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Potential drug interactions with dietary and herbal supplements during hospitalization

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Abstract

Dietary and herbal supplements (DHS) are widely used in the general population, including during hospitalization. Yet, their potential interactions with prescription drugs have seldom been delineated among inpatients. We aimed to evaluate potentially dangerous interactions of DHS with prescribed medications among inpatients. This was a cross-sectional prospective study involving a cohort of patients hospitalized in 12 departments of a public academic medical center (Bnai Zion Medical Center, Haifa, Israel) from 2009 to 2014. DHS users were determined via a questionnaire. The Natural Medicine database was used to search for potential DHS–drug interactions for identified DHS, and the clinical significance was evaluated using Lexi-interact online interaction analysis. Medical files were assessed for documentation of DHS use. Univariate and multivariate logistic regression analyses were used to characterize potential risk factors for DHS–drug interactions. Of 927 patients consenting to answer the questionnaire, 458 (49 %) reported DHS use. Of these, 215 (47 %) had at least one potential interaction during hospitalization (759 interactions). Of these interactions, 116 (15 %) were potentially clinically significant. Older age [OR = 1.02 (1.01–1.04), p = 0.002], males [OR = 2.11 (1.35–3.29), p = 0.001] and increased number of used DHS [OR = 4.28 (2.28–8.03), p < 0.001] or drugs [OR = 1.95 (1.17–3.26), p = 0.011] were associated with potential interactions in DHS users. Physicians documented only 16.5 % of DHS involved in these interactions in patients’ medical files. In conclusion, a substantial number of inpatients use DHS with potential interactions with concomitant medications. Medical staff should be aware of this, question patients on DHS usage and check for such interactions.

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References

  1. Dietary Supplements Health and Education Act (1994) https://ods.od.nih.gov/About/dshea_wording.aspx. Accessed 15 June 2015

  2. Lavy T, Haran B, Shemer J, Shani S (2000) Regulation of natural medicines in Israel and abroad. Harefuah 139(9–10):339–344 (408, 407)

    CAS  PubMed  Google Scholar 

  3. Peter AGM De Smet, PharmD., Ph.D (2002) Herbal remedies. NEJM 347(25):2046–2056

  4. Qadour E, Ben-Arye E, Goldstein L, Attias S, Schiff E (2015) Dietary supplements use during hospitalization. Harefuah. 154(1):39–42

    PubMed  Google Scholar 

  5. Wu CH, Wang CC, Kennedy J (2011) 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 33(11):1749–1758

    Article  PubMed  Google Scholar 

  6. Ben-Arye E, Halabi I, Goldstein L, Attias S, Schiff E (2014) Asking patients the right questions about herbal and dietary supplements: cross-cultural perspectives. Complement Ther Med. 22(2):304–310

    Article  PubMed  Google Scholar 

  7. Goldstein LH, Elias M, Ron-Avraham G, Biniaurishvili BZ, Mad-jar M, Kamargash I et al (2007) Consumption of herbal remedies and dietary supplements amongst patients hospitalized in medical wards. Br J Clin Pharmacol 64(3):373–380

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sood A, Sood R, Brinker FJ, Mann R, Loehrer LL, Wahner-Roedler DL (2008) Potential for interactions between dietary supplements and prescription medications. Am J Med 121(3):207–211

    Article  CAS  PubMed  Google Scholar 

  9. Alexopoulou A, Dourakis SP, Mantzoukis D et al (2008) Adverse drug reactions as a cause of hospital admissions: a 6-month experience in a single center in Greece. Eur J Intern Med. 19(7):505–510

    Article  PubMed  Google Scholar 

  10. Shapiro LE, Shear NH (1999) Drug-drug interactions: how scared should we be? CMAJ 161(10):1266–1267

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Izzo AA (2005) Herb-drug interactions: an overview of the clinical evidence. Fundam Clin Pharmacol 19(1):1–16

    Article  CAS  PubMed  Google Scholar 

  12. Spiteri Staines S (2011) Herbal medicines: adverse effects and drug-herb interactions. J Malta Coll Pharm Pract 17:38–42

    Google Scholar 

  13. Foster BC, Vandenhoek S, Hana J et al (2003) In vitro inhibition of human cytochrome P450-mediated metabolism of marker substrates by natural products. Phytomedicine 10:334–342

    Article  CAS  PubMed  Google Scholar 

  14. Islam MS, Choi H (2008) Comparative effects of dietary ginger (Zingiber officinale) and garlic (Allium sativum) investigated in a type 2 diabetes model of rats. J Med Food 11:152–159

    Article  CAS  PubMed  Google Scholar 

  15. Végh A, Lankó E, Fittler A, Vida RG, Miseta I, Takács G, Botz L (2014) Identification and evaluation of drug supplement interactions in Hungarian hospital patients. Int J Clin Pharm 36(2):451–459

