Home Medicine Navigating complementary and alternative medicine use, medication adherence, and herb–drug interaction risks among gout patients: a multicenter cross-sectional study in indonesia
Article
Licensed
Unlicensed Requires Authentication

Navigating complementary and alternative medicine use, medication adherence, and herb–drug interaction risks among gout patients: a multicenter cross-sectional study in indonesia

  • Dzulfiana Ashan ORCID logo , Elly Wahyudin ORCID logo , Dezső Csupor ORCID logo and Muh. Akbar Bahar ORCID logo EMAIL logo
Published/Copyright: October 1, 2025
Journal of Complementary and Integrative Medicine
From the journal Journal of Complementary and Integrative Medicine Volume 22 Issue 4

Abstract

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.

Keywords: complementary and alternative medicine; gout; adherence; herbal medicine; herb-drug interactions
Corresponding author: Muh. Akbar Bahar, Ph.D, Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Jl. Perintis Kemerdekaan KM10, 90245, Makassar City, South Sulawesi Province, Indonesia, E-mail:

Acknowledgments

The authors would like to express their gratitude to Hasanuddin University and the staff members of the community health care centers in Makassar for their support in data collection.

  1. Research ethics: This study received ethical approval from the Ethics Committee of the Faculty of Pharmacy, Hasanuddin University, under approval number: 291/UN4.17/KEP/2024.

  2. Informed consent: Each respondent was required to read and complete an informed consent form, signing it if they agreed to participate in the study. The study was conducted in accordance with the guidelines of the Declaration of Helsinki.

  3. Author contributions: Conceptualization: DA, EW, DC, and MAB; methodology, formal analysis, software: DA, EW and MAB; ethics and data collection: DA; Project Administration: DA; Resources: DA, MAB; investigation: DA, EW, and MAB; data curation and validation: DA and MAB; data interpretation: DA, EW, DC, and MAB; writing-original draft preparation: DA; writing-review and editing: DA, EW, DC, and MAB; supervision: EW, DC, and MAB; and acquisition of funding: DA, MAB. All authors have read and approved the final version of the manuscript.

  4. Use of Large Language Models, AI and Machine Learning Tools: The authors used ChatGPT to improve the English language quality of this manuscript. Following its use, we thoroughly reviewed and revised the content as needed and accepted full responsibility for the final published version.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: Data are available from the corresponding author upon reasonable request, subject to institutional and ethical restrictions.

References

1. World Health Organization. National policy on traditional medicine and regulation of herbal medicines Report of a WHO global survey;2005. https://www.who.int/publications/i/item/9241593237 [Accessed 20 Apr 2024].Search in Google Scholar

2. Tangkiatkumjai, M, Boardman, H, Walker, DM. Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review. BMC Complement Med Ther 2020;20. https://doi.org/10.1186/s12906-020-03157-2.Search in Google Scholar PubMed PubMed Central

3. Makarevičius, G, Dapkutė, A, Ryliškienė, K. Complementary and alternative medicine use in migraine patients: results from a national patient e-survey. Front Neurol 2024;15. https://doi.org/10.3389/fneur.2024.1378532.Search in Google Scholar PubMed PubMed Central

4. Farooqui, M, Alreshidi, H, Alkheraiji, J, Abdulsalim, S, Alshammari, MS, Kassem, L, et al.. A cross-sectional assessment of complementary and alternative medicine (cam) use among patients with chronic diseases (CDs) in Qassim, Saudi Arabia. Healthc 2022;10. https://doi.org/10.3390/healthcare10091728.Search in Google Scholar PubMed PubMed Central

5. Oktar, D, Metintas, S, Önsüz, MF, Öcal, EE, Çalişkan Pala, S. Complementary and alternative medicine uses of individuals diagnosed with chronic diseases. Clin Exp Heal Sci 2023;13. https://doi.org/10.33808/clinexphealthsci.1185236.Search in Google Scholar

6. Aljawadi, MH, Khoja, AT, Alotaibi, AD, Alharbi, KT, Alodayni, MA, Almetwazi, MS, et al.. The utilization of complementary and alternative medicine among saudi older adults: a population-based study. Evid Based Complement Altern Med 2020;1:4357194. https://doi.org/10.1155/2020/4357194. 32831865.Search in Google Scholar PubMed PubMed Central

7. Shahjalal, M, Chakma, SK, Ahmed, T, Yasmin, I, Mahumud, RA, Hossain, A. Prevalence and determinants of using complementary and alternative medicine for the treatment of chronic illnesses: a multicenter study in Bangladesh. PLoS One 2022;17. https://doi.org/10.1371/journal.pone.0262221.Search in Google Scholar PubMed PubMed Central

