Dietary supplements are vitamins, minerals, herbs, and many other products.

They
can come as pills, capsules, powders, drinks, and energy bars. Supplements do not
have to go through the testing that drugs do.
Some supplements can play an important role in health. For example, calcium and
vitamin D are important for keeping bones strong. Pregnant women can take the
vitamin folic acid to prevent certain birth defects in their babies.
To take a supplement as safely as possible:
 Tell your health care provider about any dietary supplements you use
 Do not take a bigger dose than the label recommends
 Check with your health care provider about the supplements you take if you
are going to have any type of surgery
 Read trustworthy information about the supplement

Curcumin
drug action
DRUG -
DRUG

INTERACTION
Nursing intervention
Nursing responsibilities
Nursing intervention
Nursing responsibilities
Drug-drug interaction
Contraindicated to people who are on blood-thinning medication, such as
warfarin (Coumadin), clopidogrel (Plavix), and aspirin are typically
advised against taking a curcumin or turmeric supplement, because the
supplements can enhance the drugs' blood-thinning effects, perhaps to
dangerous levels.

 :Hay fever. Taking turmeric by mouth seems to reduce hay fever symptoms
such as sneezing, itching, runny nose, and congestion.
 Depression. Most research shows that taking curcumin, a chemical found in
turmeric, by mouth reduces depression symptoms in people already using an
antidepressant.
 High levels of cholesterol or other fats (lipids) in the blood (hyperlipidemia).
Taking turmeric by mouth seems to lower levels of blood fats called
triglycerides. But the effects of turmeric on cholesterol levels are conflicting.
Also, there are many different turmeric products available. It is not known
which ones work best.
 Buildup of fat in the liver in people who drink little or no alcohol
(nonalcoholic fatty liver disease or NAFLD). Taking turmeric extract by
mouth reduces markers of liver injury in people who have this condition. It
also seems to help prevent the build-up of more fat in the liver.
  Swelling (inflammation) and sores inside the mouth (oral mucositis). Taking
curcumin, a chemical found in turmeric, by mouth, or as a lozenge or
mouthwash, seems to prevent swelling and sores in the mouth during radiation
treatment for cancer.
 Osteoarthritis. Taking turmeric extracts, alone or together with other herbal
ingredients, can reduce pain and improve function in people with knee
osteoarthritis. Turmeric might work about as well as ibuprofen for reducing
pain. But it doesn't seem to work as well as another drug, called diclofenac.
 Itching. Taking turmeric by mouth might reduce itching that is caused by
various conditions.

Be cautious with this combination

Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts
with TURMERIC
Turmeric might slow blood clotting. Taking turmeric along with medications that also
slow blood clotting might increase the risk of bruising and bleeding.
Medications for diabetes (Antidiabetics’ drugs) interacts with TURMERIC
Turmeric might lower blood sugar levels. Taking turmeric along with diabetes
medications might cause blood sugar to drop too low. Monitor your blood sugar closely.
Talinolol interacts with TURMERIC
Turmeric might decrease how much talinolol the body absorbs. Taking turmeric while
taking talinolol might decrease the effects of talinolol.
Sulfasalazine (Azulfidine) interacts with TURMERIC
Turmeric might increase how much sulfasalazine the body absorbs. Taking turmeric
while taking sulfasalazine might increase the effects and side effects of sulfasalazine.
Warfarin (Coumadin) interacts with TURMERIC
Warfarin is used to slow blood clotting. Taking turmeric while taking warfarin might
increase the effects of warfarin and increase the risk of bleeding and bruising.
Medications for cancer (Alkylating agents) interacts with TURMERIC
Turmeric is an antioxidant. There is some concern that antioxidants might decrease the
effects of some medications used for cancer. If you are taking medications for cancer,
check with your healthcare provider before taking turmeric.
Medications for cancer (Antitumor antibiotics) interacts with TURMERIC
Turmeric is an antioxidant. There is some concern that antioxidants might decrease the
effects of medications used for cancer. If you are taking medications for cancer, check
with your healthcare provider before taking turmeric.
Medications for cancer (Topoisomerase I inhibitors) interacts with TURMERIC
Turmeric is an antioxidant. There is some concern that antioxidants might decrease the
effectiveness of some medications used for cancers. If you are taking medications for
cancer, check with your healthcare provider before taking turmeric.
Amlodipine (Norvasc) interacts with TURMERIC
Turmeric might increase how much amlodipine the body absorbs. Taking turmeric while
taking amlodipine might increase the effects and side effects of amlodipine.
Paclitaxel (Abraxane, Onxol) interacts with TURMERIC
Turmeric might change how much paclitaxel stays in the body. Taking turmeric while
taking paclitaxel might change the effects and side effects of paclitaxel. However, this
doesn't seem to be a big concern.

