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Albassam AA, Alenzi AN, Alhaqbani NK, Alhouty FK, Almalki ZS, Alshehri AM, Aldossari H, Iqbal MS. Beliefs, awareness, use, and factors associated with herbal supplements usage among patients with chronic diseases-A cross-sectional insight from Alkharj, Saudi Arabia. PLoS One 2024; 19:e0295116. [PMID: 38232068 PMCID: PMC10793931 DOI: 10.1371/journal.pone.0295116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 11/14/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Herbal supplements (HSs) are used to treat a variety of diseases and ailments. Individuals with chronic diseases are at a higher risk of having adverse events and drug interactions from the use of HSs. AIM This study determined the beliefs, awareness, use, and factors associated with HSs usage among patients with chronic diseases in Alkharj, Saudi Arabia. METHOD A cross-sectional study was conducted among patients with chronic diseases between February and June 2019. Face-to-face interviews were conducted at various out-patient clinics in different hospitals. Patients diagnosed with chronic diseases were included in the study. Data were analyzed by descriptive, comparative, and inferential statistics using SAS ver. 9.4. RESULTS The study participants were consisted of 533 patients, with mean age 53.6 ±12.9 years. The most prevalent chronic diseases were diabetes mellitus (67.7%), followed by hypertension (54.8%), and hyperlipidemia (53.8%). Among the studied participants, 336 (63%) had used at least one HS, whereby the most commonly used HSs were ginger (74.7%), mint (72%), and cumin (66.7%). Almost 78% of HSs users did not consult any healthcare provider about their use. HSs use varied significantly between female and male participants (p<0.05), whereby 61.5% of female participants used HSs in comparison to the male participants (38.5%). Gender (AOR 0.328; 95% CI 0.139-0.772; p = 0.0107), number of chronic diseases (AOR 1.585; 95% CI 1.084-2.318; p = 0.0312), and hyperlipidemia (AOR 2.818; 95% CI 1.507-5.269; p = 0.0.0012) were the pure factors of HSs use among the studied patients. CONCLUSION The results of this study showed that HSs usage was high among patients with chronic diseases in Saudi Arabia. Concurrent usage of HSs with drugs should be well-discussed with healthcare providers to avoid potential adverse events or drug interactions especially among patients with chronic diseases.
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Affiliation(s)
- Ahmed A. Albassam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Arwa N. Alenzi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Pharmaceutical Care Services, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
| | - Norah K. Alhaqbani
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Pharmacy Department, General Directorate of Medical Services, Ministry of Interior, Al-Kharj, Saudi Arabia
| | - Fatimah K. Alhouty
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Pharmacy Department, Al-Kharj Military Industries Corporation Hospital, Al-Kharj, Saudi Arabia
| | - Ziyad S. Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed M. Alshehri
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Hussain Aldossari
- Department of Ophthalmology, Al-Kharj Military Industries Corporation Hospital, Al-Kharj, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Shah H, Nagi J, Khare S, Hassan H, Siu A. Limiting Factors in Implementing Pharmacovigilance Principles in the Elderly. Cureus 2023; 15:e36899. [PMID: 37128538 PMCID: PMC10148568 DOI: 10.7759/cureus.36899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
The overarching aim of pharmacovigilance is to ensure the safe and effective usage of medication across the population and optimise medicines through holistic considerations. However, within the heterogeneous elderly population, several unique factors are at play, limiting the ability of clinicians to fulfil this aim. A matured physiology influencing the response and effects of drugs, increased polypharmacy enabling drug-drug interactions, and greater consumption of concurrent herbal medicines predispose patients to harmful drug events. This increasingly multimorbid subpopulation requires complex pharmaceutical regimens encouraging inappropriate prescribing and medicine non-adherence leading to suboptimal therapy. Furthermore, restrictive practices in clinical trials commonly exclude elderly patients creating disparities from expected findings within a real-world setting. These issues create an environment where elderly patients are at a heightened risk of adverse drug events and clinicians are forced to make significant decisions from limited information. With projections showing that this demographic will continue growing in size, the true burden of these limiting factors is yet to be realised.
