Advertisement

International Journal of Clinical Pharmacy

, Volume 36, Issue 2, pp 451–459 | Cite as

Identification and evaluation of drug–supplement interactions in Hungarian hospital patients

  • Anna VéghEmail author
  • Erzsébet Lankó
  • András Fittler
  • Róbert György Vida
  • Ildikó Miseta
  • Gábor Takács
  • Lajos Botz
Research Article

Abstract

Background The increasing number of patients taking supplementary products together with prescribed medicines has become a new challenge for health care systems. These products may influence therapy outcomes by inducing unwanted effects. Particularly concerning is the potential for harmful interactions between prescribed medicines and supplementary products. Objective The aims of the study were to evaluate supplement use, to identify and analyse potential interactions, and to assess the efficiency of computerised interaction screening. Setting Participants of the study were inpatients and outpatients of a Hungarian university hospital. Method A cross-sectional point-of-care survey of 200 patients was carried out. Data was collected through personal interviews and a review of the medical records. Drug–drug, drug–supplement and supplement–supplement interactions were analysed with three interaction databases (Lexi-Interact Online, Medscape Drug Interaction Checker and Mediris). Main outcome measure Prevalence of supplementary product use, number of medicines and supplementary products per patient, procurement sources of products, number of potentially severe interactions. Results There was a marked difference between data obtained from patient interviews and the medical records. 85.5 % of the surveyed patients took supplementary products during the 2 weeks prior to the interview. The average number of prescribed medicines and supplementary products were 7.8 and 2.5, respectively. Women were more likely to take supplements than men. There was no significant difference in supplement use between patients under or over 60 years, between inpatients and outpatients and among patients in various wards. 39.4 % of supplementary products were purchased outside a regulated pharmacy environment. Potentially severe drug–supplement interactions were detected with 45.2 % of supplement users; however the majority of interactions were not included in one or the other of the three databases. In addition to that the risk ratings of the same interactions varied greatly between databases. Conclusion A significant number of patients are exposed to potential drug interactions with supplementary products; however interagreement among interaction databases is poor. Our data suggest that a full medication history should specifically address the intake of supplements.

Keywords

Drug–supplement interaction Herb–drug interaction Herbal and dietary supplement Hungary Interaction database Interaction screening 

Notes

Acknowledgments

We would like to thank László Técsi for reviewing the manuscript.

Funding

This research received no external funding.

Conflicts of interest

There are no conflicts of interest.

