The co-use of conventional drugs and herbs among patients in Norwegian general practice: a cross-sectional study
Open accessAbstract
BACKGROUND: Different patient groups are known to use herbal remedies and conventional drugs concomitantly (co-use). This poses a potential risk of herb-drug interaction through altering the drug's pharmacokinetics or pharmacodynamics. Little is known about co-use among patients in general practice. The primary aim of this study was to compare patients in general practice that co-use herbal remedies and conventional drugs with those who do not. The secondary aim was to register the herb-drug combinations with potential clinical relevant interactions among the co-users. METHOD: A questionnaire based cross-sectional study conducted in the autumn 2011 in a general practice office with four general practitioners (GPs) and one intern in Western Norway. Adults >18 years who came for an office visit were invited. The questionnaire asked about demographics, herbal use, conventional drug use and communication about herbal use. Multivariable logistic regression was used to compare co-users to the other patients. RESULTS: Of the 381 patients who completed the questionnaire, the prevalence of herbal use was 44%, with bilberry (41%), green tea (31%), garlic (27%), Aloe vera (26%) and echinacea (18%) as the most frequently used. Among those using conventional drugs regularly, 108 (45%) co-used herbs. Close to 40% of patients on anticoagulants co-used herbs, with garlic and bilberry as the most frequent herbs. Compared to all other patients, co-users had significantly (p < 0.05) increased odds to be female (adjOR 2.0), age above 70 years (adjOR 3.3), use herbs to treat an illness (adjOR 4.2), use two or more herbs (polyherbacy, adjOR 12.1) and having experienced adverse effects of herbal use (adjOR 37.5). Co-use was also associated with use of analgesics or dermatological drugs (adjOR 5.1 and 7.9 respectively). Three out of four patients did not discuss herbal use with any health care professional. CONCLUSION: A sizable proportion of the GP patients co-used herbs with conventional drugs, also combinations with reported interaction potential or additive effects like anticoagulants and garlic. The low disclosure of herbal use to their GP, polyherbacy and the risk of interactions in vulnerable groups like elderly and chronically ill patients, warrant increased awareness among GPs.
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Concurrent, often undisclosed use of berberine with prescription drugs is common in older adults.
“Concurrent, often undisclosed use with prescription drugs is common in older adults, yet berberine is far from inert.”
From Berberine-Drug Interactions: Mechanisms, Clinical Relevance and Risk Stratification-A Narrative Review (2026) · cites this paper as [7]
The Abstract Results and Discussion (Characteristics of co-users) report frequent herb–drug co-use, with higher co-use among patients over 70. The Results also report that nearly 80% of herb users did not discuss their use with a health professional. These findings concern herbs generally; the paper does not establish that berberine co-use is common or often undisclosed among older adults. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBetween 5% and over 80% of older adults combine supplements with prescription drugs, and a substantial proportion carry at least one potential interaction.
“Population studies report that between 5% and over 80% of older adults combine supplements with prescription drugs, and a substantial proportion carry at least one potential interaction [3,4,5,6,7].”
From Berberine-Drug Interactions: Mechanisms, Clinical Relevance and Risk Stratification-A Narrative Review (2026) · cites this paper as [7]
The Background (page unavailable) reports herb–prescription-drug co-use among 31–75% of older adults who use herbs, and the Discussion reports that nearly 40% of patients over 70 in this study co-used herbs and drugs. The paper identifies 18 of 255 herb–drug combinations as having potential clinically relevant interactions, but it does not establish the claimed 5% to over 80% range for older adults or quantify the proportion of older adults with at least one potential interaction. (LLM, conf=0.88)
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- Authors
- Djuv, A., Nilsen, O. G., & Steinsbekk, A.
- Affiliations
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Djuv, Ane
- Venue
- BMC Complementary and Alternative Medicine
- Published
- 2013-10-30
- Volume
- 13
- Issue
- 1
- Pages
- 295-295
- ISSN
- 1472-6882 (ISSN-L)
- PMC
- PMC4228482
- OpenAlex
- W2081685648
- Cited by
- 80
- References
- 59
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 10 · 2021: 13 · 2020: 7 · 2019: 8 · 2018: 8 · 2017: 6 · 2016: 6 · 2015: 6 · 2014: 3
- FWCI
- 11.82
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Complementary and Alternative Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Funders
- Norges Teknisk-Naturvitenskapelige Universitet
- Helse Midt-Norge
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Phytochemistry Medicinal Plant Applications
- Keywords
- herb-drug interactions, general practice patients, anticoagulants, garlic, Vaccinium myrtillus, green tea, Aloe vera, Echinacea, elderly patients, general practitioners
- MeSH terms
- Adult, Aged, Aged, 80 and over, Communication, Cross-Sectional Studies, Drug Therapy, Combination, Female, Humans, Male, Phytotherapy, Middle Aged, Norway, Patients, Plant Extracts, Surveys and Questionnaires, Herbal Medicine, Herb-Drug Interactions, Young Adult
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