Introduction
According to the US-Food and Drug Administration (FDA), the interaction
between drugs and food or beverages can mainly affect the activity of
drugs, either by increasing or decreasing their medicinal effects,
causing unexpected side effects, or leading to the development of a new
pharmacological effects that drugs would not produce originally (1-3).
Many people all over the world are used to taking their drugs with food,
beverages, or herbs (4). For example, approximately, one in five Asian
people take their medications concurrently with herbal products and
juices (4). These products may contain chemicals that interfere with the
prescribed drugs leading to changes in their bioavailability and
alteration of their pharmacokinetic properties (5). People usually take
their drugs with herbs or beverages such as juices seeking for health
benefits or to taste-mask the bitterness of some drugs (6).
Some plants or herbs are well known for their ability to interact with
drugs (5). The most common example is St. John’s wort (Hypericum
perforatum ), which is used for mild depression and known for its
interactions with various drugs (7). Examples of these drugs include
antidepressants like serotonin reuptake inhibitors, immunosuppressants
such as ciclosporin and tacrolimus, human immunodeficiency virus( HIV) medications, and hormonal contraceptives (2, 7). Ginkgo
(Ginkgo biloba ), usually used to improve memory and blood
circulation, can inhibit platelet-activating factor; thus, it is
well-known for its interaction with warfarin resulting in an increased
risk of bleeding (2, 8). In addition, since the discovery of grapefruit
juice interaction with felodipine; an antihypertensive medication, many
studies were conducted on other juices to investigate their tendency to
perpetrate potential food-drug interaction (9-11).
Numerous patients do not mention the concurrent administration of their
medications with food, beverages, or herbs to their physicians or
pharmacists due to many reasons (5). Firstly, physicians do not usually
ask their patients about their method of drug administration and the
intake of other health products such as herbs or over-the-counter (OTC)
drugs, as they usually focus on the patients’ conventional drugs (12).
Secondly, physicians do not have enough knowledge about herbal remedies
uses, side effects and drug interactions (13-15). Thirdly, either
patients or their healthcare providers, do not consider natural products
an important thing to mention (8). Finally, patients fear the potential
disapproval of their healthcare providers regarding their use of
non-prescribed drugs and herbs (16, 17). As a result, patients have
fewer opportunities to learn about potential interactions with their
drugs or other herbal products (5, 18).
Several studies were conducted to assess the awareness of healthcare
professionals about simultaneous intake of food, beverages and herbal
products with drugs (19, 20), However, there are a limited number of
studies investigating the awareness of the public community toward such
practice (21, 22), which can have serious health repercussions on
individuals (23-25).
This is the first study assessing the extent of perception and use of
food, beverages, and herbs alongside conventional drugs among Jordanian
society.