Acute adverse events from over-the-counter Chinese herbal medicines: a population-based survey of Hong Kong Chinese

Abstract

BackgroundAlthough over-the-counter traditional Chinese herbal medicine (COTC) is commonly used to treat everyday illness in many parts of the world, no population-based study has been done to examine the prevalence and factors associated with COTC-related adverse events.MethodsA cross-sectional telephone survey was conducted among Hong Kong Chinese adults in 2011 (n = 1100) with informed verbal consent. Stepwise logistic regression of demographic, attitudinal and behavioral variables was used to determine factors associated with past-year adverse events.ResultsOf study respondents, 71.7% (789/1100) reported past-year COTC use and 2.3% (25/1100) reported at least one COTC-related adverse event in the past year. Of the 27 adverse events cases reported among COTC users, the most common were allergic reactions (n = 11) dizziness (n = 5), and gastro-intestinal problems (n = 4). Pills/capsules were the dosage form that caused the highest proportion of adverse events (n = 10), followed by plasters (n = 7), creams/ointments (n = 5), and ingestible powders (n = 2).Although COTC users reporting adverse events were more likely to report greater practices to avoid adverse events (OR = 6.47; 95% CI: 1.38-30.3); they were also more likely to possess lower education levels (OR = 9.64, 95% CI: 2.20-42.3) and to have received COTC information from non-reliable, mass-media information sources such as magazines (OR = 3.32; 95% CI: 1.01-8.50) or television (OR = 2.93; 95% CI: 1.03-10.7). Package labels were also felt to be unclear by 42.9% of COTC users. A large proportion of COTC users demonstrated low levels of COTC-related knowledge, while the main impediment to greater information-seeking was the belief that reliable COTC information is not obtainable from Western health professionals.ConclusionsDespite global movements toward more stringent complementary medicine regulation, the limited accessibility of reliable information and widespread misperceptions among consumers present major challenges for the safe use of complementary medicine.

Survey of Dental Students’ Attitude Regarding Oriental Medicine/Complementary and Alternative Medicine: Comparison Between Two Japanese Dental Schools

“…Prevalence of the education on oriental medicine/CAM for Western doctors appears to be effective in improving attitudes, knowledge, and skills amongst both physicians and medical students towards the use of oriental medicine/CAM (Quartey et al, 2012). It might also be useful to enhance their knowledge towards the adverse effects of herbal medicines and remedies used by oriental medicine/CAM therapies and their drug interactions (Abebe et al, 2011; Kim et al, 2013).…”

Bradycardia and Hypotension from Improper Use of Aconite Root: A Case Report and Brief Review

“…A further factor is that the prescribing and dispensing unit for herbs is the gross weight rather than the content of the active ingredients, which means that toxicity resulting from too great an amount of active ingredient can occur even when the dry weight of Aconitum plant is within the recommended dose [12]. Furthermore, to achieve the desired therapeutic effects or compensate for suboptimal effects, prescriptions by TCM physicians or self-medication can result in doses that exceed the safety level [12,19.] TCM-related misconceptions, perceptions that CHMs are low risk, and peer effects from family members, friends, acquaintances, and colleagues who have experienced satisfactory results from with CHM are pervasive in East Asia, where people are inclined to self-manage heath issues and, therefore, experience unexpected adverse events [5,19.]…”

“…In addition, the accreditation and registration of TCM practitioners and retailers would ensure that only qualified persons could prescribe CHMs and only approved shops could trade and dispense controlled herbs [18]. Most important of all, unhindered communication and extensive cooperation between TCM practitioners, retailers, and Western medicine health professionals would reduce the risk of drug interactions, whether synergistic or antagonistic, and would provide full-scale holistic healthcare for patients, and benefit scientific research on TCM in the future [19]. Despite the toxicological risks from improper use, Aconitum species have been essential herbs for CHM for over 2,000 years and merit efforts to establish a fully-fledged operating process for these valuable drugs.…”

“…Furthermore, to achieve the desired therapeutic effects or compensate for suboptimal effects, prescriptions by TCM physicians or self-medication can result in doses that exceed the safety level [12,19.] TCM-related misconceptions, perceptions that CHMs are low risk, and peer effects from family members, friends, acquaintances, and colleagues who have experienced satisfactory results from with CHM are pervasive in East Asia, where people are inclined to self-manage heath issues and, therefore, experience unexpected adverse events [5,19.] In Taiwan, only accredited and listed retailers are allowed to dispense prescribed Aconitum medicine, and other herbs.…”

“…Unfortunately, there may be therapeutic and safety concerns when inadequate processing methods are employed [18]. Furthermore, self-medication without the supervision of professionals, and misconceptions regarding these herbs, may increase the risk of fatal poisoning [12,19]. Thus, a comprehensive view of Aconitum requires consideration of the therapeutic effects, its toxicity, and relevant administrative measures.…”