Concurrent use of prescription drugs and herbal medicinal products in older adults: A systematic review

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.The use of herbal medicinal products (HMPs) is common among older adults. However, little is known about concurrent use with prescription drugs as well as the potential interactions associated with such combinations. Objective Identify and evaluate the literature on concurrent prescription and HMPs use among older adults to assess prevalence, patterns, potential interactions and factors associated with this use. Methods Systematic searches in MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, Web of Science and Cochrane from inception to May 2017 for studies reporting concurrent use of prescription medicines with HMPs in adults (≥65 years). Quality was assessed using the Joanna Briggs Institute checklists. The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) three stage approach to mixed method research was used to synthesise data. Results Twenty-two studies were included. A definition of HMPs or what was considered HMP was frequently missing. Prevalence of concurrent use by older adults varied widely between 5.3% and 88.3%. Prescription medicines most combined with HMPs were antihypertensive drugs, beta blockers, diuretics, antihyperlipidemic agents, anticoagulants, analgesics, antihistamines, antidiabetics, antidepressants and statins. The HMPs most frequently used were: ginkgo, garlic, ginseng, St John’s wort, Echinacea, saw palmetto, evening primrose oil and ginger. Potential risks of bleeding due to use of ginkgo, garlic or ginseng with aspirin or warfarin was the most reported herb-drug interaction. Some data suggests being female, a lower household income and less than high school education were associated with concurrent use. Conclusion Prevalence of concurrent prescription drugs and HMPs use among older adults is substantial and potential interactions have been reported. Knowledge of the extent and manner in which older adults combine prescription drugs will aid healthcare professionals can appropriately identify and manage patients at risk.Peer reviewedFinal Published versio

Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria

<p>Abstract</p> <p>Background</p> <p>To study the frequency and pattern of use of complementary and alternative medicine (CAM) in patients with essential hypertension attending a tertiary hypertension clinic.</p> <p>Methods</p> <p>Two hundred and twenty-five consecutive hypertensive patients attending the hypertension clinic of the Lagos University Teaching Hospital over a 3-month period were interviewed. Socio-demographic data, duration of hypertension, clinic attendance, current blood pressure, and compliance to conventional medications was documented. CAM utilization was explored using both structured and open-ended questions.</p> <p>Results</p> <p>There were 90 (40%) male and 135 (60%) female patients with mean age ± SD overall was 55.1 ± 12.4 years. 88 (39.1%) of the respondents used CAM. Herbal products were the most commonly used CAM type. Amongst the CAM users, the most common herbal product used was garlic (69.3%). Others were native herbs (25%), ginger (23.9%), bitter leaf (<it>Vernonia amygdalina</it>) (9.1%), and aloe vera (4.5%). 2.5% used spiritual therapy. There was no difference in the clinical characteristics, socio-economic status, and blood pressure control of CAM users and non-users. Patients who utilized CAM had higher BMI compared with those who did not, but the difference was not statistically significant (mean BMI ± SD of 29.1 ± 5.6 vs 27.1 ± 5.9 kg/m²; P = 0.05).</p> <p>Conclusion</p> <p>A significant proportion of hypertensive patients attending our tertiary facility and receiving conventional treatment also use CAM therapies. Clinicians need to be aware of this practice, understand the rationale for this health-seeking behaviour, proactively enquire about their use, and counsel patients regarding the potential of some of the therapies for adverse reactions and drug interactions.</p

A study of arylamine N-acetyltransferase from Salmonella typhimurium

SIGLEAvailable from British Library Document Supply Centre-DSC:D206450 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Hyptis verticillata Jacq: A review of its traditional uses, phytochemistry, pharmacology and toxicology

