Background: Antimicrobial resistance (AMR) is a global health threat arising from inappropriate antibiotic use. Data on the prescription of antibiotics in emergency departments (EDs), critical care points for infection management, are limited. Objective: This study aimed to assess systemic antibiotic use in an Indonesian ED. Methods: This retrospective observational study was conducted in the Cilacap Teaching Hospital ED in 2022. Data, including patient demographics and systemic antibiotic prescription details (World Health Organization Anatomical Therapeutic Chemical (WHO ATC): J01) were extracted from electronic medical records. Antibiotic use was analyzed according to age groups (children [0-14 years], adults [15-64 years], and the elderly [≥65 years]), administration route, and the World Health Organization Access, Watch, and Reserve classification. Results: Among all ED visits during the study period, 52.1% (14,396/27,640) received systemic antibiotics, and adults comprised 68.5% (9861/14,396) of antibiotic-exposed cases. Cephalosporins were the most frequently prescribed antibiotics in all age groups (42.4-50.9%). Penicillins were more frequently prescribed in children (29.9%) than in adults (10.0%) and the elderly (6.6%), whereas fluoroquinolones were more commonly prescribed in the elderly (21.1%) than in adults (16.2%) and children (3.8%). Watch-class antibiotics, comprising 63.9% of all prescriptions, were commonly prescribed in the elderly (71.9%). Oral route was the predominant form (65.8%), particularly in children (76.5%). The most frequently prescribed antibiotics differed across age groups, with amoxicillin followed by cefixime in children, and cefixime followed by ceftriaxone in both adults and the elderly. Conclusions: This study showed high antibiotic exposure and identified age-related differences in antibiotic prescribing, and patterns that warrant further evaluation within antimicrobial stewardship frameworks, to optimize antibiotic use and mitigate AMR.

Early-life disruption of microbiome development is known to impair health; however, the long-term effects of pregnancy-related pharmacological alterations to the maternal gut microbiota on offspring health remain unclear. This meta-analysis aimed to evaluate the impact of maternal antibiotic use (either prenatal or intrapartum) on the risk of childhood atopic dermatitis, based on cohort and case-control studies. Literature searches were conducted in EMBASE, PubMed, Cochrane, and Web of Science databases using predefined PICO (patients, intervention, comparison, outcome) criteria. Overall, our meta-analysis included 30 studies with a total of 4,125,143 mothers and 4,346,050 children. Using the random effects model, our study found that prenatal antibiotic use was associated with higher odds of atopic dermatitis in childhood (aOR: 1.32; 95% CI: 1.12; 1.56). This result remained significant after adjusting publication bias by the trim-and-fill method (aOR: 1.22; 95% CI: 1.03; 1.44), highlighting the potential relevance of antibiotic prescribing practices during pregnancy in relation to childhood atopic disease risk. Intrapartum antibiotic use was not associated with elevated risk for atopic dermatitis in the children (OR: 1.64; 95% CI: 0.84; 3.17). Prenatal antibiotic use appears to have a modest effect on atopic dermatitis in offspring.

INTRODUCTION:Acute bronchitis is a common disease caused mainly by viral infections. Although management is primarily symptomatic, antibiotics are frequently prescribed, contributing to antibiotic resistance. Elixirium thymi compositum (Formulae Normale VIII) is a traditional Hungarian herbal medicine that has been used for decades to provide symptomatic relief of acute bronchitis, but lacks robust clinical evidence. This study aims to evaluate the efficacy and safety of Elixirium thymi compositum in the treatment of pediatric acute bronchitis. METHODS AND ANALYSIS:This randomized, controlled, double-blind, superiority trial will enroll 56 patients aged 6-17 years who have been diagnosed with acute bronchitis and have a Bronchitis Severity Score between 5 and 12 points. Participants will be randomly assigned in a 1:1 ratio to receive either Elixirium thymi compositum (18-30 mL daily, depending on age) or a placebo for 5 days. The primary endpoint is symptom improvement, measured by changes in the Bronchitis Severity Score on Day 7. Secondary endpoints include safety and tolerability assessments based on adverse events and the evaluation of concomitant medication use. Data will be collected over a 7-day follow-up period. The Hungarian Medical Research Council Ethics Committee for Clinical Pharmacology and the National Centre for Public Health and Pharmacy Institutional Committee of Science and Research Ethics approved the study protocol (NNGYK/ETGY/03198-4/2025). DISCUSSION:This study will represent the first randomized controlled trial to assess the efficacy of Elixirium thymi compositum for pediatric acute bronchitis. The study results may provide strong evidence to support clinical guidelines and help to ensure that the product continues to be used, based on evidence, to treat pediatric acute bronchitis. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, NCT07030855. Registered 26 June 2025. https://clinicaltrials.gov/study/NCT07030855.

