SUPPLEMENTS & PRESCRIPTION
Dietary Supplements such as Vitamins, Herbs and Minerals aren’t without potential risks
Which supplement-prescription pairings can be risky?
6 popular supplements and their known effects on some common medications.
1. St. John’s wort
St. John’s wort is often taken to treat mild to moderate depression, or to reduce menopausal symptoms such as hot flashes. It has numerous drug interactions and can reduce the potency of birth control pills and hormone replacement therapy. It can also interfere with omeprazole (Prilosec), alprazolam (Xanax), certain statins and some antihistamines, Mayo Clinic reports.
It can render Pfizer’s new COVID-19 antiviral treatment, Paxlovid, useless.
2. CoQ10
Coenzyme Q10 is an antioxidant produced by our bodies to promote cell growth and maintenance; the levels of it in our body can decrease as we age. But CoQ10 can also interfere with the ability of blood thinners to do their job, which is to prevent blood clots from forming.
3. Turmeric
Turmeric has been shown to have many health benefits, from improving memory to lowering inflammation and even decreasing the risk of heart disease. It also has anticoagulant effects, which means you don’t want to mix turmeric supplements with a blood thinner or even, possibly, aspirin, due to the risk of internal bleeding,
Ginkgo biloba (an herb) and vitamin E are two other dietary supplements that can thin the blood, according to the Food and Drug Administration. So taking them with an anticoagulant can augment the effect.
4. Probiotics
Probiotics are full of beneficial bacteria, and are often taken to aid digestion and improve gut health. But don’t take one within two hours of taking an antibiotic, or you could reduce the effectiveness of the prescription medication.
5. Vitamin C
Vitamin C occurs naturally in many foods. It’s also consumed as a supplement for a myriad of reasons, ranging from warding off the common cold to preventing cancer.
But high-dose vitamin C supplements may reduce the effectiveness of some types of cancer chemotherapy. It can also interfere with niacin and statins and affect estrogen levels, according to Mayo Clinic.
6. Milk thistle
A flowering plant related to daisies, milk thistle is taken as a supplement to promote liver and heart health. It may also lower blood sugar, which could be a concern for someone who’s on diabetes medication.
However when combined with insulin, it can be “like taking a little bit too much” glucose-lowering medication.
Drugs That May Cause Memory Loss
Doctors once thought forgetfulness, brain fog, and confusion were normal with aging, but research shows aging doesn't necessarily mean memory decline. In fact, the Centers for Disease Control and Prevention suggest that memory, skills, and knowledge might even improve over time. Common factors that can affect memory include alcohol and drug abuse, smoking, head injuries, stroke, lack of sleep, stress, vitamin B12 deficiency, Alzheimer's disease, and depression. But what many people don’t realize is that a number of commonly prescribed drugs also can interfere with memory. Here, we’ll delve into seven types of drugs that may cause memory loss and explore alternative treatment options.
Short- vs. long-term memory
There are two key types of memory: short- and long-term, says Jessica Merrey, the lead clinical pharmacy specialist at Johns Hopkins Hospital in Baltimore. Short-term memory, also known as working memory, refers to anything that happened within the last 30 seconds — like forgetting what you meant to add to your grocery list after picking up your pen. In contrast, long-term memory involves anything beyond this brief window. Whether it’s a recent event or a childhood memory, forgetting something after more than 30 seconds is considered long-term memory loss.
Drugs that affect short-term memory can interfere with a person’s ability to focus and process information. These medications disrupt so-called messenger pathways in the brain, Merrey says, “changing the short-term memory processing.” Once a person stops taking the medications, however, short-term memory improves.
Medications that can impact long-term memory interfere with neurotransmitters in the brain. These are the body’s chemical messengers that help you to think, move, breathe and function generally, and when they don’t work like they should, a number of problems can occur, including issues with thinking and memory.
The biggest concern with medications that mess with neurotransmitter activity “is when several are used concurrently, when they are used at high doses and when they are used for long periods of time,” says Joshua Niznik, an assistant professor of medicine at the University of North Carolina School of Medicine in Chapel Hill.
