< LMCC
Epidemiology
- 50-75% of Canadian use CAM at some point in their lives
- use is highest in Western provinces, lowest in Atlantic provinces
- more likely to be used by younger patients, those with higher education and higher income
- examples: chiropractice, acupuncture, massage, naturopathy, homeopathy, traditional Chinese medicine
- most commonly used for: back/neck problems, gynecological problems, anxiety, headaches, digestive problems
- more than half of Canadians do not disclose CAM use to their physicians
Herbal Products
- over 50% of Canadians use natural health products
- most herbs have not yet been shown to be effective in clinical trials
- many patients believe herbal products are inherently safe and are unaware of potential side effects and interactions with conventional medicines
- all natural health products must be regulated under the Natural Health Products Regulations including herbal remedies, homeopathic medicines, vitamins, minerals, traditional medicines, probiotics, amino acids and essential fatty acids
- questions to ask patients who may be taking herbal products
- are you taking an herbal products, supplement or other natural remedy
- are you taking any prescription or non-prescription medications for the same purpose as the herbal product?
- are you allergic to any plant products?
- are you pregnant or breast-feeding?
Common Herbal Products
| Common Name | Reported Uses | Possible Adverse Effects | Possible Drug Interactions |
| Chamomile | mild sedative, anxiolytic, GI complaints, common cold | allergic/contact dermatitis, anaphylaxis | anxiolytics, sedatives |
| Echinacea | Common cold, flu, wound treatment, urinary tract infections, cancer | hypersensitivity, hepatotoxicity with prolonged use, avoid use if immunosuppresed | potentiates warfarin |
| Evening primrose | Dysmenorrhea, menopausal Sx, inflammation, allergies, eczema, arthritis, MS | Headache, restlessness, nausea, diarrhea, may decrease seizure threshold | anticoagulants, antiplatelets |
| Feverfew | Migraine prevention, rheumatoid arthritis, anti-inflammatory | Edginess, upset stomach, skin rash, miscarriage | Anticoagulants, antiplatelets |
| Garlic | Elevated lipids, hypertension, hyperglycemia, antimicrobial | GI irritation, contact dermatitis, may increase post op bleeding | anticoagulants, potentiates antihypertensives |
| Ginger | Nausea, motion sickness, dyspepsia, antiinflammatory | heartburn, not to be used for morning sickness | none known |
| Ginkgo biloba | Increases peripheral circulation (AD, dementia, intermittant claudication), premenstrual syndrome, vertigo | headache, cramping, bleeding, mild digestive problems, reports of intracranial hemmorage | anticoagulants, thiazide diuretics, MAO inhibitors |
| Ginseng | Energy enhancer, decreases stress, adjunct support for chemotherapy/radiation | Hypertension, nervousness, insominia, breakthrough bleeding, palpitations | Stimulant medications, antihypertensives, hormonal therapies |
| Glucosamine | osteoarthritis | GI distress, headache, drowsiness, palpitations | none known |
| Saw palmetto | BPH, adjunct to finasteride | Mild GI distress | a-adrenergics |
| St. John's Wort | Mild to moderate depression | Photosensitivity, increased liver enzymes, drowsiness, dizziness, nausea, headaches | CNS depressants |
| Valerian | Sedative, anxiolytic, muscle relaxant, PMS | Drowsiness, headache, digestive problems, paradoxical insomnia | CNS depressants |
References
Toronto Notes 2005
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