IntroductionFalls are a leading cause of injury and hospitalization in older adults, with pharmacotherapy identified as a modifiable risk factor. Tools for identifying potentially inappropriate medications (PIMs), such as the EU(7)PIM, PRISCUS, and FORTA lists, differ in methodology. However, their comparative performance in predicting fall risk has not been systematically evaluated. The aim of our work was to investigate the association between PIM use and fall risk among older adults and to analyze the correlations between PIM utilization based on three PIM lists (EU(7)PIM, PRISCUS, and FORTA C/D) and fall risk.MethodsIn a retrospective case -control study based on real-world data from Hungarian emergency and primary care settings, we analyzed fall-related emergency department visits (n=886) in individuals aged ≥65 years and matched them with a control group from general practices (n = 1364).ResultsUse of PIMs identified by all three lists was significantly associated with increased fall risk. (Use of 1 FORTA C/D active substance: AOR: 1.434; CI95%:1.120–1.838; p = 0.004; Use of 1 EU(7)PIM active substance: AOR: 1.201; CI95%: 0.907–1.591; p = 0.200; Use of 1 PRISCUS active substance: AOR: 1.390; CI95%:1.069–1.808; p = 0.014) Of the three lists, use of drugs on the PRISCUS list was most significantly associated with increased fall risk. (Use of 2 PRISCUS active substance: AOR: 1.557; CI95%:1.148–2.114; p = 0.004; Use of 3 PRISCUS active substance: AOR: 2.045; CI95%: 1.408–2.982; p = 0.000; Use of 4 PRISCUS active substance: AOR: 1.869; CI95%: 1.149–3.065; p = 0.012; Use of 5 PRISCUS active substance: AOR: 2.638; CI95%: 1.464–4.895; p = 0.002).DiscussionWe introduce the concept of “polyPIMuse” –the use of ≥5 PIM-listed drugs –which further elevated fall risk, particularly for PRISCUS and FORTA C/D lists. Despite methodological differences, all three PIM tools proved useful in predicting fall risk. Incorporating these tools into routine medication reviews may aid fall prevention strategies in geriatric care.

IntroductionCosmetic products are an integral part of daily life. However, although the regulatory framework for such products appears strict, customer safety and product quality are not guaranteed. A large proportion of consumers prefer using cosmetic products that contain natural substances to avoid exposure of their skin to chemicals. Nevertheless, some of the products marketed to meet this need are not natural or even safe.MethodsThis article presents an overview of reports on cosmetic products declared to be of natural origin in the European Union Safety Gate system between 2005 and 2023.ResultsMany reported cosmetic products posed a chemical risk by containing unauthorized substances (64%) or exceedance of authorized limits (14%). Butylphenyl methylpropional (also known as lilial) was the dominant ingredient present in several product categories. Microbial contamination was also detected (12%), but at a markedly lower rate compared to that recorded for the presence of chemicals (79%).ConclusionUse of the term “natural” to describe cosmetic products can be misleading because it does not always comply with the criteria for natural and organic cosmetic components. Importantly, such cosmetic products could pose a serious risk to consumers due to hidden unsafe substances. Hence, implementation of appropriate measures is necessary to ensure consumer safety.

Vitamin C (L-ascorbic acid) is an essential micronutrient with established roles in antioxidant defense, epigenetic regulation, collagen synthesis, redox signaling, immune modulation, and cellular stress responses. This narrative review critically evaluates the potential role of vitamin C as a modulator of the hallmarks of aging. Although mechanistic studies suggest that vitamin C influences gene expression, inflammatory regulation, mitochondrial function, and cellular stress adaptation, the available evidence remains heterogeneous and is derived predominantly from in vitro and preclinical models, whereas human data are largely observational with limited interventional confirmation. Accordingly, vitamin C should be regarded as a context-dependent modulator of cellular resilience, with potential relevance under conditions of deficiency, inflammation, or increased oxidative stress rather than as a general anti-aging agent. Future studies integrating biomarkers of biological aging with clinically meaningful healthspan outcomes are needed to determine whether these mechanistic observations translate into measurable benefits during human aging.

