Appendix 1 QUICK GUIDE TO HERB-DRUG INTERACTIONS

  Copyright © 2002 F.A. Davis Company

Appendix 1

QUICK GUIDE TO HERB-DRUG

  

INTERACTIONS

The rapid increase in the use of herbal medicines has created a rapidly growing

database of known herb-drug interactions, many of which are presented in the table

below. Keep in mind, however, that our knowledge of the interactions among pre-

scription medicines, over-the-counter medicines, and herbal medicines continues to

change constantly.

  To help detect possible herb-drug interactions, encourage patients to be open about

all medicines they may be taking, whether prescription, over the counter, or herbal. Ask

them to bring all of their medications with them to their next appointment. Caution

patients not to take herbal medicines in higher doses or more often than recommended.

Also, caution them not to experiment with herbal medicines. Urge them to tell all of their

health-care practitioners about all of the medicines they take.

  If patients are known to have adverse drug reactions, such as allergies, chronic

skin rashes, or pre-existing liver disease related to prescription medicines, warn them

that they have a higher risk of side effects from herbs as well. Reinforce the importance

of reporting any side effects of prescription, over-the-counter, and herbal medicines to

a health-care practitioner. Elderly patients, pregnant women, and children have an

increased risk of interactions and side effects from herbal medicines and should be

referred to a practitioner with specialized training in the field of herbal medicine.Also,

make a point of telling pregnant women that some herbs are unsafe to take during

pregnancy and breast-feeding.

  © Copyright 2002 F. A. Davis Publishing Company Copyright © 2002 F.A. Davis Company

SOURCE OF HERB DRUG

  INTERACTION

  INFORMATION

  ALOE GEL/JUICE Glyburide Increased hypo- Yongchaiyudha glycemic effect et al., 1996 ALOE LATEX Antiarrhythmics May potentiate the Blumenthal et al.,

  Cardiac glycosides action of 1998 Corticosteroids cardiac glyco- Licorice root sides and anti- Thiazide diuretics arrhythmic agents (as do the other drugs listed)

  ASTRAGALUS Acyclovir Increases effects DeSmet & ROOT Interleukin-2 D’Arcy, 1996

  Azathioprine Caution use Cyclosporine Methotrexate

  BITTER MELON Chlorpropamide Increases hypo- Aslam & glycemic effect Stockley, 1979 BORAGE Anticonvulsants May lower seizure Miller, 1998 threshold BROMELAIN Anticoagulants Increases Blumenthal et al., bleeding 1998

  Tetracycline Increases plasma Neurauer, 1961 and urine drug levels

  Chloramphenicol Enhances drug Neurauer, 1961 Erythromycin levels Novobiocin Penicillin 5-fluorouracil Can improve Taussig & Batkin, Vincristine efficacy 1998

  BREWER’S YEAST MAO inhibitors Increased blood Blumenthal et al., pressure 1998 BUCKTHORN Cardiac glyco- May potentiate Blumenthal et al.,

  BARK, BERRY sides toxicity with 2000 Quinidine long-term use

  BUGLEWEED Thyroid Contraindicated Blumenthal et al., preparations 1998 Thyroid McGuffin et al., treatments 1997

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SOURCE OF HERB DRUG

  INTERACTION

  INFORMATION

  BUPLEURUM Alcohol May increase WHO, 1999 CNS depressants sedation Sedatives

  CASCARA Cardiac glyco- May potentiate Blumenthal et al., SAGRADA BARK sides toxicity with 2000

  Quinidine long-term use CHASTE TREE Dopamine- May weaken Blumenthal et al.,

  BERRY receptor antag- effect (animal 1998 onists (such as studies) haloperidol)

  Metoclopramide Possible inter- Blumenthal et al., actions 2000 Hormone therapy Contraindicated Blumenthal et al., Oral contracep- 2000 tives

  CAYENNE PEPPER Aspirin Reduced mucosal Yeoh et al., 1995 damage if cayenne taken 30 minutes before aspirin

  CINCHONA BARK Anticoagulants Increases effects Blumenthal et al., 1998

  COLA NUT Caffeine Contraindicated Blumenthal et al., Psychoanaleptic 1998 drugs

  DEVIL’S CLAW Antiarrhythmics Contraindicated ESCOP, 1999 ROOT

  DONG QUAI Coumadin May increase Heck et al., 2000 effects of medication

  ECHINACEA Amiodarone Miller, 1998 If ⬎8 weeks,

  Anabolic steroids potential for Ketoconazole hepatotoxicity Methotrexate Corticosteroids Antagonistic Cyclosporin effects

  EPHEDRA Cardiac glyco- Cardiac arrhyth- Blumenthal et al., (MA HUANG) sides mias 1998

  Halothane Guanethidine Enhances sympa- Blumenthal et al., thomimetic effect 1998

  © Copyright 2002 F. A. Davis Publishing Company Copyright © 2002 F.A. Davis Company

SOURCE OF HERB DRUG

  INTERACTION

  INFORMATION

  MAO inhibitors May cause fatal Blumenthal et al., hypertension 1998 Ergotamine Hypertension WHO, 1999 Oxytocin

