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Sile I, Teterovska R, Onzevs O, Ardava E. Safety Concerns Related to the Simultaneous Use of Prescription or Over-the-Counter Medications and Herbal Medicinal Products: Survey Results among Latvian Citizens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6551. [PMID: 37623137 PMCID: PMC10454617 DOI: 10.3390/ijerph20166551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
The use of herbal medicines is increasing worldwide. While the safety profile of many herbal medicines is promising, the data in the literature show important interactions with conventional drugs that can expose individual patients to high risk. The aim of this study was to investigate the experience of the use of herbal medicines and preparations and the risks of interactions between herbal and conventional medicines among Latvian citizens. Data were collected between 2019 and 2021 using a structured questionnaire designed for pharmacy customers in Latvia. Electronic databases such as Drugs.com, Medscape, and European Union herbal monographs were reviewed for the risk of drug interactions and potential side effects when herbal medicines were involved. The survey included 504 respondents. Of all the participants, 77.8% used herbal preparations. Most of the participants interviewed used herbal remedies based on the recommendation of the pharmacist or their own initiative. A total of 38.3% found the use of herbal remedies safe and harmless, while 57.3% of respondents regarded the combination of herbal and regular drugs as unsafe. The identified herbal medicines implicated in the potential risk of serious interactions were grapefruit, St. John's wort, and valerian. As the risks of herb-drug interactions were identified among the respondents, in the future, both pharmacy customers and healthcare specialists should pay more attention to possible herb-drug interactions of over-the-counter and prescription medications.
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Affiliation(s)
- Inga Sile
- Department of Applied Pharmacy, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Latvian Institute of Organic Synthesis, 21 Aizkraukles Street, LV-1006 Riga, Latvia
| | - Renate Teterovska
- Department of Pharmaceutical Chemistry, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia;
- Department of Pharmacy, Riga Stradins University Red Cross Medical College, 5 J. Asara Street, LV-1009 Riga, Latvia;
| | - Oskars Onzevs
- Department of Commerce, Turība University, 68 Graudu Street, LV-1058 Riga, Latvia;
| | - Elita Ardava
- Department of Pharmacy, Riga Stradins University Red Cross Medical College, 5 J. Asara Street, LV-1009 Riga, Latvia;
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Gupta S, Dhawan J, McColl MA, Smith K, McColl A. Use and costs of non-prescription medications among people with spinal cord injury. Arch Phys Med Rehabil 2022; 103:1279-1284. [PMID: 35143746 DOI: 10.1016/j.apmr.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study objectives were to assess the prevalence of, and factors associated with the use and costs of non-prescription medications among people with spinal cord injury. DESIGN Observational design; a cross-sectional online survey Setting: Community in Canada Participants: Individuals with spinal cord injury Interventions: Not applicable Main Outcome Measures: Not applicable Results: A total of 160 individuals participated in this study. Of all study participants, 83% reported that they used at least one non-prescription medication over the last 12 months. On an average, participants spent $52 per month on non-prescription medications. The average use and monthly expenditure did not differ significantly by age, sex, or injury parameters. Vitamins and minerals were most commonly used and constituted 62% of all non-prescription medications listed by the participants. Musculoskeletal issues were the most common health problems for which non-prescription medications were used. CONCLUSION Non-prescription medications are a common part of therapeutic drug regimens for people with spinal cord injuries and are purchased as an out-of-pocket expense. These products may or may not have established benefits. Knowledge about the use of non-prescription medications may help prescribers to improve drug safety, medication affordability, and quality of pharmacotherapy for their patients with spinal cord injury.
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Affiliation(s)
- Shikha Gupta
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada.
| | | | - Mary Ann McColl
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Karen Smith
- Department of Physical Medicine and Rehabilitation, School of Medicine, Queen's University, Kingston, Canada
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Mitchell CA, Dever JT, Gafner S, Griffiths JC, Marsman DS, Rider C, Welch C, Embry MR. The Botanical Safety Consortium: A public-private partnership to enhance the botanical safety toolkit. Regul Toxicol Pharmacol 2021; 128:105090. [PMID: 34863907 DOI: 10.1016/j.yrtph.2021.105090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 11/29/2021] [Indexed: 12/31/2022]
Abstract
Botanical dietary supplement use is widespread and growing, therefore, ensuring the safety of botanical products is a public health priority. This commentary describes the mission and objectives of the Botanical Safety Consortium (BSC) - a public-private partnership aimed at enhancing the toolkit for conducting the safety evaluation of botanicals. This partnership is the result of a Memorandum of Understanding between the US FDA, the National Institute of Environmental Health Sciences, and the Health and Environmental Sciences Institute. The BSC serves as a global forum for scientists from government, academia, consumer health groups, industry, and non-profit organizations to work collaboratively on adapting and integrating new approach methodologies (NAMs) into routine botanical safety assessments. The objectives of the BSC are to: 1) engage with a group of global stakeholders to leverage scientific safety approaches; 2) establish appropriate levels of chemical characterization for botanicals as complex mixtures; 3) identify pragmatic, fit-for-purpose NAMs to evaluate botanical safety; 4) evaluate the application of these tools via comparison to the currently available safety information on selected botanicals; 5) and integrate these tools into a framework that can facilitate the evaluation of botanicals. Initially, the BSC is focused on oral exposure from dietary supplements, but this scope could be expanded in future phases of work. This commentary provides an overview of the structure, goals, and strategies of this initiative and insights regarding our first objectives, namely the selection and prioritization of botanicals based on putative toxicological properties.
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Affiliation(s)
| | | | | | | | | | - Cynthia Rider
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Cara Welch
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Michelle R Embry
- Health and Environmental Sciences Institute, Washington, DC, USA
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Safari D, DeMarco EC, Scanlon L, Grossberg GT. Over-The-Counter Remedies in Older Adults: Patterns of Use, Potential Pitfalls, and Proposed Solutions. Clin Geriatr Med 2021; 38:99-118. [PMID: 34794706 DOI: 10.1016/j.cger.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Over-the-counter (OTC) products such as pharmaceuticals, dietary supplements, vitamins, and herbal remedies are widely available and copiously used by older adults for health maintenance and symptom management. Owing to physiology, multimorbidity, and polypharmacy, this population is particularly vulnerable to inappropriate use of OTC products, adverse effects, and drug interactions. While OTC pharmaceuticals are bound by FDA-approved standards, dietary supplements are regulated differently, resulting in variable quality and increased possibility for adulteration. Internationally, standards for OTC products vary widely. Accessible educational information, improved provider-patient communication, and revision of regulatory policy could improve safety for older adult users of OTC products.
