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Peprah P, Appiah-Brempong E, Agyemang-Duah W, Okyere P, Gyimah AA. ‘Where were pharmaceuticals in Eden?’ Use of herbal medicine in old age: focus group discussions among community-dwelling older adults in Ghana. J Herb Med 2022. [DOI: 10.1016/j.hermed.2022.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Xing T, Sun F, Wang K, Zhao J, Wu M, Wu J. Vulnerability to fraud among Chinese older adults: do personality traits and loneliness matter? J Elder Abuse Negl 2020; 32:46-59. [PMID: 32079509 DOI: 10.1080/08946566.2020.1731042] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined correlates of the vulnerability to fraud among a group of urban Chinese older adults, focusing on the influence of personality traits and loneliness. A non-probability sample of 321 older participants recruited from six urban communities in Tianjin, China participated in a survey. Key measures included the Elder Risk for Fraud Scale, the short Big Five Inventory, and the Emotional-Social Loneliness Inventory. Regression analyses found that agreeableness personality was associated with lower risks for fraud while social loneliness was associated with higher risks for fraud. Older participants who needed medical assistance with their daily living were found at higher risks for fraud than their counterparts without medical needs. It is recommendded that policymakers and helping professionals in China should assess psychosocial risk factors for fraud. Great attention needs to be paid to older adults who demonstrate low levels of agreeableness and high levels of social loneliness.
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Affiliation(s)
- Tong Xing
- Faculty of Psychology, Key Research Base of Humanities and Social Sciences of Ministry of Education, Tianjin Normal University, Tianjin, China
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Kaipeng Wang
- School of Social Work, Texas State University, San Marcos, Texas, USA
| | - Jiawei Zhao
- Faculty of Psychology, Key Research Base of Humanities and Social Sciences of Ministry of Education, Tianjin Normal University, Tianjin, China
| | - Mengxuan Wu
- Department of Communication Sciences and Disorders, University of Texas at Austin, Austin, Texas, USA
| | - Jie Wu
- Faculty of Psychology, Key Research Base of Humanities and Social Sciences of Ministry of Education, Tianjin Normal University, Tianjin, China
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No Author. Chapitre 4 : Symptômes vasomoteurs. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S68-S72. [DOI: 10.1016/j.jogc.2019.02.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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4
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Akintoye E, Sethi P, Harris WS, Thompson PA, Marchioli R, Tavazzi L, Latini R, Pretorius M, Brown NJ, Libby P, Mozaffarian D. Fish Oil and Perioperative Bleeding. Circ Cardiovasc Qual Outcomes 2018; 11:e004584. [PMID: 30571332 PMCID: PMC6376981 DOI: 10.1161/circoutcomes.118.004584] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Fish oil is among the most common natural supplements for treatment of hypertriglyceridemia or prevention of cardiovascular disease. However, concerns about theoretical bleeding risk have led to recommendations that patients should stop taking fish oil before surgery or delay in elective procedures for patients taking fish oil by some health care professionals. Methods and Results We tested the effect of fish oil supplementation on perioperative bleeding in a multinational, placebo-controlled trial involving 1516 patients who were randomized to perioperative fish oil (eicosapentaenoic acid+docosahexaenoic acid; 8-10 g for 2-5 days preoperatively, and then 2 g/d postoperatively) or placebo. Primary outcome was major perioperative bleeding as defined by the Bleeding Academic Research Consortium. Secondary outcomes include perioperative bleeding per thrombolysis in myocardial infarction and International Society on Thrombosis and Hemostasis definitions, chest tube output, and total units of blood transfused. Participants' mean (SD) age was 63 (13) years, and planned surgery included coronary artery bypass graft (52%) and valve surgery (50%). The primary outcome occurred in 92 patients (6.1%). Compared with placebo, risk of Bleeding Academic Research Consortium bleeding was not higher in the fish oil group: odds ratio, 0.81; 95% CI, 0.53-1.24; absolute risk difference, 1.1% lower (95% CI, -3.0% to 1.8%). Similar findings were seen for secondary bleeding definitions. The total units of blood transfused were significantly lower in the fish oil group compared with placebo (mean, 1.61 versus 1.92; P<0.001). Evaluating achieved plasma phospholipid omega-3 polyunsaturated fatty acids levels with supplementation (on the morning of surgery), higher levels were associated with lower risk of Bleeding Academic Research Consortium bleeding, with substantially lower risk in the third (odds ratio, 0.30 [95% CI, 0.11-0.78]) and fourth (0.36 [95% CI, 0.15-0.87]) quartiles, compared with the lowest quartile. Conclusions Fish oil supplementation did not increase perioperative bleeding and reduced the number of blood transfusions. Higher achieved n-3-PUFA levels were associated with lower risk of bleeding. These novel findings support the need for reconsideration of current recommendations to stop fish oil or delay procedures before cardiac surgery. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT00970489.
