Karen Appold

When patients with cancer leave the hospital, they’re usually overwhelmed with multiple items demanding their attention. Chief among them is filling their outpatient prescriptions, according to Nelly G. Adel, PharmD, BCOP, BCPS, chair of pharmacy practice and associate professor of oncology at Touro College of Pharmacy in New York, New York.

Community pharmacists play an important role in helping oncology patients manage their prescriptions. First and foremost, because these patients often take many medications, it’s important to have a medication expert review them for appropriateness. “Pharmacists can review medication lists to ensure that prescribed regimens are cost-effective, safe, efficacious, and being used for the proper indication,” said Roxane L. Took, PharmD, BCACP, clinical pharmacist at Gateway Apothecary in St Louis, Missouri, and assistant professor of pharmacy practice at St Louis College of Pharmacy at University of Health Sciences and Pharmacy in St. Louis. Although other health care providers are capable of fulfilling these roles, research has shown that pharmacist-provided services can reduce physician visits, emergency department visits, hospital stays, and overall health care costs.

Another reason why community pharmacists are in a prime position to assist transitions of care for patients with cancer is because they’re the most accessible health care providers to the public. “Patients can call or walk in to see them without an appointment and receive professional medical advice about their medications or get referrals to appropriate higher levels of care if needed,” said Roman Fazylov, PharmD, BCPS, clinical pharmacist for internal medicine and assistant professor of pharmacy practice at Touro College of Pharmacy.

When patients with cancer have questions about treatment plans or a medication’s adverse effects (AEs), community pharmacists are well-equipped to offer 1-on-1, in-person counseling. In addition, these patients may try self-care practices, such as taking vitamins, minerals, and herbal supplements. “While some of these may help certain ailments, some also have serious risks,” Fazylov said.“Pharmacists can advise patients on self-care strategies that are effective and carry a low risk of adverse [effects].”

Community pharmacists also can provide access to hard-to-find medications, and they work with physicians and insurance companies to provide expedited drug coverage and access to novel therapies, said Kavel Bhathela, PharmD, a community pharmacist at Carolina Pharmacy in Charlotte, North Carolina. They can offer medication delivery as well as medical and household supplies needed for managing disease, making it convenient for transitioning patients. Furthermore, pharmacists can collaborate with other health care providers and monitor and optimize drug therapy for complex disease states.

Here’s a closer look at the specific roles community pharmacists can play in transitions of care for patients with cancer.

Before a patient even leaves the hospital, community-based specialty pharmacists work with the discharge team to reconcile all prescribed 

medications, troubleshoot prior authorizations for prescriptions, and enroll patients in copay assistance programs, said Vivianne K. Celario, PharmD, a registered community-based specialty pharmacy manager at Walgreens in New Brunswick, New Jersey. Additionally, pharmacists conduct initial consultations with patients to assess their understanding of therapy goals and potential AEs. Patients are enrolled in the pharmacy’s clinical care program, where pharmacists monitor their treatment, adherence, and AEs, and address barriers that may arise between hospital and clinic visits.

It is important for community-based specialty pharmacists to work with the discharge team to establish that any medications a patient took prior to admission, including OTC medications and supplements, continue to be safe and effective with a patient’s newly discharged medication list, Celario said. For example, newly prescribed oncology medications often have the potential for drug interactions and AEs. Pharmacists can perform drug utilization reviews and address the need for dose changes or recommend drugs to alleviate AEs to increase treatment efficacy and adherence.

Due to a rise in the use of oral and self-administered oncology prescriptions, the success of a treatment greatly depends upon the patient, which is why it’s important for patients to understand their therapy goals and potential AEs.

Community pharmacists also can review patients’ OTC and prescription medications to improve patient 

safety and adherence. Carolina Pharmacy offers medication strip packaging and medication synchronization services, which help patients keep up with taking all of their medications on time and appropriately. “Through these services, we can check and see how patients are doing, and address any questions or concerns they may have regarding their drug therapy and overall well-being, which helps to builds trust and strong relation

Community-based specialty pharmacists receive advanced training specific to oncology to effectively educate patients about their medications and the challenges they may face during their cancer journey, Celario said. These pharmacists can perform initial patient consultations, reassessments, and cycle dosing education to monitor patient adherence. In addition to onsite counseling tools, pharmacists work with manufacturers and professional and patient cancer organizations to provide patients with medication education kits, seminars, workshops, and advocacy support.

