Naranjo Questionnaire does not effectively address dietary supplements

Dietary supplements can cloud a healthcare professional's abilityto determine an adverse reaction using the existing NaranjoQuestionnaire. That was the point Celtina Reinert, PharmD,pharmacist at Sastun Center of Integrative Health Care, OverlandPark, Kansas, tried to enforce at a Tuesday session.

Dr. Reinert talked about the results of a two-year fellowshipthat tested the effectiveness of the Naranjo Questionnaire whentrying to determine the likelihood of a dietary supplementcausing an adverse reaction. The study, which began in the fallof 2006, showed that experts in the healthcare field are notconsistent when it comes to making that determination.The study was completed in two rounds, 100 published cases wereexamined, and six evaluators were questioned in each round aboutthe same cases. The results of the determinations were not thesame among the doctors, and the doctors did not generally agreewith their first determination by round two.

“So many people struggle with OTC meds,” Dr. Reinert said.Consumers think they can walk into a store that sells dietarysupplements and whatever they buy will be healthy. They assumethat because they're supplements, they can take as many as theywant, and they'll be healthy. So they're combining thesesupplements, making it hard for doctors and pharmacists to knowwhat is really causing the adverse reaction.

There's also been very little research done on these agents, shesaid. The U.S Food and Drug Administration does not study dietarysupplements, so little is known about which ones have adversereactions and which ones shouldn't be combined.

The study showed a need to make updates or changes to thequestionnaire to help include information specific for dietarysupplements, much like what was done to adjust the questionnairefor the intensive care unit.

But so far, Dr. Reinert said there are no specific plans torecommend those changes to the questionnaire.