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Affiliation(s)
- Delavar Safari
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, School of Medicine, Saint Louis University, 1438 S Grand Boulevard, St Louis, MO 63104, USA.
| | - Elisabeth C DeMarco
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, School of Medicine, Saint Louis University, 1438 S Grand Boulevard, St Louis, MO 63104, USA
| | - Lillian Scanlon
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, School of Medicine, Saint Louis University, 1438 S Grand Boulevard, St Louis, MO 63104, USA
| | - George T Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, School of Medicine, Saint Louis University, 1438 S Grand Boulevard, St Louis, MO 63104, USA
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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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Gbeasor-Komlanvi FA, Tchankoni MK, Adjonko AB, Zida-Compaore WIC, Kouakou NK, Belo M, Agbonon A, Ekouevi DK. Prevalence and factors associated with poor self-rated health among communitydwelling older adults in Lomé (Togo) in 2019. J Public Health Afr 2020; 11:1302. [PMID: 33209236 PMCID: PMC7649730 DOI: 10.4081/jphia.2020.1302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/17/2020] [Indexed: 11/24/2022] Open
Abstract
The number of older adults is increasing worldwide, including in sub-Saharan Africa (SSA). However, there is a paucity of data on the overall health status of older adults living in SSA. To assess the prevalence and factors associated with poor Self-Rated Health (SRH) among community-dwelling older adults in Lomé, Togo, we conducted a cross-sectional study from January to June 2019 in Lomé among community-dwelling older adults aged 50 years and older. A 30- minute questionnaire was used to collect socio-demographic characteristics, medical history, patterns of medication use and use of herbal products and dietary supplements during a face-to-face interview. SRH was assessed using a single item: Overall, you would say that your health is… (1) excellent, (2) very good, (3) good, (4) fair and (5) poor with response fair or poor defining poor SRH. A total of 344 respondents with median age 63 years, (IQR: 55-72) were enrolled in the study. Women represented 57.6% of the sample. Overall prevalence of poor SRH was 56.4% (95%CI: 51.0-61.9) and was the highest among females (62.6% vs 47.9%; P=0.007) and participants ³60 years (61.5% vs 51.1%; P=0.021). Female sex, aged ≥60 years, osteoarthritis, hospitalization within the 12 months preceding the survey, polypharmacy, and the use of herbal products were factors associated with poor SRH (P<0.05). More than half of community- dwelling older adults had poor SRH in Lomé. Further studies are needed to guide policymakers in their efforts to design and implement meaningful policies to improve older adults health conditions.
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Affiliation(s)
| | | | | | | | | | - Mofou Belo
- Faculty of Health Sciences, University of Lomé
| | - Amegnona Agbonon
- Laboratory of Physiology and Pharmacology, Lomé, University of Lomé, Togo
| | - Didier Koumavi Ekouevi
- Faculty of Health Sciences, University of Lomé
- African Center of Research in Epidemiology and Public Health, Lomé
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The Culture of Herbal Preparations Among Pregnant Women: A Remedy or a Suicide Potion? A Case Report and Mini Review. Case Rep Pathol 2020; 2020:6186147. [PMID: 32231835 PMCID: PMC7091521 DOI: 10.1155/2020/6186147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
In general, use of herbal remedies and preparations is on the ascendency in recent times among the general population and especially in young pregnant women, and this may be very dangerous due to adverse effects and interactions with drugs. A survey by the World Health Organization revealed that 70-80% of the world population resort to nonconventional medicines especially, herbal medicines in their primary healthcare. A lot of work has been done on the positive effects of herbs on the human body but very few publications on the potential side effects of consuming crude herbal preparations especially among pregnant women or the awareness of the medical team of this problem. Herbal remedies may come with many adverse effects and potentially serious interactions with some conventional medications. However, little is known about the dangers associated with consumption of herbal remedies by pregnant patients. Herbal medicines like their orthodox counterparts act through some mechanisms to bring about their curative effects in the body, and this usually goes out of order when these remedies interact with chemical drugs as a result of a combination of both by the victims. This is a case study to review the use of herbal medicine products among pregnant women, especially adolescent girls for abortive purposes, and also attempts to discuss some of the dangers associated with the use of herbal medicinal products together with conventional drugs during pregnancy.
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Gbeasor-Komlanvi FA, Zida-Compaore WIC, Dare IH, Diallo A, Darre TP, Potchoo Y, Belo M, Ekouevi DK. Medication Consumption Patterns and Polypharmacy among Community-Dwelling Elderly in Lomé (Togo) in 2017. Curr Gerontol Geriatr Res 2020; 2020:4346035. [PMID: 32351556 PMCID: PMC7178761 DOI: 10.1155/2020/4346035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/05/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the sub-Saharan African, region of the world with a fast growing aging population and where the use of herbal products is very common, there is a paucity of data on medication consumption patterns among elderly people. The objective of this study was to assess the prevalence of polypharmacy and its associated factors among community-dwelling elderly in Lomé, Togo, in 2017. METHODS A cross-sectional study was conducted from March to June 2017 in Lomé, Togo among people aged 60 years and older. The Respondent Driven Sampling method was used to recruit participants. Data on socio-demographic characteristics and medication consumption patterns, including the use of medicinal plants and dietary supplements, were collected using a standardized questionnaire during a face-to-face interview at participants' home. Descriptive and binary logistic regression analyses were performed. RESULTS A total of 370 participants with median age 65 years, (IQR: 62-71) were enrolled in the study. Almost three elderly in five (57.6%) were multimorbid (had two or more chronic diseases). Conventional drugs (78.4%), medicinal plants (14.3%) and other dietary supplements (9.5%) were used by participants. The prevalence of polypharmacy was 22.7% (95% CI: 18.5-27.3%). Concurrent use of conventional drugs and medicinal plants or other dietary supplements was observed among 17.0% of participants and 67.3% reported self-medication. Multimorbidity (aOR = 4.55; 95% CI: [2.42-8.54]) and female sex (aOR = 1.86; 95% CI: [1.00-3.47]) were associated with polypharmacy. CONCLUSION One elderly in five uses five or more medications in Togo. Further studies are needed to assess drug-drug interactions and herb-drug interactions among this population.
