AbstractIntroduction: herbal medicines (HMs) are popular and have become increasingly used in theprevention, diagnosis, and treatment of minor medical conditions and life-threatening illnesses.Patients are reluctant to link herbs with a risk of adverse effects. Adverse drug reactions (ADRs) are a common cause of hospital admission and make a significant contribution to healthcarecosts. ADRs resulting from herb-drug interactions have been identified as significant factorsresponsible for patient morbidity and mortality.
Research aim: there was a limited pool of information on HM safety and no studies of the context of use, for example alone or in combination with other herbs or allopathic medicines, in the UAE. The present research sought to address this.
Methods: in order to quantify usage of HMs in a primary care setting in the UAE, the attitudes and beliefs of UAE Nationals visiting the Al Rowda Clinic, one of biggest Primary Healthcare settings in Abu Dhabi city were sought through a questionnaire. The research was then extended to a three-month,· prospective study of secondary care patients attending the Nephrology Clinic in Sheikh Khalifa Medical City (SKMC), Abu Dhabi. Data was obtained from several sources besides the patient interview, including medical notes, drug charts and the patients' doctors. Potential links between HM use and ADRs were assessed by a consensus panel of investigators using the Naranjo algorithm.
Results: in primary care, the use of HMs was widespread; three quarters of the sample had experience of HM use; with a point-prevalence of current HM use of 38%. A wide range of herbs was used to treat a large number of disorders. Most herbal remedies were in the crude form, often used in mixtures and frequently obtained from unregulated sources. A large majority of users considered the HMs they were taking to be effective, natural and therefore safe; but an appreciable proportion ( 11 % ) cited adverse reactions which they thought were due to the HMs they were taking. Most of herb users were recommended by users' family or friends.
The use of herbs was again widespread among patients visiting the nephrology clinic in SKMC, with 468 of 688 patients (68%) reporting use at the time of interview. Over 100 different HMs, many of them mixtures, were being used. More patients in this setting were also taking prescription medicines (PMs) (70% vs 39%) and 323 (69.0%) were taking three or more herbal preparations. Approximately 70% of patients in both studies had not informed their doctors that they were using HMs.
Interestingly, 28 ADRs to HMs were identified in 26 patients (5.6%); 13 (46.4%) were judged to be probably related and 15 (53.6%) possibly related to the HM. Seven (25%) involved HMs alone and 21 involved a HM / PM interaction. Even though an association was judged to be present in 28 cases (in 26 patients) it was still often difficult to determine which, of the range of HMs taken by the patient, was the culprit. In three cases HMs contributed to existing renal disease.
Conclusions: HMs contain a myriad of pharmacologically active compounds that, when used by people with or without chronic concomitant disease, may be hazardous. Both the primary and secondary care studies contribute information on the widespread use and popularity of HMs in the UAE and show that use is not without risk. The reluctance of subjects to inform their healthcare professionals about current HM use lead the author to recommend that thorough drug histories should be taken on clinic visits or admission to ensure that the attending clinician is aware of all potentially harmful preparations being taken by the patient. Pharmacists may have an important role to play in this process
As the pharmacovigilance scheme to be adopted in UAE is developed, HM safety should be monitored alongside that of PMs.
|Date of Award||Sep 2009|
|Sponsors||Ministry of Health United Arab Emirates & United Arab Emirates University|
|Supervisor||David Brown (Supervisor) & Paul Rutter (Supervisor)|