Dietary supplements are the most commonly used form of complementary or alternative therapy, primarily because of their wide availability, relative cheapness, and because they can be bought without consulting a doctor.
(Accompanying and alternative medicine at a glance.) Dietary supplements are the most commonly used form of complementary or alternative therapy, primarily because of their wide availability, relative cheapness, and because they can be bought without consulting a doctor. The Food and Drug Administration (FDA) has issued other regulations for dietary supplements than for drugs. Prescribed only quality control and good manufacturing practices, but can not guarantee the standardization of active ingredients or efficacy. Definition The Dietary Supplement Health Education Act (DSHEA) of 1994, any product (other than tobacco) that – contains vitamins, minerals, herbs, amino acids or any other known Planzenpräparat and as an adjunct – in the form of pills, capsules, tablets or liquid solutions , is intended to normal diet defined as dietary supplements. In addition, certain hormones such as dehydroepiandrosterone (DHEA, a precursor of androgens and estrogens) and melatonin are considered dietary supplements and not as prescription drugs. Labeling The DSHEA requires that the label makes the product recognizable as a dietary supplement and inform the consumer that the effectiveness of the ingredients was not tested by the FDA. The label must also the ingredient accurately identify information on the quantity, weight and origin make (s. DSHEA- control www.fda.gov/RegulatoryInformation/Legislation/default.htm). The producers is allowed, for the structure and operation of the product to advertise declare (z. B. good for the health of the urinary tract), but they are allowed to express or implied as a drug or therapeutic (eg., For treatment of urinary tract infections) , (N. D. Talk .: In Germany dietary supplements are as food to the regulations of the Food and Consumer Goods Act and the Regulation on food supplements [NemV] According to them, particularly in the advertising of dietary supplements statements. Relating to the elimination, mitigation or prevention related diseases prohibited references to medical recommendations, medical reports or effect promises.) the expiry date should be included on the standardized product labels. Safety and efficacy Most consumers take supplements center to themselves because they think they are generally good for health, would be a safe, effective treatment and / or prevention of certain diseases, because there are natural means (ie, derived from plants or animals) and have proven experience in the medicine for centuries. The FDA requires manufacturers no safety or efficacy testing for nutritional supplements (even if their safety must be documented for some time out). Most supplements have not been evaluated according to strict criteria. In many cases the suspected safety or efficacy is established by using Traditional Certain in vitro studies Case reports animal studies, however, the manufacturers and distributors of dietary supplements have recently report serious side effects on the MedWatch system to the FDA. That they are safe and provide a useful complement to standard medications, but (chondroitin / glucosamine, St. John’s wort for. As fish oil) is now for a few supplements have proven. Since then, an increasing number of clinical studies are carried out, more and more evidence on the safety and efficacy of dietary supplements found. Information about such studies is the National Center for Complementary and Alternative Medicine of the National Institutes of Health (NCCAM) on its website (nccam.nih.gov/research/clinicaltrials) are available. Purity and standardization that dietary supplements are not controlled because regulations and official surveillance missing, also means that it is not ascertained whether they actually contain the declared by the manufacturer ingredients or active ingredient amounts. A supplement may not listed, ineffective or even harmful components or varying amounts of the active ingredients included (eg. For example, natural toxins, bacteria, pesticides, lead or other heavy metals, non-approved dyes), especially if it is comminuted whole plants or extracts are. is for consumers sometimes less nothing of active (a) substance (s) to get more time or in some cases the risk, if he is known at all. Most herbal products are mixtures in which the most active ingredient is not always known. The lack of standardization not only means that can vary the products from different manufacturers, but also that different batches from the same manufacturer may vary. This product variability is a particular source of difficulty in the implementation of rigorous clinical studies and the comparison between the different studies. Some dietary supplements, however, were standardized and possession