Due to the complexity of cancer treatments, a patient’s list of prescribed medications can be extensive. Consequently, multiple drug therapies are quite common. Known as polypharmacy, this can become problematic if patients end up with medications they don’t need, Adel said. Therefore, it’s essential for pharmacists to carefully review these patients’ medication lists and counsel them accordingly.

Comorbidities are common among patients with cancer. In addition to cardiovascular conditions and diabetes, these patients may experience mental health conditions and chronic pain. This leads to patients taking multiple prescriptions and visiting multiple providers. “Community pharmacists are essential in maintaining a patient’s most accurate drug profile, as well as bridging any communication gaps between the patient, hospital discharge team, cancer care team, and the specialists and primary care prescribers patients see,” Celario said. “Furthermore, due to their accessibility, pharmacists are great resources to assist patients in managing chronic conditions and [adverse] effects that come with having cancer and getting treatment.”

Fazylov said that pharmacists also can play roles in managing insomnia, changes in bowel habits, decreases in appetite, and other comorbidities. “Many of these issues can be managed with over-the-counter therapies,” he said. Pharmacists are trained to monitor pain medications by keeping track of total dose requirements and monitoring AEs. In turn, they can make recommendations to prescribers regarding the right dose and frequency of pain medications to help optimize pain control while keeping AEs at bay.

Many oncology medications are costly; community pharmacists can address any cost issues that patients may have. Pharmacists can relay concerns to the appropriate physician, and suggest cost-effective alternatives.

Community pharmacists also can provide delivery services through a “meds-to-beds” program in which the pharmacy brings a patient’s medications to them before hospital discharge. “These programs help identify and resolve barriers to adherence sooner than a typical community workflow process,” Took said. “By identifying medications that cannot be filled due to formulary restrictions or medication cost, this program also helps to decrease readmission rates.”

Resources are available to assist pharmacists who are looking to implement a transitions of care program. For example, the American Pharmacists Association’s Transitions of Care Toolkit was developed to help pharmacists implement or enhance their transitions of care programs in order to improve patient care, reduce health care costs, and optimize medication therapy, Took said.

Took would also encourage community pharmacies to initiate a pilot transitions of care program with patients recently discharged from the hospital, and to offer it free of charge initially. During this early phase, pharmacists can identify common characteristics of patients who are discharged, a patient populations’ needs, and a hospital’s receptiveness to working with them.

To take the program a step further, Took would advise pharmacists to work with a local hospital near their pharmacy and engage with management to develop a proposal to present to hospital leadership.

As pharmacists go through the process, they should have realistic expectations.

“Although it’s ideal to follow up with patients within 48 hours of discharge, it may not be ideal for your pharmacy’s workflow,” Took said. “You may find that it’s best to limit your service to a certain patient population, such as those aged 65 and older or patients with diabetes.”

Lastly, don’t be afraid to outsource a service or even partner with another pharmacy such as a specialty pharmacy, Bhathela said. The more services and access to care and products you provide, the more your community will rely on you for their health care needs.


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How community pharmacists can advance care as patients come home.

Cancer Care In Transition

Pharmacy errors occur for many reasons. Some can be avoided by simply improving how staff function within a pharmacy, since multitasking and distractions during work are the leading causes of dispensing errors.

“Take steps to minimize distractions as much as possible when pharmacists are working on orders,” said Deborah Sadowski, RPh, MHA, director of pharmacy services at Deborah Heart and Lung Center in Browns Mills, New Jersey. This includes having sufficient staffing to allow pharmacists to work without routine multitasking and interruptions. Adding barriers to work stations can help pharmacists improve concentration without outside distractions.

Hossam Maksoud, PharmD, chief executive officer at Community Care Rx, Hempstead, New York, said that optimum organization of one’s work space, work environment, and workflow has also been shown to markedly reduce dispensing errors. Proper lighting, adequate counter space, and comfortable temperature and humidity can help facilitate a smooth flow from 1 task to the next, which reduces the chances of dispensing errors.

