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

Introduction: Dietary and herbal supplements (DHS) are used by 30% of hematological patients despite safety concerns. A service of integrative safety consultations was implemented in the Hematological Institute of Bnai Zion Medical Center. This study examines the effect of such consultation on DHS safety in hematologic patients. Methods: Patients from the Hematological Institute were referred to the “integrative safety consultation team.” The naturopath recommended DHS according to symptoms disclosed, and safety analysis was performed by the clinical pharmacist. Symptom and side effect assessment was repeated in each follow-up visit to evaluate DHS safety. Results: Between 2021 and 2024, 42 patients were included. Twenty-eight (67%) used DHS before the consultation. Employed patients were more likely to use DHS (p = 0.02). A total of 176 potential interactions were described in 30 patients. Most interactions were theoretical (45%), with a pharmacodynamic additive mechanism (59%), involving herbs (82%) and antihypertensives (26%) or anticoagulants (23%). One side effect was disclosed following Hericium prescription to a patient that developed leg edema and neuropathic pain exacerbation (probable causality according to the Naranjo scale and FDA algorithm). Patients’ concerns improved from the first to the second visit. In 21% of the patients who used DHS before the consultation, DHS was documented in the medical chart by the time of first consultation, all of them pertaining to vitamins or minerals. Conclusion: Consideration of DHS in the management of patients with hematological conditions requires a systematic and comprehensive process to ensure patient safety and wellbeing. An integrative safety naturopathic-pharmacologic consultation can address such needs.