An epidemiological study of concomitant use of Chinese medicine and antipsychotics in schizophrenic patients: implication for herb-drug interaction

• Published in: PloS one 2011-02, Vol.6 (2), p.e17239
• Main Authors: Zhang, Zhang-Jin, Tan, Qing-Rong, Tong, Yao, Wang, Xue-Yi, Wang, Huai-Hai, Ho, Lai-Ming, Wong, Hei Kiu, Feng, Yi-Bin, Wang, Di, Ng, Roger, McAlonan, Grainne M, Wang, Chuan-Yue, Wong, Vivian Taam
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Antigens; Antipsychotic agents; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - therapeutic use; Antipsychotics; Chi-square test; Clinical outcomes; Clozapine; Combined Modality Therapy - adverse effects; Confidence intervals; Correlation analysis; Cross-Sectional Studies; Cytochrome; Demographic variables; Demographics; Drug interaction; Drug interactions; Drugs; Drugs, Chinese Herbal - therapeutic use; Emotional disorders; Epidemiologic Studies; Epidemiology; Female; Genetic research; Herb-Drug Interactions - physiology; Herbal medicine; Herbs; Hospitals; Humans; Male; Medical research; Medicine; Medicine, Chinese Traditional - adverse effects; Medicine, Chinese Traditional - utilization; Mental disorders; Mental health; Metabolism; Paranoia; Patients; Pharmaceuticals; Pharmacology; Pharmacovigilance; Psychiatric hospitals; Psychiatry; Psychosis; Psychotropic drugs; Questionnaires; Quetiapine; Retrospective Studies; Schizophrenia; Schizophrenia - drug therapy; Schizophrenia - epidemiology; Sociodemographics; Surveys; Surveys and Questionnaires; Toxicology; Trends; Urban areas; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0017239

Herb-drug interactions are an important issue in drug safety and clinical practice. The aim of this epidemiological study was to characterize associations of clinical outcomes with concomitant herbal and antipsychotic use in patients with schizophrenia. In this retrospective, cross-sectional study, 1795 patients with schizophrenia who were randomly selected from 17 psychiatric hospitals in China were interviewed face-to-face using a structured questionnaire. Association analyses were conducted to examine correlates between Chinese medicine (CM) use and demographic, clinical variables, antipsychotic medication mode, and clinical outcomes. The prevalence of concomitant CM and antipsychotic treatment was 36.4% [95% confidence interval (95% CI) 34.2%-38.6%]. Patients using concomitant CM had a significantly greater chance of improved outcomes than non-CM use (61.1% vs. 34.3%, OR = 3.44, 95% CI 2.80-4.24). However, a small but significant number of patients treated concomitantly with CM had a greater risk of developing worse outcomes (7.2% vs. 4.4%, OR = 2.06, 95% CI 2.06-4.83). Significant predictors for concomitant CM treatment-associated outcomes were residence in urban areas, paranoid psychosis, and exceeding 3 months of CM use. Herbal medicine regimens containing Radix Bupleuri, Fructus Gardenia, Fructus Schisandrae, Radix Rehmanniae, Akebia Caulis, and Semen Plantaginis in concomitant use with quetiapine, clozapine, and olanzepine were associated with nearly 60% of the risk of adverse outcomes. Concomitant herbal and antipsychotic treatment could produce either beneficial or adverse clinical effects in schizophrenic population. Potential herb-drug pharmacokinetic interactions need to be further evaluated.