  EUCALYPTUS OIL Drugs weakened Affects liver Blumenthal et al., (EXTERNAL OR or shortened detoxification 2000

  INHALED) EVENING Anticonvulsants May lower seizure Miller, 1998

  PRIMROSE OIL threshold FENNEL Ciprofloxacin Affects absorption, Zhu et al., 1999 distribution, elimination

  FENUGREEK Hypoglycemic May exaggerate Natural Medi- agents effects cines, 2000 Sulfonylureas

  FEVERFEW Aspirin May increase Herbst, 1999 Coumadin bleeding time Miller, 1998 Nonsteroidal anti- Inhibits effects of Miller, 1998 inflammatory herb drugs

  FLAXSEED Conventional May delay Blumenthal et al., medicines absorption 1998 Antidiabetic May slow glucose Blumenthal, medications absorption 2000

  GARLIC Coumadin May increase Sunter, 1991 bleeding time Herbst, 1999 Miller, 1998 Ottariano, 1999

  GINGER Anticoagulants May increase Lumb, 1994 bleeding time Herbst, 1999 Miller, 1998

  GINKGO BILOBA Aspirin May increase Rosenblatt, 1997 Coumadin bleeding time Herbst, 1999

  Miller, 1998 Papaverine May potentiate Sikora et al., effects of drug 1989 Trazodone May cause severe Prescriber’s Let-

  CNS depression ter, September 2000

  © Copyright 2002 F. A. Davis Publishing Company Copyright © 2002 F.A. Davis Company

SOURCE OF HERB DRUG

  INTERACTION

  INFORMATION

  GREEN TEA Coumadin May increase Heck et al., 2000 effects GURMAR LEAVES Glyburide May have additive Baskaran et al.,

  Tolbutamide effects 1990 Insulin May reduce insu- Shanmugasun- lin requirements daram et al.,

  1990 HAWTHORN LEAF Cardiac glyco- May enhance Blumenthal,

  WITH FLOWER sides effects of drug 2000 Adenosine May increase Blumenthal, Caffeine coronary artery 2000 Epinephrine dilatation Papaverine (controversial) Sodium nitrate Theophylline Digoxin May affect drug Miller, 1998 level monitoring

  KARELA Biguanides May cause Miller, 1998 Insulin interactions Sulphonylureas

  KAVA KAVA Alcohol May potentiate Herbst, 1999 Barbiturates effects Benzodiazepines Levodopa May reduce effects Schelosky et al.,

  1995 LICORICE ROOT Spironolactone May increase loss WHO, 1999 of potassium Miller, 1998

  Amiloride May increase loss WHO, 1999 Cardiac glyco- of potassium sides Thiazide diuretics Digoxin May create prob- Miller, 1998 lems with drug monitoring

  MARSHMALLOW All May decrease Blumenthal et al., LEAF AND ROOT absorption of 1998 medications

  OAK BARK All May decrease Blumenthal et al., absorption of 1998 medications

  © Copyright 2002 F. A. Davis Publishing Company Copyright © 2002 F.A. Davis Company

SOURCE OF HERB DRUG

  INTERACTION

  INFORMATION

  PAPAYA Coumadin Increases effect of Shulman, 1997 medication PANAX GINSENG MAO inhibitors May interact Blumenthal et al.,

  Phenelzine 1998 Miller, 1998

  Coumadin May alter bleeding Miller, 1998 times Corticosteroids May have additive Miller, 1998 Estrogens effects Digoxin May affect drug Miller, 1998 levels Biguanides Should not admin- Miller, 1998 Insulin ister together Sulfonylureas

  PSYLLIUM Conventional May delay Blumenthal et al., medicines absorption 1998 Antidiabetic May slow glucose Blumenthal et al., drugs absorption 1998

  RHUBARB ROOT Antiarrhythmics Increases toxic WHO, 1999 Cardiac glyco- effects sides Corticoadrenal steroids Thiazide diuretics

  SARSAPARILLA Bismuth Increases Blumenthal et al., ROOT Digitalis glyco- absorption 1998 sides

  Hypnotics Accelerates Blumenthal et al., elimination 1998 SAW PALMETTO Iron May limit Miller, 1998 absorption SCOTCH BROOM MAO inhibitors May cause hyper- Blumenthal, tensive crisis 2000 SENNA Cardiac glyco- Long-term use can Blumenthal, sides increase loss of 2000

  Quinidine serum potassium SIBERIAN Kanamycin May enhance Vereshchagin et

  GINSENG Monomycin effects of drugs al., 1998 STINGING Diclofenac Increased anti- Chrubasik et al.,

  NETTLES inflammatory 1997 effects

  © Copyright 2002 F. A. Davis Publishing Company Copyright © 2002 F.A. Davis Company

