Herbal and Dietary Supplements Can Be Dangerous
Taken with Prescribed Drugs
Could be tip of the iceberg says editorial - most
endangered are those with cardiovascular, central nervous system
Oct. 24, 2012 - A number of herbs and dietary
supplements (HDS) can cause potentially harmful drug interactions,
particularly among people receiving medication for problems with their
central nervous or cardiovascular systems, which is most often older
people. It is estimated that most people with chronic disease or cancer
Those are the key findings of an extensive research
review published in the November issue of IJCP, the International
Journal of Clinical Practice.
Researchers examined 54 review articles and 31
original studies. They found that the greatest problems were caused by
interactions between prescribed drugs and HDS that included ingredients
such as St John's Wort, magnesium, calcium, iron or ginkgo.
"Consumer use of HDS has risen dramatically over
the past two decades" says co-author Dr Hsiang-Wen Lin from the College
of Pharmacy, China Medical School, Taiwan.
"In the USA, for example, it is estimated that more
than 50 per cent of patients with chronic diseases or cancer use them
and that many patients take them at the same time as prescribed
"Despite their widespread use, the potential risks
associated with combining HDS with other medications, which include
mild-to-severe heart problems, chest pain, abdominal pain and headache,
are poorly understood."
Key findings of the review included:
The literature covered 213 HDS entities and 509
prescribed medications, with 882 HDS-drug interactions described in
terms of their mechanisms and severity.
Warfarin, insulin, aspirin digoxin and
ticlopidine had the greatest number of reported interactions with
More than 42 per cent of the drug interactions
were caused by the HDS altering the pharmacokinetics of the
prescribed drugs - the process by which a drug is absorbed,
distributed, metabolised and eliminated by the body.
Just over 26 per cent of the total were
described as major interactions.
Among the 152 identified contraindications, the
most frequent involved the gastrointestinal system (16.4%),
neurological system (14.5%) and andrenal ⁄ genitourinary diseases
Flaxseed, echinacea and yohimbe had the largest
number of documented contraindications (a condition or factor that
serves as a reason to withhold a certain medical treatment).
"Our extensive review clearly shows that some HDS
ingredients have potentially harmful drug interactions that are
predominately moderate in their severity" says Dr Lin. "It also showed
that herbal and botanical remedies were more likely to have documented
drug interactions and contraindications than the other dietary
supplements, such as vitamins, minerals and amino acids."
In an editorial on the review, Professor Edzard
Ernst, Emeritus Professor, University of Exeter says that the authors
provide an impressively complete overview of a fascinating and
potentially important subject.
"Survey after survey shows that large proportions
of the population are trying 'natural' remedies for illness-prevention,
all sorts of ailments, diseases or for states of reduced well-being" he
says. "Most experts therefore agree that the potential for such
interactions is substantial.
"Despite this consensus and despite the
considerable amount of documented harm generated by such interactions,
our current knowledge is still woefully incomplete."
Professor Ernst believes that the number of
interactions between HDS and prescribed drugs could be under-reported
and just the tip of the iceberg.
He feels that the situation calls for rigorous
research, increased awareness of possible HDS prescription interactions
by physicians and patients and greater government control of this public
"Patients deserve reliable information, and it is
our duty to provide it" he says. "We have to become vigilant and finally
agree to monitor this sector adequately. Each individual doctor can
contribute to this process by routinely including questions about
alternative medicine use in their medical history taking."
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