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Jairoun AA, Al-Hemyari SS, Shahwan M, Zyoud SH. Adulteration of Weight Loss Supplements by the Illegal Addition of Synthetic Pharmaceuticals. Molecules 2021; 26:molecules26226903. [PMID: 34833995 PMCID: PMC8621677 DOI: 10.3390/molecules26226903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/30/2021] [Accepted: 11/04/2021] [Indexed: 02/07/2023] Open
Abstract
Weight loss supplements that have illegal additives of pharmaceutical drugs or analogues have additional health risks, and customers may not be aware of what they are taking. This research is an essential investigation and quantification of illegally added pharmaceuticals or prescription medications, specifically fluoxetine, phenolphthalein, and sibutramine, in herbal weight loss supplements offered for sale in the United Arab Emirates (UAE). In this case, 137 weight loss supplements were collected and analyzed in this study. Reversed-phase high-performance liquid chromatography with UV absorption detection coupled to tandem mass spectrometry (RP-HPLC-MS/MS) analyses were used to determine the presence of the pharmaceutical chemicals. Among the weight loss supplements, 15.3% (95% CI: 9.2-21.4) contained undeclared sibutramine, 13.9% (95% CI: 8.01-19.7) contained undeclared phenolphthalein, and 5.1% (95% CI: 1.4-8.8) contained undeclared fluoxetine. Amongst all weight loss supplements, 17.5% (95% CI: 11.07-24) contained significant concentrations of either sibutramine, phenolphthalein, or fluoxetine. Whilst weight loss herbal supplements offered for sale in the UAE have relatively low percentages of undeclared pharmaceuticals, many people take several different supplements daily and may encounter quite high levels of combined exposure to toxic compounds.
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Affiliation(s)
- Ammar A. Jairoun
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Pulau Pinang 1800, Malaysia;
- Health and Safety Department, Dubai Municipality, Dubai P.O. Box 67, United Arab Emirates
- Correspondence: or
| | - Sabaa Saleh Al-Hemyari
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Pulau Pinang 1800, Malaysia;
- Pharmacy Department, Emirates Health Services Establishment, Dubai P.O. Box 1853, United Arab Emirates
| | - Moyad Shahwan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman P.O. Box 346, United Arab Emirates;
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Sa’ed H. Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine;
- Clinical Research Centre, An-Najah National University Hospital, Nablus 44839, Palestine
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Huang CY, Wu MY, Chang CL, Liao YC, Chen YY, Lin WC, Yen HR. Coprescription Trends in Western Medicine, Chinese Herbal Medicine and Dental Medicine among Older Adults in Taiwan from 1997 to 2013. Complement Ther Med 2021; 63:102782. [PMID: 34710559 DOI: 10.1016/j.ctim.2021.102782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/25/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Coprescription is a potential medical problem for older adults that could induce polypharmacy and subsequent complications. In Taiwan, Chinese herbal medicine (CHM) is popular among the older adults. Investigating the coprescription trends in Western medicine, CHM and dental medicine is important to avoid possible polypharmacy. METHODS We analyzed data from the Longitudinal Health Insurance Database 2000 (LHID 2000) in Taiwan. Patients ≥ 60 years old who received coprescription of Western medicine, CHM and drugs for dental care from 1997 to 2013 were included. The odds ratio (OR) and 95% confidence interval (95% CI) were estimated by a logistic regression model for evaluating the correlation between baseline characteristics and coprescription. RESULTS A total of 266,034 patients were included for the analysis. Most patients receiving coprescriptions lived in the northern Taiwan and with a monthly income lower than 20,000 new Taiwan dollars. The trends in older adults using Western medicine alone or CHM alone decreased over time, but the cohort using dental medicine alone had the opposite result. Decreased trends in coprescription with age were noted. The trends in the proportion of coprescription and the number of days of coprescription increased with the calendar year. Increased trends in the proportion of patients with coprescription were also found, except for the cohort of patients who used both Western medicine and CHM. Patients who were female, and aged 70-79 years were prone to receive coprescription. CONCLUSIONS Coprescription in older patients is not uncommon in Taiwan. Healthcare providers and policymakers should be aware of the complex coprescription pattern in the older adults.
