ASHP statement on the use of dietary supplements.

The American Society of Health-System Pharmacists (ASHP) believes that the widespread, indiscriminate use of dietary supplements presents substantial risks to public health and that pharmacists have an opportunity and a professional responsibility to reduce those risks. ASHP recognizes that patients may choose to use legally available dietary supplements, but believes that the decision to use substances that may be pharmacologically active should always be based on reliable information about their safety and efficacy. The current regulatory framework governing dietary supplements does not provide consumers or health care providers with sufficient information on safety and efficacy to make informed decisions. Furthermore, standards for product quality are currently inadequate. ASHP recognizes the concerns raised by the dietary supplement industry regarding regulating dietary supplements as nonprescription drugs because of the industry’s inability to patent product ingredients. Still, ASHP urges Congress to amend the Dietary Supplement Health and Education Act of 1994 (DSHEA) to require that the Food and Drug Administration (FDA) develop a regulatory scheme to ensure that dietary supplements are safe and effective. ASHP believes that dietary supplements, at a minimum, should (1) receive FDA approval for evidence of safety and efficacy, (2) meet manufacturing standards for identity, strength, quality, purity, packaging, and labeling, and (3) undergo mandatory postmarketing reporting of adverse events, including drug interactions. ASHP strongly encourages in vitro and clinical studies of interactions between dietary supplements and medications. Because of the demonstrated risk of these interactions, ASHP discourages the concurrent use of dietary supplements and drug therapy, especially those therapies for which failure may have irreversible consequences (e.g., immunosuppressive therapy, cancer chemotherapy, treatment for human immunodeficiency virus infection, anticoagulation therapy, and hormonal contraceptive therapy). ASHP believes that the criteria used to evaluate dietary supplements for inclusion in health-system formularies should be as rigorous as those established for nonprescription drugs and that the self-administered use of dietary supplements during a health-system stay may increase risks to patients and liabilities to health care professionals and institutions. ASHP urges pharmacists and other health care practitioners to integrate awareness of dietary supplement use into everyday practice and encourages pharmacists to increase efforts to prevent interactions between dietary supplements and drugs. ASHP also supports the education of pharmacists and other health care practitioners in the taxonomy, formulation, pharmacology, and pharmacokinetics of dietary supplements and believes that such education should be required in college of pharmacy curricula.