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Affiliation(s)
- Emmanuel Akintoye
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa, IA, USA
| | - Prince Sethi
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - William S. Harris
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
- OmegaQuant, LLC. Sioux Falls, SD, USA
| | - Paul A. Thompson
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Roberto Marchioli
- Cardiovascular Renal Metabolic (CVRM) Therapeutic Area, Medical Strategy and Science, Therapeutic Science and Strategy Unit (TSSU), IQVIA, Milan, Italy
| | - Luigi Tavazzi
- Department of Cardiology and LTTA Centre, University of Ferrara, Ferrara, Italy; Maria Cecilia Hospital- GVM Care & Research, and E.S. Health Science Foundation, Cotignola, Italy
| | - Roberto Latini
- Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche “Mario Negri”-IRCCS, Milan, Italy
| | - Mias Pretorius
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nancy J. Brown
- Department of Pharmacology and Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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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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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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Kummet CM, Spector ML, Dawson DV, Fischer M, Holmes DC, Warren J, Nisly NL. Patterns of complementary and alternative medicine (CAM) use among dental patients. J Public Health Dent 2014; 75:109-17. [PMID: 25409864 DOI: 10.1111/jphd.12078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Complementary and alternative medicine (CAM) is a diverse collection of approaches used to prevent or treat diseases. The goal of this study was to examine relationships between dental patient characteristics and current usage of CAM therapies. METHODS The CAM definition encompassed 24 therapies excluding prayer. Associations and trends in usage were assessed for gender, income, education, and age. Multivariable logistic and negative binomial models were used to identify factors impacting the use and number of CAM therapies used. RESULTS In dental patients (n = 402), nearly 67 percent of subjects reported at least one CAM treatment. Gender was significantly associated with recent utilization of CAM, biological, manipulative (all P < 0.01), and mind-body (P = 0.04) therapies, as well as the number (P < 0.01) of therapies used. Higher education levels were significant in usage of any CAM, biological, and mind-body therapies (P < 0.01). CONCLUSION A large proportion of dental patients reported use of CAM therapies. While CAM therapies and those who use them are diverse, given their widespread use, they clearly have potential impacts on the oral health of the public. Knowledge of the characteristics of dental patients who use CAM therapies is a first step in developing a broader understanding how CAM therapies and associated beliefs may affect oral health and public health programs.
