Potential drug interactions with dietary and herbal supplements during hospitalization

Abstract

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.

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Acknowledgments

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.

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Corresponding author

Correspondence to Ilana Levy.

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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.

Additional information

I. Levy and S. Attias have made equal contribution.

Appendix

Appendix

Screening for the use of dietary and herbal supplements in hospitalized patients

In this questionnaire we want to learn what is your opinion on the use of herbs and supplements of complementary medicine. Please consider only herbal and dietary supplements (vitamins, etc.) for the treatment of your medical conditions.

  1. 1.

    Year of birth:

  2. 2.

    Gender

    1. a.

      Male

    2. b.

      Female

  3. 3.

    Residence

    1. a.

      Urban

    2. b.

      Rural

  4. 4.

    Country of birth

    1. a.

      Israel

    2. b.

      Former USSR

    3. c.

      Other

  5. 5.

    Education

    1. a.

      No education

    2. b.

      Elementary school

    3. c.

      Secondary

    4. d.

      Tertiary, university

  6. 6.

    Have you used dietary supplements or herbs for health issues during the previous year? (natural products, natural medicines, grandma remedies, folk/traditional herbs picked in the wild, vitamins, etc.)

    1. a.

      Yes—Continue to question 7

    2. b.

      No—Stop here

For each supplement/herb

  1. 7.

    Name of the supplement/herb:

  2. 8.

    Dosage (if known):

  3. 9.

    How long have you been using it?

    1. a.

      Less than a month

    2. b.

      1–6 months

    3. c.

      More than 6 months

  4. 10.

    Are you using it during hospitalization?

    1. a.

      Yes

    2. b.

      No

  5. 11.

    If you are not using it during hospitalization, when did you stop using it?

    1. a.

      On day of hospitalization

    2. b.

      1 day to 1 week before hospitalization

    3. c.

      Over 1 week before hospitalization

  6. 12.

    What is the rationale for using it?

    1. a.

      Mental state improvement

    2. b.

      General strengthening

    3. c.

      Treatment of high cholesterol level

    4. d.

      Treatment of diabetes

    5. e.

      Treatment of hypertension

    6. f.

      Prevention or treatment of memory impairment

    7. g.

      Treatment of gastrointestinal problems

    8. h.

      Treatment of urinary tract infections

    9. i.

      Treatment of backache, joint or muscle pain

    10. j.

      Treatment of hot flushes and menopausal symptoms

    11. k.

      Prevention or treatment of cancer

    12. l.

      Treatment of cardiovascular conditions

    13. m.

      Treatment of respiratory conditions

    14. n.

      Other—specify.

  7. 13.

    Who advised you using herbs/supplements?

    1. a.

      Physician

    2. b.

      Pharmacist

    3. c.

      Naturopath

    4. d.

      Friends/family

    5. e.

      Publication

    6. f.

      Other—specify.

  8. 14.

    Does your primary care physician know you are using herbs/supplements?

    1. a.

      Yes

    2. b.

      No

  9. 15.

    If yes, how did he/she find out?

    1. a.

      I told him/her

    2. b.

      He/she asked

    3. c.

      Other—specify.

  10. 16.

    If you did not tell your primary care physician, what is the reason for that?

    1. a.

      I don’t think it is important

    2. b.

      This is not a medication

    3. c.

      I was concerned about the physician’s reaction

    4. d.

      The physician does not understand

    5. e.

      The physician did not ask

    6. f.

      I did not have time

    7. g.

      This is natural so it cannot harm

    8. h.

      Other—specify.

  11. 17.

    Do hospital physicians know you are using herbs/supplements?

    1. a.

      Yes

    2. b.

      No

  12. 18.

    If yes, how did they find out?

    1. a.

      I told them

    2. b.

      They asked

    3. c.

      Other—specify.

  13. 19.

    If you did not tell hospital physicians, what is the reason for that?

    1. a.

      I don’t think it is important

    2. b.

      This is not a medication

    3. c.

      I was concerned about the physicians’ reaction

    4. d.

      The physicians do not understand

    5. e.

      The physicians did not ask

    6. f.

      I did not have time

    7. g.

      This is natural so it cannot harm

    8. h.

      Other—specify.

Date:

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Levy, I., Attias, S., Ben-Arye, E. et al. Potential drug interactions with dietary and herbal supplements during hospitalization. Intern Emerg Med 12, 301–310 (2017). https://doi.org/10.1007/s11739-016-1548-x

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Keywords

  • Drug interactions
  • Dietary supplements
  • Herbal medicine
  • Inpatients
  • Hospital