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17.11.2014

Herbal medications and drug interactions, treat ed - Try Out

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As described in a previous article (The interactions of herbs and drugs, 2000 START Manuscripts), the nature of herb-drug interactions is not a chemical interaction between a drug and an herb component to produce something toxic. Such responses can occur with drug-drug interactions and with food-drug interactions, so the finding of some instances of herb-drug interaction would not be surprising.
The Chinese culture is one in which herbs were a dominant medical therapy during the 20th Century, and drugs were a relatively recent addition to the medical field. Today, doctors and pharmacists are provided courses and educational materials outlining potential problems with herbs that their patients may be using.
This chart first divides interaction concerns into broad subgroups, the main ones being related to pharmacodynamic interactions (mostly involved with herbs and drugs yielding similar effects or counteracting one another) and pharmacokinetics (such as changing the rate of absorption or elimination of a drug). Due to the paucity of actual reports of herb-drug interactions, lists of herb-drug interactions are usually padded with other information, such as reports of simple adverse reactions (not involving interactions). When published reports alluding to adverse herb reactions (but not interactions) and to pharmacology studies only are eliminated, one is left with few instances of reported herb-drug interactions.
Drug-herb interaction among commonly used conventional medicines: a compendium for health care professionals. Put simply, there were very few well-supported interactions detected: namely 22 that involved more than an individual report, or a simple pharmacology study, or a mere suggestion of potential interaction. If a patient merely asks you to assure that the herbs you prescribe will not interact or be a problem with a drug regimen being used at the same time, it is not possible to give such assurances.
All major medical journals, and many minor medical journals, have their articles listed-and often abstracted-in a huge database maintained by the National Center for Biotechnology Information (NCBI) of the National Library of Medicine (NLM), a division of the National Institutes of Health (NIH). This site (which can also be accessed through any search engine by typing in Entrez-PubMed and then following the first link) will provide a space into which the user may type the search terms, to yield a series of abstract titles, with access to abstracts (or fuller reference information when abstracts are not available).
Hazardous pharmacokinetic interaction of Saint John's wort (Hypericum perforatum) with the immunosuppressant cyclosporin. Contrary to common belief, over-the-counter herbal remedies may cause clinically relevant drug interactions. The small number of reports of specific herb-drug interactions is the reason for getting this as a typical result.
If a report of interaction appears, it is important to check the abstract (when provided) for details to confirm that there is an actual report of herb-drug interaction (as with the St.
There are more sophisticated searches that can be performed by listing more key words to try and capture more references on the first search. Absence of a report in the literature doesn't guarantee that there is no possibility of an herb-drug interaction.
The herbs mentioned in this abstract are those suspected of interacting with Warfarin, a drug with a narrow therapeutic window often used by sensitive patient populations. As noted above, the drug with greatest concern for interactions is Warfarin, but there is also a concern for interaction with any blood-thinning drug.
Potential interactions between herbal medicines and conventional drug therapies used by older adults attending a memory clinic. OBJECTIVE: Herbal medicines and conventional drug therapies are often taken in combination. This report would seem to give a shocking result: that nearly one-third of herb users (at least, among this elderly population) were at risk for herb-drug interactions.
Non-steroidal anti-inflammatory drugs (NSAIDs), particularly aspirin, have the potential to interact with herbal supplements that are known to possess antiplatelet activity (ginkgo, garlic, ginger, bilberry, dong quai, feverfew, ginseng, turmeric, meadowsweet and willow), with those containing coumarin (chamomile, motherwort, horse chestnut, fenugreek and red clover) and with tamarind, enhancing the risk of bleeding. A mild antiplatelet activity for ginkgo has been proposed as one of its mechanisms for aiding circulation to the brain and, thereby, enhancing memory. Researchers who are working to demonstrate the potential health value of herbs may be drawn to demonstrating the anti-coagulation potential for herbs during laboratory animal studies.
To be safe, a practitioner would either not prescribe ginkgo to a regular user of NSAIDS, especially aspirin and particularly for the elderly patient. Millions of people regularly take blood-thinning drugs such Warfarin, and even more take aspirin and similar medications to prevent heart attacks and strokes.


