Therapeutic Risk and Benefits of Concomitantly Using Herbal Medicines and Conventional Medicines: From the Perspectives of Evidence Based on Randomized Controlled Trials and Clinical Risk Management.

Quan Zhou,Xiu-Lai Zhang,Ling-Ling Zhu,Meng Chen

doi:10.1155/2017/9296404

Abstract

Despite increased awareness of the potential of herb-drug interactions (HDIs), the lack of rigorous clinical evidence regarding the significance provides a challenge for clinicians and consumers to make rational decisions about the safe combination of herbal and conventional medicines. This review addressed HDIs based on evidence from randomized controlled trials (RCTs). Literature was identified by performing a PubMed search till January 2017. Risk description and clinical risk management were described. Among 74 finally included RCTs, 17 RCTs (22.97%) simply addressed pharmacodynamic HDIs. Fifty-seven RCTs (77.03%) investigated pharmacokinetic HDIs and twenty-eight of them showed potential or actual clinical relevance. The extent of an HDI may be associated with the factors such as pharmacogenomics, dose of active ingredients in herbs, time course of interaction, characteristics of the object drugs (e.g., administration routes and pharmacokinetic profiles), modification of herbal prescription compositions, and coexistence of inducers and inhibitors. Clinical professionals should enhance risk management on HDIs such as increasing awareness of potential changes in therapeutic risk and benefits, inquiring patients about all currently used conventional medicines and herbal medicines and supplements, automatically detecting highly substantial significant HDI by computerized reminder system, selecting the alternatives, adjusting dose, reviewing the appropriateness of physician orders, educating patients to monitor for drug-interaction symptoms, and paying attention to follow-up visit and consultation.

Highlights

Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events [1]
Eight randomized controlled trials (RCTs) revealed either beneficial (n = 7) or deleterious (n = 1) effects of coadministration of herbal medicines on adverse drug reactions induced by conventional medicines
Four RCTs revealed synergistic efficacy and three RCTs confirmed lower efficacy, whereas the other two RCTs showed no changes in pharmacodynamics when concomitantly using herbal medicines and conventional medicines

Summary

Introduction

Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events [1]. Polypharmacy is not a problem in itself, but there is a risk of drug-drug interactions (DDIs) or herb-drug interactions (HDIs) in the event of poor awareness or a lack of coordination among care providers. Despite increased awareness of the potential of HDIs, the lack of rigorous clinical evidence regarding the significance provides a challenge for clinicians and consumers to make rational decisions about the safe combination of herbal and conventional medicines. Pharmacists are usually consulted by patients and clinical professionals for confirming whether combination use of aspirin and Ginkgo biloba is appropriate. Results of this study showed that there were no adverse bleeding events and potential adverse effects of concomitant use on platelet function in patients with peripheral artery disease or risk factors for cardiovascular disease [7]

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Results

Conclusion