8. Chan, E, House, ME, Petrie, KJ, Horne, A, Taylor, WJ, Dalbeth, N. Complementary and alternative medicine use in patients with gout: a longitudinal observational study. J Clin Rheumatol 2014;20. https://doi.org/10.1097/rhu.0000000000000059.Search in Google Scholar PubMed

9. Peltzer, K, Pengpid, S. Prevalence and determinants of traditional, complementary and alternative medicine provider use among adults from 32 countries. Chin J Integr Med 2018;24. https://doi.org/10.1007/s11655-016-2748-y.Search in Google Scholar PubMed

10. Pengpid, S, Peltzer, K. Utilization of traditional and complementary medicine in Indonesia: results of a national survey in 2014–15. Compl Ther Clin Pract 2018;33. https://doi.org/10.1016/j.ctcp.2018.10.006.Search in Google Scholar PubMed

11. Ministry of Health of Republic Indonesia. Natl Basic Health Res Rep 2018. https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/1/LaporanRiskesdas2018Nasional.pdf [Accessed 15 Apr 2024].Search in Google Scholar

12. NCCIH. Complementary, alternative, or integrative health: what’s in a name? 2021. https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name [Accessed 10 Apr 2025].Search in Google Scholar

13. Albabtain, H., Alwhaibi, M., Alburaikan, K., Asiri, Y. Quality of life and complementary and alternative medicine use among women with breast cancer. Saudi Pharm J 2018;26:416–21.10.1016/j.jsps.2017.12.020Search in Google Scholar PubMed PubMed Central

14. FitzGerald, JD, Dalbeth, N, Mikuls, T, Brignardello-Petersen, R, Guyatt, G, Abeles, AM, et al.. 2020 American college of rheumatology guideline for the management of gout. Arthritis Care Res 2020;72, https://doi.org/10.1002/acr.24180.Search in Google Scholar PubMed PubMed Central

15. Fenando, A, Rednam, M, Gujarathi, R, Widrich, J. Gout 2024. https://www.ncbi.nlm.nih.gov/books/NBK546606/.[Accessed 2 Apr 2024].Search in Google Scholar

16. Keenan, RT. Limitations of the current standards of care for treating gout and crystal deposition in the primary care setting: a review. Clin Ther 2017;39. https://doi.org/10.1016/j.clinthera.2016.12.011.Search in Google Scholar PubMed

17. Wertheimer, A, Morlock, R, Becker, MA. A revised estimate of the burden of illness of gout. Curr Ther Res Clin Exp 2013;7.10.1016/j.curtheres.2013.04.003Search in Google Scholar PubMed PubMed Central

18. Rajahthurai, SD, Farrukh, MJ, Makmor-Bakry, M, Tan, HJ, Fatokun, O, Mohd, SS, et al.. Use of complementary and alternative medicine and adherence to medication therapy among stroke patients: a meta-analysis and systematic review. Front Pharmacol 2022;13. https://doi.org/10.3389/fphar.2022.870641.Search in Google Scholar PubMed PubMed Central

19. Mohd Mujar, NM, Dahlui, M, Emran, NA, Hadi, IA, Wai, YY, Arulanantham, S, et al.. Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia. PLoS One 2017;12. https://doi.org/10.1371/journal.pone.0176394.Search in Google Scholar PubMed PubMed Central

20. World Health Organization. International classification of disease. 2019. https://doi.org/icd.who.int/browse10/2019/en [Accessed 5 May 2024].Search in Google Scholar

21. Rauf, M, Djabir, YY, Rahim, A, Tóth, B, Bahar, MA. Exploring the use of complementary and alternative medicine during pregnancy: a cross-sectional study from Indonesia. European J Integr Med 2025;28:102507. https://doi.org/10.1016/j.eujim.2025.102507.Search in Google Scholar

22. Octavia, DR, Sholikha, J, Utami, PR. Validity and reliability test of the medication adherence report scale (MARS) questionnaire for tuberculosis (TB) patients. J Pharm Sci 2024;9. https://doi.org/10.53342/pharmasci.v9i1.447.Search in Google Scholar

23. Osahon, OJ, Kingsley, O. Statistical approach to the link between internal service quality and employee job satisfaction: a case study. Am J Appl Math Stat 2016;4:178–84.Search in Google Scholar

24. Naafi, AM, Perwitasari, DA, Darmawan, E. Medication adherence among outpatients with schizophrenia at prof. Dr. Soerojo mental hospital, magelang. Kartika J Ilm Farm 2016;4:7–12. https://doi.org/10.26874/kjif.v4i2.60.Search in Google Scholar

