Archive for the ‘Herb & Supplements Interaction’ Category
Drug, Herb and Supplement and Food Interactions & Contraindications
| Are you taking garlic supplements as part of your healthy heart routine? If so, stop taking them a week before you are scheduled for surgery. Garlic’s blood thinning properties may cause a problem for your surgical team if something happens, and may complicate things a bit if you’re having dental procedures done.
Are you taking low doses of aspirin as part of your healthy heart routine? Be sure you talk this over with your physician and surgeon before you keep–or stop–taking aspirin in the days before, and after, surgery. Did you know that: … immune modulators, such as echinacea, can alter the effect of immunosuppressive drugs given to cancer and organ transplant patients? … high doses of vitamin C are so effective at detoxifying various chemicals that your daily dose may cause some of your general or local anesthesia drugs to wear off—while you are still being operated on? … consuming high amounts of soy in any form can interfere with your iodine uptake–and your thyroid medication? … that many of the “calcium-rich” dark leafy greens that are recommended for healthy eating can interfere with your body’s ability to get all the calcium it would otherwise be able to from your food and supplements? As people take more things in the effort to get or stay healthy, or stave off the effects of aging, we are creating a chemical mixture in our bodies that could, at worst, pose a serious threat to our health; at least, render virtually ineffective something else we are taking or our body is producing in the normal course of daily functioning. We cannot rely on our health care providers to keep track of everything we are taking. Along with medications they may individually prescribe us (while not being aware of what medications have been prescribed by other doctors we are seeing), most of us take a wide range of over-the-counter (OTC) medications, such as allergy pills, cough syrups, headache medicines, as well as have shelves full of vitamins, minerals, herbs, teas, tinctures and more from a variety of sources for a number of different reasons. The only one who can be fully responsible for making sure you don’t mix the wrong things together, or take things at the wrong time, is you. |
Herbal Remedies: Adverse Effects and Drug Interactions
A growing number of Americans are using herbal products for preventive and therapeutic purposes. The manufacturers of these products are not required to submit proof of safety and efficacy to the U.S. Food and Drug Administration before marketing. For this reason, the adverse effects and drug interactions associated with herbal remedies are largely unknown. Ginkgo biloba extract, advertised as improving cognitive functioning, has been reported to cause spontaneous bleeding, and it may interact with anticoagulants and antiplatelet agents. St. John’s wort, promoted as a treatment for depression, may have monoamine oxidaseinhibiting effects or may cause increased levels of serotonin, dopamine and norepinephrine. Although St. John’s wort probably does not interact with foods that contain tyramine, it should not be used with prescription antidepressants. Ephedrine-containing herbal products have been associated with adverse cardiovascular events, seizures and even death. Ginseng, widely used for its purported physical and mental effects, is generally well tolerated, but it has been implicated as a cause of decreased response to warfarin. Physicians must be alert for adverse effects and drug interactions associated with herbal remedies, and they should ask all patients about the use of these products.
Increasingly, alternative therapies such as herbal products are being used in the United States. Approximately 25 percent of Americans who consult their physician about a serious health problem are employing unconventional therapy, but only 70 percent of these patients inform their physician of such use.1
Herbal products are not tested with the scientific rigor required of conventional drugs, and they are not subject to the approval process of the U.S. Food and Drug Administration (FDA). Herbal products therefore cannot be marketed for the diagnosis, treatment, cure or prevention of disease. Nonetheless, the Dietary Supplement Health and Education Act of 1994 allows these products to be labeled with statements explaining their purported effect on the structure or function of the human body (e.g., alleviation of fatigue) or their role in promoting general well-being (e.g., enhancement of mood or mentation).2 Analysis of some of the putative effects of herbal products shows that they sometimes closely resemble claims of clinical efficacy for various diseases or conditions.
Unlike conventional drugs, herbal products are not regulated for purity and potency.2 Thus, some of the adverse effects and drug interactions reported for herbal products could be caused by impurities (e.g., allergens, pollen and spores) or batch-to-batch variability. In addition, the potency of an herbal product may increase the possibility of adverse effects.
Because physicians are likely to encounter patients who are using herbal remedies, they need to be aware of the purported effects of these products. They also need to be cognizant of the adverse effects of herbal remedies (Table 1) and the possibility of deleterious drug interactions (Table 2).
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Ginkgo Biloba
The active ingredients in Ginkgo biloba extract account for its antioxidant properties and its ability to inhibit platelet aggregation.3 Consequently, this herbal product is promoted for use in improving cognitive function and blood flow.4 To date, however, at least four reports of spontaneous bleeding in association with use of Ginkgo biloba have been published.4-8
One report4 described a 70-year-old man who presented with bleeding from the iris into the anterior chamber of the eye one week after beginning a self-prescribed regimen consisting of a Ginkgo biloba concentrated extract (Ginkoba), in a dosage of 40 mg twice daily. His medical history included coronary artery bypass surgery performed three years previously. His only medication was aspirin, in a dosage of 325 mg per day, which he had taken since his bypass surgery. After the spontaneous bleeding episode, he continued to take aspirin but discontinued the ginkgo product. Over a three-month follow-up period, he had no further bleeding episodes. Interaction of the ginkgo product and aspirin was considered the cause of his ocular hemorrhage.