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Affiliation(s)
- Chia-Yu Huang
- Department of Family Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan; School of Medicine, Tzu Chi University, Hualien 970, Taiwan; Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan
| | - Mei-Yao Wu
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; School of Post-baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan
| | - Chia-Ling Chang
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan; College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Yuan-Ching Liao
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan
| | - Ying-Yu Chen
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan
| | - Wu-Chou Lin
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 404, Taiwan.
| | - Hung-Rong Yen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung 404, Taiwan; Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 413, Taiwan.
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Taneri PE, Akis N, Karaalp A. Herbal product use patterns and possible herb-drug interactions among older adults in Turkey. J Herb Med 2021. [DOI: 10.1016/j.hermed.2021.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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The potential of drug-herbal interaction among patients with chronic diseases in Saudi Arabia. Complement Ther Clin Pract 2021; 43:101324. [PMID: 33765548 DOI: 10.1016/j.ctcp.2021.101324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 11/22/2022]
Abstract
AIMS This study aimed to estimate the prevalence of the potential drug-herbal interaction among patients with chronic diseases in Al-Kharj, Saudi Arabia and to explore factors associated with the potential of drug-herbal interaction. METHOD A cross-sectional study was conducted through interview-based questionnaire at outpatient clinics in Al-Kharj. The study included patients with chronic diseases who used herbal products. RESULTS This study included 336 patients in total. The mean age of participants was 52.4 ± 12.0 years, and their most-used medications were metformin, atorvastatin, and aspirin, while their most-used herbs were ginger (74.7%), mint (72%), and cumin (66.7%). In 310 out of 336 (92.26%) cases, at least one potential drug-herbal interaction was found, and most of these interactions (84%) were moderate. CONCLUSION A substantial percentage of potential drug-herbal interactions were found among patients with chronic diseases. Healthcare providers are encouraged to discuss the safety and efficacy of herbal products with their patients.
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Ananchaisarp T, Rungruang S, Theerakulpisut S, Kamsakul P, Nilbupha N, Chansawangphop N, Yiambunya J, Jarudamrongsak J, Prasertsri K. Usage of herbal medicines among the elderly in a primary care unit in Hat Yai, Songkhla province, Thailand. ASIAN BIOMED 2021; 15:35-42. [PMID: 37551299 PMCID: PMC10388782 DOI: 10.2478/abm-2020-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The prevalence of chronic diseases in the elderly is high, and some use herbal medicines instead of, or together with, conventional medicine. Herbal medicine usage may cause adverse events. Objectives To determine the prevalence of herbal medicine usage among the elderly attending a primary care unit (PCU) of Songklanagarind Hospital, a tertiary teaching hospital in Hat Yai, Songkhla province, Thailand, and associated factors, reasons for use, principles considered before use, perceived effects, and history of consultation with medical professionals concerning their herbal medicine usage. Methods We conducted a cross-sectional survey of a convenience sample of elderly patients who visited the PCU. Questionnaires were used to obtain data. Results We included 204 patients who met the eligibility criteria. About two-thirds were women, with a median age of 69.0 years. Most had underlying diseases and were educated. The all time prevalence of herbal medicine usage was 60.8%. Being educated was significantly associated with herbal medicine usage. Among 124 users, 79% did not consider any principles for safe use of herbal medicine, 63% had no knowledge of possible interactions with conventional medicines, and 73% had never been asked about their use of herbal medicines by their health care professionals. Conclusions There is a high prevalence of herbal medicine usage among the elderly Thai patients attending the PCU, especially by the educated. The majority did not consider the principles for safe use of herbal medicine. Health care providers should be more aware of herbal medicine usage and should increase their role in initiating a discussion about herbal medicine usage with elderly patients.
