@article{f65c2106ba064674b878799d1b585842,
title = "Complementary and alternative medicine: Risks and special considerations in pretransplant and posttransplant patients",
abstract = "Although herbs and botanicals have been available for thousands of years, detailed scientific research regarding the potential health benefits and risks of dietary supplements has been conducted only for the past 15-20 years. Millions of Americans use herbal supplements regularly, but many are not aware of the possible hidden dangers. Organ transplant recipients and patients with end-stage organ failure awaiting transplantation are at particularly high risk for potential complications due to herbal supplement use. This review provides background information regarding complementary and alternative medicine (CAM) use in the United States, regulatory history of dietary supplements in the United States, and concerns and special considerations regarding the risks associated with dietary/herbal supplement use in pretransplant and posttransplant patients.",
keywords = "complementary therapies, herb-drug interactions, herbal medicine, organ transplantation, transplantation, transplants",
author = "Corey, {Rebecca L.} and Jorge Rakela",
note = "Funding Information: Despite the many issues and problems with supplement quality, fraudulent or misleading advertising, toxicity, and drug interactions, ongoing efforts have made significant progress to improve quality standards, consumer education, and knowledge of safety and efficacy for supplements. Selected resources for obtaining reliable information pertaining to herbal/dietary supplements are listed in Table 4 . Most notably, NCCAM, a component of the National Institutes of Health, has provided funding for thousands of research projects over the past decade and continues to support ongoing efforts to explore complementary and alternative medicine in the context of rigorous science. The NCCAM and the Office of Dietary Supplements collectively disseminate authoritative information to the public and to healthcare professionals about the safety and efficacy of dietary supplements. The FDA{\textquoteright}s Center for Food Safety and Applied Nutrition (CFSAN) monitors the marketplace for potential “illegal,” “counterfeit,” or unsafe products and issues warnings or recalls when necessary. The CFSAN also provides online safety alerts for consumers and collaborates with the FTC to monitor supplement advertising. The FDA{\textquoteright}s Final Rule requiring supplement manufacturers to adhere to GMPs was the first step to improving supplement quality. In addition, independent laboratories and verification programs are available to analyze supplements and ensure that they meet certain quality standards. One such program is the U.S. Pharmacopeia (USP) Supplement Verification Program. This voluntary testing and auditing program, launched in 2001, is available worldwide to verify the quality, purity, and potency of dietary supplements. The program does not assess safety or efficacy of supplements. The USP verification program is also voluntary, so supplement manufacturers are not required to have their supplements analyzed. However, if a supplement passes the analysis and earns the “USP Verified” symbol, consumers can be assured that the supplement they are buying (1) contains the ingredients listed on the label in the declared potency and amounts, (2) does not contain harmful contaminants, (3) will break down and release into the body within a specified amount of time, and (4) has been made according to FDA current GMPs using sanitary and well-controlled procedures. When purchasing supplements, consumers should be encouraged to choose USP Verified products whenever possible. Healthcare providers should also report all supplement-related adverse events to the FDA{\textquoteright}s MedWatch program. Table 4. Selected Reliable Resources for Information Regarding Herbal or Dietary Supplements. 1. Office of Dietary Supplements, National Institutes of Health ( http://ods.od.nih.gov/ ) 2. National Center for Complementary and Alternative Medicine (NCCAM) ( http://nccam.nih.gov/ ) 3. Natural Medicines Comprehensive Database ( http://naturaldatabase.therapeuticresearch.com/ ) a 4. United States Pharmacopeial Convention (USP) ( http://www.usp.org/ ) including supplement verification program ( http://www.usp.org/usp-verification-services/usp-verified-dietary-supplements ) 5. ConsumerLab.com ( http://www.consumerlab.com/ ) a 6. United States Food and Drug Administration (FDA) Center for Food Safety and Applied Nutrition ( http://www.fda.gov/food/dietarysupplements/ ) 7. FDA MedWatch for adverse event reporting ( http://www.fda.gov/Safety/MedWatch/ ) 8. Federal Trade Commission ( http://www.ftc.gov ) a Requires paid subscription for access. ",
year = "2014",
month = jun,
doi = "10.1177/0884533614528007",
language = "English (US)",
volume = "29",
pages = "322--331",
journal = "Nutrition in Clinical Practice",
issn = "0884-5336",
publisher = "SAGE Publications Ltd",
number = "3",
}