Homeopathy

Key Points

  • The Royal Pharmaceutical Society (RPS) does not endorse homeopathy as a form of treatment because there is no scientific basis for homeopathy nor any evidence to support the clinical efficacy of homeopathic products beyond a placebo effect.
  • The RPS does not support the prescribing of homeopathic products on the NHS.
  • Pharmacists should ensure, wherever possible, that patients do not stop taking their prescribed conventional medication, if they are taking or are considering taking a homeopathic product.
  • Pharmacists must be aware that patients requesting homeopathic products may have serious underlying undiagnosed medical conditions which may require referral to another healthcare professional.
  • Pharmacists must advise patients considering a homeopathic product about their lack of efficacy beyond that of a placebo.

What is the aim of this quick reference guide?

The guide aims to outline the Royal Pharmaceutical Society's (RPS) current position with respect to homeopathy, and to advise pharmacists on how to deal with patient requests for homeopathic products.

What is homeopathy?

Homeopathy has been defined as a holistic complementary and alternative therapy based on the concept of “like to treat like” and involves the administration of dilute and ultra-dilute products prepared according to methods given in homeopathic pharmacopoeias.

What is the evidence for homeopathy?

There is no scientific or clinical evidence to support the efficacy of homeopathic products beyond that of a placebo. Although anecdotal reports of the effectiveness of homeopathic products have been published, particularly when used as part of individualised homeopathic treatment by a homeopathic practitioner, such reports do not stand up to scrutiny by meta-analysis.

What advice should pharmacists give patients?

If a patient requests advice on homeopathy, the pharmacist should advise on the lack of evidence on the efficacy of homeopathic products, and provide advice relevant to the patient’s condition. Pharmacists should also ensure that patients do not stop taking their prescribed medication if they take a homeopathic product.

When should I refer a patient?

Pharmacists will be in a position to identify serious, underlying undiagnosed medical conditions requiring the patients to be referred to another healthcare professional.

How are homeopathic products licensed?

For the purpose of licensing, the MHRA does not currently require homeopathic products to demonstrate efficacy, only quality and safety.

Are all homeopathic products ultradilute?

Although most homeopathic products are ultra-dilute and the starting material will have been diluted to below Avogadro’s number, it is possible for some homeopathic products to contain significant (measureable) quantities of the starting material. However, in MHRA licensed products available from community pharmacies, the starting material will have been considerably diluted.

What are the differences between homeopathic and herbal products?

The public frequently confuse homeopathic with herbal products. Pharmacists can help the public understand the difference between homeopathic products and herbal products. You can see a summary of these differences below

Homeopathic and herbal products comparison table

 

   

Homeopathic products

 

Herbal products

What are they
made from?

  

Often plants but may be from mineral,
animal or even synthetic material.

 

Naturally occurring plants, parts of plants or extracts of plants

Do they contain
active ingredients?

 

Generally the starting material is diluted so that few or no molecules of the starting material remain in the product. Some products are administered orally and topically that do contain measurable amounts of the starting material.

 

Often contain mixtures of many chemical compounds obtained from the plant although precise compositions can be variable due to the natural source.

How is the product
made?

 

Homeopaths believe that serial dilution and succussion (shaking) steps are critical in ensuring the efficacy of the product. They believe that the more succussion that takes place through the dilution steps, the more energy is imparted and the more efficacious the product.

 

Herbal products are prepared using either extracts of the herbal material or through use of the crude drug itself.

How are products selected?

 

Homeopaths believe in the three principles of homeopathy, one of which is that like should be treated with like. For example, they believe that a substance that causes vomiting in high doses may be used to treat vomiting using a very dilute product.

 

In a manner similar to other medicines, herbal products are selected according to the range of symptoms they are known to treat. They are often used to restore, correct or modify a physiological function. 

How is a particular product selected?

 

Homeopathic practitioners adopt a holistic approach where a detailed patient consultation takes place prior to a suitable product being recommended. The self selection of homeopathic products may be based on their traditional use in homeopathy.

 

Based on the symptoms presented, a product is selected taking account of the known pharmacological activity of the herbal product. 

How does the dose affect the efficacy of the product?

 

Due to extensive dilution, homeopathy usually involves the administration of no, or an incredibly small amount, of the starting material. Homeopaths believe that the greater the dilution of a product the more potent and efficacious it becomes.

 

Increasing the dose will increase the effect and/or increase the risk of adverse effects.

Are the products safe?

 

Generally considered by homeopaths to be non-toxic and safe for administration to adults and children, particularly at high dilution. It is important to note that some homeopathic products are not ultradilute and may contain discernable amounts of the starting material. (*see footnote)

 

Although they are obtained from natural sources, they are not without unwanted effects and cannot be regarded as “safe”. The active substance in many prescription medicines is obtained or derived from plant sources. 

Are there any side
effects?

 

Side effects have not been reported in the scientific literature for high dilution products. Homeopaths believe homeopathic products can cause aggravations (exacerbations or worsening of symptoms). May cause reactions in lactose intolerant patients.
(*see footnote)

 

May produce side effects.

Will they interact
with  prescription
or other medicines?

 

No evidence of interactions between high dilution products and conventional medicines. (*see footnote)

 

Can interact with prescription and other conventional medicines.

Are they safe in
pregnancy and
when breast
-feeding?

 

Considered by homeopaths to be suitable for use during pregnancy and while breastfeeding, but ideally under the guidance of a suitably qualified homeopath. However it is important that patients inform healthcare professionals if they are taking a homeopathic product during pregnancy and while breastfeeding, even if it is a highly diluted product. (*see footnote)

 

Certain herbal ingredients should be avoided or used with caution in pregnancy and while breastfeeding.

Should I inform
other healthcare
professionals if
I am taking
these products?

 

Although homeopaths believe this is not necessary, it is important that patients inform healthcare professionals if they are taking a homeopathic product, even if it is highly diluted. (*see footnote)

 

Patients should inform healthcare professionals if they are taking herbal products.

Labelling

 

Will include the words “homeopathic medicinal product” on the label.

 

The label or packaging will indicate it is a “herbal medicinal product”.

Is it known how
they work?

 

There is no sound scientific basis to explain the activity of homeopathic products claimed by homeopaths.

 

The effects of the active ingredients in a herbal product can be shown to have pharmacological actions.

What is the
evidence to
support the
efficacy of
these products?

 

There is no scientific or clinical evidence to support the efficacy of homeopathic products, although anecdotal reports of their effectiveness have been published, particularly when used as part of individualised homeopathic treatment by a homeopathic practitioner.

 

There is scientific evidence to support the efficacy of a limited number of herbal products in specific conditions; however, for many herbal products, efficacy has not been formally evaluated.

 

Definitions of some terms used

Dilution – homeopathic dilutions are usually centesimal, where 1 drop is added to 99 drops of diluent, or decimal where 1 drop is added to 9 drops of diluent. Diluents are generally ethanol and water mixtures.

Potentisation (also called dynamisation or attenuation) – homeopaths believe that this process increases the power of homeopathic products by successive dilutions and succussions of a mother tincture. Potentisation cannot occur without both dilution and succussion.

Succussion – the forceful agitation between each dilution step during the product of the homeopathic product. The number of times a product is succussed after each dilution step of potentisation is not well defined and can range from 20 to 100.

Mother Tincture – liquid products obtained following the maceration, incubation, and extraction of plant material, usually with an ethanol/water mixture. Mother tinctures can be given undiluted by the oral or topical routes, but are usually subject to potentisation.