Implementation of an integrative safety consultation service for the use of dietary and herbal supplements among patients with hematological diseases.

A majority of hematological patients referred to the integrative safety consultation service were already using dietary and herbal supplements (DHS) before consultation.

• 42 patients were included in the study between 2021 and 2024
• 28 patients (67%) used DHS before the consultation
• In 21% of patients who used DHS before consultation, DHS was documented in the medical chart by the time of first consultation
• All documented DHS pertained to vitamins or minerals only

Employment status was associated with greater likelihood of DHS use among hematological patients.

• Employed patients were more likely to use DHS (p = 0.02)
• This was identified through analysis of 42 patients referred to the integrative safety consultation team

A large number of potential DHS-drug interactions were identified across the patient cohort.

• A total of 176 potential interactions were described in 30 patients
• Most interactions were theoretical (45%)
• The predominant mechanism was pharmacodynamic additive (59%)
• Herbs were involved in 82% of interactions
• The most commonly implicated drug classes were antihypertensives (26%) and anticoagulants (23%)

One adverse side effect was identified following DHS prescription during the consultation service.

• A patient prescribed Hericium (lion's mane mushroom) developed leg edema and neuropathic pain exacerbation
• Causality was assessed as probable according to both the Naranjo scale and FDA algorithm
• This was the only side effect disclosed during the study period

Patients' concerns about their condition improved between the first and second consultation visits.

• Symptom and side effect assessment was repeated at each follow-up visit to evaluate DHS safety
• Patients' concerns improved from the first to the second visit
• The consultation model involved a naturopath recommending DHS based on disclosed symptoms with subsequent safety analysis by a clinical pharmacist

DHS use is common among hematological patients despite known safety concerns, and documentation of DHS use in medical records was inadequate prior to the consultation service.

• Dietary and herbal supplements are used by approximately 30% of hematological patients according to background literature
• Only 21% of DHS users had their supplement use documented in the medical chart before first consultation
• All pre-existing DHS documentation was limited to vitamins or minerals, suggesting herbal and other supplement use was routinely undocumented