Pharmacological Interactions Between Nutritional Supplements and Prescription Medications in Older Adults: A Comprehensive Review
Open accessAbstract
The global aging population faces increasing risks of supplement-drug interactions due to rising polypharmacy and widespread use of nutritional supplements. Older adults, particularly those with chronic conditions, frequently combine prescription medications with dietary supplements, yet healthcare providers often overlook these interactions, leading to preventable adverse effects. This review synthesizes evidence from 16 international studies spanning nearly three decades, examining the intersection of supplement and medication use in older adults. Key findings reveal a high prevalence of concurrent use (23-82.5%), significantly increasing the likelihood of adverse interactions, particularly with antithrombotics (e.g., warfarin and ginkgo) and absorption-disrupting minerals (e.g., calcium and levothyroxine). A critical systemic failure in patient-provider communication exacerbates these risks, as clinicians often neglect to inquire about supplement use. Despite widespread potential interactions, actual clinical harm appears concentrated in high-risk combinations. The review calls for proactive clinical strategies, including standardized supplement screening, targeted patient education, and pharmacist-led medication management. Its limitations include cross-sectional study designs and self-reported data, underscoring the need for longitudinal and intervention-based research. Future studies should prioritize causal evidence, standardized methodologies, and data from low- and middle-income countries to mitigate risks in aging populations.
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Concurrent, often undisclosed use of berberine with prescription drugs is common in older adults.
“Concurrent, often undisclosed use with prescription drugs is common in older adults, yet berberine is far from inert.”
From Berberine-Drug Interactions: Mechanisms, Clinical Relevance and Risk Stratification-A Narrative Review (2026) · cites this paper as [6]
The Review (page not available) reports that older adults commonly use supplements alongside prescription drugs and frequently fail to report supplement use to doctors. It does not identify berberine or establish that concurrent, undisclosed use of berberine specifically is common. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBetween 5% and over 80% of older adults combine supplements with prescription drugs, and a substantial proportion carry at least one potential interaction.
“Population studies report that between 5% and over 80% of older adults combine supplements with prescription drugs, and a substantial proportion carry at least one potential interaction [3,4,5,6,7].”
From Berberine-Drug Interactions: Mechanisms, Clinical Relevance and Risk Stratification-A Narrative Review (2026) · cites this paper as [6]
The Abstract reports concurrent supplement–medication use of 23–82.5%, and the Review reports that 12–16% of older adults face potential interactions. These passages support the general point, but not the claimed 5% lower bound. The Review also describes the 23–82.5% range as supplement-use rates in specific cohorts, so it does not consistently establish that range for concurrent use. (LLM, conf=0.87)
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Cites
Rayyan-a web and mobile app for systematic reviews.
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016) · Systematic Reviews · doi:10.1186/s13643-016-0384-4 · Cited by 26,092 · cited 1× · see citing works
“[8], for duplicate removal and screening.”
Potential for Interactions Between Dietary Supplements and Prescription Medications
Sood, A., Sood, R., Brinker, F. J., Mann, R., Loehrer, L. L., & Wahner‐Roedler, D. L. (2008) · The American Journal of Medicine · doi:10.1016/j.amjmed.2007.11.014 · Cited by 96 · see citing works
Herbal Supplement Use by Persons Aged Over 50 years in Britain
Canter, P. H., & Ernst, E. (2004) · Drugs & Aging · doi:10.2165/00002512-200421090-00004 · Cited by 89 · see citing works
Drug-related problems (DRPs) identified from geriatric medication safety review clinics
Chan, D., Chen, J., Kuo, H., We, C.-J., Lu, I.-S., Chiu, L., & Wu, S. (2011) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2011.02.005 · Cited by 76 · see citing works
