Polypharmacy Meets Polyherbacy: Pharmaceutical, Over-the-counter, and Natural Health Product Use Among Canadian Adults.

University of British Columbia. .
Canadian journal of public health = Revue canadienne de santé publique 07/2013; 104(3):e222-8.
Source: PubMed


Natural health products (NHP) are increasingly being used to supplement prescription medications (PM) and over-the-counter (OTC) products. The objective of this study was to examine patterns of overall health product use and how these patterns are associated with social and health factors.
We used direct health measures data from the Canada Health Measures Survey (CHMS) Cycle 1.0 (2007/2009) to examine recent product use among adults aged 18-79 years (n=3,721). Latent class analyses were used to detect use (propensity) and intensity of use among users of all three product types. Associations between social and health covariates and product patterns were examined using linear and multinomial logit regression procedures.
Three latent classes of health product use were identified. The largest (43%) was characterized by a high probability of PM and NHP but not OTC use. Class two (37%), in contrast, had a low probability of using any of the three health products. Class three (20%) had a high probability of PM and OTC but not NHP use. Age, gender, immigrant status, household size, co-morbidity, perceived health status, and having a regular doctor were associated with these patterns of use. Analyses of intensity of product use among users revealed seven distinct classes; these were differentiated by age, household size, co-morbidity and weight (BMI status).
If defining polypharmacy or polyherbacy is based simply on number of health products used, then for Canadians under age 80 neither practice appeared to be widespread. More work needs to be done to define the "poly" in polypharmacy and polyherbacy. This will inform the conversation on appropriate product use, particularly given that about one half of Canadians used medications and NHPs concurrently.

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    • "The use of herbal medicines in Western countries has increased in recent times with adverse effects being reported due to a range of factors, often derived from a single preparation [3] [4]. The popularity of herbal medicine use (and the inevitable associated adverse drug reactions) prompted Ness and co-workers [5] to coin the term " polyherbacy " to describe the use of multiple natural health products [5] [6]. A case is reported to demonstrate that significant adverse effects may also arise from this " polyherbacy " . "
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    ABSTRACT: Following a short treatment for irritable bowel with the following herbs: Astragalus propinquus, Codonopsis pilosula, Paeonia sp., Atractylodes macrocephala, Pueraria sp., Poria cocos, Dioscorea opposita, Patriniae, Psoralea corylifolia, Alpinia katsumadai, Glycyrrhiza uralensis and Dolomiaea souliei sp. a 43-year-old woman developed acute severe liver failure requiring liver transplantation. Histopathological examination of the liver showed massive hepatic necrosis in keeping with drug/chemical toxicity. Surgery was followed by multiorgan failure and death. While numerous studies have evaluated the effect of polypharmacy, the study of multiple concurrent herb use is only just emerging, despite the popularity of herbal medicine use in the western world. As this case demonstrates that fulminant hepatic failure and death may be caused by the concomitant use of a number of herbal products, the possibility of untoward effects from herbal polypharmacy must be increasingly considered in the evaluation of medicolegal cases.
    Forensic Science International 06/2014; 241C:138-140. DOI:10.1016/j.forsciint.2014.05.021 · 2.14 Impact Factor
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    • "With respect to the use of multiple DS, there is no generally accepted threshold at which extra risk is thought to occur, though there is some guidance about this topic in the polypharmacy literature. Polypharmacy is a situation of high risk for adverse interactions or drug effects, often defined as the simultaneous ingestion of five or more pharmaceuticals, though the most accurate determination of risk for a given individual would also take into effect other factors such as their medical history and the appropriateness of a pharmaceutical or pharmaceutical dose [11, 12]. The assessment of DS safety involves a careful examination of interactions between DS and pharmaceuticals to identify any adverse health outcomes associated with co-use [13, 14]. "
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    ABSTRACT: Introduction. In the United States, dietary supplement (DS) use is common, often takes place outside of the purview of health care providers, and may involve DS in combination with pharmaceuticals. This situation has led to concerns about interactions between DS and pharmaceuticals, as well as the risks from polypharmacy and polysupplement use. Methods. We used data from the Midlife in the US study (MIDUS 2 Survey) to examine DS and prescription pharmaceutical use in 3876 study participants in order to determine the demographics of high-users (5 or more) of DS and pharmaceuticals and the presence of DS-pharmaceutical co-use. Results. Over 69% of study participants regularly used DS, 49.6% regularly used both DS and pharmaceuticals, and 6.3% and 8.7% were high-users of pharmaceuticals and DS, respectively. High-users of DS, pharmaceuticals, and either were more likely than the whole cohort to be female and of lower income. Conclusions. These findings corroborate those of other national studies with respect to the demographics of DS users but add new information about people at risk of DS-pharmaceutical interactions, not an insignificant proportion of the population examined by this dataset.
    Evidence-based Complementary and Alternative Medicine 04/2014; 2014:823853. DOI:10.1155/2014/823853 · 1.88 Impact Factor
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    ABSTRACT: AimsTo examine the prevalence and associated factors of polypharmacy in a sample of nonagenarians and centenarians living in a rural area of China.Methods The data were from the “Project of Longevity and Aging in Dujiangyan” (PLAD) study. Medication use and relevant covariates were obtained by face-to-face interviews. Minor polypharmacy was defined as the concomitant use of two to four medications, whereas major polypharmacy referred to the concomitant use of five or more medications.ResultsWe included 859 participants with mean age of 93.7 ± 3.3 years. The number of chronic diseases was 1.4 ± 1.2 per subject, whereas the number of drugs was 0.8 ± 1.4 per subject. The prevalence of minor polypharmacy and major polypharmacy were 16.5% and 3.7%, respectively. Illiteracy (odds ratio [OR] 2.93, 95% confidence interval [CI] 1.52 to 5.66), cognitive impairment (OR 3.15, 95% CI 1.44 to 6.88), hypertension (OR 2.88, 95% CI 1.46 to 5.67), respiratory disease (OR 2.22, 95% CI 1.08 to 4.58), osteoarthritis (OR 1.24, 95% CI 1.01 to 1.51), and cancer (OR 10.70, 95% CI 1.90 to 126.80) were positively associated with minor polypharmacy. Illiteracy (OR 4.24, 95% CI 1.53 to 11.81), hypertension (OR 3.40, 95% CI 1.22 to 9.49), and cancer (OR 3.40, 95% CI 1.14 to 10.12) were also positively associated with major polypharmacy.Conclusions Although most subjects suffering from some chronic diseases, minor polypharmacy and major polypharmacy are not common among nonagenarians/centenarians in rural China.
    Internal Medicine Journal 07/2014; 44(12a). DOI:10.1111/imj.12534 · 1.64 Impact Factor
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