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Affiliation(s)
- Fifonsi A. Gbeasor-Komlanvi
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, BP 4089, Togo
| | | | - Ikpindi H. Dare
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | | | - Tchin P. Darre
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | - Yao Potchoo
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | - Mofou Belo
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | - Didier K. Ekouevi
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, BP 4089, Togo
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Welz AN, Emberger-Klein A, Menrad K. The importance of herbal medicine use in the German health-care system: prevalence, usage pattern, and influencing factors. BMC Health Serv Res 2019; 19:952. [PMID: 31823758 PMCID: PMC6905107 DOI: 10.1186/s12913-019-4739-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Prevalence rates for herbal medicine (HM) have been increasing worldwide. However, little is known about prevalence, user characteristics, usage pattern and factors influencing HM usage for the general German population. Methods A nationwide online survey on HM usage was conducted in Germany. The 2906 participants were categorised into three groups: the ones who used HM in the last 12 months, the ones who did not use HM in the last 12 months but in their lifetime, and the ones who did not use HM until now. Data were analysed by descriptive statistics, Chi Square tests and binary hierarchical logistic regression analyses. Results Prevalence rates of HM were found to be very high for the general German population. Self-medication appeared as a common praxis, when at the same time HM users responded that they do not inform their physician about it, rate their knowledge about HM as somewhat poor, and use the internet as the most frequent source of information. The HM user in the last 12 months was found to include people that were more likely female, highly educated, privately insured, employed, and engaged in a more health-oriented lifestyle. While certain sociodemographic- and health-related variables influence HM usage vs. non-usage, they explain variance only to a limited extent. For distinguishing the user in the last 12 months vs. the less recent user who did not use HM in the last 12 months, ratings on different reasons for HM usage were found to perform better as predictors than sociodemographic- and health-related variables. Conclusions This study demonstrated that HM usage plays an essential role in the German health-care system. Furthermore, the HM usage pattern may be potentially harmful for patients, as it included self-medication, little knowledge on interaction- and side-effects of HM, and a lack of communication with physicians about the usage. Moreover, prediction of HM usage in the previous year is impacted by variables beyond conventional sociodemographic- and health-related ones. In view of the high prevalence rates of HM in Germany, medical as well as health service providers should be aware of these issues.
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Affiliation(s)
- Alexandra N Welz
- Technical University of Munich, TUM Campus Straubing for Biotechnology and Sustainability, Chair of Marketing and Management of Biogenic Resources, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315, Straubing, Germany
| | - Agnes Emberger-Klein
- Technical University of Munich, TUM Campus Straubing for Biotechnology and Sustainability, Chair of Marketing and Management of Biogenic Resources, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315, Straubing, Germany
| | - Klaus Menrad
- Technical University of Munich, TUM Campus Straubing for Biotechnology and Sustainability, Chair of Marketing and Management of Biogenic Resources, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315, Straubing, Germany.
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Agbabiaka TB, Spencer NH, Khanom S, Goodman C. Prevalence of drug-herb and drug-supplement interactions in older adults: a cross-sectional survey. Br J Gen Pract 2018; 68:e711-e717. [PMID: 30249608 PMCID: PMC6145997 DOI: 10.3399/bjgp18x699101] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/08/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Polypharmacy is common among older adults, with increasing numbers also using prescription drugs with herbal medicinal products (HMPs) and dietary supplements. There is no reliable evidence from the UK on concurrent use of HMPs and dietary supplements with prescription drugs in older adults. AIM To establish prevalence of concurrent prescription drugs, HMPs, and dietary supplements among UK community-dwelling older adults and identify potential interactions. DESIGN AND SETTING Cross-sectional survey of older adults registered at two general practices in South East England. METHOD A questionnaire asking about prescription medications, HMPs, and sociodemographic information was posted to 400 older adults aged ≥65 years, identified as taking ≥1 prescription drug. RESULTS In total 155 questionnaires were returned (response rate = 38.8%) and the prevalence of concurrent HMPs and dietary supplements with prescriptions was 33.6%. Females were more likely than males to be concurrent users (43.4% versus 22.5%; P = 0.009). The number of HMPs and dietary supplements ranged from 1 to 8, (mean = 3, median = 1; standard deviation = 1.65). The majority of concurrent users (78.0%) used dietary supplements with prescription drugs. The most commonly used dietary supplements were cod liver oil, glucosamine, multivitamins, and vitamin D. Others (20.0%) used only HMPs with prescription drugs. Common HMPs were evening primrose oil, valerian, and Nytol Herbal® (a combination of hops, gentian, and passion flower). Sixteen participants (32.6%) were at risk of potential adverse drug interactions. CONCLUSION GPs should routinely ask questions regarding herbal and supplement use, to identify and manage older adults at potential risk of adverse drug interactions.
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Affiliation(s)
- Taofikat B Agbabiaka
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield; evidence & evaluation lead, patient safety, Medical Directorate, NHS Improvement, London
| | - Neil H Spencer
- Hertfordshire Business School, University of Hertfordshire, de Havilland Campus, Hatfield
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Cybulski M, Cybulski L, Krajewska-Kulak E, Orzechowska M, Cwalina U. Preferences and attitudes of older adults of Bialystok, Poland toward the use of over-the-counter drugs. Clin Interv Aging 2018; 13:623-632. [PMID: 29692605 PMCID: PMC5901153 DOI: 10.2147/cia.s158501] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose The aim of the study was to assess preferences and attitudes toward the use of over-the-counter (OTC) drugs among residents of Bialystok aged 60 or older. Patients and methods The study included 170 people, inhabitants of Bialystok aged over 60: 85 students of the University of a Healthy Senior and the University of Psychogeriatric Prophylaxis, and 85 students of the University of the Third Age in Bialystok. The study made use of a diagnostic survey conducted via a questionnaire prepared by the authors. Results The vast majority of respondents bought OTC drugs for own use. About one-third of the respondents from each analyzed group bought OTC drugs less often than once every 3 months. Over half of the respondents bought OTC drugs due to a cold. A majority of the respondents were of the opinion that OTC drugs should be sold only in pharmacies. Over 40% of seniors took 1 OTC drug regularly. Most respondents also took vitamins and supplements. The main sources of information on OTC drugs for the studied seniors were their doctor and pharmacist. Respondents did not always consult the treatment method with a doctor or pharmacist. Over half of the respondents familiarized themselves with the contents of the OTC drug package leaflet. Over three-quarters of the respondents were familiar with drug disposal methods; however, despite declarations of being familiar with these principles, a significant percentage did not bring back medication to a pharmacy or clinic, or threw the drugs into the trash. Conclusion Our study found that in our sample there were many OTC drug consumers who did not always demonstrate responsible attitudes toward using this group of drugs. Thus, older people should be educated on the possible adverse effects of taking OTC drugs without consulting a doctor or pharmacist as well as basic drug disposal principles. Furthermore, legislation should be introduced that will limit the wide availability of OTC drugs, particularly to the elderly; and thus, lower the costs of hospitalization and outpatient treatment of this age group. Also, a wider-reaching study should be conducted. It should include a larger group of elderly people as well as information on intake of prescribed medications in order to be able to determine the frequency of drug consumption in this population, as well as seniors' preferences and attitudes in this regard.
