Herb and drug interactions

[Guest guest]

Please be very careful with supplements. Only take what is recommended

by someone who knows wls and you particularly!! (Like

[Vitalady]).

Amber/FLRN

Herb and drug interactions: 'Natural' products not always safe

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By Mayo

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B29C44CA04> Clinic staff

You may think herbal supplements are safe because they're labeled

" natural. " But many herbal supplements contain active ingredients that

can harm you if taken with certain prescription or over-the-counter

(OTC) drugs.

In addition, some medical situations increase your risk of adverse

effects if you take herbal products. Talk to your doctor before taking

any herbal products if you're pregnant or breast-feeding or if you have:

* High blood pressure

* Thyroid problems

* Depression or other psychiatric problems

* Parkinson's disease

* Enlarged prostate gland

* Blood-clotting problems

* Diabetes

* Heart disease

* Epilepsy

* Glaucoma

* History of stroke or organ transplant

It's a good idea to talk to your doctor about any herbal supplements you

take, no matter what type of medication you're using or the condition

for which you're being treated.

Here are 14 herbs and the prescription and OTC drugs you shouldn't take

with them:

Capsicum

Avoid taking with:

* Angiotensin-converting enzyme (ACE) inhibitors - used for

diabetic kidney disease, heart failure, high blood pressure

* Theophylline (Elixophyllin, Uniphyl) - an asthma medication

* Sedatives

* Antidepressants

Capsicum may increase the absorption and the effect of these drugs. It

may also increase the likelihood of developing a cough if used with ACE

inhibitors.

Coenzyme Q-10

Avoid taking with:

* Warfarin (Coumadin) - a blood-thinning medication

* Chemotherapy

The use of warfarin and coenzyme Q-10 together increases your risk of

excessive bleeding. Coenzyme Q-10 may reduce the effectiveness of some

chemotherapy. Some drugs, such as those used to lower cholesterol

(lovastatin, pravastatin, simvastatin), blood sugar (glyburide,

tolazamide) and blood pressure (beta blockers such as Inderal,

Lopressor), can alter coenzyme Q-10's effectiveness. Also, people with

diabetes should be aware that coenzyme Q-10 may decrease their need for

insulin.

Dong quai

Avoid taking with:

* Warfarin (Coumadin) - a blood-thinning medication

* St. 's wort

* Antibiotics (sulfonamides, quinolones)

The combination of dong quai and warfarin may increase your risk of

bleeding. Using St. 's wort or certain antibiotics with dong quai

may increase your skin's sensitivity to the sun.

Echinacea

Avoid taking with:

* Anabolic steroids

* Amiodarone (Cordarone, Pacerone) - used to treat an irregular

heartbeat (arrhythmia)

* Methotrexate (Rheumatrex) - used to treat rheumatoid arthritis

* Ketoconazole (Nizoral) - an antifungal medication

* Cyclosporine (Neoral, Sandimmune) - an immunosuppressant

* HIV protease inhibitors - human immunodeficiency virus (HIV)

medications

* Benzodiazepines (Alprazolam, Valium) - anti-anxiety medications

* Calcium channel blockers - used to treat high blood pressure and

heart disease

Echinacea shouldn't be combined with other drugs that can cause liver

damage. And because this herb may stimulate the immune system, it may

interfere with the effects of immunosuppressants.

Echinacea may also elevate the levels of HIV protease inhibitors,

calcium channel blockers and anti-anxiety drugs in the blood, increasing

your risk of side effects.

Ephedra

In late December 2003, the Food and Drug Administration announced the

ban of ephedra from the marketplace because of health concerns. Ephedra

increases your risk of heart attack, stroke, seizures and death.

Combined with caffeine, decongestants, stimulants and other drugs, it

becomes especially risky.

Ephedra is a potent herb that's present in many products, especially

those designed to give you pep or help you lose weight. It goes by many

names, such as ma-huang, herbal ecstasy, mahuang, mahuanggen and ma

huang root. Any " natural " product that claims to cause weight loss or

increase energy may have ephedra in it. Carefully review the product's

contents with your doctor or pharmacist before assuming it doesn't.

Feverfew

Avoid taking with:

* Aspirin

* Ticlopidine (Ticlid) - blood-thinning medication

* Clopidogrel (Plavix) - blood-thinning medication

* Dipyridamole (Persantine) - blood-thinning medication

* Warfarin (Coumadin) - blood-thinning medication

These medications can reduce blood clot formation. Feverfew may increase

this effect, causing spontaneous and excessive bleeding.

Garlic

Avoid taking with:

* Aspirin

* Ticlopidine (Ticlid) - blood-thinning medication

* Clopidogrel (Plavix) - blood-thinning medication

* Dipyridamole (Persantine) - blood-thinning medication

* Warfarin (Coumadin) - blood-thinning medication

* Cyclosporine (Neoral, Sandimmune) - an immunosuppressant

* Saquinavir (Fortovase, Invirase) - an HIV protease inhibitor

Combined with garlic, anticoagulant medications may cause spontaneous

and excessive bleeding. Garlic may decrease the effectiveness of

immunosuppressants and HIV protease inhibitors.

Garlic may cause lower levels of blood sugar, which may decrease your

need for insulin if you have diabetes. If you take insulin and garlic

together, monitor your blood sugar carefully and report any changes to

your doctor.

Ginger

Avoid taking with:

* Aspirin

* Ticlopidine (Ticlid) - blood-thinning medication

* Clopidogrel (Plavix) - blood-thinning medication

* Dipyridamole (Persantine) - blood-thinning medication

* Warfarin (Coumadin) - blood-thinning medication

* H2 blockers and proton pump inhibitors - acid-blocking

medication

Ginger may increase the effect of anticoagulants, which may cause

excessive bleeding. It may also increase the production of stomach acid,

which could counteract the effects of antacid medications.

