At a City of Hope Medical Center, teaching hospital/research center, a pharmacist spoke to our patient group about drug interaction. She reminded us that we are responsible to follow the dosages, to alert our doctors to ALL the medications we take–prescribed and over the counter, herbals and supplements. “Remember that diet and its fat content affect our drug’s efficacy”, she added.
Pharmacists consider three types of interactions, which can happen between drug and another, with drugs and food or beverages, and drugs and conditions under which a drug is taken. They are described as follows:
1) Pharmokinectic issues of absorption, distribution, metabolic and excretion—how does the body bring it in, how long is it in the system, and where does it get absorbed? Does one drug slow down the effect, or prevent its use?
2) Pharmocodynamic effects occur when drugs with similar properties to one another are used together. They may interact with one another; such interactions might cause one or more to be ineffective, or too effective, or with side effects that are unexpected.
3) Toxicity may happen if the combinations of drugs have a toxic effect on an organ that would not occur with just one of the drugs.
For example, soranfenib (Nexavar) should be taken without food, while Sutent is recommended to be taken with food—but never with grapefruit juice.
Some drugs cannot be taken with NSAIDS; some are platelet inhibitors, for example. Sutent’s efficacy may be impaired by taking St. John’s wort, or when taken with barbiturates.
How do you keep track of all of this? Speak with the pharmacist whenever you have a change in medication—or right now, since you probably have not done that! Make an appointment to have the time cover all the questions. Bring in ALL the medications you use, even those you feel are “probably” safe or those you are embarrassed to admit you take! Pharmacists have access to extensive data bases, not only of the prescribed drugs, but also many of the supplements and herbals on the market.
As to herbals and supplements, she reminded the group that there are no controls as to the quality and quantity of active ingredients in the non-FDA approved supplements, and they can vary dramatically. Meningitis caused by a fungus in steroids produced by a US-company has caused the death of 44 and sickened at least 600 just last year.
It was fascinating to hear that, “Pharmacists don’t take medications”, but she emphasized that she rarely uses anything. It’s harder to convince her mother! Anticipating problems in the future with family-related conditions, she eats properly and exercises, for example.
Trust your gut about your body’s reactions. If something seems amiss, talk to your pharmacist or doctor to be sure you are not having a drug interaction.
Read the labels and follow the instructions. Not sure when and how much to take? Go back to the pharmacist or doctor for clear instructions.
Bring a “brown bag” of meds and such to your pharmacist to get a review of your meds. You know you should have already done this, so get going!