Traditional herbs- drugs interactions

Traditional herbs- drugs interactions

SINCE time immemorial, Basotho have used natural herbs to cure different ailments.
It will be folly to dismiss these herbs because they are part of our lives and testimonies about their efficiency abound.
Yet just because they are useful doesn’t mean there are risk-free.
One of the problems medical practitioners face is to strike a balance between traditional herbs and western medication.
The challenge is how to allow patients to use both without doing further damage to their health. Medical practitioners constantly worry about the dangers of using traditional herbs and western medicines simultaneously.
At the core of their worry is what is called Herb-Drug interactions, which are interactions that occur between herbal medicines and conventional drugs (Prescription Drugs).
These types of interactions may be more common than drug-drug interactions because herbal medicines often contain multiple pharmacologically active ingredients, while conventional drugs typically contain only one, with exceptions being some combination formulations.
The most commonly implicated conventional drugs in herb-drug interactions are those with narrow therapeutic indices such as Warfarin, Insulin, Aspirin, Digoxin and Ticlopidine.
Therapeutic Index is a ratio that compares the blood concentration at which a drug becomes toxic and the concentration at which the drug is effective. The larger the therapeutic index, the safer the drug is. If the therapeutic is small, i.e. the difference between the two concentrations is very small, then the drug must be dosed carefully and the person receiving then it should be monitored closely for any signs of drug toxicity.
Combining such a drug with traditional herbal medicines could result in lethal effects.

Significant examples

1. Cancer bush: Sutherlandia frutescens _ “Musa-pelo-o-moholo-oa-noka” or “Lerumo- la- mali”. This herb is known and believed to boost the immune system and generally improve the quality of life in HIV/AIDS and TB patients.
Scientific studies have proved that this herb lowers the plasma levels of some ARVs to sub-therapeutic levels when used together, hence reducing the ARVs efficacy. It has also been shown to interfere with Isoniazid therapy which is used as a preventative measure in TB treatment.

2. Aloe Vera is popular in Lesotho but there is need for caution when using it. When used frequently in combination with diabetes medicines such as Metformin without appropriate dose adjustments it may lower blood glucose levels resulting in serious/ life-threatening hypoglycemia.
3. St. John’s Wort is a natural remedy frequently used for depression. This herbal remedy affects the clearance of numerous drugs from the body, including some oral contraceptives, thus resulting in sub-therapeutic levels of the prescribed medicine, putting women at risk of pregnancy when they think they are protected. Certain anti-cancer drugs, ARVs, and anti-TB drugs may also be affected by this herb.
The science of interaction between most herbal remedies and western medicines is not fully understood, so more research still needs to be conducted. But the bottom line is interactions are at play, therefore, consumers need to understand this and avoid concurrent use of prescription drugs and herbal remedies. The liver and the kidneys often suffer the most especially for HIV and TB patients.

Retšelisitsoe Nkhahle is Mosotho pharmacist based in Botswana. She is pursuing an Msc.

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