Herbal Medicines & Fish Oils

Transcription

1 Lancashire Care NHS Foundation Trust Herbal Medicines & Fish Oils Pharmacy

2 What are Herbal Medicines? Herbal medicines are plants and plant remedies used in the treatment and prevention of disease. They may also be referred to as complementary medicines. The majority of herbal medicines available in the UK are unlicenced; this means there is likely to be limited clinical information available from manufacturers. The most common herbal medicines include: 1. St. John's Wort 2. Ginseng 3. Ginkgo Biloba 4. Valerian 5. Echinacea These herbal medicines may be bought alone or in combination with other herbal remedies e.g. Tesco Stress Relief tablets contain a mixture of hops, paleman and passion flower. Issues To Consider Before Taking Herbal Medicines There is little information in the literature on drug reactions between prescribed and complementary medicines, although such reactions do occur. Although generally regarded as organic and safe many herbal medicines and other medicines you can buy without a prescription have the potential to cause side effects. Being natural doesn't make something automatically safe. Always speak to your doctor before starting a herbal remedy. People taking medication such as Warfarin, Digoxin, Cyclosporin and Lithium should avoid herbal medicines.

3 What Should I Do If I Am Already Taking A Herbal Remedy? Ask your pharmacist if it is suitable for you and whether it affects any other medication you are taking. If it does, the pharmacist will give advice on what you should do. If you continue to take the herbal remedy, tell your doctor about it on your next visit to the surgery or hospital so that they can put details in your medication record. Properties of Some of The More Commonly Used Herbal Remedies 1. St John s Wort (SJW) This is the common name for the herb Hypericum Perforatum. It is widely available to buy and is used by doctors to treat depression in some countries. The National Institute of Clinical Excellence (NICE) have told health professionals in this country that they should not recommend it. SJW interacts with a lot of prescribed medication to reduce the levels of that medication in the body. The amount of active ingredient can vary between different preparations of SJW and switching from one brand to another can change the effects on levels of prescribed medication as well. When patients stop taking SJW blood levels of interacting medications may rise, leading to toxicity & side effects. SJW can also increase levels of neurotransmitters, like serotonin, and this can cause some unpleasant reactions like stomach upsets, agitation, sweating, tremors and a fast heartbeat.

4 Clinically important interactions of SJW Anticonvulsants (e.g. Carbamazepine, Phenobarbitone and Phenytoin) Decreased blood levels with a risk of seizures. You must see your doctor so they can, if necessary, monitor levels of the anticonvulsant medication and adjust the doses when the SJW is stopped. Antidepressants (e.g. Citalopram and Fluoxetine) Increased levels of serotonin which can cause adverse effects. You need to stop taking SJW. Digoxin Decreases blood levels with subsequent loss of control of heart rhythm or heart failure. See your doctor to check digoxin levels and stop SJW. Digoxin levels may increase on stopping SJW and dose of digoxin may need adjusting. Anticoagulants (e.g. Warfarin) Decreases anticoagulant effect and increases risks of blood clots. There will probably be a need for increased Warfarin dose. See your doctor so they can check an International Normalised Ratio (INR) and stop SJW. They will continue to monitor INR closely as this may rise on stopping SJW, meaning that the dose of warfarin may need adjusting.

5 Cyclosporin Decreases blood levels with a risk of transplant rejection. See your doctor so they can check cyclosporin levels and stop SJW. Cyclosporin levels may rise on stopping SJW, therefore dose may need adjusting. Any patients already taking these drugs should not start taking SJW preparations. St. John s Wort interacts with a range of other medicines significantly. Please speak to your doctor or pharmacist. 2. Ginseng Derived from the Araliaceae ivy family, the most commonly used forms in the UK are Chinese or Korean Ginseng. It is generally taken orally in tablet/capsule form consisting of powdered roots or dried root. Ginseng is widely used to prevent infection, treat fatigue and general disability or as a tonic. There is limited clinical data to support these uses. People who should not take Ginseng Available information suggests Ginseng should be used with caution in individuals with bipolar disorder, psychoses, diabetes, blood pressure problems and heart disease. People taking the following medication should not take Ginseng: Warfarin- increases bleeding. Phenelzine (Nardil)- headaches, tremor and nausea Non Steroidal Anti-inflammatory drugs e.g. Ibuprofen- increases bleeding HRT/Combined Contraceptive Pill-breast pain and vaginal bleeding Ginseng should also be stopped seven days before any surgery.

