Expert Discusses What Pharmacists Should Know About Herbal Supplements for Dementia

In an interview with Pharmacy Times® at the American Society of Health-System Pharmacists Midyear Meetings and Exhibition, Kalin Clifford, PharmD, BCGP, BCPS, FASCP, associate professor in the Geriatrics Division at Texas Tech University Health Sciences Center in the Jerry H. Hodge School of Pharmacy, discusses the potential benefits of herbal supplements for dementia care.

Q: What is the benefit of herbal supplements for individuals with dementia?

Kalin Clifford: I think that's really an interesting question because with all the ads and all the information that we are getting bombarded with, our patients are getting bombarded with online, on the internet, by their friends by their colleagues, everyone thinks that they're very safe and benign. However, we have learned over the years, they do have adverse effects that we do need to worry about. As pharmacists, we need to also be wary of that when we are looking at these products for our patients, and know that these are not benign agents, and that we do need to be cautious when we are recommending them.

Q: What should pharmacists know about herbal supplements for dementia care?

Kalin Clifford: Pharmacists need to know in regards to recommending herbal supplements when being used for dementia care, is that a lot of these agents have not really had the same thorough or rigid randomized control trials. A lot of these studies were done in very small subgroup of patients, less than 50 patients in the majority of the studies. They evaluated each patient group for up to a total of 6 months, and a lot of these studies, unfortunately, which with dementia, many times for us is safer therapies, even at an appropriate dose or even effective, we usually have to watch these patients for at least 6 months before we can say this drug has been effective or not.

The other issue with a lot of these herbal supplements as well is the data that is supporting them is not really well-founded data at this point in time, not for all herbal supplements across the board. We also need to be cautious that in our dementia patients that this could also be an additional medication, that could be an additional cost to them and may lead to more harm down the road.

Q: What are some complementary alternative medication recommendations for those with dementia?

Kalin Clifford: With the data that we have in regards to complementary and alternative medication and medication management for a lot of these patients, we do need to look at, not necessarily starting an herbal supplement all the time, the ones that do have some data are ginkgo biloba, Huperzine A, which is found in a lot of the over-the-counter supplements that we that you can get from a lot of the pharmacies that are on the market.

We also know that vitamin E may also have some effect as well. However, this data should be interpreted with caution. The best advice that I can give to a lot of our colleagues is that we really should be if we are going to consider these agents, we need to start using these much earlier when a patient's maybe being evaluated for dementia. They don't have a lot of great benefit once they've had long-standing dementia, and they've already started on other drug therapy, prescription drug therapies.

Q: What are some of the difficulties surrounding these complementary alternative medication products?

Some of the difficulties that we do need to be aware of is that there is really a lack of data in regard to their use, are we really seeing the clinical benefit that we can see compared to the other agents that are out on the market?

Honestly, with dementia itself, it is just a devastating disease that, unfortunately, that a lot of our patients do pass away with. All that we can really do with our current therapies on the market, even with our complementary and alternative medication therapy. All we can really do at this time is really delay the progression of the disease, unfortunately, which is not a lot, not really what a lot of our patients want to hear. They want to hear, hey, this is going to fix it. I'm going to get my loved one back, they're going to have normal conversations with us like we used to. Unfortunately, this time, it just doesn't always happen.

Q: Any closing thoughts?

Kalin Clifford: I think at this point in time, we just have to be aware that sometimes our patients are going to use these agents no matter what we tell them, even if we say yes, this isn't the best agent for you. I'd recommend this or even no, don't even try one of these. You're already on everything you need to be on. At this point, a patient's going to do what they want to do, and that's it. That's okay. As pharmacists, we just have to be ready to react to it. We need to know and at least be able to ask, “Okay, what else are you taking? I need to just make sure that it doesn't interact with some of your other medications.” You're saying you're taking too many medications? Well, you're taking this, let's say you're taking 10 prescription medications, but then you're also taking 15 over the counter supplements and vitamins, and that can also lead to additional pill burden that we don't often account for. Trying to make sure that as pharmacists, we are asking all the important questions are you on? What other herbal supplements are you on what other OTC agents are you on? What other prescription drugs are you on that we can't see? Maybe in the medical record that we have access to.