Skip to main content

Advertisement

SpringerLink
Log in

Perioperative Risks of Dietary and Herbal Supplements

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Patients undergoing surgery often use Dietary and Herbal Supplements (DHS). We explored the risk of DHS–drug interactions in the perioperative setting.

Methods

In this cross-sectional prospective study, participants hospitalized for surgery completed a questionnaire regarding DHS use. We used pharmacological databases to assess DHS–drug interactions. We then applied univariate and multivariate logistic regression analyses to characterize patients at risk for DHS–drug interactions.

Results

Of 526 interviewees, 230 (44%) patients reported DHS use, with 16.5% reporting using DHS that could potentially interact with anesthesia. Twenty-four (10%) patients used DHS that could potentially interact with antithrombotic drugs taken perioperatively. The medical files of three patients included reports of intraoperative bleeding. The patient files of only 11% of DHS users documented DHS use.

Conclusions

DHS use poses a significant health risk due to potential interactions. Guidelines should emphasize perioperative management of DHS use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dietary Supplements Health and Education Act (1994) https://ods.od.nih.gov/About/dshea_wording.aspx. Accessed June 15, 2015

  2. Tsen LC, Segal S, Pothier M, Bader AM (2000) Alternative medicine use in presurgical patients. Anesthesiology 93:148–151

    Article  CAS  PubMed  Google Scholar 

  3. Kaye AD, Clarke RC, Sabar R et al (2000) Herbal medications: current trends in anesthesiology practice—a hospital survey. J Clin Anesth 12:468–471

    Article  CAS  PubMed  Google Scholar 

  4. Leung JM, Dzankic S, Manku K, Yuan S (2001) The prevalence and predictors of the use of alternative medicine in pre-surgical patients in five California hospitals. Anesth Analg 93(4):1062–1068

    Article  CAS  PubMed  Google Scholar 

  5. Newmaster SG, Grguric M, Shanmughanandhan D, Ramalingam S, Ragupathy S (2013) DNA barcoding detects contamination and substitution in North American herbal products. BMC Med 11:222

    Article  PubMed  PubMed Central  Google Scholar 

  6. Alexopoulou A, Dourakis SP, Mantzoukis D et al (2008) Adverse drug reactions as a cause of hospital admissions: a 6-month experience in a single center in Greece. Eur J Intern Med 19(7):505–510

    Article  PubMed  Google Scholar 

  7. Shapiro LE, Shear NH (1999) Drug-drug interactions: how scared should we be? CMAJ 161(10):1266–1267

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Abe A, Kaye AD, Gritsenko K, Urman RD, Kaye AM (2014) Perioperative analgesia and the effects of dietary supplements. J Clin Anesth 28(2):183–189

    Google Scholar 

  9. Ang-Lee MK, Moss J, Yuan CS (2001) Herbal medicines and perioperative care. JAMA 286(2):208–216

    Article  CAS  PubMed  Google Scholar 

  10. Lee A, Chui PT, Aun CS, Lau AS, Gin T (2006) Incidence and risk of adverse perioperative events among surgical patients taking traditional Chinese herbal medicines. Anesthesiology 105(3):454–461

    Article  PubMed  Google Scholar 

  11. Franco Ruiz S, Gonzalez Maldonado P (2014) Dietary supplements and the anesthesiologist: research results and state of the art. Rev Colomb Anesthesiol 42:90–99

    Google Scholar 

  12. Ben-Arye E, Halabi I, Goldstein L, Attias S, Schiff E (2014) Asking patients the right questions about herbal and dietary supplements: cross-cultural perspectives. Complement Ther Med 22(2):304–310

    Article  PubMed  Google Scholar 

  13. Natural Medicines Comprehensive Database. http://naturaldatabase.therapeuticresearch.com. Accessed June 15, 2015

  14. Horn JR, Hansten PD, Chan LN (2007) Proposal for a new tool to evaluate drug interaction cases. Ann Pharmacother 41(4):674–680

    Article  PubMed  Google Scholar 

  15. Lima CF, Fernandes-Ferreira M, Pereira Wilson C (2007) Drinking of Salvia officinalis tea increases CCI(4)-induced hepatotoxicity in mice. Food Chem Toxicol 45(3):456–464

    Article  CAS  PubMed  Google Scholar 

  16. Perry NS, Bollen C, Perry EK, Ballard C (2003) Salvia for dementia therapy: review of pharmacological activity and pilot tolerability clinical trial. Pharmacol Biochem Behav 75(3):651–659

    Article  CAS  PubMed  Google Scholar 

  17. Avallone R, Zanoli P, Puia G, Kleinschnitz M, Schreier P, Baraldi M (2000) Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla. Biochem Pharmacol 59(11):1387–1394

    Article  CAS  PubMed  Google Scholar 

  18. Kennedy DO, Scholey AB, Tildesley NT, Perry EK, Wesnes KA (2002) Modulation of mood and cognitive performance following acute administration of Melissa officinalis (lemon balm). Pharmacol Biochem Behav 72(4):953–964

    Article  CAS  PubMed  Google Scholar 

  19. Forrest WH Jr, Bellville JW, Brown BW Jr (1972) The interaction of caffeine with pentobarbital as a nighttime hypnotic. Anesthesiology 36:37–41

    Article  PubMed  Google Scholar 

  20. Lev EI, Solodky A, Harel N, Mager A, Brosh D, Assali A, Roller M, Battler A, Kleiman NS, Kornowski R (2010) Treatment of aspirin-resistant patients with omega-3 fatty acids versus aspirin dose escalation. J Am Coll Cardiol 55(2):114–121

