Top 10 most prescribed drugs in the United
Top 10 most prescribed drugs in the United States and a review of potential drug-dietary supplement interaction Dr. Jean-Jacques Dugoua ND Ph. D Hawaii Doc Talks, Maui, March 2017 Jeanjacques. dugoua@utoronto. ca
Top 100 Most Prescribed, Top Selling Drugs Medscape August 2014 www. medscape. com/viewarticle/825053_print jeanjacques. dugoua@utoronto. ca
Top 100 Most Prescribed, Top Selling Drugs Medscape August 2014 www. medscape. com/viewarticle/825053_print jeanjacques. dugoua@utoronto. ca
jeanjacques. dugoua@utoronto. ca
Area under the curve jeanjacques. dugoua@utoronto. ca
jeanjacques. dugoua@utoronto. ca
jeanjacques. dugoua@utoronto. ca
Levothyroxine (Synthroid) Iron: Take at least 2 hours apart Calcium: Take at least 4 hours apart Chromium: L-thyroxine: 30 min before or 3 -4 hours after Coffee/Soy protein: L-thyroxine: take a minimum 1 hour before Standard meal/ High fiber meal Alpha-lipoic acid: Co-administration may decrease T 4 -T 3 conversion by 22% (PMID: 1815532). Separate by 4 hrs? jeanjacques. dugoua@utoronto. ca
Asthma Advair Diskus (Fluticasone + Salmeterol (LABA)) • Ephedra/Bitter Orange: may prolong QT interval = arrhythmia (PMID: 14722148 ) • Grapefruit: Inhibitor • St John’s wort (SJW): Inducer • Black walnut: Precipitates Drug • Activated charcoal: absorption inhibitor Salbutamol (SABA) • Same as above jeanjacques. dugoua@utoronto. ca
Mental health Abilify (Aripiprazole) – Third generation antipsychotic jeanjacques. dugoua@utoronto. ca
Abilify (Aripiprazole) • Phenylalanine: may contribute to the development and severity of tardive dyskinesia (PMID: 1352977) • Celery: may aggravate photosensitivity (PMID: 11501915) • Melatonin: potential pro-convulsant effects (PMID: 9643754) • Grapefruit: Inhibitor • St John’s wort (SJW): Inducer • Black walnut: Precipitates Drug • Activated charcoal: absorption inhibitor jeanjacques. dugoua@utoronto. ca
Cymbalta (Duloxetine) SSNRI Co-administration with 5 -HTP, l-tryptophan (PMID: 8254702), lithium, SJW (PMID: 9518947) or SAMe (PMID: 8434674), risk of: • Serotonin syndrome • Thunderclap headache, reversible cerebral arterial vasoconstriction, and ischemic strokes (i. e. , the Call-Fleming syndrome) (PMID: 11781419) jeanjacques. dugoua@utoronto. ca
jeanjacques. dugoua@utoronto. ca PMID: 20433130
Incidence 0. 4 cases per 1000 patientmonths of treatment (PMID: 10818650) jeanjacques. dugoua@utoronto. ca
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Cymbalta (Duloxetine) Risk of serotonin syndrome • Garcinia (PMID: 24699886), phenylalanine (PMID: 2437473) Decreased effectiveness • Ginkgo (PMID: 1361545) Risk of mania • DHEA (PMID: 11144700) jeanjacques. dugoua@utoronto. ca
Lyrica (Pregabalin) Theoretically, caution with sedative herbs and supplements: • 5 HTP, kava, l-trytophan, lemon balm, passion flower, valerian, skullcap, hops, lavender, German chamomile, gotu kola, catnip, California poppy, cannabis and ashwaghanda jeanjacques. dugoua@utoronto. ca
Lantus Solostar (insulin glargine injection) • Caution with oral hypoglycemics: • Aloe, berberine, cinnamon (cassia and common), vanadium, chromium, banaba, bitter melon, cissus, panax ginseng, gymnema, maitake, milk thistle, moringa, prickly pear, reishi, rhodiola, alpha lipoic acid Niacin (PMID: 2653928, PMID: 8357290) EDTA (PMID: 8305786) Apple cider vinegar (PMID: 16015276) jeanjacques. dugoua@utoronto. ca
