Address Herbal Use with Patients to Avoid Interactions

Clinical Psychiatry News, July 2001 | Go to article overview

Address Herbal Use with Patients to Avoid Interactions


Growing evidence shows that herbal remedies aren't what they seem. What experiences have you had with patient drug-herbal interactions that could have been avoided with intervention by the Food and Drug Administration? Do you think the FDA should be called upon to regulate herbal supplements? Why or why not?

Though the use of herbal supplements has increased tremendously due in part to the enactment of the Dietary Supplement Health and Education Act of 1994 (DSHEA), the research and regulation of these products has not.

Talk Back respondents agreed that the FDA's hands are tied by the DSHEA. It would be almost impossible for the FDA to regulate herbal supplements because there are so many of them and the reproducibility of the preparations from various companies is difficult, said Dr. Elliot Richelson, professor of psychiatry and pharmacology at Mayo Medical School, Rochester, Minn. However, the FDA should monitor serious problems that arise from herbal use.

The herbal industry can't be touched as long as they don't make claims of treating specific illnesses and no serious reports of toxicity emerge, according to Dr. Philip R. Muskin of Columbia University, New York. It can also be difficult to determine whether an adverse reaction following herbal use is idiosyncratic or related to the herb itself.

The FDA is limited by the DSHEA, but some type of regulatory body needs to regulate the herbal industry, said Dr. Shri K. Mishra, program director of the integrative medicine program and professor of neurology at the University of Southern California, Los Angeles. Complementary and alternative medicines, including herbal medicines, have some utility but they need to be based on scientific evidence. Herbal manufacturers make claims on labels that have no scientific basis. Also, herbal products should contain explicit information about possible drug interactions and adverse side effects.

There has to be credibility that it works--and how it works. Don't just rely on the fact that the herb has been used for thousands of years, Dr. Mishra said.

Dr. Jess P. Shatkin of the University of California, Los Angeles, shared his knowledge of drug-herbal interactions based on the literature:

* St. John's wort is also known to reduce the efficacy of digoxin and to reduce the concentrations of indinavir, cyclosporine, and combined oral contraceptives.

* Patients taking anticoagulants should probably avoid Ginkgo biloba, which reduces platelet aggregation. …

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