Masud, T., Ogliari, G., Lunt, E., Blundell, A. G., Gordon, A. L., Roller‐Wirnsberger, R., Vassallo, M., Mari, D., Kotsani, M., Singler, K., et al. (2022) · European Geriatric Medicine · doi:10.1007/s41999-021-00595-0 · Cited by 66 · see citing works
Pharmacological Interactions in the Elderly
Błeszyńska-Marunowska, E., Wierucki, Ł., Zdrojewski, T. R., & Renke, M. (2020) · Medicina · doi:10.3390/medicina56070320 · Cited by 63 · see citing works
Vitamin Supplementation Therapy in the Elderly
Thurman, J. E., & Mooradian, A. D. (1997) · Drugs & Aging · doi:10.2165/00002512-199711060-00003 · Cited by 43 · see citing works
Mind the gap: Disclosure of dietary supplement use to hospital and family physicians
Ben‐Arye, E., Attias, S., Levy, I., Goldstein, L. H., & Schiff, E. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.07.037 · Cited by 30 · see citing works
Use of dietary supplements and their interactions with prescription drugs in the elderly
Ly, J., Percy, L. A., & Dhanani, S. (2002) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/59.18.1759 · Cited by 28 · see citing works
Fravel, M. A., Ernst, M. E., Gilmartin‐Thomas, J., Woods, R. L., Orchard, S. G., Owen, A. J., & the ASPirin in Reducing Events in the Elderly Investigator Group (2023) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18305 · Cited by 26 · see citing works
Peklar, J., Henman, M. C., Kos, M., Richardson, K., & Kenny, R. A. (2014) · Drugs & Aging · doi:10.1007/s40266-014-0180-6 · Cited by 21 · see citing works
Medication-related burden from the perspective of the elderly
Alqallaf, S. M., Mattar, L., Ghuloom, K., Alabbad, K., Alshaikh, F., & Alhaddad, M. (2022) · Medicine and Pharmacy Reports · doi:10.15386/mpr-2133 · Cited by 16 · see citing works
Aykan, D. A., & Aykan, A. Ç. (2018) · Journal of Cardiovascular Pharmacology and Therapeutics · doi:10.1177/1074248418794938 · Cited by 8 · see citing works
Campos, M. J., Człapka-Matyasik, M., & Pena, A. (2024) · Foods · doi:10.3390/foods13162618 · Cited by 8 · see citing works
Jaqua, E. E., Gonzalez, J., Bahjri, K. A., Erickson, S., Garcia, C., Santhavachart, M., Nguyen, V. L., Labib, W., & Abdrabou, R. (2024) · The Permanente Journal · doi:10.7812/tpp/23.183 · Cited by 7 · see citing works
Gavronski, M., & Volmer, D. (2014) · SpringerPlus · doi:10.1186/2193-1801-3-143 · Cited by 6 · see citing works
Polypill therapy and frailty in elderly: Time to stop treating everything
Kumar, S., Godhiwala, P., Garikapati, A., & Jain, S. (2021) · Asian Journal of Medical Sciences · doi:10.3126/ajms.v12i4.33182 · Cited by 5 · see citing works
Sadowska, J., & Bruszkowska, M. (2016) · PubMed · Cited by 4 · see citing works
Complementary and Alternative Medicines: Clinical Pearls for Commonly Used Dietary Supplements
Zarowitz, B. J. M. (2010) · Geriatric Nursing · doi:10.1016/j.gerinurse.2010.05.002 · Cited by 2 · see citing works
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Dumitru, C. N., Marcu, T., Dumitru, A. O., Tudor, S. S., Ferțu, I. D., Elisei, A.-M., & Goroftei, L. (2026) · Pharmaceuticals · doi:10.3390/ph19081313 · Cited by 2 · see citing works
Tian, H., & Chen, J. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1727791 · Cited by 1 · see citing works
Razali, A. A., Mahat, N. A., Karim, N. K., & Basri, A. U. (2026) · INTERNATIONAL JOURNAL OF CARE SCHOLARS · doi:10.31436/ijcs.v9i3.580
- Authors
- Changaramkumarath, G., Abucha, J. M., Wollel, M. M., Somannagari, N., Kasagga, A., Sapkota, A., & Malasevskaia, I. A.
- Affiliations
- Chongqing Medical University (CN)
- University of Gondar (ET)
- Peking University (CN)
- Harvard University (US)
- Corresponding author
- Changaramkumarath, Gichin
- Venue
- Cureus
- Published
- 2025-09-15
- Volume
- 17
- Issue
- 9
- Pages
- e92363-e92363
- ISSN
- 2168-8184 (ISSN-L)
- PMC
- PMC12526737
- OpenAlex
- W4414205407
- Cited by
- 2
- References
- 20
- Citations by year
- 2026: 2
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Cureus (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- drug-supplement interactions, dietary supplements, older adults, polypharmacy, antithrombotic agents, warfarin, Ginkgo biloba, calcium, levothyroxine, drug absorption, patient-provider communication, pharmacist-led medication management, patient education, adverse drug reactions
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