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Herbal supplements are quite popular among your patients, but too few pharmacists are taking the time to properly educate about the risks.
During our public health rotation, Tommy Wong, my classmate, and I became aware of how often pharmacists are approached with the question: “Where are your supplements?” And, without hesitation, patients are directed to the supplement aisle while pharmacists continue with their other responsibilities.
Sales of herbal supplements have increased such that approximately 20% of the population are using herbal supplements.1 In fact, 72% of individuals using supplements will continue using them even if they were proven to be ineffective.2 Pharmacists need to be more informed about herbal supplements and provide information to patients about their relative benefits and risks.
Rarely are patients asked why are they considering taking herbal supplements, what other medications they are currently taking, and whether they have health issues that may complicate herbal supplement usage. There is a potential that using herbal supplements can do more harm or than good.1 The 1994 Dietary Supplement Health and Education Act (DSHEA) classifies herbal and botanical products as dietary supplements, and therefore, herbal products are able to be marketed freely.3
The problem with this is that the assurance of safety, efficacy, and quality control of these products continues to be suboptimal.3 Herbal preparations may vary among different manufacturers and even from batch to batch within the same manufacturer.1 Information on the labels can be misleading. Prescription medications such as steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), prescription antibiotics, sedatives, and narcotics have been found in these so-called “natural” products.2
This issue is of a particular concern in Chinese communities and where herbal supplements are readily available. U.S. herbal remedies include imported Asian-patented medicines that have been identified to contain unauthorized or toxic ingredients and Rx medications.3
Wong, fluent in reading Chinese, researched herbals locally in Oakland’s
Chinatown and found several products with misleading information and containing unauthorized agents. Prescription-only ingredients such as erythromycin were available over the counter as eye ointment. Products such as URI Tract Care Formula (Niao Lu Xian Yan Ling) is marketed “to help with inflammation of the urinary tract” in Chinese. However, the English translation only states to “help promote and maintain a healthy urinary system by establishing the body’s natural balance.” Niu Huang Jie Du Pian is a popular product advertised to help treat swelling, upset stomach, and sores in the mouth. Although it is indicated to be “safe and reliable,” there were many ingredients found in it that may interact with anticoagulants and antiplatelet drugs by increasing the risk of bleeding.
Some formulations may include acetaminophen, even though they are noted as “natural.” Patients may not look at product labeling and are at a higher risk of liver damage, especially if they are taking medications containing acetaminophen. These were just a few examples that were found at local Chinese herbal stores, demonstrating that drug-herbal interactions are just as important to keep in mind as drug-drug interactions.
Unfortunately, consumers are usually only educated about herbal supplements. They believe that, at best, herbal supplements will improve their health and, at worst, there is no impact because they are “natural” anyway.
This is why the role of pharmacists is so important. Pharmacists have the responsibility to educate and help people understand why it may be dangerous to take herbal supplements in conjunction with prescription medication. Providing this full spectrum of knowledge can result in overall better healthcare for our patients.
1. Bent S. Herbal medicine in the United States: review of efficacy, safety, and regulation: grand rounds at University of California, San Francisco Medical Center. J Gen Intern Med. 2008 Jun;23(6):854-859.
2. Hui, K., Yu, J.L., et al. The progress of Chinese medicine in the United States. University of California, Los Angeles, School of Medicine, Center for East-West Medicine, USA. Available at http://www.cewm.med.ucla.edu/sources/progress.pdf. Accessed Sept. 17, 2012.
3. National Public Radio, the Henry J. Kaiser Family Foundation, and Harvard University’s Kennedy School of Government (1999) Survey of Americans and Dietary Supplements. Available at http://www.npr.org/programs/specials/survey/front.html. Accessed Sept. 17, 2012.
Michael Hangis a 2013 PharmD candidate at Touro University-California, College of Pharmacy. He can be reached at email@example.com.