Use of herbal medicines could pose risk to patients
undergoing surgery
Health care professionals must be aware of the impact
that herbal medicines can have on the care of patients undergoing surgery,
say American researchers. In addition, patients should be encouraged to
disclose any herbal medicine use during preoperative assessment.
In a review of eight commonly used herbal medicines,
Dr Michael Ang-Lee and colleagues from the University of Chicago, Illinois,
describe how the direct and pharmacodynamic or pharmacokinetic effects
of the preparations can cause complications during surgery.
Commenting on the paper, Jo Barnes, a research fellow
at the Centre for Pharmacognosy and Phytotherapy, School of Pharmacy,
University of London, said that it should come as no surprise that the
use of herbal medicines might impact on conventional care, or lead to
adverse effects or interactions with conventional drugs. “Most pharmacies
sell herbal medicines and patients and consumers ask pharmacists for advice
on these products. This interface places pharmacists in an ideal position
to advise on their use. In addition, pharmacists can encourage patients
to inform their doctor if they are using herbal products, or, where appropriate
— and with consent — to inform the doctor on the patient’s behalf.”
However, Ms Barnes commented that an issue that
needed to be addressed was pharmacists’ knowledge and training in herbal
medicines. “While most schools do include these areas, the extent of teaching
varies. Clearly, this is an issue that the profession needs to address.”
The preparations looked at by Dr Ang-Lee and his
colleagues were echinacea, ephedra, garlic, ginkgo, ginseng, kava, St
John’s wort and valerian. For each herb the researchers reviewed the available
literature to determine how it might affect perioperative care and suggest
strategies for the management of their use. The researchers recommend
when each preparation should be discontinued before surgery (see Panel below)
based on the available pharmacokinetic and pharmacodynamic data.
They recognise that use of herbal medicines is widespread
and note that patients often fail to disclose their use during routine
preoperative assessment. “Unless this information is directly solicited,
patients may not be forthcoming,” they say. They also note that many clinicians
are unaware of potential complications of herbal medicine use.
The paper is published in JAMA (2001;
286:208).
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