Complementary and Alternative Medicines Overview

Complementary and Alternative Medicines (CAM)

Includes botanicals, nutritional products, herbal supplements, possess positive and negative effects, and can interact with prescription and OTC drugs.

CAM usage statistics

40% of adults use CAM.

CAM expenditure

$6 billion and counting in the US spent on CAM.

Patient Responsibilities for Safe CAM Therapy

Consult with the health care provider before taking any herbal preparation.

National Center for Complementary and Integrative Health (NCCIH)

Lists current clinical trials with herbal products on their website (www.nccam.nih.gov/research/clinicaltrials).

Dietary Supplement Health and Education Act of 1994 (DSHEA)

Ensure products are safe and label information is truthful and not misleading.

Current Good Manufacturing Practices (CGMPs)

Standards require package labels that declare quality and strength of contents and that product is without contaminants and impurities.

Label requirements under DSHEA

1. Name of the supplement 2. Amount of the supplement (net quantity) 3. Nutrition labeling 4. Ingredient list 5. Name and place of the manufacturer, packer, or distributor.

Physiologic effects of CAM

Can be noted (maintains blood flow, promotes healthy immunity, etc.).

Claims about CAM

No claims can be made about CAM's use in order to diagnose, treat, prevent or cure any disease or specific condition.

Cinnamon

Used to treat bronchitis, GI problems, anorexia, diabetes; generally safe without allergic reactions; may decrease blood clotting time.

Echinacea

Used for colds, flu, infections; stimulates immune system; side effects include GI effects, allergic reactions.

What is garlic used for in terms of heart health?

Lowering cholesterol and blood pressure, reducing heart disease.

What types of cancer does garlic help prevent?

Stomach and colon cancer.

What are some side effects of garlic?

Heartburn, upset stomach, body odor, decreased blood clotting time.

What is ginger commonly used for?

Nausea, motion sickness, diarrhea, pain relief, swelling, and arthritic stiffness.

What are some side effects of ginger?

GI effects such as gas, bloating, heartburn, and nausea.

What is Ginkgo biloba commonly used for?

Asthma, bronchitis, fatigue, tinnitus

How does Ginkgo biloba affect memory?

It is used to improve memory and prevent Alzheimer disease

What condition does Ginkgo biloba help decrease?

Intermittent claudication

What sexual health issue can Ginkgo biloba treat?

Sexual dysfunction

Can Ginkgo biloba be used for multiple sclerosis?

Yes, it is used to treat multiple sclerosis

What are some side effects of Ginkgo biloba?

Headache, dizziness, GI upset/nausea, increased bleeding, allergic reactions

Ginseng

Improves well-being, stamina, and immune system; treats erectile dysfunction, hepatitis C, menopausal symptoms; lowers blood glucose & blood pressure.

Ginseng Side Effects

Headaches, GI distress, hypertension, hypoglycemia, breast tenderness, menstrual irregularities, allergic reactions.

Green tea

Improves mental alertness, relieves headache; protects against heart disease and cancer; promotes weight loss.

Green tea Adverse Effects

Liver dysfunction.

Kava kava

Used for relaxation and anxiety.

Kava kava Adverse Effects

Liver damage, jaundice, dry and scaly skin, eye irritation, heart problems.

Valerian

Used for anxiety, headache, insomnia, tremors, depression, irregular heartbeat.

Valerian Side Effects

Headache, dizziness, fatigue, stomach upset.

Turmeric

Anti-inflammatory effects; used for heartburn, stomach ulcers, gallstones (may worsen), inflammation, cancer.

Turmeric High Doses Effects

May cause nausea, diarrhea.

Peppermint

Used for headache, cold symptoms, nausea, indigestion, irritable bowel syndrome, muscle and nerve pain.

Peppermint Side Effects

Heartburn, allergic reaction.

Licorice root

Used for bronchitis, sore throat, stomach ulcers, viral hepatitis.

Licorice root High Doses Effects

Can lead to edema, hypertension, low potassium level.

Saw palmetto

Used for urinary symptoms such as benign prostatic hypertrophy.

Saw palmetto Side Effects

Digestive problems, headache.

St. John's wort

Used for mental disorders, nerve pain.

St. John's wort Side Effects

Anxiety, dizziness, headache, fatigue, sensitivity to sunlight, GI problems, sexual dysfunction, many drug interactions.

Potential Hazards of Herbs

Natural substances does not mean safe; herb-drug interactions are possible; herbal products can affect lab results.

Herbal Therapy Precautions

Discontinue herbal therapy 2 to 3 weeks before surgery; do not take if taking prescription drugs, pregnant or nursing; do not give herbs to infants/young children.

Clinical Judgment: Complementary and Alternative Therapies

Recognize cues; identify all prescription and OTC drugs; assess for drug, herb, or supplement side effects.

Clinical Judgment: Take Action

Advise patient to notify health care provider before substituting herbs for a prescription or OTC drug; encourage patient to read labels and adhere to recommended information.

Potential side effects of herbal therapy

Advise patient of potential side effects of herbal therapy.

Guidelines for using herbs

Do not use herbs if pregnant or nursing. May be given for children two years of age and older. Seek care from HCP for side effects. Read labels and follow requirements. Consult HCP about other prescription and OTC drugs before starting herbs. Consult with the health care provider before taking any herbal preparation.

St. John's wort effectiveness

Current research suggests that it is no more effective than placebo when used by individuals with depression.

St. John's wort and tyramine-rich foods

Users of St. John's wort should avoid tyramine-rich foods while taking the supplement.

Herb for memory improvement

Ginkgo biloba is thought by some to improve memory associated with aging.

Ginkgo biloba historical uses

Ginkgo has been used for thousands of years to treat ailments such as asthma, bronchitis, fatigue, and tinnitus.

Ginkgo biloba and Alzheimer's prevention

In a study following older adult subjects for an average of 6 years, ginkgo was shown to be ineffective in the prevention of Alzheimer and other dementias.

Ginkgo biloba side effects

Side effects include headache, nausea, GI upset, dizziness, and allergic reactions that include severe reactions leading to death.

Ginkgo biloba and blood thinners

In patients taking blood thinners, ginkgo has been shown to increase bleeding risk.

Animal studies on ginkgo

Animal studies have shown that rats and mice given ginkgo develop tumors; however, more research is needed to determine whether this is true for humans.

Herbs to inform HCP about when on anticoagulants

Before beginning herb therapy, patients should inform the HCP about taking garlic when receiving an anticoagulant secondary to previous blood clots.

Garlic and blood clotting

Because it also reduces blood clotting, patients should be advised to notify their health care provider about taking garlic if they are having surgery or dental work.

Garlic and bleeding disorders

Patients should be cautioned not to take garlic if they have a bleeding disorder.