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Affiliation(s)
- Colleen M Kummet
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - Michael L Spector
- Department of Family Dentistry, The University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Deborah V Dawson
- Department of Pediatric Dentistry, Division of Biostatistics and Research Design, The University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Mark Fischer
- Private Practice of General Dentistry, Ankeny, IA, USA
| | - David C Holmes
- Department of Family Dentistry, The University of Iowa College of Dentistry, Iowa City, IA, USA
| | - John Warren
- Department of Preventive & Community Dentistry, The University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Nicole L Nisly
- Department of Internal Medicine, The University of Iowa College of Medicine, Iowa City, IA, USA
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RETIRED: Managing Menopause Chapter 4 Vasomotor Symptoms. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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de Souza Silva JE, Santos Souza CA, da Silva TB, Gomes IA, Brito GDC, de Souza Araújo AA, de Lyra-Júnior DP, da Silva WB, da Silva FA. Use of herbal medicines by elderly patients: A systematic review. Arch Gerontol Geriatr 2014; 59:227-33. [PMID: 25063588 DOI: 10.1016/j.archger.2014.06.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 06/05/2014] [Accepted: 06/08/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to survey the published literature for articles that describe the use of herbal supplements by elderly patients and to summarize important aspects of selected studies, including most commonly used supplements, study type, study location, and potential hazards of herbal supplement use. METHODS Literature searches were conducted on three scientific/medical databases: Medline, Web of Science, and Scopus. Search results were examined for articles involving the use of herbal products in the elderly population that met selection criteria. RESULTS Initial searches yielded 1297 articles. Of these original results, only 16 met specific selection criteria. Twelve (75%) of studies identified were performed in North America. Nine studies (56.25%) were conducted in the United States. Seven of the studies were cross-sectional (43.8%). The most commonly reported were gingko biloba, garlic, ginseng, aloe vera, chamomile, spearmint, and ginger. Of these, gingko and garlic are the most commonly used among community-dwelling elderly. Both of these supplements have the potential to interact with anticoagulants and produce bruising or bleeding problems. CONCLUSIONS The use of herbal supplements is common among the elderly, a population that takes a disproportionate share of prescription medications compared to that taken by younger populations. Among the problems uncovered by these studies was a lack of dialog between medical professionals and patients about the use of herbal supplements. Prescribers need to consider the use of herbal supplements and discuss the matter with their elderly patients when making decisions about pharmacological treatments.
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Affiliation(s)
| | | | | | - Isla Alcântara Gomes
- Department of Physiology, Federal University of Sergipe, Aracaju 49100-000, Brazil
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Henderson JV, Harrison CM, Britt HC, Bayram CF, Miller GC. Prevalence, Causes, Severity, Impact, and Management of Chronic Pain in Australian General Practice Patients. PAIN MEDICINE 2013; 14:1346-61. [DOI: 10.1111/pme.12195] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Oga EF, Sekine S, Shitara Y, Horie T. P-glycoprotein mediated efflux in Caco-2 cell monolayers: the influence of herbals on digoxin transport. JOURNAL OF ETHNOPHARMACOLOGY 2012; 144:612-617. [PMID: 23064285 DOI: 10.1016/j.jep.2012.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 09/22/2012] [Accepted: 10/02/2012] [Indexed: 06/01/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Several herbal medicines are concomitantly used with conventional medicines with a resultant increase in the recognition of herb-drug interactions. The phytomedicines Vernonia amygdalina Delile (VA), family Asteraceae; Azadiractha indica A. Juss (NL), family Meliaceae; Morinda lucida Benth (MLB), family Rubiaceae; Cymbopogon citratus Stapf (LG), family Poaceae; Curcuma longa L. (CUR), family Zingiberaceae; Carica papaya L. (CP), family Caricaceae and Tapinanthus sessilifolius Blume (ML), family Loranthaceae are used in African traditional medicine for the treatment of malaria. They are also used in several regions world over in managing other ailments like cancer and diabetes. This study investigated their interaction with digoxin (DIG) with a view to predict the potential of P-glycoprotein (p-gp) mediated drug-herb interactions occurring with p-gp substrate drugs. MATERIALS AND METHODS To assess p-gp mediated transport and inhibition, bidirectional transport studies were carried out on Caco-2 cell monolayers using digoxin (DIG) as a model p-gp substrate. Cell functionality was demonstrated using the determinations of transepithelial electric resistance (TEER), cell cytotoxicity testing utilizing the MTT assay as well as the inclusion of inhibition controls. RESULTS Under the conditions of this study, extracts of ML, VA and CP showed significant inhibition to (3)H-Digoxin basolateral-to-apical (B-A) transport at 0.02-20mg/mL; the concentrations examined. Their apical-to-basolateral (A-B) transport was further investigated. Increases in the mean A-B transport and significant decreases in the B-A transport and efflux ratio values were observed. The apparent permeability coefficient and efflux ratio were computed providing an estimate of drug absorption. CONCLUSION The findings show that extracts of ML, VA and CP significantly inhibit p-gp in vitro and interactions with conventional p-gp substrate drugs are likely to occur on co-administration which may result in altered therapeutic outcomes.
