Intro to Dietary Supplements PDF

Dietary Supplement Health and Education Act: OSHEA -regulate dietary supplement & ensure their safety (label of product-what’s required on the label) -FDA doesn’t have authority to approve dietary supplements before marketed Dietary Supplements: -clinical trials= not required -FDA can...

Dietary Supplement Health and Education Act: OSHEA -regulate dietary supplement & ensure their safety (label of product-what’s required on the label) -FDA doesn’t have authority to approve dietary supplements before marketed Dietary Supplements: -clinical trials= not required -FDA can remove DS o market if unsafe (post-marketing surveillance) -labeled as food -FDA doesn’t regulate DS but they do provide recommendation -manufacturer can go through and have a veri cation mark on DS to ensure what is labeled to be in product is inside product (Quality Assurance Program) DS claim statements: **cannot say this prevents/ cures something 1)Health claim= diet low in sodium reduced BP 2)Nutrient content claim= contains very low sodium 3)Structural claim= calcium builds strong bones 5 points to cover: 1)Appropriate use 2)Special groups 3)Adverse e ects 4)Interactions 5)Expectations Natural Products= St. John’s Wort: MOA= activate GABA & glutamate receptors; potentially inhibit monoamine oxidase inhibitor -uses= depression, anxiety, OCD, menopause, premenstrual symptoms -DOSE= 900-1,800 mg daily in 3 divided doses -safety/monitoring: ~therapeutic e ect not evident for several weeks, with prescribed antidepressant ~avoid in bipolar and schizophrenia ~limited evidence in pregnancy and lactation ~potent CYP3A4 inducer** ~potential for serotonin syndrome -side e ects= nausea fatigue, skin reaction Alpha Lipoic Acid: MOA= cofactor for glucose metabolism; acts on glucose transporters & stimulate glucose uptake -uses= diabetic peripheral neuropathy -DOSE= 600 mg TID -safety/monitoring: ~decrease food absorption ~take on empty stomach & 2-3 apart from antacid or mineral containing supplements ~AVOID in pt. With thyroid conditions ~monitor= glucose concentration ~helps prevent progression of neuropathy -side e ects= headache, nausea, diarrhea, rash Saw Palmetto: MOA= inhibit 5-alpha reductase & cystolic androgen receptor binding -uses= BPH -DOSE= 160 mg BID or 320 mg daily -safety/monitoring: ~not e ective in treating urinary symptoms ~CONTRAINDICATED in pregnancy!! ~AVOID concomitant use with antithrombotics (increases bleeding risk) & androgen if drugs ~AVOID in lactation! -side e ects= GI complications, fatigue, headache Black Cohosh: MOA=may modulate serotonin -uses=symptoms of premenstrual syndrome, dysmenorrhea, menopause, RA (rheumatoid arthritis) -DOSE= 40 mg daily in 1-2 divided doses -safety/monitoring: ~should not use for more than 6 months ~additive e ect with Tamoxifen ~no e ect on vaginal epithelium, endometrium, or hormone concentration ~AVOID in preganancy & lactation!!! -side e ects= headaches, rash, GI complaints, weight gain, hepatotoxicity Evening Primrose oil: MOA= consists of omega-6 essential fatty acids; responsible for anti-in ammatory activity -uses= mastalgia (breast pain), PMS, menopause, preclamplia, diabetic neuropathy, chronic fatigue syndrome, atopic dermatitis -DOSE= EPO 2-4grams (liquid/capsule) -side e ects= headache, nausea, diarrhea, abdominal pain Melatonin: MOA= regulate sleep and circadian rhythm -uses= sleep, jet lag -DOSE: Sleep= 0.3-5 mg (take 30-60 min prior to bedtime) Jet lag= 2-5 mg in the evening of arrival at destination and at bedtime for following 2-5 days -safety/monitoring: ~use in adolescents controversial b/c of possible hormonal e ects on sexual development -adverse e ects= nausea, vomiting, headache, irritability, dysthymia, and worsening of depressive symptoms Fish oil: OMEGA-3 FATTY ACIDS MOA= decrease interstitial absorption of cholesterol & inhibit enzymes involved in synthesis, excretion, & degradation of very low density lipoproteins therapy decrease hypotriglyceridemic action through peroxisome proliferator activated receptors (increase glucose concentrations & insulin resistance) -uses=lower TG levels, improve cardiac health, aid in treatment of depression, & relieve in ammatory conditions like RA (rheumatoid arthritis) -DOSE= 1-2 grams daily  hyperlipidemia: 2-4 grams daily in divided doses EPA: DHA ratio 1.2:1 OR 1.5:1 -safety/monitoring: ~stop before surgical procedure b/c decrease platelet aggregation -side e ects= belching with shy halitosis & GI distress *Echinacea can exacerbate asthma! *no ginkgo with seizure med Keppra *No sertaline with St. John’s wort= serotonin syndrome *No clopidogrel with ginkgo= can increase risk of bleeding *No clopidogrel with saw palmetto= can increase risk of bleeding