Examination of Herbal-drug Interactions: Implications for Patient Safety and Healthcare Practice in Lebanon: A Cross-sectional Study
Authors: Assi Mohammad , AlMoussawi Rasha , Boukhary Rima , Nasser Sahar , Wattar Jana , Akel Marwan 
Published: December 2024

Background
The lack of regulation of herbal products in Lebanon, and potential risks associated with herbal-drug interactions potentiates the need for increasing awareness and understanding of herbal-drug interactions among patients and athletes in Lebanon. This study highlights the need for increased awareness and understanding of herbal-drug interactions among healthcare professionals and patients in Lebanon.

Objective
The study aims to investigate the level of knowledge and understanding of herbal interactions and conventional medications among Lebanese patients. Moreover, the study will examine the Lebanese patients’ awareness, perception towards Herbal Drug Interactions (HDIs) and the role of pharmacists in patient education and information provided about herbal medicine.

Methods
A cross-sectional, descriptive study was performed from March to May 2023 consisting of Lebanese outpatients (General Population and Athletes) aged 20 years and older at Lebanese community pharmacies who agreed to respond to the survey questionnaire from medications, sociodemographic and clinical characteristics were collected from patients via face-to-face Interviews, and a well-structured survey questionnaire administered to a representative sample of Lebanese patients to gather data via Online Google Platform Surveys. All these calculations are performed using Statistical Package for the Social Sciences Software (SAS), SAS Institute. Descriptive statistics are used to describe independent variables. One-Way ANOVA analysis followed by a t-test (binary logistic regression) was performed to identify factors associated with HDI(s).

Results
The results of this study provide valuable insights into the current state of awareness and highlight areas for improving patient education regarding herbal-drug interactions, which included 501 patients, with a mean age of 50.248 years, 53.1% of them being female 58.9% and males 41.1%. The category of Lebanese patients who consumed Herbal medications during the last 12 months accounted for 46.7% and advising others to take herbal medication, 47.9%, versus patients who don’t consume herbal medications 53.3%. Lebanese patients get their recommendation for herbal medication use from mass media such as TV, ads, social media (32.3%), pharmacist (21.6%), family members with friends and neighbours (19%), personal reading/ Internet search (13.6%), didn’t get any recommendation (10.8%), Herbalist (9.8%), and Physician (7.4%).

Conclusion
The study provides valuable insights into the awareness of herbal-drug interactions and the need for understanding these interactions among professionals and patients where various factors affect negatively the unauthorized use of herbal products such as the economic crisis in Lebanon which negatively affected the purchasing power of Lebanese patients to buy their conventional medications, the affordable prices of herbal medications, and the reputation of folk medicine practiced by ancestors.