Herb-drug Interactions in Neuropsychiatric Pharmacotherapy - A Review of Clinically Relevant Findings

The management of neuropsychiatric disorders relies heavily on pharmacotherapy. The use of herbal products as complimentary medicine, often concomitantly, is common among patients taking prescription neuropsychiatric drugs. Herb-drug interaction, a clinical consequence of this practice, may jeopardize the success of pharmacotherapy in neuropsychiatry. Besides the wellknown ability of phytochemicals to inhibit and/or induce drug-metabolizing enzymes and transport proteins, several phytoconstituents are capable of exerting pharmacological effects on the central nervous system. This study reviewed the relevant literature and identified 13 commonly used herbal products - celery, echinacea, ginkgo, ginseng, hydroxycut, kava, kratom, moringa, piperine, rhodiola, St. John's wort, terminalia/commiphora ayurvedic mixture and valerian - which have shown clinically relevant interactions with prescription drugs used in the management of neuropsychiatric disorders. The consequent pharmacokinetic and pharmacodynamic interactions with orthodox medications often result in deleterious clinical consequences. This underscores the importance of caution in herb-drug co-medication.

Cannabis use among Danish patients with cancer: a cross-sectional survey of sociodemographic traits, quality of life, and patient experiences

PURPOSE

Patients with cancer are using cannabis for self-treatment. The reasons, experienced effects, and prevalence of use are unknown in the European general oncological population.

METHODS

Adult patients with cancer attending outpatient oncology clinics were invited to participate in a cross-sectional survey. The questionnaire consisted of sociodemographic questions, validated scales on quality of life, neuropathy, anxiety and depression as well as questions regarding use of cannabis.

RESULTS

The overall response rate was 83% (2839 patients) and 13% of patients were using or had used cannabis during their treatment. Rate of use was higher in smokers (19% vs 11%, p adjusted 0.002), in patients in active cancer treatment (14% vs 10%, p adjusted = 0.02), and in patients with depression (19% vs 11%, adjusted p = 0.002). Cannabis use was also correlated with lower quality of life (EORTC C30 SumScore mean diff. =  - 7.61, 95% CI = [- 9.69; - 5.53]). In total, 77% of users experienced at least one positive effect of cannabis, 18% experienced no effect, and 5% experienced other effects. At least one side effect was experienced by 33% of users. Management of pain and nausea were the primary reasons for initiating cannabis use (39% for both). Less nausea and better sleep were the most common effects experienced (26% for both). Oils for oral use were the most common route of administration (88%).

CONCLUSION

Cannabis use among patients with cancer is prevalent and correlated with worse quality of life. Patients report using cannabis for symptom management and many experience relief of their symptoms. However, one third of patients experienced side effects.

A comparison of two Tai Chi interventions tailored for different health outcomes

OBJECTIVES

We compared the health benefits of two different Tai Chi interventions tailored for improving blood pressure (BP) (PRESSURE) or balance (BALANCE).

DESIGN

randomized controlled trial.

SETTING

Community dwelling older adults (≥60yr) practiced Tai Chi at the fitness center of a continuous care community.

INTERVENTIONS

We tailored PRESSURE to emphasize breathing techniques and mental relaxation and BALANCE to emphasize movement principles that challenged balance. Subjects were randomized to PRESSURE (n = 12), BALANCE (n = 13), or CONTROL (n = 10). Tai Chi was practiced 3 sessions/wk, 60 min/session for 12 wk. CONTROL performed normal daily activities.

MAIN OUTCOME MEASURES

We compared the change in cardiometabolic health, balance, and functional fitness between groups with ANCOVA using baseline values, age, and body mass index as covariates.

