Surgical Patients Can Have Dangerous Drug Interactions When Taking Herbal Supplements

Many complementary and alternative medical (CAM) treatments can have serious and potentially harmful side effects when combined with medications prescribed during and after surgery, according to a review article published recently in the Journal of the American Academy of Orthopaedic Surgeons.

CAM treatments such as herbal supplements are increasingly popular, especially among older patients and those with chronic pain. In addition, nearly 20% of prescription users also take an herbal supplement, and those rates are higher, anywhere from 35% to 70%, among orthopedic patients who are candidates for surgery, the researchers reported.

“Herbal remedies are classified as dietary supplements, meaning they are exempt from the safety and efficacy regulations that the U.S. Food and Drug Administration requires for prescription and over-the-counter medications,” David T. Rispler, MD, director of the Grand Rapids/Michigan State University Orthopedic Residency Program, said in a statement. “As a result, individual herbal remedies have not been thoroughly evaluated in large clinical trials, and little information is available on the interactions between drugs and herbs.”

Because many herbal products are marketed as “natural” or “homeopathic,” consumers may assume the products are safe, even when taken with prescription medicines, Rispler added. “Herbal supplements can have a negative impact on patients both before and following surgery, and may interact with conventional medicines used to manage chronic conditions.”

“Traditional physician-patient communications, like intake interviews, often do not include the subject of alternative medical products. As a result, patients may fail to report that they are using them and continue to take them along with any prescribed medicines and before surgery, thinking the herbal products pose no risk,” Rispler said.

Although the use of herbal medicines should be monitored by patients’ primary care physicians, orthopedic surgeons should have an understanding of the potential side effects of some of the most common CAM products used by their patients. They should also be able to guide them in suspending use prior to surgery, Rispler said.

To help ensure physicians are aware of the products their patients may be using, he recommends including CAM product-use questions on health/medical assessment forms to encourage patient disclosure.

“Physician-patient communication often does not include the use of CAM therapies, which results in underreporting of their use,” he said. “To help avoid potential side effects, orthopedists should develop questionnaires that can be used prior to surgery to help determine if their patients are using CAM products.”

SourceHerbal Supplements May Cause Dangerous Drug Interactions in Orthopedic Surgery Patients [American Academy of Orthopaedic Surgeons]