A systematic review of possible interactions for herbal medicines and dietary supplements used concomitantly with disease‐modifying or symptom‐alleviating multiple sclerosis drugs

Petersen, Malene J.; Bergien, S.O.

doi:10.1002/ptr.7050

Cited by 15 publications

(7 citation statements)

References 138 publications

(179 reference statements)

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“… 21 , 22 Thus, the possibility of pharmacologic interactions is high. 23 CBD and THC affect common targets for drug metabolism (such as cytochrome P450 [CYP]3A4/2C19 enzymes), which may affect the pharmacokinetics/pharmacodynamics of other drugs that interact with these pathways. 24 , 25 CBD or marijuana use decreases clearance of drugs and their metabolites that use CYP2C19 (e.g., warfarin), increases clearance of CYP1A2-metabolized drugs, and may result in adverse additive effects in combination with sympathomimetics (e.g., hypertension), alcohol and opioids (e.g., ataxia), and anticholinergics (e.g., tachycardia).…”

Section: Discussionmentioning

confidence: 99%

Sources of Cannabis Information and Medical Guidance for Neurologic Use

et al. 2022

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Objective:As cannabis products become increasingly accessible across the United States, understanding how patients obtain medical information on cannabis and view the role of their healthcare provider in providing information is important.Methods:Participants with multiple sclerosis (MS) from the North American Research Committee on Multiple Sclerosis (NARCOMS) registry completed a supplemental survey on Δ9-tetrahydrocannabinol-containing cannabis use between March and April 2020. Participants reported dialogue with healthcare providers regarding cannabis use, information sources used to make product decisions, and expenditure on cannabis. Findings are reported using descriptive statistics.Results:Overall, 3249 participants responded (47% response rate) of whom 31% ever used cannabis and 20% currently used cannabis for MS. To determine presumed cannabis contents, respondents who had ever used cannabis (ever users) most often used dispensary-provided information (39%), word of mouth/dealer/friend (29%), and unregulated product labels (24%). For general information on cannabis for MS, ever users most often used dispensary staff (38%) and friends (32%). The primary source of medical guidance among ever users was most often ‘nobody or myself’ (48%) followed by a dispensary professional (21%); only 12% relied on their MS physician, although 70% had discussed cannabis with their MS physician. Most current users (62%) typically sourced their cannabis from a dispensary. The most common factor in selecting a cannabis product was perceived quality and safety (70%).Conclusions:Participants most often received information on cannabis for MS from dispensaries, unregulated product labels, and friends; only a small proportion used healthcare providers. Evidence-based patient and physician education is needed.

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Section: Discussionmentioning

confidence: 99%

Sources of Cannabis Information and Medical Guidance for Neurologic Use

et al. 2022

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“… 14 , 22 To maintain quality of life and improve functional outcomes, many patients seek additional help in the use of complementary and alternative medicines (CAM) such as dietary supplements or herbal drugs. 23 – 25 It was reported that 67% to 80% of MS patients use CAM and half of them even as an alternative to conventional therapies. 26 , 27 For example, vitamin D supplementation is often part of a nutritional health plan because low cholecalciferol levels in serum have been associated with a higher risk of relapses.…”

Section: Introductionmentioning

confidence: 99%

Associated factors of potential drug-drug interactions and drug–food interactions in patients with multiple sclerosis

