Promoting rational herb-drug use through pharmacy-led advice and home visits in NCD patients

Main Article Content


Medicine, Herb, Chronic disease, Herb-drug interaction, Knowledge, Behavior


Introduction: There has been a considerable increase in the concurrent use of prescribed medicines and herbal products, but most users do not have any information about drug-herb interactions. Objective: Therefore, this study aimed to investigate the effects of pharmacological advice by community pharmacists on promoting the rational use of prescribed medicines together with herbal products. Methods: The study was one group pretest-posttest experimental design, performed on a sample of 32 people who met the following criteria: aged ≥18 years, lived in an urbanized area, have NCDs such as diabetes, hypertension, dyslipidemia, or cardiovascular disease, and have used prescribed medicines and herbal products concurrently. The participants were informed and practically advised on the rational use of herbal products simultaneously with prescribed medicines, the possibility of drug-herb interactions, and self-monitoring of possible adverse effects. Results: After implementing pharmacological advice, the participants showed a significant increase in knowledge of rational drug-herb use: from 5.8±1.8 to 8.4±1.6 out of a total of 10 (p<0.001), and their score in terms of appropriate behavior rose from 21.7±2.9 to 24.4±3.1 out of a total of 30 (p<0.001). Additionally, the number of patients with herb-drug interaction risk decreased statistically significantly (37.5% and 25.0%, p=0.031). Conclusion: Pharmacy-led advice on rational use of herbal products with prescribed NCD medicines is effective in terms of promoting increases in knowledge and appropriate behavior in these matters. This is a strategy for risk management of herb-drug interactions in NCD patients.