Background: Transient receptor potential ankyrin 1 (TRPA1) and vanilloid 1 (TRPV1) are key nociceptive ion channels involved in chemosensation, pain signaling, and neurogenic inflammation. Several sesquiterpene lactones target TRPA1, but the activity profile of these secondary metabolites of the common ragweed (Ambrosia artemisiifolia) remains uncharacterized. Purpose: The purpose of this study was to explore the activity of five ragweed sesquiterpene lactones on TRPA1 and TRPV1, respectively. Methods: We investigated the effects of five ragweed-derived sesquiterpene lactones—acetoxydihydrodamsin, costunolide, isoalantolactone, peruvin, and psilostachyin—on TRPA1 and TRPV1 using 45Ca2+ uptake in receptor-overexpressing CHO cells and covalent docking to human TRPA1. Results: Costunolide, isoalantolactone and acetoxydihydrodamsin induced TRPA1 activation (counts per minute of 45Ca2+ uptake at 40 µM concentration: 5070 ± 346.5, 10,197 ± 1237, 3704 ± 1634, respectively) but not TRPV1 activation, as demonstrated by Ca2+ influx. Acetoxydihydrodamsin induced concentration-dependent TRPA1 activation that was significantly inhibited by 10 µM of the selective antagonist HC-030031. Docking studies demonstrated covalent interactions of costunolide, isoalantolactone, and acetoxydihydrodamsin (−47.3, −51.5, and −45.0 kcal/mol FITTED score) with the electrophile-sensitive binding region of TRPA1. Conclusions: Ragweed sesquiterpene lactones act as TRPA1 agonists without detectable TRPV1 activation. This study provides the first data identifying acetoxydihydrodamsin as a TRPA1 agonist, expanding the pharmacological map of ragweed sesquiterpene lactones. These results suggest that these metabolites may contribute to both the irritant properties and the pharmacological potentials of A. artemisiifolia.

Background/Objectives: Nabiximols, a standardized extract of Cannabis sativa, has been approved as an add-on therapy for patients with moderate to severe spasticity associated with multiple sclerosis (MS). Moreover, current Italian treatment algorithms suggest that cannabis-based therapies may have further relevance in the management of MS. The aim of our systematic review and meta-analysis was to assess the effectiveness of nabiximols in relieving symptoms other than spasticity in adult MS patients. Methods: A systematic search was conducted in Web of Science, MEDLINE (via PubMed), Cochrane CENTRAL and Embase on September 10, 2025. Study selection was performed according to the predefined PROSPERO protocol (CRD42022329952). Data were combined into a common denominator and examined using a random-effects model with meta-regression expressed as mean difference (MD) and a 95% confidence interval (CI). Risk of bias was assessed using the Cochrane risk of bias instrument (RoB2) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Results: Of the 49 eligible articles, 25 were included in the statistical analysis (2949 patients). Significant improvements in spasm quality (MD = −16.87; 95% CI = (−29.75)–(−3.99)), bladder function (MD = −16.38; 95% CI = (−22.18)–(−10.58)), sleep disruption (MD = −15.75; 95% CI = (−22.02)–(−9.49)) and gait function (timed walk MD(s) = −5.31; 95% CI(s) = (−9.88)–(−0.74)) were observed. Time-dependency was not significant. The subject global impression of change (SGIC) improved significantly after the first month (odds ratio (OR) = 1.69; 95% CI = (1.30)–(2.18)). Conclusion: Beyond spasticity, nabiximols may represent a signal of benefit for bladder function, sleep disruption, spasm quality, and gait function in MS, in line with the “spasticity-plus” concept. However, the evidence certainty was low to very low, and these findings should be considered exploratory.