International audienceEthnopharmacological relevanceHyptis verticillata Jacq. (Lamiaceae) (John Charles) is an important medicinal plant with a long history of traditional use, originating in Central America and now extending from Florida to Colombia and across the Caribbean. Records of its earliest use date back to the ancient Mayan and Aztec cultures of Mesoamerica. There is no indication that this plant is being used outside of the Americas.Aim of the reviewThis review aims to provide a comprehensive overview of the traditional use, phytochemistry, pharmacological activity and toxicology of Hyptis verticillata and to highlight the opportunities for greater development of the plant's medicinal properties at a local and international level.Materials and methodsAn extensive and systematic review of the literature was undertaken and all relevant abstracts and full-text articles analysed and included in the review.Key findingsA wide range of traditional uses are cited in the literature, from internal uses for conditions affecting the respiratory system, digestive tract and gynaecological system to external uses for conditions affecting the skin and musculoskeletal system. Pharmacological studies to date have demonstrated significant activity which support the traditional use of the plant as an antiinflammatory, antimicrobial, antisecretory agent and hormone modulator. In addition studies have identified anti-cancer, acaricidal, insecticidal and molluscicidal activity. No clinical trials had been completed at the time of this review. A number of key phytochemicals have been isolated, identified and published to date including: 17 lignans; 4 triterpenes; 11 diterpenes, 3 sesquiterpenes, 3 monoterpenes, 2 flavonoids, 1 polyphenol and 1 alkaloid. Nine of these phytochemicals are novel to Hyptis verticillata. Plant extracts and isolated phytochemicals exhibit a broad range of activities that include: antimitotic; antiproliferative; cytotoxic; antioxidant; antiinflammatory; antibacterial; antifungal; antiviral; anti-HIV; antisecretory; hepatoprotective; insecticidal and acaricidal.ConclusionsHyptis verticillata is a medicinal plant with current widespread traditional use in the Americas that warrants further research, clinical trials and product development to fully exploit its medicinal value

Assessing the potential for drug interactions

Understanding the potential for adverse drug reactions (ADRs), resulting from plant-drug interactions,is a key aspect of medicinal plant safety. The aim of this study was to provide an in-depth assessment of standardised extracts of Hyptis verticillata Jacq. through its impact on the activities of key human cytochrome P450 (CYP) enzymes in vitro and antioxidant properties. Crude extracts were prepared from fresh and dried aerial plant material (leaf and stem). The aqueous dried plant extract, was evaluated for its ability to inhibit the activities of human CYPs 1A1, 1A2, 1B1, 3A4 and 2D6, and characterised using high performance liquid chromatography (HPLC) and liquid chromatography – mass spectrometry (LC-MS/MS). Individual key phytochemicals identifi ed were further assessed for their ability to inhibit the activity of the enzyme most impacted. All crude extracts were assessed for antioxidant properties, using a standard DPPH radical scavenging assay. The dried plant aqueous extract demonstrated potent inhibition (IC50 values < 10 ug/ml) against the activities of CYPs 1A1 (7.6 ug/ml), 1A2 (1.9 ug/ml), 1B1 (9.4 ug/ml) and 3A4 (6.8 ug/ml) and its analysis confirmed the identity of seven phytochemicals, five lignans and two triterpenes. Screening these phytochemicals against the activity of CYP1A2 failed to identify a single agent responsible for the plant extract’s potent bioactivity. Further analysis of other crude extracts demonstrated potent inhibition of CYP1A2 activity for a dried plant ethanol extract (1.5 ug/ml), fresh plant ethanol extract (3.9 ug/ml), and moderate activity for a fresh plant aqueous extract (27.8 ug/ml). All four extracts demonstrated strong antioxidant activity (IC50 values<10 ug/ml), compared to the positive control, ascorbic acid (1.3 ug/ml), with the dried plant ethanol extract being the most potent (1.6 ug/ml). Aqueous extracts, prepared following ethnomedical recipes for H. verticillata, demonstrated inhibition of key drug metabolising enzymes in vitro. Further analysis on the potential impact of this plant on key drug metabolizing enzymes in vivo appears warranted, given the extensive use of this plant in the Americas. Key phytochemical(s) responsible for the extracts’ bioactivity could not be pinpointed, and led to one of two possible explanations: Firstly, the phytochemical(s) responsible has/have not yet been identified, or, secondly, the potent bioactivity is due to synergistic interactions amongst the many constituents of the whole plant extract being greater than the sum of individual phytochemical bioactivities tested. Four traditional preparations demonstrated strong antioxidant activity, which, together with the plant extracts potent inhibition of known carcinogen activators, CYPs 1A1 and 1B1, and previously reported anti-inflammatory and anticancer properties, warrants further research into the potential chemopreventive properties of this interesting plant