Spotlight Commentary: Why we need to pay attention to toxicity associated with herbal medicines

Enioutina, Elena Y.; Job, Kathleen M.; Sherwin, Catherine M.T.

doi:10.1111/bcp.14340

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…Nonetheless, the use of CHMs for pre-dialysis patients should still be cautioned and prescribed by certificated TCM doctors or practitioners even though we reported the CMN for pre-dialysis DN. Herbal toxicity, not only renal toxicity, should still be noticed ( Hudson et al, 2018 ; Yang et al, 2018 ; Enioutina et al, 2020 ). An example is aconitine, a suspicious compound related to kidney toxicity ( Yang et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Associations Between Using Chinese Herbal Medicine and Long-Term Outcome Among Pre-dialysis Diabetic Nephropathy Patients: A Retrospective Population-Based Cohort Study

et al. 2021

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Background: Chronic kidney disease (CKD) has become a worldwide burden due to the high co-morbidity and mortality. Diabetic nephropathy (DN) is one of the leading causes of CKD, and pre-dialysis is one of the most critical stages before the end-stage renal disease (ESRD). Although Chinese herbal medicine (CHM) use is not uncommon, the feasibility of using CHM among pre-dialysis DN patients remains unclear.Materials and methods: We analyzed a population-based cohort, retrieved from Taiwan’s National Health Insurance Research Database, to study the long-term outcome of using CHM among incident pre-dialysis DN patients from January 1, 2004, to December 31, 2007. All patients were followed up to 5 years or the occurrence of mortality. The risks of all-cause mortality and ESRD were carried out using Kaplan-Meier and competing risk estimation, respectively. Further, we demonstrated the CHM prescriptions and core CHMs using the Chinese herbal medicine network (CMN) analysis.Results: A total of 6,648 incident pre-dialysis DN patients were analyzed, including 877 CHM users and 5,771 CHM nonusers. With overlap weighing for balancing all accessible covariates between CHM users and nonusers, we found the use of CHM was associated with lower all-cause mortality (0.22 versus 0.56; log-rank test: p-value <0.001), and the risk of mortality was 0.42 (95% CI: 0.36–0.49; p-value <0.001) by adjusting all accessible covariates. Further, the use of CHM was associated with a lower risk of ESRD (cause-specific hazard ratio: 0.59, 95%CI: 0.55–0.63; p-value <0.001). Also, from the 5,901 CHM prescriptions, we found Ji-Sheng-Shen-Qi-Wan, Astragalus mongholicus Bunge or (Astragalus membranaceus (Fisch.) Bge.), Plantago asiatica L. (or Plantago depressa Willd.), Salvia miltiorrhiza Bunge, and Rheum palmatum L. (or Rheum tanguticum (Maxim. ex Regel) Balf., Rheum officinale Baill.) were used as core CHMs for different CHM indications. Use of core CHMs was associated with a lower risk of mortality than CHM users without using core CHMs.Conclusions: The use of CHM seemed feasible among pre-dialysis DN patients; however, the beneficial effects still need to be validated by well-designed clinical trials.

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Section: Discussionmentioning

confidence: 99%

Associations Between Using Chinese Herbal Medicine and Long-Term Outcome Among Pre-dialysis Diabetic Nephropathy Patients: A Retrospective Population-Based Cohort Study

et al. 2021

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“…Dear Editor, We read with interest the commentary published in the British Journal of Clinical Pharmacology (BJCP) on the need of paying attention to toxicity associated with herbal medicines 1 ; as a group involved since may years in the activities of pharmacovigilance and phytovigilance, 2 we consider very important to report the onset of every adverse event (AE) related to the use of medicinal plants. Herein, we described a case of erectile dysfunction (ED) occurrence in a user of a prescribed galenic preparation containing Serenoa repens (SR).…”

Section: Serenoa Repens Induced Erectile Dysfunction: Underdiagnosis ...mentioning

confidence: 99%

“…Valentina Maggini 1 Niccolò Lombardi 2,3 Giada Crescioli 2,3 Francesco Sivelli 1 Alfredo Vannacci 2,3 Fabio Firenzuoli…”