6 3. Ginkgo Biloba Extract from the leaves of the Ginkgo Biloba tree is claimed to have a beneficial effect in a variety of conditions: a) Alzheimer's Disease b) Cardiovascular Disease c) Cerebral Vascular Insufficiency d) Tinnitus People who should not take Ginkgo Biloba: Ginkgo biloba should be avoided during pregnancy and breast feeding due to a lack of information. It should be used with caution in epilepsy as it may increase the frequency of seizures. Ginkgo Biloba needs to be stopped 36 hours before surgery. People taking anticoagulant and anti-platelet drugs (e.g. Warfarin, Aspirin and Clopidogrel) should not take ginkgo biloba due to risk of bleeding. 4. Valerian Valerian is derived from a common plant Valeriana Officinalis. Types of presentation include Capsules Pills Liquid Extract Tincture Infusion Tea. It is used for anxiety, stress and sleep problems. Valerian can also be used in combination with other herbs for pain management and to influence a whole range of health problems that may be affected by disruption of the nervous system.

7 Side Effects These can include Mild headache Feeling sick Nervousness Palpitations Grogginess on waking. Long term use with large doses may increase the range and severity of side effects. Interacts with Several species of Echinacea are used medicinally, including Echinacea Purpurea and Echinacea Pallida. It is used for stimulating the immune system and in the prevention and treatment of viral upper respiratory tract infections. It can also be used on the skin to aid wound healing. Echinacea should not be used continually for longer than 10 days, due to lack of safety data. Long-term use is associated with hepatotoxicity (liver damage) and so Echinacea should not be taken with other drugs that may affect the liver (e.g. anabolic steroids, amiodarone and methotrexate). People who should not take Echinacea: Sedatives Tranquillisers Antidepressants. 5. Echinacea Individuals under 12 years of age. Individuals with progressive systemic diseases e.g. Tuberculosis, Diabetes, HIV & Multiple Sclerosis, Asthma, connective tissue disease, blood disorders. Pregnant and breast feeding women. Those prescribed courses of immunosuppressant therapy e.g. Corticosteroids and Cyclosporin, chemotherapy. Side effects Allergic reactions Asthma Bronchoseasm Decrease in number of waste blood cells.

8 Conclusions There are many more herbal remedies available, too many to list here. Always inform your doctor if you plan to start taking any of these medicines. Main groups of people at risk are: pregnant women, breast feeding mothers, children, elderly. Any individual taking prescribed drugs where levels need to be closely monitored should avoid all herbal remedies. Always report an interaction or adverse effect via the yellow card scheme, or to your doctor or pharmacist. Never give herbal remedies to children. Always look for particulars on the label that will tell you if it has a licence. What To Do If You Think You Have Had An Adverse Reaction To Your Herbal Medicine Stop the herbal medicine and tell your doctor or pharmacist. You can report a reaction yourself, directly to the Medicines Healthcare Regulatory Authority (MHRA) using a system called the YELLOW CARD SCHEME.This can be done online or by filling out a paper yellow form which is available upon request by calling Alternatively you can ask you doctor or pharmacist to report the reaction to the MHRA for you. Any information received will be held in complete confidence and your personal details will not be given to anyone else without your permission.

