Alternative Medications

In addition to traditional medications, consumers have access to many substances that are not considered a part of conventional or mainstream pharmacothera-peutics. These substances often consist of natural products such as herbal preparations, vitamins, minerals, and other nutritional substances that are taken to promote optimal health or to treat various conditions. These products are usually classified as dietary supplements by the Food and Drug Administration (FDA), and are therefore not subjected to the rigorous testing and scrutiny required for prescription drugs and many over-the-counter medications. 

These nontraditional products are often described as complementary or alternative medications (CAMs), to differentiate them from the more conventional medications that are classified as drugs by the FDA. lb be specific, a complementary medication is a substance that is used in addition to a conventional treatment, whereas an alternative medication is used as a substitute for a more traditional or mainstream treatment.44 Other terms are applied to specific interventions, such as herbal remedies, naturopathic treatments, phytomedicines, and so forth. Flowever, for the purpose of this chapter the term CAM will be used to encompass the array of substances that fall outside conventional pharmacotherapeutic regimens. 

CAMs and other nontraditional healing philosophies (meditation, yoga, acupuncture, and so forth) have been a mainstay in certain cultures and societies. Western cultures, however, have generally been more aligned with conventional treatments and medications. Nonetheless, the interest and use of CAMs in persons living in the United States has increased dramatically over the past several years. Although it is dif- 

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Interview the patient to assess complementary or alternative medication use. Counsel appropriately based on indications and drug interactions. 

Perform a thorough history of prescription, nonprescription, and alternative medications. 

Obtain a thorough history of prescription, non-prescription, and complementary/alternative medication use. Determine what treatments have been helpful to the patient in the past Is the patient taking any medications that may increase PD symptoms ... 

CAM, complementary and alternative medications CNS, central nervous system CVA, costovertebral angle OTC, over-the-counter OUI, overflow urinary incontinence SUI, stress urinary incontinence UTI, urinary tract infection UUI, urge urinary incontinence. 

Drug desensitization is a potentially life-threatening procedure that requires continuous monitoring in a hospital setting with suitable access to emergency treatment and intubation. It should be undertaken only under the direction of a physician with suitable training and experience. In such hands, desensitization presents less risk than treatment failure with a less effective alternative medication. 

Drug desensitization maybe undertaken in the absence of useful alternative medications. The risk of severe systemic reactions and anaphylaxis associated with desensitization must be compared with the risk of not treating the patient. Thorough evaluation should establish that the drug probably caused the reaction by an... 

Consult with a physician trained in desensitization if the patient has a true allergy and no acceptable alternative medication is available. 

Complementary and alternative medicines A group of practices and products that are not presently considered to be part of conventional medicine, including alternative medical systems (e.g., homeopathic medicine and naturopathic medicine), mind-body interventions (e.g., meditation and mental healing), biologically-based therapies (e.g., dietary supplements, vitamins, herbs, and other natural products), manipulative body-based methods (e.g., acupuncture and massage), and energy therapies (e.g., therapeutic touch and bioelectromagnetic-based therapies). 

First, optimize current mood stabilizer or initiate mood-stabilizing medication lithium,0 valproate,0 or carba-mazepine0 Consider adding a benzodiazepine (lorazepam or clonazepam) for short-term adjunctive treatment of agitation or insomnia if needed Alternative medication treatment options carbam-azepine0 if patient does not respond or tolerate, consider atypical antipsychotic (e.g., olanzapine, quetiapine, risperidone) or oxcarbazepine. 

Alternative medication treatment options carbam-azepine0 if patient does not respond or tolerate, consider oxcarbazepine. 

The reduction in the numbers of incinerators and the limitations of autoclaves have created the need for alternative medical waste treatment systems. Currently, there are over 40 such technologies available from greater than 70 manufacturers within the United States, Europe, the Middle East, and Australia. While these systems vary in their treatment capacity, the extent of automation, and overall volume reduction, all alternative technologies utilize one or more of the following methods (1) heating the waste to a minimum of 90 to 95°C by means of microwaves, radio waves, hot oil, hot water, steam, or superheated gases (2) exposing the waste to chemicals such as sodium hypochlorite (household bleach) or... 

Based on the information given, what kind of person would be least likely to seek out alternative medical treatment ... 

