Pharmacy Perspectives

An Interview with Martha Paula, MEd, PharmD Drug Education Coordinator, Kaiser Permanente

From the Winter 1999 issue of Hopes & Dreams, newsletter of the Illinois Chapter, Huntington's Disease Society of America.

Are herbal products really drugs?

Yes, but they are classified as "dietary supplements" -- a group that includes herbal products, "natural" products, some hormones, plant extracts, enzymes, and minerals. Dietary supplements are practically immune to Food and Drug Administration (FDA) regulations. In other words, there are no testing standards for efficacy and safety. There are no manufacturing standards for purity, strength, active ingredient, or contaminants. There are generally no expiration dates, lot numbers for tracking, or controls over labeling statements.

Are they dangerous to take?

In some cases, yes. There is a lot of hyperbole, hoax, and hype out there. There are no incentives for drug companies to do extensive studies with these products, so the risks are assumed by the consumer. Having said that, I do believe that there is a place for some products. The key here is letting your health care provider know about ALL medications (yes, these are medications) that you are taking -- any "natural" or herbal products or hormones, prescription drugs, and over-the- counter agents.

Can you tell us a little bit about ginkgo biloba?

This agent is widely sold in Europe, and is a hardy plant that has survived millions of years. It does dilate blood vessels. It inhibits platelets from aggregating or clumping, and is an antioxidant. How these effects translate into a benefit is unclear - however if blood flow is improved in the brain, memory enhancement or improved concentration could occur. It may slow the progression of Alzheimer's Disease. Ginkgo may also improve circulation to the legs. Continuous treatment may offer best results. The side effects include gastrointestinal disturbances (nausea, vomiting, or diarrhea), headache, and allergic skin reactions. There are drug interactions, too. People on warfarin, aspirin or other blood thinners (anticoagulants) should check with their physician, as bleeding could occur with herbal agents and anticoagulants.

What about St. John's Wort?

This plant has been shown in European studies to be more effective than a placebo (a pill with no active ingredient) in mild to moderate depression. It may have sedative and anti-inflammatory activity. We are not sure about its exact mechanism of antidepressant action. Side effects are minor - and include gastrointestinal effects, restlessness, tiredness, allergic reactions, and photosensitivity. (Use should not be only self-treated. St. John's Wort should not be combined with prescription antidepressants without physician awareness and agreement.)

Does Coenzyme Q10 have any benefit?

This product claims to inhibit the aging process as an antioxidant, and strengthen the heart and immune system. It is naturally produced by cells in the body and helps convert food into energy, but may not be effective taken orally, or may require larger doses. It is being reviewed by experts, and is included in current research studies in Huntington's Disease. It does not appear to have significant side effects. But again, check with your health provider before starting any herbal or natural product.

What do you tell those who want to use herbal or natural products?

I ask them to be cautious. Natural does not mean automatically healthful and safe. Just like prescription drugs, these agents have risks and benefits. Western medicine knows far less about the effects of these agents. Check with your doctor and pharmacist about specific products and drug interactions with your prescription and over-the- counter medications before you start using them. Learn as much as you can about the product. Be aware that this is a big industry, and manufacturers make LOTS of money -- without having to prove their products are safe or that they work.

I would definitely stick with single-herb products, not combinations. Don't rely on packaging information -- seek out independent sources for information. Two I recommend are The Honest Herbal - A Sensible Guide to the Use of Herbs and Related Remedies (third edition, 1993), or Herbs of Choice: The Therapeutic Use of Phytomedicinals (1994), both by Tyler. Try to make an informed choice, and reevaluate after a trial period.

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Created: Jan. 27, 2000
Last updated: Dec. 4, 2010