 Developing a routine for entering, filling, and checking prescriptions helps in organizing workflow. In addition, working with 1 drug product at a time and affixing the label to a patient’s prescription container before working on the next prescription can help prevent mix-ups.

Approximately 83% of errors are discovered during counseling and are corrected before a patient leaves the pharmacy.

 “Therefore, it’s important to go beyond offering to counsel and actually provide counseling for every patient,” Maksoud said. “Open a container and show the actual medication to the patient during counseling, rather than handing it to a patient in a sealed bag.” Completing this process provides an opportunity for the patient to see the medication and ask questions if it looks different from what they’re used to getting.

Counseling should also include instructions on how to take a medication and the appropriate route of administration, because many dispensing errors are attributed to misunderstood directions for use.

 Educating patients about safe and effective medication use promotes patient involvement in their health care, which will likely reduce medication errors, Maksoud added.

Now that you’re equipped with some general information on how to avoid prescription errors, here’s a look at 7 common mistakes and advice on how to avoid them.

Dispensed a similar, but incorrect medication.

 Using barcode technology at all touchpoints can reduce the risk of dispensing an incorrect medication, Sadowski said. Build barcode technology into the receiving process, as well as at points of dispensing and at bedside administration in hospitals. Physically separate medications that look or sound alike when storing them on shelves.

Keith Veltri, BPharm, PharmD, associate professor at Touro College of Pharmacy, New York, New York, and clinical pharmacy manager of family medicine at Montefiore Medical Center, Bronx, New York, suggests employing Tall Man Lettering (TML) to differentiate drug names that look and sound similar. TML, a term dubbed by The Institute for Safe Medication Practices (ISMP) in 1999, indicates a portion of a drug’s name in uppercase letters (eg, on stock bottles and electronic medication orders) to help distinguish lookalike drugs from one another and avoid medication errors. For example, in TML, “hydralazine” and “hydroxyzine” are written “hydrALAzine” and “hydroxyzine,” respectively.

Common mistake #2: Dispensed the wrong quantity or dosage.

 Using barcode technology is a key strategy to avoiding these types of errors as well, Sadowski said. Other strategies include storing different dosages in different physical spaces, such as a 200 mg strength on 1 shelf and a 400 mg strength 2 shelves lower on the opposite side. Most importantly, regardless of other technologies used, always read labels 3 times.

Recheck prescriptions whenever possible, ideally by another person and preferably by a pharmacist, Maksoud said, because confirmation bias and preconceived notions make self-checking a poor method to reduce errors. If another pharmacist is not available, delay self-checking. This will allow a pharmacist to study the prescription from a fresh perspective, which will help identify an error that they may have missed the first time.

Common mistake #3: Incorrectly entered data.

 Pharmacists shouldn’t second guess illegible or ambiguous prescriptions, nonstandard abbreviations, acronyms, decimals, and call-in prescriptions, which are frequently associated with medication errors.

When in doubt, call the prescriber for clarification and promptly document it, Maksoud said. Immediately transcribe all verbal prescriptions to a blank prescription pad and read it back to the prescriber to ensure that you have correctly transcribed it.

Sadowski has found that using computerized physician order entry is the key to reducing errors from handwriting and incomplete information in medication orders. Minimizing the amount of free-text information required for order entry by providing pre-built drop-down menu choices with complete information helps ensure that providers accurately complete order entry.

Common mistake #4: Improperly stored a medication.

 Refer to package inserts and drug information references to ensure familiarity with proper storage requirements for all drugs. Using robust temperature and humidity monitoring systems for all storage areas including room temperature monitoring, freezers, refrigerators, and warmers are best practices, Sadowski said. These systems should provide continuous monitoring, providing real-time as well as historical data, and can send multi-level alerts when temperatures are out-of-range and allow documentation of actionable interventions that were taken when alerts were triggered.

Veltri recommends displaying a chart of common medications that require either refrigeration or freezing in the pharmacy. Routinely checking all medications on shelves and discarding any expired medications, regardless of where they’re kept, is also key.