RESULTS

Subjects were physically active, Tai Chi naive (97.1 %), white, mostly female (82.9 %), and older (78.9 ± 5.7 yr) with resting systolic BP (SBP) of 126.5 ± 14.4 mmHg and diastolic BP of 69.3 ± 8.4 mmHg. PRESSURE significantly improved Chair Sit-to-Stand Test (CSTS) (1.0 ± 1.8 vs.-0.6 ± 0.8times/30s,p = 0.03) versus CONTROL, and gait speed (12.8±43.3 vs.-24.1±22.4cm/sec, p = 0.02) versus BALANCE. Meanwhile, BALANCE significantly improved Single Leg Stance Test (5.4±18.0 vs.-8.2±10.3 s, p = 0.049) and CSTS (1.0±1.7 vs.-0.6±0.8times/30s, p = 0.03), and tended to lower SBP (-4.2±16.0 vs. 3.5±8.3mmHg, p = 0.052) versus CONTROL.

CONCLUSION

Within 3 months, Tai Chi improved several health outcomes independent of the type of practice among physically active, Tai Chi naive older adults. Therefore, healthcare and exercise professionals may recommend Tai Chi to physically active older adults without specifying the type of practice.

Acupuncture for Cancer-Related Anorexia: a Review of the Current Evidence

PURPOSE OF REVIEW

Loss of appetite/anorexia is extremely common among cancer patients, affecting as many as half of newly diagnosed patients and 70% of patients with advanced disease. Effective management of this disabling symptom of cancer remains a major challenge in the field of oncology. We conducted a systematic review of the current evidence on acupuncture and/or moxibustion as an intervention for cancer-related anorexia.

RECENT FINDINGS

Acupuncture, as a part of traditional Chinese medicine practice, has demonstrated effectiveness in managing many cancer- and treatment-related symptoms, especially chemotherapy-induced or postoperative nausea. However, the efficacy of acupuncture in treating cancer-related anorexia/loss of appetite is not clear. The current level of evidence is insufficient to make a definitive conclusion on the benefit of acupuncture/moxibustion for treating chronic cancer-related anorexia/appetite problems. Future large randomized controlled trials of high methodological quality are needed.

Gender Differences in Beliefs and Attitudes Towards Complementary and Alternative Medicine Use Among a Non-urban, Malaysian Population

The choice to take-up specific complimentary and alternative medicine (CAM) modalities is influenced by many factors including cultural background, experience and peer-participation. In this study we investigated the beliefs and attitudes that contributed to CAM choices in a non-urban Malaysian population (N = 700). We found significant differences in the beliefs held by men and women in this population. Specifically, women believed more strongly than men that CAM providers offered healthy lifestyle advice (p = 0.042) and that those who were averse to discomfort from conventional treatments were more likely to take up CAM (p = 0.016). In addition, those individuals who chose to use CAM more strongly believed that CAM products were more healthy than conventional treatments (p = 0.002), that their effects were well understood (p = 0.002) and that CAM products worked with the body (p = 0.017). The data obtained in this study emphasize the lessons that can be learned by conventional healthcare providers in communicating the benefits of treatments to their patients. CAM users also believed that CAM products never caused harm (p = 0.007), which is a concern given that the modes of action of some CAM modalities and their interaction with prescribed treatments are not always well understood.

Traditional healing practices in rural Bangladesh: a qualitative investigation

Background

Traditional healing practice is an important and integral part of healthcare systems in almost all countries of the world. Very few studies have addressed the holistic scenario of traditional healing practices in Bangladesh, although these serve around 80% of the ailing people. This study explored distinctive forms of traditional healing practices in rural Bangladesh.

Methods

During July to October 2007, the study team conducted 64 unstructured interviews, and 18 key informant interviews with traditional healers and patients from Bhabanipur and Jobra, two adjacent villages in Chittagong district, Bangladesh. The study also used participatory observations of traditional healing activities in the treatment centers.

