Rx Update: July 2002

Herbal Supplements and Other Alternative Medicines Policy and Procedure

Mary Ross, R.Ph., M.B.A., Barbara Mutnick, R.Ph., M.H.P., Joan Murhammer, R.Ph.
Peer Review Status: Internally Reviewed

The Pharmacy & Therapeutics Subcommittee has determined that herbal supplements and other alternative medicines (collectively referred to as herbal supplements) are usually not recommended for the following reasons:

• The lack of readily available clinical information from research trials demonstrating their effects, doses, and side effects;
• The lack of consistent methods for preparation and labeling of herbal supplements, which do not guarantee the amount of substances being taken for any given regimen;
• The ability for herbal supplements to interfere with potential treatments, which might be received during a patient's hospital stay;
• The ability for herbal supplements to contain other substances, which might not be labeled on the container, and which might interfere with other treatments or disease states.

For these reasons, the hospital policy and procedure for administration of personal supplies of medications has been revised to include herbal supplements.

If while conducting an admitting patient history a nurse identifies a patient that is currently taking an herbal supplement, he/she will document in the medical record the name(s) of the herbal supplements that the patient is taking. If the physician, based on the assessment of potential risks versus potential benefits, approves the continued use of an herbal supplement, the order should be written on the Physician's Order Form (Form A1-a). The patient will need to provide the physician or other member of the health care team with the names of the herbal supplements, doses, and frequency of administration. The Pharmacy will add the herbal supplement to the patient's medication profile and screen for drug interactions, disease state interactions, and potential adverse effects. The herbal supplement in question must be identifiable by Pharmacy (e.g., in the original container and recognizable upon checking with available databases or by calling the manufacturer). If the supplement is not identifiable (e.g., a bag of an unmarked/unverifiable substance), the patient will not be allowed to take it while in the hospital.

The patient is responsible for supplying and administering his/her own herbal medication. Pharmacy will not routinely purchase herbal supplements due to the liability associated with purchasing products with non-FDA regulated contents. If the physician does not approve the continued use of an herbal medication, the physician will explain to the patient why it is not recommended and will document this discussion in the medical record.

Hospital-Wide Conversion from Humulin® Insulin to Novolin® Insulin

The Pharmacy and Therapeutics Subcommittee has declared that the Humulin® and Novolin® insulin products are therapeutically equivalent and may be used interchangeably. Effective Tuesday, July 2, 2002, therapeutic interchange to the Novolin® brand is permitted for all prescriptions for regular, NPH, Lente, and 70/30 insulin prescriptions. Ultralente insulin is not available in the Novolin® brand and will, therefore, continue to be dispensed as the Humulin® brand. Both NovoLog® and Humalog® are currently on the UIHC formulary and are available for use, but are not included in the therapeutic interchange.

Outpatients will receive a letter the first time the new product is dispensed that explains the product change and that no change in dose or monitoring is needed. This therapeutic interchange has been discussed with members of the Adult and Pediatric Endocrinology staff and they are in agreement. Title Page