Ginger may lower your blood pressure or blood sugar levels, which may

reduce your need for blood-pressure-lowering medications or insulin if

you have diabetes. Monitor your blood pressure or blood sugar levels if

you take these medications and report any changes to your doctor.

Ginkgo

Avoid taking with:

* Aspirin

* Ticlopidine (Ticlid) - blood-thinning medication

* Clopidogrel (Plavix) - blood-thinning medication

* Dipyridamole (Persantine) - blood-thinning medication

* Warfarin (Coumadin) - blood-thinning medication

* Antidepressants

* Antipsychotic medications

* Insulin

Ginkgo may increase the anticoagulant effect of these drugs and has the

potential to cause spontaneous and excessive bleeding when used in

conjunction with these medications. It can also increase the amount of

antidepressant medication in your blood. When combined with

antipsychotic medications, ginkgo may cause seizures. Ginkgo also

affects insulin levels, so if you're taking the two together, monitor

your glucose levels carefully.

Ginseng

Avoid taking with:

* Warfarin (Coumadin) - blood-thinning medication

* Phenelzine (Nardil) - an antidepressant

* Digoxin (Lanoxicaps, Lanoxin) - heart medication

* Insulin and oral antidiabetic medications

Used with warfarin, ginseng can increase your risk of bleeding problems.

Ginseng with phenelzine may cause headache, trembling and manic

behavior. Ginseng may interfere with digoxin's pharmacologic action or

the ability to monitor digoxin's activity.

Ginseng can reduce blood sugar levels in people with type 2 diabetes

(formerly called adult-onset or noninsulin-dependent diabetes). Without

careful glucose monitoring, the use of ginseng with insulin or oral

antidiabetic medications may cause dangerously low blood sugar levels.

Ipriflavone

Avoid taking with:

* Warfarin (Coumadin) - blood-thinning medication

* Antipsychotics

* Tacrine (Cognex) - an Alzheimer's disease medication

* Theophylline (Elixophyllin, Uniphyl) and zafirlukast (Accolate)

- asthma medications

* Caffeine

* Tamoxifen (Nolvadex) - a cancer treatment and prevention

medication

* Cyclobenzaprine (Flexeril) - a muscle relaxant

* Celecoxib (Celebrex) - pain-relieving arthritis medication

* Nonsteroidal anti-inflammatory medications - pain-relieving

medication

Ipriflavone affects the way these drugs are metabolized, usually

increasing the levels of the medications in the blood and the effects of

the drugs.

Kava

Avoid taking with:

* Sedatives

* Sleeping pills

* Antipsychotics

* Alcohol

* Drugs used to treat anxiety or Parkinson's disease

Combined with these drugs, kava can produce deep sedation and, in some

cases, even coma. In late 2001, following reports from Europe of liver

problems in several people who used kava, the Food and Drug

Administration started investigating the safety of this herb. Until more

is known, don't start taking kava or products that contain kava. If you

already do so, contact your doctor for advice and ask if you need liver

function tests to check for unexpected liver problems. Don't take kava

if you have a history of liver problems, if you're depressed, or if you

take antidepressants or prescription sedatives.

Melatonin

Avoid taking with:

* Nifedipine (Adalat, Procardia) - used to lower blood pressure

and treat heart disease

* Fluvoxamine (Luvox) - an antidepressant

Melatonin may reduce nifedipine's ability to lower blood pressure, which

could lead to an increased heart rate and blood pressure level if these

drugs are taken together. Fluvoxamine slows the metabolism of melatonin,

which may result in excessive sleepiness.

St. 's wort

Avoid taking with any prescription medications. In particular, avoid

taking St. 's wort and:

* Antidepressants

* HIV protease inhibitors - used to treat HIV/AIDS

* Non-nucleoside reverse transcriptase inhibitors - used to treat

HIV/AIDS

* Digoxin (Lanoxicaps, Lanoxin) - heart medication

* Theophylline (Elixophyllin, Uniphyl) - an asthma medication

* Cyclosporine (Neoral, Sandimmune) - an immunosuppressant

* Chemotherapy

* Oral contraceptives

* Nifedipine (Adalat, Procardia) and diltiazem (Cardizem, Dilacor)

- blood pressure and heart disease medications

* Warfarin (Coumadin) - blood-thinning medication

* Alcohol

* Tamoxifen (Nolvadex) - a cancer treatment and prevention

medication

St. 's wort has been shown to affect your body's metabolism of all

of these drugs. Many other drugs are likely to be affected, too. Until

more is known about St. 's wort's ability to alter the metabolism of

pharmaceutical medications, it's probably best not to combine such

medications with St. 's wort.

Also, the combination of St. 's wort with some antidepressants, such

as selective serotonin reuptake inhibitors, may cause an excess of

serotonin (serotonin syndrome). Typical symptoms include headache,

stomach upset and restlessness.

St. 's wort may reduce the effectiveness of some oral

contraceptives. Use another form of birth control while taking St.

's wort.

Related Information

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* Complementary

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Center

* Food

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objectid=000851DA-6222-1B37-8D7E80C8D77A0000> & Nutrition Center

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Additional Resources

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* National <http://dietary-supplements.info.nih.gov/> Institutes

of Health: Office of Dietary Supplements

* National Center for Complementary and <http://nccam.nih.gov/>

Alternative Medicine

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December 31, 2003

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Amber K. Reid, RN, CDMS, CCM, CLCP

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Orange Park, FL 32067-0266

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Fax 904 272-2418

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