Susan Egbert is a third-year pharmacy student at the University of Louisiana at Monroe.
Your patients are using herbal products, but do you know enough about them?
Since ancient times, people have used natural products to cure ailments and conditions. Despite the long history behind herbal remedies and natural products, there has been major skepticism from Western medical practitioners because of the lack of scientific evidence for them.
Although some lines of herbal products are reliable and safe, others have been found to contain adulterants (including heavy metals) or do not contain a full dose of the active herbal ingredient on the label. In some cases products have been found to have no active ingredient.
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In countries like China and India, healthcare professionals are expected to have extensive knowledge about herbal medicines, and are expected to be able to recommend products or recognize when a patient is experiencing an herbal-drug interaction. Trained professionals in those countries easily counsel patients about herbal medications, but American pharmacists and physicians are less comfortable with them.
An article published in the Journal of Nutrition notes that 70% of Americans age 60 and older say they use a vitamin, mineral, herb, or other type of supplement each day and 29% say they use four or more each day. Despite this many people taking these supplements, healthcare providers do not receive the training they need to identify herb-drug interactions, herb-disease interactions, or other potential problems. There needs to be encouragement for pharmacy and medical students to learn about these medications because they will receive questions about them from patients.
There are many reasons why a patient takes an herbal or dietary supplement, which can include religious or personal values. The patient’s choice should be respected and the medication profile should be based around the patient’s choice as much as it can.
Because pharmacy schools do not encourage the study of herbal medicine, pharmacists lack the knowledge they need to answer questions about these products from patients. However, there are many sources of information that are built on evidence which pharmacists can use. One is the Natural Medicine Database. This subscription database is easy to navigate and includes subjects like clinical pharmacology. Many retail pharmacies have access to this database. Another resource is the American Botanical Council.
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Healthcare professionals need to understand that it is OK to say, “I don’t know,” when discussing an herbal product. They can tell the patient that they will look for reliable information and get back to them.
How should we as providers interact with patients who take herbal/dietary supplements? When asking about the use of herbal products and other supplements, a pharmacist should not inadvertently discourage the patient from taking an herbal product or make them feel they have to hide their use. We can ask, “What herbal supplements are you taking?” rather than, “Do you take herbal supplements?” If we ask in this manner, patients are more inclined to tell their providers what they take. We can then also steer patients to brands of herbal products that are known to be reliable and unadulterated.
Once the full medication profile (prescription, OTC, and herbal or dietary supplement) has been recorded, a pharmacist can then run a drug interaction report. If there is an interaction between an herbal remedy and a prescription or OTC medication, the pharmacist should have some information about the nature of the interaction. Although pharmacists may want to choose a prescription medication over an herbal/dietary supplement, they should keep in mind what the patient wants and why they are taking an herbal or other supplement.