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Affiliation(s)
- Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Lukasz Cybulski
- National Security Student, Faculty of Social Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Elzbieta Krajewska-Kulak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Magda Orzechowska
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Urszula Cwalina
- Department of Statistics and Medical Informatics, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
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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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Welz AN, Emberger-Klein A, Menrad K. Why people use herbal medicine: insights from a focus-group study in Germany. Altern Ther Health Med 2018. [PMID: 29544493 DOI: 10.1186/s12906-018-2160-6]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of herbal medicine, as one element of complementary and alternative medicine, is increasing worldwide. Little is known about the reasons for and factors associated with its use. This study derives insights for the use of herbal medicine in Germany regarding the usage aims, role played by the type of illness, reasons for preferred usage and sources of information. METHODS Using a qualitative methodological approach, six focus groups (n = 46) were conducted. Two groups with young, middle-aged and elderly participants, respectively. After audiotaping and verbatim transcription, the data were analysed with a qualitative content analysis. RESULTS We found that treating illnesses was the most frequently discussed aim for using herbal medicine over all age groups. Preventing illnesses and promoting health were less frequently mentioned overall, but were important for elderly people. Discussions on herbal medicine were associated with either mild/moderate diseases or using herbal medicine as a starting treatment before applying conventional medicine. In this context, participants emphasized the limits of herbal medicine for severe illnesses. Dissatisfaction with conventional treatment, past good experiences, positive aspects associated with herbal medicine, as well as family traditions were the most commonly-mentioned reasons why herbal medicine was preferred as treatment. Concerning information sources, independent reading and family traditions were found to be equally or even more important than consulting medicinal experts. CONCLUSIONS Although herbal medicine is used mostly for treating mild to moderate illnesses and participants were aware of its limits, the combination of self-medication, non-expert consultation and missing risk awareness of herbal medicine is potentially harmful. This is particularly relevant for elderly users as, even though they appeared to be more aware of health-related issues, they generally use more medicine compared to younger ones. In light of our finding that dissatisfaction with conventional medicine was the most important reason for a preferred use of herbal medicine, government bodies, doctors, and pharmaceutical companies need to be aware of this problem and should aim to establish a certain level of awareness among users concerning this issue.
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Affiliation(s)
- Alexandra N Welz
- TUM Campus Straubing for Biotechnology and Sustainability, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315, Straubing, Germany
| | - Agnes Emberger-Klein
- TUM Campus Straubing for Biotechnology and Sustainability, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315, Straubing, Germany
| | - Klaus Menrad
- TUM Campus Straubing for Biotechnology and Sustainability, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315, Straubing, Germany.
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Welz AN, Emberger-Klein A, Menrad K. Why people use herbal medicine: insights from a focus-group study in Germany. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:92. [PMID: 29544493 PMCID: PMC5855977 DOI: 10.1186/s12906-018-2160-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 03/07/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The use of herbal medicine, as one element of complementary and alternative medicine, is increasing worldwide. Little is known about the reasons for and factors associated with its use. This study derives insights for the use of herbal medicine in Germany regarding the usage aims, role played by the type of illness, reasons for preferred usage and sources of information. METHODS Using a qualitative methodological approach, six focus groups (n = 46) were conducted. Two groups with young, middle-aged and elderly participants, respectively. After audiotaping and verbatim transcription, the data were analysed with a qualitative content analysis. RESULTS We found that treating illnesses was the most frequently discussed aim for using herbal medicine over all age groups. Preventing illnesses and promoting health were less frequently mentioned overall, but were important for elderly people. Discussions on herbal medicine were associated with either mild/moderate diseases or using herbal medicine as a starting treatment before applying conventional medicine. In this context, participants emphasized the limits of herbal medicine for severe illnesses. Dissatisfaction with conventional treatment, past good experiences, positive aspects associated with herbal medicine, as well as family traditions were the most commonly-mentioned reasons why herbal medicine was preferred as treatment. Concerning information sources, independent reading and family traditions were found to be equally or even more important than consulting medicinal experts. CONCLUSIONS Although herbal medicine is used mostly for treating mild to moderate illnesses and participants were aware of its limits, the combination of self-medication, non-expert consultation and missing risk awareness of herbal medicine is potentially harmful. This is particularly relevant for elderly users as, even though they appeared to be more aware of health-related issues, they generally use more medicine compared to younger ones. In light of our finding that dissatisfaction with conventional medicine was the most important reason for a preferred use of herbal medicine, government bodies, doctors, and pharmaceutical companies need to be aware of this problem and should aim to establish a certain level of awareness among users concerning this issue.
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Affiliation(s)
- Alexandra N. Welz
- TUM Campus Straubing for Biotechnology and Sustainability, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315 Straubing, Germany
| | - Agnes Emberger-Klein
- TUM Campus Straubing for Biotechnology and Sustainability, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315 Straubing, Germany
| | - Klaus Menrad
- TUM Campus Straubing for Biotechnology and Sustainability, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315 Straubing, Germany
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Varlı M, Bahşi R, Doğan Ş, Uysal H, Subaşı Ş, Toper M, Peksarı S, Keskin S, Mut Sürmeli D, Turgut T, Öztorun HS, Aras S. Nonprescription Product Use Among Geriatric Outpatients. ANKARA MEDICAL JOURNAL 2017. [DOI: 10.17098/amj.364163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rashrash M, Schommer JC, Brown LM. Prevalence and Predictors of Herbal Medicine Use Among Adults in the United States. J Patient Exp 2017; 4:108-113. [PMID: 28959715 PMCID: PMC5593261 DOI: 10.1177/2374373517706612] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the prevalence of herbal medicine use among US adults and to assess factors associated with and predictors of herbal use. DESIGN The data for herbal products use were collected from the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Roles. Chi-square test was used to analyz factors associated with herbal use, and predictors of herbal use were assessed with logistic regression analysis. RESULTS Factors associated with herbal supplement use include age older than 70, having a higher than high school education, using prescription medications or over-the-counter (OTC) medications, and using a mail-order pharmacy." All Disease state associated significantly with herbal use. Approximately thirty-eight percent of those who used herbals used prescription medications and 42% of those who used herbals also used an OTC medication. The most frequent conditions associated with herbal supplement use were a stroke (48.7%), cancer (43.1%), and arthritis (43.0%). Among herbal product users, factors that predicted use included having higher than school education, using OTC medications, using mail-order pharmacy, stroke, obesity, arthritis, and breathing problems. CONCLUSIONS More than one-third of respondents reported using herbal supplements. Older age and higher education were associated with a higher use of herbal supplements. People with chronic diseases are more likely to use herbal medicines than others. OTC drug users and patients with stroke are more likely to use herbal medicines than others.