jeanjacques. dugoua@utoronto. ca
Crestor (Rosuvastatin) • Theoretical risk of hepatoxicity when taken in combination: • Black cohosh, cinnamon, colloidal silver, kava, garcinia, gotu kola, green tea (supplements), niacin, red yeast, spearmint tea and vitamin A jeanjacques. dugoua@utoronto. ca
Statins • Lovastatin (AUC 15 x) • Simvastatin (AUC 16 x) • Atorvastatin (AUC 83%) • Pitavastatin (AUC 13%) • No significant effect on non-CYP 3 A 4 metabolized statins: • Rosuvastatin, pravastatin or fluvastatin jeanjacques. dugoua@utoronto. ca
• Inhibits organic anion transporting polypeptides (OATP) • Believed to affect OATP for only a short time. • Separate drug administration with consumption of apple and grapefruit juice by at least 4 hours • Likely to avoid this interaction • Herbs: black cohosh, Siberian ginseng jeanjacques. dugoua@utoronto. ca
Rhabdomyolysis? • Case study 48 yo • ezetimibe 10 mg qd + rosuvastatin 5 mg qod (17 months) • Hx serum CK • 200 ml twice/wk (3 weeks) pomegranate • Urgent thigh pain + serum CK (138, 030 U/L, normal < 200 U/L) • Inhibits intestinal CYP 3 A 4, no effect on hepatic CYP 3 A 4. jeanjacques. dugoua@utoronto. ca
The biologics Humira (Adalimumab) • RA, AS, psoriatic arthritis, crohn’s disease, UC, plaque psoriasis, hidradenitis suppurativa, uveitis, Behcet's disease (orphan) jeanjacques. dugoua@utoronto. ca
The biologics Enbrel (Etanecept) • AS, Acute RA, psoriatic arthritis and plaque psoriasis Remicade (Infliximab) • RA, AS, psoriatic arthritis, plaque psoriasis, crohn’s disease, UC and idiopathic pulmonary fibrosis (orphan) • Copaxone (Glatiramer) • MS, ALS (orphan) and primary progressive MS (orphan) jeanjacques. dugoua@utoronto. ca
Enbrel (Etanacept) jeanjacques. dugoua@utoronto. ca
Remicade (Infliximab) jeanjacques. dugoua@utoronto. ca
Copaxone ( Glatiramer) jeanjacques. dugoua@utoronto. ca
Humira (Adalimumab) jeanjacques. dugoua@utoronto. ca
Enbrel (Etanecept) jeanjacques. dugoua@utoronto. ca
Remicade (infliximab) jeanjacques. dugoua@utoronto. ca
Copaxone (Glatiramer) jeanjacques. dugoua@utoronto. ca
Biologic Drug Interaction Anything that stimulates the immune system • AHCC, mistletoe, astragalus, beta-glucans, American ginseng, panax ginseng, andrographis, Bacillus coagulans, bupleurum, cat’s claw, chagas, echinacea, cordiceps, elderberry, galacto-oligosaccharides, larch arabinogalactans, melatonin, picrorhiza, selenium, shitake, Siberian ginseng and thymus extract • Lactobacillus spp. probiotics? Immune suppressants • Thunder god vine jeanjacques. dugoua@utoronto. ca
Nexium (Esomeprazole) • Grapefruit – inhibitor • SJW – Inducer • Black walnut: Precipitates Drug • Activated charcoal: absorption inhibitor • Betaine HCl? • Apple cider vinegar? jeanjacques. dugoua@utoronto. ca
Top 10 most prescribed drugs in the United States and a review of potential drug-dietary supplement interaction Dr. Jean-Jacques Dugoua ND Ph. D Hawaii Doc Talks, Maui, March 2017 Jeanjacques. dugoua@utoronto. ca
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