Patient consultation is essential in recommending herbals

Pharmacists should take an active role in advising patients about interactions between herbals and prescription drugs.

That is the opinion of Ara DerMarderosian, Ph.D., professor of pharmacognosy and medicinal chemistry, University of the Sciences, Philadelphia College of Pharmacy, as well as Roth Chair of Natural Products and scientific director of the school’s new Complementary & Alternative Medicine Institute. He is concerned about the danger in patients self-diagnosing and treating a disease with herbals. He is also urging patients to inform their healthcare practitioners about the herbs they are taking.

"There’s no way the average consumer can decide on his own—‘I’m depressed, I’m using St. John’s wort,’" he said. "It’s not a good idea for a person to self-diagnose depression."

A perfect example is diabetes patients who have to be careful about taking certain herbs that may alter their sugar levels, DerMarderosian continued. "Ginseng possibly affects diabetes control. If patients are on a particular drug, ginseng could lower sugar to a greater degree," he said.

Excessive use of herbs is another concern DerMarderosian cited. He warned that patients who want to lose weight could abuse senna, a laxative. The patient can become dependent on the herb, and long-term use can be hazardous—resulting in potassium loss and respiratory conditions.

DerMarderosian also advises pharmacists not to promote too much experimentation with herbs. Herbs should be used more for prevention of a condition than for treatment, he said. "Most of these products take a long time to work—two to three weeks," he noted.

Devan Patel, Pharm.D., owner of The Medicine Shoppe, Longboat, Fla., recommends herbals but advises pharmacists to check what guidelines herbal manufacturers use to process their medications. "You want to recommend the highest quality. Some firms have problems with inconsistencies within their manufacturing process," he said.

Ron Toy, R.Ph., owner of Model Pharmacy, Modesto, Calif., often advises patients to not take herbals when they are using prescription medications. He is particularly cautious when it comes to recommending herbals to seniors, because many seniors are taking more than one prescription medication. "The most important thing I ask is what Rx medication they are taking because of potential interactions. A lot of seniors take Coumadin and ginkgo. There’s a known drug interaction with gingko and Coumadin," he warned, with ginkgo enhancing Coumadin’s blood-thinning effect. Toy also cautioned that ginger can prolong bleeding time, and ginseng decreases anticoagulant activity.

If pharmacists encounter patients who suffer adverse effects from herbals, they should heed DerMarderosian’s advice to record and report these effects.

Sandra Levy

Sandra Levy. Patient consultation is essential in recommending herbals.

Drug Topics

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