Cannabidiol (CBD) is a non-psychotropic phytocannabinoid that is an active compound of several medicines with a well-established safety profile. Cannabidiol-containing food supplements and edibles are also available on the market. Due to the lack of established daily intake safety guidelines for CBD and the known adverse effects of this compound, the associated food safety risks are substantial. To assess the safety of foodstuffs, a method for ultra-high performance liquid chromatography coupled with photodiode array detector (UHPLC-PDA) was developed for cannabigerol, CBD, and Delta 9-tetrahydrocannabinol (THC) identification. For CBD-content quantification, a reversed phase UHPLC-PDA method was developed and validated. The method was linear over the range of 0.03-1 mu g/injection. The accuracy of the method established as recovery ranged from 95.2% to 100.42%, the precision was 3.89%, and the intermediate precision was 4.01%. All samples were cannabigerol and THC free. Cannabidiol concentrations were in range of 12.87-51.57 mg/ml. Two food supplements were accurately labelled, two were under-labelled and eight were over-labelled for CBD content. The hemp seed oils were CBD-free. Our findings are consistent with international data. Incorrect labelling, poorly described components, and unsafe dosages of CBD are all risk factors that make food supplements unsafe, whereas hemp seed oil on the Hungarian market appears to be free of phytocannabinoids.

IntroductionCannabidiol (CBD) has gained interest in equine medicine due to its potential therapeutic effects. Preclinical studies suggest that CBD may influence metabolic pathways relevant to metabolic syndrome, which present in both human and equine populations. The aim of this study was to evaluate the effects of oral CBD on metabolic parameters in Connemara ponies and to characterize its pharmacokinetics.MethodsA total of 13 Connemara ponies [seven with equine metabolic syndrome (EMS)] were stratified by EMS status and age and randomly assigned to a CBD-treated group (2 mg/kg orally, twice daily for 21 days; n = 7) or a control group receiving flaxseed oil (n = 6). Body weight, body condition score (BCS), and cresty neck score (CNS) were recorded pre and post-treatment. Oral sugar tests were performed to assess insulin and glucose responses. Blood samples were analyzed for glucose, insulin, triglycerides, and CBD pharmacokinetics. Safety and clinical parameters were monitored throughout.ResultsCBD did not significantly affect body weight, BCS, CNS, blood glucose, or triglycerides. Insulin concentrations during the oral sugar test increased significantly in the CBD group (mean change: 10.74 ± 5.19 μIU/mL; p = 0.046), whereas no significant change was observed in control (−6.21 ± 6.14 μIU/mL; p = 0.319). Plasma CBD and metabolite concentrations were measurable, with Cmax increasing from 22.79 ± 13.24 ng/mL to 39.93 ± 14.45 ng/mL after the, tmax ranging from 3.14 ± 1.07 to 2.29 ± 0.76 h, and an accumulation ratio of 2.75 ± 1.51, indicating moderate accumulation. Steady-state was reached within 4–5 days, and treatment was well tolerated.ConclusionCBD did not improve metabolic parameters but was associated with an increased insulin response during the OST, suggesting modulation of insulin dynamics of unclear clinical relevance. This finding may raise concerns regarding CBD use in EMS-prone horses. CBD showed predictable pharmacokinetics, with slow elimination and potential accumulation of CBD and 7-COOH-CBD. These findings highlight the need for further studies to clarify dose-dependent metabolic effects and to establish safe and effective dosing strategies, particularly in EMS-prone horses.

Background/Objectives: Several recent human studies have associated the use of certain medicines, such as antibiotics and antacids, with allergic conditions, potentially through microbiome disruption. In contrast, probiotics which may prevent dysbiosis, could have protective effects. Our meta-analysis aimed to evaluate the impact of these drugs (consumed during pregnancy or early life) on the risk of childhood food allergy, based on the available literature. Methods: Literature searches were conducted in the EMBASE, PubMed, Cochrane, and Web of Science databases using predefined PICO criteria. Overall, our meta-analysis included 25 studies involving 1,662,861 mothers and 5,164,280 children. Results: Using the random-effects model, we found that prenatal and early life antibiotic use (up to 2 years of age) was associated with higher odds of food allergy in childhood (OR: 1.34; 95% CI [1.10, 1.63], OR: 1.53; 95% CI [1.18, 1.98], respectively). Proton pump inhibitors were also associated with a risk of food allergies (OR: 2.65; 95% CI [1.22-5.77]), whereas the impact of H2-receptor antagonists was non-significant (OR: 2.07; 95% CI [0.96-4.45]). Probiotic use during the first two years of life was not associated with decreased risk for food allergy in children (OR: 1.25; 95% CI [0.46, 3.38]). Conclusions: These findings suggest an association between microbiome-disrupting medications during pregnancy and early childhood and an increased risk of childhood food allergy, especially those with a family history of food allergy. However, due to the predominantly observational design of the included studies, causality cannot be established. These results highlight the need for cautious and judicious use of such medications in these populations.

