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Kumar NB, Allen K, Bell H. Perioperative Herbal Supplement Use in Cancer Patients: Potential Implications and Recommendations for Presurgical Screening. Cancer Control 2017; 12:149-57. [PMID: 16062162 DOI: 10.1177/107327480501200302] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Products made from botanicals that are used to maintain or improve health are known as herbal supplements, botanicals, or phytomedicines. Many herbs have a long history of use and claimed health benefits. However, many herbal supplements and botanicals have potent pharmacologic activity that can contribute to adverse effects and drug interactions. The use of herbal supplements by cancer patients in the perioperative period is common and consistent with the substantial increase in the use of alternative medical therapies. METHODS We reviewed the literature to examine the constituents, safety, pharmacokinetics, and pharmacodynamics of those herbal supplements that are predominantly used by cancer patients. RESULTS Different supplements possess antiplatelet activity, adversely interact with corticosteroids and central nervous system depressant drugs, have gastrointestinal manifestations, produce hepatotoxicity and nephrotoxicity, and produce additive effects when used with opioid analgesics. CONCLUSIONS With the increasing use of herbal supplements by cancer patients, surgical staff need to screen patients pre-surgically for use of these supplements. Clinical practice guidelines are needed for screening and prevention of herbal supplement usage to prevent potential adverse events that may arise from herbal medications taken alone or combined with conventional therapies during the perioperative period.
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Affiliation(s)
- Nagi B Kumar
- Department of Nutrition, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida 33612, USA.
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Yang X, Xiong X, Yang G, Wang J. Effectiveness of Stimulation of Acupoint KI 1 by Artemisia vulgaris (Moxa) for the Treatment of Essential Hypertension: A Systematic Review of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:187484. [PMID: 24744807 PMCID: PMC3972940 DOI: 10.1155/2014/187484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 11/26/2013] [Accepted: 11/28/2013] [Indexed: 11/18/2022]
Abstract
Objective. A systematic review of randomized controlled trials has been performed to assess the effectiveness of stimulation of acupoint KI 1 by Artemisia vulgaris (the Japanese name is moxa) to lower blood pressure compared to antihypertensive drugs. Methods and Findings. Articles published from 1980 to August 2013 in databases of CENTRAL, Pubmed, CBM, CNKI, VIP, and online clinical trial registry websites were searched. Studies included were randomized controlled trials (RCTs); moxibustion-type intervention on KI 1 compared with antihypertensive drugs; meta-analysis showed superior effects of moxibustion plus antihypertensive drugs on systolic blood pressure (WMD: -4.91 [-7.54, -2.28]; P = 0.0003) but no superior effects on diastolic blood pressure (WMD: -6.38 [-17.17, 4.41]; P = 0.25). Conclusions. Our systematic review of the current literature shows a beneficial effect of using moxibustion interventions on KI 1 to lower blood pressure compared to antihypertensive drugs. However, the results are influenced by the existing differences in design of the current trials.
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Affiliation(s)
- Xiaochen Yang
- Department of Cardiology, Guanganmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange, Xicheng District, Beijing 100053, China
| | - Xingjiang Xiong
- Department of Cardiology, Guanganmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange, Xicheng District, Beijing 100053, China
| | - Guoyan Yang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jie Wang
- Department of Cardiology, Guanganmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange, Xicheng District, Beijing 100053, China
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Stark TD, Mtui DJ, Balemba OB. Ethnopharmacological Survey of Plants Used in the Traditional Treatment of Gastrointestinal Pain, Inflammation and Diarrhea in Africa: Future Perspectives for Integration into Modern Medicine. Animals (Basel) 2013; 3:158-227. [PMID: 26487315 PMCID: PMC4495512 DOI: 10.3390/ani3010158] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/06/2013] [Accepted: 02/07/2013] [Indexed: 11/19/2022] Open
Abstract
There is a growing need to find the most appropriate and effective treatment options for a variety of painful syndromes, including conditions affecting the gastrointestinal tract, for treating both veterinary and human patients. The most successful regimen may come through integrated therapies including combining current and novel western drugs with acupuncture and botanical therapies or their derivatives. There is an extensive history and use of plants in African traditional medicine. In this review, we have highlighted botanical remedies used for treatment of pain, diarrheas and inflammation in traditional veterinary and human health care in Africa. These preparations are promising sources of new compounds comprised of flavonoids, bioflavanones, xanthones, terpenoids, sterols and glycosides as well as compound formulas and supplements for future use in multimodal treatment approaches to chronic pain, gastrointestinal disorders and inflammation. The advancement of plant therapies and their derivative compounds will require the identification and validation of compounds having specific anti-nociceptive neuromodulatory and/or anti-inflammatory effects. In particular, there is need for the identification of the presence of compounds that affect purinergic, GABA, glutamate, TRP, opioid and cannabinoid receptors, serotonergic and chloride channel systems through bioactivity-guided, high-throughput screening and biotesting. This will create new frontiers for obtaining novel compounds and herbal supplements to relieve pain and gastrointestinal disorders, and suppress inflammation.