Note, certain medications can affect both short- and long-term memory, while others may affect only one.
1. Antianxiety drugs (benzodiazepines)
Examples: alprazolam (Xanax), chlordiazepoxide, clonazepam (Klonopin), diazepam (Valium), flurazepam, lorazepam (Ativan), midazolam, quazepam (Doral), temazepam (Restoril) and triazolam (Halcion).
How they can affect memory: Benzodiazepines dampen activity in key parts of the brain, including those involved in the transfer of events from short-term to long-term memory. In fact, they’re used in anesthesia for this very reason.
Alternatives: Benzodiazepines should be prescribed only rarely in older adults, and then for short periods of time. It takes older people much longer than younger people to flush these drugs out of their bodies, and the ensuing buildup puts older adults at higher risk for not just memory loss but delirium, falls, fractures and motor vehicle accidents.
Another drawback: They’re addicting, says D.P. Devanand, M.D., professor of psychiatry and neurology at Columbia University Medical Center in New York City.
Talk with your doctor or other health care professional about treating your condition with other types of drugs or nondrug treatments.
2. Antiseizure drugs
Why they are prescribed: Long used to treat seizures, these medications can also be prescribed for nerve pain, bipolar disorder, mood disorders and mania.
Examples: carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), rufinamide (Banzel), topiramate (Topamax), valproic acid (Depakote), phenobarbital (Luminal), primidone (Mysoline), zonisamide (Zonegran) and phenytoin (Dilantin).
How they can affect memory: Anti-seizure medications are believed to limit seizures by dampening the flow of signals within the central nervous system. “Basically these medications are slowing the brain down. And as a consequence, memory and attention and sleepiness are common side effects of these medications,” says Aatif M. Husain, M.D., a professor of neurology and the division chief of epilepsy, sleep and neurophysiology in the department of neurology at the Duke University School of Medicine in Durham, North Carolina.
Alternatives: If you’re worried about memory and attention issues while taking one of these medications, talk to your doctor to see if an alternative drug — either in the same class or a different one — may be better for you, Husain says.
It’s also possible that other potentially treatable health issues not related to the medication may be messing with your memory, such as anxiety and poor sleep. “Seizures themselves, if the seizures are uncontrolled, can affect memory as well,” Husain says.
3. Tricyclic antidepressants
Why they are prescribed: This older class of antidepressant drugs is prescribed less often these days, but some people still use tricyclics for depression, anxiety disorders, obsessive-compulsive disorder and nerve-related pain.
Examples: amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil) and trimipramine (Surmontil).
How they can affect memory: Tricyclic antidepressants block the action of serotonin, norepinephrine and other chemical messengers in the brain, which can lead to a number of side effects, including lapses in memory.
Alternatives: Newer antidepressants like fluoxetine (Prozac), sertraline (Zoloft) and other selective serotonin reuptake inhibitors (SSRIs) don’t have the same anticholinergic effects as tricyclic antidepressants and therefore don’t interfere with cognition, Devanand explains. You can also talk with your health care provider about whether nondrug therapies might work just as well or better for you than a drug.
4. Narcotic painkillers (opioids)
Why they are prescribed: These medications are sometimes used to relieve moderate to severe pain from surgery or injuries. In some instances, they can also be used to treat chronic pain.
Examples: fentanyl (available as a patch), hydrocodone (Vicodin), hydromorphone (Dilaudid, Exalgo), morphine and oxycodone (Oxycontin). These drugs come in many different forms, including tablets, solutions for injection, transdermal patches and suppositories.
How they can affect memory: These drugs work by stemming the flow of pain signals within the central nervous system and by blunting one’s emotional reaction to pain. Both these actions are mediated by chemical messengers that are also involved in many aspects of cognition, so use of these drugs can interfere with long- and short-term memory, especially when used for extended periods of time. Researchers have also found a link between opioid use and dementia in older adults.