References

  1. 1.
    Wu CH, Wang CC, Kennedy J. Changes in herb and dietary supplement use in the U.S. adult population: a comparison of the 2002 and 2007 National Health Interview Surveys. Clin Ther. 2011;33(11):1749–58.PubMedCrossRefGoogle Scholar
  2. 2.
    Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA. 1998;280(18):1569–75.PubMedCrossRefGoogle Scholar
  3. 3.
    Hungarian National Institute for Food and Nutrition Science: List of registered food supplements. 2013. http://www.oeti.hu/?m1id=1&m2id=53. Accessed 19 Dec 2013.
  4. 4.
    Seybert H. Industry, trade and services. Internet use in households and by individuals in 2012: one third of Europeans used the internet on mobile devices away from home or work. Eurostat 50/2012. http://www.webcitation.org/6HWANZz6O. Accessed 19 Dec 2013.
  5. 5.
    Liang BA, Mackey T. Searching for safety: addressing search engine, website, and provider accountability for illicit online drug sales. Am J Law Med. 2009;35(1):125–84.PubMedGoogle Scholar
  6. 6.
    Fittler A, Lankó E, Brachmann B, Botz L. Behaviour analysis of patients who purchase medicines on the internet: can hospital pharmacists facilitate online medication safety? Eur J Hosp Pharm. 2013;20(1):8–12.Google Scholar
  7. 7.
    Cline RJ, Haynes KM. Consumer health information seeking on the Internet: the state of the art. Health Educ Res. 2001;16(6):671–92.PubMedCrossRefGoogle Scholar
  8. 8.
    Oravec JA. On the “proper use” of the internet: self-help medical information and on-line health care. J Health Social Policy. 2001;14(1):37–60.CrossRefGoogle Scholar
  9. 9.
    De Smet PAGM. Health risks of herbal remedies: an update. Clin Pharmacol Ther. 2004;76(1):1–17.PubMedCrossRefGoogle Scholar
  10. 10.
    Tsai HH, Lin HW, Simon Pickard A, Tsai HY, Mahady GB. Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review. Int J Clin Pract. 2012;66(11):1056–78.PubMedCrossRefGoogle Scholar
  11. 11.
    Skalli S, Soulaymani Bencheikh R. Safety monitoring of herb–drug interactions: a component of pharmacovigilance. Drug Saf. 2012;35(10):785–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Izzo AA. Interactions between herbs and conventional drugs: overview of the clinical data. Med Princ Pract. 2012;21(5):404–28.PubMedCrossRefGoogle Scholar
  13. 13.
    NIH Office of Dietary Supplements. 2013. Dietary supplements: what you need to know, Reviewed: 17 June 2011. http://ods.od.nih.gov/HealthInformation/DS_WhatYouNeedToKnow.aspx. Accessed 19 Dec 2013.
  14. 14.
    Saw JT, Bahari MB, Ang HH, Lim YH. Potential drug–herb interaction with antiplatelet/anticoagulant drugs. Complement Ther Clin Pract. 2006;12(4):236–41.PubMedCrossRefGoogle Scholar
  15. 15.
    Kennedy J, Wang C-, Wu C. Patient disclosure about herb and supplement use among adults in the US. Evid Based Complement Altern Med. 2008;5(4):451–6.CrossRefGoogle Scholar
  16. 16.
    Eisenberg DM, Kessler RC, Van Rompay MI, Kaptchuk TJ, Wilkey SA, Appel S, et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med. 2001;135(5):344–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Gardiner P, Graham RE, Legedza AT, Eisenberg DM, Phillips RS. Factors associated with dietary supplement use among prescription medication users. Arch Intern Med. 2006;166(18):1968–74.PubMedCrossRefGoogle Scholar
  18. 18.
    Busse JW, Heaton G, Wu P, Wilson KR, Mills EJ. Disclosure of natural product use to primary care physicians: a cross-sectional survey of naturopathic clinic attendees. Mayo Clin Proc. 2005;80(5):616–23.PubMedCrossRefGoogle Scholar
  19. 19.
    Cohen RJ, Ek K, Pan CX. Complementary and alternative medicine (CAM) use by older adults: a comparison of self-report and physician chart documentation. J Gerontol A Biol Sci Med Sci. 2002;57(4):M223–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Sood A, Sood R, Brinker FJ, Mann R, Loehrer LL, Wahner-Roedler DL. Potential for interactions between dietary supplements and prescription medications. Am J Med. 2008;121(3):207–11.PubMedCrossRefGoogle Scholar
  21. 21.
    Faubert G, Lebel D, Bussières J. A pilot study to compare natural health product-drug interactions in two databases in Canada. Pharm World Sci. 2010;32(2):179–86.PubMedCrossRefGoogle Scholar
  22. 22.
    De Smet PA. Clinical risk management of herb–drug interactions. Br J Clin Pharmacol. 2007;63(3):258–67.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Vonbach P, Dubied A, Krähenbühl S, Beer JH. Evaluation of frequently used drug interaction screening programs. Pharm World Sci. 2008;30(4):367–74.PubMedCrossRefGoogle Scholar
  24. 24.
    Brazier NC, Levine MA. Drug–herb interaction among commonly used conventional medicines: a compendium for health care professionals. Am J Ther. 2003;10(3):163–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Woodward KN. The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products. Hum Exp Toxicol. 2005;24(5):219–33.PubMedCrossRefGoogle Scholar
  26. 26.