Introduction:Cannabidiol (CBD) has shown potential therapeutic benefits in veterinary medicine, but further investigations are needed to establish its pharmacokinetics and therapeutic dosing in horses and ponies. The present study aimed to investigate the pharmacokinetic properties of CBD in Connemara ponies following oral administration of CBD oil. Methods:Ten healthy ponies received a single oral dose of CBD oil at 2 mg/kg. Blood samples were collected before dosing and up to 16 days post-administration, with physical examinations conducted at baseline and at 8, 12, and 24 h post-dose. Additional blood samples were taken at baseline and 24 h for hematological and biochemical analyses. Targeted UHPLC-MS/HRMS measurements quantified CBD and its metabolites, 7-hydroxy-CBD (7-OH-CBD) and 7-carboxy-CBD (7-COOH-CBD). Results:The CBD oil was well-tolerated, with no side effects. A significant decrease in heart rate was observed after 24 h. Changes in hematological and biochemical markers included elevated urea, slight increases in chloride, Gamma-glutamyl transferase, Total bilirubin, Lactate dehydrogenase, and a minor reduction in WBC count. CBD was detectable in 4 ponies on day 7, but none on day 12. The 7-COOH-CBD metabolite remained detectable up to day 16 in all subjects. The pharmacokinetic parameters for CBD were Cmax = 31.472 ± 8.080 ng/mL, tmax = 2.111 ± 0.928 h, t1/2 = 12.563 ± 3.054 h, and Vz/F = 198.757 ± 49.123 L/kg. Discussion:The pharmacokinetic characteristics of CBD observed in the present study are consistent with previous research in warmblood horses and provide a foundation for future studies to evaluate the therapeutic efficacy and long-term safety of CBD in ponies.

Background: Green tea (Camellia sinensis) has been consumed for centuries, and its beneficial effects on human health have been studied in recent decades. l-theanine, an active ingredient in green tea, has been used to improve cognition and mood. Although the effects of l-theanine on cognition have been investigated in clinical trials that have reported various results, these studies have not yet been critically evaluated in meta-analyses. Objectives: Our objective was to systematically evaluate the efficacy of l-theanine on cognitive functions compared to a placebo, in a meta-analysis based on randomized controlled trials (RCTs). Methods: PubMed, the Cochrane Central Register of Controlled Trials, Embase and Web of Science were searched for relevant studies until 31 July 2024 and registered in PROSPERO (registration number: CRD42024575122). Placebo-controlled clinical trials investigating the efficacy of l-theanine in healthy adults were included. Conference abstracts, study protocols and reports of non-RCTs were excluded. For risk of bias assessment, the Cochrane Risk of Bias Tool (version 2.0) was used. A random effects model was applied to conduct the meta-analysis. Mean differences (MD) with 95% confidence intervals (CIs) were calculated. Results: Based on the included five RCTs involving 148 healthy adults, l-theanine had a dose-dependent effect on cognitive function based on rapid visual information processing and recognition visual reaction time (MD: −15.20 ms; 95%-CI [−28.99; −1.41]). The effects of l-theanine were non-significant on reaction time to a simple stimulus (MD: −0.46 ms; 95% [CI: −15.65; 14.73]) and in the Stroop test (MD: −37.38 ms; 95%-CI [−86.39; 11.62]). Conclusions: The beneficial effects of l-theanine on cognitive performance could not be confirmed by all test methods. The contradictory results could be explained by the fact that l-theanine only affects certain cognitive domains, but also by the low number of trials and the heterogeneity of the test preparations. Further trials using standardized products with larger sample sizes are required for the accurate assessment of efficacy.