Herbs may interact with the blood thinning drugs in different ways, some of them beneficial, some of them potentially harmful. Meanwhile, physicians are starting to realize that many herbs possess potent pharmacological activity.
Vitamin K is found in high concentrations in many foods, including dark green leafy vegetables (especially turnip greens), alfalfa sprouts, broccoli, asparagus, egg yolks and dairy products. Another aspect of blood clotting involves the clumping together of platelets: the combination of platelets clumps and the fibrin clot is what causes blood to thicken into full clots. If your doctor starts you on anticoagulant medication and your diet already includes vegetables rich in vitamin K.
While you're taking anticoagulants, avoid regular use of concentrated, standardized extracts of herbs that are known to have antiplatelet activity, such as ginkgo, which is commonly sold as 50:1 concentrate. If you are generally healthy and taking an antiplatelet drug such as aspirin for preventive purposes, you may want to try switching to ginkgo, which has many benefits.
Given the increasingly large number of people taking complex mixtures of herbs, vitamins and drugs, it's probable that we will see more reports of side effects and negative interactions. Cupp MJ, Herbal remedies: adverse effects and drug interactions, American Family Physician 1999. Chang HM and But PPH (editors), Pharmacology and Applications of Chinese Materia Medica, (2 vols.), 1986 World Scientific, Singapore. According to IDA Cambie pharmacy manager Edwin Kwong, R.Ph, that potential interaction should not be taken lightly. Herbal supplements may decrease a drug's effectiveness or, conversely, amplify the effects to a dangerous level. Likewise, it's important to ask a health professional about potential interactions with your existing medications before buying a new herbal supplement.
Note: High doses of licorice can lead to increased blood pressure, water retention, and potassium loss.
Not only are herbal or natural medicines also on the rise, but the identification of natural medicines that are known inhibitors of CYP3A4 are also increasing in number.
As such, clinicians should be aware of common herbal or natural medicines available over-the-counter (OTC) and on the internet that can result in clinically relevant herb-drug interactions thereby putting patients at increased risk for clinically relevant side effects. This is likely due to the low dose of any individual herb component usually consumed and the simple absence of significant interaction at any reasonable dose.
A variety of electronic databases and hand-searched references were used to identify documentation of interactions between herbal products and drugs from the most commonly used therapeutic classes. With the enclosed report we would like to alert other physicians that herbal extracts of Saint John's Wort (Hypericum perforatum) may cause a sudden remarkable decrease of cyclosporin trough concentrations. These herbs are often provided in single-herb products where they are at a relatively large dosage.
The objective of our study was to identify the range of natural health products and conventional drug therapies used by older adults (aged 65 years and over) attending a memory clinic, and to specifically evaluate the frequency of potential interactions between herbal medicines and conventional drug therapies.
At the same time, with the use of herbal medicines more popular now than ever, surveys show that most people don't tell their physicians about their use of herbs or vitamin supplements.
Concerns have been raised in prominent medical journals that this activity could have detrimental effects, especially for patients taking certain types of medications.
If you toss bottles of herbal supplements in your basket while shopping at a health food store, you might think of them as being more like food products than medications.
Kwong warns patients to be especially careful about taking herbal and drug products that serve the same purpose.
If your doctor is not interested in herbal supplementation or is not willing to address your questions about supplements, your pharmacist can be an important resource. Remember: Talk to your doctor or pharmacists for the best, most current and personalized advice.
Information on this site is provided for informational purposes and is not meant to substitute for the advice provided by your own physician or dietitian.


MEDLINE, Allied and Complementary Medicine Database, CINHAL, HealthSTAR, and EMBASE were searched from 1966 to the present. John's Wort the most common herb (54 cases) involved." Thus, 14 cases were well-documented in this report published about 2 years earlier than the new report which found 22 reasonably supported cases. DESIGN: We interviewed consecutive patients attending the Memory Disorders Clinic at the Baycrest Centre for Geriatric Care, a University of Toronto teaching hospital, between 4 July and 15 August 2000. Cautious physicians have chosen the route of absolute avoidance rather than risk an adverse reaction, they recommend that patients stop taking herbs altogether.
Or, if you are taking antiplatelet drugs everyday, the addition of ginkgo or one of the herbs listed in the first two sections of the chart above could lead to uncontrolled bleeding.
This same rationale applies to concentrated forms of any of the antiplatelet herbs, although it's probably safe to eat fresh ginger or garlic in food or to have a cup or two of green tea every day. But rather than turning back the clock on herbal medicine, I propose learning from these examples and upgrading our database of medical information. But the truth is that herbal supplements have potent effects that can interfere with both prescription and non-prescription medications.
Information and statements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. This change was in temporal relationship to hypericum extract co-medication, and a re-challenge gave similar results….The potential clinical consequence of this pharmacokinetic herb-drug interaction is apparent, since low cyclosporin levels are associated with an increased risk of rejection after organ transplantation and are usually not suspected upon intake of plant products…. If you feel that it's essential to your health to continue taking any of the anticoagulant or antiplatelet herbs listed in the chart along with prescription, there's another option. We collected information on current and previously-used natural health products and current conventional drug therapies. Aspirin is the most common antiplatelet agent; others include dipyridamole (Persantine), sulfinpyrazone (Anturane), clopidogrel (Plavix), and ticlodipine (Ticlid). Using a matrix of 165 possible drug-herb interaction pairs (15 therapeutic drug classes by 11 herbal products), we identified 51 (31%) interactions discussed in the literature. John's Wort declined dramatically after revelations that it could cause herb-drug interactions along with reports questioning its effectiveness. Patients were classified as having the potential for an interaction if they were using a current herbal medicine in combination with a conventional drug therapy and the interaction had been reported previously in the medical literature.
Twenty-two of these 51 drug-herb pairs (43%) were supported by randomized clinical trials, case-control studies, cohort studies, case series, or case studies.
The remaining interaction pairs reflected theoretic reasoning in the absence of clinical data. RESULTS: Of the 195 patients in our sample, 33 (17%) were 'current users', 19 (10%) were "past users," and 143 (73%) were "never users" of herbal medicines. Most interactions were pharmacokinetic, with most actually or theoretically affecting the metabolism of the affected product by way of the cytochrome P450 enzymes. Among the 52 patients who were "current or past users," the most frequently used herbal medicines were ginkgo (Ginkgo biloba) [39 users], garlic (n = 10), glucosamine sulphate (n = 9), and echinacea (n = 8). Among the 33 patients who were current users, the most commonly-used herbal medicines were ginkgo (n = 22), glucosamine sulphate (n = 8) and garlic (n = 6).
Among the 33 current users, we identified 11 potential herb-drug interactions in nine patients. To create a comprehensive and valid list of herb-drug interactions would require a substantial increase in research activities in this area.
The 11 herb-drug interactions we identified were between ginkgo and aspirin [n = 8], ginkgo and trazodone (n = 1), ginseng and amlodipine (n = 1), and valerian and lorazepam (n = 1).
Almost one-third of current users of herbal medicines were at risk of a herb-drug interaction.




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