Carol is a 62-year-old female,
and she has been undergoing chemotherapy treatments for her leukemia.
After several rounds of chemotherapy,
she just wasn't responding like she should.
Her oncologist started to review things with her,
and was inquiring about many different things.
He said, "Now you're not taking any other medications, right?"
She said, "No, I don't take any medications at all.
The only pill I take everyday is St. John's wort for my depression."
The oncologist said, "Oh, really?
Well, that actually does count as a medication."
Unfortunately, St. John's wort was found
to be what was interfering with her chemotherapy.
Unfortunately, this can occur with the use of botanicals.
There are many instances where botanicals can potentially harm patients.
So, we need to be really careful about these practices.
We will learn more about special patient populations in this video.
Patients may seek out botanicals for many reasons,
such as desiring less cost or fewer side effects,
or maybe they just want to take a more natural approach to their healthcare.
There are certain populations of patients, however,
that may be more vulnerable to harm from botanicals,
and you should generally avoid recommending botanicals to these groups.
It's important to be able to identify these special patient populations and
exercise proper precautions anytime you are considering recommending a botanical.
Special populations that are particularly susceptible to
adverse reactions with botanicals include infants or the elderly,
immunocompromised patients, pregnant or breastfeeding women,
patients with impaired kidney or liver function,
perioperative patients, or those patients who are taking multiple medications.
Both infants and the elderly are more susceptible to
potential side effects and toxicity from pharmaceuticals and botanicals.
Elderly patients may also have
multiple medical concerns and be on a long list of pharmaceuticals,
making this a riskier patient population in which to use them.
So, just remember the extremes of age, the very young,
the very old, botanicals should be used with caution if at all.
Immunocompromised patients have a weakened immune system.
This may be from a medical condition or
perhaps due to a medication that they may be taking.
Examples of immunocompromised medical conditions include cancer,
autoimmune disease, organ transplant patients, and HIV.
Patients who are on steroids or other medications that suppress the immune system,
such as for rheumatoid arthritis or inflammatory bowel disease,
are also considered immunocompromised.
This is a concern because these patients are more
susceptible to infections and other illnesses.
In addition, these patients tend to be on
pharmaceuticals that have a very narrow therapeutic window.
So, they're likely to have multiple risk factors for herb-drug interactions.
Women who are pregnant or breastfeeding are often
consuming botanicals with the assumption that they are safer.
It's true there are some botanical that had been
well-studied and are safe to use in pregnancy and breastfeeding.
However, there are many that carry an increased risk of miscarriage,
birth defects, or have other harmful effects to the fetus or breastfeeding child.
For a large portion of botanicals,
we simply don't know,
and that's what makes this so challenging.
There's not a lot of research that's done on pregnant women for a simple reason.
It's a really risky population to perform experiments on.
This means we often don't know how a botanical may affect the mother or the baby.
A good rule of thumb that I always follow is, when in doubt,
if we're not sure how it's going to affect the mother or the child,
it's best to simply not use the botanical.
Both the liver and kidneys are organs in
the body where a lot of medications are metabolized.
If either the kidneys or liver are not functioning optimally due to disease, trauma,
previous surgeries, et cetera,
this will impact how pharmaceuticals and botanicals are metabolized in the body.
It can potentially lead to increased levels of toxicity.
If you or a family member have ever had surgery,
you know the surgeon will want to know each and
every medication the patient is taking beforehand.
Many people truly forget to include supplements or botanicals when discussing this,
with the assumption that since the products are natural,
it won't cause any harm.
However, many supplements and botanicals can increase the risk of bleeding,
which is a really important thing to know before a person has surgery.
Make sure to always ask if a patient is taking supplements or
botanicals and disclose this to the surgeon and anesthesia team,
as it may impact patient care.
These days, it's not uncommon for some patients to be on a long list of medications,
sometimes as many as 15-20.
This is particularly a concern for
elderly patients who tend to have more medical problems.
When a patient is on a lot of other medications,
it's safest to use botanicals with extreme caution, if at all.
Of course, it will depend on the particular
botanical in the specific types of pharmaceuticals.
But with each drug a person is on,
the risk for herb-drug interactions goes up.
I just identified several populations that are more
susceptible to adverse reactions from botanicals.
It is best to avoid using botanicals with
a special populations addressed here the majority of the time.
If you are to proceed with recommending a
botanical to a patient with one of these special populations,
you must have a strong evidence base for safe use,
and verify there are no other factors that may cause an adverse reaction.
Regardless of whether a patient is part of the special populations,
it's always essential to err on the side of caution and avoid the use of a
botanical when there is a potential for interactions with other medications.
You can explore more by reviewing the week one video,
Evaluating and Selecting Research Sources,
for further guidance on where and how to find
reputable vetted sources of research on botanicals with special populations,
reading the information about risks for pregnant and breastfeeding patients,
and completing the Recommending Botanicals to Special Populations practice quiz.
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