HERBAL SEDATIVES AND HYPNOTICS: A COMPARATIVE ANALYSIS OF THEIR USE IN THE WESTERN REGION OF NORTH MACEDONIA

Arijeta Shabani; Mirlind Bexheti

doi:10.35120/medisij040241s

Authors

Arijeta Shabani Department of Pharmacy, Faculty of Medical Sciences, University of Tetova, North Macedonia Author
Mirlind Bexheti Department of Pharmacy, Faculty of Medical Sciences, University of Tetova, North Macedonia Author

DOI:

https://doi.org/10.35120/medisij040241s

Keywords:

herbal sedatives, anxiety disorders

Abstract

This study aims to analyze the use of herbal sedatives in North Macedonia, comparing their usage to conventional sedatives and hypnotics. The analysis examines sales data of herbal and conventional sedatives from January 2022 to December 2024, collected from pharmacies in the western region of North Macedonia. The findings reveal that the use of herbal sedatives is relatively low, ranging from 1.2% in Tetovo to 7% in Struga, although there is an increase in demand in certain cities. Despite this growth, the overall use of herbal sedatives remains limited. Furthermore, the study underscores the need for developing healthcare policies that integrate herbal sedatives into the healthcare system. This can be achieved through the creation of educational programs, training for healthcare professionals, and the establishment of guidelines for the safe and effective use of these medicines. Such integration could lead to an increase in the use of herbal sedatives and improve public health by providing new treatment options for sleep and anxiety disorders.

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References

Akhondzadeh, S., Naghavi, HR., Vazirian, M., Shayeganpour, A., Rashidi, H., Khani, M. (2001). Passionflower in the treatment of generalized anxiety: a pilotdouble-blind randomized controlled trial with oxazepam. J Clin Pharm.Ther. 26: 363–367

Algradi, AM., Liu, Y., Yang, B-Y., Kuang, H-X. (2021). Review on the genus Brugmansia: Traditional usage, phytochemistry, pharmacology, and toxicity. Journal of Ethnopharmacology. 279: 113910. doi: 10.1016/j.jep. 2021.113910

Ashraf, M., Saeed, H., Saleem, Z., Rathore, H.A., Rasool, F., Tahir, E., Bhatti, T., Khalid, J., Bhatti, I., Tariq, A. (2019). A cross-sectional assessment of knowledge, attitudes and self-perceived effectiveness of complementary and alternative medicine among pharmacy and non-pharmacy university students. BMC Complementary Altern. Med. 19, 95.

Avidan, A.Y., Neubauer, D.N. (2017). Chronic Insomnia Disorder. Continuum (Minneap Minn). 23, 1064–1092. Benke, D., Barberis, A., Kopp, S., Altmann, KH., Schubiger, M., Vogt, KE., et al. 2009. GABAA receptors as in vivo substrate for the anxiolytic action of valerenic acid, a major constituent of valerian root extracts. Neurophar¬macology.56:174-181.

Benkherouf, AY., Eerola, K., Soini, SL., Uusi-Oukari, M. (2020). Humulone modulation of GABAA receptors and its role in hops sleep-promoting activ ity. Front Neurosci. 14:594708.

Benkherouf, AY., Logrén, N., Somborac, T., Kortesniemi, M., Soini, SL., Yang, B., et al. (2020a). Hops compounds modulatory effects and 6-prenylnaringenin dual mode of action on GABAA receptors. Eur J Pharmacol. 3: 172962.

Bravo, R., Franco, L., Rodríguez, AB., Ugartemendia, L., Barriga, C., Cubero, J. (2018). Tryptophan and hops: chrononutrition tools to improve sleep/wake circadian rythms. Ann Clin Nutr. 1:1004.

Buysse, DJ. 2014. Sleep health: can we define it? Does it matter? Sleep. 37:9-17.

Carbone, K., Gervasi, F. (2022). An updated review of the genus Humulus: a valuable source of bioactive compounds for health and disease preven tion. Plants (Basel). 11:3434.

Chien, KL., Chen, PC., Hsu, HC., Su, TC., Sung, FC., Chen, MF., Lee, YT. (2010). Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: report from a community-based cohort. Sleep. 33 (2): 177-184. doi: 10.1093/sleep/33.2.177

Dantas, L., de Oliveira-Ribeiro, A., de Almeida-Souza, L., Groppo, F. (2017). Effects of passiflora incarnata and midazolam for control of anxiety in patients undergoing dental extraction. Medicina Oral, Patologia Oral y Cirugia Bucal. e95-e101.

