LMCC/Complementary and Alternative Medicine

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Epidemiology[edit]

  • 50-75% of Canadian use CAM at some point in their lives
  • use is highest in Western provinces, lowest in Atlantic provinces
  • more likely to be used by younger patients, those with higher education and higher income
  • examples: chiropractice, acupuncture, massage, naturopathy, homeopathy, traditional Chinese medicine
  • most commonly used for: back/neck problems, gynecological problems, anxiety, headaches, digestive problems
  • more than half of Canadians do not disclose CAM use to their physicians

Herbal Products[edit]

  • over 50% of Canadians use natural health products
  • most herbs have not yet been shown to be effective in clinical trials
  • many patients believe herbal products are inherently safe and are unaware of potential side effects and interactions with conventional medicines
  • all natural health products must be regulated under the Natural Health Products Regulations including herbal remedies, homeopathic medicines, vitamins, minerals, traditional medicines, probiotics, amino acids and essential fatty acids
  • questions to ask patients who may be taking herbal products
    • are you taking an herbal products, supplement or other natural remedy
    • are you taking any prescription or non-prescription medications for the same purpose as the herbal product?
    • are you allergic to any plant products?
    • are you pregnant or breast-feeding?

Common Herbal Products[edit]

Common Name Reported Uses Possible Adverse Effects Possible Drug Interactions
Chamomile mild sedative, anxiolytic, GI complaints, common cold allergic/contact dermatitis, anaphylaxis anxiolytics, sedatives
Echinacea Common cold, flu, wound treatment, urinary tract infections, cancer hypersensitivity, hepatotoxicity with prolonged use, avoid use if immunosuppresed potentiates warfarin
Evening primrose Dysmenorrhea, menopausal Sx, inflammation, allergies, eczema, arthritis, MS Headache, restlessness, nausea, diarrhea, may decrease seizure threshold anticoagulants, antiplatelets
Feverfew Migraine prevention, rheumatoid arthritis, anti-inflammatory Edginess, upset stomach, skin rash, miscarriage Anticoagulants, antiplatelets
Garlic Elevated lipids, hypertension, hyperglycemia, antimicrobial GI irritation, contact dermatitis, may increase post op bleeding anticoagulants, potentiates antihypertensives
Ginger Nausea, motion sickness, dyspepsia, antiinflammatory heartburn, not to be used for morning sickness none known
Ginkgo biloba Increases peripheral circulation (AD, dementia, intermittant claudication), premenstrual syndrome, vertigo headache, cramping, bleeding, mild digestive problems, reports of intracranial hemmorage anticoagulants, thiazide diuretics, MAO inhibitors
Ginseng Energy enhancer, decreases stress, adjunct support for chemotherapy/radiation Hypertension, nervousness, insominia, breakthrough bleeding, palpitations Stimulant medications, antihypertensives, hormonal therapies
Glucosamine osteoarthritis GI distress, headache, drowsiness, palpitations none known
Saw palmetto BPH, adjunct to finasteride Mild GI distress a-adrenergics
St. John's Wort Mild to moderate depression Photosensitivity, increased liver enzymes, drowsiness, dizziness, nausea, headaches CNS depressants
Valerian Sedative, anxiolytic, muscle relaxant, PMS Drowsiness, headache, digestive problems, paradoxical insomnia CNS depressants

References[edit]

Toronto Notes 2005