Debus

Bachmann

Frahm

et al. 2022

Therapeutic Advances in Chronic Disease

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Background: Multiple sclerosis (MS) is the most common immune-mediated demyelinating disease in younger adults. Patients with MS (PwMS) are vulnerable to the presence of potential drug–drug interactions (pDDIs) and potential drug–food interactions (pDFIs) as they take numerous medications to treat MS, associated symptoms and comorbidities. Knowledge about pDDIs and pDFIs can increase treatment success and reduce side effects. Objective: We aimed at determining the frequency and severity of pDDIs and pDFIs in PwMS, with regard to polypharmacy. Methods: In the cross-sectional study, we analysed pDDIs and pDFIs of 627 PwMS aged ⩾18 years. Data collection was performed through patient record reviews, clinical examinations and structured patient interviews. pDDIs and pDFIs were identified using two DDI databases: Drugs.com Interactions Checker and Stockley’s Interactions Checker. Results: We identified 2587 pDDIs (counted with repetitions). Of 627 PwMS, 408 (65.1%) had ⩾ 1 pDDI. Polypharmacy (concomitant use of ⩾ 5 drugs) was found for 334 patients (53.3%). Patients with polypharmacy (Pw/P) were found to have a 15-fold higher likelihood of having ⩾ 1 severe pDDI compared with patients without polypharmacy (Pw/oP) (OR: 14.920, p < 0.001). The most frequently recorded severe pDDI was between citalopram and fingolimod. Regarding pDFIs, ibuprofen and alcohol was the most frequent severe pDFI. Conclusion: Pw/P were particularly at risk of severe pDDIs. Age and educational level were found to be factors associated with the occurrence of pDDIs, independent of the number of medications taken. Screening for pDDIs/pDFIs should be routinely done by the clinical physician to increase drug safety and reduce side effects.

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“…The present paper is based on a larger sequential explanatory mixed methods study, carried out from February 2019 to June 2020. The study consisted of a cross-sectional survey [8], a systematic literature review [16] and qualitative in-depth interviews. The results shared in this paper are based on data from the interviews, the primary aim of which was to explore information-seeking behavior among PwMS related to their use of DIHES.…”

Section: Methodsmentioning

confidence: 99%

“I need personal experiences or some sort of documentation”: a qualitative study on where people with multiple sclerosis seek information on dietary and herbal supplements

Bergien

Petersen

Larochelle

et al. 2021

BMC Complement Med Ther

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Background The use of dietary and herbal supplements (DIHES) is widespread among people with multiple sclerosis (PwMS). PwMS are a highly informed patient group, and they use several types of sources to seek information on subjects related to their disease. However, it is still unknown where PwMS seek information about DIHES. It is important that PwMS make decisions about DIHES based on accurate, useful and accessible information. Therefore, the aim of this study was to explore where PwMS seek information on DIHES and how they experience and engage with this information. Methods Semi-structured interviews were conducted with eighteen PwMS using DIHES. Participants were selected from a cross-sectional survey. Diversity sampling was used, based on relevant characteristics such as gender and number of DIHES used during the past 12 months. The interviews were conducted face-to-face or over the telephone and lasted between 30 min and 1 hour. The interviews were recorded, transcribed verbatim, and analyzed using thematic network analysis in NVivo 12 Pro software. Results Three main themes emerged in the analysis: i) engaging with healthcare professionals (HCPs) regarding DIHES, ii) social networks as a source of information regarding DIHES, and iii) reliance on bodily sensations. Most participants navigated all three types of sources. All participants had at some point discussed DIHES with an HCP. Information from HCPs was considered reliable and valuable, but HCPs were viewed as uncommitted to the dialogue about DIHES. Recommendations from others were often the driver of decisions regarding use of DIHES. However, the information from PwMS’ networks could be overwhelming and difficult to navigate. Finally, PwMS relied on their own experiences regarding DIHES and let their bodily sensations guide their use of DIHES. Conclusions Participants often rely on all three types of information sources to create a nuanced and comprehensive information base. However, PwMS may feel overwhelmed or confused with all the information they have gathered. These findings indicate the need for better guidance for PwMS concerning DIHES and an openness among HCPs to engage in dialogue.

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A systematic review of possible interactions for herbal medicines and dietary supplements used concomitantly with disease‐modifying or symptom‐alleviating multiple sclerosis drugs

Cited by 15 publications

References 138 publications

Sources of Cannabis Information and Medical Guidance for Neurologic Use

Sources of Cannabis Information and Medical Guidance for Neurologic Use

Associated factors of potential drug-drug interactions and drug–food interactions in patients with multiple sclerosis

“I need personal experiences or some sort of documentation”: a qualitative study on where people with multiple sclerosis seek information on dietary and herbal supplements

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