Niepożądane efekty interakcji leków psychotropowych z produktami leczniczymi i suplementami diety zawierającymi wyciągi roślinne.

Jarosław Woroń,Marcin Siwek

doi:10.12740/pp/onlinefirst/80998

Abstract

Assessment of adverse drug interactions with herbal preparations (HP), i.e., plant medicines and nutritional supplements which contain plant extracts. Analysis of 147 cases of adverse events with clinical picture indicating probability or certainty of resulting from inclusion of HP into the applied pharmacotherapy (mostly psychotropic drugs). The most common effect of interactions between SSRI or SNRI antidepressants and HP were hemorrhagic complications associated with Japanese ginkgo biloba (27.45% of complications in this subgroup). Another common complication was serotonin syndrome (SS) (11.8%) occurring during the use of ginseng (one case of SS after the addition of bacopa). In the group of antipsychotic drugs, the highest number of interactions was observed in the case of haloperidol, and the highest number of complications (29.8%) was associated with ginseng (including 6 cases of ventricular arrhythmias in combination with haloperidol), milk thistle (including 7 cases of pancreatitis in combination with haloperidol or risperidone, 1 case of hepatotoxicity after adding aripiprazole) and rhodiola rosea. As for hypnotics and sedatives - interactions with ginseng were most frequently reported, mainly intensified sedative effects, cognitive disorders and disturbances in consciousness. In 132 cases, withdrawal of the plant preparation resulted in a decrease in the severity of the reported adverse reactions or a complete resolution of the described symptoms. HP (especially ginseng, rhadiola rosea, ginkgo biloba, milk thistle) are associated with a significant risk of pharmacokinetic and pharmacodynamic interactions with psychotropic drugs. Because of the resulting complications and side effects, any decision to include a herbal supplement should be preceded by a detailed safety analysis with benefit and risk assessment.

Highlights

Politherapy in psychiatry is often found in practice
The most common effect of interactions between SSRI or SNRI antidepressants and herbal preparations (HP) were hemorrhagic complications associated with Japanese ginkgo biloba (27.45% of complications in this subgroup)
In the group of antipsychotic drugs, the highest number of interactions was observed in the case of haloperidol, and the highest number of complications (29.8%) was associated with ginseng, milk thistle and rhodiola rosea

Summary

Introduction

Politherapy in psychiatry is often found in practice. Both psychiatrists recommend and patients without consulting the physician purchase plant medicines as well as nutritional supplements containing plant extracts, regardless of the risk of interactions with the concurrently used drugs, including psychotropic drugs [1, 2]. As the number of preparations increases, the incidence of abnormalities in treatment is growing [4, 5] This phenomenon includes, among others, polypharmacy (i.e., combining multiple drugs which, instead of leading to widening or enhancing therapeutic effect, is associated with the accumulation of interactions and the risk of complications), and inadequate and insufficient use of drugs, which may lead to complications and lack of expected efficacy. We do not talk about adverse symptoms of treatment, but about problems associated with the treatment (drug related problems – DRPs) The scope of this issue includes, apart from adverse drug reactions, the need for additional treatment, the use of inadequate medications and their dosage, unnecessary treatment, induction of drug interactions. It has been clearly demonstrated that the number of DRPs increases linearly with the number of taken medicines [6]

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