SOURCE OF HERB DRUG

  INTERACTION

  INFORMATION

  ST. JOHN’S WORT Selective serotonin Nausea, headache, Lantz et al., 1999 reuptake inhibitors tremors Roundtree, 2001 Anticonvulsants Contraindicated Roby et al., 2000 Antifungals because of Piscitelli et al., Antiretrovirals possible break- 2000 Calcium channel through bleeding, blockers lowered blood Chemotherapeutics levels, de- Cyclosporine creased drug Macrolide anti- effectiveness biotics Nonsedating anti- histamines Oral contracep- tives Warfarin Tetracycline Increased risk of Herbst, 1999 blood clots Iron May limit Miller, 1998 absorption

  VALERIAN Alcohol May potentiate Upton, 1999 Barbiturates effects Herbst, 1999

  McCaleb et al., 2000

• The Food and Drug Administration has a list of unsafe herbs. The Internet address is: http://lep.cl.msu.edu/msueimp/htdoc/modO3/03900066.html © Copyright 2002 F. A. Davis Publishing Company

  

Appendix 2

HERBS THAT MAY INCREASE

CLOTTING TIMES OR INTERACT WITH

ANTICOAGULANTS

Sources: Heck et al., 2000 and Ottariano, 1999.

• Astragalus
• Ginkgo biloba
• Bilberry
• Ginseng
• Bromelain
• Green tea
• Capsaicin
• Horse chestnut
• Dong quai
• Red clover
• Evening primrose oil
• Skullcap
• Feverfew
• Sheep sorrel
• Garlic
• Willow bark
• Ginger

  

Appendix 3

HERBS THAT MAY HAVE A

• Aloe latex
• Elder
• Boneset
• Fennel
• Buckthorn
• Milk thistle
• Cascara sagrada
• Psyllium
• Dandelion root and leaf
• Senna Sources: Ottariano, 1999 and McGuffin, 2000.

  © Copyright 2002 F. A. Davis Publishing Company Copyright © 2002 F.A. Davis Company

Appendix 4

HERBS THAT SHOULD NOT BE TAKEN

  Copyright © 2002 F.A. Davis Company

LAXATIVE EFFECT

  

INTERNALLY

LIVER TOXICITY: Comfrey Germander

  Chaparral Life root

CANCER-CAUSING EFFECTS:

• Sassafras LIFE-THREATENING TOXICITY IN ANIMALS:
• Pennyroyal oil (has killed some animals after use as a flea repellent.)

  

Warning: Many plants are toxic and should never be used internally; consult a book on poisonous

plants.

  

Appendix 5

HERBS THAT SHOULD NOT BE TAKEN

DURING PREGNANCY

  Agave Blue cohosh root

  Alder Black cohosh

  Aloe (oral use) Black walnut

  Angelica Buchu

  Buckthorn Cascara

  Barberry Castor oil

  Basil Chaste tree berry

  Bilberry leaves Coltsfoot

  Birthroot Comfrey

  © Copyright 2002 F. A. Davis Publishing Company

• Cotton root bark
• Lobelia
• Damiana
• Milk thistle
• Devil’s claw root
• Mistletoe
• Dong quai
• Mugwort
• Ephedra
• Myrrh
• Ergot
• Oregon grape
• False unicorn
• Osha
• Feverfew
• Pennyroyal leaf, flower, and oil
• Ginger
• Ginkgo biloba (Egb)
• Pleurisy root
• Ginseng
• Red clover
• Goldenseal
• Rue leaf
• Gotu kola
• Rhubarb
• Green tea (caffeine content)
• Sarsaparilla
• Hawthorn
• Scotch broom
• Hops
• Senna
• Horehound
• Shepherd’s purse
• Horse chestnut
• Southernwood
• Horseradish
• St. John’s wort
• Horsetail
• Tansy leaf
• Hyssop
• Uva ursi
• Juniper berries
• Wormwood
• Kava kava
• Yarrow
• Licorice
• Yellow dock

  © Copyright 2002 F. A. Davis Publishing Company

  

Warning: Urge patients to use all herbs cautiously during pregnancy. Some herbs in the list above

may induce abortion or stimulate the uterus to contract. Other herbs may have a laxative effect.

  

Advise patients against exceeding recommended dosages, and tell patients to consult with their

health-care practitioners about the length of time to take any herbal medicine. For more information

on herbs that may or may not be used safely in pregnancy, consult the Botanical Safety Handbook.

  Appendices Copyright © 2002 F.A. Davis Company

  

Appendix 6

HERBS THAT SHOULD NOT BE TAKEN

• Aloe (oral use)
• Garlic
• Barberry
• Ginseng
• Bilberry leaves
• Goldenseal
• Black cohosh
• Green tea (caffeine content)
• Bladderwrack
• Hawthorn
• Borage
• Horse chestnut
• Buckthorn
• Horseradish
• Bugleweed
• Hyssop
• Cascara sagrada
• Kava kava
• Chaste tree berry
• Licorice root
• Coltsfoot
• Psyllium
• Comfrey
• Senna
• Elecampane
• Stillingia
• Ephedra
• Wormwood
• Feverfew
• Yellow dock

  

Warning: Other herbs may be unsafe also. Tell patients to consult a health-care practitioner before

taking any herb while breast-feeding.

  © Copyright 2002 F. A. Davis Publishing Company

  Copyright © 2002 F.A. Davis Company