Internal and Emergency Medicine

, Volume 12, Issue 3, pp 301–310 | Cite as

Potential drug interactions with dietary and herbal supplements during hospitalization

  • Ilana LevyEmail author
  • Samuel Attias
  • Eran Ben-Arye
  • Lee Goldstein
  • Elad Schiff


Dietary and herbal supplements (DHS) are widely used in the general population, including during hospitalization. Yet, their potential interactions with prescription drugs have seldom been delineated among inpatients. We aimed to evaluate potentially dangerous interactions of DHS with prescribed medications among inpatients. This was a cross-sectional prospective study involving a cohort of patients hospitalized in 12 departments of a public academic medical center (Bnai Zion Medical Center, Haifa, Israel) from 2009 to 2014. DHS users were determined via a questionnaire. The Natural Medicine database was used to search for potential DHS–drug interactions for identified DHS, and the clinical significance was evaluated using Lexi-interact online interaction analysis. Medical files were assessed for documentation of DHS use. Univariate and multivariate logistic regression analyses were used to characterize potential risk factors for DHS–drug interactions. Of 927 patients consenting to answer the questionnaire, 458 (49 %) reported DHS use. Of these, 215 (47 %) had at least one potential interaction during hospitalization (759 interactions). Of these interactions, 116 (15 %) were potentially clinically significant. Older age [OR = 1.02 (1.01–1.04), p = 0.002], males [OR = 2.11 (1.35–3.29), p = 0.001] and increased number of used DHS [OR = 4.28 (2.28–8.03), p < 0.001] or drugs [OR = 1.95 (1.17–3.26), p = 0.011] were associated with potential interactions in DHS users. Physicians documented only 16.5 % of DHS involved in these interactions in patients’ medical files. In conclusion, a substantial number of inpatients use DHS with potential interactions with concomitant medications. Medical staff should be aware of this, question patients on DHS usage and check for such interactions.


Drug interactions Dietary supplements Herbal medicine Inpatients Hospital 



We acknowledge 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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consents have been given verbally by patients as stated in the Institutional Ethics Committee of our medical center.