25. Shahjalal, M, Chakma, SK, Ahmed, T, Yasmin, I, Mahumud, RA, Hossain, A. Prevalence and determinants of using complementary and alternative medicine for the treatment of chronic illnesses: a multicenter study in Bangladesh. PLoS One 2022;17. https://doi.org/10.1371/journal.pone.0262221.Search in Google Scholar PubMed PubMed Central

26. Sari, Y, Anam, A, Sumeru, A, Sutrisna, E. The knowledge, attitude, practice and predictors of complementary and alternative medicine use among type 2 diabetes mellitus patients in Indonesia. J Integr Med [Internet] 2021;19:347–53. https://doi.org/10.1016/j.joim.2021.04.001.Search in Google Scholar PubMed

27. Poli, MA, Hossain, MJ, Kholil, I, Yasmin, S, Bhowmick, B, Kundu, LR. Traditional medicine use and associated factors in chronic patients in Jamalpur, Bangladesh: a cross-sectional study. Front Public Health 2025;13. https://doi.org/10.3389/fpubh.2025.1548728.Search in Google Scholar PubMed PubMed Central

28. Chowdhuri, PD, Kundu, K. Factors determining choice of complementary and alternative medicine in acute and chronic diseases. J Compl Integr Med 2020;17:1–10. https://doi.org/10.1515/jcim-2019-0105.Search in Google Scholar PubMed

29. Latte-Naor, S, Sidlow, R, Sun, L, Li, QS, Mao, JJ. Influence of family on expected benefits of complementary and alternative medicine (CAM) in cancer patients. Supp Care Cancer 2018;26:2063–9. https://doi.org/10.1007/s00520-018-4053-0.Search in Google Scholar PubMed PubMed Central

30. Madan, V. A review on the phytochemistry and pharmacology of cymbopogon citratus stapf. (Lemongrass). Pharm Innov J [Internet] 2018;300:300–4.Search in Google Scholar

31. Anh, NH, Kim, SJ, Long, NP, Mvin, JE, Yoon, YC, Lee, EG, et al.. Ginger on human health: a comprehensive systematic review of 109 randomized controlled trials. MDPI J 2020;12. https://doi.org/10.3390/nu12010157.Search in Google Scholar PubMed PubMed Central

32. Veisi, P, Zarezade, M, Rostamkhani, H, Ghoreishi, Z. Renoprotective effects of the ginger (Zingiber officinale) on Diabetic kidney disease, current knowledge and future direction: a systematic review of animal studies. BMC Complement Med Ther 2022;22. https://doi.org/10.1186/s12906-022-03768-x.Search in Google Scholar PubMed PubMed Central

33. Afriani, T, Yulion, R, Andriani, M, Syufyani, F, Fadri, D. The effect of ginger (Zingiber Officinale Roscoe) fractionation in decreasing uric acid level of hyperuricemic white mice. Setúbal Municipality, Portugal: Scitepress; 2020:467–74 pp.10.5220/0009838404670474Search in Google Scholar

34. Sharifi-Rad, J, Rayess, YE, Rizk, AA, Sadaka, C, Zgheib, R, Zam, W, et al.. Turmeric and its major compound curcumin on health: bioactive effects and safety profiles for food, pharmaceutical, biotechnological and medicinal applications. Front Pharmacol 2020;11. https://doi.org/10.3389/fphar.2020.01021.Search in Google Scholar PubMed PubMed Central

35. Farrar, AJ, Farrar, FC. Clinical aromatherapy. Nurs Clin 2020;55:489–504. https://doi.org/10.1016/j.cnur.2020.06.015. 33131627.Search in Google Scholar PubMed PubMed Central

36. Crawford, C, Boyd, C, Paat, CF, Price, A, Xenakis, L, Yang, E, et al.. The impact of massage therapy on function in pain populations — a systematic review and meta-analysis of randomized controlled trials: part I, patients experiencing pain in the general population. Pain Med 2016;17:1353–75. https://doi.org/10.1093/pm/pnw099.Search in Google Scholar PubMed PubMed Central

37. Lee, WB, Woo, SH, Min, B, Cho, S. Acupuncture for gouty arthritis: a concise report of a systematic and meta-analysis approach. Rheumatology 2013;52:1225–32. https://doi.org/10.1093/rheumatology/ket013.Search in Google Scholar PubMed

38. Al-Bedah, AMN, Elsubai, IS, Qureshi, NA, Aboushanab, TS, Ali, GIM, El-Olemy, AT, et al.. The medical perspective of cupping therapy: effects and mechanisms of action. J Tradit Complement Med 2019;9. https://doi.org/10.1016/j.jtcme.2018.03.003.Search in Google Scholar PubMed PubMed Central

