The Pharmacist's Role in Herbal Care

Satyaendra Shrivastava, MPharm, MBA; Darshan Dubey; Shweta Kapoor; Pawan Dubey, PhD

Disclosures

May 23, 2007

Herbal medicines are in great demand and are used by approximately 80% of the world's population.[1] Their popularity is due largely to their presumed safety, efficacy, cultural acceptability, and lesser side effects compared with prescription medications; perhaps most important, they are viewed as cost effective and accessible.[2,3,4,5]

The past few years in particular have seen a major increase in the use of herbal products. The global market was $5.6 billion by the end of 2006; growing at an average annual growth rate of 1.7%, it is expected to exceed $6.1 billion by 2011.[6]

Herbal medicinal products may have therapeutically beneficial effects, but a number of them cause adverse effects and drug interactions similar to conventional agents. The interaction potential of herbs with conventional drugs is an especially critical concern for drugs with narrow therapeutic indexes. Therefore, knowing the efficacy and safety of herbal drugs is crucial.

In fact, one of the most serious hazards associated with herbal medicines is that many patients are under the illusion that because herbs are obtained from nature, they are completely safe and have no side effects. Thus, it is important that they be instructed to take proper precautions while using herbal medicines.

Unfortunately, few patients inform their primary care providers about their use of herbal products. Pharmacists play a critical role in educating patients and healthcare providers about the available evidence on the efficacy of these products, as well as in making recommendations that are consistent with that evidence. By actively embracing the responsibility for counseling individuals on the appropriate use of herbal products, pharmacists will become recognized experts in this rapidly growing area, and will be able to positively influence the quality of care.

Pharmacists can play a key role by asking patients about their use of herbal products, and by discussing this issue with healthcare providers. Pharmacies should stock only those herbal products that meet the Good Manufacturing Practice guidelines.[7] Pharmacists can help monitor patients who use herbal products for any potential adverse events, and can counsel them to ensure that appropriate results are obtained.[8] Various pharmacist roles are discussed below.

Patients often fail to volunteer information about their use of herbal products and other "natural" products. Therefore, pharmacists should ask specific questions about such usage while taking drug histories. They can encourage patients to be open about this by conducting their inquiries in an open, nonjudgmental fashion. Questions should cover the specific healthcare purpose for which the patient is using an herbal product.

Pharmacists and other health professionals must be vigilant in detecting and reporting any potential adverse events from herbal medicines.

Pharmacists need to stay current on accurate information about herbal medicines and use this expertise when advising patients.[9] They should strive to provide unbiased evaluations and to correct any misconceptions about the benefits and toxicity of these medicines.[10]

Pharmacists are in a position to determine whether an herbal therapy used by a patient is appropriate or not. The pharmacist should review a patient's complete drug regimen and disease states, to identify any potential or actual drug-related problems, in addition to evaluating the herbal medicines' efficacy, safety, and cost-effectiveness.[11] Special care should be exercised if the patient is pregnant or has allergies.

Pharmacists need to establish rapport with their patients, maintain regular contact and follow-up, and most importantly, encourage the use and continuation of therapeutics that have been proven effective.

Pharmacists can be a valuable source of information for both conventional and alternative medical care providers. Ideally, they should provide regular updates to the healthcare team on commonly used herbal medicines. Pharmacists have the expertise to identify and distinguish between side effects that are induced by conventional agents or by plant-derived products.

Pharmacists can also collaborate with other members of the healthcare team on research into the use of herbal medicines, and they should share the responsibility of publishing these results.[8]

In addition to integrating information about herbal products across the curriculum, specific courses must be designed to help pharmacists attain higher skill levels in this area. For pharmacists to serve as educators on the use of herbal medicines, they must possess a thorough knowledge of these products. They also need to learn effective oral communication skills and have critical appraisal skills for retrieving and evaluating relevant information on herbal medicines.

The use of herbal medicines is growing at an outstanding rate all over the world. Herbal remedies are now available not only in drug stores but also in grocery stores. The basis for pharmacist involvement with herbal products is an extension of their established role in pharmaceutical care, clinical pharmacy practices, and collaborative healthcare teams. To assure that comprehensive care is maintained, patients need to be encouraged to share information with their primary care providers about their herbal medicines, or to allow their pharmacist to inform their providers.

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