Self-medication with nutritional supplements and herbal over-thecounter products

Abstract

In recent years, the popularity increased for nutritional supplements and herbal products. Prescription drugs, but not herbal therapies are paid by health insurances. They are sold over-the-counter (OTC) on the patients’ own expense. However, there are potential risks of self-medication, e.g. incorrect self-diagnosis, severe adverse reactions, dangerous drug interactions, risk of addiction etc. They are often used by patients at their own discretion without knowledge of and control by their physicians. Certain users are at risk of intoxication. Multiple medications taken by older patients increase the risk for adverse drug reactions, drug-drug interactions, and compliance problems for this age group (polypharmacy). Herbals should be discontinued prior to operations to avoid interactions with anesthetics or anticoagulants. Herbal preparations may also be carcinogenic or interfere with cancer treatments. Pregnant women use various OTC preparations. However, in many cases, it is unclear whether their use is safe for mother or baby. Self-medication with herbals is also largely distributed among anxious and depressive patients, and patients with other conditions and symptoms. The popularity of herbal products has also brought concerns on quality, efficacy and safety. Cases of botanical misidentification, contaminations with heavy metals, pesticides, radioactivity, organic solvents, microbials as well as adulteration with chemical drugs necessitate the establishment of international quality control standards. Hepatotoxic effects have been reported for more than 300 plant species, and some commonly used herbs have been demonstrated to interact with Western medication. Health care professionals have a critical responsibility assessing the self-care ability of their patients. Databases are available for pharmacists with information on action, side effects and toxicities as well as herb-drug interactions. There is a need for established guidelines regarding the correct use of nutritional supplements and herbal OTC preparations (phytovigilance). Physicians, pharmacists, and other health care professionals have to counsel patients and the general public on the benefits and risks associated with herbal drugs. Information centers for consumers and general practitioners are needed, and convincing evidence on safety and efficacy of herbal products has to be demonstrated in placebo-controlled, double blind and randomized clinical trials.

References

  1. [1]

    Barrett, B.; Kiefer, D.; Rabago, D. Altern. Ther. Health Med.1999, 5, 40–49.

    PubMed  CAS  Google Scholar 

  2. [2]

    Akerele, O. World Health Forum1993, 14, 390–395.

    PubMed  CAS  Google Scholar 

  3. [3]

    Chan, K. Chemosphere2003, 52, 1361–1371.

    PubMed  CAS  Article  Google Scholar 

  4. [4]

    Maxion-Bergemann, S.; Wolf, M.; Bornhöft, G.; Matthiessen, P. F.; Wolf, U. Forsch Komplementmed.2006, 13, 42–45.

    PubMed  Article  Google Scholar 

  5. [5]

    Ruiz, M. E. Curr. Drug Saf.2010, 5, 315–323.

    PubMed  Article  Google Scholar 

  6. [6]

    Consolini, A. E.; Ragone, M. I. Curr. Drug Saf.2010, 5, 333–341.

    PubMed  Article  Google Scholar 

  7. [7]

    Yusuff, K. B.; Tayo, F. Int. J. Clin. Pharm.2011, 33, 558–564.

    PubMed  Article  Google Scholar 

  8. [8]

    Cassileth, B. R. CA Cancer J. Clin.1999, 49, 362–375.

    PubMed  CAS  Article  Google Scholar 

  9. [9]

    Glisson, J. K.; Walker, L. A. Am. J. Med.2010, 123, 577–582.

    PubMed  Article  Google Scholar 

  10. [10]

    Vora, C. K.; Mansoor, G. A. Curr. Hypertens. Rep.2005, 7, 275–280.

    Google Scholar 

  11. [11]

    Bent, S.; Ko, R. Am. J. Med.2004, 116, 478–485.

    PubMed  Article  Google Scholar 

  12. [12]

    Huxtable, R. J. Drug Saf.1990, 5, 126–136.

    PubMed  Article  Google Scholar 

  13. [13]

    Vacas Rodilla, E.; Castellà Dagà, I.; Sánchez Giralt. M.; Pujol Algué, A.; Pallarés Comalada, M. C.; Balagué Corbera, M. Aten. Primaria. 2009, 41, 269–274.

    PubMed  Article  Google Scholar 

  14. [14]

    Tam-McDevitt, J. Oncology (Williston Park).2008, 22, 1052–1060.

    PubMed  Google Scholar 

  15. [15]

    González-Stuart, A. Maturitas2011, 68, 52–55.

