Patient-safety regarding the concomittant use of naturoceuticals and pharmaceuticalsSiguranța pacientului cu privire la administrarea concomitentă a produselor naturiste și farmaceutice

Varga Erzsébet1, Puski Gabriella-Melinda2, Mészáros Ágnes3

1. Department of Pharmacognosy and Phytotherapy, Faculty of Pharmacy, University of Medicine and Pharmacy Targu Mures, Romania 2. Pharmacy S.C. Farma-Line, Sfântu Gheorghe, Romania3. University Pharmacy Departmanet of Pharmacy Administration. Faculty of Pharmacy Semmelweis University, Hungary

Introduction and objectivesNaturoceuticals, herbal medicines became increasingly popular among patients; 40 % of the USA population uses herbal remedies and one out of 25 patient are subject of clinically signifficant interactions.

Introduction and objectivesNaturoceuticals, herbal medicines became increasingly popular among patients; 40 % of the USA population uses herbal remedies and one out of 25 patient are subject of clinically signifficant interactions.

DiscussionFrom a patient perspective herbal products are easy to use not only because they are non-prescription drugs but also because patients believe that they do not have any harmful effect.Since in Stroke patients post-stroke-depression is very common, 29,6% of the patients are affected; and a herbal medicine is a finished product intended for self-medication, consequently patients can easily take them to control their depressive symptoms. 21% of stroke patients after 6 weeks of the stroke used a herbal product, and 23% of the patients used a herbal product after 6 month.St John’s Wort (SJW) enhances CYP3A4 activity and decreases blood concentrations of CYP3A4 substrates, like the drug level of a new oral anticoagulant, rivaroxaban. It is show in several studies that a two week therapy with SJW decreases drug blood concentration levels between 26-42% depending on the different drug, resulting in a suboptimal therapy.The risk of stroke when patients are on rivaroxaban is 1,7%; if medication is stoppet the risk of stroke (within 1 year) increases to 14,2% on average (wearies between 31,6 -11,4%) Ginkgo has a direct thrombolytic effect, if jointly used with antithrombotic drugs oral anticoagulants, it increases the risk of bleeding increases substantially.

DiscussionFrom a patient perspective herbal products are easy to use not only because they are non-prescription drugs but also because patients believe that they do not have any harmful effect.Since in Stroke patients post-stroke-depression is very common, 29,6% of the patients are affected; and a herbal medicine is a finished product intended for self-medication, consequently patients can easily take them to control their depressive symptoms. 21% of stroke patients after 6 weeks of the stroke used a herbal product, and 23% of the patients used a herbal product after 6 month.St John’s Wort (SJW) enhances CYP3A4 activity and decreases blood concentrations of CYP3A4 substrates, like the drug level of a new oral anticoagulant, rivaroxaban. It is show in several studies that a two week therapy with SJW decreases drug blood concentration levels between 26-42% depending on the different drug, resulting in a suboptimal therapy.The risk of stroke when patients are on rivaroxaban is 1,7%; if medication is stoppet the risk of stroke (within 1 year) increases to 14,2% on average (wearies between 31,6 -11,4%) Ginkgo has a direct thrombolytic effect, if jointly used with antithrombotic drugs oral anticoagulants, it increases the risk of bleeding increases substantially.

St John's wort, Hypericum perforatum L., Hyperici herbaGinkgo, Gingko biloba L., Ginkgo folium

References: Stys T. Stys A. Kelly P. Lawson W.: Trends in use of herbal and nutritional supplements in cardiovascular patitens. Clinical Cardiology. 27(2):87-90, 2004; Rocket AF trial New England Med J 2011; (6) J Raunso: Increased short term thromboembolism or death after interruption warfarin treatment patients with AF. Eur Heart J 2011

References: Stys T. Stys A. Kelly P. Lawson W.: Trends in use of herbal and nutritional supplements in cardiovascular patitens. Clinical Cardiology. 27(2):87-90, 2004; Rocket AF trial New England Med J 2011; (6) J Raunso: Increased short term thromboembolism or death after interruption warfarin treatment patients with AF. Eur Heart J 2011

Conclusion: the adequate adherence of the patients should be monitored and improved with a special focus on the use of herbal remedies, hereby we can ensure patient safety, cost-effective medication management.

Conclusion: the adequate adherence of the patients should be monitored and improved with a special focus on the use of herbal remedies, hereby we can ensure patient safety, cost-effective medication management.