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Release: March 11, 1999

Patients need to be smart about using herbal therapies, UI pharmacist says

IOWA CITY, Iowa -- As more and more people turn to herbs to treat what ails them, a University of Iowa pharmacist recommends that patients be cautious.

"Safety is a big concern," said Teresa Klepser, Pharm.D., UI assistant professor of pharmacy. "People feel herbs are safe because they're natural and available without a prescription. They have effects on the body, so by definition they are drugs. People should treat them that way and let their physicians and pharmacists know they are using them."

Klepser serves on the advisory panel for the UI Family Care Center's Alternative and Complementary Care Clinic -- a once-a-week clinic that the UI Hospitals and Clinics created based on patient demand. In her role, Klepser advises patients about the use of herbal therapies, such as the popular feverfew, garlic, ginkgo, Asian ginseng, saw palmetto, St. John's wort and valerian.

People who come to the UI clinic seeking guidance on alternative medicine represent just a fraction of the population turning toward the new approach to health care, and the popularity is likely to grow. According to one estimate, Americans spent $3.24 billion for herbal therapies in 1997.

Klepser wants to make sure that all people understand the pros and cons of herbs. Klepser and her husband, Michael E. Klepser, Pharm.D., UI assistant professor of pharmacy, recently wrote an article, "Unsafe and Potentially Safe Herbal Therapies" in the American Journal of Health-System Pharmacy.

The Klepsers offer some considerations for people who are taking or thinking of using herbal therapies:

* While it is true that herbs are less potent than traditional drugs, they do have side effects and risks. People need to be aware of these factors and act accordingly.

* It is important that patients notify their doctors, preferably before they begin taking the herbs. This advice is even more important for people on medications because the herbs and traditional drugs could interact. For example, many older people take ginkgo to improve their memory. Many elderly also take aspirin to reduce their chances of stroke. Combining aspirin and ginkgo increases risks for bleeding. In the case of St. John's wort, which individuals take to ward off mild depression, the herb can interact with antidepressants, causing serotonin syndrome that can progress into cardiac arrest, coma, seizures or multiple organ failure.

* People also need to be aware that no agency in the United States currently regulates herbs. As a result, there is no formal standardization. The amount of herb in one brand might not be the same as in another. As a good rule, opt for the more expensive brands. The cheaper versions may not contain an effective amount of the herb, the herb may not be high quality or the manufacturer may be putting the herbs into the pill haphazardly. The more expensive a brand is, the more likely it is that the manufacturer is taking steps to make the product more standardized and of higher quality.

The reasons why people choose to take herbal therapies vary, Klepser said. A majority of the patients opting for herbal therapies have chronic problems, such as migraines or persistent back pain, and have exhausted traditional methods. Also, there are those individuals who take herbs to promote healthy living, Klepser added.

"Patients like to take part in controlling their disease or health," she said. "Taking herbs, which don't require a prescription, allow people that control. Some people believe that the use of herbs is just a phase, but statistics show use is escalating. Hopefully, there will be more acceptance and integration of alternative medicine with traditional medicine, but it will take a while. In the meantime, education, awareness and communication with one's physician are key."