Biggs Jessica M, Morgan Jill A, Lardieri Allison B, Kishk Omayma A, Klein-Schwartz Wendy
Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland.
J Pediatr Pharmacol Ther. 2017 Nov-Dec;22(6):385-393. doi: 10.5863/1551-6776-22.6.385.
The use of dietary supplements has increased and is associated with adverse effects. Indications for use include recreation, body image concerns, mood enhancement, or control of medical conditions. The risk of adverse effects may be enhanced if agents are used improperly. The objective of this study was to determine the frequency of abuse and misuse of 4 dietary substances among adolescents reported nationally to poison centers. Secondary outcomes included an assessment of medical outcomes, clinical effects, location of treatments provided, and treatments administered.
This descriptive retrospective review assessed data concerning the use of garcinia (Garcinia cambogia), guarana (Paullinia cupana), salvia (Salvia divinorum), and St John's wort (Hypericum perforatum) among adolescents reported nationally to poison centers from 2003 to 2014. Adolescents with a singlesubstance exposure to one of the substances of interest coded as intentional abuse or misuse were included. Poison center calls for drug information or those with unrelated clinical effects were excluded. Data were collected from the National Poison Data System.
There were 84 cases: 7 cases of Garcinia cambogia, 28 Paullinia cupana, 23 Salvia divinorum, and 26 Hypericum perforatum. Garcinia cambogia was used more frequently by females (100% versus 0%), and Paullinia cupana and Salvia divinorum were used more frequently by males (61% versus 36% and 91% versus 9%, respectively). Abuse, driven by Salvia divinorum, was more common overall than misuse. Abuse was also more common among males than females (p <0.001). Use of these agents fluctuated over time. Overall, use trended down since 2010, except for Garcinia cambogia use. In 62 cases (73.8%), the medical outcome was minor or had no effect or was judged as nontoxic or minimally toxic. Clinical effects were most common with Paullinia cupana and Salvia divinorum. Treatment sites included emergency department (n = 33; 39.3%), non-healthcare facility (n = 24; 28.6%), admission to a health care facility (n = 8; 9.5%), and other/unknown (n = 19; 22.6%).
Abuse and misuse of these dietary supplements was uncommon, and outcomes were mild. Further research should be performed to determine use and outcomes of abuse/misuse of other dietary supplements in this population.
膳食补充剂的使用呈上升趋势且与不良反应相关。其使用指征包括娱乐、关注体型、改善情绪或控制疾病状况。若使用不当，不良反应风险可能会增加。本研究的目的是确定全国中毒控制中心报告的青少年中4种膳食物质滥用和误用的频率。次要结果包括对医疗结局、临床效应、治疗地点及所实施治疗的评估。
本描述性回顾性研究评估了2003年至2014年全国中毒控制中心报告的青少年中藤黄果（藤黄属）、瓜拉那（巴西香可可）、鼠尾草（鼠尾草属）和圣约翰草（贯叶连翘）的使用数据。纳入了单一物质接触感兴趣物质之一且编码为故意滥用或误用的青少年。排除了中毒控制中心关于药物信息的咨询电话或具有无关临床效应的电话。数据从国家中毒数据系统收集。
共有84例病例：藤黄果7例、瓜拉那28例、鼠尾草23例、圣约翰草26例。藤黄果在女性中使用更频繁（100%对0%），瓜拉那和鼠尾草在男性中使用更频繁（分别为61%对36%和91%对9%）。总体而言，由鼠尾草驱动的滥用比误用更常见。滥用在男性中也比女性更常见（p<0.001）。这些物质的使用随时间波动。总体而言，自2010年以来使用呈下降趋势，但藤黄果的使用除外。在62例（73.8%）病例中，医疗结局轻微或无影响，或被判定为无毒或毒性极小。临床效应在瓜拉那和鼠尾草中最常见。治疗地点包括急诊科（n = 33；39.3%）、非医疗机构（n = 24；28.6%）、入住医疗机构（n = 8；9.5%）以及其他/不明（n = 19；22.6%）。
这些膳食补充剂的滥用和误用并不常见，且结局较轻。应开展进一步研究以确定该人群中其他膳食补充剂滥用/误用的情况及结局。
