SPS resources

SPS has a variety of resources on complementary medicines, which we recommend you check first. Please also see our guide: Questions to ask when reviewing herbal medicines and interactions.

If the information is not available on the SPS website or the information resources listed, or if your clinical scenario is complex, we suggest you seek further advice from our Medicines Advice service.

Recommended resources

In addition to our own resources, we particularly recommend the following resources. Many are free to access unless indicated.

MHRA Herbal medicines

The MHRA lists herbal medicines that have a Traditional Herbal Registration (THR) and lists banned or restricted herbal ingredients. These lists only relate to herbal medicines considered by the MHRA to have medicinal uses. Many herbal medicines are classified as food supplements and will not be listed.

Clinical Knowledge Summaries and NICE

Clinical Knowledge Summaries (CKS) and NICE Clinical Guidelines can sometimes include the use or avoidance of herbal medicines.

For example:

• Irritable bowel syndrome in adults
• Management of aphthous ulcer
• Management of erectile dysfunction
• Managing vasomotor symptoms
• Support for people living with dementia and their carers

Use the NICE website search function to locate any UK guidance statements relating to the herbal medicine.

Summaries of Product Characteristics

Summaries of Product Characteristics (SmPCs/SPCs) are available via electronic Medicines Compendium and MHRA. They list interactions with other medicinal products and other forms of interaction in section 4.5.

Other useful sections include:

• contraindications (4.3)
• special warnings and precautions for use (4.4)
• pharmacodynamic properties (5.1)
• pharmacokinetic properties (5.2)

SmPCs sometimes include interactions with herbal medicine. They are useful to understand how conventional medicines are metabolised and how they affect metabolism of other medicines.

Some food supplements are available as licensed medicines such as omega oils and calcium and vitamin D preparations.

Stockley’s Herbal Medicines Interactions

Available to subscribers via Medicines Complete, monographs in Stockley’s Herbal Medicines Interactions describe the evidence, mechanism, clinical importance and management of herbal medicines, food supplements, nutraceuticals with conventional medicines.

The Interaction Checker allows users to search for interactions between multiple medicines; information is provided for each pair of interacting drugs, with links to the full Stockley monographs.

National Center for Complementary and Integrative Health

A series of brief factsheets with basic information about specific herbs from the US Department of Health and Human Services. The factsheets include potential side effects, safety advice, and major interactions with conventional medicines.

NatMed Pro

NatMed Pro (subscription required) is a comprehensive USA database with monographs on vitamins, minerals, herbs and foods. Each monograph provides guidance on effectiveness, potential safety concerns, typical dosing, and interactions.

The database also has tools including an interaction checker for conventional medicines and complementary medicines. The tool recognises a wide range of combination complementary medicines available in the USA.

Memorial Sloan Kettering Cancer Center

Referenced monographs on the US based Memorial Sloan Kettering Cancer Center are aimed at patients and healthcare professionals.

The information for herbal medicines includes mechanism of action, side effects and warnings, effects on liver enzymes, and commonly reported interactions.

Mayo Clinic

Monographs from the US based Mayo Clinic include herbal medicines and food supplements.

The information for herbal medicines includes suggested uses, cautions, safety and side effects, and possible interactions.

Herbal Medicines

Available to subscribers via Medicines Complete, monographs in Herbal Medicines cover the most commonly used herbal medicines. The potential interactions with conventional medicines are highlighted within the monographs.

The monographs include information on pharmacological properties of herbal medicines.

Stockley’s Drug Interactions

Available to subscribers via Medicines Complete, monographs in Stockley’s Drug Interactions include interactions with commonly used herbal medicines.

The Interaction Checker allows users to search for interactions between multiple herbal medicines and conventional medicines; information is provided for each pair of interacting medicines, with links to the full Stockley monographs.

Dietary Supplements

Available to subscribers via Medicines Complete, monographs in Dietary Supplements cover the most commonly available vitamins, minerals and natural substances taken as food supplements. Guidance on safe use of supplements is provided.

Training resources

If you would like more information on how to approach answering questions on drug interactions we recommend:

Medicines Learning Portal

The Medicines Learning Portal is aimed at trainee hospital pharmacists but the content is also relevant to clinical primary care healthcare professionals. The portal includes a tutorial on alternative medicine which provides advice on:

• safety issues
• questions to ask when considering questions relating to alternative medicine