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| Coquitlam Connection |
| How to Use Herbal Products Safely |
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| A woman pregnant with her first child paid a visit to her obstetrician's office. After the exam, she shyly said, ''My husband wants me to ask you...,'' to which the doctor replies, ''I know, I know,'' placing a reassuring hand on her shoulder. ''I get asked that all the time. Sex is fine until late in the pregnancy.'' ''No, that's not it,'' the woman confessed. ''He wants to know if I can still mow the lawn.'' |
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| Barbara Cadario, B.ScPhm., M.Sc. Program Coordinator, BC Regional Adverse Drug Reaction Centre, Vancouver, BC The story is a common one. A middle-aged woman, hoping to increase her energy and perhaps lose a few pounds, was taking an herbal supplement. The label listed an impressive array of exotic plant names. She noticed a bit of dizziness, a few non specific complaints, but it did not occur to her to attribute them to the herbal product. Luckily for her, a friend took an interest and identified one of the herbal ingredients, Sida cordifolia, as a botanical source of ephedrine, and guarano as a source of caffeine. Health Canada has issued a warning to consumers to avoid products containing Ephedra or ephedrine, especially if combined with caffeine, due to serious effects on the body ranging from dizziness to irregular heart rate, seizures, heart attacks and strokes. At least ten cases have resulted in death. Needless to say, the lady stopped taking the herbal product. If you are taking any kind of pill or elixir that contains material that comes from a plant, then you are taking an herbal product. While most people do not describe problems with herbal products, the safety of these products is coming under increased scrutiny because of recent reports that some of them can have serious side effects and can seriously interact with therapeutic drugs. This article will explain the concerns and hopefully help you to use herbal products more safely. What kinds of problems have occurred with herbal products? The problems of most concern have been: 1. Adulteration with toxic ingredients: There have been herbal products sold in Canada that were found to be contaminated with unacceptable levels of mercury, lead, arsenic or cadmium. 2. Adulteration with unlabelled drugs: Sometimes herbal products contain drugs that are not listed on the label. For example, in Canada a product called Miralex Cream, despite claims that it was "all natural", was found to contain a topical corticosteroid drug. People using this product were exposing themselves to the potential side effects of topical corticosteroid drugs without realizing it. 3. Drug interactions: Case reports have recently described life-threatening interactions between herbal products and therapeutic drugs. St. John's wort has been implicated in many of these interactions (see chart) and should not be used by anyone taking other drugs, especially those listed. We do not know all the interactions that might occur for St. John's wort or for other herbal products. 4. Side effects: Any compound that has medical effects on the body will also usually cause some kind of side effects in some people. This is true for prescription medicines and its turning out to be true for herbal products as well. A serious side effect that has only recently been recognized is the possibility of bleeding when taking ginkgo products or garlic tablets. Avoid these products if you have any medical conditions that make you more likely to bleed, or if you take any drugs that would increase your tendency to bleed, such as warfarin or ASA. Sometimes people are allergic to herbal products. Allergic reactions are a type of side effect that occurs when your body responds to a foreign material, in this case plant material, with typical allergic symptoms such as a rash, sneezing, or itchy, watery eyes. In serious allergic reactions, it can become difficult to breathe and immediate medical attention is needed. 5. Lack of safety information: The biggest problem with herbal products is that we have only limited information on their safety. We do not know all the side effects, or how they might interact with therapeutic drugs, or with each other. The safety of herbal products in general has not been adequately demonstrated for children, pregnant women or breast-feeding women, or for long-term use. "Natural" does not mean safe: think of poison ivy! Ancient cures are also not necessarily safe, since the way we use herbs is quite different from how they were used centuries ago. Instead of plucking a leaf from our garden and making an herbal tea, we now have concentrated pill forms that we can consume in large quantities for months at a time, and we now have potent therapeutic medications with which they can interact. One of the most serious cases of herbal interaction involved the use of St. John's wort in a patient who had received a heart transplant. The herbal preparation interacted with the immunosuppressive drugs needed to prevent rejection of the new heart, putting the patient at serious risk. In olden times, there were no heart transplants and no immunosuppressive drugs to worry about, but times have changed! 