Quality Control and Complication Screening Programme of Chinese Medicinal Drugs at the First German Hospital of Traditional Chinese Medicine - A Retrospective Analysis.
BACKGROUND
The use of drugs derived from plants is a cornerstone of Traditional Chinese Medicine (TCM). Yet, too little is known about risk and safety of Chinese medicinal drugs (CMD). Therefore, the TCM hospital Bad Kötzting has developed a quality control and complication screening programme in order to ensure a safe administration of TCM drugs to their patients.


METHODS
All Chinese medicinal drugs delivered to the hospital between September 1, 2012 and December 31, 2013 entered the quality control program and were screened for microbial contamination, aflatoxin, pesticides and heavy metals. A routinely applied complication screening programme monitored liver enzymes in all patients. Case causality assessment by CIOMS scale and identification of admitted herbs were conducted. Additionally, side effects of patients were identified by a routinely performed web-based documentation system.


RESULTS
In 5 of 23 investigated samples (21.7%) the initial testing showed microbial contamination (2), pesticide (2) and heavy metals (1). The drugs were tested for authenticity and adulterations, respectively. All 994 patients (mean age 52.6 years; 72.6% female) admitted were available for analysis. 448 (45.1%) of all patients reported having perceived at least one side effect of treatment. They experienced mainly gastrointestinal symptoms (13.6%), neurovegetative symptoms (10.8 %), temporary deteriorations of pain (8.8%), diarrhoea (5.9%), nausea (1.6%) and vomiting (0.5%). Further, 6 patients with a more than 2-fold elevation (compared to maximum normal value or elevated admission values) of ALT were found in the systematic laboratory control with a non-conclusive causality assessment for TCM-drugs.


CONCLUSIONS
Approximate incidence rates and analysed drugs associated with liver damage revealed a low rate of liver injury. Patients should be informed of the gastrointestinal symptoms caused by and potential hepatotoxicity of TCM herbs.
Dieter
D
Melchart
Stefan
S
Hager
Jingzhang
J
Dai
Wolfgang
W
Weidenhammer
D004340:Drug Contamination / Q000517:prevention & control*; D004353:Drug Evaluation, Preclinical / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis* / Q000517:prevention & control*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects* / Q000592:standards*; D005858:Germany; D006761:Hospitals; D006801:Humans; D008403:Mass Screening; D008516:Medicine, Chinese Traditional / Q000592:standards*; D011786:Quality Control
D004365:Drugs, Chinese Herbal