Published Online, 30 October 2007, www.theannals.com, DOI 10.1345/aph.1H463b.
The Annals of Pharmacotherapy: Vol. 41, No. 12, pp. 2073. DOI 10.1345/aph.1H463b
© 2007 Harvey Whitney Books Company.
Authors' Reply
Theresa L Charrois, BScPharm MSc
Research Associate CARE Program Department of Pediatrics University
of Alberta Edmonton, Alberta, Canada
Richard L Hill, MB BS
Deputy Director Adverse Drug Reactions Unit Therapeutic Goods
Administration Woden, Australia
Duc Vu, MSc PhD
Director Bureau of Cardiology, Allergy and Neurological Sciences
Therapeutic Products Directorate Health Canada Ottawa, Canada
Brian C Foster, PhD
Senior Science Advisor Therapeutic Products Directorate Health
Canada
Heather S Boon, BScPhm PhD
Associate Professor Leslie Dan Faculty of Pharmacy University of
Toronto Toronto, Ontario, Canada
Sunita Vohra, MD MSc
Director CARE Program Associate Professor Department of Pediatrics
University of Alberta 8213 Aberhart Centre #1 11402 University Avenue
Edmonton, Alberta T6G 2J3 Canada fax 780/492-2105
svohra{at}ualberta.ca
Published Online, October 30, 2007. www.theannals.com, DOI 10.1345/aph.1H463b
We thank Dr. Dennehy for her careful analysis. As part of our research
program to identify natural health product (NHP)-related adverse events, we
partnered with community pharmacists to assess their awareness of
NHP–drug interactions. To assess pharmacists' knowledge, we inquired
about a range of potential interactions, from those that are well established
in the literature to those that are new, emerging, or with few supporting
clinical data. If we had limited our examples to widely published
interactions, we would have been unable to probe more deeply and discriminate
between levels of knowledge. The responses requested from pharmacists ranged
from "have not heard of this interaction" to "have heard of
it and could counsel on it." Counseling patients to stop taking the 2
listed products together was not necessarily the correct answer, as we are
aware of the debate in the literature, and this was beyond the scope of our
survey. We wholeheartedly agree with Dennehy that more clinical data are
needed to either support or refute suspected drug–NHP interactions. Our
group is endeavoring to help expand this body of literature.
We found that pharmacists want and need more information to effectively
care for patients taking NHPs (over 90% of respondents wanted additional
training in NHPs). We are currently developing education and research around
pharmacist involvement in the active surveillance of adverse events related to
NHPs. By partnering with community pharmacists to proactively ask patients
about NHP–drug interactions, we hope to further this area of knowledge
and provide the clinically relevant data that are so urgently needed.