    PubMed  Article  Google Scholar 

  16. [16]

    Fitzcharles, M. A.; Lussier, D.; Shir, Y. Drugs Aging2010, 27, 471–490.

    Google Scholar 

  17. [17]

    Fitzpatrick, A. L.; Fried, L. P.; Williamson, J.; Crowley, P.; Posey, D.; Kwong, L.; Bonk, J.; Moyer, R.; Chabot, J.; Kidoguchi, L.; Furberg, C. D.; DeKosky, S. T. Contemp. Clin. Trials2006, 27, 541–553.

    PubMed  Article  Google Scholar 

  18. [18]

    Mahady, G. B. J. Cardiovasc. Nurs.2002, 16, 21–32.

    PubMed  Article  Google Scholar 

  19. [19]

    Frost, E. A. Middle East J. Anesthesiol.2006, 18, 851–878.

    PubMed  Google Scholar 

  20. [20]

    King, A. R.; Russett, F. S.; Generali, J. A.; Grauer, D. W. BMC Complement. Altern. Med.2009, 9, 38.

    PubMed  PubMed Central  Article  Google Scholar 

  21. [21]

    Norred, C. L.; Zamudio, S.; Palmer, S. K. AANA J.2000, 68, 13–18.

    PubMed  CAS  Google Scholar 

  22. [22]

    Rowe, D. J.; Baker, A. C. Aesthet. Surg. J.2009, 29, 150–157.

    PubMed  Article  Google Scholar 

  23. [23]

    Spolarich, A. E.; Andrews, L. J. Dent. Hyg.2007, 81, 67.

    PubMed  CAS  Google Scholar 

  24. [24] (a)

    Montbriand, M. J. Oncol. Nurs. Forum2004, 31, E99–115

    Google Scholar 

  25. [24] (b)

    Montbriand, M. J. Erratum in: Oncol. Nurs. Forum2006, 33, 684

    Google Scholar 

  26. [24] (c)

    Montbriand, M. J. Comment in: Oncol. Nurs. Forum2006, 33, 684; author reply 684.

    Google Scholar 

  27. [25]

    Gratus, C.; Wilson, S.; Greenfield, S. M.; Damery, S. L.; Warmington, S. A.; Grieve, R.; Steven, N. M.; Routledge, P. BMC Complement. Altern. Med.2009, 9, 14.

    PubMed  PubMed Central  Article  Google Scholar 

  28. [26]

    Marks, L. S.; DiPaola, R. S.; Nelson, P.; Chen, S.; Heber, D.; Belldegrun, A. S.; Lowe, F. C.; Fan, J.; Leaders, F. E. Jr.; Pantuck, A. J.; Tyler, V. E. Urology2002, 60, 369–375; discussion 376–377.

    PubMed  Article  Google Scholar 

  29. [27]

    Wong, C. Prostate cancer herbal remedy taken off market. http://altmedicine.about.com/cs/govtregulation/a/PCSpes.htm.

  30. [28]

    Lowe, F. C. Urology2001, 58, 71–76; discussion 76–77.

    PubMed  CAS  Article  Google Scholar 

  31. [29]

    McKenna, L.; McIntyre, M. J. Adv. Nurs.2006, 56, 636–645.

    PubMed  Article  Google Scholar 

  32. [30]

    Born, D.; Barron, M. L. MCN Am. J. Matern. Child Nurs.2005, 30, 201–206.

    PubMed  Article  Google Scholar 

  33. [31]

    Tiran, D. Complement. Ther. Nurs. Midwifery2002, 8, 191–196.

    PubMed  Article  Google Scholar 

  34. [32]

    Holst, L.; Wright, D.; Haavik, S.; Nordeng, H. Midwifery2011, 27, 80–86.

    PubMed  Article  Google Scholar 

  35. [33]

    Dugoua, J. J.; Perri, D.; Seely, D.; Mills, E.; Koren, G. Can. J. Clin. Pharmacol.2008, 15, e66–73.

    Google Scholar 

  36. [34]

    Candlish, J. K. Singapore Med. J.1999, 40, 550–552.

    PubMed  CAS  Google Scholar 

  37. [35] (a)

    Bray, G. A. Obesity (Silver Spring)2008, 16, 509–514

    Article  Google Scholar 

  38. [35] (b)

    Bray, G. A. Erratum in: Obesity (Silver Spring)2008, 16, 1723.

    Google Scholar 

  39. [36]

    Saper, R. B.; Eisenberg, D. M.; Phillips, R. S. Am. Fam. Physician2004, 70, 1731–1738.

