Natural products are becoming increasingly popular among Canadians. According to Health Canada, over 70 percent of the population uses them. Some are seeking ways to improve or maintain their health, while others are hoping to find a cure to their health problems. Physicians and pharmacists do not always share their patients’ enthusiasm for these products, partly due to the risk of interactions between traditional medication and natural products.
Since they are made of natural plants or herbs, consumers often assume that natural products are safe. While it is true that many natural products are harmless – and even beneficial – for the health when used according to the manufacturer’s recommendations, consumers must exercise caution when taking different natural products and medications at the same time: there can be interactions between natural products and traditional medication that could lead to adverse and even toxic effects.
What is an interaction? An interaction occurs when the effect of one product counteracts or intensifies the effects of another product. Here is an example: Mr. Jones is taking warfarin (Coumadin®). Warfarine is an anticoagulant, i.e. a drug that “thins” the blood. It is used to reduce the risk of blood clot formation. With warfarin, a small dosage variation can have a significant impact on the effect of the medication. If a natural product increases the effect of warfarin (as does ginkgo biloba), Mr. Jones would be at risk of excessive bleeding, as his blood would no longer be coagulating sufficiently. On the other hand, if a natural product reduces the effect of warfarin (as does St. John's-wort, for example), Mr. Jones would be at higher risk of blood clots.
Interactions between natural products and medication can produce benign adverse reactions (e.g. headaches or transient digestive disturbances) or bring about more serious consequences (such as a loss of blood sugar control in diabetics). It is therefore important to assess potential health risks and benefits before taking a natural product. Special caution should be exercised with products that combine several ingredients, as such products compound the risks of an interaction with traditional medication.
The fact that a natural product can interact with your traditional medication does not mean that you won’t be able to use the natural product. In some cases, the interaction can be avoided by changing when you take one product or the other. It may also be possible to adjust the dosage of the traditional medication or of the natural product in order to take the interaction into account. In such cases, make sure you inform your prescribing physician if you decide to stop using the natural product or to change how much of it you take, as this may require that your traditional medication dose be altered as well.
Before undertaking an alternative medicine treatment, take the time to get well informed on the product you wish to take. Has its efficacy been proven? What are its adverse effects? How long does it take before its beneficial effect can be observed? Does it have any interactions with other natural products or with traditional medication (with or without a prescription)? Does the product come from a trusted manufacturer? Unfortunately, it isn’t always easy to find reliable information on natural products! It is important to use one’s judgment, especially with Internet sites. Go to the source: Speak to your pharmacist, who will be able to answer your questions.
Also bear in mind that until recently, the manufacturing practices for natural products sold in Canada were not subject to any regulation. It was consequently impossible for consumers to be certain that the product contained only what was written on the label, and at the right dose! In January 2004, Health Canada implemented new regulations to address this loophole. Natural products will now have to conform to strict controls as to manufacturing practices, clinical evidence of efficacy and the information included on labels, among other things. This new regulation will be phased in gradually until 2010. Products that meet the new standards will bear a special code on the label (natural products: the letters NPN – Natural Product Number – followed by an eight-letter code; homeopathic products: the letters DIN-HM). Before purchasing a product, make sure that the label bears a DIN (former drug identification number) code or the new NPN or DIN-HM codes. These codes are your assurance that the product meets Canadian manufacturing standards.
In conclusion, natural products should be treated the same way as traditional medication. Always speak to your pharmacist before beginning a treatment with natural products. Your pharmacist can check whether there is an interaction between your regular medication and the natural product you wish to take. Additionally, you should always tell your pharmacist and physician about any natural product you are taking. Speak to them before you start or stop taking a natural product so that they can adjust your traditional medication dose, if required.
Pharmacists are your medication experts. Never hesitate to consult them, as they will be able to answer your questions on both natural products and traditional medication.