of a corresponding marking on the label. New regulations for the production of dietary supplements in the US there is through the Good Manufacturing Practices (GMP). These rules strengthen standards for hygiene of facilities and production equipment and for the purity of the raw materials. The rules of GMP also provide for proper labeling, packaging and storage of the finished product. Other concerns more critical points are the use of nutritional supplements instead of conventional medicines stability of supplements (especially herbal products), contributing to misdiagnosis Most information comes from sporadic individual case reports (s once they are produced intoxication interactions between dietary supplements and medication. Some possible interactions of Nahrungsmittelergänzugen *), and from the literature. Despite these concerns, many patients are so convinced of the benefits of the supplements that they continue to use it, with or without the consent of their physician. Either they do not remember, it notify him or her want to hide it consciously. For this reason (incl. Food supplements) should be in demand in the medical history with outpatients at regular intervals, whether they have sooner or recently tried out a complementary or alternative treatment. Many doctors refer on their own specific supplements in the treatment and justify this with the proven benefits of a means to ensure greater safety of use in patients who would take such means in any case the desire, and with their own belief that there are safe and are effective agents. Some common concerns in the use of these supplements are placebo effects can simulate a real effectiveness, especially if the patient and / or physician believes strongly in the supplement. Therapeutic responses to additions -placebo mediated or otherwise Magi could mistakenly be accepted as evidence of a specific, possibly false, confirmed diagnosis. The safety of supplements, there are few data to which you could hold in advising the patient. But experts believe that supplements, based on the total number of doses, total rarely cause problems and that products that have been processed correctly, are probably safe. As a result, they advise you to refer supplements from known companies, or encourage many to buy products made in Germany, which are monitored by strict regulated than in the US because they are treated like drugs. The supplements listed below are among the most popular and are considered effective or questionable. More comprehensive information is provided by the NCCAM on its website (www.nccam.nih.gov/) are available. Some possible interactions of Nahrungsmittelergänzugen * supplements Affected drug interaction chamomile barbiturates and other sedatives can intensify the effects of sedatives or extend, because its essential oils have additive effects iron supplements can iron absorption because of planzlichen tannins reduce warfarin can increase the risk of bleeding, because chamomile Phytocoumarine contains, may have additive effects Echinacea potentially hepatotoxic drugs by cytochrome P-450 enzymes metabolised (eg. As amiodarone, anabolic steroids, ketoconazole, methotrexate) can slow down the metabolism of these drugs and increase the risk of liver damage when taken for a period> 8 weeks immunosuppressants (eg. Corticosteroids, cyclosporine) Can the immunosuppressive effect on T reduce -Zell- stimulation ephedra stimulants (z. B. caffeine, adrenaline, phenylpropanolamine, pseudoephedrine) Increases the stimulatory effects of other drugs, increasing risk of irregular or fast heartbeat and high blood pressure MAOIs May intensify effects of these medications and increase the risk of side effects (eg. As headaches, tremors, irregular or rapid heartbeat, high blood pressure) Feverfew medicines for migraine (eg ergotamine see table. Headache characteristics, broken down by cause) can increase heart rate and blood pressure because it has additive vasoconstrictive effects platelet-inflammatory drugs may increase the risk of bleeding because feverfew inhibits platelet aggregation (additive effect) iron supplements tannins in the plant can inhibit the absorption of iron NSAIDs The effectiveness of NSAIDs in the prevention and management of migraines is feverfew reduced warfarin can increase the risk of bleeding because warfarin may have additive effects garlic antihypertensives Can an antihypertensive effect reinforce platelet-inflammatory drugs can reduce the risk of bleeding increased because these medications increase inhibitory effect of garlic in platelet aggregation and fibrinolytic action Protease inhibitors (z. B. saquinavir) The blood levels of protease inhibitors is reduced by garlic Warfarin Can the risk of bleeding by enhancing the anticoagulant effect increase Ginger platelet-inflammatory drugs can increase the risk of bleeding due to the reinforcing effect of antiplatelet agents Warfarin Can