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Ginkgo biloba may also interact with warfarin (Coumadin). A 78-year-old woman who had been taking warfarin for five years after coronary bypass surgery suffered a left parietal hemorrhage after using a ginkgo product for two months.5 No change was noted in her prothrombin time. The intracerebral bleeding was attributed to the antiplatelet effects of ginkgo.
In another reported case,6 a 33-year-old woman was diagnosed with bilateral subdural hematomas after almost two years of ingesting Ginkgo biloba, in a dosage of 60 mg twice daily. Her other medications were acetaminophen and an ergotamine-caffeine preparation, which she used briefly. While she was taking Ginkgo biloba, her bleeding times were 15 and 9.5 minutes. Within 35 days after she stopped taking the ginkgo product, her bleeding times were normal (three to nine minutes).
An additional case of spontaneous intracerebral hemorrhage was reported in a 72-year-old woman who had been taking Ginkgo biloba, in a dosage of 50 mg three times daily, for approximately six months.7 No history of head trauma could be elicited.
Until further information is available, patients who are taking garlic, vitamin E,8 warfarin, aspirin or other drugs with antiplatelet or anticoagulant effects should be cautioned about potential interactions with ginkgo products. Patients who are taking ginkgo products should be counseled to inform their physician about unusual bleeding or bruising, new-onset headaches or vision changes.
Burdock (Arctium lappa)
Natural Standard assigns a letter grade for indications based on the quality of available scientific evidence (view Grading Rationale). Letter grades have the following meaning:
- Strong scientific evidence for this use; – Good scientific evidence for this use; – Unclear scientific evidence for this use; – Fair scientific evidence against this use (it may not work); – Strong scientific evidence against this use (it likely does not work). Read the rest of this entry »
Passion Flower (Passiflora incarnata L.)
Apricot vine, banana passion fruit (P. mollissima), Calmanervin (combination product), Compoz (combination product), corona de cristo, EUP, Euphytose (combination product), Fleischfarbige, fleur de la passion, flor de passion, granadilla, grenadille, Jamaican honeysuckle (P. laurifolia), madre selva, maypops, Naturest, passiflora, passionflower, passion vine, Passionsblume, purple passion flower, Sedacalm, water lemon, wild passion flower. Read the rest of this entry »
Chaparral (Larrea tridentate), Nordihydroguaiaretic acid
Natural Standard assigns a letter grade for indications based on the quality of available scientific evidence (view Grading Rationale). Letter grades have the following meaning:
- Strong scientific evidence for this use; – Good scientific evidence for this use; – Unclear scientific evidence for this use; – Fair scientific evidence against this use (it may not work); – Strong scientific evidence against this use (it likely does not work). Read the rest of this entry »
Burdock (Arctium lappa)
Natural Standard assigns a letter grade for indications based on the quality of available scientific evidence (view Grading Rationale). Letter grades have the following meaning:
- Strong scientific evidence for this use; – Good scientific evidence for this use; – Unclear scientific evidence for this use; – Fair scientific evidence against this use (it may not work); – Strong scientific evidence against this use (it likely does not work).
Uses based on scientific evidence Scale Read the rest of this entry »
Bromelain (Ananas comosus)
Ananas sativus, Ananase®, bromeline (pleural), Bromelainum, Bromeliaceae (family), Bromelin, Bromelins, plant protease concentrate, pineapple extract, Traumanase®.
Natural Standard assigns a letter grade for indications based on the quality of available scientific evidence (view Grading Rationale). Letter grades have the following meaning:
- Strong scientific evidence for this use; – Good scientific evidence for this use; – Unclear scientific evidence for this use; – Fair scientific evidence against this use (it may not work); – Strong scientific evidence against this use (it likely does not work). Read the rest of this entry »
Black Cohosh (Cimicifuga racemosa L.)
Actaea macrotys, Actaea racemosa L., actee a grappes, Amerikanisches wanzenkraut, baneberry, black snakeroot, botrophis serpentaria, bugwort, cohosh bugbane, Cimicifuga, Cimicifugae racemosae rhizoma, cimicifugawurzelstock, herbe au punaise, macrotys, Macrotys actaeoides, rich weed, rattle root, rattle snakeroot, rattle top, rattle weed, richweed, schwarze schlangenwurzel, solvlys, squaw root, Thalictrodes racemosa, Traubensilberkerze, Wanzenkraut. Read the rest of this entry »
Betel Nut
Natural Standard assigns a letter grade for indications based on the quality of available scientific evidence (view Grading Rationale). Letter grades have the following meaning:
- Strong scientific evidence for this use; – Good scientific evidence for this use; – Unclear scientific evidence for this use; – Fair scientific evidence against this use (it may not work); – Strong scientific evidence against this use (it likely does not work). Read the rest of this entry »
Belladonna (Atropa belladonna L. or its variety acuminata Royle ex Lindl)
Natural Standard assigns a letter grade for indications based on the quality of available scientific evidence (view Grading Rationale). Letter grades have the following meaning:
Strong scientific evidence for this use; – Good scientific evidence for this use; Unclear scientific evidence for this use; – Fair scientific evidence against this use (it may not work); – Strong scientific evidence against this use (it likely does not work). Read the rest of this entry »