A good deal of the evidence on herb-to-drug interactions discussed in this article is based on case reports, which are sometimes incomplete. Hence, the likelihood of herb-drug interactions is theoretically higher than are two popular herbal products marketed to treat liver disorders and depression. For health care providers: a summary of key research results about herb-drug interactions and safety information.
Interaction? Herbal Drug to How an Handle
Two weeks after he discontinued use of the ginseng product, his INR was 3. Because of the risks associated with a decreased INR, the patient was not rechallenged with ginseng. Until studies or additional case reports can verify the interaction between ginseng and warfarin, it would be prudent to closely monitor patients on warfarin who begin taking dietary supplements that contain this herb. A possible mechanism for this interaction is not yet known.
Kava is an herbal sedative with purported antianxiety or calming effects. In one case series involving four patients, 29 kava was associated with extrapyramidal effects at dosages of to mg per day. Symptoms occurred 90 minutes after one patient took a single mg dose, four hours after one patient took a single mg dose, four days after one patient began taking mg three times daily, and 10 days after one patient began taking mg twice daily.
The extrapyramidal side effects included oral and lingual dyskinesia, torticollis, painful twisting movements of the trunk, oculogyric crisis and exacerbation of Parkinson's disease. Kava has also been shown to have additive effects with central nervous system depressants. A patient who was taking alprazolam Xanax , cimetidine Tagamet and terazosin Hytrin became lethargic and disoriented after ingesting kava.
Kava should not be used with benzodiazepines, barbiturates, antipsychotics and alcohol. In addition, patients with Parkinson's disease should be discouraged from using kava products. Kava dermopathy has been reported with the use of kava as a traditional South Pacific beverage. Recently, two cases associated with use of commercially available kava preparations were reported. Erythematous, infiltrated plaques then developed on his face, chest and back.
A similar case involved a year-old woman who presented with papules and plaques on her face, arms, back and chest after taking a kava extract for three weeks.
In both cases, biopsy revealed lymphocytic infiltration of the dermis with destruction of the sebaceous glands. Because kava is lipophilic, it was hypothesized that kava can concentrate in sebaceous oils and trigger an immune response, resulting in a drug reaction.
Because dietary supplements are becoming increasingly popular, physicians need to ask questions about the use of herbal products as part of the medication history Table 3. Even though herbal products are available without a prescription, medical guidance is necessary because of the adverse effects of these products and the potential for drug interactions.
Consequently, physicians need to stay abreast of trends in dietary supplement use, with the realization that for most supplements the adverse effects and potential for drug interactions are not well characterized. If so, are you taking any prescription or nonprescription medications for the same purpose as the herbal product?
Objective information about herbal products can be obtained in publications such as Alternative Medicine Alert and Review of Natural Products Already a member or subscriber? She earned her pharmacy degree at West Virginia University School of Pharmacy and completed a hospital pharmacy practice residency at West Virginia University Hospitals. Address correspondence to Melanie Johns Cupp, Pharm.
Box , Morgantown, WV Reprints are not available from the author. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. Dietary Supplement Health and Education Act of Rosenblatt M, Mindel J.
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Tan Sheet ; 5 Retrieved October from the World Wide Wed: Am J Kidney Dis. Pharmaceutical Products Press, Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Kava and dopamine antagonism [Letter]. J Neurol Neurosurg Psychiatry. Coma from the health food store: Sebotropic drug reaction resulting from kava-kava extract therapy: J Am Acad Dermatol.
Hospital and clinical associate professor in family and community medicine at the Milton S. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
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Adverse Effects and Drug Interactions. Mar 1, Issue. Abstract Ginkgo Biloba St. John's wort Gastrointestinal disturbances, allergic reactions, fatigue, dizziness, confusion, dry mouth, photosensitivity Ephedra ma huang Hypertension, insomnia, arrhythmia, nervousness, tremor, headache, seizure, cerebrovascular event, myocardial infarction, kidney stones Kava Sedation, oral and lingual dyskinesia, torticollis, oculogyric crisis, exacerbation of Parkinson's disease, painful twisting movements of the trunk, rash.
John' s wort Antidepressants Ephedra Caffeine, decongestants, stimulants Ginseng Warfarin Kava Sedatives, sleeping pills, antipsychotics, alcohol. Have you used this herbal product before? Are you allergic to any plant products? Are you pregnant or breast-feeding? Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. See My Options close. To see the full article, log in or purchase access.
More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Continue reading from March 1, Previous: It could not be said that is true perspective. Constantly, herbs and foods may interact with medications normally taken that result in serious side reactions.
Experts suggest that natural does not mean it is completely safe. The medication that is taken by mouth travels through the digestive system in the same way as food and herbs taken orally do.
When drugs and certain foods are taken at the same time, they might interact in such a way that decrease the effectiveness of the ingested drug or reduce the absorption of food nutrients. High-risk patients, such as the elderly patients taking three or more medications for chronic conditions, patients suffering from diabetes , hypertension , depression , high cholesterol or congestive heart failure should be especially monitored for such drug food interactions.