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1. World Health Organization. Noncommunicable diseases. 2021. news-room/fact-sheets/detail/noncommunicable-diseases. Assessed 13 April 2021.
2. World Health Organization. The top 10 causes of death. 2020. Assessed 13 April 2021.
3. World Health Organization. Non-communicable diseases are the no. 1 killers in the WHO SEA Region. 2022. Assessed 20 June 2022.
4. Thomson P, Jones J, Browne M, et al. Why people seek complementary and alternative medicine before conventional medical
treatment: a population-based study. Complement Ther Clin Pract. Nov 2014;20(4):339-346.
5. Tangkiatkumjai M, Boardman H, Walker DM. Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review. BMC Complement Med Ther. Nov 2020;20(1):363.
6. National Drug Information. National List of Essential Medicines and Evidence-based information. 2022. Accessed 14 July 2022.
7. Drug Act B.E. 2510 and its Amendments. Bangkok: Office of the Council of State. 1967.
8. Sawanpanyalert P, Suwankesawong W. Health Product Vigilance System in Thailand. Health Product Vigilance Center (HPVC).Food and Drug Administration, Thailand. 2016.
9. Kwankhao P. Lesson Learned of Herbal and Traditional Medicine (HTM) use from EGAT study. PMAC Side Meeting January 29,2020.
10. Kanjanahattakij N. Herbal or traditional medicine consumption in a Thai worker population: pattern of use and therapeuti ccontrol in chronic diseases. BMC Complement Altern Med. 2019;19(258):1-9.
11. Peltzer K, Pengpid S, Puckpinyo A, et al. The utilization of traditional, complementary and alternative medicine for noncommunicable diseases and mental disorders in health care patients in Cambodia, Thailand and Vietnam. BMC ComplementAltern Med. 2016;8(16):92.
12. Izzo AA. Interactions between herbs and conventional drugs: overview of the clinical data. Medical Principles and Practice.2012;21(5):404-428.
13. De Smet PA. Clinical risk management of herb–drug interactions. Br J Clin Pharmacol. 2007;63(3):258-267.
14. Hu Z, Yang X, Ho PC, et al. Herb-drug interactions: a literature review. 2005;65(9):1239-1282.
15. Sutthiruk S. Effectiveness of the promotion program for healthy use of herbs for the elderly, Natai Subdistrict, Ban Na DoemDistrict, Surat Thani. Quality Health Development Quarterly. 2015;3(3):86-98.
16. AltMedDex® System (Internet database). Greenwood Village, CO: Thomson Healthcare. /altmeddex/ Accessed 15 September 2017.
17. Rxlist. Turmeric. Accessed 2 February 2018.
18. Sornsuvit C, Phosuya C, Jaroonwanichkul D, et al. The Use of Herbal and Dietary Supplements and Potential Interactions with
Drugs in Patients with Chronic Disease. Thai Pharm Health Sci J. 2012;7(4):149-154.
19. Chaimay B, Boonrod T, Simla W. Factors Affecting Herbal Uses in Primary Health Care. The Public Health Journal of Burapha University. 2012;7(2):25-37.
20. Mueangchang W. Factors related to self-treatment with herbal remedies on people in MeaChai District, Phayao Province. A Thesis submitted in partial fulfillment of the requirement for the degree of master of public health major in health promotionmanagement, Thammasat University, Academic year 2016.
21. Wongboonnak P, Wongtrakul P, Mahamongkol H, et al. The Survey of Medicine, Food Supplement and Herbal Products UsedProblems Among Elderly a Case Study at the Community of Tumbon Srisa Chorakhe Noi, Samut Prakan Province. HCU Journalof Health Sciences. 2016;20(39):97-108.
22. Djuv A, Nilsen OG, Steinsbekk A. The co-use of conventional drugs and herbs among patients in Norwegian general practice: across-sectional study. BMC Complement Altern Med. 2013;13:2-11.
23. Peng CC, Glassman PA, Trilli LE, et al. Incidence and severity of potential drug–dietary supplement interactions in primary care patients: an exploratory study of outpatient practices. Arch Intern Med. 2004;164(6):630-636.
24. Gelal A. Influence of menthol on first pass elimination. Boletín Latinoamericano y del Caribe de Plantas Medicinales yAromáticas. 2008;7(2):119-124.
25. Dresser GK, Wacher V, Wong S, et al. Evaluation of peppermint oil and ascorbyl palmitate as inhibitors of cytochrome P4503A4
activity in vitro and in vivo. Clin Pharmacol Ther. 2002;72(3):247-255.
26. Wongkrajang Y, Supharattanasitthi W. Herbs and modern medicine… is it good to eat together? A Public article 2022. knowledge/article/209 Accessed 15 June 2022.
27. Tachjian A, Maria V, Jahangir A. Use of herbal products and potential interactions in patients with cardiovascular diseases. J 
Am Coll Cardiol. 2010;55(6):515-525.
28. Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions. Evid Based Complement Alternat Med.2014;957362:1-19.
29. Kwon HW, Shin JH, Lim DH, et al. Antiplatelet and antithrombotic effects of cordycepin-enriched WIB-801CE from Cordycepsmilitaris ex vivo, in vivo, and in vitro. BMC Complement Altern Med. 2016;16(1):508.
30. Bao TT, Wang GF, Yang JL. Pharmacological actions of Cordyceps sinensis. Zhong xi yi jie he za zhi= Chinese Journal of ModernDevelopments in Traditional Medicine. 1988;8(6):352-354.
31. Bijak M, Bobrowski M, Borowiecka M, et al. Anticoagulant effect of polyphenols-rich extracts from black chokeberry and grapeseeds. Fitoterapia. 2011;82(6):811-817.
32. Golanski J, Muchova J, Golanski R, et al. Does pycnogenol intensify the efficacy of acetylsalicylic acid in the inhibition ofplatelet function? In vitro experience. Postepy Hig Med Dosw. 2006;60:316-321.
33. Gupta RC, Chang D, Nammi S, et al. Interactions between antidiabetic drugs and herbs: an overview of mechanisms of actionand clinical implications. Diabetol Metab Syndr. 2017;26(9):59.
34. Ghayur MN, Gilani AH. Ginger lowers blood pressure through blockade of voltage-dependent calcium channels. J CardiovascPharmacol. 2005;45(1):74-80.
35. Morigiwa A, Kitabatake K, Fujimoto Y, et al. Angiotensin converting enzyme-inhibitory triterpenes from Ganoderma lucidum.Chemical and Pharmaceutical Bulletin. 1986;34(7):3025e3028.
36. Ulbricht C, Chao W, Costa D, et al. Clinical evidence of herb-drug interactions: a systematic review by the natural standardresearch collaboration. Curr Drug Metab. 2008;9:1063-1120.
37. Hikino H, Ishiyama M, Suzuki Y, et al. Mechanisms of hypoglycemic activity of ganoderam B: A glycan of Ganoderma lucidum fruit body. Planta Medica Journal. 1989;55(5):423-428.
38. Takagi J, Imada T, Kikuchi T, et al. A New Platelet Aggregation Factor from Gynostemma pentaphyllum MAKINO. Chem PharmBull. 1985;33(12):5568-5571.
39. Attawish S, Chivapat S, Phadungpat J, et al. Chronic toxicity of Gynostemma pentaphyllum. Fitoterapia, 2004;75(6):539-551.
40. Kistler A, Liechti H, Pichard L, et al. Metabolism and CYP-inducer properties of astaxanthin in man and primary humanhepatocytes. Archives of Toxicology. 2002;75(11-12): 665-75.