1. Herbal and Dietary Supplement Therapy
Chapter 48
Herbal and Dietary Supplement Therapy
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2. Chapter 48
Lesson 48.1
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3. Objectives
Describe the possible impact of the use of herbal and dietary supplement products on cultural/ethnic beliefs
Summarize the primary actions, uses, and interactions of the herbal and dietary supplement products cited
Self-care and alternative therapies are very popular.
There are more than 250 herbal medicines.
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4. Herbal and Dietary Supplements
“All natural” is NOT synonymous with “better”
Some herbal medicines/supplements are harmful
Adverse effects
Drug interactions
Most have been used for centuries.
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5. Dietary Supplement Health and Education Act of 1994
Almost all herbal medicines, vitamins, minerals, amino acids for health reclassified as “dietary supplements,” a food category
Allows manufacturers to include information about products’ effects on the body on labels and in advertisements
Must state that product is not evaluated by FDA
Does not stop others from making claims
Intent of DSHEA was to ensure that safe and appropriately labeled products remain available to consumers who want to use them.
Anyone can make claims of therapeutic value; most claims are unproven.
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6. Dietary Supplements
Herbal medications, vitamins, minerals, amino acids, other chemicals used for health reclassified
No safety, effectiveness requirements
Vast majority of claims unproven
No standardized manufacturing requirements
Several organizations test for labeled potency, good manufacturing practices, and contamination—not safety or effectiveness
National Sanitation Foundation (NSF) International began testing dietary supplements in 2003.
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7. Label Certification
A, From ConsumerLab.com; B, from NSF International; C, from U.S. Pharmacopeia.
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8. Role of Health Care Professional
Moral, ethical responsibility to recommend only medicines proven safe and effective
Factors to consider
Most supplements not scientifically tested
Consumers may be misinformed
Supplements cannot cure serious conditions
Quality control is deficient
Exercise caution for pregnant or pediatric patients
Watch for adverse effects
Examine label carefully
Be aware of a medicine’s legal versus popular use.
Reliable resources specific to dietary supplements are widely available, as are peer-reviewed journal articles.
Knowledge should be based on current scientific information.
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9. Assessment Discuss patient’s reasons for interest and/or use
Obtain list of patient symptoms and information about changes in symptoms since supplement use
Find out source of recommendation
Obtain complete list of all medications
Determine cultural/ethical beliefs contributing to supplement use decision
Discuss cultural and ethnic beliefs with patient
Dietary supplements are affected by religious beliefs also (e.g., many Muslims prefer alcohol-free products).
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10. Patient Education Expectations of therapy
Discuss medication information
Ensure understanding of proper use
Promote the development and maintenance of a written record of monitoring parameters
Complete the Premedication Data column of the patient self-assessment form to track response to drug therapy
Enhanced compliance is based on belief in the prescribed regimen.
Disclosure of taking dietary supplements before surgical procedures is extremely important.
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11. Herbal Therapy Aloe Black cohosh Chamomile Echinacea Ephedra
Topically for pain, inflammation, itching
Black cohosh
Reduce symptoms of PMS, dysmenorrhea, menopause
Chamomile
Anti-inflammatory and antispasmodic effects
Echinacea
Nonspecific immunostimulant
Ephedra
Bronchodilator, nasal decongestant
Aloe may have hypoglycemic effects.
Echinacea may interfere with immunosuppressive therapy.
Ephedra is contraindicated in patients with heart conditions, hypertension, diabetes, and thyroid disease.
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12. Herbal Therapy (cont’d)
Feverfew
Reduce frequency and severity of migraines
Garlic
Lower serum cholesterol and triglycerides
Ginger
Alleviate nausea and vomiting
Ginkgo
Treat short-term memory loss, headache, dizziness, tinnitus, emotional instability
Ginseng
Unsubstantiated claims to increase resistance to stress and disease
Feverfew, garlic, ginger, and ginkgo reduce platelet aggregation. Ginseng may affect platelet aggregation and blood coagulation.
Ginkgo is often used by geriatric patients.
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13. Herbal Therapy Goldenseal Green tea Saw palmetto St. John’s wort
Antiseptic and astringent
Green tea
Improve cognitive performance
Saw palmetto
Reduce DHT levels associated with BPH
St. John’s wort
Treat mild depression; wound healing
Valerian
Used for restlessness, promotes sleep
Goldenseal may have weak antibacterial properties and may stimulate the immune system to help fight a cold.
Watch for serotonin syndrome with St. John’s wort.
Do not confuse valerian with valium.
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14. Other Dietary Supplements
Coenzyme Q10
Creatine
Gamma-hydroxybutyrate (GHB)
Lycopene
Melatonin
Policosanol
Omega-3 fatty acids
S-adenosylmethionine (SAM-e)
Creatine is used as a performance enhancing substance.
GHB (“rave drug”) can cause death, and was banned by the FDA in 1990.
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