Background: Gastrointestinal endoscopy is crucial for diagnosing colorectal cancer and inflammatory bowel diseases, but its effectiveness can be impacted by peristalsis, poor bowel preparation, and inadequate withdrawal time. Conventional antispasmodics, though effective, may not be suitable for elderly patients or those with comorbidities. L-menthol, derived from peppermint oil, has emerged as a safer alternative. Through calcium channel blockade, L-menthol promotes GI smooth muscle relaxation. This study evaluated L-menthol’s efficacy and safety as a potential alternative to antispasmodic agents in endoscopy. Methods: Following PRISMA2020 guidelines and the Cochrane Handbook, we conducted a systematic review and meta-analysis of randomized controlled trials involving adults undergoing endoscopy, comparing L-menthol to placebo. The primary outcome was the adenoma detection rate, with secondary outcomes, including severity of peristalsis, safety, withdrawal time, and ease of examination. We searched five databases on 31 May 2023, with updates on 20 October 2024. Results: Fourteen studies were included. L-menthol reduced peristalsis during colonoscopy and upper endoscopy, achieving a suppression rate of 55.9% (560/1002 patients; odds ratio (OR) = 3.88, 95% confidence interval (95% CI): 2.13–7.07), which improved mucosal visualization. It improved ease of examination (OR = 2.53, 95% CI: 1.35–4.73), allowing endoscopists to perform procedures with less technical difficulty. However, L-menthol had no significant impact on the adenoma detection rate (OR = 1.06, 95% CI: 0.69–1.64), indicating no added benefit for lesion detection, and did not prolong withdrawal time (MD = 3.24 s, 95% CI: −101.05–107.53). Adverse event rates remained low and comparable to placebo (OR = 0.97, 95% CI: 0.74–1.27). Conclusions: L-menthol reduces peristalsis and enhances ease of examination without adverse events. Although its effect on the adenoma detection rate remains inconclusive, its antispasmodic properties make it a promising alternative for patients who cannot tolerate conventional agents.

Amateur and professional athletes often consume protein supplements to accelerate muscle gain; however, it has been suggested that these products not only are associated with risks when consumed excessively. Several recent reports have indicated that certain products are contaminated with heavy metals. Therefore, in this study, we aimed to investigate protein powders in Hungary for heavy metal contamination. A total of 22 commercially available protein powders (including whey, vegan, and beef based) were purchased on the internet for testing. We analysed the samples using laser-induced breakdown spectroscopy (LIBS) and inductively coupled plasma mass spectrometry (ICP-MS) to assess heavy metal contamination. The products were analysed for the presence of 16 elements (Be, Al, Cr, Mn, Co, Ni, Cu, As, Se, Rb, Cd, Sb, Cs, Ba, Hg, and Pb). The LIBS spectral analysis revealed the characteristics of the protein elements (C, C2, H, N, and O) and alkaline metals (Ca, Na, K, and Mg), which were consistent with the previous results. Neither LIBS nor ICP-MS measurements detected significant heavy metal content in the investigated samples above the limit specified in the regulations. Heavy metal contamination of protein supplements can be a serious health threat. Based on the varied results of the previous studies, it is prudent to include testing for heavy metals as part of the routine and mandatory quality control of these products.

OBJECTIVES:The use of complementary and alternative medicine (CAM) is increasing worldwide, specifically among gout patients, due to the perceived safety, low cost, and accessibility, but data on the usage remain limited. Therefore, this study aimed to assess the prevalence of CAM use, the predictors associated with CAM use, the impact on medication adherence, and the potential herb-drug interactions among gout patients. METHODS:This cross-sectional study was conducted from June to November 2024 across all 47 community health centers in Makassar City, Indonesia. The entire respondents were patients aged 18 years and older diagnosed with gout. Eligible respondents were recruited through direct questionnaire distribution, collecting data on socio-demographics, CAM and conventional medicine use, CAM perceptions, and medication adherence, while potential herb-drug interactions were assessed using the UpToDate database. RESULTS:Among the 430 respondents, 52.8 % reported using CAM, with herbal medicine being the most frequently used option. CAM use was significantly associated with prior experience (p<0.001) and influence from family or friends (p<0.001). A significant association was also found between CAM use and medication adherence (p<0.001), with a higher proportion of non-CAM users exhibiting high adherence (76.8 vs. 7.9 %) and a higher proportion of CAM users demonstrating poor adherence (8.4 vs. 0.5 %). Four potential herb-drug interactions were identified, namely ginger-aspirin (n=2), ginger-glibenclamide (n=1), honey-warfarin (n=1), and garlic-aspirin (n=1), suggesting a need for clinical monitoring. CONCLUSIONS:The frequent use of CAM among gout patients highlights the crucial role of healthcare practitioners in educating patients about safety, efficacy, and potential interactions. It also underscores the need for strategies to address medication non-adherence associated with CAM use and to monitor herb-drug interactions in clinical settings.