Side Effects: Nausea, numbness/tingling of the lips/tongue, and an unpleasant taste in the

mouth may occur. If these effects last or get worse, tell your doctor. A very serious
allergic reaction to this product is rare. Your risk of an allergic reaction is higher if you

have asthma, frequent allergic reactions/skin rashes, or hay fever. Seek immediate

medical attention if you notice any of the following symptoms of a serious allergic

reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness,

trouble breathing.

WHAT IS TURMERIC AND HOW DOES IT WORK?

Turmeric is a natural herb that is commonly used as a spice in a wide variety of food. It

is a plant that is originally from India. Turmeric is also called curcumin, which is the

active ingredient in the spice. When used as a spice in food, turmeric powder is yellow in

color. It can also be used as an herbal supplement as follows:

Taken orally, turmeric is used to as a treatment for indigestion (dyspepsia), abdominal

pain, hemorrhage, diarrhea, flatulence, abdominal bloating, loss of appetite, jaundice,

hepatitis, and liver disease, gallbladder complaints, headaches, bronchitis, colds,

respiratory infections, fibromyalgia, leprosy, fever, amenorrhea, and cancer.

WHAT ARE DOSAGES OF TURMERIC?

Dosages of Turmeric Should Be Given as Follows:

Adult and Pediatric Dosage Forms & Strengths

Extract standardized to 95% curcumin

Indigestion (Dyspepsia)

500 mg taken orally four times a day

200mg/mL (Depo-Turmeric)

Colorectal Cancer
Curcumin extract: 440 to 2200 mg (containing curcumin 36 to 180 mg) once daily for no

more than 4 months

Dosage Considerations

There is no dosage consideration for turmeric.

WHAT ARE WARNINGS AND PRECAUTIONS FOR TURMERIC?

Warnings

This medication contains turmeric. Do not take curcumin if you are allergic to turmeric

or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison

Control Center immediately. Keep out of reach of children. In case of overdose, get

medical help or contact a Poison Control Center immediately.

folic acid (folate) Folvite

Dosage & Route
Dosage: Oral Administration: Folic acid is well absorbed and may be
administered orally with satisfactory results except in severe instances of intestinal
malabsorption.
Parenteral Administration: Intramuscular, intravenous, and subcutaneous routes
may be used if the disease is exceptionally severe, or if gastrointestinal absorption
may be, or is known to be, impaired.
Usual Therapeutic Dosage: Adults and children regardless of age, up to 1.0 mg
daily. Resistant cases may require larger doses.
Available forms : Tablets—0.4, 0.8, 1 mg; injection—5 mg/mL
Dosages : Administer orally unless patient has severe intestinal malabsorption.
Interventions
 Administer orally if at all possible. With severe GI malabsorption or very
severe disease, give IM, IV, or subcutaneously.
 Test using Schilling test and serum vitamin B12 levels to rule out pernicious
anemia. Therapy may mask signs of pernicious anemia while the neurologic
deterioration continues.
 WARNING: Use caution when giving the parenteral preparations to
premature infants. These preparations contain benzyl alcohol and may
produce a fatal gasping syndrome in premature infants.
 WARNING: Monitor patient for hypersensitivity reactions, especially if drug
previously taken. Keep supportive equipment and emergency drugs readily
available in case of serious allergic response.

Classification: Folic acid, Vitamin supplement

Indications:
Folic acid is effective in the treatment of megaloblastic anemias due to a deficiency
of folic acid as may be seen in tropical or non-tropical sprue, in anemias of
nutritional origin, pregnancy, infancy, or childhood.