6. Lack of standardization: For most herbal products, the active ingredients are not precisely known. For example, although the St. John's wort sold in Canada is usually standardized to one chemical, hypericin, there is another chemical (hyperforin) that is now also considered to be active and which may be more important. Plants contain many different chemicals, and varying composition. As a result, the toxicity of an herbal product may vary depending on the brand used. Other concerns Herbal products can also be a problem if they delay you from getting proper medical treatment. For example, St. John's wrote has been promoted to treat depression, but it is not effective in patients with severe depression. People with depression should not try to self-medicate. Since a qualified doctor best identifies the seriousness of a depressive state, people should see their doctor before using St. John's wort. On the other hand, herbal products can be a problem if used when they are unnecessary, since there can be no benefit if there is no problem, but there is still a risk of a side effect. St. John's wort is another good example of this: people might use it if they are just having a "bad day" and are not actually depressed How is the safety of herbal products monitored in Canada? Did you realize that you could help to monitor the safety of herbal products? Health Canada includes herbal products in its safety-monitoring program that exists for therapeutic drugs, known as the Canadian Adverse Drug Reaction Monitoring Program. Physicians, pharmacists, other health professionals and the lay public can report any suspected adverse reactions associated with herbal products or therapeutic drugs, including allergies and interactions, to this program. Historically, herbal products have been classified as either foods or drugs in Canada, depending on the purpose for which they are sold. Any herbal product that makes claims that it will treat or prevent disease is regulated as a drug, and such products are given DIN or GP numbers by the government. This indicates that they have passed a review of their formulation, labeling and instructions for use. Most herbal products have been approved based on information from traditional herbal references, with the precaution that they must not be known to be unsafe. Herbal products marketed to treat or prevent serious ailments must have more scientific and clinical evidence. The way that herbal products are regulated in Canada may change, due to the creation in 1999 of the Natural Health Products Directorate in Ottawa. This department has mandate to maintain the accessibility of natural products, including herbal products, while ensuring that they are safe. New standards and regulatory processes may develop. Recommendations for using herbal products safely: 1. Tell your doctor and pharmacist which herbs you are taking. You should discuss your need for the product and consider alternatives. They can tell you if there is any new safety warnings, for example if any products have been removed from the market due to adulteration or other concerns. 2. Stop taking herbal products several weeks before surgery. 3. Stop taking herbal products if you are pregnant or breast-feeding. 4. Do not use herbal products in children. 5. If the herbal product is not helping you, there is little reason to take it since you may be placing yourself at risk for side effects. Be aware that you are taking an herbal product "at your own risk". If any unexpected and undesirable effects occur at any time while you are taking the herbal product, a. Stop taking it; b. Tell your physician or pharmacist about this unexpected effect; and Report this unexpected reaction to the Canadian Adverse drug Reaction Monitoring Program. Your physician or pharmacist will have the correct form to fill out, and can help you. Adverse reaction reports involving drugs and herbals can also be made verbally to Health Canada by calling toll free 1-866-234-2345 from anywhere in Canada. Barbara Cadario has a degree in pharmacy from the University of Toronto as well as a Masters Degree in Pharmacology and Toxicology from the University ofBritish Columbia. She is the Program Coordinator for the BC Regional Adverse Drug Reaction Centre in Vancouver, British Columbia, which is part of a national strategy to monitor the safety of drugs marketed in Canada She is also a co-editor and author of a book on therapeutic drugs, the Drug Information Reference, produced by the BC Drug and Poison Information Centre. Employed by the University of British Columbia, she can be contacted at 604-806-8625 Via: The Inside Tract; The Canadian Society of Intestinal Research Prince George, BC "Ostomy Hotline" Okanagan Mainline Ostomy Association, September 2002 |