Seventy-five percent to 80% of the world population depends on crude plant drug preparations or labeled herbal drugs to treat their health problems because of economic considerations. The present global market for these products has been estimated to be approximately 20 billion US dollars and is growing at the rate of 15–20% annually. Thus, plant-based therapeutic agents continue to have scientific, social and commercial significance and appear to be gathering a momentum in health-relevant areas. Hence, detailed and scientifically designed research on these plants would help to identify safe and effective drugs for memory enhancement.[28
Analysis of the results of our study revealed that maximum people using MVEM were between the ages of 11 and 20 years (17.54%), followed by the ages of 21 and 40 years (17.12%). Results also showed that students (17.29%) and the persons of business or service class (15.29%) were the highest users of these medicines.
This is an age in which the values of performance, efficiency, improvement and self-realization are ever-present. Good physical and mental health is therefore considered a major asset in society.[29
] With the explosion of information and advancement of industrialization, the students as well as the persons of business or service class are resorting to MVEM to improve and enhance attention, memory, vitality and other measures of wellbeing. The patients opt for herbal MVEM considering that they have fewer side-effects.[26
] Also, use of MVEM by their friends or relatives might have prompted them to prefer the same.
Although the pharmacists normally do not provide counseling to their customers, we observed that 65% pharmacists showed interest in providing counseling to all their customers if suitable information is given by the manufacturers. It was found that most of the polyherbal formulations of cognition enhancers were sold without valid physicians’ prescription (65%) in the rural area and 46% in the urban area of Gujarat region from the Ayurvedic or general medical stores. Majority of people who use herbal medicines or over-the-counter medicines do not reveal to their physician or pharmacists and may have the side-effects from the interactions between herbal components and concurrent pharmacotherapy.[30
] Therefore, it is important for the pharmacist to take up the responsibility of patient counseling and patient awareness regarding the drug-drug interactions strongly, especially if the drug is sold without prescription. This work does not address “nonmedical use of prescription nootropics/stimulants,”[31
] a subject that may require a separate research.
We found that 45 herbal drugs were used alone or in combination in the form of extract, tea or powder as MVEM in Gujarat region. Evaluation of various constituents in the 25 marketed herbal cognition enhancers revealed that Brahmi (Bacopa monniera), Shankhpushpi (Evolvulus alsinoides), Ashwangandha (Withania somnifera), Jatamansi (Nardostychos jatamansi), Vacha (Acorus calamus) and Amla (Embelica officinalis) are commonly used herbs in several herbal preparations. In Gujarat region, the leading brands in the market survey were found to be Mentat (The Himalaya Drug Company), Shankhpushpi (Zandu) and Shankhpushpi Syrup (Unjha Pharmacy), etc. Twelve Ayurvedic formulations were found to be used commonly as vitality-enhancing medicines, among which Chyavanprash (Zandu) was found to be a leading brand.
Recent research on Bacopa monnieri
whole plant-standardized dry extract suggested that B. monnieri
has potential for safely enhancing cognitive performance in the elderly patients.[32
] Nahata et al
. showed positive effects of Evolvulus alsinoides
Linn. on learning behavior and memory-enhancement activity in rodents.[33
However, these claims must be critically evaluated in terms of modern scientific parameters. These plant-derived products should be carefully standardized and their efficacy and safety for a specific application should be demonstrated. When such a project is envisaged, some prerequisites must be met. It is important to carefully correlate the disease description in the ancient literature with the modern etiology and clinical picture to ensure correct correspondence. For that, a similar pharmacoepidemiological study on doctors and patients also would be beneficial.