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Pharmacists Raise Concerns Over Combining Vitamin D with Anti-hypertensive Drugs

Pharmacists say while taking supplements can support overall health, they can, however, interact with medications, potentially affecting their effectiveness, and causing adverse reactions.

They noted, for example, that taking Vitamin D with thiazide diuretics, which are antihypertensive medications, may reduce their efficacy, increasing the risk of uncontrolled blood pressure and stroke.

The pharmacists further warned against combining antibiotics with ‘blood tonic’ or supplements containing iron.

Hypertension, commonly called, high blood pressure is the persistent rise in the pressure of blood vessels.

According to the World Health Organisation (WHO), hypertension is a serious medical condition that can raise the risk of heart, brain and kidney diseases among other ailments.

While the WHO notes that one in four men and one in five women have hypertension globally, 11 per cent of all deaths in Nigeria are due to cardiovascular diseases.

Several studies have reported that self-medication and non-adherence to drug regimens are common medication misuse problems in Nigeria.

The studies further noted that these have led to poor health outcomes and adverse drug reactions.

Supplements are vitamins, minerals or botanical materials taken to improve or maintain normal health.

A Consultant Pharmacist and the Managing Director/Chief Executive Officer of Merit Healthcare Limited, Lolu Ojo, said supplements are also taken in times of stress, heavy workload or physical exertion.

He explained that since most disease conditions induce stress, supplements can be taken to augment the natural body’s supply of vitamins and essential minerals.

He, however, noted that not all supplements and medications are compatible.

The American Food and Drug Administration noted that combining dietary supplements and medications could have adverse and life-threatening effects.

It stated that drugs for HIV/AIDs, heart disease, depression, treatments for organ transplants, and birth control pills are less effective when taken with a particular herbal supplement.

It further noted that the advice of healthcare practitioners should be taken before combining prescription medicines with dietary supplements.

Commenting on the issue, a Professor of Pharmacoeconomics and Social Pharmacy at the Niger Delta University, Wilberforce Island, Bayelsa State, Ismail Suleiman, said that some supplements contain substances that may adversely react to some drugs.

According to him, taking anti-malaria along with supplements containing anti-oxidants would inhibit the effectiveness of the medications.

He, however, clarified that not all drugs are affected by all supplements, adding, “Everything has to be individualised depending on the drug or supplement in question.”

The don further said, “For example, anything that contains ferrous, may form complex with certain drugs. We have ferrous and we have ferric. Ferric is a form of iron and that is one of the most important components of blood tonic.

“In Mist-Mag (an antacid), we have magnesium and when taken with tetracycline, it can cause what is called complex, which means that it would allow the antibiotics to be well absorbed.

“So, supplements that contain magnesium and metallic radicals are not to be taken with some antibiotics. For instance, ciprofloxacin should not be taken with supplements containing metallic radicals because it would be complex and this will make the drug not to be well absorbed and reach the minimum effective concentration.

“When one takes a drug, there is a minimum level that the drug must get to for it to elicit its required therapeutic activities. Of course, there is also the maximum therapeutic level which should not be exceeded to avoid it being toxic.

“So, if the minimum concentration of a drug is not reached, that is if the drug does not reach the required level of adequate therapeutic formation to be absorbed into the system, it will train the organism being treated to become resistant to the drug.”

To address potential interactions between supplements and medications, the pharmacist recommended a two-hour interval between the prescription medicine and supplement, stating that this could help minimise the risk of the drug.

Suleiman also said that some antibiotics such as Ampliclox and Amplicin are best taken on an empty stomach to ensure optimal absorption, stating that taking them after a meal may result in reduced absorption and effectiveness.

The pharmacist also warned that all non-steroidal anti-inflammatory drugs, popularly called pain relievers, must be taken after food to prevent peptic ulcers.

The don asserted that the combination of supplements and medications depended on the specific drug, patient and disease condition being treated, noting that it is important to tailor the approach to each situation rather than adopting a one-size-fits-all approach.

He said, “If a patient refuses to adhere to the drug usage, such that a drug that is supposed to be taken 12 hourly, is not followed, it will hinder the effectiveness of the drug.

“If the frequency of dosage and duration for a drug is not followed, there is a problem. The person will succeed in eradicating a fraction of the organisms and the remaining will bounce back and multiply. For example, a five-day drug taken for three days will clear 80 per cent of the bacteria and the remaining 20 per cent would multiply exponentially.”

Suleiman advised patients on hypertensive drugs against discontinuing them without their physician’s recommendation.

Ojo, on his part, further said supplements interact with medications and that the extent and consequences of the interaction depend on the nature of the supplement and the medication involved.

He said, “Supplements can and do interact with medications. The extent and consequences of the interaction depend on the nature of the supplement and the medication involved.

“For instance, taking Vitamin D with thiazide diuretics may reduce their effectiveness and increase the risk of hypercalcemia.”

He further noted that individuals who take supplements containing Vitamin D with antihypertensive drugs are at risk of uncontrolled blood pressure and, consequently stroke or other cardiovascular problems.

“Reduced efficacy of antihypertensive drugs may lead to the BP being out of control with a risk of stroke and or other cardiovascular complications.

“On the other hand, if hypercalcemia sets in, this could lead to peptic ulcer, pancreatitis and bone complications.”

He advised, “Always consult your pharmacists before taking any medication. Drugs are not snacks and should be taken on prescription, and if over-the-counter, it should be based on the advice of a pharmacist.”

SOURCE: HealthWise