The DSHEA legislation of 1994 made it possible for manufacturers to sell dietary supplements directly to the public without the level of FDA approval or oversight required of pharmaceuticals. Reports of adulteration and contamination have occurred, but the magnitude of this problem remains unknown. However, information is available on many products independently tested for content and purity. Table e4–3 provides an overview of selected dietary supplements commonly used in the United States today.
Table e4–3.Overview of selected dietary supplements (listed in alphabetical order). ||Download (.pdf) Table e4–3. Overview of selected dietary supplements (listed in alphabetical order).
| ||Leading Indications ||Dosage ||Level of Evidence1 ||Safety2 ||Interactions; Side Effects ||Comments |
|Coenzyme Q10 ||1. Systolic heart failure ||50–100 mg two times daily ||1. B ||I ||None ||Fat-soluble, choose product with oil vehicle or take with meal containing fat |
|2. Hypertension ||2. B |
|3. Statin-induced myopathy ||3. C |
|4. Migraine ||4. C |
|Fish oil ||1. CHD (secondary prevention) ||Fish twice weekly for general health (300–500 EPA plus DHA), omega-3 fatty acids 1 g/day for heart disease, 3–5 g/day for hypertriglyceridemia or hypertension ||1. B ||I ||Theoretical risk of bleeding at high doses only ||Unclear if CAD benefit when added to guideline-adherent pharmaceutical care |
|2. Hypertriglyceridemia ||2. A ||I |
|3. Heart failure ||3. A ||I |
|4. Hypertension ||4. A |
|Glucosamine sulfate and chondroitin ||Osteoarthritis (knee) ||Glucosamine 500 mg three times daily; chondroitin 400 mg three times daily ||B ||I ||None reported; rare reports of constipation, diarrhea, drowsiness || |
|Melatonin ||1. Insomnia ||0.1–5 mg ||1. B ||I ||None || |
|2. Jet lag ||2. A |
A. GLUCOSAMINE & CHONDROITIN
Glucosamine and chondroitin have been used in Europe alone and in combination to treat osteoarthritis (OA) since the 1980s. While glucosamine and chondroitin use appears to have decreased in the United States, studies from the United Kingdom and Australia report a 20% use of glucosamine. It is an amino-monosaccharide synthesized by chondrocytes that serves as a substrate for the synthesis of cartilage. It is prepared commercially from crustacean shells. Besides providing structural support, it may also have anti-inflammatory activity. Oral glucosamine is well-tolerated and does not elevate serum glucose levels in humans. There is evidence that a dose of 1200 mg once a day of chondroitin is as effective as 400 mg three times daily. There are case reports of an increased INR in patients taking warfarin who ingest glucosamine. There is also a theoretical risk of allergic ...