39. Kim, KE, Park, JS, Cho, IY, Yoon, YS, Park, SK, Nam, SY. Use of a spinal thermal massage device for anti-oxidative function and pain alleviation. Front Public Health 2020;8. https://doi.org/10.3389/fpubh.2020.00493.Search in Google Scholar PubMed PubMed Central

40. Rashrash, M, Schommer, JC, Brown, LM. Prevalence and predictors of herbal medicine use among adults in the United States. J Patient Exp 2017;4. https://doi.org/10.1177/2374373517706612.Search in Google Scholar PubMed PubMed Central

41. Gouws, C, Hamman, JH. What are the dangers of drug interactions with herbal medicines? Expert Opin Drug Metab Toxicol 2020;16. https://doi.org/10.1080/17425255.2020.1733969.Search in Google Scholar PubMed

42. Rai, A, Eapen, C, Prasanth, VG. Interaction of herbs and glibenclamide: a review. ISRN Pharmacol 2012;2012:1–5. https://doi.org/10.5402/2012/659478.Search in Google Scholar PubMed PubMed Central

43. Ali, BH, Blunden, G, Tanira, MO, Nemmar, A. Some phytochemical, pharmacological and toxicological properties of ginger (Zingiber officinale Roscoe): a review of recent research. Food Chem Toxicol 2008;46:409–20. https://doi.org/10.1016/j.fct.2007.09.085.Search in Google Scholar PubMed

44. Hurren, KM, Lewis, CL. Probable interaction between warfarin and bee pollen. Am J Heal Pharm 2010;67. https://doi.org/10.2146/ajhp090489.Search in Google Scholar PubMed

45. Teoh, L, Moses, G, McCullough, MJ. A review of drugs that contribute to bleeding risk in general dental practice. Aust Dent J 2020;65:118–30. https://doi.org/10.1111/adj.12751.Search in Google Scholar PubMed

46. Yao, TK, Lee, RP, Wu, WT, Chen, IH, Yu, TC, Yeh, KT. Advances in gouty arthritis management: integration of established therapies, emerging treatments, and lifestyle interventions. Int J Mol Sci 2024;25. https://doi.org/10.3390/ijms251910853.Search in Google Scholar PubMed PubMed Central

47. Odegard, BR, Ferguson, MR, Naja, F, Ayoub, J, Banna, J. A qualitative investigation of the perceptions of complementary and alternative medicine among adults in Hawaiʻi. BMC Complement Med Ther 2022;22. https://doi.org/10.1186/s12906-022-03603-3.Search in Google Scholar PubMed PubMed Central

48. Aizuddin, AN, Zamzuri, MAIA, Mansor, J, Nurumal, SR, Yunus, SZSA, Razak, MAA, et al.. Perception of integrating complementary and alternative medicine practice in patient’s treatment among the healthcare practitioners: a systematic review. Pan Afr Med J 2022;43. https://doi.org/10.11604/pamj.2022.43.19.31133.Search in Google Scholar PubMed PubMed Central

49. Farrukh, MJ, Makmor-Bakry, M, Hatah, E, Jan, TH. Impact of complementary and alternative medicines on antiepileptic medication adherence among epilepsy patients. BMC Complement Med Ther 2021;21. https://doi.org/10.1186/s12906-021-03224-2.Search in Google Scholar PubMed PubMed Central

50. Alfian, SD, Sukandar, H, Arisanti, N, Abdulah, R. Complementary and alternative medicine use decreases adherence to prescribed medication in diabetes patients. Ann Trop Med Publ Health 2016;9:174–9. https://doi.org/10.4103/1755-6783.179108.Search in Google Scholar

Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jcim-2025-0211).

