The co-use of conventional drugs and herbs among patients in Norwegian general practice: a cross-sectional study

Abstract

BackgroundDifferent patient groups are known to use herbal remedies and conventional drugs concomitantly (co-use). This poses a potential risk of herb-drug interaction through altering the drug’s pharmacokinetics or pharmacodynamics. Little is known about co-use among patients in general practice. The primary aim of this study was to compare patients in general practice that co-use herbal remedies and conventional drugs with those who do not. The secondary aim was to register the herb-drug combinations with potential clinical relevant interactions among the co-users.MethodA questionnaire based cross-sectional study conducted in the autumn 2011 in a general practice office with four general practitioners (GPs) and one intern in Western Norway. Adults >18 years who came for an office visit were invited. The questionnaire asked about demographics, herbal use, conventional drug use and communication about herbal use. Multivariable logistic regression was used to compare co-users to the other patients.ResultsOf the 381 patients who completed the questionnaire, the prevalence of herbal use was 44%, with bilberry (41%), green tea (31%), garlic (27%), Aloe vera (26%) and echinacea (18%) as the most frequently used. Among those using conventional drugs regularly, 108 (45%) co-used herbs. Close to 40% of patients on anticoagulants co-used herbs, with garlic and bilberry as the most frequent herbs. Compared to all other patients, co-users had significantly (p < 0.05) increased odds to be female (adjOR 2.0), age above 70 years (adjOR 3.3), use herbs to treat an illness (adjOR 4.2), use two or more herbs (polyherbacy, adjOR 12.1) and having experienced adverse effects of herbal use (adjOR 37.5). Co-use was also associated with use of analgesics or dermatological drugs (adjOR 5.1 and 7.9 respectively). Three out of four patients did not discuss herbal use with any health care professional.ConclusionA sizable proportion of the GP patients co-used herbs with conventional drugs, also combinations with reported interaction potential or additive effects like anticoagulants and garlic. The low disclosure of herbal use to their GP, polyherbacy and the risk of interactions in vulnerable groups like elderly and chronically ill patients, warrant increased awareness among GPs.

Which potential harms and benefits of using ginger in the management of nausea and vomiting of pregnancy should be addressed? a consensual study among pregnant women and gynecologists

“…Similarly, another study reported that physicians seldom ask if the patient was using herbal therapies [55]. Therefore, many patients end up using herbal and conventional therapies concurrently [12]. This has been attributed to poor communication and the insufficient time allocated to the clinical consultation [56].…”

“…The potential harms and benefits provided by the interviewed gynecologists and women were noted. We then conducted an extensive literature review to identify potential harms and benefits of using ginger in pregnant women [1–3, 6–8, 11, 12, 18–35]. All potential harms and benefits provided by the gynecologists and women as well as those found in the literature were summarized, formulated into statements, and included into a questionnaire.…”

“…Scientific evidence on the effectives of ginger in managing NVP is still inconclusive in view of the conflicting reports regarding the evidence of its effectiveness [1, 6]. Moreover, prior studies showed that ginger was associated with many health related issues like decreasing platelet aggregation, increasing stomach acid production, herb-herb and herb-medication interactions [1, 12, 13]. Therefore, gynecologists and other physicians who are frequently consulted by pregnant women with NVP should discuss the potential harms and benefits of using ginger in case they opted for using ginger to manage NVP.…”

En mann med endret utseende

“…I følge Bransjerådet for naturmidler bruker vi i Norge naturmidler og kosttilskudd for mer enn 2 milliarder kroner i året (3). Trass i at behandling med naturmidler er utbredt (4), kan informasjon om pasientenes inntak av slike midler vaere mangelfull (5). Naturmidlene kan -avhengig av innhold -betraktes som enten kosttilskudd eller legemidler, og import av begge disse produktkategoriene er omfattet av restriksjoner (6).…”

New antithrombotic therapies and complementary and alternative medicine (CAM): Chartering into unknown territory

“…This has significant implications particularly in preor post-operative patients, patients with clotting disorders, those on anticoagulant therapy, and the elderly [35]. Elderly patients pose significant risk due to polypharmacy and polyherbacy issues [36,37].…”