Items filtered by date: Wednesday, 26 September 2018

Another warning has been issued to adults and seniors who mix herbal remedies, over the counter supplements and prescription medications.

A study from the University of Hertfordshire in the UK found 44% of women and 22% of men surveyed mixed their prescription medications with herbal remedies and over the counter supplements.

Individuals may have changes in their metabolism and medication breakdown as they age causing variances in body absorption and efficacy of medications.  Adding supplements or herbal remedies could cause unpredictable reactions.

These effects could include:

  • Less efficacy of prescription medication causing poor blood pressure, sugar, heart rhythm control, for example)
  • Enhanced active compounds of medications taken (possibly causing overdose)
  • Nausea
  • Vomiting
  • Body aches
  • Jaundice
  • Blood thinning causing easy bleeding
  • Renal failure
  • Liver failure
  • Anemia
  • Mania and other personality changes
  • and  more

For example, St. John’s Wort could interfere with the effectiveness of one’s birth control and ginseng could worsen one's hypoglycemia if they are taking insulin.

Grapefruit juice could interfere with the metabolism of a statin, a popular medication used to decrease cholesterol. By raising its levels in the blood, one drink could cause a patient to have increased side effects such as muscle cramps and liver issues.

Iron supplements can interfere with one’s absorption of their thyroid medication, and ginkgo biloba, if taken with a blood pressure medication, could cause the blood pressure to drop even lower. Moreover it can increase bleeding if taken with an anticoagulant.

And if alcohol is mixed with any prescription medication, deadly side effects (such as respiratory depression when used with opiates) can ensue.

So the moral is, just because a supplement states is “natural,” or a frequently consumed food appears to be safe, its combination with medication could prove deadly.

Although the interactions are numerous, the AAFP created a table of common ones:

 

Herbal and Dietary Supplement–Drug Interactions

HERBAL OR DIETARY SUPPLEMENT

DRUG

COMMENT

RECOMMENDATION*

Patients taking oral anticoagulants

Cranberry (juice)

Warfarin (Coumadin)

Interaction possible based on seven reports of increased INR, although a clinical study showed no interactions47

Suspect an interaction if INR elevated

Fish oil

Warfarin

Interaction possible, with case reports showing an elevated INR, although a clinical study showed no effect of fish oil on anticoagulation status8,9

Suspect an interaction if INR elevated

Garlic

Warfarin

Interaction unlikely based on a clinical study that found garlic is relatively safe and poses no serious hemorrhagic risk for closely monitored patients taking warfarin oral anticoagulation therapy10

Suspect an interaction if bruising or bleeding occurs despite an appropriate INR

   

One review found no case reports of interactions with garlic and warfarin11

 

Ginkgo

Warfarin

Interaction possible, though controlled clinical studies show no effect of ginkgo on the kinetics or dynamics of warfarin12,13

Experts recommend caution, although available research does not support this conclusion

 

Aspirin

Interaction suspected based on four case reports of spontaneous bleeding14,15

Suspect an interaction if spontaneous bleeding occurs

Ginseng

Warfarin

Interaction possible based on conflicting research findings

Avoid combination if possible

   

American ginseng (Panax quinquefolius)reduces blood concentrations of warfarin16,17

 
   

Coadministration of warfarin with Asian ginseng (Panax ginseng) did not affect the pharmacokinetics or pharmacodynamics of warfarin18

 

St. John’s wort

Warfarin

Interaction suspected based on decreases in INR in case reports and in a study in 12 healthy volunteers18

Evaluate warfarin response when St. John’s wort is initiated or stopped

Vitamin E (> 400 IU daily)

Warfarin

Interaction suspected based on a single patient (with rechallenge), resulting in an increase in INR19

Evaluate warfarin response when vitamin E is used in combination

   

One clinical trial showed no interaction20

 

Patients taking cardiovascular medications

Eleuthero (Eleutherococcus senticosus) [corrected]

Digoxin

Possible increase in digoxin levels without clinical signs (case report)21

Monitor digoxin level when eleuthero is initiated or stopped [corrected]

St. John’s wort

Digoxin

Suspected decrease in digoxin levels without clinical signs in a controlled study22

Monitor digoxin level when St. John’s wort is initiated or stopped

 

Verapamil (Calan)

Interaction suspected based on decreased bioavailability in a study in eight healthy volunteers23

Increase verapamil dose, if necessary, if diminished response occurs

 

Statins

Interaction suspected based on decreased plasma blood levels in a clinical study24

Monitor serum lipid levels after St. John’s wort is added

Patients taking psychiatric medications

Ginkgo

Atypical antidepressant (trazodone [Desyrel])

Interaction possible based on one case report of coma25

Evaluate for emotional and/or behavioral changes in patient response after ginkgo is initiated or stopped

Ginseng

Monoamine oxidase inhibitors

Interaction possible based on two case reports of manic-like symptoms, headache, and tremulousness17

Avoid combination if possible

St. John’s wort

SSRIs

Interaction suspected based on case reports of drowsiness or serotonin syndrome26

Taper off St. John’s wort when initiating an SSRI

 

Benzodiazepines

Interaction suspected based on pharmacokinetic studies showing decreased serum levels (25 to 50 percent) without clinical signs2729

Adjust the dose of benzodiazepine as needed

 

Tricyclic antidepressants

Interaction possible based on decreased amitriptyline plasma levels but no clinical effects in a study of 12 depressed patients27,30

Monitor patient response after St. John’s wort is initiated or stopped

 


 

INR = International Normalized Ratio; SSRI = selective serotonin reuptake inhibitor.

