Hospital To Study Mix Of Medicines
The Sunday Age
Sunday October 6, 2002
Concern about the possible dangers of combining alternative medicine with prescription drugs has prompted the Royal Melbourne Hospital to set up a study involving up to 400 people.
The hospital's director of emergency medicine research, Associate Professor David Taylor, said he suspected isolated reports of people experiencing problems when they combined medicines were ``just the tip of the iceberg" and researchers hoped to establish what proportion of people took potentially dangerous combinations of medicines.
"For each case report or patient who presents to an emergency department with horrible problems there are probably a whole stack more who have the potential for problems," he said.
"They're taking a prescription medicine and they're taking a complementary medicine that potentially has side effects or interactions that could do them some harm," he said.
Co-researcher Nicola Walsham said early findings showed about 75 per cent of those surveyed had taken some form of complementary medicine. Of those, a couple had reported side effects with prescription drugs.
Simone Taylor, a doctor of pharmacy at Austin & Repatriation Medical Centre's emergency department and a member of the research team, said people's reactions to combining prescription drugs with complementary medicines could range from negligible to quite significant.
Some complementary medicines reduced the effect of prescription drugs, while others could increase the effects, she said. St John's wort could influence the effect of some HIV drugs, and could reduce the effectiveness of Warfarin, a drug used to prevent serious blood clots.
But the effects of Warfarin could be increased if someone took ginseng. Drugs documented as producing potentially dangerous side effects when used alone were royal jelly, ginkgo biloba, kava, St John's wort, and ephedra, which is used for weight loss.
Professor Taylor said people should tell their doctors what alternative medicines they were taking so they could be advised whether it was safe to continue. Emergency patients suffering from combining prescription and complementary medicines were probably under-recognised because of a lack of disclosure.
Professor David Taylor said the potential for problems would increase as the population aged and more people experimented with different therapies. He believed people commonly took complementary medicines with other drugs without realising the potential danger.
"We're getting more of an indication of how people feel about their alternative medicines and whether they think it's safe . . . and whether they're reporting it to their doctors," he said.
Complementary medicines could vary in purity because they were not subject to regulations as prescription drugs were, making it difficult to know whether a product would interact with other drugs, he said.
The research team will sign up 400 people to take part in the research and hopes to report by early next year. Participants were selected at random from people presenting at the Royal Melbourne's emergency department.
Researchers aim to include a variety of ethnic backgrounds in the study, to establish where alternative medicine use was highest. ``Asian groups, for example, might be much higher users of complementary medicines, particularly older Asians," Professor Taylor said. ``That's their culture, that's their background, that's their ethnicity."
He said many people were unconscious when admitted to hospital emergency departments, or were unable to tell staff what complementary drugs they were taking.
"If we give them various drugs not knowing that half of them have some kind of complementary medicine on board there is potential for interaction and there's nothing we can do about that," Professor Taylor said.
"If their doctors know their patients are taking natural medicines they are then in a position to say: `that's all right' or `your prescription medicine could interact badly with what you're taking - so lay off it'," he said.
DANGEROUS LIAISONS
Natural medicines that can hurt healing
ST JOHN'S WORT: Increases production of liver enzymes that break down medications, potentially decreasing the effect of those medications.
INTERACTS WITH: Warfarin, a medicine used to prevent blood clots; Immuno suppressant medication such as cyclosporin, prescribed to organ transplant patients; anti-retroviral drugs, which people take for HIV, and anti-epileptic medications.
• St John's Wort may produce seratonin syndrome if taken with anti-depressants or painkillers.
GINKGO BILOBA: Can make platelets less sticky.
INTERACTS WITH: Aspirin, which also makes platelets less sticky, so can have a compounded effect; Warfarin, making people more prone to bleeding.
GINSENG: Thins blood.
INTERACTS WITH: Warfarin, making people more prone to bleeding problems.
EPHEDRA: Used for weight loss. Can cause hypertension, insomnia, increased blood pressure, which can lead to heart attack, stroke.
INTERACTS WITH: Anything that acts similarly such as caffeine or guarana.
© 2002 The Sunday Age
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