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Affiliation(s)
- Timo D Stark
- Lehrstuhl für Lebensmittelchemie und Molekulare Sensorik, Technische Universität München, Lise-Meitner Str. 34, D-85354, Freising, Germany.
| | - Dorah J Mtui
- Department of Biological Sciences, University of Idaho, Moscow, ID 83844, USA.
| | - Onesmo B Balemba
- Department of Biological Sciences, University of Idaho, Moscow, ID 83844, USA.
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Abstract
INTRODUCTION Noradrenergic reuptake inhibitors can be effective analgesics, finding application in a wide variety of clinical pain settings. Due to a shift toward noradrenergic-mediated pain pathways following nerve injury, they are particularly well suited to the treatment of neuropathic pain. This phenotypic shift makes neuropathic pain difficult to control with opioids alone; some noradrenergic reuptake inhibitors have demonstrated synergy with opioids. Agents currently in early clinical trials are discussed and include both novel delivery of old drugs and the development of new drugs. AREAS COVERED This review was limited to noradrenergic reuptake inhibitors and analgesia. Literature search included the terms adrenergic, noradrenergic, reuptake, inhibitors, analgesia, NET, norepinephrine transporter, and pain using Medline, Google scholar, Web of Knowledge, www.clinicaltrials.gov, and Pharmaprojects (Informa UK Ltd. 2012). EXPERT OPINION Topical drug delivery and the use of combinations of agents both topically and systemically are under active investigation. The intrathecal delivery of noradrenergic reuptake inhibitors, allowing delivery directly to the central nervous system thus limiting systemic exposure, represents an exciting avenue of investigation. Gaps in current knowledge have complicated the development of prophylactic therapies for susceptible individuals or preemptive intervention. Disease-modifying agents and selective inhibitors would facilitate these treatment strategies.
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Affiliation(s)
- Craig T Hartrick
- Oakland University William Beaumont School of Medicine, 525 O'Dowd Hall, Rochester, MI 48309, USA.
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Wong WW, Gabriel A, Maxwell GP, Gupta SC. Bleeding risks of herbal, homeopathic, and dietary supplements: a hidden nightmare for plastic surgeons? Aesthet Surg J 2012; 32:332-46. [PMID: 22395325 DOI: 10.1177/1090820x12438913] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The utilization of complementary and alternative medicine has increased tremendously in the last two decades. Herbal products, homeopathic medicines, and dietary supplements are extremely popular and are available without a prescription (which likely contributes to their popularity). Despite their "natural" characteristics, these remedies have the potential to cause bleeding in patients who undergo surgery. The high use of these supplements among cosmetic surgery patients, coupled with increasing reports of hematomas associated with herbal and homeopathic medicines, prompted the authors to conduct a comprehensive review focused on bleeding risks of such products in an effort to raise awareness among plastic surgeons. This review focuses on 19 herbs, three herbal formulas, two herbal teas, and several other supplements that can cause bleeding perioperatively and postoperatively. In addition to being aware of such adverse effects, plastic surgeons must adequately screen all patients and educate them on the possible dangers associated with these treatments.
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Perioperative Management of Antidepressants and Herbal Medications in Elective Plastic Surgery. Plast Reconstr Surg 2009; 123:377-386. [DOI: 10.1097/prs.0b013e3181934892] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaye AD, Baluch A, Kaye AJ, Frass M, Hofbauer R. Pharmacology of herbals and their impact in anesthesia. Curr Opin Anaesthesiol 2007; 20:294-9. [PMID: 17620834 DOI: 10.1097/aco.0b013e3281f8d0eb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, LSU School of Medicine, New Orleans, LA 70112, USA.
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Leak JA. Perioperative considerations in the management of the patient taking herbal medicines. Curr Opin Anaesthesiol 2007; 13:321-5. [PMID: 17016323 DOI: 10.1097/00001503-200006000-00016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of herbal products has recently increased dramatically in the United States. Patients are flocking to use these and many other complementary or alternative therapies. Perhaps disillusionment with managed care, loss of the traditional doctor-patient relationship, or simply increased access on store shelves, in the media, and on the Internet have all led to this increased use. As physicians, we are facing a paucity of information regarding the true dangers of these products, and there is virtually no information on how they may affect the perioperative milieu. The following review will discuss the limitations of Food and Drug Administration protection, and will review as well as provide an outline of the potential adverse reactions and side-effects that might affect anesthesia administration. To date, no double-blind, placebo-controlled studies have been carried out that specifically address herbal-anesthetic interactions or outcomes.
