As Chiropractors we have the unique opportunity to provide nutritional advice for our patients in addition to our adjustments, manual therapies, physiotherapies, and rehabilitative services. (In most states) As healthcare becomes more complex, and our society becomes increasingly litigious, we have a responsibility to our patients and our practices’. It is imperative to make sure that when nutritional advice is given that we perform our due diligence to make sure that the nutritional supplement recommended is not contraindicated by a patient’s medication. While drug-drug interactions have long been appreciated, the topic of drug-nutrient interactions has not gotten the attention that it deserves, and this topic is emerging in the literature1. Statistically, 1 in 4 Prescription Drug users also take Nutritional Supplements 2; and currently over 15 million Americans are at risk for potential Supplement-Drug interactions 3, 4!
To help illustrate this, let’s take a look at Lipitor, which was one of the most commonly prescribed medications last year. A commonly recommended nutrient for soft tissue repair by Chiropractors is magnesium. If magnesium supplementation is combined with Lipitor, the drugs absorption may be reduced by the nutrient, ultimately decreasing the drugs intended action 5. If you recommend magnesium to a patient who is taking Lipitor, the effect of drug may be negatively impacted by your recommendation, putting you at risk for a lawsuit. This does not necessarily mean that you cannot recommend magnesium to this patient if you deem it clinically appropriate; it simply means that you need to do your research and document that the patient was instructed to take the magnesium at a different time of day than their Lipitor, in order to avoid this potential interaction.
Thoroughly analyzing your patient’s medications may not only protect you from potential litigation, but it may also improve your patient care, and increase your nutritional supplement sales. Just as there are nutritional supplements that should not be recommended if contraindicated by medication, there are also numerous nutritional supplements that may be helpful for specific medications. Most Chiropractors know that Lipitor reduces CoQ10 synthesis, and as such CoQ10 should be supplemented back in the diet. There are 1000’s of other medications that can benefit from the addition of supplements to help offset the drugs side effects, or even help the medications work more efficiently. Using programs like eMedFx.com can quickly and easily connect you to this information.
All of this information is available in textbooks, PDRs, Pubmed, and other research databases but can be very cumbersome to locate and document. Programs like eMedFx (www.eMedFx.com) are available to help connect you to the research in a more efficient manner to help limit your liability, improve your patient care, and even increase your revenue.
The bottom line is this; blindly recommending nutritional supplements to your patients that are also taking medications can put you at risk for a lawsuit. Finding and documenting research to help reduce your liability does not have to be painful. If you implement a program like eMedFx into your office, you will not only increase your awareness of these potential interactions, you will likely also increase your supplement sales in the process.
Santos CA, Boullata JI. Pharmacotherapy. 2005 Dec;25(12):1789-800.
Gardiner, P. MD et al. Factors Associated with Dietary Supplement use Among Prescription Medication Users. Arch Intern Med (2006)
Smolinske, S. Dietary Supplement-Drug Interactions. JAMWA (1999)
Boullata, J. Natural Health Product Interactions with Medication. Nut Clin Pract. (2005)
Threlkeld DS, ed. Diuretics and Cardiovasculars, Antihyperlipidemic Agents, HMG-CoA Reductase Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Sep 1998, 172a.
Dr. Todd Mexico and Dr. Brandon Blood are practicing Chiropractors and owners of www.eMedFx.com. A web-based search tool, eMedFx.com has been designed to effortlessly analyze your patient’s prescription medications and nutritional supplements. eMedFx connects its users to literature on nutritional supplement recommendations that may offset negative effects of specific medications. eMedFx also cross-references your patient's medications with possibly harmful nutritional supplement interactions. This information is then exported to patient-specific reports for documentation. Dr. Mexico and Dr. Blood can be reached at hidemail('drmexico', 'emedfx', 'com'); or hidemail('drblood', 'emedfx', 'com');.