Common dilemmas in kids

2015

Clinical

Your questions about complementary medicines answered

Volume 44, No.6, 2015 Pages 373-374

Sanne Kreijkamp-Kaspers

Treasure McGuire

Suzanne Bedford

Peter Loadsman

Marie Pirotta

Geraldine Moses

Mieke L van Driel

This is the first article in a series providing evidence-based answers to common questions about complementary medicines from consumers and healthcare professionals.

Complementary medicine use in Australia is widespread – an estimated two-thirds of Australians use complementary medicines.1 A survey of Australians aged 50 years or older revealed that 46.3% had used complementary medicines in the previous 24 hours.2 Unlike conventional medicines, complementary medicines are available without prescription or medical advice. In the survey, 53% of complementary medicines were bought from pharmacies and about 40% at supermarkets and health food shops, often without any accompanying medical advice.2

Complementary medicines, as defined by the Australian Therapeutic Goods Administration (TGA) and the Therapeutic Goods Act 1989 (Amended), include medicinal products containing ingredients such as herbs, vitamins, minerals, nutritional supplements, homeopathic and certain aromatherapy preparations.3

Despite the general public and some health professionals assuming that complementary medicines are ‘natural’ and therefore safe,4 this is not always the case.5–9 Consumers often fail to tell their doctor that they use a complementary medicine.10 Even when general practitioners (GPs) are aware of complementary medicine use, their ability to advise patients about their risks is limited.11 Furthermore, reliable resources are not easily accessible.11 Given their widespread use and the associated potential risks, it is essential that information gaps or concerns regarding complementary medicines are identified and addressed.

Source of the questions

To identify the most commonly asked questions, we analysed 125,919 calls from the NPS MedicineWise (NPS) Medicines Line (1 September 2002–30 June 2010) for consumers and 57,840 calls from the Therapeutic Advice and Information Service (TAIS; 2000–30 June 2010) for community healthcare providers. Both call centres were funded by NPS and operated by Mater Health Services, South Brisbane. Calls about complementary medicines comprised 8.2% of consumer calls (10,288 calls) and 9.3% of healthcare professional calls (5410 calls).

The median age of consumers enquiring about complementary medicines was 53 years (interquartile range (IQR) 36–67 years); 73% were female. The median age of non-complementary medicine callers was 49 years (IQ 25–65 years) and 68% were female. Of the TAIS enquiries, 47% were from community pharmacists and 37% from GPs. Other callers included nurses (2.4%) and specialists (1.4%).

Selection of the questions

We selected the most frequently mentioned complementary medicines from each call centre. For the selected complementary medicines, two researchers (GP and pharmacist) independently identified the recurring themes for the respective complementary medicines through trend analysis of call narratives.

For each complementary medicine, 3–4 recurring themes were identified. The research team then identified the most relevant questions to be answered, based on their professional experience. This was conducted by three GPs, two pharmacists who staffed the phone lines, and a non-medical researcher. Four questions for each complementary medicine were selected (two from the consumer and two from the health professional call centres). For these questions, an evidence-based answer was developed.

Evidence-based answers

We sourced data from a range of quality information sources, including specialised complementary medicines information resources,10,12 bibliographic databases (EMBASE, Medline), monographs (eg Micromedex, AusDI), Australian Medicines Handbook and product information. We used language appropriate to the target audience (consumer or health professional). Answers were designed to be succinct but evidence-based.

What are the questions about?

Table 1 shows the top 10 ranked complementary medicines for both target audiences. Of note was that the top three complementary medicines, namely glucosamine, St John’s wort and fish oil, were the same in both groups.

In general, consumers were most concerned about safety: 34% asked about possible interactions, compared with 13% in the non-complementary medicines calls, and 12% asked about adverse drug reactions (ADRs), compared with 20% in the non-complementary medicines calls. A similar pattern emerged for healthcare professionals: 42% asked about interactions, compared with 22% of non-complementary medicines calls, and 22% asked about ADRs, compared with 21% of non-complementary medicines calls.