In order to avoid mix-ups among lookalike drugs, Maksoud advises storing them away from each other. Medication bottles should be properly organized with labels facing forward. Routinely check all medications on shelves and discard any expired ones. Using storage bins, cabinets, or drawers can result in misplacing lookalike drugs. Lock up or sequester drugs with a high potential of causing errors.


Common mistake #5: Forgot to fully inform a patient about side serious effects or drug interactions.

 Jitu Patel, BPharm, MS, head pharmacist and chief compliance officer at 

, Brooklyn, New York, advises pharmacists to build systems and technology that make it easy to communicate drug interactions and adverse effects to patients. During the first fill, build rapport with a customer by talking about the importance of adhering to their therapy and encouraging dialogue to build a personal connection.

When a patient receives their prescription from 

, the patient is offered pharmacy consultation for their medication. “With any medication we dispense, whether we’re filling it for the first time or not, we include a small leaflet about a drug’s uses and [adverse] effects,” Patel said. “Counseling is also available via our mobile app or in-person at our pharmacy.”

When doing patient counseling at discharge from a hospital, review medications in advance and prepare important information ahead of time to ensure that no vital information is missed if a discussion gets side-tracked or other questions arise at the time, Sadowski said. If important information is missed, follow up with the patient as soon as possible to relay the information and answer any further questions.

Common mistake #6: Communication issues, particularly during transitions of care from one level to another.

 One of the most common causes of medical errors in general is failure to communicate effectively between caregivers, particularly as patients transition from 1 level of care to another, Sadowski said. Efficient hand-off strategies between care team members is crucial to preventing these avoidable errors. This includes creating a culture where 1 team member is comfortable questioning another at any level when clarity is needed or questions regarding orders or procedures arise. Having well-defined policies and procedures around communication is essential.

Common mistake #7: Making typos related to zeros and abbreviations.

 Misplaced zeros, decimal points, and faulty units are common causes of medication errors due to misinterpretation.

 A transcription or interpretation error involving a zero or a decimal point could result in a patient receiving at least 10 times more medication than indicated, which could result in serious consequences if the medication was levothyroxine or warfarin, for example.

Prevent such errors by using computer alerts or by only stocking a single strength of a medication, Maksoud said. These errors may be detected when reviewing label directions during patient counseling. ISMP offers a list of error-prone abbreviations, symbols, and dose designations. Being familiar with this information may also help prevent dispensing errors.

Santell JP, Hicks RW, McMeekin J, Cousins DD. Medication errors: experience of the United States Pharmacopeia (USP) MEDMARX reporting system.

https://pubmed.ncbi.nlm.nih.gov/12856391/

Cohen MR. Medication Errors, 2nd edition. American Pharmacists Association. 2007. 

Ukens C. Deadly dispensing: an exclusive survey of Rx errors by pharmacists.

https://www.questia.com/magazine/1P3-11192915/deadly-dispensing

Hicks RW, Cousins DD, Williams RL. Selected medication-error data from USP's MEDMARX program for 2002.

Lilley LL, Guanci R. Careful with the zeros! How to minimize one of the most persistent causes of gross medication errors.

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.

Multitasking and distractions during work are the leading cause of dispensing errors. 

How to Prevent 7 Common Prescription Mistakes

An estimated 80% of Americans will be infected with human papillomavirus (HPV) at some point. For many people, the infection will clear on its own without causing symptoms; for others, it can cause cancer later in life.

Pharmacists are highly trained and conveniently positioned to advocate for and administer vaccines. “As highly accessible healthcare professionals, pharmacists are equipped to identify patients who should receive the HPV vaccine and increase vaccination rates to assist with disease prevention,” said Katelyn Johnson, PharmD, MS, BCACP, assistant professor of pharmacy practice and community pharmacist at University of Cincinnati James L. Winkle College of Pharmacy and Kroger Health in Cincinnati, Ohio.

