Pharmacist Insight on St. John's Wort, Cranberry, Garlic

Pharmacist Insight:

Pharmacists Spoken with: Kaitlin Baraszu, PharmD, Rick Gray, BSPharm, Steve Snider, BSPharm from Meijer Pharmacy in Woodhaven, MI

Team Member Assigned: Mary Rothermal

Herbal #1: St. John’s Wort

Knowledge level of the RPh about the clinical issues associated with product: I spoke with two pharmacists regarding their personal knowledge level of St. John’s Wort and the counseling points they felt were necessary to give to a patient inquiring about St. John’s Wort.  One pharmacist said he felt he possessed not only adequate amount of information to counsel on the product but also understood its clinical significance of this product in other countries than the United States.  The pharmacist told me he would be very thorough in talking with the patient due to major drug interactions and he would be sure to gather an updated medication history before making a recommendation to buy this supplement.  

How comfortable she/he is with discussing this product to a patient: One of the pharmacists I discussed St. John’s Wort with told me he would not recommend the product due to the safety concerns, while also admitting he has read studies that have shown its benefit on those with depression.  He feels that as a community pharmacist he does not have a good way to follow up with the patient to ensure compliance, monitor adverse effects and be available to consistently answer questions regarding the product.  The other pharmacist I spoke to had a completely different opinion on the product.  He said he had also read a multitude of studies attesting to the clinical benefits of St. John’s Wort and that he would just be adamant that the patient calls the pharmacy with any questions and lets their physician know of the addition to their medications immediately.

Herbal #2: Cranberry

Knowledge level of the RPh about the clinical issues associated with product: The pharmacist felt very knowledgable about cranberry use for urinary tract infection prevention.  He explained cranberry adheres to the walls of the bladder and can help to prevent urinary tract infections in this way.  He said that he was not aware of any drug interactions or safety concerns with supplementation of cranberry.  The pharmacist said he would stress the supplement would only be effective as a preventative measure and that is does not work as an antibacterial agent.  

How comfortable she/he is with discussing this product to a patient: Steve, the pharmacist I spoke with, said he would feel at ease discussing to a patient the clinical benefits of cranberry.  He did, however, tell me he could not recall if the knowledge he had about the supplement came from pharmacy school or information he had gathered on his own during his many years of community practice.

Herbal #3: Garlic

Knowledge level of the RPh about the clinical issues associated with product: I spoke to two pharmacists at Meijer about the use of garlic in clinical scenarios.  The first one said that there was never a case she would suggest it, this was explicitly due to the fact that she was not comfortable with her knowledge of the product rather than any issues with safety.  The second pharmacist I spoke with said he did not believe the product contained potency enough to lower blood pressure and would have to look up the dosing if he was asked about that.  Both pharmacists agreed the product did not work.

After speaking with a pharmacist at CVS I found that garlic may help to lower cholesterol slightly, however the effect is not marked. She said that there shouldn’t be many major drug interactions and that it should be OK to take with standard statin medications.

How comfortable she/he is with discussing this product to a patient: Both pharmacists I spoke with said the only safety concern they were aware of with regards to garlic was its potential interaction with anticoagulation medication.  Both agreed they would have to refer to a clinical pharmacology site before being able to answer any further questions about garlic.

The pharmacist sounded comfortable speaking about garlic but did not provide a lot of information.