Contraindications/Precautions:
Folic acid hypersensitivity. Folic acid is contraindicated for use in patients with
folic acid hypersensitivity.
 Pernicious anemia. ...
 Benzyl alcohol hypersensitivity, neonates, premature neonates. ...
 Pregnancy. ...
 Breast-feeding. ...
 Renal disease, renal failure, renal impairment.

Side Effects :
  rash,
 itching/swelling (especially of the face/tongue/throat),
 dizziness, or.
 trouble breathing, seek medical help immediately.

Adverse Reactions:
When taken by mouth: It is likely safe for most people to take folic acid in doses of
no more than 1 mg daily. Doses higher than 1 mg daily may be unsafe. These doses
might cause stomach upset, nausea, diarrhea, irritability, confusion, behavior
changes, skin reactions, seizures, and other side effects.

Folvite generally does not interact with other medications, but use caution if taking
other folic acid supplements, or pyrimethamine. Tell your doctor all medications
and supplements you are taking.

NutreStore Nutritionals
Glutamine
Glutamine is indicated for the treatment of Short Bowel Syndrome (SBS)
in patients receiving specialized nutritional support when used in
conjunction with a recombinant human growth hormone that is approved
for this indication.

Dosages of Glutamine:
Dosage Forms and Strengths
Powder for oral solution
 5 g/packet (as L-glutamine)
Dosage Considerations – Should be Given as Follows:
Short Bowel Syndrome
Indicated for short bowel syndrome in patients receiving specialized
nutritional support when used in conjunction with recombinant human
growth hormone
 30 g/day orally in divided doses (i.e., 5 g taken 6 times each day) for
up to 16 weeks

Administration
 Dissolve each 5 g packet in 8 oz water before drinking; the volume of
water may be varied according to the patient's preference
 Take with meals or snacks at 2-3 hour intervals while awake
 If transiently intolerant to oral intake, a dose may be delayed for up to
2 hours
 Pediatric: Safety and efficacy not established

Side Effects
Common side effects of Glutamine include:
 Swelling of extremities
 Nausea
 Cramping rectal pain/feeling the need to have a bowel movement
 Runny or stuffy nose
 Dizziness
 Skin rash
 Ear or hearing symptoms
 Itching
 Vomiting
 Stomach or abdominal pain
 Gas
 Dry mouth
 Muscle or joint pain
 Back pain
 Headache
 Tiredness
 Increased sweating

Drug-Drug Interaction
If your doctor has directed you to use this medication, your doctor or
pharmacist may already be aware of any possible drug interactions and
may be monitoring you for them. Do not start, stop, or change the dosage
of any medicine before checking with your doctor, health care provider or
pharmacist first.
 Glutamine has no known severe, serious, moderate, or mild
interactions with other drugs.

Warnings
 This medication contains glutamine
 Do not take NutreStore if you are allergic to glutamine or any
ingredients contained in this drug
 Keep out of reach of children. In case of overdose, get medical help
or contact a Poison Control Center immediately.
Contraindications
None
Cautions
Metabolized to glutamate and ammonia; levels of these metabolites may
increase with hepatic impairment
Monitor renal and hepatic function

Nursing Reponsibilities
Routine monitoring of renal and hepatic function is recommended in
patients receiving NUTRESTORE and intravenous parenteral nutrition
(IPN), particularly in those with renal or hepatic impairment. Glutamine is
metabolized to glutamate and ammonia, which may increase in patients
with hepatic dysfunction.
The safety and efficacy of NUTRESTORE have not been studied beyond
16 weeks of treatment.

Nursing Intervention
 Dissolve each 5 g packet in 8 oz water prior to drinking; volume of
water may be varied according to the patient’s preference
 Take with meals or snacks at 2-3 hr intervals while awake
 If transiently intolerant to oral intake, a dose may be delayed for up to
2 hr
 Tenesmus (19%)
 Rhinitis (19%)
 Dizziness (13%)
 Rash (13%)
 Ear or hearing symptoms (13%)