Interação entre fármacos e plantas: abordagem à perceção da classe médica

Abstract

ResumoIntrodução: O consumo concomitante de medicamentos/produtos à base de plantas e/ou medicamentos tradicionais à base de plantas com fármacos biológicos ou de síntese química sujeitos a prescrição médica pode constituir um problema de gravidade variável. Em concordância com este facto, tem surgido um interesse crescente da comunidade científica sobre o tema das interações entre medicamentos/produtos à base de plantas com fármacos de síntese química ou biológicos. De acordo com cinco principais motores de busca, a produção científica sobre esta temática, duplicou na década de 2010-2020.Objetivos: A presente dissertação teve como objetivo conhecer a posição da classe médica no que é relativo a aspetos essenciais sobre a temática das interações entre fármacos de síntese ou biológicos, e produtos à base de plantas (PBP). Por uma questão de agilização do presente trabalho, define-se que “PBP-Produtos à base de plantas”, é um termo no qual se englobam “medicamentos tradicionais à base de plantas”,” medicamentos à base de plantas,” substâncias derivadas de plantas”,” preparações à base de plantas “, e” suplementos alimentares à base de plantas”, isentos de qualquer prescrição, e que sejam consumidos sem obrigatoriedade de vigilância médica. Resultados: Os respondentes do género feminino (n=157, 69,4%), e do género masculino (n=69, 30,5%) distribuíram-se por uma faixa etária predominante (43,8%) e 25-35 anos com tempo de exercício de Medicina, em ambos os géneros (ca 41%) na janela 3-10 anos de exercício. Existiu um claro predomínio de participação das ARS do Norte e ARS Lisboa e Vale do Tejo, com 24,3% e 31,41% do total de respostas, respetivamente, sendo a ARS Alentejo a menos representada (3,5%). A maioria dos médicos (64,1%) respondeu não exercer no setor privado, nunca ouviu falar do reconhecimento legal dos medicamentos tradicionais à base de plantas, e desconhece (73,4%) a existência de algum observatório ou site que aborde a temática relativa às interações entre medicamentos de uso tradicional/suplementos à base de plantas com fármacos de prescrição. A maioria dos respondentes (n=176, 77,8%) considera que os PBP influenciam o efeito terapêutico dos fármacos, e 58,4% (n=132), eventualmente aceitaria um convite para participar num debate sobre a temática das interações entre PBP e fármacos correntes de prescrição médica, enquanto que 59,2% (n=134) considera importante a formação médica incluir terapia com PBP, e 64,6% (n=146), gostaria de aprofundar conhecimentos de prática clínica sobre os PBP. A quase totalidade dos respondentes (n=214, 94,69%) nunca teve formação na área da terapia com PBP, e quase 38% (n=84, 37,1%) revelam questionar o doente sobre utilização destes produtos, em menos de metade das vezes. Foi reconhecida (n=170, 75,5%) ser importante ou muito importante a abordagem destes temas.

AbstractIntroduction: Concomitant consumption of herbal medicines/products and/or traditional herbal medicines with biological or synthetic drugs subject to current and general medical prescription can be a problem of varying severity. And in accordance with this fact, there has been a growing interest in the scientific community on the topic of interactions between medicines/herbal products with drugs. According to five main search engines, the scientific production on this subject, in the 2010-2020 decade alone, doubled!Objectives: This dissertation aimed to know the position of the medical profession, regarding essential aspects on the topic of interactions between biological or synthetic drugs and over-the-counter herbal products. For the sake of streamlining the present work, it is defined that “PBP-Herbal products”, is a term which includes “traditional herbal medicines”, “herbal medicines”, “Herbal substances”, "Herbal preparations", and "Herbal food supplements".Methodology: Data collection was carried out through an original questionnaire in an anonymous form, based on the “Microsoft Office Forms” platform, with the data provided being used exclusively for statistical analysis, with no personal, individualizing information having been collected, in addition to gender and age. The form questions, in addition to the acceptance questions, were grouped into profile questions, perception questions, opinion questions and perceived needs, training questions, attitude questions and, finally, questions about the opinion regarding the distributed questionnaire.Results: Female (n=157, 69.4%) and male (n=69, 30.5%) respondents were distributed by a predominant age group (43.8%) and 25-35 years with practice time in Medicine, in both genders (ca 41%) in the 3-10 years of practice window. There was a clear predominance of participation by ARS do Norte and ARS Lisboa e Vale do Tejo, with 24.3% and 31.41% of the total responses, respectively, with ARS Alentejo being the least represented (3.5%). Most physicians (64.1%) responded that they do not practice in the private sector, and have never heard about legal recognition of traditional herbal medicines, and are unaware (73.4%) of the existence of any observatory or website that addresses the theme related to interactions between herbal medicines/supplements and biological or synthetic prescription drugs. Most respondents (n=176, 77.8%) consider that PBP influence the therapeutic effect of drugs, and 58.4% (n=132) would eventually accept an invitation to participate in a debate on the topic of interactions between PBP and current biological or synthetic prescription drugs, while 59.2% (n=134) consider it important for medical training to include PBP therapy, and 64.6% (n=146) would like to deepen their knowledge of clinical practice on PBP. Most respondents (n=214, 94.69%) had never had training in the area of therapy based plant and revealed (n=84, 37.1%) that they question the patient about the use of medicinal plants in less than half of the interviews. It was recognized (n=170, 75.5%) that it was important or very important to approach these themes.Conclusions: Almost all (94.6%) physicians answered that they had never had training in the area of therapy based on plant, only ca. 5.4 % had, and the vast majority (88%) have the opinion that PBPs can influence or greatly influence the expected effects of biological or synthetic drugs. There is a weak positive correlation between the group of respondents who claim to have knowledge of the interaction with PBP, and the group of respondents who claim to have had training in plant therapy. There is a strong correlation between the group that demonstrates knowledge about interactions and the group that indicated that they would like to deepen their knowledge about plant based therapy. In question 8 (Have you heard of the legal recognition of traditional herbal medicines?), 64.1% answered NO, 35.8% answered YES. Question 13 (Do you consider it important for medical training to include therapy with herbal medicines/supplements?), had 73.8% of the options marked as “Important” and “Very Important”. There is a strong correlation between the answers to the two questions. Question 15 (Do you ask patients if they use medicinal plants for therapeutic purposes?), has a strong correlation with the physical space (question 6) in which the doctor performs his/her role. This allows us to conclude that, regardless of the physical space where they work, doctors are concerned about questioning patients about the possible use of medicinal plants. Currently, the medical universe not only recognizes the limitations in this area, but is even open to learning and including this topic in medical training, as the respondents assumed its importance in the context of drug prescription, as well as assuming the influence that PBP have on action of biological or synthetic prescription drugs.