Perhaps this charge will be less credible in the future. American public interest in alternative medicine has expanded dramatically in recent years. According to polls, interest is particularly strong among persons of above average education who are in relatively poor health. The alternative medications they adopt are available largely as food supplements and herbal remedies in 1997 the market for these commodities amounted to 3.6 billion. Orthodox medicine has not ignored this solid trend, and many American medical schools now offer courses and sponsor research into alternative... 

In this context, judging the qualifications of an alternative medicine practitioner can be difficult— there are no universally accepted guidelines. Some states require licensing of alternative medicine practitioners (e.g., acupuncturists, naturopathic herbalists), and licensure is often used by courts to establish school-specific standards of care. In cases where no licensing exists, courts apply conventional medical or lay standards of care. Eisenberg (1997) has proposed strategies for physicians in guiding patients who seek alternative medical treatment. 

Eisenberg DM. (1997). Advising patients who seek alternative medical therapies. Ann Intern Med. 127(1) 61-69. 

Behavioral Complication Preferred Medications Alternative Medications ... 

Blocking the beta receptor can lower blood pressure, slow heart rate, trigger erectile dysfunction (impotence), or worsen breathing difficulties in patients with asthma or emphysema. The best way to manage these side effects is to use the lowest effective dose. If the side effects remain intolerable at the least effective dose, then it s probably necessary to switch to an alternative medication. 

There is a strong case for public intervention in vaccine provision, particularly in view of the external benefits of vaccines. It is important that decisions by government bodies reflect both benefits and costs of the alternatives, which the lOM committee s recommendations promoted. Fortunately, although there are some disagreements about how best to quantify benefits of vaccines and of alternative medical interventions, the amount of agreement among the experts far exceeds the areas of disagreement. 

The prevalence of complementary and alternative medication (CAM) is increasing among older adults. In a recent report, nearly two thirds of ambulatory elderly used at least one form of CAM, but much of CAM use was unrecognized by physicians, CAMS have been associated with adverse events (Table 9) and important drug interactions between CAMs and conventional drug therapies have been... 

Considering the need, if any, for alternative treatments (e.g., psychotherapy, behavioral therapy, or alternative medications)... 

Wetzel MS, Kaptchuk TJ, Haramati A, Eisenberg DM. Complementary and alternative medical therapies implications for medical education. Ann Intern Med 2003 138(3) 191-196. 

Adams KE, Cohen MH, Eisenberg D, Jonsen AR. Ethical considerations of complementary and alternative medical therapies in conventional medical settings. Ann Intern Med 2002 137(8) 660-664. 

Navo MA, Phan J, Vaughan C, et al. An assessment of the utilization of complementary and alternative medication in women with gynecologic or breast malignancies. J Clin Oncol 2004 22(4) 671-677. 

Gelenberg AJ, Shelton RC, Crits-Christoph P, et al. The effectiveness of St. John s wort in major depressive disorder a naturalistic phase 2 followup in which nonresponders were provided alternate medication. J Clin Psychiatr 2004 65(8) 1114 1119. 

Kessler RC, Davis RB, Foster DF, et al. Long-term trends in the use of complementary and alternative medical therapies in the United States. Ann Intern Med 2001 135 262-268. 

To support approval as a nonbotanical drug, adequate and well-controlled clinical studies are required. Not only must the treatment be shown to be effective, with real patient benefits in morbidity and/or mortality to justify the safety risk of adverse reactions as observed, but the clinical data must also provide practical instructions for use, which can be reasonably followed by health care professionals. There is no reason why these requirements should be different for botanical drugs, because patient suffering and treatment benefits are independent of medical theory or practice. Regardless of medical systems and terminology used, courses of diseases/conditions should be established and treatment effects must be clinically meaningful. Incorporation of alternative medical practice into the clinical studies will be acceptable if the new set of instructions derived from such studies will be practical. 

As noted above, all available information on the historical use of botanical preparations will be accepted for safety consideration. But for FDA clinical reviewers, such experiences are often poorly documented and difficult to interpret or correlate with the paradigm of conventional (Western) medicine. In the alternative medical system, almost all the diagnoses to be treated with herbal medicine are defined in imprecise and foreign terms. Typically, one herbal medicine is indicated for numerous seemingly unrelated conditions, most of which are symptomatic relief without clear mechanisms. Furthermore, many botanicals are combinations of multiple herbs, but few references are available for the rationale of combining so many ingredients. 

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