Consult Experts When Mixing Drugs, Herbal Supplements

By John Voket

As the month of July draws to a steamy finish, so too does Herbal/Prescription Awareness Month.

The annual occasion provides opportunities for local and area professionals whose primary goal is to see that their clients and patients do no’t make things worse instead of better when combining conventional pharmaceuticals prescribed by their medical doctors and herbal supplements that are obtained on one’s own, or preferably, under the advice of a naturopath or pharmacist.

According to the US Department of Health and Human Services National Mental Health Information Center, herbal supplements are classified by the Food and Drug Administration (FDA) as part of a general group of “dietary supplements.” In 1994, the Dietary Supplement Health and Education Act (DSHEA) was created. Under this act, a dietary supplement must meet all of the following conditions:

It is a product (other than tobacco) intended to supplement the diet, which contains one or more of the following: vitamins; minerals; herbs or other botanicals; amino acids; or any combination of the above ingredients.

It is intended to be taken in tablet, capsule, powder, softgel, gelcap, or liquid form.

It is not represented for use as a conventional food or as a sole item of a meal or the diet.

It is labeled as being a dietary supplement.

Locally, at the Newtown Drug Center Pharmacy, consulting pharmacist Richard Gubbiotti often counsels customers when they are considering adding an herbal supplement to a regimen of prescription medications.

“The customers who come to us and mention they are going to take, or have started taking, an herbal or supplemental item are doing the right thing,” Mr Gubbiotti said during a visit to the Church Hill Road pharmacy earlier in the month. “For the most part, any herbal supplement should be considered in the same way as a prescription medicine. Taking something inappropriate or the improper dose can do more harm than good.”

The local pharmacist, who spent many years dispensing in the pharmacy at Waterbury Hospital, has had exposure to situations that can be significantly more dangerous for individuals who just start taking an herbal remedy on their own without any consultation. Mr Gubbiotti said that in his experience, it is a rare case where herbal and pharmaceutical interactions become toxic or dangerous for the patient, but it can happen.

He advised against anyone on any type of conventional prescription to begin taking an herbal supplement unchecked “because they read about it, heard from a friend or other source that the supplement has been proven successful for the type of condition they may have.”

“A lot of interactions are dose dependent, and a lot of these interactions are highly individualized,” Mr Gubbiotti said.

Leave Nothing

To Chance

At the Hawleyville Naturopathic Medical Center (LLC) naturopathic physicians and partners Josh Berry, ND, and Liz Herman, ND, do not leave anything to chance when advising their patients on the proper dosage and practices for supplements. According to Dr Berry, every single item they dispense is individually formulated based on their understanding of each patient’s individual lifestyles, needs, and of course, on which prescription medications they may be taking.

“We stock a huge variety of supplements that we can mix and dispense in capsule or liquid form,” Dr Berry said. “And we match every dose exclusively for each patient.”

Dr Berry said even extremely common herbal remedies like echinacea, elderberry, ginkgo, and hawthorne berries and leaves can be either harmful or ineffective if not matched to the particular issue of each patient. He said visitors to the practice are about evenly balanced between those seeking natural alternatives in concert with primary physician care, to those who subscribe almost exclusively to natural or holistic practices, even an increasing number of children.

“We’ve been seeing a lot of parents coming in with their children, who are trying to get them off of antibiotics,” he said. “These are children who may have been experiencing chronic ear infections, who have been on and off the medication for years.”

Dr Herman said that in almost all cases, she can achieve positive results for her patients when they are balancing advice from their physician as well as from a naturopath. Dr Berry agreed.

“Ideally it is our goal to get our patients off all medications including herbal supplements,” he said. “If we are ultimately successful in treating a patient, it means they are off of everything.”

Dr Herman said in most cases, an improper dose of an herbal supplement will have little negative impact. But she concurred with Mr Gubbiotti that it is the odd situation that professionals dispensing herbal supplements have to watch for.

“It’s more the one in 100 case, not the other 99 in 100 that you have to be concerned about,” Dr Herman said. “The problem comes when you’re dealing with individuals on heart medication or prescription blood thinners, anticoagulants, and thyroid medications.”

She also warned against companies advertising the latest, greatest cure for what ails you.

“People should be wary of any new herbal product that is being promoted,” she said. “Most of what we use has been around for centuries, and is tested and proven effective in most cases. But if you hear about a brand new product, I advise that they do not try it on their own.”

A Partnership

From his practice in Danbury, naturopath Dr Michael Gazsi said he is optimistic about the future as more and more medical doctors begin consulting with and working in partnership beside naturopaths for the overall good of the patient.

“I’ll always consult with any medical doctor who calls on behalf of a patient when they are sincerely interested in how we can help,” Dr Gazsi said. “Both professions need to have better avenues of communication.”

After 11 years of practicing locally, including seeing dozens of patients from Newtown, Dr Gazsi said that today, it is typically the younger doctors who take more of an interest in combining naturopathic and prescription remedies.

“It’s because they are seeing positive results,” he said.

When his patients ask about herbal supplements, or he is advising them, Dr Gazsi said he always asks about their history of prescription use.

“The two I worry about most are blood thinners and antidepressants,” he said. “A lot of very popular over the counter things like fish oil and other supplements can cause hemorrhaging in the worst case scenario, if they are being combined in high dosage with drugs like Coumadin. And if you are taking antidepressants, some herbal formulas increase serotonin.”

While patients may feel they can trust ads or reports in health magazines or on Internet websites — even experienced health food shop operators — all three naturopaths and the local pharmacist advise anyone considering herbal remedies to bring their ideas, and a list of all prescriptions they are taking, straight to a qualified expert.

“If you are not working with a naturopath who knows about combining one kind of drug with another herbal supplement, you can run into problems,” Dr Herman concluded.

Mr Gubbiotti said he and the staff at the Drug Center Pharmacy are always willing to answer any questions anyone may have.

“Don’t forget, the FDA doesn’t approve herbal remedies because they are not tested to the level of approved pharmaceuticals,” he said. “So we always welcome anyone, customer or not, to come in with their list of prescriptions. We’ll be happy to tell them about any known adverse herbal and pharmaceutical reactions, no matter what month it is!”