    Article  CAS  PubMed  Google Scholar 

  21. Son DJ, Cho MR, Jin YR, Kim SY, Park YH, Lee SH, Akiba S, Sato T, Yun YP (2004) Antiplatelet effect of green tea catechins: a possible mechanism through arachidonic acid pathway. Prostaglandins Leukot Essent Fatty Acids 71(1):25–31

    Article  CAS  PubMed  Google Scholar 

  22. Lee JJ, Jin YR, Lee JH, Yu JY, Han XH, Oh KW, Hong JT, Kim TJ, Yun YP (2007) Antiplatelet activity of carnosic acid, a phenolic diterpene from Rosmarinus officinalis. Planta Med 73(2):121–127

    Article  CAS  PubMed  Google Scholar 

  23. Ravn HB, Vissinger H, Kristensen SD, Wennmalm A, Thygesen K, Husted SE (1996) Magnesium inhibits platelet activity—an infusion study in healthy volunteers. Thromb Haemost 75(6):939–944

    CAS  PubMed  Google Scholar 

  24. Nordström DC, Honkanen VE, Nasu Y, Antila E, Friman C, Konttinen YT (1995) Alpha-linolenic acid in the treatment of rheumatoid arthritis. A double-blind, placebo-controlled and randomized study: flaxseed vs. safflower seed. Rheumatol Int 14(6):231–234

    Article  PubMed  Google Scholar 

  25. Backon J (1991) Ginger as an antiemetic: possible side effects due to its thromboxane synthetase activity. Anesthesia 46(8):705–706

    Article  CAS  Google Scholar 

  26. Ganzera M, Schneider P, Stuppner H (2006) Inhibitory effects of the essential oil of chamomile (Matricaria recutita L.) and its major constituents on human cytochrome P450 enzymes. Life Sci 78(8):856–861

    Article  CAS  PubMed  Google Scholar 

  27. Cochrane ML (2015) Inhibition of cytochrome P450 2C9 by essential oils. Medical Sciences Thesis

  28. Kaye AD, Baluch A, Kaye AJ, Frass M, Hofbauer R (2007) Pharmacology of herbals and their impact in anesthesia. Curr Opin Anaesthesiol 20(4):294–299

    Article  PubMed  Google Scholar 

  29. Practice Guidelines for Perioperative Blood Management. http://www.asahq.org/quality-and-practice-management/standards-and-guidelines/search?q=herb. Accessed Sept 12, 2015

  30. Hogg LA, Foo I (2010) Management of patients taking herbal medicines in the perioperative period: a survey of practice and policies within Anaesthetic Departments in the United Kingdom. Eur J Anaesthesiol 27(1):11–15

    Article  PubMed  Google Scholar 

  31. Wirsansky I (2012) Educational interventions for developing awareness and imparting skill questioning about use of dietary and herbal supplements among hospitalized patients. Fundamental Sciences MD Thesis. Technion

  32. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R (2012) American college of chest physicians. Perioperative management of antithrombotic therapy: antithrombotic Therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 141(2 suppl):e326S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Ms. Silvi Auerbach, Ms. Rita Stern, Ms. Anat Melamed, Ms. Ramzia Sarouzi, Ms. Alexandra Kamladi-nov, Ms. Shani Shitrit, Ms. Nur Zahawa, Ms. Wafa Halabi, Ms. Rana Huri, Ms. Riham Hanifes, Ms. Missa Abu-Hussein, Ms. Rachel Alberg, Ms. Meital Attias, Ms. Yulia Korshov, Ms. Dikla Cogan, Ms. Marina Ukon, Ms. Michal Fassoua, Ms. Einav Kadour, Ms. Inbal Halabi, Ms. Shlomit Grimberg, Ms. Sarah Ben Shlosh and Ms. Myriam Rosenblum for their contribution in interviewing patients; Ms. Ilana Merhav and Ms. Tanya Kligerman for their assistance in the literature search; Ms. Ronit Leiba for the statistical processing.

Author information

Author notes

    Authors and Affiliations

    1. Internal Medicine B Department, Bnai Zion Medical Center, Golomb 47, 3339419, Haifa, Israel

      Ilana Levy & Elad Schiff

    2. Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel

      Samuel Attias & Elad Schiff

    3. School of Public Health, University of Haifa, Haifa, Israel

      Samuel Attias

    4. Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel

      Eran Ben-Arye, Lee Goldstein, Ibrahim Matter, Mostafa Somri & Elad Schiff

    5. Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Western Galilee District, Haifa, Israel

      Eran Ben-Arye

    6. Clinical Pharmacology Unit, Haemek Medical Center, Afula, Israel

      Lee Goldstein

    7. Surgery Department, Bnai Zion Medical Center, Haifa, Israel

      Ibrahim Matter

    8. Anesthesiology Department, Bnai Zion Medical Center, Haifa, Israel

      Mostafa Somri

    Authors
    1. Ilana Levy
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Samuel Attias
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Eran Ben-Arye
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Lee Goldstein
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Ibrahim Matter
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Mostafa Somri
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Elad Schiff
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Ilana Levy.

    Ethics declarations

    Conflict of interest

    None of the authors has a conflict of interest.

    Additional information

    Ilana Levy and Samuel Attias have contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Levy, I., Attias, S., Ben-Arye, E. et al. Perioperative Risks of Dietary and Herbal Supplements. World J Surg 41, 927–934 (2017). https://doi.org/10.1007/s00268-016-3825-2

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00268-016-3825-2

    Keywords

    Search

    Navigation