Community pharmacists are among the most accessible health care professionals; more than 90% of Americans live within 5 miles of a pharmacy, noted Deanna Tran, PharmD, BCACP, an assistant professor of pharmacy practice and science at the University of Maryland School of Pharmacy in Baltimore. These providers interact with customers who are picking up their medications, getting an OTC recommendation, or just passing by while buying something else. “Through these regular interactions, pharmacists are uniquely positioned to provide education on HPV and HPV vaccines, debunk myths associated with the vaccine, and administer the vaccine at the pharmacy,” she said.

Furthermore, young adults, including those in the age group indicated for the vaccine, often seek out convenient health care. Community pharmacists can provide that convenience, Tran said. Pharmacies may be open later than a traditional medical office or clinic practice, and pharmacists can administer vaccines with minimal wait times or without appointments. Community pharmacists can also play a vital role in rural or underserved areas, where a primary care provider may not be as easily visited.

Pharmacists who work in an ambulatory care clinic or in a hospital also can help boost vaccination rates. As medication experts, they often review medications and screen patients for necessary vaccinations, Tran said.

HPV vaccination helps prevent new HPV infections. It does not prevent progression of HPV infection to disease, decrease time to clearance of HPV infection, or treat HPV-related disease.

The Advisory Committee on Immunization Practice (ACIP) recommends that the HPV vaccination series be started at age 11 or 12 years, although it can be initiated as early as age 9. Catch-up is recommended for all individuals through age 26 who weren’t adequately vaccinated previously.

For unvaccinated patients aged 27 to 45 years, vaccination can be considered based on shared clinical decision-making between the provider and patient. “Although transmission is most likely to occur in adolescents and young adults, some people may have specific behavioral or medical risk factors that increase their risk of HPV infection,” said Danielle C. Mayer, PharmD, BCACP, an assistant professor in the Department of Pharmacy Practice at Thomas Jefferson University’s Jefferson College of Pharmacy in Philadelphia, Pennsylvania. Currently, HPV vaccines aren’t licensed for use in adults older than 45.

“Vaccine effectiveness is lower in this older age group because these individuals may already be exposed to HPV, so a discussion with a provider would be beneficial,” Tran added.

The vaccine is not recommended for pregnant women. If a woman has not been fully vaccinated for HPV, Mayer recommends starting or finishing the series in the postpartum period. The vaccine can be administered to a woman who is breastfeeding.

Gardasil 9 is the only HPV vaccine currently distributed in the United States. For patients aged 9 through 14 years, Gardasil 9 can be administered using a 2- or 3-dose schedule. For the 2-dose schedule, the second dose should be given 6 to 12 months after the first dose. If the second dose is administered less than 5 months after the first, a third dose should be given at least 4 months later. For the 3-dose schedule, Gardasil 9 should be administered 2 and 6 months after the first dose. Study results have shown that in patients aged 9 through 14 years, the 2-dose schedule, with at least 6 months between doses, provided an antibody response as good as or better than that of the 3-dose schedule.

For patients aged 15 through 45 years and for immunocompromised patients, including those with HIV infection, Gardasil 9 should be administered using a 3-dose schedule at 0, 2, and 6 months.

Existing vaccines cover only a limited number of the more than 100 HPV types, according to Zvi Loewy, PhD, professor of pharmaceutical and biomedical sciences, associate dean of research, and immediate past dean at Touro College of Pharmacy in New York, New York. The Merck vaccine covers high-risk HPV types (16 and 18) and those that cause genital warts (6 and 11). A vaccine made by GlaxoSmithKline covers oncogenic, or high-risk, types (16 and 18) exclusively. Another vaccine in development covers 9 types of HPV.

State laws differ regarding a pharmacist’s ability to give the vaccine. Of 50 states and the District of Columbia, 40 have laws expressly granting pharmacists the authority to administer the HPV vaccine, Loewy said; 22 have laws that authorize pharmacists to vaccinate preadolescents aged 11 or 12 years, the age group recommended by the CDC. Pharmacists have prescriptive authority in just 5 states.

More than 12 years of monitoring data and research demonstrate that the HPV vaccine is very safe, Tran said. Similar to other vaccines, the HPV vaccine can cause injection site reactions such as pain, redness, or swelling, as well as nausea and headache.

