Original articlePotential Interactions of Drug–Natural Health Products and Natural Health Products–Natural Health Products among Children
Section snippets
Patients and Samples
The study was approved by the Hospital for Sick Children Institutional Review Board (Toronto, Ontario, Canada). We conducted a cross-sectional study of children 0 to 18 years with quasirandomized sampling, whereby a trained research assistant approached every third family registered in the Pediatric ED to conduct a face-to-face 15-minute interview. Trained translators interviewed families who preferred to speak in Spanish, Cantonese, or Mandarin. After English, these are the most common
Results
During the study period, we approached a total of 2011 families. Eighty-five (4.2%) were excluded because parents refused to be interviewed, 37 (1.8%) had participated in the study during a previous visit to the ED, 30 (1.5%) did not speak any of the 4 study languages, 29 (1.4%) left the ED before being interviewed, 19 (0.9%) were not seen by the ED team, and 7 (0.3%) because their parents were not present when the interviewer approached them.
A total of 1804 families were interviewed in this
Discussion
This study determined the rate of potential NHP-drug and NHP-NHP interactions in a large population of children visiting a tertiary ED. Concurrent drug-NHP use was documented in every fifth patient, and 15% of NHP users were receiving more than 1 NHP simultaneously. We report that a considerable number of patients (16% of our cohort) had taken a pair of medications/products that could theoretically result in pharmacodynamic or pharmacokinetic interactions. Eight percent of the children in this
References (77)
- et al.
The costs of treating rheumatoid arthritis patients with complementary medicine: exploring the issue
Complement Ther Med
(1999) - et al.
Complementary therapies for acute pediatric pain management
Pediatr Clin North Am
(2000) - et al.
The integration of complementary therapies in North and South Thames Regional Health Authorities’ critical care units
Complement Ther Nurs Midwifery
(1999) - et al.
Use of alternative therapies among emergency department patients
Ann Emerg Med
(2000) Herb-drug interactions
Lancet
(2000)- et al.
Drug biotransformation interactions in man VI: acetaminophen and ascorbic acid
J Pharm Sci
(1976) - et al.
Reduction of serum-1, 25-dihydroxyvitamin-D3 in children receiving glucocorticoids
Lancet
(1978) - et al.
Oxyradicals and multivitamin tablets
Free Radic Biol Med
(1991) - et al.
Effects of valproate and carbamazepine on serum levels of homocysteine, vitamin B12, and folic acid
Brain Dev
(2003) - et al.
Selective inhibition of vitamin B12 absorption by para-aminosalicylic acid
Gastroenterology
(1972)
Effect of ascorbic acid on gastrointestinal aluminium absorption
Lancet
Effect of aloe vera preparations on the human bioavailability of vitamins C and E
Phytomedicine
Unconventional medicine in the United States: prevalence, costs, and patterns of use
N Engl J Med
Taking the edge off: why patients choose St. John’s Wort
J Fam Pract
Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey
JAMA
Complementary and alternative medicine use among adults: United States, 2002
Adv Data
A cross-sectional survey of complementary and alternative medicine use by children and adolescents attending the University Hospital of Wales
BMC Complement Altern Med
Inclusion of complementary medicine increases health costs
Complement Ther Med
Alternative medicine use by homeless youth
Arch Pediatr Adolesc Med
Complementary and alternative medicine for children: does it work?
Arch Dis Child
Use of complementary treatment by those hospitalised with acute illness
Arch Dis Child
Parental attitude towards alternative medicine in the paediatric intensive care unit
Eur J Pediatr
Complementary and alternative medicine use by children visiting a pediatric emergency department
Can J Clin Pharmacol
The use of complementary medicine in pediatric outpatient clinics
Ambulatory Child Health
Adolescents’ use of complementary and alternative medicine
Pediatr Res
Use, understanding, and beliefs about complementary and alternative medicines among emergency department patients
Acad Emerg Med
Characteristics of pediatric and adolescent patients attending a naturopathic college clinic in Canada
Pediatrics
To err is human: building a safer health system
Variables associated with medication errors in pediatric emergency medicine
Pediatrics
Frequency of hospitalization after exposure to known drug-drug interactions in a Medicaid population
Pharmacotherapy
Coma in a patient with Alzheimer’s disease taking low dose trazodone and gingko biloba
J Neurol Neurosurg Psychiatry
Association of Ginkgo biloba with intracerebral hemorrhage
Neurology
Interaction of ginseng with phenelzine
J Clin Psychopharmacol
Kava and dopamine antagonism
J Neurol Neurosurg Psychiatry
Coma from the health food store: interaction between kava and alprazolam
Ann Intern Med
St. John’s wort and antidepressant drug interactions in the elderly
J Geriatr Psychiatry Neurol
Mania in a patient receiving testosterone replacement postorchidectomy taking St John’s wort and sertraline
J Psychopharmacol
Herbal medicines as a factor in delirium
Psychiatr Serv
Cited by (47)
Questionnaires assessing the use of complementary health approaches in pediatrics and their measurement properties: A systematic review
2020, Complementary Therapies in MedicineCitation Excerpt :There is growing evidence supporting the use of certain types of CHA (like massage) for symptom management and to improve quality of life.15–19 However, for some types of CHA, such as natural/biological products, there is a potential risk of interactions when used in conjunction with conventional treatments and may pose a threat to the health of users.20–22 Despite this risk, many families use CHA for their children alongside conventional treatment,23 but only 20 %–65 % of families discuss CHA use with their child’s healthcare providers (HCP).24
Complementary and alternative medicine use in children with cystic fibrosis
2016, Complementary Therapies in Clinical PracticeCitation Excerpt :A significant proportion of CAM users in our study were in fact using multiple different modalities and products. Despite the lack of perceived harm from CAM, the potential for harmful interactions when using multiple CAM modalities is a cause for vigilance given many CF patients concurrently take multiple prescribed pharmaceutical agents [27]. Discussing CAM with families allows for an opportunity to identify potential toxic combinations of CAM and conventional medication use.
Herbal medicine and degenerative complications of type 2 diabetes: What relationship?
2015, Medecine des Maladies MetaboliquesManagement of Natural Health Products in Pediatrics: A Provider-Focused Quality Improvement Project
2015, Journal of Pediatric Health CareCitation Excerpt :Communication is essential to identify which products are being taken, why, and to prevent potential drug-herb interactions. Depending on its pharmacodynamic interaction, an NHP can alter the function of CYP450 liver enzymes, rendering a prescription drug more toxic or ineffective (Goldman, Rogovik, Lai, & Vohra, 2008). For example, the use of 5-hydroxytryptophan (commonly found in St Johns wort) with concurrent use of antidepressants is contradicted because of the increased risk for serotonin syndrome (Natural Standard, 2013).
Pharmacokinetic interactions between drugs and dietary supplements: Carbohydrate, protein, vitamin and mineral supplements
2015, Dietary Supplements: Safety, Efficacy and QualityNatural health product use and management in pediatrics: An integrative review
2014, European Journal of Integrative MedicineCitation Excerpt :Clinicians must monitor responses from NHP (this includes knowing signs and symptoms of adverse events and knowing where to report them). Clinicians also must be aware that some NHPs can affect lab results as well as have dangerous implications for patients undergoing surgery [24]. Serum testing to monitor NHPs is rare (often because the clinician does not know what to measure), which makes clinical awareness and monitoring even more pertinent [25].
Sponsored by the Hospital for Sick Children Foundation’s Research Grants in Complementary and Alternative Therapies and Child and Youth Health Competition and supported by the Child & Family Research Institute (CFRI), BC Children’s Hospital.