About 38 million adults in the United States use herbal and dietary supplements, yet only one-third reveal the use of these supplements to their primary care providers. Use of herbal supplements, dietary supplements, and over-the-counter medications with prescription medications can put patients at risk for a variety of interactions. Bleeding tendencies increase with the use of many common herbal supplements such as garlic, saw palmetto, Ginkgo, Echinacea, milk thistle, St John's wort, ginseng, black cohosh, green tea, and valerian. In fact, many of these supplements should be discontinued several weeks prior to surgery. St John's wort increases the risk of serotonin syndrome when combined with selective serotonin reuptake inhibitors. This herbal supplement also can reduce the effectiveness of immunosuppressants, antiretroviral medications, anticoagulants, contraceptives, and antiarrhythmics.

Authors Anastasi, Chang, and Capili present questions for assessing patients' use of herbal and dietary supplements. Including these questions in any patient assessment will assist in obtaining relevant data and identifying and addressing potentially dangerous interactions. Patients should be asked if they take any type of herbal or dietary supplement, an if so, determine how much and how often. Requesting that the patient explain why he/she is taking a particular supplement and who advised him/her to take that supplement may also be helpful. If faculty can help students learn the significance of obtaining this information and incorporate these few questions into their patient assessments, perhaps some of the healthcare issues that result from unexpected interactions can be reduced.

Source: Anastasi J, Chang M, Capili, B. Herbal supplements: talking with your patients. J Nurse Pract. 2011; 7(1), 29-35. Available at:http://www.medscape.com/viewarticle/735530. Accessed February 15, 2011.

Submitted by: Robin E. Pattillo, PhD, RN, CNL, news editor at [email protected]