9 Which Herbal Medicines Have Been Assessed By The Regulator? Herbal medicines licensed in the UK have a Product Licence (PL) number on the label. Traditional herbal medicines registered in the UK have a Traditional Herbal Registration (THR) number on the label. Please note that there is no requirement under the THR scheme to prove scientifically that the product works. Look for PL or THR on the product labels. If the product has a PL or THR number then you know it is regulated by the MHRA and meets the required standards. Unlicensed Herbal Medicines Treat with caution claims about safety that are not backed up by credible evidence. Be wary of any unlicensed medicine suggesting you should stop taking, or change the dose of a prescribed medicine. Always consult your doctor before making any changes to your prescribed medication. Information is available on the MHRA website about any particular herbal remedy.

10 Fish Oils th Sold by pharmacists since the early years of the 20 Century, cod liver oil is one of the oldest and most well-known food supplements. It is not a herbal remedy. The oil first gained its reputation as an effective preventative remedy against Ricketts because of its high vitamin D content. A series of papers published in the 1970 s reported a lower rate of heart disease in populations who ate a traditional diet high in seal meat, whale meat and fish. Due to these reports, fish oil supplements began to increase in popularity. Fish oil is a rich source of omega-3 fatty acids. The body is unable to make these, so they have to be provided by the diet. The richest sources of omega-3 fatty acids are oily fish and fish oil. Only about one third of the UK population consume oily fish on a regular basis. The Department of Health recommend eating two portions of fish each week, one of which should be oil rich. Some people do not like oily fish and may wish to take a fish oil supplement. It has been suggested that omega-3 fatty acids are beneficial in a number of different conditions: Coronary heart disease and stroke Inflammatory conditions, e.g. Rheumatoid arthritis, inflammatory bowel disease, psoriasis and asthma Autoimmune disorders e.g. Lupus Cancers Diabetes Mental Health Disorders e.g. Depression, Schizophrenia and Alzheimer`s Disease

11 The potential role of fish oils in various mental disorders has been reported. A limited number of studies have found low levels of omega-3 fatty acids in cell membranes of patients with depression, schizophrenia and Alzheimer's disease. It has been suggested that low dietary intakes of omega-3 fatty acids might be associated with these conditions. It remains to be seen whether the observed low levels of cell membrane omega-3 fatty acids are a cause or an effect of the illnesses. Safety Fish oils are generally considered safe and have not been associated with any serious adverse effects, although one safety concern is the potential to increase bleeding time. Patients taking anticoagulant medication or those with blood clotting disorders should be monitored whilst taking fish oils. The risk will increase if you are taking other dietary supplements that may prolong bleeding time, such as vitamin E, garlic and Ginkgo Biloba. This does not mean that you have to avoid fish oils just let your doctor know that you take fish oils. Side Effects Associated with Antidepressants

12 Further advice and information is available from the Pharmacy Team Contact Details: Central Lancashire Fylde Coast East Lancashire Other sources of information: The Mental Health Helpline This provides an information and listening service for people in Lancashire. It is available between 7:00pm and 11:00pm Mondays to Fridays and from 12:00 noon until 12:00 midnight on Saturdays and Sundays. Freephone Customer Care If you wish to pay a compliment about the Trust s services, make a comment, raise a concern or complaint, please contact the Customer Care Department on , freephone or customer.care@lancashirecare.nhs.uk If you have problems reading the print we can provide this leaflet in large print, audio book or Braille. Lancashire Care NHS Foundation Trust. All Rights Reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. Data Protection Lancashire Care NHS Foundation Trust adheres to The Data Protection Act The Trust will endeavour to ensure that your information remains secure and confidential at all times. For further information regarding data protection please visit the Trust s website or ask a member of staff for a copy of our leaflet entitled Sharing Information With Us. Copies of this leaflet are available from: Lancashire Care NHS Foundation Trust, Sceptre Point, Sceptre Way, Bamber Bridge, Walton Summit, Preston PR5 6AW Tel: communications@lancashirecare.nhs.uk Website: Date Produced: Review Date: Leaflet Code: Name of Leaflet: September 2013 September /2013 Herbal Medicines & Fish Oils