Dimpfel, W., Suter, A. (2008). Sleep improving effects of a single dose administration of a valerian/hops fluid extract–a double blind, randomized, placebo-controlled sleep-EEG study in a parallel design using electrohypnograms. Eur J Med Res.13: 200–204

Farah, GJ., Ferreira, GZ., Danieletto-Zanna, CF., Luppi, CR., Jacomacci, WP. (2019). Assessment of Valeriana officinalis L. (valerian) for conscious sedation of patients during the extraction of impacted mandibular third molars: a randomized, split-mouth, double-blind, crossover study. J Oral Maxillo fac Surg. 77: 1796.e1–1796.e8

Franco, L., Galán, C., Bravo, R., Bejarano, I., Peñas-Lledo, E,, Rodríguez, AB, et al. (2015). Effect of non-alcohol beer on anxiety: relationship of 5-HIAA. Neurochem J. 9:149-152.

Harvey, AG. (2001). Insomnia: Symptom or diagnosis? Clin. Psychol. Rev. 21(7):1037-59.

Henst, RHP., Pienaar, PR., Roden, LC., Rae, DE. (2019). The effects of sleep extension on cardiometabolic risk factors: A systematic review. Journal of Sleep Research. 28 (6): e12865. doi: 10.1111/jsr.12865

Houghton, PJ. (1999). The scientific basis for the reputed activity of valerian. J Pharm Pharmacol. 51:505-512.

Ibarra, A., Feuillere, N., Roller, M., Lesburgere, E., Beracochea, D. (2010). Effects of chronic administration of Melissa officinalis L. extract on anxiety-like reactivity and on circadian and exploratory activities in mice. Phyto medicine. 17: 397–403

Koetter, U., Schrader, E., Käufeler, R., Brattström, A. (2007). A randomized, double blind, placebo-controlled, prospective clinical study to demonstrate clinical efficacy of a fixed valerian hops extract combination (Ze 91019) in patients suffering from non-organic sleep disorder. Phytother Res. 21: 847–851

Kowalczyk, A., Kurpas, D., Bodalska, A., Han, S., Kuchar, E., Marciniak, D., Fecka, I. (2019). The use of OTC herbal sedatives by pharmacy patients. Acta Poloniae Pharmaceutica, Drug Research, Vol. 76 No. 4 pp. 769ñ775, DOI: 10.32383/appdr/105938

Leach, MJ., Page, AT. (2015). Herbal medicine for insomnia: a systematic review and meta-analysis. Sleep Med Rev 24:1-12.

Lee, J., Jung, HY., Lee, SI., Choi, JH., Kim, SG. (2020). Effects of Passiflora incarnata Linnaeus on polysomnographic sleep parameters in subjects with insomnia disorder: a double-blind randomized placebo-controlled study. Int Clin Psychopharmacol. 35: 29–35

Miroddi, M., Calapai, G., Navarra, M., Minciullo, PL., Gangemi, S. (2013). Passiflora incarnate L.: ethnopharmacology, clinical application, safety and evaluation

Morin, CM., Drake, CL., Harvey, AG., Krystal, AD., Manber, R., Riemann, D. et al. (2015). Insomnia disorder. Nat Rev Dis Primers. 1:15026.

Morin, CM., Koetter, U., Bastien, C., Ware, JC., Wooten, V. (2005). Valerian-hops combination and diphenhydramine for treating insomnia: a random¬ized placebo-controlled clinical trial. Sleep. 28:1465-1471.

Ozarowski, M., Mikolajczak, PL., Piasecka, A., Kachlicki, P., Kujawski, R., Bogacz, A, et al. (2016). Influence of the Melissa officinalis Leaf Extract on Long-Term Memory in Scopolamine Animal Model with Assessment of Mechanism of Action. Evidence-Based Complementary and Alternative Medicine. E.B. Complement Alternat Med. 9729818. doi: 10.1155/2016/9729818

Pizinger, TM., Aggarwal, B., St-Onge, MP. (2018). Sleep Extension in short sleepers: an evaluation of feasibility and effectiveness for weight management and cardiometabolic disease prevention. Frontiers in Endocrinology (Lausanne). 9: 392. doi: 10.3389/fendo.2018.00392

