Potential Herb-Drug Interactions Among Elderly Nursing Home Residents in Romania
Keywords:
herb-drug interactions, nursing home, ginkgo-biloba, valerian, pharmacokineticsAbstract
BACKGROUND: Herbal supplements are widely used as complementary or alternative medicines, but their phytochemical effects on conventional drugs are often overlooked. Evidence shows that herb-drug interactions (HDIs) are significant in clinical pharmacology. However, the current use of herbal supplements and the prevalence of HDIs among elderly patients in nursing homes is not known.
AIM: Our study investigates the algorithm-predicted HDIs during herb-drug coadministration among elderly patients in nursing homes in a Romanian sample.
METHODS: We collected demographic data, clinical history and medication of elderly patients from three nursing homes across Romania. We focused on patients using Valerian and Ginkgo biloba (Ginkgo) to investigate their role in HDIs. A freely available online platform was used (MedScape Drug Interaction Checker) to identify and describe potential HDIs with severity grades from 1 to 4 (1=minor; 2=monitor closely; 3=serious, use alternative; 4=contraindicated). Further analyses were carried out using GraphPad Prism.
RESULTS: 275 patients were included, of these, 10 used Valerian-containing products and 23 used Ginkgo. The average age was 84.58.2 for women; and 7311.0 for men, 60.6% of patients were female and 39.4% male. A total of 304 possible interactions were identified, with 9.2% (n=28) predicted to be related to the coadministration of Valerian or Ginkgo with synthetic drugs. 10.7% (n=3) of the interactions were grade 1, 42.8% (n=12) were grade 2, 46.4% (n=13) were grade 3, and no grade 4 interaction was found. The most commonly affected drug classes in HDIs were antiplatelets (n=10), anticoagulants (n=1), and NSAIDs (n=1) for Ginkgo, and benzodiazepines (n=7), sedatives (n=5), and SSRIs (n=3) for Valerian. The number of possible interactions between the Valerian and Ginkgo-treated groups was compared using the Mann-Whitney U test, which revealed a significant difference (p=0.02) with a higher number of interactions in the case of Valerian. We conducted a regression analysis that showed a significant relationship between the number of drugs/supplements taken and the number of interactions with severity grades 1 (R²=0.40; p<0.0001) and 2 (R²=0.69; p<0.0001). Additionally, in the case of Ginkgo usage, a significant regression was found for HDIs (R²=0.28; p=0.0087).
CONCLUSION: We found a significant number of potential HDIs caused by Valerian and Ginkgo, with nearly half of these being serious enough to warrant increased attention or consideration of alternatives. The most frequently affected drug classes were antiplatelets for Ginkgo and benzodiazepines, sedatives, and SSRIs for Valerian. Our regression analysis showed that the number of drugs/supplements could predict the number of possible interactions with severity grades 1 and 2, and Ginkgo-related HDIs. Since the identified interactions are predictions, future research is needed to assess their actual occurrence and clinical impact.
References
Sönnerstam, E., Sjölander, M., Lövheim, H. et al. Clinically relevant drug–drug interactions among elderly people with dementia. Eur J Clin Pharmacol 74, 1351–1360 (2018). https://doi.org/10.1007/s00228-018-2514-5
Fugh-Berman, A., & Ernst, E. (2001). Herb-drug interactions: review and assessment of report reliability. British journal of clinical pharmacology, 52(5), 587–595. https://doi.org/10.1046/j.0306-5251.2001.01469.x
Le, T. T., McGrath, S. R., & Fasinu, P. S. (2022). Herb-drug Interactions in Neuropsychiatric Pharmacotherapy - A Review of Clinically Relevant Findings. Current neuropharmacology, 20(9), 1736–1751. https://doi.org/10.2174/1570159X19666210809100357
Downloads
Published
How to Cite
License
Copyright (c) 2024 Hanna Sebesi, László István Bába, Melinda Kolcsár, Zsolt Gáll, Soma Dávid
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org
