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Cover page of the Journal of Health Sciences


 
 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 13  |  Issue : 1  |  Page : 11-15

Polypharmacy in diabetes: A boon or a bane


Department of Dravyaguna, All India Institute of Ayurveda, New Delhi, India

Date of Submission09-Sep-2019
Date of Acceptance30-Oct-2019
Date of Web Publication23-Jan-2020

Correspondence Address:
Dr. Geetika Pahuja
Department of Dravyaguna, All India Institute of Ayurveda, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_175_19

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  Abstract 


Diabetes is one among the various lifestyle disorders and was reported to be 7th leading cause of death by the WHO in 2016. To manage blood glucose levels and combat associated medical conditions, polypharmacy is becoming the choice of treatment by diabetics. Due to the unawareness of diabetics regarding the polypharmacy, it was thought to gather the scientific published literature at a place which will guide both the physicians as well as patients to choose a right herb along with conventional medicine. The scientific online portals were reviewed, and data reporting synergistic or antagonistic effects were searched for their clinical as well as preclinical evidence. There are several herbs mentioned in classical texts, which have antidiabetic potential and other beneficial effects on one's body. These drugs do exhibit synergistic as well as antagonistic effects when used along with conventional medicines. One should opt for polypharmacy cautiously and judiciously under medical supervision only.

Keywords: Concomitant use, diabetes, herb and drug interaction, home remedies, polypharmacy, Prameha


How to cite this article:
Pahuja G, Kumar P, Ghildiyal S, Nesari T. Polypharmacy in diabetes: A boon or a bane. Indian J Health Sci Biomed Res 2020;13:11-5

How to cite this URL:
Pahuja G, Kumar P, Ghildiyal S, Nesari T. Polypharmacy in diabetes: A boon or a bane. Indian J Health Sci Biomed Res [serial online] 2020 [cited 2020 Feb 18];13:11-5. Available from: http://www.ijournalhs.org/text.asp?2020/13/1/11/276420




  Introduction Top


In diabetic capital, India,[1] polypharmacy has become a trend[2],[3],[4],[5] to manage the sugar levels and associated conditions. Thus, herb–drug interaction incidents are increasing and getting acknowledged. In general, botanical/herbal formulations are thought of as health supplements and to have no side effects. As an herb contains several pharmacologically active constituents which work synergistically to produce significant effects. When it is taken concomitantly with drugs, it may act synergistically or antagonistically, arising a need to analyze their positive as well as the negative effects. Hence, an attempt is made to gather the data useful in opting polypharmacy.


  Materials and Methods Top


Botanicals indicated for Prameha (diabetes mellitus) were compiled from Brihattrayi, that is, Charak samhita, Sushruta samhita, and Astanga Hridaya. Published research data from PubMed, Google Scholar, Sci-Hub, and various other research journals were referred to gather the information regarding the available scientific documentation of their antidiabetic studies and interaction studies of these botanicals with conventional medicines. The available data are presented in a scientific manner.


  Observations and Results Top


Botanicals indicated for Prameha in Barihattrayi and available data regarding their Interaction with drugs is listed in [Table 1] and [Table 2] respectively.
Table 1: Botanicals indicated for Prameha (diabetes mellitus) in Brihattrayi

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Table 2: Herb-drug interaction data

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  Discussion Top


Diabetes mellitus has become one of the important health concerns in today's era. In 2016, diabetes was the direct cause of 1.6 million deaths.[22] The diabetic population in the country is close to hitting the alarming mark of 69.9 million by 2025.[1] Due to the chronic nature of the disease, secondary failures to oral antihyperglycemics and associated diseases, polypharmacy has become the need of the hour.

As per the study, the botanicals/herbal formulations are being used by around 80% of today's global population as a supplement to conventional medicine.[23] As botanical/herbal formulations are claimed to have no side effects and thought of as nervine tonics and health supplements, these are frequently chosen to combat these medical conditions. The fact that an herb contains several pharmacologically active constituents which work synergistically to produce significant effects remains unnoticed and is generally taken concurrently with drugs. When taken concomitantly, it may alter the normal pharmacodynamics or kinetics of the drugs by acting synergistically or antagonistically to them. Thus, polypharmacy should be opt judiciously and cautiously. As maximum times, the information regarding the use of polypharmacy is not shared with the physicians.[24] Hence, adverse events or failures in treatment are getting acknowledged.

On combing Brihattrayi, 86 botanicals are cited for the management of Prameha (Diabetes Mellitus), of which 73 botanicals have been screened for their antidiabetic potential, and out of them, many are in use as an OTC product or as prescription medicine. Although 73 botanicals have been screened for their antidiabetic potential, only nine botanicals are screened for their interaction with antihyperglycemic agents and insulin. As the above-mentioned botanicals are from Brihattrayi only, many more botanicals may be entitled to the same action in other Samhitas/Chikitsa granthas; it may be assumed that these may also interact with other conventional medicines when taken concurrently. Thus, vigilance is necessary regarding the ongoing pattern of polypharmacy, and time-to-time update regarding their interactions is the need of an hour if any.

Although the herbs are of utmost importance, as they are of innumerable benefits to humankind opting polypharmacy is a right step. However, along with such concomitant usage of medicines of various types, a need arises to analyze the positive as well as the negative role of herbs and its modalities when used concomitantly. Such data are critical for the development of future clinical guidelines to better health-care outcomes. Both the synergistic effects as well as antagonistic effects may be taken positively. The herbs having synergistic as well as additive effects may lead to enhanced antidiabetic effects and may require guidance for dosage management of antihyperglycemic agents, thereby minimizing their side effects or might help in combating secondary failures to them. Furthermore, antagonistic effects may lead to harmful effects. Thus, both cases warrant cautionary usage/selection and should be used judiciously under medical supervision only.


  Conclusion Top


The above data suggest that caution should always be exercised by both patients as well as physicians while opting for polypharmacy. Furthermore, these botanicals may be used concomitantly with conventional medicines, especially in chronic illnesses due to their compromised body functions (e.g., renal and hepatic functions in particular), but rationally and under judicial medical guidance only. However, further research is needed on the mechanisms of action underlying these herb–drug interactions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Chakrapanidutta S. Charak Samhita. Varanasi: Chaukhamba Subhartiprakashana; 2016.  Back to cited text no. 6
    
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Shastri A. Sushruta Samhita. Reprint Edition. Varanasi: Chaukhamba Sanskrit Samsthana; 2006.  Back to cited text no. 7
    
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Gupt KA. Astang Hridya. Reprint Edition. Varanasi: Chaukhamba Prakashana; 2012.  Back to cited text no. 8
    
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Raja P, Thejaswini JC, Gurupadayya BM, Mruthyunjaya K, Latha Saranya CH. Evaluation of influence of gymnema tea on antidiabetic activity of metformin in diabetic rats. Indo Am J Pharm Res 2013;3:12.  Back to cited text no. 11
    
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Appiah-Opong R, Commandeur JN, Axson C, Vermeulen NP. Interactions between cytochromes P450, glutathione S-transferases and Ghanaian medicinal plants. Food Chem Toxicol 2008;46:3598-603.  Back to cited text no. 21
    
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Malagi KJ, Kamath M, Adiga SH, Herb-drug interaction in diabetes: A bane or a boon. J Diabetes Metab Disord Control 2014;1:53-7.  Back to cited text no. 23
    
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    Tables

  [Table 1], [Table 2]



 

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