Herbal Medicine

Herbal Medicine

اسلاید 1: www.tabaye.ir

اسلاید 2: Herbal MedicinePenny FranklinMA Complementary Health StudiesSenior Lecturer Non medical prescribingUniversity of PlymouthMay 2005

اسلاید 3: Intended presentation outcomesDiscuss the significance of Complementary and alternative medicine for conventional prescribingHighlight the difficulties involved in obtaining reliable information on this topicDiscuss significant drug interactions and cautions that relate to different patient groups

اسلاید 4: HistoryComplementary and alternative medicine (CAM)Herbal medicine at least 5,000 years oldCAM interest grown over past two decadesOver 31 million visits to CAM practitioners 1998 (Thomas et al, 2001)One in five Britons seeks complementary or alternative therapy.Perceived to be ‘safe’Research lagging behindHealth care professionals are thought to know

اسلاید 5: What is CAM?Complementary and alternative medicine. The treatment of disease using methods other than recognised/conventional medicine. Use of homeopathic, herbal, aromatherapy and over the counter vitamin supplements to treat conditionsOften not adequately clinically trialledMight not have a product licence

اسلاید 6: Homeopathic and Herbal medicineHomeopathy: Homeos (Similar) Pathos (disease)Like cures like – remedy mimics symptomsThe greater the dilution – the greater the therapeutic effect (serial dilution)- hardly any or no trace of active ingredientManufacture controlled by Medicines Act 1968Medical claims cannot be made for remediesHowever, leaflets can be displayed nearbyMedical homeopaths (medically qualified and regulated by GMC)Non Medical homeopaths (regulated by different bodies/Fellowship of homeopaths etc

اسلاید 7: Effects on patients Limited evidence with regard to adverse drug reactionsLittle evidence with regards to drug interactions

اسلاید 8: HerbalismNational Institute of Medical Herbalists 1864 (professional body)Phytotherapy-the science of herbalism

اسلاید 9: Herbal medicinesPlant derived medicines at pharmacological doses where effects can be measuredSymptom based approach to diagnosis

اسلاید 10: Commonly used herbal medicinesGlucosamine (not strictly herbal)- For relief of joint pain (side effects:mild GI symptoms, rash, drowsiness, headache and insomniaMay alter glucose sensitivityCaution if pregnant or breastfeeding or if allergic to shell fish

اسلاید 11: Saw PalmettoUrogenital conditions – Benign prostatic hyperplasiaSide effects: - dizziness, and GI disturbanceRare,- mild puritis, headache and hypertension? Erectile dysfuntion (similar to placebo)Drug interactions ? Hormonal therapies (Contraception and HRT)Cautions: Pregnancy and breastfeeding, sex hormone dependent cancers

اسلاید 12: ValerianInsomniaSide effects: headache, drowsiness, (sedation) GI symptoms, rarely nervousness and excitability? Cardiac disturbances rarely on sudden withdrawal (not confirmed)Precautions: Pregnancy and breastfeeding, before driving or operating heavy machinery, Not to be taken if known hypersensitivityCan cause dependency

اسلاید 13: St John’s WortMild depression – Caution (Liver enzyme inducer (anti-epileptics)( theophylline )(the Pill) (SSRI’s), ( wafarin)

اسلاید 14: EchinaceaPrevention of upper respiratory tract infectionsSide effects: Nausea, dizziness, shortness of breath, burning and numbing sensation on tongue, dermatitis, hepatitis, puritus and hepatoxicityDrug interactions: Other hepatotoxic drugs e.g anabolic steroids, amiodarone, ketoconazole and methotrexate also immunosuppressants (might decrease effect)Cautions: asthma, atopy or allergy, hypersensitivity to sunflowers, liver dysfunction, TB, diabetes, HIV, MS, SLE and other autoimmune diseasesPregnancy and breastfeedingDo not take continuously for more than eight weeks

اسلاید 15: Regulation of herbal medicinesLicensed: Marketing authorisation (product license) issued by Medicines and Health Care products Regulatory Agency (MHRA)Have to meet safety, quality and efficacy standards similar to conventional drugsUnlicensed: Exempt from licensing requirements (Section 12 of Medicines act 1968)

اسلاید 16: Section 12 Medicines Act 1968Section 12 (1) person can make, sell and supply herbal remedy as part of business provided remedy is manufactured on the premesis and supplied as the consequence of a consultation between patient and herbalist12(2) allows manufacture and supply whereProcess of manufacture consists of drying, crushing or comminutingRemedy sold without any written recommendation as to its useRemedy sold under a designation which only specifies the plant and the process and does not apply any other name to the remedy

اسلاید 17: Statutory regulationMoves afoot to regulate industry

اسلاید 18: House of Lords Select Committee 2000Tougher regulation More rigorous testingGreater supervision of practiceOnly those with a statutory regulation or powerful self regulation should be available on NHS Only by referral from GP.

اسلاید 19: Safety and Regulation.“We are concerned about the safety implications of an unregulated herbal sector and we urge that all legislative avenues be explored to ensure better control of this unregulated sector in the interests of public health.”

اسلاید 20: SafetyLack of data‘Natural’ does not always mean safe e.g digitalisKava Kava hepatotoxicity

اسلاید 21: Safety IssuesRemember herbal remedies are medicinesReport adverse reactions to doctor or pharmacistMay interact with other medicinesNatural does not mean safe

اسلاید 22: Duty of Care when prescribingTo facilitate full and informed consentTo do no harmNegligence – Proven breach of duty of care and harm to patient

اسلاید 23: When prescribingAlways ask the patient what else they are takingIncluding Over the Counter medication and herbal medicinesConsider potential drug interactionsBNF (2005) and Stockley (2002)

اسلاید 24: AlertPatients taking drugs with a narrow theraputic index e.g wafarin or a drug therapy which is considered critical ( e.g insulin) should avoid using complementary medicinesWomen who are pregnant or breastfeeding should avoid complementary medicines

اسلاید 25: ProblemsPoor manufacturing processAdulteration to include toxic substances and conventional drugsMisidentification of herbsSubstitution of herbsVarying strengths of preparationsIncomplete labellingIncorrect dosage and instructions

اسلاید 26: ReportingTo the MHRA using yellow card reportingImportant for all drugs especially those less well known.

اسلاید 27: Referenceshttp://www.mcs.gov.uk/ourwork/licensingmeds/herbalsafetyStockley IH (2002) Drug interactions. 6th edition. London: Pharmaceutical Press; 2002Thomas, K et al., Use and expenditure on complementary therapies in England: a population based survey. Complementary Therapies in Medicine 2001; 9(1): 2-11Zollman C, Vickers A. ABC of complementary medicine: what is complementary medicine? BMJ 1999; 319: 693-696UKMI Complementary Medicines Summaries December 2002