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Affiliation(s)
- Mohamed Rashrash
- Chapman University School of Pharmacy, Rinker Health Science Campus, Irvine, CA, USA
| | - Jon C Schommer
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | - Lawrence M Brown
- Chapman University School of Pharmacy, Rinker Health Science Campus, Irvine, CA, USA
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Fan Y, He L, Zhang R. Classification of Use Status for Dietary Supplements in Clinical Notes. PROCEEDINGS. IEEE INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICINE 2017; 2016:1054-1061. [PMID: 28824824 DOI: 10.1109/bibm.2016.7822668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Clinical notes contain rich information about dietary supplements, which are critical for detecting signals of dietary supplement side effects and interactions between drugs and supplements. One of the important factors of supplement documentation is usage status, such as started and discontinuation. Such information is usually stored in the unstructured clinical notes. We developed a rule-based classifier to identify supplement usage status in clinical notes. The categories referring to the patient's status of supplement use were classified into four classes: Continuing (C), Discontinued (D), Started (S), and Unclassified (U). Clinical notes containing 10 of the most commonly consumed supplements (i.e., alfalfa, echinacea, fish oil, garlic, ginger, ginkgo, ginseng, melatonin, St. John's Wort, and Vitamin E) were retrieved from the University of Minnesota Clinical Data Repository. The gold standard was defined by manually annotating 1000 randomly selected sentences or statements mentioning at least one of these 10 supplements. The rules in the classifier was initially developed on two-thirds of the set of 7 supplements (i.e., alfalfa, garlic, ginger, ginkgo, ginseng, St. John's Wort, and Vitamin E); the performance was evaluated on the remaining one-third of this set. To evaluate the generalizability of rules, we further validated the second testing set on other 3 supplements (i.e., echinacea, fish oil, and melatonin). The performance of the classifier achieved F-measures of 0.95, 0.97, 0.96, and 0.96 for status C, D, S, and U on 7 supplements, respectively. The classifier also showed good generalizability when it was applied to the other 3 supplements with F-measures of 0.96 for C, 0.96 for D, 0.95 for S, and 0.89 for U. This study demonstrated that the classifier can accurately classify supplement usage status, which can be further integrated as a module into the existing natural language processing pipeline for supporting dietary supplement knowledge discovery.
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Affiliation(s)
- Yadan Fan
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Lu He
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Rui Zhang
- Institute for Health Informatics, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Pitkälä KH, Suominen MH, Bell JS, Strandberg TE. Herbal medications and other dietary supplements. A clinical review for physicians caring for older people. Ann Med 2016; 48:586-602. [PMID: 27427263 DOI: 10.1080/07853890.2016.1197414] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Evidence for the safety and effectiveness of dietary supplements is mixed. The extent to which older people use dietary supplements concomitantly with conventional medications is often under-appreciated by physicians. We conducted a literature review on clinical considerations associated with dietary supplement use, focusing on benefits and harms, motivations for use and contribution to polypharmacy among older people. Vitamin D ≥ 800 IU has demonstrated benefits in fracture prevention. Vitamins A, E, and β-carotene have been associated with an increase in total mortality in several meta-analyses. A range of non-vitamin dietary supplements have been studied in randomized controlled trials but their efficacy remains largely unclear. Supplement use has been associated with a range of adverse events and drug interactions yet physicians rarely initiate discussions about their use with older patients. Older people may take dietary supplements to exercise control over their health. Given the contribution of supplements to polypharmacy, supplements may be targeted for "deprescribing" if the risk of harm is judged to outweigh benefits. This is best done as part of a comprehensive, patient-centered approach. A respectful and non-judgmental discussion may result in a shared decision to reduce polypharmacy through cessation of dietary supplements. KEY MESSAGES Herbal medications and other dietary supplements are highly prevalent among older people. Physicians are often unaware that their patients use herbal medications and other dietary supplements concomitantly with conventional medications. Herbal medications and other dietary supplements contribute to high rates of polypharmacy, particularly among older people with multimorbidity. Herbal medications and other dietary supplements can interact with conventional medications and be associated with a range of adverse events. Physicians need to be patient-centered and non-judgmental when initiating discussions about herbal medications and other dietary supplements. This is important to maintain and develop patient empowerment and self-management skills.
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Affiliation(s)
- Kaisu H Pitkälä
- a Department of General Practice and Primary Health Care , Helsinki , Finland.,b Unit of Primary Health Care, University of Helsinki, and Helsinki University Hospital , Helsinki , Finland
| | - Merja H Suominen
- a Department of General Practice and Primary Health Care , Helsinki , Finland.,b Unit of Primary Health Care, University of Helsinki, and Helsinki University Hospital , Helsinki , Finland
| | - J Simon Bell
- c Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Melbourne , Australia.,d Sansom Institute, University of South Australia , Adelaide , Australia.,e Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| | - Timo E Strandberg
- f University of Helsinki, Clinicum , Helsinki , Finland.,g Helsinki University Hospital , Helsinki , Finland.,h University of Oulu, Centre for Life Course Health Research , Oulu , Finland
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Turkmenoglu FP, Kutsal YG, Dolgun AB, Diker Y, Baydar T. Evaluation of herbal product use and possible herb–drug interactions in Turkish elderly. Complement Ther Clin Pract 2016; 23:46-51. [DOI: 10.1016/j.ctcp.2016.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/16/2016] [Indexed: 12/13/2022]
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Gardiner P, Filippelli AC, Kabbara K, Lin SC, Sadikova E, Kaptchuk TJ, Kemper K. Online Education for Improving Communication and Documentation of Dietary Supplements Among Health Professionals Practicing in a Hospital Setting. J Altern Complement Med 2015; 21:638-44. [PMID: 26270001 DOI: 10.1089/acm.2015.0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about the feasibility of online education in improving communication and documentation of dietary supplements (DS) among clinicians. METHODS This prospective educational study included clinicians at an urban teaching hospital. The curriculum included video streams, didactics, and interactive case presentations to discuss (1) DS safety and effectiveness, (2) cultural competency, (3) managing DS in a hospital setting, and (4) DS adverse events. Participants were surveyed, at baseline and after training, about DS knowledge, confidence, communication, and documentation practices. RESULTS Thirty-nine of 61 (64%) recruited clinicians completed all four patient cases and post-tests. Most (82%) were women and 59% were physicians. The mean DS knowledge test score increased after the curriculum (p < 0.0001), and the clinician confidence score also increased (p < 0.0001). Most (82%) participants reported that curriculum changed their use of evidence-based resources (p = 0.01). There was a change in the indications for symptom management (p = 0.05) and gastrointestinal/digestive health issues (p = 0.03). There were statistically significant increases in the frequency of asking patients about DS use during discharge (p = 0.01), and 82% responded that the curriculum changed their DS documentation. CONCLUSION An online curriculum is an effective tool for presenting DS education to clinicians with the goal of improving clinicians' knowledge, confidence, and documentation practices about DS.
