Dietary supplements. See

Dietary supplements see Herbal drugs Diethylpropion see Diet pills Dihydro-2(3H)-furanone see GBL Dilaudid see Hydromorphone Dilaudid-Hp see Hydromorphone Dillies see Hydromorphone Dipper see PCP (phencyclidine)... 

Most of the thiamine sold worldwide is used for dietary supplements. Primary market areas include the following appHcations addition to feed formulations, eg, poultry, pigs, catde, and fish (see Feeds and feed additives) fortification of refined foods, eg, flours, rice, and cereal products and incorporation into multivitamins. Small amounts are used in medicine to treat deficiency diseases and other conditions, in agriculture as an additive to ferti1i2ers (qv), and in foods as flavorings. Generally for dry formulations, the less soluble, nonhygroscopic nitrate is preferred. Only the hydrochloride can be used for intravenous purposes. Coated thiamine is used where flavor is a factor. 

Always acknowledge the limits of your own knowledge, and incorporate this into the patient counseling. I don t know is no longer an acceptable professional answer for pharmacists selling dietary supplements. However, saying I don t know, but let me see if I can find out is acceptable. 

In February 2004, the FDA withdrew ephedra, one of the most popular dietary supplements, from the market because it finally had enough information to prove that ephedra presented an unreasonable risk of illness or injury under the conditions of use recommended on the product labeling. This withdrawal did not happen until many people suffered from the terrible potential side effects of this supplement (see Chapter 4). 

Stimulant drugs commonly abused in the USA include methamphetamine ("crank," "crystal"), methylenedioxymethamphetamine (MDMA, "ecstasy"), and cocaine ("crack") as well as pharmaceuticals such as pseudoephedrine (Sudafed) and ephedrine (as such and in the herbal agent Ma-huang) (see Chapter 32). Caffeine is often added to dietary supplements sold as "metabolic enhancers" or "fat-burners" and is also sometimes combined with pseudoephedrine in underground pills sold as amphetamine substitutes. 

Figure A.3A.3 LC/MS analysis of a dietary supplement consisting of extract of Trifolium pratense (red clover). Reversed-phase C18 HPLC and negative ion electrospray ionization mass spectrometry were used with a quadrupole mass spectrometer analyzer (Agilent also see Table A.3A.1). The map illustrates the abundance of information provided by this hyphenated technique with HPLC mass chromatograms in one dimension and mass spectra in another dimension.

The primary roles and the recommended daily intake of major and trace minerals are listed in Table 38-3. Similar to vitamins, these minerals are typically obtained from dietary sources. Specific minerals may likewise be included in various multivitamins and other dietary supplements, with the intent that these minerals will promote good health and prevent disease. Again, there is generally no need for mineral supplements for most people eating a reasonably balanced diet. On the other hand, mineral supplements can be helpful in specific situations where the body s need for a mineral may exceed dietary supply. Some examples of appropriate supplementation include calcium supplements for people with osteoporosis (see Chapter 31), potassium supplements for people on diuretics (see Chapter 21), and iron supplements for people with certain anemias. Hence, mineral supplements may be helpful in certain individuals, but the dose and type of supplement should be adjusted carefully. 

Borage Borago officinalis (Boraginaceae) seed 28-35 linoleic (38), y-linolenic (23-26), oleic (16), palmitic (11) dietary supplement for y-linolenic acid content (see page 46)... 

Soya (soybean) Glycine max (Leguminosae/ Fabaceae) seed 18-20 linoleic (44-62%), oleic (19-30), palmitic (7-14), a-linolenic (4-11), stearic (1-5) food oil, dietary supplement, carrier oil (aromatherapy) Soya oil contains substantial amounts of the sterols sitosterol and stigmasterol (see page 256)... 

MedWatch program. The FDA recently established the Special Nutritionals Adverse Event Monitoring System, a searchable database including information about suspected adverse events associated with dietary supplements or nutritional products. This database includes reports that have been submitted to MedWatch and can be accessed via the Internet (http //vm.cfsan.fda.gov/ dms/ aems.html). Continued efforts by health-care professionals to recognize and report suspected interactions between prescription medications and herbal and other alternative therapies should ultimately increase knowledge and awareness of interactions and improve the quality of patient care (see Heck et al., 2000 Izzo, 2004 Butterweck, 2004 Chan, 2005). 

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