by Tammy Chernin, RPh
Medicines and herbs
Medicines and herbs
When medicine and herbs don't mix
Known herb-drug interactions
Although the area of herb-drug interactions is under-researched, there are some interactions we do know about.
Feverfew
Feverfew is most commonly used for the treatment of migraines. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Motrin, Advil) may reduce the effectiveness of feverfew. It can also inhibit platelet activity and should not be taken together with blood thinners such as Coumadin. Feverfew contains tannin, which has the ability to inhibit iron absorption, and should not be used for longer than four months without medical supervision. The recommended dosage is 125 mg daily; each dosage unit should contain at least 0.2% parthenolide.
Garlic
Most recent uses for garlic focus on its ability to treat high cholesterol and high blood pressure. Garlic can increase the risk of bleeding and should not be used concurrently with blood thinners. It has been reported to induce heartburn and flatulence, sweating, lightheadedness and allergic reactions. The German Commission E (Germanys equivalent to the FDA in the United States) recommends a dosage of 4 g of fresh garlic daily.
Ginger
Ginger is often recommended for motion sickness, nausea and for loss of appetite. It has also been shown to prolong bleeding time and its use with aspirin or Coumadin should be avoided. Excessive consumption of ginger may also interfere with cardiac and anti-diabetic therapy. It is usually well tolerated but may cause stomach upset or heartburn in some people. For motion sickness it is taken one hour before traveling. The total daily dose is 2-4 g.
Ginkgo Biloba
Ginkgo biloba is one of the most popular plant extracts in Europe and has recently received approval in Germany for the treatment of dementia. There have been reports of spontaneous bleeding in people taking ginkgo and again, it should not be used with blood thinners. People who take anti-convulsant medications, such as carbamazepine and phenytoin, or phenobarbital should not take gingko without the knowledge of a physician, because it reduces the efficacy of these medications. Ginkgo is generally safe and well tolerated with the most common adverse reactions being stomach upset, headache and dizziness. German Commission E recommends a dosage of 40 mg of ginkgo three times daily with meals for at least four to six weeks. Preparations should be standardized to contain 6% terpene lactones and 24% ginkgo flavone glycosides.
Ginseng
Ginseng is used to combat overall debility, as well as lack of energy and concentration. It has also been used as an aphrodisiac. There is tremendous variation in products labeled as ginseng; in one study, only 25% of the commercially available products actually contained ginseng. Nevertheless, ginseng enjoys widespread popularity.
Siberian ginseng has been associated with falsely elevated digoxin levels (a heart drug used to treat congestive heart failure) by interfering with the test used to determine digoxin blood levels. Ginseng may also affect fasting blood glucose levels, so people who need to control their blood glucose levels should take ginseng with caution. Concomitant use with warfarin, heparin, aspirin and NSAIDs should be avoided. Additionally, ginseng may cause headache, nervousness, and manic episodes in patients with manic-depressive disorders or psychosis or those on antidepressants, particularly the monoamine oxidase inhibitors (MAOI) such as phenelzine (Nardil). Side effects include high blood pressure, restlessness, nervousness, insomnia, skin eruptions, edema and diarrhea. German Commission E recommends Asian ginseng be taken as 1-2 g of crude herb daily or as 100-300 mg of ginseng extract three times daily. Commercial products should contain at least 4%-5% ginsenosides.
Kava Kava
Kava Kava is recommended for anxiety, sedation and relaxation. Excessive sedation may result when Kava Kava is taken with other sedatives (flurazepam, temazepam) or anti-anxiety drugs, particularly alprazolam (Xanax). The toxicity of kava is increased if taken with alcohol. Until the clinical significance of Kavas action on platelet activity is determined, its use with blood thinners should be cautioned. Long-term use is not advised and is characterized by dry, flaking, discolored skin and reddened eyes. The herb is contraindicated in patients with certain types of depression because it may increase the risk of suicide. The daily dosage is the equivalent of 60 mg to 120 mg kava pyrones.
St. Johns Wort
St. Johns Wort is most widely used to treat mild to moderate depression, anxiety and seasonal affective disorder. Adverse reactions reported include stomach upset, allergic reactions, fatigue and restlessness. Photosensitivity is usually rare and is associated with higher dosages. Fair-skinned people should be particularly cautious. Concomitant use with other photosensitizers, such as piroxicam (Feldene) or tetracycline should be avoided. St. Johns Wort should not be used with MAOIs (phenelzine) or selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft or Celexa. St. Johns Wort has been reported to prolong narcotic-induced (codeine) sleeping times as well as decreasing barbiturate-induced sleeping times and caution is advised when combining these medications. The herb also contains tannin and may interfere with iron absorption. The usual dosage is 300 mg of standardized extract three times daily or 450 mg twice daily. It may take up to four to six weeks to see desired effect.
Valerian
German Commission E recommends valerian for use in the management of restlessness and nervous disturbances of sleep. Valerian may cause headache, hangover, excitability, insomnia, uneasiness and cardiac disturbances. Given its sedative property it would be wise to avoid barbiturates (Phenobarbital), sedatives (flurazepam, temazepam) and alcohol while on valerian. Valerian is also a tannin-containing herb and may interfere with iron absorption. Persons currently taking antidepressants should take valerian only under medical supervision. The usual dosage of the extract is 2-3 g, one to several times per day.
