Complementary medicines and interaction with medications

It is estimated that two thirds of Australians use complementary medicines and spend around $4 billion on the complementary medicines industry.

Complementary medicines are any product such as herbs, vitamins, minerals, nutritional products and aromatherapy preparations available without a prescription. Complementary medicine also include wellness modalities such as acupuncture, yoga and massage.

The industry includes degree qualified practitioners registered with the Australian Health Practitioners Regulation Agency such as osteopaths, chiropractors and Chinese medicine practitioners. In addition, there are self-regulated industries such as naturopaths and herbalists. However, other providers within the complementary medicines industry may call themselves ‘practitioners’ without bearing any qualifications.

Complementary Medicines

The Therapeutic Goods Administration (TGA) regulates complementary medicines in Australia under the Australian Register for Therapeutic Goods. Most complementary medicine products registered in Australia are registered as Listed medicines (AUST L). This means the TGA considers these products as low risk listed medicines, and assess the products only for safety and quality.

Prescription medicines available in Australia (and some over the counter products) are listed as Registered medicines (AUST R). This means they have been assessed for safety, quality and effectiveness at treating a particular medical condition and are generally only available with a prescription or by talking to your pharmacist.

People often self-prescribe complementary medicines believing there is no harm in taking natural products. It is important to remember that some prescription medicines were originally derived from plants such as aspirin (derived from willow bark), quinine (derived from cinchona bark) and digoxin (derived from foxglove).

Complementary medicines can still cause harmful effects and allergic reactions.

Some common complementary products include calcium, vitamin D, fish oil and nutritional products such as protein shakes. While people may purchase these products as an ‘insurance policy’, it is a good idea to have your diet analysed by an Accredited Practising Dietitian if you feel you are lacking something. They can advise if dietary changes are required. Or, have blood pathology taken to establish if you are low in any vitamins and minerals.

When talking to your health care team always advise them of all complementary medicines you are taking.

Many complementary medicines can interact with your prescription medications

Some common interactions include:

  • St John’s wort can affect the metabolism of many prescription medications and should not be taken with antidepressants.
  • Fish oil may interact with warfarin causing an additive bleeding risk. Some surgeons may delay surgery if fish oil has not been discontinued for a nominated period of time prior to surgery.
  • Some nutritional supplements such as high energy protein shakes may not be beneficial for people with diabetes. They can contain a large number of calories, or could adversely affect your health conditions.

Before taking any oral complementary medicine, ask your health care team:

  • Is it safe and effective?
  • Is it necessary?
  • How will it affect my diabetes?

It is important that you never stop taking your prescribed medication.

Complementary therapies

Complementary therapies are often considered as physical or spiritual therapies and are utilised to improve overall health, such as:

  • Yoga to improve flexibility and strength,
  • Massage to help manage physical pain or to help with relaxation,
  • Meditation to help slow down the mind and reduce stress.

Some complementary therapies, such as those listed above, are becoming more accepted as legitimate therapies to help improve health and wellbeing. They are considered effective at reducing stress.

If you choose to use complimentary therapies ask the practitioner what qualifications they have and how long they took to obtain. Massage therapists are required to complete a certificate level 4, a remedial massage therapist may have a diploma of remedial therapies, while a myotherapist may hold a degree in health science. (Myotherapy is a form of physical therapy used to treat or prevent soft tissue pain and restricted joint movement caused by muscle or myofascia dysfunction. Myotherapists use a range of techniques such as sports and remedial massage, stretching, cold and hot therapy, nerve stimulation via a TENS machine and trigger point therapy.) Yoga instructors may have qualifications ranging in supervised training hours from 200 hours up to 2000 hours before they are qualified.

Ask your health care team what comparable benefits are available through Medicare such as with physiotherapists, exercise physiologists and psychologists.

It is important to note that while some complementary medicine practitioners may have qualifications at degree level, these qualifications may not be assessed with the same rigor of health degrees obtained through mainstream universities.

Ultimately, if you do decide to use complementary medicines and therapies you should advise your health care team. They can help answer the question of whether it is safe and if it will affect your diabetes.

 

Alison Crow
Pharmacist and Credentialled Diabetes Educator

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