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Affiliation(s)
- Thareerat Ananchaisarp
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Supeecha Rungruang
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Saralee Theerakulpisut
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Peerada Kamsakul
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Nichapat Nilbupha
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Napat Chansawangphop
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Jirameth Yiambunya
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Jirayu Jarudamrongsak
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Kanokwan Prasertsri
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
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The Utilization of Complementary and Alternative Medicine among Saudi Older Adults: A Population-Based Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4357194. [PMID: 32831865 PMCID: PMC7428939 DOI: 10.1155/2020/4357194] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is an integral part of patients' therapeutic experience worldwide. Among Saudi older adults, less is known about CAM utilization. OBJECTIVES To determine the prevalence, patterns, and factors associated with CAM utilization among SOA. METHODS In the Saudi National Survey for Elderly Health (SNSEH), subjects were asked about CAM use during the last twelve months before the interview. CAM use was defined as any use of herbal products, acupuncture, bloodletting, cauterization, medical massage, bones manual manipulation, honey, or religious rituals. Demographic characteristics included gender, age, marital status, region, educational level, and residence area. In addition, multiple comorbidities were included as possible factors that may be associated with CAM use. Multivariable logistic regression was used to explore factors associated with CAM utilization. All statistical analyses were done using STATA v.14. RESULTS Out of 2946 respondents, 50.4% were males, the mean age was 70.3 ± 8.3 years, and 70% were illiterate. CAM use was prevalent (62.5%). The most common CAM types were herbal products (25.4%), acupuncture (21.2%), bloodletting (12%), honey (9.5%), cauterization (7.4%), medical massage and bones manual manipulation (4%), and traditional bone setting (2.1%). In the multivariable regression, age, gender, and marital status did not have an impact on the odds of using CAM. Subjects from rural areas were 2.92 times more likely to use CAM compared with subjects in urban areas (OR = 2.92; 95%CI: 2.28-3.75). Subjects with metabolic disorders (OR = 0.50; 95% CI: 0.42-0.60) or kidney disease were less likely to use CAM (OR = 0.30; 95%CI: 0.14-0.64). About pain, CAM is used more in neck pain (OR = 1.69; 95%CI: 1.30-2.21) and also used in back pain (OR = 1.22; 95%CI: 1.03-1.46). CONCLUSIONS CAM use was very prevalent among SOA. Clinicians and pharmacists must ask about CAM use among older adults as many of CAM may interact with patients medications.
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Feltrin C, Farias IV, Sandjo LP, Reginatto FH, Simões CMO. Effects of Standardized Medicinal Plant Extracts on Drug Metabolism Mediated by CYP3A4 and CYP2D6 Enzymes. Chem Res Toxicol 2020; 33:2408-2419. [DOI: 10.1021/acs.chemrestox.0c00182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Clarissa Feltrin
- Programa de Pós-Graduação em Farmácia, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, 88040-900, Santa Catarina, Brazil
| | - Ingrid Vicente Farias
- Programa de Pós-Graduação em Farmácia, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, 88040-900, Santa Catarina, Brazil
| | - Louis Pergaud Sandjo
- Departamento de Química, Universidade Federal de Santa Catarina, Florianópolis, 88040-900, Santa Catarina, Brazil
| | - Flávio Henrique Reginatto
- Programa de Pós-Graduação em Farmácia, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, 88040-900, Santa Catarina, Brazil
| | - Cláudia Maria Oliveira Simões
- Programa de Pós-Graduação em Farmácia, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, 88040-900, Santa Catarina, Brazil
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Dastjerdi AG, Akhgari M, Kamali A, Mousavi Z. Principal component analysis of synthetic adulterants in herbal supplements advertised as weight loss drugs. Complement Ther Clin Pract 2018. [DOI: https://doi.org/10.1016/j.ctcp.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Principal component analysis of synthetic adulterants in herbal supplements advertised as weight loss drugs. Complement Ther Clin Pract 2018; 31:236-241. [PMID: 29705461 DOI: 10.1016/j.ctcp.2018.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/24/2022]
