Squeeze in a yoga class while you wait for your prescription

It’s not your typical pharmacy.

Instead of glaring fluorescent lights, there is soft lighting that comes from a wind-powered generator. Instead of linoleum, the floors are covered in recycled carpet. Instead of ‘80s Muzak, there are the sounds of acoustic guitar. And in the back room, yoga classes and nutrition seminars are held.

The store’s staff includes a naturopathic doctor and a clinical herbal therapist. There are all the normal drugstore things: chocolate bars, Huggies, toothpaste. But there is also an extensive selection of herbs and dietary supplements.

Pharmaca Integrative Pharmacy, which opened its first Southern California store this month in Pacific Palisades, was founded in 2000 by Barry Perzow, a retailer whose previous ventures have included gourmet specialty foods and organic products.

The Pacific Palisades store is one of a small but growing number of pharmacies trying to tap into the market of Americans curious about alternative health care -- people who are as inclined to try yoga or a dietary supplement to treat their ills as visit a traditional medical doctor or pop a prescription drug.

Although many traditional pharmacies, health food stores and supermarkets have expanded their offerings of herbs and supplements in recent years because of growing demand, many lack staff that is properly trained to talk about proper usage, side effects or possible interactions between, for example, an herbal product and prescription drugs. Also, many patients either do not tell their doctors that they are taking herbs and supplements or, when they do tell, find their doctors poorly informed about these products.

For that reason, companies such as Pharmaca, Berkeley-based Elephant Pharmacy and Akron, Ohio-based Ritzman Natural Health Pharmacy are betting that integrative pharmacies are the wave of the future.

“These are the pharmacies that are going to be on the front lines,” said Candy Tsourounis, director of the Pharmacy School Drug Information Center at UC San Francisco. “We are going to see them draw both types of customers -- those refilling prescription medicine, but also those who would like to find out more about St. John’s wort and kava kava -- something that traditional pharmacies have not done very well.”

Pharmaca, which opened its first store in Boulder, Colo., in 2000 and now has 11 stores, in San Francisco and Sonoma, Calif.; Santa Fe, N.M.; Portland, Ore.; Seattle and elsewhere, plans to open as many as 10 additional locations during the next two years. Elephant Pharmacy, which opened in 2002 and bills itself as a “holistic” pharmacy, plans to open two stores in the Bay Area by mid-2005 and is considering locations in Southern California, according to founder Stuart Skorman.

Major drugstore retailers are not standing by idly watching this trend. Rite-Aid, one of the nation’s largest pharmacy chains, has placed GNC Live Well stores inside 1,200 of its 3,400 U.S. locations and is adding them to every new or remodeled outlet, said Jody Cook, a Rite-Aid spokeswoman. One of the largest investors in Elephant Pharmacy stores is the CVS/pharmacy chain, said Skorman.

“Healthcare is changing,” said David Pinto, editor of Chain Drug Review, an industry newsletter. “People are self-medicating more than ever before. Which drugstore you go to has become strictly a matter of convenience.... All of a sudden it is less about convenience and more about all the other stuff.” Elephant Pharmacy, for example, has “melded conventional healthcare and whatever you would call the pharmacy equivalent of natural foods.”

Pharmaca’s stores are staffed with naturopathic doctors, nurses, nutritionists, herbalists, homeopaths and aestheticians. Store pharmacists receive at least six hours of in-house training on such subjects as herb drug interaction, and they participate in conference calls and training sessions every month, as well as weekly meetings with alternative health practitioners, company officials said.

When customers come in to fill a prescription, pharmacists are supposed to ask if they are taking any herbs or supplements, as well as suggest ways to compensate for nutrient depletion from any prescription medications. Because birth control pills can cause side effects such as nausea and headaches, for example, a pharmacist might recommend that a woman take folic acid or magnesium. Customers buying antibiotics might be encouraged to pick up some acidophilus and probiotics. If a customer is struggling with insomnia, a pharmacist might recommend yoga.

“People say about us, ‘Oh, that’s the pharmacy that prescribes yoga,’ ” said Perzow. “And we do. For insomnia and high blood pressure, studies have shown yoga is extremely effective.”

In the herbal products section of the Pacific Palisades store, brief information on individual vitamins and herbs is posted next to the product -- not unlike the notes you might find in an independent bookstore. The information is compiled by an advisory board of doctors and research analysts who specialize in complementary medicine. At a kiosk, customers can type in the name of an herb or supplement to find out which medications might have negative interactions with it. There is a private consultation room for customers who don’t want to discuss medical issues out on the open floor.

Other integrative pharmacies do similar things. At Elephant Pharmacy, there are free classes each day on topics such as nutrition, ayurvedic medicine and infant massage, and the stores post information about supplements prepared by a group of researchers and medical doctors.

Some studies have found that the amount of active ingredient contained in herbal products can vary widely. It can be very difficult even for well-informed customers to sort out, for example, whether one brand of echinacea is likely to work better than another. To try to address that problem, Pharmaca tests some products itself and also sends representatives to visit manufacturers to check the quality of their botanical supplies and their production processes.

On a recent morning, customers breezed through the store filling prescriptions and buying last-minute gifts. For his elderly mother, one man bought special vitamins that are taken under the tongue for faster absorption; another spoke with an herbalist about which brand of elderberry supplement to buy to treat the flu.

Another customer, Denise Mangimelli, said she appreciated the array of natural products that she can’t always find at other stores. “I’m fascinated by all the information. It helped me make my magnesium choice,” said Mangimelli, who bought a bag of supplements as stocking stuffers for her family.

Even the best-trained health professionals, however, may not have all the answers that customers need. A big problem with determining what physical effects a supplement may have is a dearth of scientific studies about their effectiveness, side effects and interactions with prescription drugs.

Steve Kliewer, a molecular biologist at the University of Texas Southwestern Medical Center in Dallas, said herbs had not been tested systematically for their potential interaction with drugs. Studies of St. John’s wort, for example, have shown that it changes people’s metabolism and turns on enzymes that make more than 70% of drugs on the market ineffective.

“St. John’s wort is something people have been using for hundreds of years,” said Kliewer. “But it is only in the ‘90s that we became aware of the negative interactions. Now we can predict that it will interact with most drugs on the market.”

Even as integrative pharmacies promise more help for customers, the problem remains that there is a lack of reliable information about supplements and few places to turn for accurate information. For now, Kliewer has one suggestion for every patient: Let your doctor know about any herb or supplement you are using.