulent claims)
http://www.consumer.ftc.gov/sites/all/libraries/games/weightlosschallenge/
1) causes weight loss of two pounds or more a week for a month or more without dieting or exercise;
2) causes substantial weight loss no matter what or how much the consumer eats;
3) causes permanent weight loss even after the consumer stops using product;
4) blocks the absorption of fat or calories to enable consumers to lose substantial weight;
5) safely enables consumers to lose more than three pounds per week for more than four weeks;
6) causes substantial weight loss for all users; or
7) causes substantial weight loss by wearing a product on the body or rubbing it into the skin.
“your pharmacist is trained to really understand what exactly a drug does, how it interacts with other drugs, and potential problems you might come across”
“this might include information your doctor doesn’t know”
“doctors aren’t always aware of every single possible drug interaction. So if you have a lot of prescriptions, especially if they’re from different doctors, it’s worth discussing the issue with your pharmacists because they have a lot more information than your doctor does”
http://lifehacker.com/your-pharmacist-is-more-useful-than-you-think-510727546
Not all interactions will cause problems but some interactions can be serious.
Not all interactions will cause problems but some interactions can be serious.
On average, a community pharmacy is located within two miles of every American home.
Why do I need to know my medications? Doesn’t my doctor keep track of them?
List should include OTCs, vitamins, herbals, supplements
Using 1 pharmacy:
Reduces chances for drug interactions
Using 1 pharmacy:
Reduces chances for drug interactions