the risk of bleeding by increase amplification of the anticoagulant effect Gi nkgo anticonvulsants (eg. As phenytoin) may reduce the antikonvulsivische effect because impurities in the Gingko preparations can reduce the anticonvulsant effects of MAO inhibitors (eg. As tranylcypromine) May intensify effects of these medications and increase the risk of side effects (eg. As headaches, tremors, manic episodes) NSAIDs can reduce the risk of bleeding due to the reinforcing effect of platelet aggregation inhibitors increase the risk of bleeding, warfarin can increase its enhanced anticoagulant effect Ginseng Antihyperglycemic drugs (eg. B. Glipizide) May intensify effects of these drugs, which can lead to hypoglycemia aspirin and other NSAIDs can increase the risk of bleeding due to the reinforcing effect of platelet aggregation inhibitors, corticosteroids may intensify side effects of corticosteroids, because ginseng has an anti-inflammatory effect of digoxin can increase digoxin estrogens can adverse effects of estrogen increases one Strengths MAOIs May cause headache, tremors, and manic episodes cause opioids Can the effectiveness of opioids reduce Warfarin Can the risk of bleeding by enhancing the anticoagulant effect increase Canadian turmeric warfarin and heparin can inhibit the effects of warfarin and heparin and thus the risk of thromboembolism increase Green tea warfarin can reduce the effectiveness of warfarin, which will increase the risk of thromboembolism Kava sedatives (eg. As barbiturates, benzodiazepines) Can the effect of sedatives intensify or prolong licorice / liquorice (Glycyrrhiza glabra) antiarrhythmics Can dasvRisiko increase of cardiac arrhythmia, so that therapeutic interventions are less effective antihypertensive drugs can promote salt and water retention and lead to an increase in blood pressure, so antihypertensive drugs less effective are digoxin can descend potassium levels, which increases the risk of digoxin toxicity Diuretics can worsen by diuretics, the potassium excretion and thus the benefits of potassium-sparing diuretics affect (eg. As spironolactone) MAOIs May intensify effects of these medications and increase the risk of side effects (eg. As headaches, tremors, manic episodes) milk thistle Antihyperglycemic drugs May intensify effects of these drugs, which can lead to hypoglycemia protease inhibitors (eg. B. indinavir, saquinavir) can by increasing the Indinavirspiegels in the blood with metabolizing enzymes interfere saw palmetto Estrogens (eg. As oral contraceptives) May intensify effects of these drugs St. John’s wort cyclosporine Can the cyclosporine in the blood lower, reducing the chance of organ transplant rejection increased digoxin can reduce digoxin levels in the blood, making it less effective, which is associated with potentially dangerous results iron supplements can reduce the absorption of iron MAOIs Can effects of M strengthen AO inhibitors, potentially causing very high blood pressure, which may require emergency treatment nucleoside reverse transcriptase inhibitors increases the metabolism of these drugs, reducing their effectiveness is reduced Oral contraceptives increases the metabolism of these drugs, reducing their effectiveness is impaired Photosensitive drugs (z. As lansoprazole, omeprazole, piroxicam, sulfonamide antibiotics) can increase sun sensitivity protease inhibitors can reduce the blood levels of protease inhibitors, thereby their effectiveness compromised SSRI (eg., Fluoxetine, paroxetine, sertraline) May intensify effects of these drugs tricyclic antidepressants may enhance effects of these drugs warfarin can lower the warfarin levels in the blood, bringing the Risk of thromboembolism increases valerian sedatives (eg. As barbiturates, benzodiazepines) May intensify effects of sedatives * Caution is advised when supplements are used as these products are not standardized and therefore vary considerably and because information is constantly changed by their use. The theoretical status of many published interactions does not remove the need for careful use. Before prescribing a drug doctors and therapists, patients should ask if they are taking supplements and if so, what. Physicians must recognize potential harmful drug interactions and supplements that are taken from a patient and then determine appropriate medications and dosages. The sale of dietary supplements containing ephedra is banned in the US. When this substance is the real, natural licorice, not the usual, artificially flavored licorice candy. MAO inhibitors = monoamine oxidase inhibitor; NSAIDs = nonsteroidal anti-inflammatory drugs; SSRIs = selective serotonin reuptake inhibitors. For more information IDietary Supplement Health Education Act (DSHEA) legislation MedWatch: The FDA Safety Information and Adverse Event Reporting Program National Institutes of Health National Center for Complementary and Integrative Health