    Article  PubMed  Google Scholar 

  16. Graham RE, Gandhi TK, Borus J, Seger AC, Burdick E, Bates DW, Phillips RS, Weingart SN (2008) Risk of concurrent use of prescription drugs with herbal and dietary supplements in ambulatory care. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds) Advances in patient safety: new directions and alternative approaches. Technology and Medication Safety, vol 4. Agency for Healthcare Research and Quality, Rockville, US

  17. Mouly S, Morgand M, Lopes A, Lloret-Linares C, Bergmann JF (2015) Drug-foods interactions in internal medicine: what physicians should know? Rev Med Interne 36(8):530–539

    Article  CAS  PubMed  Google Scholar 

  18. Gardiner P, Filippelli AC, Sadikova E, White LF, Jack BW (2015) Medication and dietary supplement interactions among a low-income, hospitalized patient population who take cardiac medications. Evid Based Complement Alternat Med 2015:429826

    Article  PubMed  PubMed Central  Google Scholar 

  19. Alsanad SM, Williamson EM, Howard RL (2014) Cancer patients at risk of herb food supplement-drug interactions—a systematic review. Phytother Res 28(12):1749–1755

    Article  PubMed  Google Scholar 

  20. Donaldson M, Touger-Decker R (2013) Dietary supplement interactions with medications used commonly in dentistry. J Am Dent Assoc 144(7):787–794

    Article  CAS  PubMed  Google Scholar 

  21. Natural Medicines Comprehensive Database (2015) http://naturaldatabase.therapeuticresearch.com. Accessed 15 June 2015

  22. Sarma DN, Barrett ML, Chavez ML, Gardiner P, Ko R, Mahady GB, Marles RJ, Pellicore LS, Giancaspro GI, Low Dog T (2008) Safety of green tea extracts: a systemic review by the US Pharmacopeia. Drug Saf 31(6):469–484

    Article  PubMed  Google Scholar 

  23. Kandarkar SV, Sawant SS, Ingle AD, Deshpande SS, Maru GB (1998) Subchronic oral hepatotoxicity of turmeric in mice—histopatological and ultrastructural studies. Indian J Exp Biol 36(7):675–679

    CAS  PubMed  Google Scholar 

  24. Landbo C, Almdal TP (1998) Interaction between warfarin and coenzyme Q10. Ugeskr Laeger 160(22):3226–3227

    CAS  PubMed  Google Scholar 

  25. Schmolz M, Marz RW, Schaudt M, Schaudt C, Lauster C (2014) Immunomodulatory activities of a concentrated fruit and vegetable juice tested in a randomized, placebo-controlled, double-blind clinical trial in healthy volunteers. Food Nutr Sci 5:341–350

    Article  Google Scholar 

  26. Goodnight SH Jr, Harris WS, Connor WE (1981) The effects of dietary omega 3 fatty acids on platelet composition and function in man: a prospective, controlled study. Blood 58(5):880–885

    CAS  PubMed  Google Scholar 

  27. Peng CC, Glassman PA, Trilli LE et al (2004) Incidence and severity of potential drug-dietary supplement interactions in primary care patients: an exploratory study on 2 outpatient practices. Arch Intern Med 164:630–636

    Article  PubMed  Google Scholar 

  28. McCune JS, Haltfield AJ, Blackburn AA et al (2004) Potential of chemotherapy-herb interactions in adult cancer patients. Support Care Cancer 12:454–462

    Article  PubMed  Google Scholar 

  29. Dergal JM, Gold JL, Laxer DA et al (2002) Potential interactions between herbal and conventional drug therapies used by older adults attending a memory clinic. Drugs Aging 19:879–886

    Article  CAS  PubMed  Google Scholar 

  30. Wirsansky I (2012) Educational interventions for developing awareness and imparting skill questioning about use of dietary and herbal supplements among hospitalized patients. Fundamental Sciences Theses. Technion

Download references

Acknowledgments

We acknowledge Ms. Silvi Auerbach, Ms. Rita Stern, Ms. Anat Melamed, Ms. Ramzia Sarouzi, Ms. Alexandra Kamladi-nov, Ms. Shani Shitrit, Ms. Nur Zahawa, Ms. Wafa Halabi, Ms. Rana Huri, Ms. Riham Hanifes, Ms. Missa Abu-Hussein, Ms. Rachel Alberg, Ms. Meital Attias, Ms. Yulia Korshov, Ms. Dikla Cogan, Ms. Marina Ukon, Ms. Michal Fassoua, Ms. Einav Kadour, Ms. Inbal Halabi, Ms. Shlomit Grimberg, Ms. Sarah Ben Shlosh and Ms. Myriam Rosenblum for their contribution in interviewing patients; Ms. Ilana Merhav and Ms. Tanya Kligerman for their assistance in the literature search; Ms. Ronit Leiba for the statistical processing.