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Affiliation(s)
- Paula Gardiner
- 1 Department of Family Medicine, Boston University Medical Center , Boston, MA
| | - Amanda C Filippelli
- 1 Department of Family Medicine, Boston University Medical Center , Boston, MA
| | - Karim Kabbara
- 2 Information Technology-Application Service, Boston University School of Medicine , Boston, MA
| | - Steven C Lin
- 3 Department of Medicine, University of California at San Diego , San Diego, CA
| | - Ekaterina Sadikova
- 4 Department of Research and Evaluation, Kaiser Permanente , Pasadena, CA
| | - Ted J Kaptchuk
- 5 Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, MA
| | - Kathi Kemper
- 6 Department of Pediatrics, Ohio State University College of Medicine , Columbus, OH
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Gardiner P, Filippelli AC, Sadikova E, White LF, Jack BW. Medication and Dietary Supplement Interactions among a Low-Income, Hospitalized Patient Population Who Take Cardiac Medications. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:429826. [PMID: 25949262 PMCID: PMC4407526 DOI: 10.1155/2015/429826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/07/2015] [Accepted: 03/24/2015] [Indexed: 02/06/2023]
Abstract
Purpose. To identify characteristics associated with the use of potentially harmful combinations of dietary supplements (DS) and cardiac prescription medications in an urban, underserved, inpatient population. Methods. Cardiac prescription medication users were identified to assess the prevalence and risk factors of potentially harmful dietary supplement-prescription medication interactions (PHDS-PMI). We examined sociodemographic and clinical characteristics for crude (χ (2) or t-tests) and adjusted multivariable logistic regression associations with the outcome. Results. Among 558 patients, there were 121 who also used a DS. Of the 110 participants having a PHDS-PMI, 25% were asked about their DS use at admission, 75% had documentation of DS in their chart, and 21% reported the intention to continue DS use after discharge. A multivariable logistic regression model noted that for every additional medication or DS taken the odds of having a PHDS-PMI increase and that those with a high school education are significantly less likely to have a PHDS-PMI than those with a college education. Conclusion. Inpatients at an urban safety net hospital taking a combination of cardiac prescription medications and DS are at a high risk of harmful supplement-drug interactions. Providers must ask about DS use and should consider the potential for interactions when having patient discussions about cardiac medications and DS.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
| | - Amanda C. Filippelli
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
| | - Ekaterina Sadikova
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Brian W. Jack
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA
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Gardiner P, Sadikova E, Filippelli AC, White LF, Jack BW. Medical reconciliation of dietary supplements: don't ask, don't tell. PATIENT EDUCATION AND COUNSELING 2015; 98:512-517. [PMID: 25636694 PMCID: PMC4404157 DOI: 10.1016/j.pec.2014.12.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/08/2014] [Accepted: 12/27/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore inpatient reconciliation of dietary supplement (DS) use and determine characteristics associated with DS documentation. METHODS We analyzed DS use among 558 inpatients recruited from the Re-Engineered Discharge clinical trial to identify: (1) if patients self-reported DS and (2) if DS use was documented at admission. We examined socio-demographics for association with documentation using chi squares and t-tests. Logistic regression was performed to assess adjusted associations with DS documentation. RESULTS Sixty percent reported DS use (n=333). Among users, 36% had admission DS documentation, 20% were asked about use at admission, 18% reported disclosing use to a provider, and 48% reported they would continue to use DS. Overall, 6% of participants were asked, disclosed, and had documentation of DS. Logistic regression revealed increased age associated with lower odds of DS documentation. Identifying as Hispanic or African American reduces DS documentation odds compared to those identifying as white. CONCLUSIONS There is lack of consistent DS medical reconciliation in the inpatient setting. While more than half of patients used DS prior to hospitalization, most were not asked about use on admission. PRACTICE IMPLICATIONS This study adds to literature on medical reconciliation which requires that providers inquire and document patient DS use.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, USA.
| | - Ekaterina Sadikova
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, USA
| | - Amanda C Filippelli
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, USA
| | - Laura F White
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Brian W Jack
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, USA
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Correlation between the use of ‘over-the-counter’ medicines and adherence in elderly patients on multiple medications. Int J Clin Pharm 2014; 36:92-7. [PMID: 24293336 DOI: 10.1007/s11096-013-9892-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Medication adherence is a multifaceted issue that is influenced by various factors. One factor may be the concurrent use of over-the-counter (OTC)medicines. The use of OTC medicine has been reported as common amongst elderly patients. OBJECTIVE To determine if a correlation exists between the use of OTC medicines and adherence to prescribed medications in elderly patients. SETTING Non-institutionalised elderly patients in Denmark. METHODS Elderly unassisted patients aged ≥65 prescribed five or more prescription drugs were included in the study. Information on the use of concurrent OTC medications (herbal medicines, dietary supplements, or non-prescribed drugs) was elicited during home visit interviews. Prescription drug adherence was determined by pill counts. A patient was categorised as non-adherent if the me an adherence rate for all drugs consumed was\80 %. Different sensitivity analyses were made where adherence was defined different. MAIN OUTCOME MEASURE Medication adherence based on pill-count. RESULTS A total of 253 participants included 72 % who used OTC medicines and 11 % who did not adhere to their prescriptions. Users of OTC medicines, however, were significantly more likely to be adherent than were non-users (odds ratio 0.41; 95 %confidence interval 0.18–0.91). Sensitivity analyses where adherence was defined different show no relationship between adherence and use of OTC medicine. Furthermore,separate analyses of herbal medicines, dietary supplements,or non-prescribed drugs did not correlate with adherence to prescriptions. CONCLUSION Amongst elderly patients on multiple medications a positive relationship was found between the overall use of OTC medicines and adherence to prescription drugs, in contrast to none when adherence were defined different or herbal medicines, dietary supplements, or non-prescribed drugs were analysed separately.
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Pharmacotherapy and over-the-counter drug use among elderly in Belgrade, Serbia. Geriatr Nurs 2013; 34:486-90. [DOI: 10.1016/j.gerinurse.2013.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/30/2013] [Accepted: 08/05/2013] [Indexed: 11/19/2022]
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Olesen C, Harbig P, Barat I, Damsgaard EM. Correlation between the use of 'over-the-counter' medicines and adherence in elderly patients on multiple medications. Int J Clin Pharm 2013; 36:92-97. [PMID: 24122210 DOI: 10.1007/s11096-013-9863-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/30/2013] [Indexed: 01/02/2023]
Abstract
Background Medication adherence is a multifaceted issue that is influenced by various factors. One factor may be the concurrent use of over-the-counter (OTC) medicines. The use of OTC medicine has been reported as common amongst elderly patients. Objective To determine if a correlation exists between the use of OTC medicines and adherence to prescribed medications in elderly patients. Setting Non-institutionalised elderly patients in Denmark. Methods Elderly unassisted patients aged ≥65 prescribed five or more prescription drugs were included in the study. Information on the use of concurrent OTC medications (herbal medicines, dietary supplements, or non-prescribed drugs) was elicited during home visit interviews. Prescription drug adherence was determined by pill counts. A patient was categorised as non-adherent if the mean adherence rate for all drugs consumed was <80 %. Different sensitivity analyses were made where adherence was defined different. Main outcome measure Medication adherence based on pill-count. Results A total of 253 participants included 72 % who used OTC medicines and 11 % who did not adhere to their prescriptions. Users of OTC medicines, however, were significantly more likely to be adherent than were non-users (odds ratio 0.41; 95 % confidence interval 0.18-0.91). Sensitivity analyses where adherence was defined different show no relationship between adherence and use of OTC medicine. Furthermore, separate analyses of herbal medicines, dietary supplements, or non-prescribed drugs did not correlate with adherence to prescriptions. Conclusion Amongst elderly patients on multiple medications a positive relationship was found between the overall use of OTC medicines and adherence to prescription drugs, in contrast to none when adherence were defined different or herbal medicines, dietary supplements, or non-prescribed drugs were analysed separately.
