Disclosure I have no relevant financial relationships with any companies related to the content of this course. Weeding Out the Fiction on OTCs, Herbals and Marijuana Use in Transplant Rebecca Florez, PharmD Heart & Lung Transplant 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF Medical Center Most common uses of OTC Medication: Indication for Self-Medicating 80 70 60 50 40 30 20 10 0 OTCs Use in Solid Organ Transplant 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation 9/26/2018 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation 1 | [footer text here]
Nephrotoxicity from NSAIDs Common OTCs Can bind to tacrolimus and cyclosporine resulting in lower levels. Recommend to space by 2 hours. Can mask the symptoms of c.diff. Rule out first. Nephrotoxic. Cases of Acute renal failure with minimal use. 9/26/2018 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation 9/26/2018 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation Common OTCs Common OTCs Anticholinergic side effects: dry mouth, difficulty Can lead to a serious infection known as the “brain- eating” amoeba and bacterial infections. Use only urinating, tachycardia. High doses can cause distilled, sterile or boiled water (within 24h). hallucinations and delirium. Contains salicylate….. Used to treat diarrhea. Directly stimulates alpha and beta receptors. Causing: C.diff must be ruled out before it can be used to vasocontriction, tachycardia, and increased BP. Increases self-treat. Can increase risk of bleeding with risk of arrhythmias and hypertension. Urinary retention anticoagulants, can bind to other meds like cipro. Acute phosphate nephropathy (APN) has been reported. Herbal blend: Echinacea Some cases have resulted in permanent HD. Risk Lonicera,Forsythia, Schizonepeta, Ginger, Vitex factors->55 yo, preexisting renal dysfunction, bowl Trifolia, Isatis. obstruction, other renally toxic meds. 9/26/2018 9/26/2018 9/26/2018 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation 2 | [footer text here]
Exponential growth to $8 Billion Market in 2017 Herbal Therapy Use in Solid Organ Transplant 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation Herbal Therapy Prevalence and Predictors of Herbal Medicine Use Among Adults in the US • I found this herbal Data on herbal product use was collected from 2015 National Consumer Survey wonder drug on (NCSME-PR) the internet. • 26,157 eligible respondents were included in the study • 1/3 reported current use of at least 1 herbal medicine (35%) Everyone says it • The average number of herbal supplements 2.6 works like a charm. Can you Demographic Characteristics of the herbal users: • approve it for my • Predominately female (71%) use? • White (81%), although ethnic diversity was a limit to the study • Greater than a high school education (77%) • Annual household income >80K (79%) • Those individuals with Chronic diseases reported higher usage of herbal medicines • 69% of herbal medication users were also taking prescription medication J Patient Exp. 2017.Sep; 4(3): 108-113 9/26/2018 9/26/2018 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation 3 | [footer text here]
Herbal Therapy- 3A4 Inhibitors or Inducers Herbal Therapy- Immune Enhancers St. Jonh’s wart – Inducer Echinacea root Chaga • • • Astragalus root Maitake • • Ginkgo Biloba – use • Reishi mushrooms Cordyceps caution • • Schisandre berry Royal Sun Blazei • • Ginseng – use caution • Prickly Ash bark Enokitake • • Garlic – Inhibitor • Baptisia root Mesima • • Schisandra- Inhibitor • Elderberry Turkey Trail • • Kava – Inhibitor Yerba Santa leaf Lion’s mane • • • Yarrow aerials Artist’s Conk Grapefruit Extract- • • • Inhibitor Goldenseal root Agarikon • • Lovage root Amadou • • Cranberry Extract – • Cinnamon bark Ginseng • • Inducer/Inhibitor ??? Osha root Birch polypore • • Ligustrum berry • 9/26/2018 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation 9/26/2018 9/26/2018 UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation UCSF TRANSPLANT 2018 – Pioneering Advances in Transplantation 4 | [footer text here]
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