    PubMed  Google Scholar 

  40. [37] (a)

    Zhu, X.; Proctor, M.; Bensoussan, A.; Smith, C. A.; Wu, E. Cochrane Database Syst. Rev.2007, 4, CD005288

    PubMed  Google Scholar 

  41. [37] (b)

    Zhu, X.; Proctor, M.; Bensoussan, A.; Smith, C. A.; Wu, E. Update in: Cochrane Database Syst. Rev.2008, 2, CD005288.

  42. [38]

    Kelley, K. W.; Carroll, D. G. J. Am. Pharm. Assoc.2003, 50, e106–115.

    Google Scholar 

  43. [39]

    Haimov-Kochman, R.; Brzezinski, A.; Hochner-Celnikier, D. Eur. J. Contracept. Reprod. Health Care2008, 13, 133–137.

    PubMed  Article  Google Scholar 

  44. [40]

    Saeed, S. A.; Bloch, R. M.; Antonacci, D. J. Am. Fam. Physician2007, 76, 549–556.

    Google Scholar 

  45. [41]

    Singh, Y. N.; Singh, N. N. CNS Drugs 2002, 16, 731–743.

    PubMed  Article  Google Scholar 

  46. [42]

    Sarris, J.; LaPorte, E.; Schweitzer, I. Aust. N. Z. J. Psychiatry2011, 45, 27–35.

    PubMed  Article  Google Scholar 

  47. [43]

    Morin, A. K.; Jarvis, C. I.; Lynch, A. M. Pharmacotherapy2007, 27, 89–110.

    PubMed  CAS  Article  Google Scholar 

  48. [44]

    Meolie, A. L.; Rosen, C.; Kristo, D.; Kohrman, M.; Gooneratne, N.; Aguillard, R. N.; Fayle, R.; Troell, R.; Townsend, D.; Claman, D.; Hoban, T.; Mahowald, M. J. Clin. Sleep Med. 2005, 1, 173–187.

    PubMed  Google Scholar 

  49. [45]

    Steele, T.; Rogers, C. J.; Jacob, S. E. Dermatol. Nurs.2007, 19, 448–450, 457–463.

    PubMed  Google Scholar 

  50. [46]

    Reuter, J.; Merfort, I.; Schempp, C. M. Am. J. Clin. Dermatol.2010, 11, 247–267.

    PubMed  Google Scholar 

  51. [47]

    Burgess, J. A.; van der Ven, P. F.; Martin, M.; Sherman, J.; Haley, J. J. Contemp. Dent. Pract.2008, 9, 88–98.

    PubMed  Google Scholar 

  52. [48]

    Kassler, W. J.; Blanc, P.; Greenblatt, R. Arch. Intern. Med.1991, 151, 2281–2288.

    PubMed  CAS  Article  Google Scholar 

  53. [49]

    Roxas, M.; Jurenka, J. Altern. Med. Rev.2007, 12, 25–48.

    PubMed  Google Scholar 

  54. [50]

    Silber, T. J. J. Adolesc. Health2005, 37, 256–260.

    PubMed  Article  Google Scholar 

  55. [51]

    Manoguerra, A. S.; Cobaugh, D. J. Clin. Toxicol. (Phila)2005, 43, 1–10.

    Article  Google Scholar 

  56. [52]

    Chan, K. Chemosphere2003, 52, 1361–1371.

    PubMed  CAS  Article  Google Scholar 

  57. [53]

    Efferth, T.; Kaina, B. Curr. Drug Metabol.2012, in press.

  58. [54]

    Efferth, T. Chin. J. Nat. Med.2011, 9, 1–6.

    Google Scholar 

  59. [55]

    Larrey, D. Presse Med.1994, 23, 691–693.

    PubMed  CAS  Google Scholar 

  60. [56]

    Stickel, F.; Egerer, G.; Seitz, H. K. Public Health Nutr.2000, 3, 113–124.

    PubMed  CAS  Google Scholar 

  61. [57]

    Bent, S. J. Gen. Intern. Med.2008, 23, 854–859.

    Article  Google Scholar 

  62. [58]

    Ulbricht, C.; Chao, W.; Costa, D.; Rusie-Seamon, E.; Weissner, W.; Woods, J. Curr. Drug Metab.2008, 9, 1063–1120.

    PubMed  CAS  Article  Google Scholar 

  63. [59]

    Delgoda, R.; Westlake, A. C. Toxicol Rev.2004, 23, 239–249.

