Abstract
BackgroundHerb-drug interactions are an important issue in drug safety and clinical practice. The aim of this epidemiological study was to characterize associations of clinical outcomes with concomitant herbal and antipsychotic use in patients with schizophrenia.Methods and FindingsIn this retrospective, cross-sectional study, 1795 patients with schizophrenia who were randomly selected from 17 psychiatric hospitals in China were interviewed face-to-face using a structured questionnaire. Association analyses were conducted to examine correlates between Chinese medicine (CM) use and demographic, clinical variables, antipsychotic medication mode, and clinical outcomes. The prevalence of concomitant CM and antipsychotic treatment was 36.4% [95% confidence interval (95% CI) 34.2%–38.6%]. Patients using concomitant CM had a significantly greater chance of improved outcomes than non-CM use (61.1% vs. 34.3%, OR = 3.44, 95% CI 2.80–4.24). However, a small but significant number of patients treated concomitantly with CM had a greater risk of developing worse outcomes (7.2% vs. 4.4%, OR = 2.06, 95% CI 2.06–4.83). Significant predictors for concomitant CM treatment-associated outcomes were residence in urban areas, paranoid psychosis, and exceeding 3 months of CM use. Herbal medicine regimens containing Radix Bupleuri, Fructus Gardenia, Fructus Schisandrae, Radix Rehmanniae, Akebia Caulis, and Semen Plantaginis in concomitant use with quetiapine, clozapine, and olanzepine were associated with nearly 60% of the risk of adverse outcomes.ConclusionsConcomitant herbal and antipsychotic treatment could produce either beneficial or adverse clinical effects in schizophrenic population. Potential herb-drug pharmacokinetic interactions need to be further evaluated.
Highlights
With the widespread use of various herbal products which are often concomitantly used with pharmaceutical drugs, herb-drug interactions have become an important issue in drug safety and clinical practice [1,2]
In order to improve the therapeutic efficacy and reduce adverse side effects related to antipsychotic therapy, herbal medicine and other alternative therapies have been increasingly introduced into the treatment of schizophrenia [8]
Patients who met the following criteria were eligible for the study: (1) aged 15 years or above; (2) had a primary diagnosis of schizophrenia or schizoaffective disorder based on International Classification of Diseases (ICD), 10th Edition [13]; (3) had been taking conventional antipsychotic treatment for at least 6 weeks; and (4) patients, their caregivers and/or doctors could provide necessary information about Chinese medicine (CM) use if CM was used
Summary
With the widespread use of various herbal products which are often concomitantly used with pharmaceutical drugs, herb-drug interactions have become an important issue in drug safety and clinical practice [1,2]. It is well documented that concomitant use of herbal medicine with conventional drug treatment can alter pharmacokinetic profiles of many classes of pharmaceutical drugs, including psychotropic agents, anticoagulants, oral contraceptives, immunosuppressants, cardiovascular drugs, anti-HIV, anticancer agents and antiepileptics [1,2,6]. Whether such concomitant treatment with herbal and conventional medicine is associated with clinical outcomes in a defined population of patients remains to be determined. The aim of this epidemiological study was to characterize associations of clinical outcomes with concomitant herbal and antipsychotic use in patients with schizophrenia
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