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Affiliation(s)
- Enoche F Oga
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chiba 260-8675, Japan
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Bauman ME, Mack G, Bruce AK, Bauman ML, Nolan K, Massicotte MP. Natural Health Product Utilization in Warfarinized Children; Prevalence and Knowledge. J Pharm Technol 2012. [DOI: 10.1177/875512251202800303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background:The need for long-term thromboprophylaxis in children using warfarin therapy is increasing. Natural health products (NHPs) are administered to children by parents who perceive them to be useful and acceptable adjuncts or alternatives to conventional therapies. Interactions of NHPs with prescribed therapies may result in serious adverse events. NHP usage is underevaluated in children and there are no studies evaluating NHP usage in warfarinized children.Objectives:To explore NHP use in warfarinized children and their siblings to determine the prevalence, varieties, and reasons for NHP usage, as well as the potential effect on warfarinization (eg, time in therapeutic range [TTR]).Methods:This is a 3-phase cross-sectional cohort study that includes the (1) prevalence (2) NHP education and knowledge assessment, and (3) the follow-up NHP utilization phase.Results:Forty-six percent of warfarinized children consumed NHPs, with time in therapeutic range of 74%. The mean score for baseline knowledge of NHPs and warfarin following the education phase was 67%. Follow-up NHP use was 30%, and increased consistency of utilization with TTR was 83% (p < 0.05), consistent with education provided.Conclusions:The consistent prevalence rates over time of NHP usage in warfarinized children indicate the need for future studies. Education remains vital to combat the potential risks of NHP-warfarin interaction, encouraging patient disclosure and consistency.
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Affiliation(s)
- Mary E Bauman
- MARY E BAUMAN MN NP, Nurse Practitioner, Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Gordon Mack
- GORDON MACK MD, Fellow, Stollery Children's Hospital
| | - Aisha K Bruce
- AISHA K BRUCE MD FRCPC, Staff Physician, Stollery Children's Hospital
| | - Michelle L Bauman
- MICHELLE L BAUMAN BScN, Research Student, Stollery Children's Hospital
| | - Kyle Nolan
- KYLE NOLAN BA, Research Student, Stollery Children's Hospital
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Berginc K, Kristl A. The effect of garlic supplements and phytochemicals on the ADMET properties of drugs. Expert Opin Drug Metab Toxicol 2012; 8:295-310. [PMID: 22313151 DOI: 10.1517/17425255.2012.659662] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Garlic supplements have received wide public attention because of their health-beneficial effects. Although these products are considered as innocuous, several case reports and studies have shown the capacity of individual garlic phytochemicals/supplements to interfere with drug pharmacokinetics. AREAS COVERED This review covers recently published literature on garlic chemistry and composition, and provides a thorough review of published studies evaluating drug-garlic interactions. The authors illustrate the mechanisms underlying pharmacokinetic interactions, which could serve as important highlights in further research to explain results for drugs with narrow therapeutic indices or for drugs, utilizing multiple absorption, distribution and metabolism pathways. EXPERT OPINION To increase the relevance of further research on safety and efficacy of garlic supplements and phytochemicals, their composition should be addressed before conducting in vitro or in vivo research. It is also strongly recommended to characterize in vitro formulation performance to assess the rate and extent of garlic phytochemical release in order to anticipate the in vivo impact on the pharmacokinetics of concomitantly consumed drugs. The main conclusion of this review is that the impact of garlic on different stages of pharmacokinetics, especially on drug absorption and metabolism, is drug specific and dependent on the type/quality of utilized supplement.