Results

Majority of the community members, especially people of low socioeconomic status, first approached the traditional healers with their medical problems. Only after failure of such treatment did they move to qualified physicians for modern treatment. Interestingly, if this failed, they returned to the traditional healers. This study identified both religious and non-religious healing practices. The key religious healing practices reportedly included Kalami, Bhandai, and Spiritual Healing, whereas the non-religious healing practices included Sorcery, Kabiraji, and Home Medicine. Both patients and healers practiced self-medication at home with their indigenous knowledge. Kabiraji was widely practiced based on informal use of local medicinal plants in rural areas. Healers in both Kalami and Bhandari practices resorted to religious rituals, and usually used verses of holy books in healing, which required a firm belief of patients for the treatment to be effective. Sorcerers deliberately used their so-called supernatural power not only to treat a patient but also to cause harm to others upon secret request. The spiritual healing reportedly diagnosed and cured the health problems through communication with sacred spirits. Although the fee for diagnosis was small, spiritual healing required different types of treatment instruments, which made the treatment implicitly expensive.

Conclusions

Traditional healing was widely practiced as the means of primary healthcare in rural areas of Bangladesh, especially among the people with low socioeconomic status. The extent of services showed no decline with the advancement of modern medical sciences; rather it has increased with the passage of time.

The use of complementary medicine in patients with diabetes

OBJECTIVE:

Diabetes mellitus (DM) is a growing health problem with serious complications. The chronic and progressive nature of the disease often leads patients to use complementary and integrative medicine. The present study aimed to investigate the frequency of use of alternative medicine by patients with DM and the products used.

METHODS:

Between September 2014 and May 2015, 301 patients with DM were selected from Bezmialem Foundation University Hospital Diabetes Clinic to participate in the study.

RESULTS:

The results of the study indicate that 81 (26.9%) patients had tried alternative medicine, and 50 (16.6%) patients continued to use some form of alternative medicine product. A total of 43 (14.3%) patients used such products every day and 24 (8%) patients had used alternative medicine products for up to 6 months. Glycated hemoglobin (HbA1c) levels were significantly decreased in patients using alternative medicine products compared to the remainder of patients in the study (p=0.017). No other significant difference was found between the two groups. It was observed that among patients using alternative medicine products, only 10 (12%) had informed their physicians.

CONCLUSION:

This study indicated that patients with diabetes are very likely to use alternative medicine products. Additional studies are needed to further determine the efficacy of these products. Patients as well as health providers must be educated about complementary medicine and alternative products.

Self-Reported Use of Complementary and Alternative Medicine among the Health Care Consumers at a Tertiary Care Center in Ajman, United Arab Emirates

Background:

Complementary and alternative medicine (CAM) covers a wide range of approaches, including herbal medicine, manual healing techniques, traditional therapies and mind-body interventions. CAM is widely used throughout the world to treat a variety of illnesses and to maintain health.

Aim:

Complementary and alternative medicine (CAM) is popular across the world, and is widely practiced. Utilization pattern and reasons for use and non-use among patients attending a tertiary care center are assessed in this study.

Subjects and Methods:

One hundred and thirty-five patients of different nationalities, above the age of 18 years, Gulf Medical College Hospital and Research Centre, Ajman, UAE, were interviewed using an open-ended structured questionnaire. In addition to socio-demographic characteristics, the acceptability, utilization pattern and reasons for use and non-use were elicited from the participants after obtaining consent from them. PASW 18 version was used to perform Chi-square test and descriptive statistics.

Results:

Among the 135 participants were 20-81 years old, those from the Far East used most 85.7% (6/7), then Pakistan 38.5% (15/39) and India 23% (16/70). The most common system used was homeopathy. Physicians advised 28.2% (11/39) of users, whereas others used non-medical information. Around 71.8% (28/39) reported good outcome for themselves and family; however, only 10% (4/39) recommended it to others. Most of the users, 75% (101/135), were not sure whether CAM was based on scientific evidence, while 18% (24/135) felt it was. Good previous experience and less treatment complications were the most common reasons for using CAM and non-use due to lack of knowledge or need.

Conclusion:

About one-third of the seekers of modern medicine care also use CAM, and mostly without physician advice; hence, the importance of discussing the same while taking the clinical history. In view of the belief that CAM has fewer side-effects, there is even more need for physician-initiated discussion.