ABSTRACT
Title
Potential interactions between synthetic drugs, herbal medicine and dietary supplements during preoperative anaesthesiological assessment.
Authors
E. Gallo; A. Pugi; E. Lucenteforte; G. Diddi; M. La Torre; P. Lupi, F. Lapi; A. Mugelli; F. Firenzuoli; A. Vannacci
Department of Preclinical and Clinical Pharmacology, Centre for Molecular Medicine (CIMMBA), Centre for Integrative Medicine, University of Florence.
Anaesthesiology Unit ASL 11 Hospital, Empoli, Italy
Anaesthesiology Unit ASL 10 Hospital, Florence, Italy
Anaesthesiology Unit ASL 4 Hospital, Prato, Italy
Department of Preclinical and Clinical Pharmacology, Centre for Molecular Medicine (CIMMBA), Centre for Integrative Medicine, University of Florence.
Anaesthesiology Unit ASL 11 Hospital, Empoli, Italy
Anaesthesiology Unit ASL 10 Hospital, Florence, Italy
Anaesthesiology Unit ASL 4 Hospital, Prato, Italy
Abstract
Patients who need surgery use herbs much more often than the general population (Tsen, 2000). Adverse reactions were reported frequently during the perioperative period (Ang-Lee, 2001). Concomitant medicines, invasive anaesthesiological-surgical techniques or psysiopathological disturbances may be the cause of the adverse reactions. Moreover, side effects experienced by the patient may either derive from the direct effects of the herbal medicine (HM) (e.g. potential bleeding from garlic, gingko, hypertension, hypopotassemia and arrhythmia from liquorice) or from pharmacological interactions with anaesthetics and synthetic drugs taken simultaneously with consequent alterations of the drug metabolism (e.g. potentiation of the effects of benzodiazepine by valerian, pharmacokinetic interactions of P 450 cytochrome and P-glycoprotein by hypericum and grapefruit). In this field we performed a survey aimed at evaluating the potential interactions among prescribed drugs, HMs and/or other complementary alternative medications used concurrently by patients. Possible interactions between medications and herbal medicines were reviewed using customary literature sources such as Micromedex health care series. Patients were advised to interrupt herbal treatment at least two weeks before surgery.
Method
This survey was conducted from November 2007 to February 2008, in three hospitals of Tuscany (Italy): The sample population consisted of patients admitted to the hospital in order to undergo a surgical intervention. Data were collected by means of a semi-structured questionnaire. Potential drug-herb interactions were identified using Micromedex® database, and through two searches of MEDLINE® database.
Results
On the basis of 478 (83,5%) entered the analysis according to data quality checking, 238 patients use HRS, Fifty-six (23,5% of 238 )could not be considered because they missed the type of HRs being consumed. Among 182 evaluable patients 174 (95,6%) were at least exposed to one synthetic medications and natural product concurrently, these were detectable for potential interactions and 55 (30.2% of 182) were exposed to one potential interaction; 42 with HMs and seventeen with dietary supplements, four both. Univariate models did not show any significant predictors among age, gender, level of education and operatory class of risk .Potential interactions that have been identified by our analysis. In our study 18.2%, (10/55) of patients were exposed to one potential interaction with antiplatelet and anticoagulant drugs; 12.7%, (7/55) with oral hypoglycemic; 12.7%, (7/55) with antiarrhythmic and cardiotonic drugs; 20%, (11/55) antihypertensives; 10.9%, (6/55) with benzodiazepines; antidepressants; 7.3%, (4/55) corticosteroids; 3.6%, (2/55) thyroid and anti-thyroid hormones.
Discussion
In the case of prospective surgery or a physical examination to be performed under anaesthesia, the interactions between herbs, drugs, and anaesthetic techniques may be numerous because the high number of active principles contained by certain herbal-based products. Natural products should therefore be subject to careful attention on the part of the anaesthetist, who should determine their suspension if necessary. It is certainly important to have all relevant information before surgery, as the undesirable effects deriving from the intake of herbal medicine in pre- and post-operative anaesthesia may be serious, immediate, and even life-threatening. The intake of herbal medicine may result in cardiovascular instability, hydro-electrolyte imbalances, alterations in heart rhythm and blood pressure, endocrinal disorders, coagulation disorders, as well as prolongation of the anaesthesia.
Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA. 2001 Jul 11;286(2):208-16.
Tsen LC, Segal S, Pothier M, Bader AM. Alternative medicine use in presurgical patients. Anesthesiology 2000; 93: 148-51.
Method
This survey was conducted from November 2007 to February 2008, in three hospitals of Tuscany (Italy): The sample population consisted of patients admitted to the hospital in order to undergo a surgical intervention. Data were collected by means of a semi-structured questionnaire. Potential drug-herb interactions were identified using Micromedex® database, and through two searches of MEDLINE® database.
Results
On the basis of 478 (83,5%) entered the analysis according to data quality checking, 238 patients use HRS, Fifty-six (23,5% of 238 )could not be considered because they missed the type of HRs being consumed. Among 182 evaluable patients 174 (95,6%) were at least exposed to one synthetic medications and natural product concurrently, these were detectable for potential interactions and 55 (30.2% of 182) were exposed to one potential interaction; 42 with HMs and seventeen with dietary supplements, four both. Univariate models did not show any significant predictors among age, gender, level of education and operatory class of risk .Potential interactions that have been identified by our analysis. In our study 18.2%, (10/55) of patients were exposed to one potential interaction with antiplatelet and anticoagulant drugs; 12.7%, (7/55) with oral hypoglycemic; 12.7%, (7/55) with antiarrhythmic and cardiotonic drugs; 20%, (11/55) antihypertensives; 10.9%, (6/55) with benzodiazepines; antidepressants; 7.3%, (4/55) corticosteroids; 3.6%, (2/55) thyroid and anti-thyroid hormones.
Discussion
In the case of prospective surgery or a physical examination to be performed under anaesthesia, the interactions between herbs, drugs, and anaesthetic techniques may be numerous because the high number of active principles contained by certain herbal-based products. Natural products should therefore be subject to careful attention on the part of the anaesthetist, who should determine their suspension if necessary. It is certainly important to have all relevant information before surgery, as the undesirable effects deriving from the intake of herbal medicine in pre- and post-operative anaesthesia may be serious, immediate, and even life-threatening. The intake of herbal medicine may result in cardiovascular instability, hydro-electrolyte imbalances, alterations in heart rhythm and blood pressure, endocrinal disorders, coagulation disorders, as well as prolongation of the anaesthesia.
Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA. 2001 Jul 11;286(2):208-16.
Tsen LC, Segal S, Pothier M, Bader AM. Alternative medicine use in presurgical patients. Anesthesiology 2000; 93: 148-51.