Herbal Supplements In The Middle East (Iraq And Jordan): Regulation, Quality And Safety Of And Development Of A Method To Detect Common Adulterants

Herbal supplements are important and widely used health care choices but also pose a global challenge in quality and safety. The lack of regulations and less stringent supply chains, for example, result in adulterations with undeclared synthetic substances. The extent and nature of this issue are unknown in the Middle East. Pharmacists manage these products, and their role is critical to educate and advise the public on the risks and benefits associated with these products. Besides, analytical methods for easy implementation in laboratories without sophisticated instrumentations and limited resources are always in demand, particularly in developing countries. This research project’s objective was to determine the extent and nature of low-quality herbal supplements and explore pharmacists' perceptions and views towards herbal supplements, focusing on two Middle Eastern countries (i.e., Iraq and Jordan). Two questionnaires were used to explore Iraqi and Jordanian pharmacists' perception of herbal supplements. Of 74 participants included in the Iraqi pharmacists' pilot survey, 97% reported the availability of these products in their pharmacies; slimming aids followed by sexual enhancements were the most requested products by Iraqi consumers. The Jordanian pharmacists' survey included 401 participants; 98% reported the availability of these products in their pharmacies; supplements for slimming followed by sexual enhancements were the most requested by the Jordanian consumers. 56% of Jordanian pharmacists reported good knowledge about regulations, adverse reactions, and interactions of herbal medicines. The nature of low-quality herbal supplements was determined using 40 samples promoted as slimming aids and sexual enhancers. This study used HPTLC and packaging analysis. The HPTLC identified that 47.5% of slimming and sexual enhancer samples contain at least one adulterant, i.e., a substance not declared on the packaging and leaflet. The packaging and leaflet analysis showed that 73% contained no safety information. The results of this multi-disciplinary PhD project could provide a unique contribution to the evolving discipline of pharmacy research, education, and quality assurance of herbal supplements.