HEART Insight:
doi: 10.1097/01.HEARTI.0000390857.70182.c7
Features: Online Bonus/Medicine Chest

Mind Your Meds

MacReady, Norra

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Taking OTC Products And Supplements With Certain Prescriptions Can Have Unintended Consequences

All drugs can have side effects. Even an innocuous-seeming “natural” supplement sold at a health food store, can have unintended effects, either directly or by interacting with medications your doctor has prescribed.

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“Anyone who has cardiovascular disease or its risk factors needs to be mindful of what they are taking,” says cardiologist Elsa-Grace Giardina, M.D., Professor of Medicine at Columbia College of Physicians and Surgeons in New York City. If you've already had a heart attack, you may be taking medications to control blood pressure, regulate heart rhythm, lower cholesterol and keep blood clots at bay. Any of these drugs can interact with something else in your medicine chest - even an over-the-counter (OTC) product.

This is especially true as we get older. Liver and kidney function change with age, making it harder for the body to eliminate drugs. And that, in turn, can increase the risk of a drug-drug interaction, says Robert Page, Pharm.D., Associate Professor of Clinical Pharmacy and Physical Medicine at the University of Colorado in Denver. Older patients - as well as those who have a history of heart attack or heart failure - are also likely to be taking several medications, any of which may interact with each other in unexpected ways.

So, while it's always best to check with your doctor before starting any medication, caution is even more important when you're a senior citizen. “Being 75 or more years of age is a big risk factor for adverse drug effects,” Dr. Page warns. “Those are the people I worry about.” Your doctor may want to evaluate the health of your liver, kidneys, and possibly other organs to determine whether it's safe for you to take a particular drug, to calculate a dose that is safe and effective, and to make sure it won't interfere with the actions of your other medications.

Drugs used to manage many cardiovascular conditions often have a “narrow therapeutic window,” meaning there is not that much difference between the dose that is effective and the doses that are likely to be excessive or insufficient. An OTC product or nutritional supplement that interferes with how much or how quickly a drug is metabolized could be a prescription for trouble. This is why a thorough medical history always takes into account prescription and OTC products and nutritional supplements you take regularly.

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Whenever you think you may be having a side effect from a drug, call your doctor right away. He or she may be able to change the dose or dosing schedule, switch you to a different drug, or have you discontinue another drug in your regimen. That's why it's so important to keep your doctor informed of everything you take. “Every patient has to be their own best advocate,” says Giardina.

Here are tips for keeping your risk of drug interactions and side effects low:

▪ Before buying any OTC drug or nutritional supplement, read the label carefully and ask your doctor or pharmacist about any ingredients you're unfamiliar with, or if the product might interact with medicines you are currently taking.

▪ Be alert to any worsening of symptoms of heart failure or any other condition you have, as this may signal an adverse reaction to a drug or combination of drugs. For instance, water retention may be a response to anti-inflammatory agents, such as aspirin, ibuprofen and naproxen, which can decrease kidney function.

▪ Monitor your blood pressure. Many drugs and supplements can raise blood pressure or interfere with the effectiveness of prescription medication used to control hypertension (high blood pressure). Such products include steroids, non-steroidal anti-inflammatory drugs (NSAIDs), nasal decongestants and other cough and cold remedies, diet pills, cyclosporine, erythropoetin, tricyclic antidepressants and monoamine oxidase inhibitors.

▪ Tell all of your healthcare providers about all of the drugs and supplements you're taking, and keep them informed of any changes. Maintain an up-to-date list of all your prescription and OTC drugs, vitamins, and supplements. Bring a copy to every doctor visit, and ask that it be added to your medical records every time you start or stop taking a drug or supplement. Better yet, ask your doctor before starting an OTC drug or supplement to begin with, rather than providing that information after the fact.

▪ The pharmacy is a good place to store your drug information. If you can, use one pharmacy for all your prescriptions so all your records are in one place and easily accessible.

▪ Check dosages and dosing schedules to make sure you are not taking too much of a medication - even on refills. If you had been taking a medication once a day and the label on the refill indicates that the drug at the same dosage should be taken twice a day, call your doctor or pharmacy to make sure it's not a mistake.

▪ Your pharmacist is a good source for information about your prescription and OTC drugs, vitamins, and supplements. Your pharmacist can work with you and your doctor to help reduce the risk for interactions.

▪ Follow your doctor's advice. Don't substitute an OTC supplement for a prescription medication without her approval, and don't insist that she prescribe a certain drug for you because it worked for your friend, boss, or favorite movie star. Everyone reacts to drugs differently, and what works for one person may cause serious side effects in someone else. Let your doctor decide what drugs, if any, you should use.

▪ Never order a prescription drug over the Internet without a prescription. HI

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▪ The Medicine Chart from the AHA allows you to list all the medicines you take, their dosages, the medical condition they treat and prescribing doctor all on one handy form: www.americanheart.org/presenter.jhtml?identifier=92.

▪ The AHA's Heart360 enables you to manage heart health by tracking weight, blood pressure, blood glucose, cholesterol, and physical activity over time, as well as medications you take to manage cardiovascular disease risk: http://www.heart360.org.

▪ The National Council on Patient Information and Education (NCPIE) offers information that promotes safe and effective use of OTC and prescription drugs. Visit www.talkaboutrx.org.

▪ The USDA Food and Nutrition Information Centers offers a wealth of data on dietary supplements - vitamins, minerals and herbal formulations - including warnings and safety information. Visit http://www.nutrition.gov and click on the “Dietary Supplements” link under “Browse By Subject” in the left-hand navigation box.

© 2010 American Heart Association, Inc.