The Risks of Combining Dietary Supplements and Prescription Medicine
Case study:
A 28-year-old man shows up at the emergency department with severe calf pain after exercising. The patient was on prescription sertraline and said he took dietary supplements before working out. What was causing his pain?
Answer:
The patient developed serotonin syndrome with rhabdomyolysis-induced acute compartment syndrome (ACS), which was caused by vigorous exercise and the combination of the dietary supplement Natrol 5-HTP and selective serotonin reuptake inhibitor (SSRI) sertraline, according to a report co-authored by Yesha Patel, PharmD, a clinical assistant professor of drug information at the University of Illinois at Chicago College of Pharmacy. Rhabdomyolysis is also a known adverse reaction associated with 5-HTP, noted the report.
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Serotonin syndrome is often challenging to identify and demands obtaining a patient’s complete medication list, including prescription drugs, non-prescription drugs, illicit substances, and dietary supplements. The case also highlighted the importance of recognizing drug-dietary supplement interactions, according to Dr. Patel. “More often than not, patients are not aware of the potential dangers associated with the interactions,” she said. “They might think supplements are harmless, but they need to check with their pharmacists or physicians to make sure there are no associated interactions before they start any new medication or supplement.”
Adverse reactions to supplements are becoming a growing problem as the supplement market expands. This case was challenging because the patient denied using dietary supplements, when in fact he possessed more than 21 products, which were formulated to burn excess fat, decrease appetite, and increase sexual function. Unfortunately, getting an incomplete picture of a patient’s medication regimen at the point of care is not unusual, according to Dr. Patel.
“It should be second nature for pharmacists to ask patients if they’re on any herbal supplements,” she said. “That extra step will generate a complete medication list and a comprehensive picture of their overall health condition, which leads to more informed clinical decisions.”
In fact, in this case, clinical pharmacists played a key role in identifying and researching all of the dietary supplements taken by the patient to check for drug interactions. That investigation helped the treating physicians understand the etiology of the serotonin syndrome that developed.
—Dan Cook
