C H A P T E R 6
Challenges to effective drug therapy
63
Because many OTC drugs interact with prescription
drugs, with possibly serious adverse or toxic effects, it is
important that the healthcare provider ask specifically
when taking a drug history whether the person is taking
any OTC drugs or other medications. Many people do
not consider OTC drugs to be “real” drugs and do not
mention their use when reporting a drug history to their
healthcare provider. Every drug-teaching session should
include information on which particular OTC drugs
must be avoided or advice to check with the healthcare
provider before taking any other medications or OTC
products.
ALTERNATIVE THERAPIES AND HERBAL
MEDICINE
Another aspect of the increasing self-care movement is
the rapidly growing market of alternative therapies and
herbal medicines. Herbal medicines, both commercial
and traditional (such as Rongoa– Ma– ori or Indigenous
Australian) and
alternative therapies
are found in
ancient records and have often been the basis for the dis-
covery of an active ingredient that is later developed into
a regulated medication. Today, alternative therapies can
also include non-drug measures, such as imaging and
relaxation.
There is a considered element of the placebo effect
in using some of these therapies. The power of believing
that something will work and that there is some control
over the problem is often very beneficial in achieving
relief from pain and suffering. The challenge for the
healthcare provider is to balance the therapies that the
person wishes to use with the medical regimen that is
prescribed. This may involve altering doses or timing of
various drugs. See Appendix F for an extensive listing
of alternative and complementary therapies.
Currently, these products are not controlled or
tested by the TGA or MEDSAFE; they are considered
to be dietary supplements, and therefore the advertis-
ing surrounding these products is not as restricted or
as accurate as with classic drugs. Consumers are urged
to use the “natural” approach to medical care and to
self-treat with a wide variety of products. Numerous
Internet sites point out natural treatments that can
be used to cure various disorders. Television ads and
magazine spreads push the use of these products in place
of prescribed medications. Many people who want to
gain control of their medical care or who do not want
to take “drugs” for their diabetes, depression or fatigue
are drawn to these products. Appendix F lists common
alternative therapies and their suggested uses.
Several issues are of concern to the healthcare
provider when a person elects to self-treat with alterna-
tive therapies. The active ingredients in these products
have not been tested; when test results are available,
often the tests were for only a very small number of
people with no reproducible results. When a person
decides to take bilberry to control diabetes, for example,
the reaction that will occur is not really known. In
some people, the blood glucose level might decrease;
in others, it might increase. The incidental ingredients in
many of these products are unknown. Many ingredients
come directly from plants or from the conditions under
which they grow, such as the fertiliser used for the plant,
or depend on the time of the year when the plant was
harvested. The other ingredients that are compounded
with the product have a direct effect on its efficacy. Saw
palmetto, a herb that has been used successfully to alle-
viate the symptoms of benign prostatic hypertrophy, is
available in a wide variety of preparations from different
manufacturers. A random sampling of these products
performed in 2000 revealed that the contents of the
identified active ingredient varied from 20% to 400% of
the recommended dose. It is difficult to guide people to
the correct product with such a wide range of variability.
People often do not mention the use of alternative
therapies to the healthcare provider. Some people believe
that the healthcare provider will disapprove of the use
of these products and do not want to discuss it; others
believe that these are just natural products and do not
need to be mentioned. With the increasing use of these
products, however, several drug interactions that can
cause serious complications for people taking prescrip-
tion medication have been reported. People with diabetes
who decide to use juniper berries, ginseng, garlic, fenu-
greek, coriander, dandelion root or celery to “maintain
their blood glucose level” may run into serious problems
with hypoglycaemia when they also use their prescrip-
tion antidiabetic drugs. If the person does not report
the use of these alternative therapies to the healthcare
provider, extensive medical tests and dose adjustments
might be done to no avail.
St John’s wort, a highly advertised and popular
alternative therapy, has been found to interact with
oral contraceptives, digoxin (a heart medication), the
selective serotonin reuptake inhibitors (used for depres-
sion), theophylline (a drug used to treat lung disease),
various antineoplastic drugs used to treat cancer and
the antivirals used to treat acquired immune deficiency
syndrome (AIDS). People using St John’s wort for the
symptoms of depression who are also taking
Prozac
(fluoxetine) for depression may experience serious side
effects and toxic reactions. If the healthcare provider is
not told about the use of St John’s wort, treatment of the
toxicity can become very complicated.
Asking people specifically about the use of any
herbal or alternative therapies should become a routine
part of any health history. If a person presents with an
unexpected reaction to a medication, ask them about
any herbal or natural remedies they may be using. If a
