Therapeutic Risk and Benefits of Concomitantly Using Herbal Medicines and Conventional Medicines: From the Perspectives of Evidence Based on Randomized Controlled Trials and Clinical Risk Management.
Therapeutic Risk and Benefits of Concomitantly Using Herbal Medicines and Conventional Medicines: From the Perspectives of Evidence Based on Randomized Controlled Trials and Clinical Risk Management.
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同时使用草药和传统药物的治疗风险和益处：从基于随机对照试验和临床风险管理的证据的角度来看
DOI：
10.1155/2017/9296404
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Zhou Q
中科院分区：
文献类型：
--
作者：
Zhang XL;Chen M;Zhu LL;Zhou Q
尽管人们越来越多地认识到草药相互作用(HDI)的潜力，但缺乏关于其重要性的严格临床证据，为临床医生和消费者就草药和传统药物的安全组合做出理性决定提供了挑战。这篇综述是基于随机对照试验(RCT)的证据进行的。文献是通过执行PubMed搜索确定的，直到2017年1月。描述了风险描述和临床风险管理。在74篇最终纳入的RCT中，17篇(22.97%)仅涉及药效学HDIs。57个随机对照试验(77.03%)研究了药物动力学HDIs，其中28个具有潜在或实际的临床相关性。HDI的程度可能与药物基因组学、草药中有效成分的剂量、相互作用的时间进程、目标药物的特性(如给药途径和药代动力学特征)、草药处方成分的修改以及诱导剂和抑制剂的共存等因素有关。临床专业人员应加强对HDI的风险管理，如提高对治疗风险和益处的潜在变化的认识，询问患者目前使用的所有常规药物和草药及补充剂的情况，通过计算机提醒系统自动检测高度实质性的HDI，选择替代药物，调整剂量，审查医嘱的适当性，教育患者监测药物相互作用的症状，并注意随访和咨询。
Despite increased awareness of the potential of herb-drug interactions (HDIs), the lack of rigorous clinical evidence regarding the significance provides a challenge for clinicians and consumers to make rational decisions about the safe combination of herbal and conventional medicines. This review addressed HDIs based on evidence from randomized controlled trials (RCTs). Literature was identified by performing a PubMed search till January 2017. Risk description and clinical risk management were described. Among 74 finally included RCTs, 17 RCTs (22.97%) simply addressed pharmacodynamic HDIs. Fifty-seven RCTs (77.03%) investigated pharmacokinetic HDIs and twenty-eight of them showed potential or actual clinical relevance. The extent of an HDI may be associated with the factors such as pharmacogenomics, dose of active ingredients in herbs, time course of interaction, characteristics of the object drugs (e.g., administration routes and pharmacokinetic profiles), modification of herbal prescription compositions, and coexistence of inducers and inhibitors. Clinical professionals should enhance risk management on HDIs such as increasing awareness of potential changes in therapeutic risk and benefits, inquiring patients about all currently used conventional medicines and herbal medicines and supplements, automatically detecting highly substantial significant HDI by computerized reminder system, selecting the alternatives, adjusting dose, reviewing the appropriateness of physician orders, educating patients to monitor for drug-interaction symptoms, and paying attention to follow-up visit and consultation.