In the UK the herbal medicine market is worth approximately £100 million at retail value. That is a lot of herbal medicine being sold, and up until recently without very much in the way of regulation. The quality and safety of OTC herbal remedies was not previously assured and there was a lack of onpack indication and contraindication information for consumers or their healthcare providers. In 2005, the Traditional Herbal Medicinal Products Directive was passed, allowing the manufacturers of herbal products a means to acquire Traditional Herbal Registrations. The intention of these new regulations was to allow manufacturers to provide consumers and healthcare professionals with the necessary product information in a controlled and harmonised manner throughout the European market, enabling informed, healthy choices.

To gain a Traditional Herbal Registration, manufacturers have to provide evidence of the safety and quality of the product (the same standards that apply for pharmaceutical products) and evidence of traditional use of the herb for a specific indication, which must be minor and selflimiting. Traditional use is set at 30 years minimum, with 15 of these being within Europe.

Once a registration is gained, the product can carry an indication on the packaging to say: ‘A traditional herbal medicinal product for [the condition/s that the MHRA has agreed to], based on traditional use only’. The manufacturers of registered products can then provide all the technical data needed by healthcare professionals, and can implement proper pharmacovigilance procedures and receive inspections from the MHRA, as any pharmaceutical company would do.

Herbal remedy scenarios
There are many situations in which a herbal remedy will come to your aid with certain customers. It may be that they want to avoid a certain type of medication that doesn’t suit them, for example a customer who finds that NSAIDs give them unpleasant side effects. Or they might want to try ‘something more natural’, and appreciate the fact that you have a variety of options for them. Then there are some herbs that can help tackle issues for which there may not be real solutions in the mainstream pharmacy armoury.

Customer 1 – Menopause
A menopausal woman, suffering from hot flushes and night sweats that badly disrupt her sleep at night and sap her confidence during the day. She can’t take HRT because she has a history of cardiovascular problems. Sage has a long history of use for hyperhidrosis. Its mode of action has never been linked to any hormonal pathway and therefore it is not necessary to know what the state of play is with regard to the customer’s hormone levels: if she’s sweating then sage may help. It can be used as often as required. A very simple herb to use, this can be of great assistance where there seems to be no help available elsewhere.

Customer 2 – Topical anti-inflammatory
A woman who is currently breastfeeding has a mild sprain and wants to use a topical anti-inflammatory.
Arnica gel is available for muscular aches, pains and stiffness, sprains, bruises, and swelling after injury. This is herbal arnica, as opposed to homeopathic arnica. The gel is made from extracts of fresh arnica flower heads and is suitable for use while breastfeeding. Just to make it even more helpful, it can be used while pregnant if under the supervision of a healthcare professional.

Customer 3 – Rheumatic pain
A gentleman with rheumatic pain is having trouble finding a painkiller that doesn’t upset his stomach. He is also concerned about the amount of painkilling medication that he has been taking, and doesn’t want to add to it.
Devil’s claw is used for rheumatic or muscular pain as well as general aches and pains in the muscles and joints. Using devil’s claw doesn’t involve moving up the medication, as it contains no conventional actives. It can be used as often as required. It does not appear to block the COX pathways completely, and therefore doesn’t appear to create the problems that can be linked to COX inhibitors.

Customer 4 – Raised cholesterol
A gentleman with slightly raised cholesterol has tried statins but found that he experienced soreness in his muscles and felt unduly tired. He wonders if there is anything else he could try.
There is research to show that cynara (Globe Artichoke) has cholesterol-lowering effects both in vitro1 and in vivo2. It is a food and can be incorporated into the diet, but most people prefer to take it as a supplement to gain a regular dose. It is not associated with muscle pain or fatigue, and is thought to have a beneficial effect on the digestive system. It should not be expected to have a dramatic or swift effect on cholesterol levels but, taken over a period of several months in combination with a sensible diet and some exercise, it has been shown to be beneficial. There are no dietary restrictions such as avoiding citrus fruit with cynara supplements.

Customer 5 – BPH
A gentleman with BPH has been experiencing problems with his medication. He wants to know if there is something that can help him without affecting his ability to have sex.
The herb saw palmetto can be used for symptomatic relief of BPH3. Side effects appear to be mainly belching, stomach upsets and allergic skin rashes. It can be taken alongside any other medication, including medication for BPH with the doctor’s approval. It can be taken long-term. It is not associated with negative effects on any aspects of sexual function.

General advice for using herbal remedies

  • If the product has an in-pack leaflet (as all registered products do) then follow the instructions and advice on the leaflet and product packaging;
  • If there is any doubt as to the nature of the problem, consult a doctor for diagnosis.

If the product has no in-pack leaflet or labelling advice:

  • Do not use when pregnant or breastfeeding unless under the supervision of a healthcare professional;
  • Do not exceed stated doses;
  • Do not use alongside medication with the same action e.g. tranquillising herbs alongside tranquillising medication;
  • Do not take more than three herbal remedies concurrently; n Stop taking herbal remedies 14 days before surgery.

A. Vogel
Herbal Remedies

References
1.Fintelmann V, Menssen HG. Recent results of research on artichoke leaf extract with lipid metabolism and dyspepsia. Dtsch Apoth Dg 1996; 136: 1405.
2. Bundy R et al. Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: a randomised, double blind placebo controlled trial. Phytomedicine 2008; 15: 668-75.
3. Wilt T, Ishami A, Stark G, et al. Cochrane Database Syst Rev 2000; 2:CD001423.