Plushner, SL. (2000). Valerian: Valeriana officinalis. Am J Health Syst Pharm. 57: 328, 333, 335

Sadabadi, F., Darroudi, S., Esmaily, H., Asadi, Z., Ferns, GA,, Mohammadpour, AH., Nooriyan, AH., Mobarhan, MG., Moohebati, M. (2023). The importance of sleep patterns in the incidence of coronary heart disease: a 6-yearprospective study in Mashhad, Iran. Scientific Reports. 13 (1): 2903. doi:10.1038/s41598-023-29451-w

Sateia, MJ., Buysse, DJ., Krystal, AD., Neubauer, DN., Heald, JL. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 13: 307–349

Savage, K., Firth, J., Stough, C., Sarris, J. (2018). GABA-modulating phytomedicines for anxiety: a systematic review of preclinical and clinical evidence. Phytother Res. 32: 3–18

Shakeri, A., Sahebkar, A., Javadi, B. (2016). Melissa officinalis L.–A review of its tradi tional uses, phytochemistry and pharmacology. J Ethnopharmacol. 188: 204–228

Sharma, S., Kukreti, P., Kataria, D. (2018). Sedative hypnotic’s overdose: Epidemiology, diagnosis, and management. Indian Journal of Medical Specialities. 9(3):134-9.

Shi, Y., Dong, J.W., Zhao, J.H., Tang, L.N., Zhang, J.J. (2014). Herbal Insomnia Medications that Target GABAergic Systems: A Review of the Psychopharmacological Evidence. Curr. Neuropharmacol. 12, 289–302.

Shi, Y., Dong, JW., Zhao, JH., Tang, LN., Zhang, JJ. (2014). Herbal insomnia medi¬cations that target GABAergic systems: a review of the psychopharma¬cological evidence. Curr Neuropharmacol.12:289-302

Shinjyo, N., Waddell, G., Green, J. (2020). Valerian root in treating sleep problems and associated disorders—a systematic review and meta-analysis. J Evid Based Integr. 25:2515690X20967323

Stock, AA., Lee, S., Nahmod, NG., Chang, AM. (2020). Effects of sleep extension on sleep duration, sleepiness, and blood pressure in college students. Sleep Health. 6 (1): 32-39. doi: 10.1016/j.sleh.2019.10.003

Taibi, DM., Landis, CA., Petry, H., Vitiello, MV. (2007). A systematic review of va lerian as a sleep aid: safe but not effective. Sleep Med Rev. 11:209 230.

Temirova, OA., Horodetska, NY., Khaitovych, MV., Potaskalova, VS. (2023). Pharmaceutical care is an important component of the rational use of sedative drugs. Msu-journal, Vol. 19 No. 3, https://doi.org/10.32345/2664-4738.3.2023.13

Villet, S., Vacher, V., Colas, .A, Danno, K., Masson, J-L., Marijnen, P, et al. (2016). Open-label observational study of the homeopathic medicine Passiflora Compose for anxiety and sleep disorders. Homeopathy.105(1):84-91.

Welz, A.N., Emberger-Klein, A., Menrad, K. (2018). Why people use herbal medicine: Insights from a focus-group study in Germany. BMC Complementary Altern. Med. 18.

Winkelman, JW. 2015. Insomnia disorder. N Engl J Med. 373:1437-1444.

Zanoli, P., Zavatti, M. (2008). Pharmacognostic and pharmacological profile of Humulus lupulus L.J Ethnopharmacol.116:383-396.

Zeng, L-N,, Zong, Q-Q., Yang, Y., Zhang, L., Xiang, Y-F., et al. (2020). Gen¬der difference in the prevalence of insomnia: a meta-analysis of observational studies. Front Psychiatry. 11:577429.

Zhang, H., Liu, P., Wu, X., Zhang, Y., Cong, D. 2019. Effectiveness of Chinese herbal medicine for patients with primary insomnia: A PRISMA-compliant meta-analysis. Medicine (Baltimore). 98, e15967.

Ziegler, G., Ploch, M., Miettinen-Baumann, A., Collet, W. (2002). Efficacy and toler ability of valerian extract LI 156 compared with oxazepam in the treat ment of non organic insomnia– a randomized, double-blind, compara tive clinical study. Eur J Med Res. 7: 480–486