Received: 2025-06-10
Accepted: 2025-09-12
Published Online: 2025-10-01

© 2025 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Efficacy of mangosteen as local drug delivery for improving periodontal health in adults with periodontitis: a systematic review and meta-analysis of randomized controlled trials
  4. Catechins in cancer therapy: integrating traditional and complementary approaches
  5. Phytochemical innovations in oral cancer therapy: targeting oncogenic pathways with natural compounds
  6. Opinion Paper
  7. Naturopathy and the Ottawa Charter: a synergistic model for community health promotion in rural India
  8. Research Articles
  9. Investigating the therapeutic potential of medical leech and leech saliva extract in flap survival: an in vivo study using rats
  10. Alstonia boonei stem bark aqueous extract ameliorates elevated parasitemia levels, normalises blood glucose, modulates inflammatory biomarkers and enhances antioxidant status in Plasmodium berghei-infected/diabetic mice
  11. Nutritional, antioxidant, enzyme inhibitory and toxicity assessments of an herbal formulation using in vitro, ex vivo, and in vivo approaches
  12. Molecular docking, molecular dynamic simulation, and ADME analysis of Moringa oleifera phytochemicals targeting NS5 protein: towards the development of novel anti-dengue therapeutics
  13. Impact of licorice supplementation on cardiac biomarkers and histomorphological changes in rats
  14. Effects of minas frescal cheese enriched with Lactobacillus acidophilus La-05 on bone health in a preclinical model of chronic kidney disease
  15. Teratogenic effect of unregistered traditional Chinese medicine containing Atractylodis lancea radix, Glycyrrhiza glabra radix, Rheum officinale rhizome, and Angelica dahurica radix on fetal morphology of BALB/c mice
  16. Network pharmacology based investigation of the multi target mechanisms of Murraya koenigii (curry leaves) in non-alcoholic steatohepatitis (NASH)
  17. Protective effects of citronellol on Escherichia coli septicemia-derived liver lesions in Wistar rats
  18. The effects of spilanthol (SA3X) supplementation on muscle size and strength in healthy men – a randomized parallel-group placebo-controlled trial
  19. Navigating complementary and alternative medicine use, medication adherence, and herb–drug interaction risks among gout patients: a multicenter cross-sectional study in indonesia
  20. Evaluation of photobiomodulation for modulating peripheral inflammation via the lumbosacral medullary region
  21. Traditional alternative and complementary medicine: a review of undergraduate courses and curricula in Peru
  22. Congress Abstracts
  23. Natural Health Products Research Society of Canada Natural Health Products and Cancer Mini-Symposium 2025
https://doi.org/10.1515/jcim-2025-0211
Keywords for this article
complementary and alternative medicine; gout; adherence; herbal medicine; herb-drug interactions

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Efficacy of mangosteen as local drug delivery for improving periodontal health in adults with periodontitis: a systematic review and meta-analysis of randomized controlled trials
  4. Catechins in cancer therapy: integrating traditional and complementary approaches
  5. Phytochemical innovations in oral cancer therapy: targeting oncogenic pathways with natural compounds
  6. Opinion Paper
  7. Naturopathy and the Ottawa Charter: a synergistic model for community health promotion in rural India
  8. Research Articles
  9. Investigating the therapeutic potential of medical leech and leech saliva extract in flap survival: an in vivo study using rats
  10. Alstonia boonei stem bark aqueous extract ameliorates elevated parasitemia levels, normalises blood glucose, modulates inflammatory biomarkers and enhances antioxidant status in Plasmodium berghei-infected/diabetic mice
  11. Nutritional, antioxidant, enzyme inhibitory and toxicity assessments of an herbal formulation using in vitro, ex vivo, and in vivo approaches
  12. Molecular docking, molecular dynamic simulation, and ADME analysis of Moringa oleifera phytochemicals targeting NS5 protein: towards the development of novel anti-dengue therapeutics
  13. Impact of licorice supplementation on cardiac biomarkers and histomorphological changes in rats
  14. Effects of minas frescal cheese enriched with Lactobacillus acidophilus La-05 on bone health in a preclinical model of chronic kidney disease
  15. Teratogenic effect of unregistered traditional Chinese medicine containing Atractylodis lancea radix, Glycyrrhiza glabra radix, Rheum officinale rhizome, and Angelica dahurica radix on fetal morphology of BALB/c mice
  16. Network pharmacology based investigation of the multi target mechanisms of Murraya koenigii (curry leaves) in non-alcoholic steatohepatitis (NASH)
  17. Protective effects of citronellol on Escherichia coli septicemia-derived liver lesions in Wistar rats
  18. The effects of spilanthol (SA3X) supplementation on muscle size and strength in healthy men – a randomized parallel-group placebo-controlled trial
  19. Navigating complementary and alternative medicine use, medication adherence, and herb–drug interaction risks among gout patients: a multicenter cross-sectional study in indonesia
  20. Evaluation of photobiomodulation for modulating peripheral inflammation via the lumbosacral medullary region
  21. Traditional alternative and complementary medicine: a review of undergraduate courses and curricula in Peru
  22. Congress Abstracts
  23. Natural Health Products Research Society of Canada Natural Health Products and Cancer Mini-Symposium 2025
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2026 De Gruyter Brill
Downloaded on 7.1.2026 from https://www.degruyterbrill.com/document/doi/10.1515/jcim-2025-0211/html
Scroll to top button