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There has been a virtual explosion of interest in all kinds of …
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General advice to consumers on the use of herbal remedies • Because herb/drug interactions can occur, the patient should consult the physician if he is using and/or thinking about using an herbal remedy.• People should be aware that just because something is "natural" does not mean that it is safe. • Lack of standardization can result in differences among particular products, and even among different batches of a particular brand.• Herbal remedies should not be used in pregnancy, breast feeding or even considering getting pregnant.• Avoid giving herbs to infants.• Never use larger than the recommended dose.• Long-term use of herbal remedies should be avoided except under the supervision of a healthcare provider.• Avoid herbal remedies with known toxic effects and known side effects, such as ma-huang.• Any illness that does not get better in a reasonable time requires medical attention. If symptoms persist, the physician or the pharmacist must be consulted.• If any one suffers an adverse reaction to a herbal remedy, it must be brought to the notice of the physician or pharmacist. Marketing plays a big part in the use of herbal products and the media help significantly to provide information about natural health products to consumers. There is caution that one of the biggest problems with many mass media stories today is scientific inconsistency. There are many articles about the possible uses for herbal products yet few include the scientific evidence to support many of the claims made. Critics tend to focus on two areas -- safety and the lack of evidence of effectiveness. Unlike conventional drugs, herbal products are not regulated for purity and potency and this could cause adverse effects and drug interactions. Studies of herbal medicines are fewer than for drugs mainly because herbs cannot be patented so there is little money to be made by funding studies. The controversy surrounding the herbal industry continues and although regulations are being put in place the situation is still "buyer beware." Currently no minds are being changed. The Role of Pharmacists Many times, the pharmacists are frequently asked by both patients and other health care providers about the use of herbal products. The basis for pharmacist involvement with herbal products is an extension of their established roles in pharmaceutical care, clinical pharmacy practices, and collaborative health care teams. The pharmacist plays a key role in providing care to patients who are taking or contemplating taking herbal products. The variability in the degree of scientific evidence on efficacy and safety available to support the use of herbal products makes it even more imperative that pharmacists assume an active role in this area of practice. Ideally, pharmacists should stock only those products that were manufactured with conformity to GMP guidelines. In addition, products containing only the part of the plant that was proven in clinical trials to be effective should be stocked. Herbal and natural products with questionable or unproven efficacy or those known to be harmful should not be inventoried, recommended, or sold. To encourage consumers to discuss their use, inquiries should be conducted in an open and nonjudgmental fashion similar to the manner of inquiring about other over-the-counter products. Pharmacists should strive to provide unbiased evaluations and to correct any misconceptions about the benefits and toxicities of these products in a manner similar to that done for over-the-counter and prescription agents. For the consumer using herbal products, the pharmacist should determine if the patient’s herbal therapy is appropriate or if other therapies, conventional or otherwise, would provide better alternatives. The pharmacist should review the patient’s drug regimen (including prescription, over-the-counter, and herbal and natural products) and disease states for potential or actual drug-related problems. Allergies should be reviewed carefully, with special caution for those who have plant and pollen allergies. Caution should be taken when little is known about the short-term or long-term effects of any product. Pharmacists need to establish rapport with their patients, maintain regular contact and follow-up, and, most important, encourage the use and continuation of therapies that have been effective. Combinations of certain herbal products and conventional drugs may cause synergy of similar adverse events or may result in significant drug interactions. Pharmacists play a critical role in educating patients and health care providers about the evidence available regarding efficacy and potential adverse effects, and in making recommendations consistent with that evidence. The pharmacist should provide updates to the health care team on commonly used herbal products and serve as a resource for questions from the team members. The pharmacist also should collaborate with the health care team in conducting research on the use of botanical agents. Staying informed and educating others should be an integral part of all pharmacists’ responsibilities in providing complete pharmaceutical care to patients. To conclude, it is believed that the pharmacists are active participants in the care of patients who are taking herbal products. Furthermore, good information about many of these products is not available. These combined factors present a challenge for pharmacists as they seek to provide optimal care and counseling to patients who use herbs or supplements.
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