*— All recommendations have a strength of recommendation taxonomy (SORT) evidence rating of C (consensus, disease-oriented evidence, usual practice, expert opinion, or case series). For information about the SORT evidence rating system, see https://www.aafp.org/afpsort.xml.

Information from references 4 through 30.

----

 

 

Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

Published in Health
Wednesday, 26 September 2018 15:02

Bill Cosby sentenced for sexual assault

Bill Cosby has been denied bail and was sentenced to 3 - 10 years for drugging and raping Andrea Constand while she was incapacitated. Cosby is now an 81 year old convicted sex offender.

 

For those who have not heard, Cosby’s record of allegations began back in 2000 when several women came forward accusing him of sexual assault and rape going as far back as 1965 and into the 80’s and 90’s. One of them was Andrea Constand who sued Cosby in civil court after the D.A. refused to prosecute him in criminal court. She settled for an undisclosed amount in 2006.

 

There was some media coverage but for the most part, too many folks never really believed that TV’s dad (from the Cosby Show in the 80’s) was a serial rapist. And then, suddenly, just as quickly as the accusations were made - the allegations were swept under the rug and went away. For way too long.

 

Cut to 2014.

 

Stand up comic Hannibal Buress had been working on new material in his routine. And one of his bits was about Bill Cosby “talking down to young black men about their mode of dress and telling them to pull up their pants.” Buress shot back at Bill with, “Yeah, but you raped women, Bill Cosby, so that kind of brings you down a couple of notches!” You can watch video of the bit here.

 

The audience laughs along because it sounds like Buress is joking. He is, after all - a comedian. Plus, I mean, Bill Cosby - a rapist? Come on!! But then Buress doubles down and encourages people to go home and Google, “Bill Cosby rape.”

 

The bit began to get a little press, which is how I heard about it. I did exactly as Buress said (because I couldn’t believe it). I Googled, “Bill Cosby rape.” And I was shocked. There was story after story about Bill Cosby drugging and raping women as far back as the 60’s. And there were trials and investigations back in 2000 and all I could think of is, “How the hell did I not know about this?”

 

Well, there were many who thought the same thing and suddenly a media firestorm picked up. Then, over the course of the next few years - more than sixty women came forward with similar stories - that Bill Cosby either attempted to assault them (but the woman escaped) or that Cosby drugged them, sexually assaulted or raped them, when they were too incapacitated to give consent or object.

 

Oh, and there were multiple police reports to back this up in several states from multiple decades, so it’s not like this is anything new. Law enforcement has reports on Cosby ranging from attempted assault, to sexual assault to rape in the 80’s, the 90’s, in 2000, in 2002, multiple reports in 2005, a report of attempted assault in 2013, and then dozens and dozens or reports in 2014 and 2015 who came forward to recount their stories from the past.

 

One, of course, wonders - if Cosby hadn’t been rich and famous, would he have been caught and put away a long time ago? Well - probably. But - he is rich and famous. And he’s rich and famous for playing a really, really nice guy on TV. And that warps people’s minds. Folks really want to believe that the onscreen persona that actors play is - exactly who they are. So no one wanted to believe that super nice TV personality Cosby dad - was a serial rapist.

 

Of course there were some people who knew the nice TV dad guy was an act. Richard Pryor’s widow, Jennifer Lee Pryor, on a 2015 podcast interview for Allison Rosen is Your New Best Friend, had this to say about Cosby and the allegations:

 

“Bill’s just a fucking hypocrite, and dirty on the inside. It was a well-kept secret that Bill fucked everything that moved.”

 

Pryor was upset that Cosby came down on her husband and told him to always “be clean” in his act. For anyone who remembers Richard Pryor you know damn well that “be clean” was never, ever on his mind. (Richard Pryor died in 2005).

 

Jennifer clarifies that no one had any idea about the drugging and the assault, which is probably true. I mean, even if you are married (which Cosby was) it’s totally legal to “fuck anything that moves” - as long as it is all consensual. Adultery is not sexual assault. If Cosby’s wife knew that Cosby was committing adultery and she chose not to leave him - that’s none of our business! So I won’t speculate.

 

Anyway, all I’m suggesting is that there were obviously folks that knew Cosby’s squeaky clean image was completely fraudulent. Alas, knowing someone is morally dubious doesn’t mean you know they are a serial rapist.

 

But I digress.

 

Cosby had his day in court. In fact, he had multiple days in court over multiple decades. And finally, finally his victims get some semblance of justice. A 3-10 year sentence. Hopefully, that sentence is on the longer side but I won’t hold my breath. I’ve seen too many rapist men get sentenced and then released after a shockingly short time incarcerated.

 

The famous case of Brock Turner comes to mind. You remember that douche bag, right? He raped an unconscious woman behind a dumpster. He was caught by two Swedish exchange students who luckily happened to be passing by. Brock ran, one of them went to assist the victim, the other chased and caught Brock. Turner was eventually arrested, charged and sentenced. The Judge was super duper nice to the rapist and gave him a six month sentence. Turner was out of jail three months later.  

 

Three months in jail for raping an unconscious woman.

 

So, forgive me if I don’t hold out much hope that filthy rich Bill Cosby will spend much time in jail. And, he’s at the end of his life. Sure, he’s had a rough few years what with the accusations and the criminal investigation but, basically - he got away with it for almost his entire life. Despite the fact that there were a dozen accusations against him in multiple states over multiple decades - it still took more than 20 years to convict him of sexual assault.

 

Which, I guess, is better than nothing.

 

Published in News & Information