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Affiliation(s)
- Katja Berginc
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, 1000 Ljubljana, Slovenia
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A pilot study to compare natural health product–drug interactions in two databases in Canada. ACTA ACUST UNITED AC 2010; 32:179-86. [DOI: 10.1007/s11096-010-9364-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 01/06/2010] [Indexed: 11/26/2022]
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Rogovik AL, Vohra S, Goldman RD. Safety considerations and potential interactions of vitamins: should vitamins be considered drugs? Ann Pharmacother 2009; 44:311-24. [PMID: 20040703 DOI: 10.1345/aph.1m238] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To examine adverse effects, adverse events, and potential interactions of vitamins in light of their current prevalence of use, and to discuss whether vitamins should be considered over-the-counter drugs or natural health products/dietary supplements. DATA SOURCES We performed a MEDLINE/PubMed search, explored 4 online databases (Medline Plus, Drug Digest, Natural Medicine Comprehensive Database, and the database of the University of Maryland), and examined reference lists of included studies published from 1966 through October 2009. STUDY SELECTION AND DATA EXTRACTION The studies were reviewed, with an emphasis on randomized controlled clinical trials. We included articles with the most clinically important information with regard to adverse events and interactions. DATA SYNTHESIS Vitamins are used by over one third of the North American population. Vitamins have documented adverse effects and toxicities, and most have documented interactions with drugs. While some vitamins (biotin, pantothenic acid, riboflavin, thiamine, vitamin B(12), vitamin K) have minor and reversible adverse effects, others, such as fat-soluble vitamins (A, E, D), can cause serious adverse events. Two water-soluble vitamins, folic acid and niacin, can also have significant toxicities and adverse events. CONCLUSIONS Our recommendation is that vitamins A, E, D, folic acid, and niacin should be categorized as over-the-counter medications. Labeling of vitamins, especially those intended for children and other vulnerable groups, should include information on possible toxicities, dosing, recommended upper intake limits, and concurrent use with other products. Vitamin A should be excluded from multivitamin supplements and food fortificants.
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Affiliation(s)
- Alexander L Rogovik
- Pediatric Research in Emergency Therapeutics (PRETx) Program, St. Michael's Hospital, Toronto, ON, Canada
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Levine MA, Xu S, Gaebel K, Brazier N, Bédard M, Brazil K, Lohfeld L, MacLeod SM. Self-reported use of natural health products: A cross-sectional telephone survey in older Ontarians. ACTA ACUST UNITED AC 2009; 7:383-92. [DOI: 10.1016/j.amjopharm.2009.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2009] [Indexed: 10/19/2022]
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American College of Medical Toxicology position statement: Dietary supplements (Update). J Med Toxicol 2009. [DOI: 10.1007/bf03161097] [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] Open
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Engdal S, Klepp O, Nilsen OG. Identification and Exploration of Herb-Drug Combinations Used By Cancer Patients. Integr Cancer Ther 2009; 8:29-36. [DOI: 10.1177/1534735408330202] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: This survey aims to identify herb-chemotherapeutic drug combinations in a defined group of cancer patients and to explore possible clinical consequences of these combinations. Methods: Herb-chemotherapeutic drug combinations were identified among adult cancer patients, and clinical consequences of the combinations were explored by literature searches in medical databases on possible mutual effects on similar cytochrome P-450 metabolising enzymes (CYPs) and/or the P-glycoprotein (P-gp) transporter. Results: Among 42 cancer patients using herbal remedies concurrently with chemotherapy, 136 two-agent herb-drug combinations were registered and 47 different potential herb-drug interactions were identified on the level of CYP metabolism and P-gp transport in vitro. Garlic, ginger, green tea and noni juice were the herbal remedies most frequently used in such combinations. For 48 % of the herbal remedies identified no literature data exist on their interaction potentials. Clinical studies were available for four herbal remedies only. Minor clinical potential for CYP interactions in humans was indicated for green tea and Echinacea. P-gp interactions were only investigated for garlic, which showed a significant interaction potential both in vivo and in vitro. Conclusion: The large number of in vitro potential herb-drug interactions identified urge for more clinical pharmacokinetic interaction studies in humans.
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Affiliation(s)
- Silje Engdal
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway,
| | - Olbjørn Klepp
- Department of Oncology, Sunnmøre Public Hospital Enterprise, Ålesund Hospital, Ålesund, Norway
| | - Odd Georg Nilsen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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MINE Y, YOUNG D. Regulation of Natural Health Products in Canada. FOOD SCIENCE AND TECHNOLOGY RESEARCH 2009. [DOI: 10.3136/fstr.15.459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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