Section: Contributorsunclassified

Serenoa repens induced erectile dysfunction: Underdiagnosis and phytovigilance

Maggini

Lombardi

Crescioli

et al. 2021

Brit J Clinical Pharma

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“…Another key concern is that the increased use of herbal medicines has been accompanied by their adulteration, which includes increased use of synthetic compounds to increase profit levels; however, this leads to concerns with quality control unless proactively addressed ( Ekar and Kreft, 2019 ; Enioutina et al, 2020 ; Kum et al, 2021 ; Okaiyeto and Oguntibeju, 2021 ). Alongside this, there have also been an increase in the extent of falsified medicines, including herbal medicines, for both life style and health-related conditions across countries ( BottomLineInc, 2014 ; Newsmax_Fake_2015 ; Nuryunarsih, 2016 ; Ekar and Kreft, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Tool to Improve Community Pharmacists’ Surveillance Role in the Safe Dispensing of Herbal Supplements

Jairoun

Al‐Hemyari²,

Abdulla³

et al. 2022

Front. Pharmacol.

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Background: There has been an appreciable increase in the use of herbal supplements, including immune boosters, during the current COVID-19 pandemic. However, there are concerns with falsified herbal supplements.Objectives: Developed a new questionnaire that can potentially help community pharmacists identify the extent of falsified herbal supplements.Methods: A 9-month cross sectional study was conducted among 500 community pharmacies across United Arab Emirates. A new 5-factor, 24-itmes scale was developed based on current labelling requirements across countries and piloted. This included seven items on identified uses and contraindication, seven items on hazard identification, four items on product identity, three items on packaging and product insert and three items on product handling and storage. The face and content validity of the scale was assessed via the content validity index (CVI). Its construct validity was tested using an exploratory factor analysis (EFA) via principally component analysis (PCA). The model was subsequently confirmed through partial confirmatory factor analysis (PCFA). Its reliability was assessed via test-retest reliability, internal consistency, item internal consistency (IIC), and intraclass correlation coefficients (ICCs).Results: The CVI of the finalized questionnaire was 0.843. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.891, and Bartlett’s test of sphericity indicated significance (p-value < 0.001). Confirmation of the subsequent 5-domains was achieved through PCFA using maximum likelihood analysis with oblimin rotation. The PCFA obtained values was 0.962 for NFI, 0.977 for CFI, and 0.987 for the Tucker Lewis Index. All values were greater than 0.95, and the RMSEA value was 0.03 (i.e., less than 0.06). Consequently, the model had a good fit. All domains demonstrated Cronbach’s alpha coefficients above 0.70, with 0.940 for the full instrument. Meanwhile, all items met the IIC correlation standard of ≥0.40. The instrument presented good ICC statistics of 0.940 (0.928–0.950) as well as statistical significance (p < 0.001). Community pharmacists with more than 10 experience years were more likely to identify falsified herbal supplements compared to those with 1–10 years experience (p < 0.001).Conclusion: This study developed and validated a new instrument to identify safe herbal supplements, which should enhance the role of the community pharmacists in the safe and effective treatment of suitable patients with herbal supplements.

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Spotlight Commentary: Why we need to pay attention to toxicity associated with herbal medicines

Cited by 11 publications

References 14 publications

Associations Between Using Chinese Herbal Medicine and Long-Term Outcome Among Pre-dialysis Diabetic Nephropathy Patients: A Retrospective Population-Based Cohort Study

Associations Between Using Chinese Herbal Medicine and Long-Term Outcome Among Pre-dialysis Diabetic Nephropathy Patients: A Retrospective Population-Based Cohort Study

Serenoa repens induced erectile dysfunction: Underdiagnosis and phytovigilance

Development and Validation of a Tool to Improve Community Pharmacists’ Surveillance Role in the Safe Dispensing of Herbal Supplements

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