Patients come to the consultation area & ask me about safe doses for taking vitamins. An example is Vitamin E. The patient comes to the consultation area with 2 bottles of vitamin E. One bottle is 400 IU and the other is 1000 IU. She asks which one she should take and what will happen if she takes too much. Looking at the back of the bottle I see that 400 IU is 1,333% total Dalily Recommended value and 1000 IU is 3,333% of DRV. How can I possibly tell someone that taking something that is 1,333% or 3,333% of your DRV is safe? If someone can explain this to me I would greatly appreciate it. Thank you.
Vitamin Overdose
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As a prepharmacy student, you shouldn't be telling anyone anything. You don't know enough to counsel.
My personal recommendation would be that neither are safe. Studies have shown that 400 IU of Vitamin E or more can be dangerous. I'd ask the patient why they wanted to take it and then go from there. A lot of people think that it helps with memory loss, but that's never been proven.
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Just show her this video for the adverse effects: http://www.youtube.com/watch?v=HxwkyKV8PU4
The advice about you not knowing enough to be counseling people is good feedback. No offense intended, but your knowledge is incomplete right now so please leave that to the professionals. 🙂 Its pretty safe to say most studies done with vitamins are of poor quality. There have been a few studies that have shown harm from vitamin E with regards to increased cardiovascular risks and increased prostate cancer, but these studies, IMO, did not control for enough to consider the results sound. If someone really wants to take Vitamin E, I'd say keep it to a 400 IU pill or less as theres no benefit to taking huge doses.
Unless a person has a documented deficiency disorder, you're probably right.
But 400IU is a huge dose, it is 1,333X the recommended daily allowance. What literature, studies, or data support telling a customer it is ok to take something 1,333X more than what is recommended? If you told someone that taking 400IU was ok to take and they got sick because of an overdose and sued you, how would you protect yourself? What literature or resource are you using where you can tell someone it is safe to take something that is 1,333 times more potent than what is recommended.
Your state laws may vary, but it's probably not even legal.
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Because you have no clue what the RDA is, what it means and how that correlates with the use or misuse of supplements. This is proof that you do not yet have the training to make these kinds of recommendations.
I am asking the question in the context of what a PHARMACIST should do and/or recommend and what resource a PHARMACIST has to back up their decision. I appreciate all the other comments about the law and ethics but was specifically looking for a response regarding how a PHARMACIST would handle this situation in the retail setting.
I don't recommend that people take Vitamin E at all without speaking to their doctor first to see if there is a legitimate need for it. I have seen studies that indicated it wasn't very helpful, and that it could be potentially harmful even in low doses.
Thank you for your opinion, I really appreciate it.
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Why don't you ask your PHARMACIST?
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You have to keep current though most retail pharmacists only have access to secondary literature. There is enough information out there to form an opinion. Pharmacist Letter has a Natural Products database and so does the Medical Letter. Make sure that when you are a pharmacist you subscribe to some journal that covers natural products...
At work we have Natural Medicines Comprehensive Database, Pharmacist Letter, and Clinical Pharmacology. I posted on here after doing some research and asking colleagues. My literature search along with verbal inquires from colleagues yielded mixed opinions. I posted on studentdoctor.net to expand my search and get the opinions of additional healthcare professionals. I appreciate the people who took their time to respond with intelligent and thoughtful feedback. Old Timer: Thank you for your above reply, I appreciate your time and opinion.
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uhm, you're WAY too fixated on the concept of the RDA.
Indeed. Again - go to pharmacy school first and then you will become equipped with the knowledge to answer this question. It's not really practical for me to sit here and type out everything I know about Vitamin E and RDA.
Thank you for your opinion.
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So, what did you find in your research?
There are risks with taking it above RDA, even at 400 IU.
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I've always have been a firm believer that unless you are either A) have a documented deficiency or co-morbid condition that is linked to a deficiency or B) you are on TPN and they are adding stuff already, there is no reason to take supplements or vitamins. I always shake my head when people start taking supplements beyond vitamin D or B12.
Even multivitamins, I feel people are oversold on their effectiveness. Unless you are so unconcerned about diet (in which case you wouldn't be concerned about vitamins either) you probably don't need them.
Even multivitamins, I feel people are oversold on their effectiveness. Unless you are so unconcerned about diet (in which case you wouldn't be concerned about vitamins either) you probably don't need them.
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I would personally add fish oil to this short list (unless, of course, you eat a lot of fish), but other than that I completely agree. People are way too fixated on micronutrient content when mounting evidence is showing that it's the food as a whole that's really important.
For a multivitamin, I'll agree that most probably don't need them, but I'd say it's probably marginally better to take it than to go without. (Don't even think about bringing up that bull**** Iowa Women Study). I think I'm a reasonably healthy eater, but I know that some days I don't get any fruits/veggies and hit all my nutrients. Plus it's revenue for the pharmacy.
When you get down to each individual vitamin, that's where it goes a little crazy. Unless you know you're deficient or have some crazy disease, you don't need a B complex, C, D, iron, B12, Fish Oil, Flaxseed Oil, CoQ10, selenium cocktail on top of it.
Working on a presentation for a study that found contradictory evidence in high-dose vit E supplementation with cancer patients during radiation therapy. This was on 1 capsule of 400IU a-tocopherol daily. In all cancer types, supplementation significantly increased the risk of developing secondary cancers. Some reports are indicating it becomes a pro-oxidant at high doses.
After reading this article and the references, I am now very cautious in who I would say should be taking vit E, or any fat-soluble vitamin for that matter. So, unless I'm counceling an indigent, there's a good chance they should just stay away from it.
There are obviously many reports and studies being done with this, but this one came to mind first when I read your post. I'd also say stay away from counciling, you aren't paid enough for the trouble that could occur from it.
After reading this article and the references, I am now very cautious in who I would say should be taking vit E, or any fat-soluble vitamin for that matter. So, unless I'm counceling an indigent, there's a good chance they should just stay away from it.
There are obviously many reports and studies being done with this, but this one came to mind first when I read your post. I'd also say stay away from counciling, you aren't paid enough for the trouble that could occur from it.
