Transcript Herbal

Claudine Hughes
Chief Pharmacist, NMIC
Medicines should be prescribed only when they are
necessary, and in all cases the benefit of
administering the medicine should be considered
in relation to the risk involved
Important to discuss the treatment options carefully
with the patient to ensure that the patients is
content to take the medicine as prescribed
Who can prescribe?

Doctors
 Dentists
 Vets
Future – Nurses, Pharmacists??
Influencing Factors

Clinical status of the patient
 Considerations of cost and value for money
 Pressure from P’ceutical Industry
 New drug development
 Patient preference
 Local formulary or prescribing policies
Questions to ask before
prescribing a drug?

What is it?

What is the drug used for?

How effective is this drug?

How safe is this drug?
Questions to ask before
prescribing a drug?

Who should not receive it?

Where did I hear about it?

What is it’s place in therapy?

Does this drug provide good value for money?

Legal Issues

S1A and S1B

Generic Prescribing
Information Support

BNF

Prescriber’s Guide

www.medicines.ie
Clinical Pharmacy

Comprehensive clinical pharmacy service in
SJH
 Daily ward visits by Clinical Pharmacists
 Prescription review includes: assessment of
legibility, dose & frequency, route of
administration, drug-drug interactions
 Source of information
 Audit review
Consequences of Poor
Prescribing
Medication Errors
Adverse Drug Effects
Medication Errors
“To err is human”, IOM 1999 – 25%
treatment errors related to medication
Prescribing is an important area in terms of
error occurrence

Types include: Wrong drug, dose,
inadequate consideration of patient factors
Aminophylline
Amitriptyline
Carbamazepine
Carbimazole
Chlorpromazine
Chlorpropamide
Daonil
Losec
Ritonavir
Danol
Lasix
Retrovir
Inderal
Trental
Epilim
Ipral
Tegretol
Epanutin
Adverse Drug Reactions

May occur due to lack of consideration for
drug-drug interactions

Failure to dose adjust in patient’s with
impaired organ function
Herbal Medicines
................. Not all that is natural is
harmless
Why do people use herbal
medicines?

Used in developing countries where cost of
drugs is prohibitive, poor accessibility to
drugs in rural areas, shortage of physicians

Perception that natural = safe

“More” ADRs reported with conventional
medicines than herbal preparations
Why do people use herbal
medicines?

Provide a sense of control, a mental comfort
from taking action e.g. cancer, AIDS

Cultural & religious beliefs

Use differs by ethnic group, income, age &
educational level
Problems Associated with Use
of Herbal Medicines

Lack of QC & standardisation

Adulteration with other plants, pharmaceutical
drugs or heavy metals

Inappropriate use / misleading claims

Type A & B ADRs
Problems Associated with Use
of Herbal Medicines

Potential for drug interactions

Lack of knowledge re: interactions, ADRs
Ask me no questions – I’ll tell
you no lies
(why patients may not volunteer
information)

Lack of awareness of the potential for
adverse effects/interactions
 Don’t consider product to be a medicine
 Fear of censure
 Belief that the doctor/pharmacist doesn’t
know about alternative medicines
Sources of Information

Textbooks

Product Information from manufacturers

Published articles, studies, case reports

Regulatory authorities
St. John’s Wort

Safety of concurrent administration of SJW
with prescription or OTC medications has
not been established

Inducer of Cytochrome P450

Documented interactions with a number of
prescription drugs
St. John’s Wort

With SSRIs, triptans - symptoms
characteristic of serotonin syndrome
 Theophylline (CYP1A2), cyclosporin
(CYP3A4) and warfarin (CYP2C9) - reports
of a reduction in the serum concs
 With COC - reports of breakthrough
bleeding - reduced efficacy?
 Advice published by the IMB and CSM
Ginkgo Biloba

ADRs - generally infrequent & transient
 GI upset, headaches, dizziness
 Contact with whole ginkgo plant associated
with severe allergic reactions
 May prolong bleeding time - caution in
patients taking anticoagulant/antiplatelet
medication
Echinacea





ADRs - Relatively free of toxicity either topically
or orally
Mild allergic reactions reported
Serious allergic reactions reported in patients with
a Hx of asthma, atopy, allergic reactions
Drug Interactions - Antagonises
immunosuppressants
Increased bleeding time
In conclusion…

Interest in and information on alternative
therapies is increasing
 Lack of regulation – things are not always
what they seem…
 Information on use of these therapies must
be specifically elicited from patients