Background: The global resurgence in the use of herbal remedies—especially among older adults with chronic illnesses—has raised serious safety concerns regarding herb-drug interactions (HDIs). Despite being perceived as natural and harmless, many herbal products possess potent pharmacological activity and may alter the efficacy or toxicity of prescribed medications, especially in polypharmacy settings (Posadzki et al., 2021).
Objective:
This study aims to evaluate the prevalence, nature, and clinical relevance of HDIs in a mixed population of patients using traditional herbal products alongside prescription drugs. It also assesses the awareness levels among healthcare providers and users regarding such interactions.
Methods: A cross-sectional hospital-based observational study was conducted at a tertiary care facility in Lahore, Pakistan, from January to June 2025. Data were gathered using patient interviews (n=200), chart reviews, and a structured survey for physicians and pharmacists (n=50). Additionally, a literature-based comparison of key HDIs was performed using data from published studies between 2018 and 2024 (Chan et al., 2019; Jiang et al., 2020).
Results: Among surveyed patients, 47% reported concurrent use of herbal and allopathic medicines. Of these, 31% had experienced symptoms potentially linked to HDIs, such as increased bleeding (noted in 8.5% using ginkgo with anticoagulants), altered blood pressure (6.2% using licorice), or reduced drug efficacy (e.g., St. John’s wort reducing antidepressant potency in 4.8%). Only 18% of patients had informed their physicians about herbal use. Surveyed healthcare providers underestimated HDI prevalence, with 62% lacking formal training on the topic
Conclusion: Herb-drug interactions are underreported yet clinically significant in real-world settings. There is an urgent need for improved surveillance, education, and regulatory oversight to mitigate preventable adverse outcomes from concurrent herbal and pharmaceutical use.
Keywords: herbal-drug interactions, traditional medicine, pharmacovigilance, patient safety, polypharmacy, complementary therapies, survey, Pakistan