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Affiliation(s)
- Charlotte Olesen
- Department of Geriatrics, Aarhus University Hospital, P.P. Ørumsgade 11, bygn. 7, 1, 8000, Aarhus C, Denmark,
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Palmour N, Vanderbyl BL, Zimmerman E, Gauthier S, Racine E. Alzheimer’s Disease Dietary Supplements in Websites. HEC Forum 2013; 25:361-82. [DOI: 10.1007/s10730-013-9217-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Olesen C, Harbig P, Barat I, Damsgaard EM. Absence of 'over-the-counter' medicinal products in on-line prescription records: a risk factor of overlooking interactions in the elderly. Pharmacoepidemiol Drug Saf 2012; 22:145-50. [PMID: 23097415 DOI: 10.1002/pds.3362] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/25/2012] [Accepted: 10/01/2012] [Indexed: 11/10/2022]
Abstract
PURPOSE To assess possible origins of harmful interactions in elderly patients arising from the current absence of information on over-the-counter (OTC) medicines in the Danish 'on-line prescription record'. METHODS Information on current use of prescription drugs and OTC medicinal products (non-prescription drugs, herbal medicine, dietary supplements, and others) was collected by home visit interviews. The latter OTC products were not listed in an on-line prescription record that covered the previous two years. Information on interactions between OTC medicines and between OTC products and prescription drugs was obtained from the Danish National Drug Interaction Database. RESULTS Of the 309 patients recruited (median age 75 years, interquartile range (IQR) 70-81), 229 (74%) used 568 OTC medicines not listed in the Danish 'on-line prescription record', amongst which we identified 166 potential interactions - between OTC treatments or between OTC and prescription drugs. Fifty percent of patients taking OTC medicines were exposed to potential interactions, i.e. one to three instances per patient. Twenty-five percent of patients exposed to interactions experienced interaction listed as 'Can be used with certain precautions'. CONCLUSION The absence of information on OTC products in an on-line prescription record entails a risk of overlooking interactions in elderly patients. Such products should be included in on-line medication records to prevent adverse effects from interactions. However, online medication records are not available in all countries and as inclusion of data on OTC drugs seem not to be feasible presently. Still, it is highly recommended that the patient's drug list is reviewed on a regular basis.
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Affiliation(s)
- C Olesen
- Department of Geriatrics, Aarhus University Hospital, P.P. Ørums Gade 11, Aarhus C, Denmark.
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Nunkoo DH, Mahomoodally MF. Ethnopharmacological survey of native remedies commonly used against infectious diseases in the tropical island of Mauritius. JOURNAL OF ETHNOPHARMACOLOGY 2012; 143:548-564. [PMID: 22884867 DOI: 10.1016/j.jep.2012.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 07/12/2012] [Accepted: 07/14/2012] [Indexed: 06/01/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Infectious diseases (IDs) still remain a major cause of mortality and morbidity worldwide. This study has been geared to gather primary ethnopharmacological information on common native remedies (NRs) used to treat and/or manage common infectious diseases from different regions of Mauritius, a tropical multicultural island in the Indian Ocean. Given the dearth of updated information on traditional medicine of Mauritius, this work can provide an opportunity to establish valuable primary information on the different NRs used by the local people and hence open new perspectives for further pharmacological research. AIM OF THE STUDY To collect, preserve and document primary ethnopharmacological data from the local population concerning NRs commonly used against IDs in the tropical island of Mauritius. MATERIALS AND METHODS Face to face interviews were conducted with Mauritians and herbalists (n=307) using a semi-structured questionnaire. Quantitative ethnobotany parameters such as informant consensus factor (F(IC)), fidelity level (FL), use value (UV) and variety of use (VU) were used for herbal and animal products. Statistical analysis such as Pearson correlation and Chi-squared test were performed to delineate any association. RESULTS It was found that 94.8% of the local people claimed that managing IDs with NRs was part of their culture and have been using it since childhood. A total of 39 plant species belonging to 24 families and 9 animal species were reported to be traditionally used in the formulation of herbal remedies and animal products, respectively. Sociodemographic characteristics (gender, age, place of residence and income) had a significant (p<0.01) impact on the use of these NRs. The most relevant family contributing much to the medicinal flora was Zingiberaceae (No of citation=301). The average F(IC) for all ailments for medicinal plants and animal products were 0.963 and 0.972, respectively. Acalypha indica L. had the highest FL (0.83) for skin and subcutaneous tissue problems. Panoply of animal products (Anguilla japonica, Periplaneta americana and Helix aspersa) were culturally used, whereby products from Bos taurus, (42.0%) were the most utilized zootherapy. Other remedies used in concurrence with herbal and animal products involved cultural rituals and prayers that were never reported in previous studies. Therapeutic properties of some herbal remedies reported correlated to some extent with those of previous studies while others have open potential perspectives for further research as their chemistry and pharmacology have not been published. CONCLUSIONS Given the plethora of novel information obtained from the present survey, it is obvious that the indigenous population still relies to a great extent on NRs which need to be preserved and used sustainably. Nonetheless, further research is needed to probe the possible active constituents that could be the basis of an evidence based investigation to discover new drugs.
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Affiliation(s)
- D Hema Nunkoo
- Department of Health Sciences, Faculty of Science, University of Mauritius, Reduit, Mauritius
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Reimer KJ, Koch I. Metals and metalloids in complementary and alternative medicines. Maturitas 2012; 72:267-8. [DOI: 10.1016/j.maturitas.2012.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
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Yasein NA, Barghouti FF, Irshaid YM, Suleiman AA. Discrepancies between elderly patient’s self-reported and prescribed medications: a social investigation. Scand J Caring Sci 2012; 27:131-8. [DOI: 10.1111/j.1471-6712.2012.01012.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thorpe CT, Lassila HC, O'Neil CK, Thorpe JM, Hanlon JT, Maher RL. Reconsideration of key articles regarding medication-related problems in older adults from 2011. THE AMERICAN JOURNAL OF GERIATRIC PHARMACOTHERAPY 2012; 10:2-13. [PMID: 22330099 PMCID: PMC3378666 DOI: 10.1016/j.amjopharm.2012.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 01/04/2012] [Indexed: 05/31/2023]
Affiliation(s)
- Carolyn T Thorpe
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Izzo AA. Interactions between herbs and conventional drugs: overview of the clinical data. Med Princ Pract 2012; 21:404-28. [PMID: 22236736 DOI: 10.1159/000334488] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 10/05/2011] [Indexed: 12/25/2022] Open
Abstract
This article provides an overview of the clinical evidence of interactions between herbal and conventional medicines. Herbs involved in drug interactions--or that have been evaluated in pharmacokinetic trials--are discussed in this review. While many of the interactions reported are of limited clinical significance and many herbal products (e.g. black cohosh, saw palmetto, echinacea, hawthorn and valerian) seem to expose patients to minor risk under conventional pharmacotherapy, a few herbs, notably St. John's wort, may provoke adverse events sufficiently serious to endanger the patients' health. Healthcare professionals should remain vigilant for potential interactions between herbal medicines and prescribed drugs, especially when drugs with a narrow therapeutic index are used.