  1. 1.
    Dietary Supplements Health and Education Act (1994) Accessed 15 June 2015
  2. 2.
    Lavy T, Haran B, Shemer J, Shani S (2000) Regulation of natural medicines in Israel and abroad. Harefuah 139(9–10):339–344 (408, 407) PubMedGoogle Scholar
  3. 3.
    Peter AGM De Smet, PharmD., Ph.D (2002) Herbal remedies. NEJM 347(25):2046–2056Google Scholar
  4. 4.
    Qadour E, Ben-Arye E, Goldstein L, Attias S, Schiff E (2015) Dietary supplements use during hospitalization. Harefuah. 154(1):39–42PubMedGoogle Scholar
  5. 5.
    Wu CH, Wang CC, Kennedy J (2011) Changes in herb and dietary supplement use in the U.S. adult population: a comparison of the 2002 and 2007 National Health Interview Surveys. Clin Ther 33(11):1749–1758CrossRefPubMedGoogle Scholar
  6. 6.
    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):304–310CrossRefPubMedGoogle Scholar
  7. 7.
    Goldstein LH, Elias M, Ron-Avraham G, Biniaurishvili BZ, Mad-jar M, Kamargash I et al (2007) Consumption of herbal remedies and dietary supplements amongst patients hospitalized in medical wards. Br J Clin Pharmacol 64(3):373–380CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sood A, Sood R, Brinker FJ, Mann R, Loehrer LL, Wahner-Roedler DL (2008) Potential for interactions between dietary supplements and prescription medications. Am J Med 121(3):207–211CrossRefPubMedGoogle Scholar
  9. 9.
    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):505–510CrossRefPubMedGoogle Scholar
  10. 10.
    Shapiro LE, Shear NH (1999) Drug-drug interactions: how scared should we be? CMAJ 161(10):1266–1267PubMedPubMedCentralGoogle Scholar
  11. 11.
    Izzo AA (2005) Herb-drug interactions: an overview of the clinical evidence. Fundam Clin Pharmacol 19(1):1–16CrossRefPubMedGoogle Scholar
  12. 12.
    Spiteri Staines S (2011) Herbal medicines: adverse effects and drug-herb interactions. J Malta Coll Pharm Pract 17:38–42Google Scholar
  13. 13.
    Foster BC, Vandenhoek S, Hana J et al (2003) In vitro inhibition of human cytochrome P450-mediated metabolism of marker substrates by natural products. Phytomedicine 10:334–342CrossRefPubMedGoogle Scholar
  14. 14.
    Islam MS, Choi H (2008) Comparative effects of dietary ginger (Zingiber officinale) and garlic (Allium sativum) investigated in a type 2 diabetes model of rats. J Med Food 11:152–159CrossRefPubMedGoogle Scholar
  15. 15.
    Végh A, Lankó E, Fittler A, Vida RG, Miseta I, Takács G, Botz L (2014) Identification and evaluation of drug supplement interactions in Hungarian hospital patients. Int J Clin Pharm 36(2):451–459CrossRefPubMedGoogle Scholar
  16. 16.
    Graham RE, Gandhi TK, Borus J, Seger AC, Burdick E, Bates DW, Phillips RS, Weingart SN (2008) Risk of concurrent use of prescription drugs with herbal and dietary supplements in ambulatory care. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds) Advances in patient safety: new directions and alternative approaches. Technology and Medication Safety, vol 4. Agency for Healthcare Research and Quality, Rockville, USGoogle Scholar
  17. 17.
    Mouly S, Morgand M, Lopes A, Lloret-Linares C, Bergmann JF (2015) Drug-foods interactions in internal medicine: what physicians should know? Rev Med Interne 36(8):530–539CrossRefPubMedGoogle Scholar
  18. 18.
    Gardiner P, Filippelli AC, Sadikova E, White LF, Jack BW (2015) Medication and dietary supplement interactions among a low-income, hospitalized patient population who take cardiac medications. Evid Based Complement Alternat Med 2015:429826CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Alsanad SM, Williamson EM, Howard RL (2014) Cancer patients at risk of herb food supplement-drug interactions—a systematic review. Phytother Res 28(12):1749–1755CrossRefPubMedGoogle Scholar
  20. 20.
    Donaldson M, Touger-Decker R (2013) Dietary supplement interactions with medications used commonly in dentistry. J Am Dent Assoc 144(7):787–794CrossRefPubMedGoogle Scholar
  21. 21.
    Natural Medicines Comprehensive Database (2015) Accessed 15 June 2015
  22. 22.
    Sarma DN, Barrett ML, Chavez ML, Gardiner P, Ko R, Mahady GB, Marles RJ, Pellicore LS, Giancaspro GI, Low Dog T (2008) Safety of green tea extracts: a systemic review by the US Pharmacopeia. Drug Saf 31(6):469–484CrossRefPubMedGoogle Scholar
  23. 23.
    Kandarkar SV, Sawant SS, Ingle AD, Deshpande SS, Maru GB (1998) Subchronic oral hepatotoxicity of turmeric in mice—histopatological and ultrastructural studies. Indian J Exp Biol 36(7):675–679PubMedGoogle Scholar
  24. 24.
    Landbo C, Almdal TP (1998) Interaction between warfarin and coenzyme Q10. Ugeskr Laeger 160(22):3226–3227PubMedGoogle Scholar
  25. 25.
    Schmolz M, Marz RW, Schaudt M, Schaudt C, Lauster C (2014) Immunomodulatory activities of a concentrated fruit and vegetable juice tested in a randomized, placebo-controlled, double-blind clinical trial in healthy volunteers. Food Nutr Sci 5:341–350CrossRefGoogle Scholar
  26. 26.
    Goodnight SH Jr, Harris WS, Connor WE (1981) The effects of dietary omega 3 fatty acids on platelet composition and function in man: a prospective, controlled study. Blood 58(5):880–885PubMedGoogle Scholar
  27. 27.
    Peng CC, Glassman PA, Trilli LE et al (2004) Incidence and severity of potential drug-dietary supplement interactions in primary care patients: an exploratory study on 2 outpatient practices. Arch Intern Med 164:630–636CrossRefPubMedGoogle Scholar
  28. 28.
    McCune JS, Haltfield AJ, Blackburn AA et al (2004) Potential of chemotherapy-herb interactions in adult cancer patients. Support Care Cancer 12:454–462CrossRefPubMedGoogle Scholar
  29. 29.
    Dergal JM, Gold JL, Laxer DA et al (2002) Potential interactions between herbal and conventional drug therapies used by older adults attending a memory clinic. Drugs Aging 19:879–886CrossRefPubMedGoogle Scholar
  30. 30.
    Wirsansky I (2012) Educational interventions for developing awareness and imparting skill questioning about use of dietary and herbal supplements among hospitalized patients. Fundamental Sciences Theses. TechnionGoogle Scholar

Copyright information

© SIMI 2016

Authors and Affiliations

  1. 1.Internal Medicine B DepartmentBnai Zion Medical CenterHaifaIsrael
  2. 2.Complementary Medicine DepartmentBnai Zion Medical CenterHaifaIsrael
  3. 3.Rappaport Faculty of MedicineThe Technion-Israel Institute of TechnologyHaifaIsrael
  4. 4.Clinical Pharmacology UnitHaEmek Medical CenterAfulaIsrael
  5. 5.School of Public HealthUniversity of HaifaHaifaIsrael
  6. 6.Integrative Oncology Program, Oncology Service, Lin Medical CenterClalit Health ServicesHaifa and Western Galilee DistrictIsrael

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