Alternatives: In patients under the age of 50 years, nonsteroidal anti-inflammatory drugs (NSAIDs) are the frontline therapy for pain. Unfortunately, NSAID therapy is less appropriate for older patients, who have a much higher risk of gastrointestinal bleeding. Research shows the risk goes up with the dosage and duration of treatment.
Acetaminophen (Tylenol) may be another option, but again, it’s important to consult your doctor about risks, side effects and drug interactions for all medications.
5. Sleeping aids (nonbenzodiazepine sedative-hypnotics)
Why they are prescribed: Sometimes called the “Z” drugs, these medications can be used to treat insomnia and other sleep problems. They also are prescribed for mild anxiety.
Examples: eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien).
How they can affect memory: Although these are molecularly distinct from benzodiazepines (see No. 1, above), they act on many of the same brain pathways and chemical messengers, producing similar side effects and problems with addiction and withdrawal. The “Z” drugs also can cause amnesia and sometimes trigger dangerous or strange behaviors, such as cooking a meal or driving a car with no recollection of the event upon awakening.
Alternatives: There are alternative drug and nondrug treatments for insomnia and anxiety, so talk with your health care professional about options. Melatonin, for instance, can help to reestablish healthy sleep patterns. And cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for the sleep disorder.
Before stopping or reducing the dosage of these sleeping aids, be sure to consult your health care provider. Sudden withdrawal can cause serious side effects, so a health professional should always monitor the process.
What About Statins?
Statins appeared in an earlier version of this article, published in 2016, but more recent research is giving these cholesterol-lowering drugs the boot from the list.
“Very large studies performed in hundreds of thousands of individuals monitored very carefully do not show any increase in memory problems or anything else related to brain function,” says Donald Lloyd-Jones, M.D., chair of the Department of Preventive Medicine at Northwestern Medicine and immediate past president of the American Heart Association (AHA). A 2018 scientific statement from the AHA says there is “no convincing evidence for a causal relationship” between statins and cognitive dysfunction.
In fact, Lloyd-Jones says the data suggests that statins may be protective against cognitive decline, since they are effective at preventing strokes.
If you have concerns about potential side effects from statins – or any drug – talk to your doctor. “Any medication can cause any number of different types of side effects. And those vary from individual to individual,” Lloyd-Jones says.
This part of the article was taken from AARP webpage: https://www.aarp.org/health/drugs-supplements/info-2017/caution-these-10-drugs-can-cause-memory-loss.html?cmp=EMC-DSM-NLC-OTH-WBLTR-1532702-1950619-8604491-NA-09072024-Webletter-MS1-NA-NA-S99A-Health&encparam=qlR3myENqRNIAzH69ss7YeZDrWbQrXfSYNbTNY9oAjc%3d
Talk to your doctor
Patients should talk to their doctors about the supplements they are taking.
A study found that fewer than 50 percent of patients disclose the use of dietary supplements, and even among those who do, only about one-third of the supplements taken are mentioned to doctors.
Reason for this: Patients may not realize the over-the-counter herbs or extra vitamins they’re working into their daily pile of pills count as anything that needs to be discussed with a doctor.
To help avoid any health hazards that can arise from mixing supplements and medications, it’s important to ask your doctor about possible adverse reactions before starting any new medication or supplement.
The FDA suggests bringing a list of everything you take — over-the-counter medicines (pain pills, allergy relief, etc.), dietary supplements and prescription drugs — with you to your next routine appointment to make sure your information is up to date. And be sure to keep track of the dosages and how many times a day you take them.
Also, if you’re planning a surgery, don’t be surprised if your doctor asks you to stop taking dietary supplements two or three weeks before the procedure to avoid changes in heart rate, blood pressure or bleeding risk.
Interested in learning more?
The National Institutes of Health has a database where you can search for a supplement and find links to verified sources with information about the product and its interactions.
The Button below will take you directly to the National Institutes of Health Office of Dietary Page.
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