Be careful of drug interactions

While many patients are aware of prescription drug interactions, supplements may also interact with prescription and non-prescription medicines.

DCs should do whatever they can to minimize the risk of drug interactions by asking patients the right questions and reviewing the scholarly health literature.
According to the Centers for Disease Control and Prevention (CDC), over 75 percent of medical physician visits involve prescription drugs in some way. Furthermore, between 2009 and 2012, nearly 50 percent of surveyed patients took at least one prescription medication within the previous 30 days.ⁱ

Many of your patients, then, are taking at least one prescription regularly. Over-the-counter medications are also in common use. If you offer nutritional advice to your patients and provide supplement recommendations, look for opportunities to engage patients with their healthcare and discuss the potential risks created by drug and supplement interactions.

Recognize common medicines and interactions

“From my clinical experience, I see a lot of anti-depressant, analgesic, anti-inflammatory, and muscle relaxers when treating my chiropractic patients. With my nutrition patients, I see almost anything,” said Scott Schreiber, DC, a certified nutrition counselor at Delaware Back Pain & Sports Rehabilitation Centers in Newark, Delaware.

Schreiber suggests that chiropractors investigate the drug classes and side-effects of medications the patient is taking to see if they conflict with or even magnify the impact of the supplement. Supplements may affect the body in ways that compound medicinal effects or unintended side-effects.

“In a typical chiropractic practice, the most common interaction would be a patient taking a prescription anti-inflammatory and also an anti-inflammatory supplement,” Schreiber said.

Another common example in Schreiber’s practice includes sleep medication ‘stacking’ with sleep-promoting supplements.

“When I detect this, I notify the prescribing doctor and discuss the negative effects with the patients. Myself, the other doctor and the patient discuss the next course of action, either [a] pharmaceutical or natural route.”

Thoroughly research each supplement you recommend

Schreiber says he uses online resources, continuing professional education courses and health journals to stay informed and provide his patients with the latest healthcare advice. As a trained nutritionist, he has also pursued advanced training in the nutrition field. Schreiber recommends that chiropractors interested in nutrition consider ways they can obtain additional training and study nutrition information.

“I read a lot of journals, including medical, chiropractic, and nutrition. I also have a Physician’s desk reference app on my phone, which I have access to while treating patients.”

A few great resources, Schreiber said, include Drugs.com’s Drug Interactions Checker, The Chiropractic Research Organization’s Drug-Nutrient Depletion and Interaction Charts and the U.S. Food and Drug Administration’s “Drug Interactions: What You Should Know. These free resources can get you started on researching drug and supplement interactions, but it is important to remember that information changes quickly and should be verified from multiple up-to-date scholarly resources, such as Pharmacists Schools page on Drug Side Effects and Interactions.

Partner with your patients

Patients can play an important role in staying healthy and minimizing drug interactions, as Schreiber recommends. Asking the right questions and obtaining complete patient histories may help prevent interaction and contraindication problems later.

“The best prevention is taking a careful history and making sure that the patient is giving you all the correct information. I require a list from my patients. My nutrition patients sign a consent form stating that they have provided all the correct information,” said Schreiber.

Patients at Schreiber’s practice are also required to acknowledge understanding of the possible danger of interactions between medicines and pharmaceuticals.

Safely introduce new supplements

By gathering research as needed from a variety of sources and having quality conversations with patients, you can safely introduce supplements as part of patient care. Being thoroughly knowledgeable about supplements adds another competency to your practice and improves the care you offer your patients.

References

Centers for Disease Control and Prevention. “FastStats: Therapeutic Drug Use.” http://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm. Accessed October 2015.