Introduction: The use of herbal medicine is on the rise worldwide, and safety issues associated with herbal medicines may have an exacerbated impact in elderly because this population has an increased susceptibility and sensitivity to health complications due to the aging process. Methods: This cross-sectional study was carried out at a primary health care unit in the city of Macapa, Brazil. The herbal medicines used and the sociodemographic characteristics of 123 voluntarily consenting participants were collected using a structured questionnaire. A total of 132 herbal medicines with oral or topical administration were donated by the elderly for microbial analysis before consumption, and 18 water samples used in the preparation of homemade herbal medicines were collected. Bacterial and fungal counts and identification of bacterial pathogens (Escherichia coli, Salmonella spp., Pseudomonas aeruginosa and Staphylococcus aureus) were performed according to the regulations of the Brazilian Pharmacopoeia and World Health Organization. Water analysis for the detection of coliforms and E. coli was carried out using Colilert® according to the manufacturer's instructions and the techniques established by Standard Methods. Results: Of the study participants, 78.8% were women. Bacterial growth was observed in samples from 51.5% of study and 35.6% had fungal growth. A total of 31.8% of the herbal medicine samples exceeded the safety limits (CFU/g ≤ 10 5), including 16.7% of the homemade herbal medicines and 15.1% of the commercial herbal medicines. It was also found that 31.0% of the samples exceeded the safety limit for fungal growth. The microorganisms most commonly isolated from the herbal medicines were S. aureus (49.2%), followed by Salmonella spp. (34.8%), E. coli (25.8%), and P. aeruginosa (14.4%). Of water samples analyzed, 77.8% were positive for total coliforms (1 ml) and in 66.7% water samples E. coli was detected (1 ml), making them unfit for consumption. Conclusions: The use of homemade and commercial herbal medicines is a major risk to the health of elderly who use these therapies due to the lack of microbial quality standards. We observed levels of viable bacteria and fungi that were above safety limits; in addition, we were able to isolate pathogenic bacteria from these herbal medicines.

Practices described as traditional medicine may coexist with formalized, science-based medicine. In this context, the present study aimed to verify the profile of the elderly who consumed herbal medicines concomitantly with medications and to identify suspected adverse drug reactions (ADRs) in the Brazilian Amazon (Macapá, Amapá). The study was carried out in two steps: a cross-sectional study (structured questionnaire) and a clinical study (pharmacotherapeutic follow-up). Out of 208 participants, 78.8% were female with age between 60 and 69 years (58.7%), 59.1% used herbal medicines concurrently with medications, and 40.9% did not report use of herbal medicine. Losartan was the most used medication, and Lippia alba (Mill.) N.E. Br was the most common herbal medicine used. The total prevalence of suspected ADRs, among the elderly who answered the structured questionnaire, was 41.3%, with 27.4% being in the elderly who used herbal medicines and medications, and 13.9% being in the elderly who used only medications. Meanwhile, the total prevalence of suspected ADRs was 71.0% among the elderly patients who underwent pharmacotherapeutic follow-up, 60.5% in elderly who used herbal medicines and medications, and 10.5% in elderly who used only medications. The most reported ADR symptoms were related to disorders that affect the nervous system (38.4%) in the structured questionnaire and related to digestive disorders (36.4%) in the pharmacotherapeutic follow-up. The probability associated with the occurrence of a given ADR in the face of a set of demographic, socioeconomic, and clinical variables was estimated; the results showed that, in the studied population, only sex (p = 0.030) had an influence on the occurrence of ADR. The prevalence of ADRs with probable causality was high in this study population, but it was only sex-related, although more prevalent in the elderly who consume herbal medicines.

Objective:The purpose of this study was to analyze the primary and secondary labels of plantbased medicines. Method: This research has a cross-sectional and descriptive. The procedure consisted of analyzing 100 labels of medicinal plant-based products used by elderly people from (in) Macapá-AP, in 2017. A script was prepared to verify their adequacy to health standards based on the Brazilian legislation (commercial name, botanical nomenclature, active ingredients, concentration, route of administration, age-restricted use, quantity and pharmaceutical form, preservation care, company name, CNPJ -Brazils's companies registration number, composition, SAC, expiration date, manufacture and batch), descriptive analysis of the data was performed (protocol number 38400314.9.0000.0003). Results: Only 4% of the products completely met the analyzed criteria. One of the main problems observed was the absence of a uniform standard of presentation of information on the packaging. About 7% of these products did not present any information besides the popular name of the medicinal plant used, 37% of the packages (or labels) contain statements and images that induce self-medication, errors in use, or references to "natural medicine", besides, transmitting the idea that the product has superior properties to drugs on the market. Conclusions: The results obtained suggest that the packaging of medicinal plant-based products induces the irrational use of medicines due to the lack of adequate information, as well as the presence of inadequate makenting strategies, in accordance with current national legislation.

Objective: The purpose of this study was to analyze the consumption profile with the possible stimulants effects on the central nervous system (CNS) in academics of the Pharmacy course at the Universidade Federal do Amapá, through a validated questionnaire. Method: this pharmacoepidemiologic research has a cross-sectional and descriptive study. The procedure consisted of a three-domain questionnaire’s elaboration: 1. Sociodemographic; 2. Beck Depression Inventory (BDI); and 3. Dundee Ready Education Environment Measure (DREEM) questionnaire, with a probability sampling of 166 students. The questionnaire/ sociodemographic domain was validated through specialists and the application was conducted in three different period steps for ten academics (protocol number 3.753.673). Result: The validation process resulted in predominantly poor/weak concordances, and 60,8% of the interviewed academics confirmed consuming psychostimulants, of these about 51% consumes two or more substances considered CNS stimulants. As shown, the proposed instrument was validated, despite the week’s concordance in the Kappa index. Conclusion: The collected data from the instrument showed that the CNS stimulants consumption affects more than 50% of the students and that these substances bring risk to life, being observed abstinence symptoms by its users.