Some people at higher risk for drug-nutrient interactions They are who [ 3 ]:. It has been reported that most plants and plant extracts are used as prescribed medicines in France and Germany [ 6 ]. The number of medicals tending to use such herbal medicines is increasing, those suffering from cancer are inclined to use herbal medicine due to hope to cure, disease improvement, preventing disease to convert to metastatic form, supporting immunity system, reducing stress, and relaxation.
Furthermore, the main aims of using herbal medicine in Cancer treatment are: Primary prevention of cancer through creating an unfavorable environment for growth of cancer cells, Prevention of a recurrence of cancer, Increasing body's immune system, and reducing side effects resulting from using modern treatment methods including chemotherapy and radiotherapy [ 7 ].
Difference of herbal drugs and chemical drugs: In spite of similarities, there are some important differences between modern and herbal medicines.
It is claimed that various parts of plant extract work together in a synergetic way. The evidence show that synergetic and buffering effects of whole plant extracts. But that these characteristics apply for all plants is still under question. Synergetic and buffering principles are applied for combination of different plants. It was reported that the combination of plants increases therapeutic effects and reduces side effects. This is in contrast with using methods of usual and chemical medicines, because using several modern drugs at the same time is avoided as much as possible [ 8 ].
Herbal medicines are sophisticated natural compounds influencing at the same time the different phases of diseases through different mechanisms. On the other hand, chemical medicines are individual synthetic compounds interfering in an ideal [ 9 ]. The quality of herbs is very important as some herbs require specialist treatment after collection, for example the most highly esteemed quality of Asian ginseng comes from plants of certain varieties that are at least 7 years old, and which have been fermented and dried before processing.
This makes them expensive and thus very liable to adulteration, the most common adulterant being liquorice, which has known adverse reactions, including an interaction profile different to that of ginseng.
Mistaken identity and adulteration may account for inaccurate reports as to the safety of an herbal medicine and damages the reputation of a herb. Even more dangerous is the practice of adulteration of herbal medicinal products with synthetic medicines, such as corticosteroids and even warfarin [ 10 ].
Quality control and good manufacturing practice is therefore obviously of equal importance to herbal medicines as to conventional drugs, and when quality control methods can be further refined, H-DI reports will become more reliable. At present it is difficult to decide whether there is a true interaction or not, since the composition and even the identity of a herb within a herbal product cannot always be validated. Even though reputable herbal manufacturers have quality assurance procedures in place, which minimise variability within their own products, there will inevitably be differences between preparations made by different methods and by different companies [ 11 ].
Herbal medicinal products are by definition complex mixtures of many compounds, leading to the possibility of a total extract having a different profile of H-DIs than an isolated compound. For example, genistein inhibits various CYP enzymes but the whole extract of soya, in which genistein occurs, does not [ 12 ]. Opposing effects have even been reported on the extracts of the same plant using in vitro and in vivo methods: It is not known whether this is due to the extracts having a different composition, or whether it is a species specific effect, or perhaps it is an example of the difference between in vitro and in vivo results.
This phenomenon illustrates once again the danger of extrapolating the results of in vitro or in vivo experiments, which examine the experimental effect of a single compound, on a possibly species specific enzyme, in a laboratory, to clinical situations. It is therefore most important that the association between experimental results and clinical situations is clarified to enable accurate predictions to be made, and that the contribution of a single ingredient in a mixture is put in perspective [ 14 ].
The constitution of a herbal medicinal product can also vary greatly, depending on the source material, which is determined by genetics, and the conditions under which it is grown, as well as the method of processing, including extraction, storage, and formulation of the product. These may occur out of accidental misuse or due to lack of knowledge about the active ingredients involved in the relevant substances. Interactions between food and drugs may inadvertently reduce or increase the drug effect.
The majority of clinically relevant food-drug interactions are caused by food induced changes in the bioavailability of the drug [ 15 ].
There are three types of accepted drug-food interactions based on their nature and mechanisms. They cause either an increase or decrease in the oral bioavailability of a drug.
The precipitant agent may modify the function of enzymes or transport mechanisms that are responsible for biotransformation. Changes in the cellular or tissue distribution, systemic transport, or penetration to specific organs or tissues can occur.
In the last two decades there has been a considerable increase in the herbal remedy market. Interactions between herbal remedies and drugs have been put on the agenda and received increased attention [ 17 ]. Both serious and less serious adverse interactions have been reported e. The typical herb user was female, aged 30 to 69 years, with higher education or hospitalized in the last year. Forty-one per cent of USA adults reported the use of herbal remedies to self-treat before seeking medical care from a physician [ 20 ].
Drug-herb interactions are based on the same pharmacokinetic and pharmacodynamic principles as drug-drug interactions.
Traditional Chinese medicine: herb-drug interactions with aspirin
Keywords: herb–drug interactions, risk management .. in current Dutch recommendations on how to deal with herb–drug interactions [43, 44]. For this reason, the adverse effects and drug interactions associated with herbal remedies are largely unknown. Ginkgo biloba extract. Herb-drug interactions are drug interactions that occur between herbal medicines and conventional drugs. These types of interactions may be more common.