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Affiliation(s)
- J A Leak
- Department of Anesthesiology, Department of Symptom Control and Palliative Care, Houston, TX 77030, USA
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Ryu KH. Anesthetic Drug Interactions. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Keon Hee Ryu
- Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea
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Kaye AD, Kaye AM, Hegazi A, Sabar R, Deaton B, Powell J, Hofbauer R. Nutraceuticals: potential roles and potential risks for pain management. Pain Pract 2006; 2:122-8. [PMID: 17147685 DOI: 10.1046/j.1533-2500.2002.02013.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Over the past 2 decades, the world health market has been flooded with over the counter herbal products, also known as nutraceuticals. Although many of these products are neither recommended nor prescribed by conventional medical practitioners, an increasing number of people are taking these products on a daily basis. A recent survey at Texas Tech University School of Medicine in Lubbock, Texas concluded that 32% of patients scheduled for elective surgery or pain procedures were taking one or more herbal supplements; however, 70% did not disclose these during a routine anesthetic assessment.(1) Pain physicians are also increasingly needed in the care of these patients. As many of these agents carry a potential to cause bleeding problems, we have reviewed here briefly, the basic mechanisms of coagulation and correlated the role of commonly used herbs known to possess side effects, which can cause excessive bleeding. In addition, we have reviewed a number of potential useful herbal derived agents for pain management.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Texas Tech University School of Medicine, Lubbock, Texas 79430, USA
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Heller J, Gabbay JS, Ghadjar K, Jourabchi M, O'Hara C, Heller M, Bradley JP. Top-10 list of herbal and supplemental medicines used by cosmetic patients: what the plastic surgeon needs to know. Plast Reconstr Surg 2006; 117:436-45; discussion 446-7. [PMID: 16462323 DOI: 10.1097/01.prs.0000197217.46219.a7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Widespread use of herbal medications/supplements among the presurgical population may have a negative effect on perioperative patient care. Thus, the authors' goal was to identify the prevalence of such use in a cosmetic surgery patient population compared with use among the general public; to assess physician awareness of proper management of these herbal medications/supplements; and to review the literature to provide rational strategies for managing perioperative patients taking these remedies. METHODS To assess patient (n = 100) and general public (n = 100) usage rates, open-ended lists of (1) the most common herbal medications/supplements and (2) homeopathic treatments were compiled. Board-certified plastic surgeons (n = 20) were then given the same list of herbs/supplements and surveyed on their awareness of these treatments and perioperative side effects. RESULTS The usage rate for cosmetic versus public surveys for herbal medicines/supplements was 55 percent versus 24 percent (p < 0.001), with 35 percent versus 8 percent (p < 0.001) engaging in homeopathic practices, respectively. Cosmetic patients' top four herbal/supplements of usage were chondroitin (18 percent), ephedra (18 percent), echinacea (14 percent), and glucosamine (10 percent). The top four used by the general public were echinacea (8 percent), garlic (6 percent), ginseng (4 percent), and ginger (4 percent). The physician survey demonstrated awareness of 54 percent of the listed supplements/herbal medicines, 85 percent of which were not suggested to be discontinued preoperatively, with only ephedra achieving 100 percent physician discontinuation preoperatively. CONCLUSIONS Herbal medicines and supplements displayed greater prevalence in the cosmetic surgery population than in the population at large. Furthermore, side effects and potential complications warrant addressing these remedies as pharmaceuticals rather than as safe and "natural." Thus, a descriptive "top-10" list with perioperative recommendations was compiled for the plastic surgeon.
