In Turkey, 65 Percent of Individuals Over the Age of 89 Use Herbal Medicines and Mixtures Without Physician Recommendation
There are many traditional medicine practices in our country, although their prevalence is not fully known. Scientific evidence from randomized controlled trials is based on strong evidence only for acupuncture, some herbal medicines, and some hand therapies. In a study conducted in our country in this field, it was determined that 65% of individuals over the age of 92.9 used drugs other than physician recommendation, and 89.3% used herbal-based drugs/mixtures. It has been reported that those who receive advice from friends and relatives for drug use and the frequency of drug side effects are higher.
Herbal Treatment Affects the Success of Medical Treatment Due to Mistakes
Exaggeration of the effects of herbal resources among the public and in the press, applications made by people without medical education, and mistakes made in the collection, storage and use of plants affect the success of the medical treatment applied. Patients often stop treatment, thinking that medical treatment will be useless, and turn to herbal medicines or complementary treatments.
Hiding from Healthcare Personnel
Many studies have shown that complementary and alternative treatment methods directly interact with medical treatment. It has been determined that 70% of the patients use herbal medicine (phytotherapeutic) or health support products (nutraceutical) and hide it from healthcare personnel. It is reported that the use of such drugs/mixtures by patients may hide the symptoms in some disease cases and prevent the physician from making a correct diagnosis. It has been shown that 100% of 36 cancer patients started alternative treatment along with medical treatment and 75% continued to use it. Medicinal plants, like other drugs, have therapeutic effects. Issues such as overdose, duration of use, use during pregnancy, and interaction with other drugs used should not be overlooked.
Drug-Herb Interaction is a Significant Public Health and Safety Issue
Drug-herb interaction is an important public health and safety problem. Many drug-herb interactions can lead to unexpected values in routine outpatient therapeutic drug monitoring. For example, diabetic patients may develop hypoglycemia if they take ginseng herb. Dandelion may cause hypotension in patients with hypertension. Licorice root may increase cardiac problems by increasing potassium loss. St. John's wort may reduce the effects of drugs such as cyclosporine and digoxin. As a result of overdose, plants may cause many side effects (organ failure, phototoxicity, hypertension, etc.).
Plants That Most Cause Drug-Plant Interactions
St. John's Wort
It is one of the herbal products most frequently used by the general population. It is used in the treatment of mild and moderate depression. The hypericin and hyperforin contained in its structure constitute its pharmacological activity. St. John's wort use has the potential to significantly affect and alter the metabolism of other drugs. It has an inducing effect on CYP3A4 microsomal enzymes that carry out the metabolism of many drugs. It blocks the reuptake of serotonin, noradrenaline and dopamine in neurons. It reduces the effects of drugs by preventing their absorption by using the P-glycoprotein pathway. It causes toxicity by increasing drug absorption through inhibition of P-glycoprotein. It causes side effects such as photosensitivity, gastrointestinal irritation, headache, allergic reactions, fatigue and restlessness. In one publication, the authors reported 3 cases of hypomania that occurred 6 months and 2 weeks after using St. John's wort.
Ginseng (Panax Ginseng)
Ginseng is a herbal medicine widely used in China, the USA and Asian countries. It is divided into two: Asian Ginseng and American ginseng. The ginsenoids found in their structures and their biological activities differ from each other. American ginseng used together with warfarin reduces the effectiveness of warfarin and increases the risk of hypoglycemia when used together with antidiabetic drugs. When used regularly in patients with type 2 diabetes, it reduces fasting blood sugar and HbA1c levels, but it causes hypoglycemia attacks because it rapidly lowers postprandial blood sugar. In a survey conducted among chronically ill patients in outpatient clinics, ginseng was the most popular herbal supplement after vitamin supplements. The interaction between ginseng and the anticancer agent imanitib may cause hepatotoxicity.
Gingko
Gingko biloba is prepared from the leaves of the gingko tree. Terpenoids and flavonoids are its active ingredients. Gingko biloba inhibits CYP4A3 enzyme activation. It has an inductive effect on CYPA4, CYP2C9, CYP2C19 and CYP1A2 activity. It can also reduce the effect of drugs by inhibiting P-glycoprotein. Yang et al. They showed that cyclosporine decreased serum concentration in the presence of gingko and onion in rats. Granger reported that in 2 cases, there was no change in valproic acid levels with the use of gingko, but seizures developed within 2 weeks. The effect of tolbutamide, which is used as a glucose-lowering drug, increases in people using gingko. Gingko is used in the treatment of peripheral vascular diseases, neurodegenerative diseases, tinnitus, vertigo, glaucoma, cognitive diseases and Alzheimer's. Gingko causes bleeding by inhibiting platelet-activating factor. Fransen et al. listed 3 health benefits of gingko loban as improving brain and peripheral circulation, reducing symptoms related to advanced age, and improving memory.
Garlic
Garlic (Allium Sativum) is both a spice and herbal supplement widely used to lower cholesterol and blood pressure. It is rich in allicin and alliin, which contain sulfur. When used as a spice, it does not interact with medications since its active content is relatively low. However, those sold in herbal medicine stores contain higher levels of contracting structures, which can cause chemical interactions with drugs. Garlic can inhibit platelet aggregation, which has shown that it may interact with warfarin. There is an interaction between spontaneous bleeding after surgery and garlic consumed before and after surgery. The effects of garlic were investigated in 10 healthy volunteers using saquinavir. Saquinivir has been shown to reduce plasma levels of the drug by inducing hepatic CYP3A4 metabolism. Serum concentration decreased to 1200% in patients who used 54 mg of garlic for certain periods. After 10 days, serum concentrations returned to 60-70% of baseline values.
What to do ?
Many patients all over the world use herbal treatments to treat diseases and relieve symptoms. Some herbal products can have dangerous side effects. Applying herbal treatment methods to patients receiving medical treatment reduces or may cause them to lose their chance of benefiting from scientifically based treatments. Lack of pharmacological information on herbal products and inadequate knowledge of plant-drug interactions among healthcare professionals make it difficult to identify safety and side effects. In order to get good results from the plants to be used in treatment; Make sure it is the right plant. Extraction methods must be done correctly and stored correctly. The correct dose should be taken by evaluating the scientific literature.