Author information

Author notes

    Authors and Affiliations

    1. Internal Medicine B Department, Bnai Zion Medical Center, Golomb 47, 3339419, Haifa, Israel

      Ilana Levy & Elad Schiff

    2. Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel

      Samuel Attias & Elad Schiff

    3. Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel

      Eran Ben-Arye, Lee Goldstein & Elad Schiff

    4. Clinical Pharmacology Unit, HaEmek Medical Center, Afula, Israel

      Lee Goldstein

    5. School of Public Health, University of Haifa, Haifa, Israel

      Samuel Attias

    6. Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel

      Eran Ben-Arye

    Authors
    1. Ilana Levy
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    2. Samuel Attias
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    3. Eran Ben-Arye
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    4. Lee Goldstein
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    5. Elad Schiff
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    Corresponding author

    Correspondence to Ilana Levy.

    Ethics declarations

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Statement of human and animal rights

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

    Informed consent

    Informed consents have been given verbally by patients as stated in the Institutional Ethics Committee of our medical center.

    Additional information

    I. Levy and S. Attias have made equal contribution.

    Appendix

    Appendix

    Screening for the use of dietary and herbal supplements in hospitalized patients

    In this questionnaire we want to learn what is your opinion on the use of herbs and supplements of complementary medicine. Please consider only herbal and dietary supplements (vitamins, etc.) for the treatment of your medical conditions.

    1. 1.

      Year of birth:

    2. 2.

      Gender

      1. a.

        Male

      2. b.

        Female

    3. 3.

      Residence

      1. a.

        Urban

      2. b.

        Rural

    4. 4.

      Country of birth

      1. a.

        Israel

      2. b.

        Former USSR

      3. c.

        Other

    5. 5.

      Education

      1. a.

        No education

      2. b.

        Elementary school

      3. c.

        Secondary

      4. d.

        Tertiary, university

    6. 6.

      Have you used dietary supplements or herbs for health issues during the previous year? (natural products, natural medicines, grandma remedies, folk/traditional herbs picked in the wild, vitamins, etc.)

      1. a.

        Yes—Continue to question 7

      2. b.

        No—Stop here

    For each supplement/herb

    1. 7.

      Name of the supplement/herb:

    2. 8.

      Dosage (if known):

    3. 9.

      How long have you been using it?

      1. a.

        Less than a month

      2. b.

        1–6 months

      3. c.

        More than 6 months

    4. 10.

      Are you using it during hospitalization?

      1. a.

        Yes

      2. b.

        No

    5. 11.

      If you are not using it during hospitalization, when did you stop using it?

      1. a.

        On day of hospitalization

      2. b.

        1 day to 1 week before hospitalization

      3. c.

        Over 1 week before hospitalization

    6. 12.

      What is the rationale for using it?

      1. a.

        Mental state improvement

      2. b.

        General strengthening

      3. c.

        Treatment of high cholesterol level

      4. d.

        Treatment of diabetes

      5. e.

        Treatment of hypertension

      6. f.

        Prevention or treatment of memory impairment

      7. g.

        Treatment of gastrointestinal problems

      8. h.

        Treatment of urinary tract infections

      9. i.

        Treatment of backache, joint or muscle pain

      10. j.

        Treatment of hot flushes and menopausal symptoms

      11. k.

        Prevention or treatment of cancer

      12. l.

        Treatment of cardiovascular conditions

      13. m.

        Treatment of respiratory conditions

      14. n.

        Other—specify.

    7. 13.

      Who advised you using herbs/supplements?

      1. a.

        Physician

      2. b.

        Pharmacist

      3. c.

        Naturopath

      4. d.

        Friends/family

      5. e.

        Publication

      6. f.

        Other—specify.

    8. 14.

      Does your primary care physician know you are using herbs/supplements?

      1. a.

        Yes

      2. b.

        No

    9. 15.

      If yes, how did he/she find out?

      1. a.

        I told him/her

      2. b.

        He/she asked

      3. c.

        Other—specify.

    10. 16.

      If you did not tell your primary care physician, what is the reason for that?

      1. a.

        I don’t think it is important

      2. b.

        This is not a medication

      3. c.

        I was concerned about the physician’s reaction

      4. d.

        The physician does not understand

      5. e.

        The physician did not ask

      6. f.

        I did not have time

      7. g.

        This is natural so it cannot harm

      8. h.

        Other—specify.

    11. 17.

      Do hospital physicians know you are using herbs/supplements?

      1. a.

        Yes

      2. b.

        No

    12. 18.

      If yes, how did they find out?

      1. a.

        I told them

      2. b.

        They asked

      3. c.

        Other—specify.

    13. 19.

      If you did not tell hospital physicians, what is the reason for that?

      1. a.

        I don’t think it is important

      2. b.

        This is not a medication

      3. c.

        I was concerned about the physicians’ reaction

      4. d.

        The physicians do not understand

      5. e.

        The physicians did not ask

      6. f.

        I did not have time

      7. g.

        This is natural so it cannot harm

      8. h.

        Other—specify.

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    Levy, I., Attias, S., Ben-Arye, E. et al. Potential drug interactions with dietary and herbal supplements during hospitalization. Intern Emerg Med 12, 301–310 (2017). https://doi.org/10.1007/s11739-016-1548-x

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    • DOI: https://doi.org/10.1007/s11739-016-1548-x

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