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Urostemol – General things worth knowing

Whilst watching Tv in the comfort of my lounge, I came across an advert for Urostemol, and thus as any curious pharmacist decided to learn about this medication. I knew eventually at some point, a patient would ask me about this medication.

Behind the counter!

Ok, so I also noticed that this medication is kept behind the counter at boots pharmacy. I am not entirely certain why it is kept behind the counter, as it is a GSL. I can only assume maybe, as the medication is costly or perhaps as it is new medication in the market and it is felt that it would benefit from the supervision of a pharmacist. Nonetheless, it is important as a pharmacist to ensure you are competent.

What is Urostemol?

Firstly, it is important to note and make it clear that Urostemol is an herbal medicine and such cannot make medicinal claims, and its registration with the MHRA like all herbal medicines is based on their longstanding use.

Now, according to http://www.urostemol.co.uk, the product comes in the following preparations:

Urostemol men

Ingredients:

Fink therapeutic pumpkin and saw palmetto fruit.

Urostemol femina, is a traditional herbal medicine aimed at relieving frequent and urgent urination.

Ingredients:

Fink therapeutic pumpkin, fragrant sumac bark, Hops

Urostemol prosta

Ingredients:

Fink therapeutic pumpkin

Urostemol capsules

The key excipient in the Urostemol preparations is derived from the seeds of the FINK therapeutic pumpkin. These pumpkins contain high amounts of phytosterols and are specifically bred for traditional herbal medicines; they differ from the pumpkins used during Halloween.

 What is Urostemol used for?

It is indicated for the relief of symptoms associated with lower urinary tract symptoms such as:

  • urgency to urinate
  • frequent urination day and night
  • incomplete emptying of the bladder
  • weak or interrupted urinary flow.

Urostemol Prosta differs slightly, as it actually states that it may also be used in patients who have confirmed benign prostatic hyperplasia.

How is Urostemol taken?

The herbal medication is to be taken as advised on the packaging unless advised otherwise by the doctor. It is advised that this is taken with plenty of water and taken preferentially before meals.

What is Phytosterols?

Phytosterols are plant stanols and sterols, which are considered as functional foods. They have been linked to provide a variety of health related benefits, such as reducing cholesterol and improving urination.

Interactions:

Now, although the SPC for the product states that there no known reported interactions. There are concerns that phytosterol pills inhibit the absorption of fat soluble vitamins. Thus, in my opinion could theoretically be problematic in patients with certain vitamin deficiency or in patients taking orlistat. I would also not recommend the medication be used alongside certain medicines, which require therapeutic drug monitoring or are high risk, such as warfarin or methotrexate.

Herbal medicines are very rarely tested alongside medications, thus we have limited information about how they interact with other medicine. The last thing we want to do is recommend them to be used alongside a high-risk medication like warfarin.

Allergies and patient beliefs to consider

I believe you should always check for allergies, this herbal medication does contain some E numbers, black iron oxide, yellow iron oxide and red iron oxide.

Also, the herbal medication does contain lactose therefore, it is important to check if your patient is lactose intolerant. The presence of Gelatin may mean the product is unsuitable for vegetarians and also for patients with Islamic believes. Therefore, this should also be borne in mind.

The pumpkin extract has been obtained using ethanol extract, and thus may be worth informing your patients if they have Islamic beliefs.

 Refer to a doctor in the following situations:

If a patient complains that they do not feel well after 7-days of taking the medication, or fail to ascertain an improvement in symptoms after 4-weeks of taking the medication.

If a patient experiences any of the following: fever, bladder spasms, blood in urine, pain when urinating, difficulty urinating, stomach pain, loin pain or back pain.

Restrictions of use:

Age: it is important to note that the medication is not licensed for use in-patient less than 18 years old.

Product type: Now, it may seem unnecessary for me to say this, but I do have to state this, as I have often found common sense is not common. If the product states for use in ‘men’ even if this is the only product you have on your shelf, then do not sell it for women.

Allergy to pumpkin seeds or pumpkin-like plants or any of the excipients listed in the PIL.

Evidence Based practice:

Prior to recommending or sales of any product to a patient it is important to be reasonably certain of the evidence behind the use of the medication. I came across an article by Hong et al (2009) that explored the effect of pumpkin seed oil, saw palmetto oil in Korean men with benign hyperplasia symptoms. The article explored 4 experimental arms (groups), group A received potato starch, group B received pumpkin seed oil, group C received palmetto oil and group D received both palmetto and pumpkin seed oil. The effects of the experimental arms was measured using the International prostate symptom score, quality of life, serum prostate specific antigen, prostate volume and maximal urinary flow rate were measured. The results showed a reduction in the prostate symptom score in group B, C and D within 3 months. When compared to baseline, the quality of life score improved within 3 months in group B, C and was improved after 6 months in group D. The authors concluded that palmetto and pumpkin seed oil were clinically safe and maybe useful as complementary or alternative medicines in the treatment of BPH.

NB: It is important to note that the article above has been summarized by myself, therefore, I strongly advise you read the full article here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809240/

Patient advice

Whether or not you decide to sell the product to your patient, it is important to provide healthy life advice or refer to a doctor. Therefore, discuss with your patient their current lifestyle and provide advice (see appendix list 1).

Disclaimer: All data and information provided in this article is for informational purposes only. I make no representations as to accuracy, completeness, currentness, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. All information is provided on an as-is basis.

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Competing interest: none to declare

Photocredits: Hobvias Sudoneighm

License: https://creativecommons.org/licenses/by/2.0/

References:

Appendix list 1 – useful resources