Medical reconciliation of dietary supplements: Don’t ask, don’t tell

Gardiner, Paula; Sadikova, Ekaterina; Filippelli, Amanda C.; White, Laura F.; Jack, Brian

doi:10.1016/j.pec.2014.12.010

Cited by 62 publications

(46 citation statements)

References 38 publications

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“…Clinicians could be encouraged to educate patients about potential cardiac effects from these products. However, since dietary supplement histories are infrequently obtained, 30–33 particularly among younger adults, 32 other opportunities for informing users of these potential adverse effects may be needed.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Visits for Adverse Events Related to Dietary Supplements

et al. 2015

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Background: Dietary supplements, such as herbals/complementary nutritionals and micronutrients (vitamins/minerals), are commonly used in the U.S., yet national data on adverse effects are limited. Methods: We used a nationally representative stratified probability sample of 63 emergency departments (2004–2013) to describe U.S. emergency department visits for dietary supplement adverse events. Results: Based on 3,667 cases, we estimated that 23,005 (95% confidence interval [CI], 18,611–27,398) emergency department visits, resulting in 2,154 (CI, 1,342–2,967) hospitalizations, were attributed to adverse events from supplements annually. Emergency department visits for supplement adverse events commonly involved young adults aged 20–34 years (28.0%; CI, 25.1%−30.8%) and unsupervised children (21.2%; CI, 18.4%−24.0%). Excluding unsupervised child ingestions, 65.9% (CI, 63.2%−68.5%) of emergency department visits for single-supplement adverse events involved herbals/complementary nutritionals; 31.8% (CI, 29.2%−34.3%) involved micronutrients. Herbal/complementary nutritional products for weight loss (25.5%; CI, 23.1%−27.9%) and increased energy (10.0%; CI, 8.0%−11.9%) were commonly implicated. These weight loss or energy products caused 71.8% (CI, 67.6%−76.1%) of supplement adverse events involving palpitations, chest pain, and/or tachycardia, and 58.0% (CI, 52.2%−63.7%) involved persons aged 20–34 years. Among adults aged ≥65 years, choking or pill-induced dysphagia/globus caused 37.6% (CI, 29.1%−46.2%) of all emergency department visits for supplement adverse events; micronutrients were implicated in 83.1% (CI, 73.3%−92.9%) of these visits. Conclusions: Over 20,000 emergency departments visits in the US annually are attributed to dietary supplement adverse events; these commonly involve cardiovascular manifestations from weight loss or energy products in younger adults, micronutrient ingestions by unsupervised children, and swallowing problems, usually from micronutrients, in older adults.

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Section: Discussionmentioning

confidence: 99%

Emergency Department Visits for Adverse Events Related to Dietary Supplements

et al. 2015

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“…However, 17% of all subjects answered that they did not discuss these supplements with their physicians or pharmacists, because they were never asked about it, which is consistent with previous findings [ 48 ]. This may have been associated with both patients’ and physicians’ insufficient recognition of the interactions between dietary supplements and medications, not only in Japan [ 43 ], but in other countries [ 49 , 50 , 51 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

Concomitant Use of Dietary Supplements and Medicines in Patients due to Miscommunication with Physicians in Japan

et al. 2015

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We previously reported that some patients used dietary supplements with their medication without consulting with physicians. Dietary supplements and medicines may interact with each other when used concomitantly, resulting in health problems. An Internet survey was conducted on 2109 people who concomitantly took dietary supplements and medicines in order to address dietary supplement usage in people who regularly take medicines in Japan. A total of 1508 patients (two admitted patients and 1506 ambulatory patients) and 601 non-patients, who were not consulting with physicians, participated in this study. Purpose for dietary supplement use was different among ages. Dietary supplements were used to treat diseases in 4.0% of non-patients and 11.9% of patients, while 10.8% of patients used dietary supplements to treat the same diseases as their medication. However, 70.3% of patients did not declare dietary supplement use to their physicians or pharmacists because they considered the concomitant use of dietary supplements and medicines to be safe. A total of 8.4% of all subjects realized the potential for adverse effects associated with dietary supplements. The incidence of adverse events was higher in patients who used dietary supplements to treat their disease. Communication between patients and physicians is important for avoiding the adverse effects associated with the concomitant use of dietary supplements and medicines.

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“…[20] These issues are compounded by reports suggesting that a significant percentage of certain patient populations are not discussing use of dietary supplements with their physician. [21] In Australia, dietitians are in a key position to advise patients and the general public about the evidence and limitations of specific dietary supplements [22]. However, there is currently no published literature that has investigated: the usage of dietary supplements in dietetic practice; barriers and enablers for their use; and the level of research interest, confidence and general knowledge regarding dietary supplement-related issues.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%