Reliance on medicinal plant therapy among cancer patients in Jamaica.

PURPOSE: Patients' perspective of their treatment regime plays a vital role in its success. Recognizing the high prevalence of medicinal plant usage among Jamaicans at large, we investigated the engagement of such remedies by cancer patients, with the aim of uncovering self-medicating habits, perceptions and details of utilized plants. METHODS: A structured, interviewer-based questionnaire was administered to 100 patients attending the oncology and urology clinics at the University Hospital of the West Indies in Kingston, Jamaica. A method of convenience sampling was employed and the data were analyzed using summary statistics and statistical significance tests. RESULTS: A large proportion (n = 80, 80%) of interviewed patients, engaged medicinal plants in their treatment regimes. Such habits were independent of person's education, economic status and were higher among the 55-74 age groups (p < 0.05) compared with younger patients. The use of herbs was hinged on the patient's strong sense of tradition and positive perspective of herbal efficacy (88%), fueled by anecdotal accounts from fellow patients. Majority of such users (74.7%) were under concomitant treatment with a prescription medicine, and worryingly, only 15% of patients made their oncologists aware. Annona muricata L. and Petiveria alliacea L. were the most commonly used plants for treating breast and prostate cancers, respectively. CONCLUSION: A large proportion of Jamaican cancer patients use medicinal plants in self-medicating practices and their perceptions and habits need to be considered by physicians, in the design of safe and effective care regimes.

Utilização de fitoterápicos por idosos: resultados de um inquérito domiciliar em Belo Horizonte (MG), Brasil / Herbal drug use by elderly people: results from a domiciliary survey in Belo Horizonte (MG), Brazil

Os fi toterápicos constituem uma modalidade de terapia complementar ou alternativa diante das necessidades de saúde e seu uso tem sido crescente na população idosa de diversos países. Entretanto, apresentam interações medicamentosas e reações adversas importantes e sua utilização não deve ser indiscriminada. Este estudo objetivou caracterizar o perfi l de utilização de fi toterápicos por aposentados e pensionistas do INSS, com 60 anos e mais, residentes em BeloHorizonte, MG. A partir do cadastro do INSS, selecionou-se uma amostra aleatória de 881 idosos para entrevista. Investigou-se a prevalência de uso de fi toterápicos e interações medicamentosaspotenciais. Um total de 667 (80,3%) dos selecionados foi entrevistado. Setenta e um participantes (10,6%) utilizaram fi toterápicos nos últimos 15 dias, principalmente aqueles preparados a partir de extratos de ginkgo (41,8%), aesculus (12,3%) e isofl avonas de soja (8,2%). Mais de 60% dos fi toterápicos foram adquiridos em farmácias de manipulação. Aproximadamente 45%dos usuários de fi toterápicos estavam expostos a pelo menos uma interação medicamentosa potencial entre eles e medicamentos sintéticos, tais como entre ginkgo e diuréticos tiazídicos(14) e antiagregante plaquetário/anticoagulantes (8). São necessárias estratégias de orientaçãopara o uso racional de fi toterápicos entre idosos, mais vulneráveis aos prejuízos decorrentes da utilização inadequada desses.

The herbal drugs constitute an alternative or complementary therapyfor the health needs and its use has been growing in the aged population of many countries. However, herbal drugs present important adverse effects and drug interactions and should not be indiscriminately used. The aim of this study was to investigate the profile of herbal drug use by elderly and pensioner residents of Belo Horizonte, Brazil. Eight hundred and eighty-oneretirees were randomly selected from the Instituto Nacional do Seguro Social (INSS) database for in-home interview. The prevalence of herbal drugs use, and possible drug interactions were investigated. Results showed that 667 (80.3%) of selected individuals were interviewed. Seventyone subjects (10.6%) used herbal drugs in the past 15 days, mainly those prepared from ginkgo (41.8%), horse chestnut (12.3%), and soya extract (8.2%). More than 60% of the herbal drugswere acquired in compounding pharmacies. Almost 45% of the herbal drug users were exposed to at least one potential herb-drug interaction, such as between ginkgo and thiazide diuretics(14) and antithrombotic/anticoagulants (8). Strategies to provide orientation for the rational use of these products in elderly people are necessary, since they are the population most exposed to polypharmacy and in consequence, most vulnerable to inappropriate uses of medications.

Interações entre fármacos e medicamentos fitoterápicos à base de ginkgo ou ginseng / Interactions between drugs and ginkgo or ginseng herbal medicines

Os medicamentos fitoterápicos são amplamente utilizados, principalmente, pelos portadores de doenças crônicas e em associações medicamentosas com diversos fármacos. As possíveis interações entre eles estão sendo muito estudadas, pois podem alterar os perfis de eficácia e segurança de muitos fármacos. Nesta revisão, as informações foram localizadas, avaliadas e sistematizadas e contêm as principais interações entre fármacos e medicamentos fitoterápicos elaborados com ginkgo ou ginseng. Verificou-se que os medicamentos fitoterápicos elaborados com tais plantas podem interferir na farmacocinética e/ou farmacodinâmica de diversos fármacos, podendo provocar conseqüências graves aos pacientes. O ginkgo pode interferir com anticoagulantes orais, antiplaquetários e com fármacos metabolizados pelo sistema P450-CYP3A4. O ginseng pode interagir com antidepressivos inibidores da monoamino oxidase, anticoagulantes orais, anti-hipertensivos, e contraceptivos à base de estrogênios. Além disso, não é recomendada a administração concomitante de ginkgo ou ginseng com antineoplásicos. Nesse sentido, o uso concomitante de medicamentos fitoterápicos à base de ginkgo ou ginseng com outros fármacos deve ser adequadamente monitorado.

Herbal medicines are widely used especially by patients with chronic diseases, often administered concomitantly with synthetic drugs, raising the potential of pharmacokinetic and pharmacodynamic drug-herb interactions. From the last years, there is an increasing interest in this subject reflected by the great number of documented case reports, in vivo studies, and also clinical trials evaluating drug-herb interactions. The aim of this paper was to review the literature in order to identify reported interactions between ginkgo or ginseng herbal medicines and drugs as well as to evaluate and summarize these information. Interactions between ginkgo or ginseng herbal medicines and drugs can occur and may lead to serious consequences. Ginkgo has the potential to cause significant interactions with anticoagulant and antiplatelet drugs, and also with drugs metabolized by the cytochrome P450 enzyme system, especially by CYP3A4. Ginseng has the potential to cause significant interactions with monoamine oxidase inhibitors, warfarin, antihypertensive agents and estrogens. Additionally, both should be avoided with anticancer drugs. Based on these data and regarding patient's safety, the concomitant use of herbal medicines and drugs has to be properly surveyed by physicians and/or other health care professionals.