Elsevier

The Journal of Pediatrics

Volume 152, Issue 4, April 2008, Pages 521-526.e4
The Journal of Pediatrics

Original article
Potential Interactions of Drug–Natural Health Products and Natural Health Products–Natural Health Products among Children

https://doi.org/10.1016/j.jpeds.2007.09.026Get rights and content

Objective

To determine the frequency of concurrent use of conventional medications and natural health products (NHP) and their potential interactions in children arriving at an emergency department.

Study design

A survey of parents and patients 0 to 18 years at a large pediatric ED in Toronto, Ontario, Canada.

Results

A total of 1804 families were interviewed in this study. Concurrent drug-NHP use was documented in 355 (20%) of patients and 269 (15%) of NHP users were receiving more than one NHP simultaneously. Theoretically possible NHP-drug or NHP-NHP interactions in the preceding 3 months were identified in 285 (16%) children. There were 35 different NHP-medication interaction pairs and 41 NHP-NHP interaction pairs. NHP-medication interactions were predominantly pharmacokinetic (modified absorption, 35%); potential NHP-NHP interactions were mostly pharmacodynamic (increased risk of bleeding, 47%).

Conclusions

Medications are used concurrently with NHP in every fifth pediatric patient in the emergency department and many NHP users are receiving more than 1 NHP simultaneously. One quarter of all paired medication-NHP or NHP-NHP could potentially cause interactions. Although we can not confirm that these were true interactions resulting in clinical symptoms, parents and health care providers need to balance the potential benefit of concurrent NHP-medication use with its potential harms.

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

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    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.

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