Historical Aspects of Herbal Use and Comparison of Current Regulations of Herbal Products between Mexico, Canada and the United States of America

Use of herbal medication in the perioperative period: Potential adverse drug interactions

Use of herbal medications and supplements has experienced immense growth over the last two decades, with retail sales in the USA exceeding $13 billion in 2021. Since the Dietary Supplement Health and Education Act (DSHEA) of 1994 reduced FDA oversight, these products have become less regulated. Data from 2012 shows 18% of U.S. adults used non-vitamin, non-mineral natural products. Prevalence varies regionally, with higher use in Western states. Among preoperative patients, the most commonly used herbal medications included garlic, ginseng, ginkgo, St. John's wort, and echinacea. However, 50-70% of surgical patients fail to disclose their use of herbal medications to their physicians, and most fail to discontinue them preoperatively. Since herbal medications can interact with anesthetic medications administered during surgery, the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications 1-2 weeks before elective surgical procedures. Potential adverse drug effects related to preoperative use of herbal medications involve the coagulation system (e.g., increasing the risk of perioperative bleeding), the cardiovascular system (e.g., arrhythmias, hypotension, hypertension), the central nervous system (e.g., sedation, confusion, seizures), pulmonary (e.g., coughing, bronchospasm), renal (e.g., diuresis) and endocrine-metabolic (e.g., hepatic dysfunction, altered metabolism of anesthetic drugs). During the preoperative evaluation, anesthesiologists should inquire about the use of herbal medications to anticipate potential adverse drug interactions during the perioperative period.

An evaluation of the antioxidant potential and in vitro enzyme inhibition profile of selected bryophytes from Northeast Anatolia (Türkiye)

Interest in the use of bryophytes in pharmaceutical, cosmetic, and food industrial applications is growing worldwide due to their secondary metabolites. In this study, n-hexane crude extracts and further fractions (aqueous, ethyl acetate and n-butanol) of aqueous ethanol (80:20, ethanol:H2O, v/v) were obtained from five different bryophytes (Pellia epiphylla, Conocephalum conicum, Porella platyphylla, Plagiomnium cuspidatum and Mnium spinulosum) collected from Trabzon, Türkiye. The total phenolic compound (TPC) content, antioxidant capacity (AC) and enzyme inhibition activity (acetylcholine esterase, butyrylcholine esterase, tyrosinase, α-amylase and α-glucosidase) of the extracts and fractions were species-specific and varied significantly between the crude extracts and fractions. Among the different bryophytes, Porella platyphylla and Pellia epiphylla in n-butanol and Plagiomnium cuspidatum and Mnium spinulosum in ethyl acetate fraction exhibited the highest TPC contents and AC values. The contents of phenolic acids liberated in free, ester and glycoside forms were also species-specific. p-Hydroxybenzoic acid (p-HBA) in free form in P. cuspidatum and P. platyphylla, p-coumaric acid (p-CoA) in ester form and m-hydroxybenzoic acid (m-HBA) in glycoside form in M. spinulosum were the major phenolic acids in the bryophytes. The n-hexane extracts of the bryophytes, in particular M. spinulosum, had IC50 values ​​almost 100 times lower than acarbose. This suggests that M. spinulosum in particular may represent a possible candidate for the production of new antidiabetic agents.Communicated by Ramaswamy H. Sarma.

Polypharmacy and Excessive Polypharmacy Among Persons Living with Chronic Pain: A Cross-Sectional Study on the Prevalence and Associated Factors

Purpose

Polypharmacy can be defined as the concomitant use of ≥5 medications and excessive polypharmacy, as the use of ≥10 medications. Objectives were to (1) assess the prevalence of polypharmacy and excessive polypharmacy among persons living with chronic pain, and (2) identify sociodemographic and clinical factors associated with excessive polypharmacy.

Patients and Methods

This cross-sectional study used data from 1342 persons from the ChrOnic Pain trEatment (COPE) Cohort (Quebec, Canada). The self-reported number of medications currently used by participants (regardless of whether they were prescribed or taken over-the-counter, or were used for treating pain or other health issues) was categorized to assess polypharmacy and excessive polypharmacy.

Results

Participants reported using an average of 6 medications (median: 5). The prevalence of polypharmacy was 71.4% (95% CI: 69.0-73.8) and excessive polypharmacy was 25.9% (95% CI: 23.6-28.3). No significant differences were found across gender identity groups. Multivariable logistic regression revealed that factors associated with greater chances of reporting excessive polypharmacy (vs <10 medications) included being born in Canada, using prescribed pain medications, and reporting greater pain intensity (0-10) or pain relief from currently used pain treatments (0-100%). Factors associated with lower chances of excessive polypharmacy were using physical and psychological pain treatments, reporting better general health/physical functioning, considering pain to be terrible/feeling like it will never get better, and being employed.

Conclusion

Polypharmacy is the rule rather than the exception among persons living with chronic pain. Close monitoring and evaluation of the different medications used are important for all persons, especially those with limited access to care.