Fainting after receiving any vaccine is more common among adolescents, and dizziness or fainting may be more common with the HPV vaccine. Johnson suggests having patients sit or lie down for 15 minutes of observation after getting the vaccine. Patients may minimize potential pain by relaxing their arm during administration and moving their arm around afterward.

Ask the experts: human papillomavirus. Immunization Action Coalition. October 10, 2018. Updated March 1, 2020. Accessed June 29, 2020. 

www.immunize.org/askexperts/experts_hpv.asp

Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. 

Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination - updated recommendations of the Advisory Committee on Immunization Practices. 

CDC recommendations for patients 9-26 years of age. Merck Vaccines. June 2020. Accessed June 29, 2020. 

https://www.merckvaccines.com/gardasil9/cdc-recommendations-hpv-vaccination/

Pharmacists should counsel patients on how taking steps now can prevent certain cancers later.

Communicating Facts Can Help Boost HPV Vaccination Rates

Americans are desperate to be well. Being well, however, is not the business model of modern medicine, according to Kathy Campbell, PharmD, clinical community pharmacist and CEO/owner of Dr Kathy Health, LLC, and Medicap Pharmacy in Owasso, Oklahoma. The American health care system is structured to respond to a patient’s diagnosis, not prevent disease.

The $40 billion supplement industry,1 which includes vitamins and nutraceuticals, represents Americans’ willingness to spend money to be healthy. “Pharmacists are perfectly positioned and trained to understand the chemistry of supplements and foods, and as well as drugs and diseases,” Campbell said. “They can assist customers by recommending appropriate supplements. Sales of these products can also benefit a pharmacy’s bottom line.”

Bowe Craine, PharmD, co-owner and pharmacist in charge at Okie’s Pharmacy II Inc., in Blaine, Tennessee, agreed, and said that pharmacists should be at the forefront of not only selling supplements, but that they should also educate patients on OTC products that may not be FDA approved.

When looking to grow business with supplement sales, pharmacists should first educate themselves. “Research the most common products in various categories, and then analyze which ones fit your community’s needs,” Craine said. For example, if you have a large patient population with inflammatory conditions, such as irritable bowel disease or arthritis, then you should start with products like turmeric, fish oil, or cannabidiol (CBD) oil.

“Get out from behind the counter and talk to customers,” Craine said. “Ask how they feel about their current therapies and if they’re sufficient. Be confident in your ability to make recommendations about products that can improve quality of life. Not only will you increase your sales and profit margins, but you will also create loyal customers and build trusting relationships.”

Campbell recommended attending an 8-hour continuing education course from the National Community Pharmacists Association and Dr Kathy Health, Creating Health-Pharmacist-led Lifestyle and Weight Management, which teaches supplementation basics and foundational training in assisting patients with health.

When researching supplements, Craine uses UpToDate, PubMed, or the Dietary Supplements Labels Database to study their safety, efficacy, and various uses. National Center for Complementary and Integrative Health’s website is also recommended to get a better understanding of the usefulness and safety of supplements with evidenced-based research, advises Dipan B. Ray, MPharm, MS, PhD, RPh, senior director of experiential education at Touro College of Pharmacy in New York, New York.

Nina Chhabra, PharmD, a natural medicines specialist at Northwell Health/Vivo Health Pharmacy in New Hyde Park, New York, subscribes to reputable databases, such as the Natural Medicine Database, which provides detailed information regarding supplements like their level of effectiveness, safety information, dosing information, and possible drug interactions. ConsumerLab.com provides third-party testing results. The National Institute of Health’s website shows if any clinical trials were conducted to support a particular product’s usage, she said.

By far, the most popular supplement Craine sells are multivitamins. “Consumers take them mainly to avoid vitamin deficiencies which can lead to problems such as osteoporosis, muscle cramps, and fatigue,” he said.

Hemp-derived CBD topped Chhabra’s list in 2019. Patients use this product to help manage anxiety and stress, for insomnia or to support sleep, and for different types of pain related to fibromyalgia, headaches and migraines, and muscle and joint pain.

Vitamin D is the most popular supplement currently used. It helps the body absorb calcium in order to increase bone density and therefore reduces the risk of developing osteoporosis, especially in women and the elderly, he said.

