Medicina alternativa e integrativa

Use of Herbal Medicines and Implications for Conventional Drug Therapy Medical Sciences

Abstract

Rivera JO, Loya AM and Ceballos R

Herbal medicines are an important part of healthcare throughout the world. In many countries including the U.S., herbal medicines are not regulated as extensively as conventional drug therapy. At present, there is a dearth of research evaluating the use of herbal medicines, especially in clinical trials. This, together with the ongoing development of new conventional drug therapies, compounds the number of unknown outcomes when using elements of these two treatment approaches together. Although many benefits can be derived from the use of herbs, potential areas of concern include possible product contamination and/or adulterations, potential toxicity, high potential of known and unknown drug/herb interactions, and substituting proven conventional medicine with herbal medicine. Mechanisms involved in herb-drug interactions are not fully understood, but both pharmacokinetic and pharmacodynamic processes may play a role. Because these can occur in 30-40% of older adults, health care providers and patients must be aware of potential interactions in order to monitor for alterations in therapeutic efficacy and/or potential toxicity. With the advances of the internet and increased emphasis on a global economy, consumers have much greater access to herbal products from anywhere in the world. A number of concerns arise when obtaining herbal medicines from the internet, as currently there is no system in place to verify legitimacy of sites. Additionally, there are cost implications with a worldwide herbal medicine market estimated at US $83 billion annually. The worldwide implementation of standards for growing, selecting, manufacturing, conducting appropriate clinical trials, and treating patients with herbal medicines is necessary. The World Health Organizations has provided a number of technical guidelines to standardized herbal medicines throughout the world. Pharmacists are in prime position to help and monitor the use of herbal medicines, especially in older adults. Strategies for the safe use of herbs should include educational efforts directed at both the consumers and healthcare providers about the benefits and dangers of herbs and encouraging providers to ask their patients about their use of herbs without being judgmental, ensuring open communication with patients. Integrative Medicine, which is defined in the U.S. by the National Center for Complementary and Alternative Medicine as “a practice that combines both conventional and CAM treatments for which there is evidence of safety and effectiveness” has been gradually gaining acceptance within conventional medicine and should be considered the model of the future of healthcare