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Affiliation(s)
- Angelo A Izzo
- Department of Experimental Pharmacology, Federico II University of Naples, Naples, Italy.
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Eichhorn T, Greten HJ, Efferth T. Self-medication with nutritional supplements and herbal over-thecounter products. NATURAL PRODUCTS AND BIOPROSPECTING 2011; 1:62-70. [PMCID: PMC4131654 DOI: 10.1007/s13659-011-0029-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 11/07/2011] [Indexed: 06/08/2023]
Abstract
In recent years, the popularity increased for nutritional supplements and herbal products. Prescription drugs, but not herbal therapies are paid by health insurances. They are sold over-the-counter (OTC) on the patients’ own expense. However, there are potential risks of self-medication, e.g. incorrect self-diagnosis, severe adverse reactions, dangerous drug interactions, risk of addiction etc. They are often used by patients at their own discretion without knowledge of and control by their physicians. Certain users are at risk of intoxication. Multiple medications taken by older patients increase the risk for adverse drug reactions, drug-drug interactions, and compliance problems for this age group (polypharmacy). Herbals should be discontinued prior to operations to avoid interactions with anesthetics or anticoagulants. Herbal preparations may also be carcinogenic or interfere with cancer treatments. Pregnant women use various OTC preparations. However, in many cases, it is unclear whether their use is safe for mother or baby. Self-medication with herbals is also largely distributed among anxious and depressive patients, and patients with other conditions and symptoms. The popularity of herbal products has also brought concerns on quality, efficacy and safety. Cases of botanical misidentification, contaminations with heavy metals, pesticides, radioactivity, organic solvents, microbials as well as adulteration with chemical drugs necessitate the establishment of international quality control standards. Hepatotoxic effects have been reported for more than 300 plant species, and some commonly used herbs have been demonstrated to interact with Western medication. Health care professionals have a critical responsibility assessing the self-care ability of their patients. Databases are available for pharmacists with information on action, side effects and toxicities as well as herb-drug interactions. There is a need for established guidelines regarding the correct use of nutritional supplements and herbal OTC preparations (phytovigilance). Physicians, pharmacists, and other health care professionals have to counsel patients and the general public on the benefits and risks associated with herbal drugs. Information centers for consumers and general practitioners are needed, and convincing evidence on safety and efficacy of herbal products has to be demonstrated in placebo-controlled, double blind and randomized clinical trials.
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Affiliation(s)
- Tolga Eichhorn
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Henry Johannes Greten
- Heidelberg School of Chinese Medicine, Karlsruher Straße 12, 69126 Heidelberg, Germany
- Biomedical Sciences Institute Abel Salazar, University of Porto, Porto, Portugal
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
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Cattan M, Hogg E, Hardill I. Improving quality of life in ageing populations: what can volunteering do? Maturitas 2011; 70:328-32. [PMID: 21958942 DOI: 10.1016/j.maturitas.2011.08.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 08/31/2011] [Indexed: 11/25/2022]
Abstract
The year 2011 was declared the 'European Year of Volunteering' to recognise the contribution volunteers make to society. Such cross-national events reflect the high profile of volunteering and political imperatives to promote it. The purpose of this review is to provide a comprehensive review of current knowledge (articles published between 2005 and 2011) regarding the role of volunteering in improving older people's quality of life (QoL) and to identify areas requiring further research. Volunteering was defined as an activity that is freely chosen, does not involve remuneration and helps or benefits those beyond an individual's immediate family. Our search identified 22 studies and 5 review articles that addressed the benefits of volunteering on older people's quality of life. Most of the research had been conducted in the United States, Canada and Australia using data from longitudinal studies. The majority of the studies concluded that there is a positive association between older people's quality of life and engagement in volunteering. Due to the study designs and the heterogeneity of the research, causality is difficult to demonstrate and the knowledge the studies bring to the subject is variable. This review shows that volunteering may help to maintain and possibly improve some older adults' quality of life. However, there are still major gaps in our understanding of who actually benefits, the social and cultural context of volunteering and its role in reducing health and social inequalities.
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Affiliation(s)
- Mima Cattan
- Northumbria University, School of Health, Community & Education Studies, Newcastle upon Tyne, United Kingdom.
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Sirisangtrakul W, Sripanidkulchai B. Interference of Thai traditional medicine (Yahom Ampanthong) on hepatic cytochrome P450 enzymes and pentobarbital-induced sleeping in mice. Pak J Biol Sci 2011; 14:91-98. [PMID: 21916258 DOI: 10.3923/pjbs.2011.91.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Yahom Ampanthong, a Thai traditional medicine, is commonly used for treatment of nausea, vomiting and syncope. Its formula is composed of more than 10 medicinal plants. Currently, the herbal-drug interactions were reported among the case of co-administration of traditional and Western medicines, since cytochrome P450 enzymes involve in drug metabolism and affect the drug action. This study aimed to investigate the effects of Yahom extracts on hepatic cytochrome P450 enzymes and pentobarbital-induced sleeping in mice. Powder of Yahom Ampanthong was extracted with three different solvents, i.e., dichloromethane, methanol and distilled water. The activities of CYP1A1, CYP1A2, CYP2B, CYP2E1 and CYP3A4 were determined after the administration of Yahom extracts for 4 weeks. All three extracts significantly inhibited CYP1A1, CYP1A2, CYP2E1 activities. In contrast, only dichloromethane and methanol extracts enhanced CYP2B activity. However, all three extracts did not affect CYP3A4 activity. When compared to the control group, the dichloromethane extract-treated animals showed shorter pentobarbital-induced sleeping time after treatment for 1 and 4 weeks. In conclusion, Yahom Ampanthong extracts modulated hepatic microsomal cytochrome P450 activities and decreased the pentobarbital-induced sleeping time. Therefore, the concomitant administration of Yahom with certain drugs may give rise to the herbal-drug interaction, which may affect the clinical implication of drug actions.
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Affiliation(s)
- Wanna Sirisangtrakul
- Faculty of Pharmaceutical Science, Khon Kaen University, Khon Kaen 40002, Thailand
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