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Affiliation(s)
- Justin Heller
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California 90069, USA
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The Potential Hazards of Used and Abused Perioperative Drugs, Herbs, and Dietary Supplements. ACTA ACUST UNITED AC 2006. [DOI: 10.1097/00126869-200634010-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaye AD, Kucera I, Sabar R. Perioperative anesthesia clinical considerations of alternative medicines. ACTA ACUST UNITED AC 2004; 22:125-39. [PMID: 15109694 DOI: 10.1016/s0889-8537(03)00113-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The presence of nutraceutical agents in the United States health care system dictates the need for a general understanding of these agents by all physicians and health care providers. Increasing trend toward reimbursement of herbal medicines by the insurance companies and managed care organizations have further encouraged their use. Because herbs are listed under the "supplement" category by the Food and Drug Administration, the Dietary Supplement and Health Education Act establishes no protocol for standardization of the products labeled as "supplements" thereby increasing the risk for adverse effects associated with the use of these products. Moreover, there is little motivation for the manufacturers to conduct randomized, placebo-controlled, double-blinded safety and efficacy trials on these drugs. Reports indicate that within the last 2 decades,more than 100 herbogenic deaths have occurred [100]. Many serious complications have been reported, including renal failure and need for renal or hepatic transplantation after taking nutraceuticals [101-107]. The anesthesiologists should have a detailed knowledge and understanding of the potential risks and purported benefits of herbal medicines and should thoroughly inquire about patient's use of herbal products [108- 11 ]. In addition,the education of each patient regarding the serious, potential drug-herb inter-actions should be a routine component of preoperative assessment. The American Society of Anesthesiologists (ASA), suggests that all herbal medications should be discontinued 2 to 3 weeks before an elective surgical procedure. If the patient is not sure of the contents of the herbal medicine, he or she should be urged to bring the container so that the anesthesiologist can review the contents of the herb or preparation. Although this idea holds some promise in the elective-care settings, anesthetic care in emergency settings should be based on a thorough drug-intake history from the patient or a relative, if possible.Unfortunately, the anesthesia literature has not addressed this new group of health supplements, despite many of these drugs having the potential to cause serious health problems and drug-herb interactions. There is a need to conduct additional scientific clinical trials to study the anesthetic responses to commonly used nutraceutical agents.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Texas Tech Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA.
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Sabar R, Kaye AD, Frost EA. Perioperative considerations for the patient taking herbal medicines. HEART DISEASE (HAGERSTOWN, MD.) 2001; 3:87-96. [PMID: 11975777 DOI: 10.1097/00132580-200103000-00006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There has been a significant increase in the proliferation and use of dietary supplements known as neutraceuticals. Since 1994, herbal products have been regulated by the Dietary Supplement Health and Education Act (DSHEA), which does not require burden of proof to demonstrate premarketing safety and efficacy studies. Scientific literature and government policies have not adequately addressed this fast-emerging group of more than 20,000 health supplements. Lack of purity and standardization of these agents, combined with minimal education in traditional homeopathic medical education, has led to serious health-related problems including arrhythmias, cardiovascular compromise, strokes, and deaths. Even though 30% of our traditional medicines are derived from botanicals, most physicians are either unfamiliar or unwilling to develop any level of expertise with neutraceuticals. A review emphasizing perioperative considerations is provided of the history of herbal medicines, governmental policies, and specific herbal agent-drug interactions.
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Affiliation(s)
- R Sabar
- Department of Anesthesiology, Texas Technical University School of Medicine, Lubbock, Texas, USA
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Kaye AD, Sabar R. Herbal Medicinal Products for the Treatment of Pain. Pain Pract 2001. [DOI: 10.1046/j.1533-2500.2001.01011.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Alan D. Kaye
- Department of Anesthesiology
Texas Tech University School of Medicine
Lubbock, Texas
| | - Raj Sabar
- Department of Anesthesiology
Texas Tech University School of Medicine
Lubbock, Texas
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Kaye AD, Clarke RC, Sabar R, Vig S, Dhawan KP, Hofbauer R, Kaye AM. Herbal medicines: current trends in anesthesiology practice--a hospital survey. J Clin Anesth 2000; 12:468-71. [PMID: 11090733 DOI: 10.1016/s0952-8180(00)00195-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVES To develop a simple survey to determine the patient population actively utilizing dietary supplements and/or herbs, during the preoperative period. DESIGN Prospective study, with survey instrument. SETTING University medical center. PATIENTS 1,017 patients presenting for preanesthetic evaluation prior to outpatient surgery. INTERVENTIONS After undergoing preanesthetic evaluation, patients were asked to complete a survey listing which of the nine most popular nutraceuticals currently available on the market they were using. MEASUREMENTS AND MAIN RESULTS A total of 1017 surveys were submitted over a period of five months, with 32% being poorly completed and thus discarded. Of the remaining 755 valid surveys, 482 patients used at least one nutraceutical agent. 90% of these patients were using vitamins, 43% garlic extracts, 32% Gingko Biloba, 30% St. John's Wort, 18% Ma Huang, 12% Ecchinaceae, 10% Aloe, 8% Cascare, 3% licorice. CONCLUSION A significant population of patients scheduled for an elective surgical procedure are self-administering nutraceutical agents. Some of these agents have the potential to cause serious drug interactions and hemodynamic instability during surgery. Hence, it may be important to identify patients self-administering these medications, during the preoperative period.
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Affiliation(s)
- A D Kaye
- Department of Anesthesiology, Texas Tech University, Lubbock, TX 79430, USA
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