How to talk to your patients about supplements

By Kristi C. Torres, Pharm.D. | May 11, 2020

Your patients stop to talk to you every day about their prescription medications. They may be asking about side effects or the timing of a dose. In turn, you review their patient medication profile (PMP) to make sure their prescription medications are safe to be taken together. But what about the products not listed on their prescription profile?

Many patients take one or more over-the-counter supplements in addition to their prescriptions. In fact, 77% of adults in America take dietary supplements, according to a 2019 CRN Consumer Survey on Dietary Supplements. Some supplements may affect how their prescriptions work, so it is important to talk about it. But how do you get your patients to open up?

Ask open-ended questions to update the patient’s medication list

When you are counseling patients, you are often focused on the medication(s) they are picking up at that time, but this is also a great time to check in on other treatments. Pharmacists are the most accessible source of reliable information on both supplements and prescription medications.

You may open the conversation by saying “I’ve reviewed the medications that we have on file in the pharmacy. What other medications or over-the-counter supplements are you currently taking?” Some patients may worry that you might judge them for their supplement use, so it is important to have an easy, open dialogue.

As a healthcare professional, your body language may also affect how comfortable a patient is with opening up to you. If possible, sit with the patient to have a conversation. Let the patient know why you are asking about supplement use. While many supplements may play an important role in the health of your patient, they may not mix well with prescription medications.

Although the CRN survey indicates that 30% of adults take supplements for their overall health, The reasons for your patients choosing supplements for their health may be sensitive. Conditions such as depression and anxiety are not always easy to talk about, and your patients may have chosen to self-treat with supplements rather than discuss these conditions with their healthcare providers. Sensitivity in your approach will help you gain your patient’s trust so you can have an effective conversation.

Popular supplements for patients

Vitamins and minerals are the most popular supplements, according to the CRN survey, followed by specialty supplements (i.e., probiotics), herbals and botanicals (turmeric, CBD), fitness supplements (protein), and weight-loss supplements. There are numerous supplements your patients may inquire about, but there are a few that are hot topics.

CBD (cannabidiol) products are one of the fastest growing market trends in the supplement industry. In some cities, there are CBD outlets opening in every major shopping center. CBD is thought to provide some relief in symptoms associated with everything from seizure disorders and anxiety to nausea and inflammation. How does this affect your patients?

As you may know, CBD products are metabolized by the same cytochrome P-450 enzyme system that processes so many prescription drugs. If your patients are consuming a significant amount of CBD products, their metabolism of other drugs may be affected, which can sometimes lead to dangerous side effects. For instance, CBD may slow the metabolism of the cholesterol-lowering statin drugs. This could potentially lead to increased blood levels of statins, and therefore a higher incidence of side effects such as peripheral pain. CBD has also been associated with lowering blood pressure. This could have an additive effect with prescription agents meant to lower blood pressure. A patient could experience bradycardia, dizziness, or other side effects of their blood pressure being too low.

What else do my patients need to know about supplements?

Supplement interactions

St. John’s Wort is another popular supplement. It’s long been thought to help improve mood, depression, and menopausal symptoms—but it also has some significant interactions with prescription medications. Ironically, some of the most clinically significant interactions are with prescription medications intended to treat the same symptoms. St. John’s Wort is thought to increase serotonin levels in the brain. Popular antidepressants, such as fluoxetine, work by increasing serotonin. The additive effects of these two substances used together may lead to too much available serotonin. This can leave the patient affected by low blood pressure, sweats, or negative mental state changes.

Side effects of supplements

Aside from prescription interactions, it is important to cover the potential side effects of the supplements. St. John’s Wort, for instance, may cause insomnia or irritability. A patient who is struggling with depressive or menopausal symptoms may already be experiencing these issues, and St. John’s Wort could make them worse. When you empower your patients with information, they can fully understand what to expect.

Best quality supplement brands

It is important to let patients know that the manufacturing of supplements is not as tightly regulated as that of prescription drugs, so they can make sure their supplement is from a reputable source. By educating your patients, you may prevent them from receiving substandard, or even harmful, products. You might recommend pharmaceutical grade supplements from one of the following companies:

Metagenics
Pure Encapsulations
Nordic Naturals
Gaia Herbs
Designs for Health
Douglas Labs
Integrative Therapeutics
DiVinci Labs
Transformation Enzymes
Master Supplements
Thorne Research
Nu Medica

Supplements are a big part of our patient’s lives, and pharmacists are prepared to have informative discussions with their patients about them. Your knowledge becomes their power, so make sure to get them to talk to you about their supplement use.