Magazine article Drug Topics

Integrating Botanicals with Drugs: A Confounding Job

Magazine article Drug Topics

Integrating Botanicals with Drugs: A Confounding Job

Article excerpt

As if there were not enough adverse drug events (ADEs) associated with conventional drug therapy, health providers now have to contend with interactions stemming from alternative over-the-counter botanical products. According to Larry Westfall, Pharm.D., president of Healthcare Decisions, Baltimore, there are sure to be unforeseen issues that arise once therapies are integrated. He was speaking at the Third Annual International Congress on Alternative & Complementary Therapies, held recently in Arlington, Va.

"Over the past few years, there has been a tremendous increase in public awareness of natural healing and of treatments such as botanicals," Westfall said. An advocate and a consumer of natural health products, he said that the lay media are fueling potential ADEs between conventional and natural drugs, and perhaps natural drugs by themselves. "If the lay press had its way, everyone would be on melatonin and DHEA and everything would be fine."

One product, St. John's wort, has received much publicity over its antidepressant properties, Westfall continued. It comes in different forms, including powdered root, a stronger extract, or a combination of both. Thus, "standardized doses are difficult to come by."

Moving to other herbals, Westfall said the increasingly popular ginseng and ginkgo biloba may interfere with the action of blood thinners. Although both consumers and health-care professionals may be aware of the potential problem, there are such sparse data that most ADEs due to natural products are still unknown, and the consumer must be cautious. While in many lay publications natural remedies are presented as harmless, they are not so in every case, he cautioned.

The increase in conventional ADEs has also been very costly to the healthcare system as a whole and for clinicians individually, he said. Medication errors are the second most frequent as well as expensive malpractice claim. It has been estimated that ADEs related to conventional drug therapy cost our nation from $75 to $100 billion annually.

There are also existing drug issues, such as compliance, that have always been significant and may be further confounded by natural medications, Westfall continued. He said some research has shown that most ADEs resulting from conventional therapy are dose-dependent, predictable, and preventable, provided the physician has the right information on the patient in the first place. …

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