Potential Interactions of Drug–Natural Health Products and Natural Health Products–Natural Health Products among Children
Received 24 May 2007; received in revised form 18 July 2007; accepted 12 September 2007. published online 09 November 2007.
Objective
To determine the frequency of concurrent use of conventional medications and natural health products (NHP) and their potential interactions in children arriving at an emergency department.
Study design
A survey of parents and patients 0 to 18 years at a large pediatric ED in Toronto, Ontario, Canada.
Results
A total of 1804 families were interviewed in this study. Concurrent drug-NHP use was documented in 355 (20%) of patients and 269 (15%) of NHP users were receiving more than one NHP simultaneously. Theoretically possible NHP-drug or NHP-NHP interactions in the preceding 3 months were identified in 285 (16%) children. There were 35 different NHP-medication interaction pairs and 41 NHP-NHP interaction pairs. NHP-medication interactions were predominantly pharmacokinetic (modified absorption, 35%); potential NHP-NHP interactions were mostly pharmacodynamic (increased risk of bleeding, 47%).
Conclusions
Medications are used concurrently with NHP in every fifth pediatric patient in the emergency department and many NHP users are receiving more than 1 NHP simultaneously. One quarter of all paired medication-NHP or NHP-NHP could potentially cause interactions. Although we can not confirm that these were true interactions resulting in clinical symptoms, parents and health care providers need to balance the potential benefit of concurrent NHP-medication use with its potential harms.
aPediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, BC Children’s Hospital, Department of Pediatrics, University of British Columbia, and Child & Family Research Institute (CFRI), Vancouver, British Columbia
bDivision of Pediatric Emergency Medicine, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario
cComplementary and Alternative Research and Education (CARE) Program, Department of Pediatrics, Stollery Children’s Hospital, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Reprint requests: Ran D. Goldman, MD, Division of Pediatric Emergency Medicine, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
Sponsored by the Hospital for Sick Children Foundation’s Research Grants in Complementary and Alternative Therapies and Child and Youth Health Competition and supported by the Child & Family Research Institute (CFRI), BC Children’s Hospital.
ABSTRACT