# Medicinal herbs and drug interactions



## Guest (Aug 23, 2000)

Since so many BB members are using/trying herbs, I thought this would be useful...---------------------------------------------Arch Intern Med 1998 Nov 9;158(20):2200-11 Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Miller LG Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Amarillo 79121, USA.Herbal medicinals are being used by an increasing number of patients who typically do not advise their clinicians of concomitant use. Known or potential drug-herb interactions exist and should be screened for. If used beyond 8 weeks, Echinacea could cause hepatotoxicity and therefore should not be used with other known hepatoxic drugs, such as anabolic steroids, amiodarone, methotrexate, and ketoconazole. However, Echinacea lacks the 1,2 saturated necrine ring associated with hepatoxicity of pyrrolizidine alkaloids. Nonsteroidal anti-inflammatory drugs may negate the usefulness of feverfew in the treatment of migraine headaches. Feverfew, garlic, Ginkgo, ginger, and ginseng may alter bleeding time and should not be used concomitantly with warfarin sodium. Additionally, ginseng may cause headache, tremulousness, and manic episodes in patients treated with phenelzine sulfate. Ginseng should also not be used with estrogens or corticosteroids because of possible additive effects. Since the mechanism of action of St John wort is uncertain, concomitant use with monoamine oxidase inhibitors and selective serotonin reuptake inhibitors is ill advised. Valerian should not be used concomitantly with barbiturates because excessive sedation may occur. Kyushin, licorice, plantain, uzara root, hawthorn, and ginseng may interfere with either digoxin pharmacodynamically or with digoxin monitoring. Evening primrose oil and borage should not be used with anticonvulsants because they may lower the seizure threshold. Shankapulshpi, an Ayurvedic preparation, may decrease phenytoin levels as well as diminish drug efficacy. Kava when used with alprazolam has resulted in coma. Immunostimulants (eg, Echinacea and zinc) should not be given with immunosuppressants (eg, corticosteroids and cyclosporine). Tannic acids present in some herbs (eg, St John wort and saw palmetto) may inhibit the absorption of iron. Kelp as a source of iodine may interfere with thyroid replacement therapies. Licorice can offset the pharmacological effect of spironolactone. Numerous herbs (eg, karela and ginseng) may affect blood glucose levels and should not be used in patients with diabetes mellitus.Publication Types: Review Review, tutorial


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## JeanG (Oct 20, 1999)

Wow! This is one I'm going to print out and hang on my refrigerator door.Thanks for posting it, Guy.







JeanG


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## Guest (Aug 23, 2000)

Jean,That's not all; it's been recently discovered that St. John's Wort negativelyinteracts with protease inhibitors, a class of anti-HIV drug. The two are metabolized by the same enzymes, and they effectively cancel each other out. Individuals who are using protease inhibitors for HIV/AIDS treatment should *not* use St. John's Wort!Herbs are not harmless; if they have biological action, they are drugs! The problem is that many people don't see them as drugs, and neglect to tell their GP about any herbs they may use.


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## rxgirl (Aug 21, 2000)

just another herbal note...st. john's wort also decreases spermatogenesis...this is not often asked of those seeking fertility treatment...that's why it's important to tell your doctor and pharmacist ALL drugs you currently take to fully assess your situation...


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## Epona (Jul 27, 2000)

Thank you for posting this! I am interested in the herbal approach, yet I am wary of interactions like these. You can never be too careful! Also, it is my understanding that herbal supplements aren't regulated very much, if at all (?). It pays to read up on these things.


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## Guest (Aug 23, 2000)

I'd like to add that Chamomile is in the Ragweed family and might cause a reaction in people allergic to Ragweed.


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## Guest (Aug 23, 2000)

ponygirl,No, herbs are not regulated at all. There is no guarantee that what the companies say is in the bottle is actually *in* the bottle.There is one website which has been conducting independant testing of various OTC herbs for potency; it is: www.consumerlab.com/; what they have found so far is disconcerting, though not really surprising.


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## vikee (Feb 5, 2000)

Guy, Thanks for the information and web site. Hope you are and continue to do well!vikee


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## Nicol (Aug 13, 2000)

There are LOADS of drug reactions out there (I even have a book on it) so you should always check with a Dr. or Pharmacist before taking anything. Another one is Aloe Vera and steroids, they can stop heart function and cause death.


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## K9Mom (Sep 20, 1999)

Excellent post! Thank you Guy!


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## moldie (Sep 25, 1999)

Great post Guy. I've been looking for something like this. I took echineacia earlier this year when my son had a cold. It made me terribly fatigued. I thought this might be because there was a warning about people with some autoimmune conditions such as MS not to take it. I just figured that fibro must be in this category. However, now I also find, according to this article, that it shouldn't be taken with drugs like ketoconazole which is, I believe, like/is Diflucan which I am on (an antifungal with side-effects of possible liver problems).


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## Guest (Aug 26, 2000)

Moldie,Diflucan is also known as fluconazole. It's not the same drug as ketoconazole, but it is related. A rare side effect of fluconazole in lab animals is an increase in liver tumors, and it should be used with caution in people with existing liver disease. Liver problems associated with fluconazole are rare. However, there is an increased risk of such problems if taken with other drugs (such as oral antidiabetes drugs) which also affect liver function.


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## moldie (Sep 25, 1999)

Thanks Guy, Sometimes I remember the exact name of it and sometimes, like this, it escapes me. (I'll blame it on my feeble fibro foggy brain). I knew it was an "azole" ending which could affect the liver too.


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