🌱 Herbal Medicines Flashcards
(24 cards)
What is the difference between a herbal medicine and a medicine derived from herbal origins?
herbal medicine -> medicines that involve using plant materials and extracts to treat disease and maintain good health. Minimal processing involved
- eg St John’s wort OTC to treat mild depression.
- evidence for use is based on historical use
medicine derived from herbal origins - These are medicines that where the active compound is originally sourced from a plant, but the drug is isolated, purified and scientifically developed
- eg digoxin (foxglove), paclitaxel (yew tree).
- evidence for use is based on rigorous clinical trials
Herbal medicines characteristically have a lot of pharmacologically active ingredients - what is the implication of this?
- liable to a plethora of DDIs and ADRs when used
Give 3 examples of herbal medicines and what they are used for?
- Guarana - used for alertness and energy, lots of caffeine
- Valerian root - sedative effects thus used as sleep aid
- St John’s Wort - mild - moderate depression
What is the most common type of side effect of herbal medications??
Type - A reactions - where the px experiences exaggerated pharmacological effects when the drug is given at normal therapeutic levels.
What should a patient do if they experience side effects of herbal medicines?
- report via the Yellow Card Scheme
Are herbal products safe?
No
Natural does not = safe
A lot of them have a plethora of pharmacologically active compounds within them and thus are liable to ADR and DDI’s.
Give an example of herbal product that has been banned in the UK due to its threat to safety?
- kava kava
- a crop from the pacific islands, used for contemptment , relaxation and mood
It has now been banned in the UK due to
.
What are some reasons that most herbal medicines are acc unsafe?
⚠️ some are unregulated
⚠️ failure to have a GMP
⚠️ some have varying strengths
⚠️ some may be adulterated (ie have heavy or toxic metals within)
⚠️ dosing instructions may be incorrect
Under the Traditional Herbal Medicine Registration Scheme, what is the efficacy and permitted indication for herbal medicines based on?
✅ traditional and historical use of the medicine. A herbal drug must be in medical use for at least 30 years, including 15 yrs in the EU.
✅ if there is evidence to show efficacy - can obtain a full MA
Do Herbal medicines need to demonstrate efficacy from clinical trials regarding their evidence for use in the UK?
NO
If there is NO license for a herbal medicine, what can be be alternatively sold as to the public?
Food 🥘 or cosmetics 💄- as it doesn’t comply with the UK medicines legislation
The THMRS is operated under what?
The MHRA
Came into effect on 1st May 2011
Granted there is evidence for use of a herbal product in the last 30 yrs and 15 in the EU, what indications does the THMRS grant herbal medicines be used for?
- ## minor health conditions where medical supervision IS NOT REQUIRED
How can we know a herbal medicine is valid and able to be used/sold?
- must have a THR certification mark , and the THR number on the packaging.
✅ this indicates that the traditional herbal medicine has been registered with the MHRA
What does the THR certification symbol and number indicate/prove?
- the herbal medicine has been registered with the MHRA under the traditional herbal medicine registration scheme, and meets the requirements relating to its :
- ✅ quality
- ✅ safety
- ✅ evidence
Of traditional use and other criteria’s set out in the human medicines regulations
What are the benefits of THMRS for patients 🧍🏾♀️
- ✅ensures the quality and safety of herbal medicines available for self selection by patients, and it determines that the efficacy of the herbal is pharmacologically plausible.
- ✅It ensures that the correct ingredient is at the right dose
- ✅ that it doesn’t contain other pharmaceutical agents or heavy metals.
- (In the past→ lots of examples of herbals containing mercury → deadly).
What else must be provided with the supply of a herbal medicine?
- a patient information leaflet from the manufacturer
Give some examples of some conditions and routes of administration that are permitted for the use of Herbal Medicines
🤷♀️ indications - common cold, cough, sleep problems, migraines, minor skin conditions
👄 routes of administration - ONLY ORAL, inhalation and external routes are licensed
❌ Give a few examples of banned and restricted herbal ingredients
- belladonna root
- mandrake
- poppy capsule
What is the main exemption for the * traditional herbal medicine registration scheme*?
- herbal practitioners who make and supply their own products on their own premises are not obliged to own a license allowing the to do so
👶 we should avoid prescribing and advising the use of herbal medications in high risk patients. Give some examples of high risk patients?
- 🥛 breast feeding
- 🤒 cancer patients
- 👧🏽 children
- 👵 elderly + frail
- 🫨 epilepsy
- 🩸 HIV and immunocompromised
- PX with multiple morbidities and or polypharmacy
- 🤪 psychiatric disorders
- 🫘 renal impairment
💊 we should avoid prescribing and advising the use of herbal medications to px taking high risk medications.
Give some examples of *high risk medications *
- anticoagulants 🩸
- anti-epileptics 🫨
- NTIs 📈
- anti retrovirals 🦠
- antiplatelets and aspirin 🩸
- insulin 💉
- immunosuppressants 🤒
- chemotherapy 👨🦲
-cardiac medications 🫀
What are some practice points for pharmacists, regarding the use, sale and supply of herbal medicines?
- ✅ALWAYS ask about use of herbal / homeopathic /vitamin use as part of a clinical review
- Products with a PL or THR will be assessed by the MHRA to ensure the are safe
- 🗣️Warn patients about the RISK of ADRS → just because it’s NATURAL doesn’t make it safe 🪴
- If they experience any not listed or different → report via yellow card scheme
- 🚑If the SE persist, or Px developed ADR from herbal medicine → let GP or pharmacist know → can escalate.
- 🤓Advice patient to read the PIL
Case question eg : A patient calls the hospitals medicines hotline, asking if they can start taking “St Johns Wort”. They have recently been discharged from hospital with a new Rx for warfarin - can they start SJW?
- NO - SJW is a CYP enzyme inducer and so will :
- 📉 increase metabolism of warfarin - sub therapeutic (n) of warfarin left in body - px gets sub therapeutic dose
- 🩸 reduces the px INR bc of lack./reduction in anticoagulation from warfarin left
- 🥅 increased risk of thromboembolism
