There is a common misconception that because herbs and vitamins are natural, they won’t do any harm with medications. As people get older, a higher percentage of people end up on blood thinners, statins for cholesterol or medicines to regulate arrhythmia (irregular heartbeat). Other medications may be for diabetes or blood sugar.
While a lot of people would prefer not to take these medications, it is not a good idea to stop any medications without consulting your doctor. Also, before starting any new supplements, you should check with your doctor or naturopath to see if there are any interactions.
Some of the most common questions we get are:
1. Can I take this vitamin with my blood thinners?
Warfarin (coumadin) is one of the older types of blood thinners that limits coagulation (prevents blood clots from forming). Blood thinners are a bit of a misleading term as the thickness of the blood isn’t changed. But they do protect people at risk of blood clots forming, which can protect against heart attacks and strokes. These medicines can include anticoagulants and antiplatelets.
Usually, they are prescribed to people with irregular heartbeat, heart disease, blood vessel disease or deep vein thrombosis (DVT) or following surgery (knee or hip replacement). People with a history of heart attack or stroke are also often prescribed blood thinners.
Some common blood thinners include:
- Aspirin- antiplatelet medication
- Warfarin (brand names Coumadin, Marevan)- oldest blood thinner, blocks vitamin K-dependent clotting factors.
- Heparin- used by injection in hospital usually, impacts the enzyme thrombin production
- Dalteparin (Fragmin)
- Enoxaparin (Clexane)- made from heparin
- dabigatran (Pradaxa)- impacts the enzyme thrombin production
- Apixaban (Eliquis)- impacts the enzyme thrombin production
- Savaysa (edoxaban)- blocks a vitamin K-dependent protein called Xa.
- Xarelto (rivaroxaban)- blocks a vitamin K-dependent protein called Xa.
Other natural foods that can affect blood thinning include ingredients such as alcohol and foods or herbs like garlic, ginger, celery seed and anise seed.
Supplements that can affect blood thinning may include the following: vitamin E, fish oil, garlic, vitamin K2, Korean ginseng, curcumin, glucosamine, ginkgo, bilberry, cranberry, CoQ10, turmeric (curcumin) and horny goat weed. Please note this list is not comprehensive, and you still need to seek the guidance of a health professional to decide if these supplements are right for you.
Warfarin, being an older type of blood thinner, is more likely to interact with supplements. Also, patients on warfarin need regular blood tests to check the level of anticoagulation. A measure known as INR (international normalised ratio) has been developed to compare the rate of blood clotting between someone taking anticoagulants and someone who is not.
2. Can I take this vitamin with my statins?
Lipid-lowering medications (statins) aim to reduce cholesterol by interfering with an enzyme the body uses to make cholesterol — this means the body can’t make as much cholesterol as before. Statins also increase the amount of cholesterol the liver takes up and removes from the blood. Statins are also known as the HMG-CoA reductase inhibitors.
Some common statins include:
- atorvastatin (brand names include Lipitor, Lorstat).
- fluvastatin (Lescol or Vastin).
- pravastatin (e.g., Pravachol, Cholstat).
- rosuvastatin (Cavstat, Crestor); and
- simvastatin (e.g., Lipex, Zocor, Zimstat).
Supplements that can affect statins include St. John's wort and possibly quercetin, which may decrease blood levels of some statin drugs. When taken with atorvastatin, it may actually result in increased cholesterol levels. Certain forms of magnesium may also decrease blood levels of statin drugs -- particularly Crestor. Because of this, be sure to separate antacids or supplements containing aluminium or magnesium 2 hours away from Crestor.
Red yeast rice should not be combined with prescription statins without supervision.
Soy isoflavones were found to reduce the bioavailability of simvastatin by an average of 48% in people carrying a certain gene, but another form of gene is known to increase the activity of simvastatin as well as atorvastatin.
3. Can I take this vitamin with my diabetes medication (insulin or metformin)?
One interaction people may not be aware of is that metformin can reduce vitamin B12 levels and lead to vitamin B12 deficiency. You may need to have your B12 levels monitored and treated accordingly.
Some supplements to avoid or be aware of potential interactions include chromium (which may further lower blood sugar), Korean ginseng, glucosamine, soy isoflavones, ginkgo, Ziziphus, and bilberry. Another thing to be aware of is that some supplements may have lactose (milk sugars) in them.
4. Can I take this vitamin with my blood pressure medication?
Some types of blood pressure medications work in a way that can increase your potassium levels, so you need to avoid potassium in supplements, as taking them can increase your potassium too much. Some glucosamine tablets contain potassium, and some other supplements may contain potassium. So be sure to check the label of your medications and see if you are on one of these where you need to be cautious.
Some herbs can have an additive effect on the blood pressure medication, so check with your health professional.
5. I’m having surgery in a few weeks. Should I stop my supplements?
Some supplements such as garlic, ginkgo, fish oil and vitamin E can thin the blood, which may increase how much you bleed during surgery. Other supplements like milk thistle might affect how you react to anaesthetics or blood pressure.
6. When is the best time to take my supplements?
If you are on prescription medications, then you should aim to take your supplements 2 hours away from your medications. Particularly fibre supplements, as they can change how the prescription medication is absorbed.
B vitamins and Zinc should preferably be taken after food as they can cause nausea on an empty stomach.
Fish oils and oil-based supplements like vitamin E, Co Q10, and Vitamin D can cause nausea if taken on an empty stomach. Take it with a meal, as it will help absorb the fats.
Key Takeaways
- Prescription medications can interact with supplements.
- Some supplements can make you nauseous if you take them at the wrong time.
- Check with your health professional before starting a new supplement if you are on medication.
*Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health, prescriptions, or medical condition. Never disregard the advice of a medical professional or delay in seeking it because of something you have read on this Website.