In addition to serving as a resource on which supplements to take, pharmacists should make customers aware of possible adverse drug reactions.

A general myth is that most supplements are safe because they’re derived from natural sources. “The truth is that a majority of herbal supplements interact with other drugs and can have significant adverse effects,” Ray said.
	
	For example, Chhabra noted that turmeric, curcumin, and fish oil supplements can thin blood. If a patient takes a blood-thinning agent such as aspirin or warfarin, she warns them to stop taking these supplements before surgery or any medical procedure that could affect their clotting time.

Chamomile, often used as a sleep aid, interacts with birth control, Craine pointed out. Ginger, which prevents nausea and vomiting, can lower blood sugar and interact with blood thinners if high doses are taken. Yohimbe may aid with erectile dysfunction, but it can raise blood pressure and heart rate and cause tremors.

Consumers should understand the importance of selecting the most appropriate products depending on their medical histories and current medication use. “Before using any such products, patients should share their current medications and over-the-counter products with their physicians and pharmacists so they can counsel them about any potential risks and benefits,” Ray said. “I encourage patients to report any side effects to physicians or pharmacists immediately.”

Because the kidneys and liver break down supplements just as they do prescription drugs, Chhabra asks customers if they have any issues with these organs. “Supplements can cause interactions for patients who take prescription drugs because they can compete with the same pathway,” she said.

Craine aims to ensure that customers buy products from reputable companies. For example, he’ll recommend a multivitamin with the United States Pharmacopeia (USP) seal of approval. “This seal means you can trust that the bottle’s contents contain exactly what the label states,” he noted.

Craine asks patients for feedback as well. “I want to know if a product helped or if it had side effects, so I can relay that to other patients,” he said.

The most frequent questions Chhabra gets from patients is if a product is safe and if it works. “I emphasize that safety is our primary concern, however it is hard to find robust clinical evidence about efficacy,” Chhabra said. “This is simply because large trials that can show this are rarely performed. Unlike prescription drugs, supplements are considered safe unless proven otherwise.”

Currently, Chhabra also receives many questions about hemp-based CBD products. “Although CBD appears to be safe, it is relatively new and we’re still learning its exact uses,” she said. “I recommend patients start taking low doses and slowly increase the dosage every 2 to 3 days until they feel an effect. But I caution them to only use products that provide third-party testing results, which can help ensure it’s a quality product and reveal its CBD content as well as any contaminants such as heavy metals, pesticides, and bacterial growth.”

The most frequently asked question consumers ask Ray is, “How much should I take?” He pointed out that all vitamins need to meet a certain Recommended Daily Allowance (RDA) as stated on the label to achieve desired benefits.

Supplements, Vitamins, and Nutraceuticals: What’s the Difference?

The best way to describe the differences between vitamins, supplements, and nutraceuticals is to consider supplements as the main category that these agents fall into.

The Dietary Supplement Health and Education Act of 1994 (DSHEA) defines dietary supplements as “a product intended to supplement the diet that bears or contains 1 or more dietary ingredients, including a vitamin, mineral, herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total dietary intake, or a concentrate, metabolite, constituent, extract, or combination of any of the aforementioned ingredients.”2

Nutraceutical products are generally derived from food sources intended to be used for health benefits, whereas vitamins are organic compounds that are needed from external sources, such as food, because the body can’t make them, explained Chhabra.

“If someone can’t obtain enough of a necessary vitamin from a food source alone, they may use a supplement that contains that specific vitamin,” Chhabra said. “Vitamins are essential for bodily functions, whereas nutraceuticals are used to supplement the diet and are typically food or food sources and are used for a specific health benefit.”

1. Statista. Total US dietary supplements market size from 2016 to 2024. https://www.statista.com/statistics/828481/total-dietary-supplements-market-size-in-the-us/.
	2. National Institutes of Health, Office of Dietary Supplements. Dietary Supplement Health and Education Act of 1994 Public Law 103-417 103rd Congress. https://ods.od.nih.gov/About/DSHEA_Wording.aspx#sec3

When looking to grow business with supplement sales, pharmacists should first educate themselves.