Table 1. Most commonly asked about CMs in the call centre databases

 

Healthcare professionals’ questions (%)

n = 5410

Rank

Consumers’ questions (%)

n = 10,288

Rank

Glucosamine*

620 (11.5%)

1

1670 (16.2%)

1

St John's wort*

367 (6.8%)

2

689 (6.7%)

3

Fish oil*

323 (6.0%)

3

1067 (10.4%)

2

Ginkgo biloba*

169 (3.1%)

4

357 (3.5%)

6

Coenzyme Q10

140 (2.6%)

5

283 (2.8%)

9

Vitamin D

Not in top 10

 

507 (4.9%)

5

Valerian

133 (2.5%)

6

300 (2.9%)

8

Magnesium

124 (2.3%)

7

Not in top 10

 

Black cohosh

113 (2.1%)

8

Not in top 10

 

Calcium

112 (2.1%)

9

241 (2.3%)

10

Zinc

112 (2.1%)

10

Not in top 10

 

Multivitamins

Not in top 10

 

586 (5.7%)

4

Iron

Not in top 10

 

353 (3.4%)

7

*These will be addressed in this series of articles on complementary medicines

Competing interests: The authors received an Integrative Medicine grant from the RACGP.
Provenance and peer review: Commissioned, externally peer reviewed.

Resources

References

  1. NPS Medicinewise. NPS Annual Consumer Surveys: Findings About Complementary Medicines Use. 2008. Available at www.nps.org.au/about-us/what-we-do/our-research/complementary-medicines/nps-consumer-survey-cms-use-findings [Accessed 5 March 2014].
  2. Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, Barnes J. A national census of medicines use: a 24-hour snapshot of australians aged 50 years and older. Med J Aust 2012;196:50–53.
  3. Australian Government Department of Health: Therapeutic Goods Administration. Australian regulatory guidelines for complementary medicines (ARGCM). Available at www.tga.gov.au/ pdf/ cm-argcm.pdf [Accessed 15 September 2014].
  4. Myers S, Cheras P. The other side of the coin: safety of complementary and alternative medicine. Med J Aust 2004;181:222–25.
  5. Izzo AA, Borrelli F, Capasso R. Herbal medicine: The dangers of drug interaction. Trends Pharmacol Sci 2002;23:358–91.
  6. Barnes J. Quality, efficacy and safety of complementary medicines: Fashions, facts and the future: Part ii: Efficacy and safety. Br J Clin Pharmacol 2003;55:331–40.
  7. Werneke U, Earl J, Seydel C, Horn O, Crichton P, Fannon D. Potential health risks of complementary alternative medicines in cancer patients. Br J Cancer 2004;90:408–13.
  8. Posadzki P, Watson LK, Ernst E. Adverse effects of herbal medicines: An overview of systematic reviews. Clin Med 2013;13:7–12.
  9. Lim A, Cranswick N, South M. Adverse events associated with the use of complementary and alternative medicine in children. Arch Dis Child 2011;96:297–300.
  10. McGuire TM, Walters JA, Dean AJ, et al. Review of the quality of complementary medicines information resources: Summary report 2009. Sydney: NPS, 2009. Available at www.nps.org.au/__data/assets/pdf_file/0005/69656/CMsInfoSummary.pdf [Accessed 12 March 2014].
  11. Pirotta M, Kotsirilos V, Brown J, Adams J, Morgan T, Williamson M. Complementary medicine in general practice. A national survey of GPs. Aust Fam Physician 2010;39:946–50.
  12. Natural Medicines Comprehensive Database. 13th edn. Stockton, CA: Therapeutic Research Faculty, 2012. Available at www.naturaldatabase.com [Accessed 2 February 2015].

Correspondence afp@racgp.org.au

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Type

Clinical

2015