I have had a fair number of consults from providers who are referring patients who would like to take supplements or are currently taking supplements. In my humble opinion, no healthcare professional is more educated than a pharmacist to handle addressing whether a supplement is likely to be safe or not. Even if I have never heard of a supplement, our skillset lends toward identifying potential concerns and resolving them appropriately. Here are some of the most important questions to consider when patients want to take supplements.
My first question to ask in a professional manner is “why do you want to take this supplement”? As pharmacists, we always want a diagnosis for every medication so we know how to appropriately monitor a new medication for efficacy. If the patient doesn’t have a good reason why they want to take a supplement other than “someone recommended it” I will try to steer my patient away from taking another pill.
If the patient does have a good reason to take a new supplement, it is also important to look at that reason. If the patient wants to take ginger for GI upset, this should absolutely prompt you to look at their entire medication list to ensure they are not having adverse effects from another drug.
The next concern that I usually review is the potential for drug interactions. There are numerous supplements that have the potential to interact with prescription and over-the-counter medications. Grapefruit juice is a classic example. Running a drug interaction screen is important to maximize the safety of any new supplement. Here’s a classic case scenario where I run through some of these issues.
How much? Some patients want to take things to the extreme and they will sometimes use the “if some is good, more is better” mentality. We should try to limit doses to what has been studied and proven safe. This can be challenging with some supplements that may not have much evidence behind them.
What side effects? Supplements certainly can have adverse effects and it is important to make sure you know what those adverse effects might be. Educating our patients about this risk is important and if there is minimal benefit to be gained from the literature we have, it may be another reason to help our patient avoid another unnecessary pill.
Cost? Many supplements can be significantly expensive for patients. We take the time to identify cost concerns with prescription medications, and supplements should be no different.
Is there a plan to discontinue? For many supplements that are treating symptoms, it is a great idea to reassess the supplement periodically. For agents that are used in managing pain or other subjective symptoms, be sure to check in periodically (i.e. 1 month, 3 months, etc.) to ensure that the supplement has been effective.
What other questions should we consider when patients want to take supplements?