Management of the interactions’ risks when using phytomedicines in children

Abstract

phytomedicines play an essential role in the treatment of children's diseases. Means of
 plant origin have a better safety profile, and due to the content of biologically active substances, they af-fect various links of pathological processes. However, data on the safety and efficacy of phytomedicines
 in children are limited and mostly derived from studies in adults. In addition, there are risks of pharma-cokinetic and pharmacodynamic drug interactions. This study aims to study the risks of interaction when
 using phytomedicines and drugs in children. 100 parents participated in the study, most of whom had1 or 2 children. An analysis of the pharmacotherapy courses of 50 children was also done. It has beenestablished that parents when choosing medicines for children, consider their origin. Thus, more than70% of respondents consider phytomedicines to be safer for children and choose them for the treatmentof acute respiratory viral infections (73%), diseases of the throat (64%), oral cavity (59%), disorders ofthe gastrointestinal tract (28%) and others. The phytomedicines of choice were: Chlorophyllip, Sinupret,Wormil Phyto, Proteflazid, Darsil, Cholelesan, etc., which 80% of respondents used in combination withother medicinal products and without a doctor's prescription (75% of respondents). It was revealed that
 10% of respondents noted the appearance of undesirable reactions after using phytomedicines, in com-bination with other medicinal products in children, the manifestations of which were: allergic reactions,
 digestive disorders, headache/dizziness. Based on the results of the analysis of the pharmacotherapycourses, it was established that the children received an average of 5.8 ± 1.7 medicines. In particular,28% received 2 or more phytomedicines. In more than 40% of children, the risks of pharmacokineticinteraction of phytomedicines with other medicinal products were revealed. Thus, 10% received herbal
 remedies based on St. John's wort, which is a CYP3A4 inducer and reduces the effectiveness of albenda-zole, omeprazole, pantoprazole, and levocetirizine. While more than 30% of children received products
 based on turmeric, silymarin, or grapefruit extract, which are strong CYP3A4 inhibitors. Risks of phar-macokinetic interaction at the stage of absorption (6% of children) were associated with the use of flax
 and plantain seeds. In 10% of children, the risk of pharmacodynamic interaction due to the use of thickeucalyptus leaf extract and an antiseptic agent was revealed. Therefore, when using phytomedicines in
 children, it is necessary to consider the risks of drug interactions. Phytomedicines can affect the pharmacokinetics of other drugs and change the realization of the clinical effect. When choosing and usingphytomedicines the interaction of the doctor-pharmacist-parent is essential.