Concomitant Use, Potential Depletions, and Interactions – DNI/DSI Webcast Part 2

Transcript - Part 2

Concomitant Use, Potential Depletions, and Interactions

As far as background for supplement use and potential for depletion and interaction, as well as our discussion, we're going to be talking about that next. As far as changes and prescriptions and over-the-counter and supplement use over the last decade or so, we've seen increases in both arenas. So, the rate of folks using at least one prescription medication over this time has increased from 84 to 87%. Also, those using supplements has increased even more so, anywhere from 51 to 63%, at least in this study which just came out recently.

When we look at concomitant use, folks who are using at least one prescription and one dietary supplement, we see that at least three-fourths of older Americans are using at least one prescription medication and at least one dietary supplement.

If we dig a little bit deeper into this literature, we see that at least a third of those concomitant users are actually using more than three prescription products, three plus prescription products, and at least three dietary supplements. Again, that can be a set up for a poly-pharmacy situation and a potential interaction or potential depletion which we'll be talking about.

As far as the potential for that concomitant use to go on to a potential interaction or nutrient depletion issue, simply because we have a higher rate of use from both categories, the rate of potential interaction, at least in the studies that came out recently show that that has increased over the last decade from 8% to approximately 15%.

The numbers in the drug nutrient depletion category are a little bit more difficult to come by, but those estimates are based on a lot of other categories and factors, including dose of the medications, the background diet supplementation that may or not be happening. So, as an example, two examples here, thiamine deficiency is quite prevalent at very high doses of medication use for CHF [congestive heart failure], but that can go down, but still is significant at lower doses.

It becomes even more complicated with certain medications where there are multiple classes in the family, and CoQ10 [coenzyme Q10] is a great example of that when it's co-administered with a statin medication, and we'll talk about that specifically later on.

As far as factors associated with dietary supplement use among prescription medication users, we see a few important trends that we'll be hearing more about later, but one of them is that there is a low rate of actual disclosure. In this case, 69% did not disclose to a conventional provider. When they were asked further about their actual dietary supplement use, the most common scenario supplements were echinacea, ginseng, ginkgo, garlic, and glucosamine. We'll call those the G supplements. We'll come back and discuss those more specifically later.

The most common conditions for supplement use were areas such as menopause, GI symptoms, and pain, specifically, headache. The easy way to remember this is any conditions that they may not have a very specific, immediate curative agent, where a patient may be sort of having a number of symptoms like the GI scenario or menopause with various symptoms are typically arenas where supplements are going to be loo