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Agbabiaka TB, Wider B, Watson LK, Goodman C. Concurrent Use of Prescription Drugs and Herbal Medicinal Products in Older Adults: A Systematic Review. Drugs Aging 2018; 34:891-905. [PMID: 29196903 PMCID: PMC5730633 DOI: 10.1007/s40266-017-0501-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background The use of herbal medicinal products (HMPs) is common among older adults; however, little is known about concurrent use with prescription drugs, as well as potential interactions associated with such combinations. Objective The aim of this systematic review was to identify and evaluate the literature on concurrent prescription and HMP use among older adults to assess prevalence, patterns, potential interactions and factors associated with this use. Methods Systematic searches were conducted in the MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, Web of Science and Cochrane databases from inception to May 2017 for studies reporting concurrent use of prescription medicines with HMPs in adults ≥ 65 years of age. Quality was assessed using the Joanna Briggs Institute checklists. And the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) three-stage approach to mixed method research was used to synthesise data. Results Twenty-two studies were included. A definition of HMPs or what was considered an HMP was frequently missing. Prevalence of concurrent use by older adults varied widely between 5.3 and 88.3%. Prescription medicines most combined with HMPs were antihypertensive drugs, β-blockers, diuretics, antihyperlipidemic agents, anticoagulants, analgesics, antihistamines, antidiabetics, antidepressants and statins. The HMPs most frequently used were Ginkgo biloba, garlic, ginseng, St John’s wort, Echinacea, saw palmetto, evening primrose oil and ginger. Potential risks of bleeding due to the use of Ginkgo biloba, garlic or ginseng with aspirin or warfarin was the most reported herb–drug interaction. Some data suggest being female, and having a lower household income and less than a high-school education were associated with concurrent use. Conclusion The prevalence of concurrent prescription drugs and HMP use among older adults is substantial and potential interactions have been reported. Knowledge of the extent and manner in which older adults combine prescription drugs will aid healthcare professionals in appropriately identifying and managing patients at risk. Systematic Review Registration Number: PROSPERO 2014:CRD42014009091. Electronic supplementary material The online version of this article (10.1007/s40266-017-0501-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Taofikat B Agbabiaka
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK. .,Patient Safety, Medical Directorate, NHS Improvement, London, UK.
| | - Barbara Wider
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Leala K Watson
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
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Dubey S, Mitra K, De BK, Mondal A, Bishayee A. Effects of Paederia foetida and its Bioactive Phytochemical Constituent Lupeol on Hepatic Phase I Drug Metabolism. Nat Prod Commun 2017. [DOI: 10.1177/1934578x1701200906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There are many possible complications associated with the concomitant use of herbs and medications, but limited information is available on herb-herb or herb-drug interactions. Paederia foetida Linn. (family: Rubiaceae) is utilized in the Indian traditional medicine. It exhibits various pharmacological properties, such as antidiabetic, analgesic, anti-inflammatory, antimicrobial, hepatoprotective, anthelmintic, antiulcer and antioxidant activities. The purpose of the present work was to investigate the inhibitory potential of the P. foetida ethanolic extract and its bioactive constituent lupeol on hepatic phase I drug metabolizing enzymes. The high performance thin layer chromatography was performed for qualitative analysis of various extracts of P. foetida. The effects of P. foetida extract on rat liver microsomes (RLMs) and individual cytochrome P-450 (CYP) isozymes (CYP3A4 and CYP2D6) were investigated using CYP450-carbon monoxide complex assay and fluorescence microplate assay, respectively. The ethanolic extract and lupeol (both at a concentration of 100 μg/mL) showed 45±3.3 and 44±3.8% inhibition of rat liver microsomes, respectively, which were significantly less than that of known inhibitor ketoconazole (74±5.4% inhibition at 100 μg/mL). The 50% inhibitory concentrations (IC50) of ethanolic extract on CYP3A4 and CYP2D6 were 78±2.3 and 82±3.1 μg/mL, respectively, whereas its major bioactive constituent lupeol has IC50 values of 83±2.0 and 84±2.6 μg/mL for CYP3A4 and CYP2D6, respectively. The results were of lesser magnitude compared to known inhibitors, ketoconazole and quinidine, respectively. The current study revealed that P. foetida has less inhibitory potential in comparison to that of known inhibitors, ketoconazole and quinidine, on two major drug metabolizing isozymes, CYP3A4 and CYP2D6. Thus, the use of P. foetida as a complementary or alternative medicine may be safe in regard to herb-drug interactions.