    Council for International Organizations of Medical Sciences. 2013. Suspect adverse reaction report form. http://www.cioms.ch/index.php/cioms-form-i. Accessed 19 Dec 2013.
  27. 27.
    Bazzie KL, Witmer DR, Pinto B, Bush C, Clark J, Deffenbaugh J Jr. National survey of dietary supplement policies in acute care facilities. Am J Health Syst Pharm. 2006;63(1):65–70.PubMedCrossRefGoogle Scholar
  28. 28.
    Kroll DJ, Barnes R, Bickford CJ, Boothby L, Brennan C, Carr-Lopez S, et al. ASHP statement on the use of dietary supplements. Am J Health Syst Pharm. 2004;61(16):1707–11.PubMedGoogle Scholar
  29. 29.
    Bush TM, Rayburn KS, Holloway SW, Sanchez-Yamamoto DS, Allen BL, Lam T, et al. Adverse interactions between herbal and dietary substances and prescription medications: a clinical survey. Altern Ther Health Med. 2007;13(2):30–5.PubMedGoogle Scholar
  30. 30.
    Norred CL. Complementary and alternative medicine use by surgical patients. AORN J. 2002;76(6):1013–21.PubMedCrossRefGoogle Scholar
  31. 31.
    Tsen LC, Segal S, Pothier M, Bader AM. Alternative medicine use in presurgical patients. Anesthesiology. 2000;93(1):148–51.PubMedCrossRefGoogle Scholar
  32. 32.
    Peng CC, Glassman PA, Trilli LE, Hayes-Hunter J, Good CB. Incidence and severity of potential drug-dietary supplement interactions in primary care patients: an exploratory study of 2 outpatient practices. Arch Intern Med. 2004;164(6):630–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Samojlik I, Mijatović V, Gavarić N, Krstin S, Božin B. Consumers’ attitude towards the use and safety of herbal medicines and herbal dietary supplements in Serbia. Int J Clin Pharm. 2013;35(5):835–40.PubMedCrossRefGoogle Scholar
  34. 34.
    WHO Collaborating Centre for Drug Statistics Methodology. 2013. Anatomical therapeutic chemical (ATC) classification system, last updated: 25 March 2011. http://www.whocc.no/atc/structure_and_principles/. Accessed 19 Dec 2013.
  35. 35.
    Vitry AI. Comparative assessment of four drug interaction compendia. Br J Clin Pharmacol. 2007;63(6):709–14.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Faubert G, Lebel D, Bussières J. A pilot study to compare natural health product-drug interactions in two databases in Canada. Pharm World Sci. 2010;32(2):179–86.PubMedCrossRefGoogle Scholar
  37. 37.
    Medscape Drug Interaction Checker. 2013. http://reference.medscape.com/drug-interactionchecker. Accessed Jan 2013.
  38. 38.
    Barnes J, Mills SY, Abbot NC, Willoughby M, Ernst E. Different standards for reporting ADRs to herbal remedies and conventional OTC medicines: Face-to-face interview with 515 users of herbal remedies. Br J Clin Pharmacol. 1998;45(5):496–500.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Van Roon EN, Flikweert S, Le Comte M, Langendijk PNJ, Kwee-Zuiderwijk WJM, Smits P, et al. Clinical relevance of drug–drug interactions: a structured assessment procedure. Drug Saf. 2005;28(12):1131–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Hines LE, Murphy JE, Grizzle AJ, Malone DC. Critical issues associated with drug–drug interactions: highlights of a multistakeholder conference. Am J Health Syst Pharm. 2011;68(10):941–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Far E, Curkovic I, Byrne K, Roos M, Egloff I, Dietrich M, Kirch W, Kullak-Ublick GA, Egbring M. Validation of a transparent decision model to rate drug interactions. BMC Pharmacol Toxicol. 2012;13:7.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Kornblith A, Heard K. Reliability and validity of 5 databases for the identification of warfarin–medication interactions. Clin Appl Thromb Hemost. 2011;17(6):E95–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Borgert CJ, Borgert SA, Findley KC. Synergism, antagonism, or additivity of dietary supplements: application of theory to case studies. Thromb Res. 2005;117(1–2):123–32.PubMedCrossRefGoogle Scholar
  44. 44.
    Horn JR, Hansten PD, Chan LN. Proposal for a new tool to evaluate drug interaction cases. Ann Pharmacother. 2007;41(4):674–80.PubMedCrossRefGoogle Scholar
  45. 45.
    Indermitte J, Beutler M, Bruppacher R, Meier CR, Hersberger KE. Management of drug-interaction alerts in community pharmacies. J Clin Pharm Ther. 2007;32(2):133–42.PubMedCrossRefGoogle Scholar
  46. 46.
    Cash JJ. Alert fatigue. Am J Health Syst Pharm. 2009;66(23):2098–101.PubMedCrossRefGoogle Scholar
  47. 47.
    Peng CC, Glassman PA, Marks IR, Fowler C, Castiglione B, Good CB. Retrospective drug utilization review: incidence of clinically relevant potential drug–drug interactions in a large ambulatory population. J Manag Care Pharm. 2003;9(6):513–22.PubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Anna Végh
    • 1
    Email author
  • Erzsébet Lankó
    • 2
  • András Fittler
    • 1
  • Róbert György Vida
    • 1
  • Ildikó Miseta
    • 1
  • Gábor Takács
    • 1
  • Lajos Botz
    • 1
  1. 1.Department of Pharmaceutics and Central Clinical Pharmacy, Medical SchoolUniversity of PécsPecsHungary
  2. 2.First Department of Internal Medicine, Clinical CentreUniversity of PécsPecsHungary

Personalised recommendations