Identification and prevention of deleterious effects of supplementary health products on medical therapy ñ A challenge for clinical pharmacists

Abstract

Background In the last decade it has become a challenging problem for the pharmaceutical profession that alongside their prescribed drug treatment patients take supplementary products (OTC, herbal remedies, food supplements, ‘panacea’ etc.) without consulting their physician or pharmacist. The authors propose clinical pharmacists gather detailed information about drugs, additional remedies and their procurement sources, as interactions with medicines may harm health, decrease efficacy of the medical treatment and reduce patient compliance. Purpose Our study aims at exploring and analysing interactions between drugs and additional remedies among inpatients and outpatients at departments of internal medicine. This is a pilot study to confirm the practical applicability of our interaction monitoring system, which the authors plan to introduce at the clinic. Materials and methods A database has been developed by our department in collaboration with HC Pointer Ltd., which contains all the authorised or notified paramedicines and food supplements having a noteworthy market in Hungary. Screening is based on the evaluation of 155 components with potential for interactions, the synonyms of which give us a total of 3184 entries to be searched. Patient interviews and review of the medical records were performed by clinical pharmacists. The authors have gained information regarding current medication and additional remedies, past medical history, immunisation status and known allergies with the aid of a medication history worksheet. Results The authors have surveyed 98 patients so far, 58 of them (59,2%) have reported use of supplementary products (OTC, vitamins, herbal products, homeopathic remedies) along with their prescribed medicines. Potential interactions have been identified in seven cases (7,1%). Antithrombotic and antidiabetic agents were most commonly involved in interactions. Conclusions Gathering detailed information about the use of supplementary products should be included in medical histories in clinical pharmaceutical practice. Documentation and evaluation of interactions between herbal products and prescribed drugs can prevent adverse reactions and introduce higher standards for patient care. Special software and databases are indispensable due to the complexity of possible interactions.