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Affiliation(s)
- Sourabh Dubey
- Department of Pharmacology, Bengal Institute of Pharmaceutical Sciences, Kalyani - 741 235, Nadia, West Bengal, India
| | - Kuntal Mitra
- Department of Pharmacology, Bengal Institute of Pharmaceutical Sciences, Kalyani - 741 235, Nadia, West Bengal, India
| | - Bijoy Kumar De
- Department of Pharmacology, Bengal Institute of Pharmaceutical Sciences, Kalyani - 741 235, Nadia, West Bengal, India
| | - Arijit Mondal
- Department of Pharmaceutical Chemistry, Bengal College of Pharmaceutical Sciences and Research, Durgapur - 713 212, Burdwan, West Bengal, India
| | - Anupam Bishayee
- Department of Pharmaceutical Sciences, College of Pharmacy, Larkin University, Miami, Florida 33169, USA
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Therapeutic Risk and Benefits of Concomitantly Using Herbal Medicines and Conventional Medicines: From the Perspectives of Evidence Based on Randomized Controlled Trials and Clinical Risk Management. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:9296404. [PMID: 28491115 PMCID: PMC5405391 DOI: 10.1155/2017/9296404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/22/2017] [Accepted: 04/02/2017] [Indexed: 12/30/2022]
Abstract
Despite increased awareness of the potential of herb-drug interactions (HDIs), the lack of rigorous clinical evidence regarding the significance provides a challenge for clinicians and consumers to make rational decisions about the safe combination of herbal and conventional medicines. This review addressed HDIs based on evidence from randomized controlled trials (RCTs). Literature was identified by performing a PubMed search till January 2017. Risk description and clinical risk management were described. Among 74 finally included RCTs, 17 RCTs (22.97%) simply addressed pharmacodynamic HDIs. Fifty-seven RCTs (77.03%) investigated pharmacokinetic HDIs and twenty-eight of them showed potential or actual clinical relevance. The extent of an HDI may be associated with the factors such as pharmacogenomics, dose of active ingredients in herbs, time course of interaction, characteristics of the object drugs (e.g., administration routes and pharmacokinetic profiles), modification of herbal prescription compositions, and coexistence of inducers and inhibitors. Clinical professionals should enhance risk management on HDIs such as increasing awareness of potential changes in therapeutic risk and benefits, inquiring patients about all currently used conventional medicines and herbal medicines and supplements, automatically detecting highly substantial significant HDI by computerized reminder system, selecting the alternatives, adjusting dose, reviewing the appropriateness of physician orders, educating patients to monitor for drug-interaction symptoms, and paying attention to follow-up visit and consultation.
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Enioutina EY, Salis ER, Job KM, Gubarev MI, Krepkova LV, Sherwin CMT. Herbal Medicines: challenges in the modern world. Part 5. status and current directions of complementary and alternative herbal medicine worldwide. Expert Rev Clin Pharmacol 2016; 10:327-338. [PMID: 27923318 DOI: 10.1080/17512433.2017.1268917] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Herbal medicine (HM) use is growing worldwide. Single herb preparations, ethnic and modern HM formulations are widely used as adjunct therapies or to improve consumer wellbeing. Areas covered: This final part in the publication series summarizes common tendencies in HM use as adjunct or alternative medicine, education of healthcare professionals and consumers, current and proposed guidelines regulating of production. We discuss potential HM-HM and HM-drug interactions that could lead to severe adverse events in situations where HMs are taken without proper medical professional oversight. Expert commentary: A number of serious problems have arisen with the steady global increase in HM use. HM interaction with conventional drugs (CD) may result in inadequate dosing of CD or adverse reactions; HM-HM interaction within herbal supplements could lead to toxicity of formulations. Inadequate education of clinicians and patients regarding medicinal properties of HMs must be addressed regionally and globally to ensure consumer safety.
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Affiliation(s)
- Elena Yu Enioutina
- a Division of Clinical Pharmacology, the Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , UT , USA.,b Division of Microbiology and Immunology, the Department of Pathology , University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Emma R Salis
- c New Zealand School of Pharmacy , University of Otago , Dunedin , New Zealand
| | - Kathleen M Job
- a Division of Clinical Pharmacology, the Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , UT , USA
| | | | - Lubov V Krepkova
- e Division of Toxicology, Center of Medicine , All-Russian Research Institute of Medicinal and Aromatic Plants (VILAR) , Moscow , Russia
| | - Catherine M T Sherwin
- a Division of Clinical Pharmacology, the Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , UT , USA.,f Department of Pharmacology and Toxicology , University of Utah , Salt Lake City , UT , USA
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