    PubMed  CAS  Article  Google Scholar 

  64. [60]

    Shord, S. S.; Shah, K.; Lukose, A. Integr. Cancer Ther.2009, 8, 208–227.

    PubMed  CAS  Google Scholar 

  65. [61]

    Dykeman-Sharpe, J. CANNT J.2003, 13, 17–28.

    PubMed  Google Scholar 

  66. [62]

    Blowey, D. L. Adolesc. Med. Clin.2005, 16, 31–43.

    PubMed  Article  Google Scholar 

  67. [63]

    Cheng, K. F.; Leung, K. S.; Leung, P. C. Am. J. Chin. Med.2003, 31, 163–169.

    PubMed  CAS  Article  Google Scholar 

  68. [64]

    Ioannides, C. Xenobiotica2002, 32, 451–478.

    PubMed  CAS  Article  Google Scholar 

  69. [65]

    Kober, M.; Pohl, K.; Efferth, T. Curr. Drug Metab.2008, 9, 1027–1037.

    PubMed  CAS  Article  Google Scholar 

  70. [66]

    Yoon, S. L.; Schaffer, S. D. Geriatr. Nurs.2006, 27, 118–129.

    PubMed  Article  Google Scholar 

  71. [67]

    Bush, T. M.; Rayburn, K. S.; Holloway, S. W.; Sanchez-Yamamoto, D. S.; Allen, B. L.; Lam, T.; So, B. K.; Tran, de H.; Greyber, E. R.; Kantor, S.; Roth, L. W. Altern. Ther. Health Med.2007, 13, 30–35.

    PubMed  Google Scholar 

  72. [68]

    Brazier, N. C.; Levine, M. A. Am. J. Ther.2003, 10, 163–169.

    PubMed  Article  Google Scholar 

  73. [69]

    Mohamed, M. E.; Frye, R. F. Planta Med.2011, 77, 311–321.

    PubMed  CAS  Article  Google Scholar 

  74. [70]

    Laven, A. Pharm. Unserer Zeit2009, 38, 448–453.

    PubMed  Article  Google Scholar 

  75. [71]

    Glisson, J. K.; Walker, L. A. Am. J. Med.2010, 123, 577–582.

    PubMed  Article  Google Scholar 

  76. [72]

    Tiran, D. Br. J. Nurs.2006, 15, 645–648.

    PubMed  Article  Google Scholar 

  77. [73]

    Mitty, E.; Flores, S. Geriatr. Nurs.2007, 28, 83–89.

    PubMed  Article  Google Scholar 

  78. [74]

    Jaski, M. E.; Schwartzberg, J. G.; Guttman, R. A.; Noorani, M. Eff. Clin. Pract.2000, 3, 31–34.

    PubMed  CAS  Google Scholar 

  79. [75]

    McCabe, B. J. Curr. Opin. Clin. Nutr. Metab. Care2004, 7, 21–26.

    PubMed  Article  Google Scholar 

  80. [76]

    Howard, N.; Tsourounis, C.; Kapusnik-Uner, J. J. Altern. Complement. Med.2001, 7, 667–680.

    Google Scholar 

  81. [77]

    Newton, G. D.; Benninghoff, A. J.; Pray, W. S.; Popovich, N. G. J. Am. Pharm. Assoc. (Wash)2002, 42, 267–277.

    Article  Google Scholar 

  82. [78]

    Lim, J. M.; Sullivan, E.; Kennedy, D. Aust. N. Z. J. Obstet. Gynaecol.2009, 49, 168–172.

    PubMed  Article  Google Scholar 

  83. [79]

    Assemi, M.; Torres, N. M.; Tsourounis, C.; Kroon, L. A.; McCart, G. M. Ann. Pharmacother.2002, 36, 787–792.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Thomas Efferth.

Additional information

This article is published with open access at Springerlink.com

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

Eichhorn, T., Greten, H.J. & Efferth, T. Self-medication with nutritional supplements and herbal over-thecounter products. Nat. Prod. Bioprospect. 1, 62–70 (2011). https://doi.org/10.1007/s13659-011-0029-1

Download citation

Keywords

  • botanicals
  • contamination
  • complementary and alternative medicine
  • drug interactions
  • geriatric
  • gynecology
  • insomnia
  • hepatotoxicity
  • menopause
  • nephrotoxicity
  • over-the-counter
  • pain
  • phase I/II enzymes
  • pharmacognosy
  • pharmacovigilance
  • phytochemicals
  • phytotherapy
  • phytovigilance
  • quality control