Abstract

Editorial - Promoting the Safe use of Herbal Medicines

  The global use of herbal medicines has been steadily increasing and today a large number of the world's population use herbal medicines as their primary form of health care. This popularity, mainly influenced by patients' dissatisfaction with conventional allopathic medicines may also be attributed to several other reasons.  Often associated with traditional and personal beliefs, herbal medicines because of its natural origin are perceived to be highly effective therapeutically, safe and free of side-effects, and in some cases complementary to western or orthodox medicine.  They are freely available from health stores &pharmacies and they actually allow the user the means to self-treat a range of conditions for which orthodox and even over-the-counter (OTC) medicines are limited or unavailable. This has led to extensive herbal self-medication, as users are often unaware of the adverse drug reactions (ADR’s) that these medicines may pose.

  While skeptics tend to disregard the therapeutic efficacy of herbal medicines treating them as glorified placebos, the general public tends to get thoroughly confused because of inadequate information and even misinformation. Those who may be more susceptible to the adverse effects of herbal medicines include infants,children, elderly and pregnant women. As compared to conventional medicine, in most of the developing world, the scrutiny of herbal medicines in terms of safety and efficacy with regulation on sales,import and manufacture is sadly lacking. In fact, the likelihood of occurrence of herb–drug interactions could be actually more than that observed with drug–drug interactions,. This is because while the drug is usually a single chemical moiety,herbs and herbal medicines are a mixture of several active constituents.

    The prevention of these ADRs is highly dependent on the ability of health care professionals to assess and communicate emerging information on drug risk to the public and its care-givers. The physician should be aware of any herbal drug the patient may be taking before writing a prescription.

  Pharmacists should develop comprehensive,ongoing programs for monitoring and reporting adverse drug reactions (ADRs).  They should deem it their responsibility and professional obligation to report any suspected ADR and to educate health professionals regarding potential ADRs.  

  However, it is quite an arduous task to build an evidence- base and  to determine the true prevalence of herbal ADR’s as most of the time this data is unavailable because of inadequate information on the contents of the herb.    

 Patients may not inform health care providers about the herbal medications they may be taking as in most cases the herbal medicine is least suspected for reactions or interactions caused. Herbal medicinal products are not regulated by the licensing bodies like the FDA, hence misidentification, substitution and/or adulteration of herbal drugs with other natural / waste products is extremely probable.

 To obtain authentic data, the provider should be required to document all relevant information. The adverse event should be clearly described, alternative explanations should be explored and a re challenge should be considered. The herbal medicine should be analyzed to ascertain the contents of the product. Well-documented case reports could serve as a critical early warning system. Further the resolution of drug interactions require dosage adjustments, temporary or complete elimination of one or the other agent to avoid serious consequences and close monitoring of the subject.

  The benefits of effective Pharmacovigilence should be appreciated and pursued by all healthcare professionals as any improvement in drug safety or understanding will ultimately lead to better patient care.