Warning: Until more research is done, pregnant or nursing women, and children should not take herbal treatments without consulting a health care practitioner.
Feverfew
Feverfew is most commonly used for the treatment of migraines. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Motrin, Advil) may reduce the effectiveness of feverfew. It can also inhibit platelet activity and should not be taken together with blood thinners such as Coumadin. Feverfew contains tannin, which has the ability to inhibit iron absorption, and should not be used for longer than four months without medical supervision. The recommended dosage is 125 mg daily; each dosage unit should contain at least 0.2% parthenolide.
Garlic
Most recent uses for garlic focus on its ability to treat high cholesterol and high blood pressure. Garlic can increase the risk of bleeding and should not be used concurrently with blood thinners. It has been reported to induce heartburn and flatulence, sweating, lightheadedness and allergic reactions. The German Commission E (Germanys equivalent to the FDA in the United States) recommends a dosage of 4 g of fresh garlic daily.
Ginger
Ginger is often recommended for motion sickness, nausea and for loss of appetite. It has also been shown to prolong bleeding time and its use with aspirin or Coumadin should be avoided. Excessive consumption of ginger may also interfere with cardiac and anti-diabetic therapy. It is usually well tolerated but may cause stomach upset or heartburn in some people. For motion sickness it is taken one hour before traveling. The total daily dose is 2-4 g.
Ginkgo Biloba
Ginkgo biloba is one of the most popular plant extracts in Europe and has recently received approval in Germany for the treatment of dementia. There have been reports of spontaneous bleeding in people taking ginkgo and again, it should not be used with blood thinners. People who take anti-convulsant medications, such as carbamazepine and phenytoin, or phenobarbital should not take gingko without the knowledge of a physician, because it reduces the efficacy of these medications. Ginkgo is generally safe and well tolerated with the most common adverse reactions being stomach upset, headache and dizziness. German Commission E recommends a dosage of 40 mg of ginkgo three times daily with meals for at least four to six weeks. Preparations should be standardized to contain 6% terpene lactones and 24% ginkgo flavone glycosides.
Ginseng
Ginseng is used to combat overall debility, as well as lack of energy and concentration. It has also been used as an aphrodisiac. There is tremendous variation in products labeled as ginseng; in one study, only 25% of the commercially available products actually contained ginseng. Nevertheless, ginseng enjoys widespread popularity.
Siberian ginseng has been associated with falsely elevated digoxin levels (a heart drug used to treat congestive heart failure) by interfering with the test used to determine digoxin blood levels. Ginseng may also affect fasting blood glucose levels, so people who need to control their blood glucose levels should take ginseng with caution. Concomitant use with warfarin, heparin, aspirin and NSAIDs should be avoided. Additionally, ginseng may cause headache, nervousness, and manic episodes in patients with manic-depressive disorders or psychosis or those on antidepressants, particularly the monoamine oxidase inhibitors (MAOI) such as phenelzine (Nardil). Side effects include high blood pressure, restlessness, nervousness, insomnia, skin eruptions, edema and diarrhea. German Commission E recommends Asian ginseng be taken as 1-2 g of crude herb daily or as 100-300 mg of ginseng extract three times daily. Commercial products should contain at least 4%-5% ginsenosides.
Kava Kava
Kava Kava is recommended for anxiety, sedation and relaxation. Excessive sedation may result when Kava Kava is taken with other sedatives (flurazepam, temazepam) or anti-anxiety drugs, particularly alprazolam (Xanax). The toxicity of kava is increased if taken with alcohol. Until the clinical significance of Kavas action on platelet activity is determined, its use with blood thinners should be cautioned. Long-term use is not advised and is characterized by dry, flaking, discolored skin and reddened eyes. The herb is contraindicated in patients with certain types of depression because it may increase the risk of suicide. The daily dosage is the equivalent of 60 mg to 120 mg kava pyrones.
St. Johns Wort
St. Johns Wort is most widely used to treat mild to moderate depression, anxiety and seasonal affective disorder. Adverse reactions reported include stomach upset, allergic reactions, fatigue and restlessness. Photosensitivity is usually rare and is associated with higher dosages. Fair-skinned people should be particularly cautious. Concomitant use with other photosensitizers, such as piroxicam (Feldene) or tetracycline should be avoided. St. Johns Wort should not be used with MAOIs (phenelzine) or selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft or Celexa. St. Johns Wort has been reported to prolong narcotic-induced (codeine) sleeping times as well as decreasing barbiturate-induced sleeping times and caution is advised when combining these medications. The herb also contains tannin and may interfere with iron absorption. The usual dosage is 300 mg of standardized extract three times daily or 450 mg twice daily. It may take up to four to six weeks to see desired effect.
Valerian
German Commission E recommends valerian for use in the management of restlessness and nervous disturbances of sleep. Valerian may cause headache, hangover, excitability, insomnia, uneasiness and cardiac disturbances. Given its sedative property it would be wise to avoid barbiturates (Phenobarbital), sedatives (flurazepam, temazepam) and alcohol while on valerian. Valerian is also a tannin-containing herb and may interfere with iron absorption. Persons currently taking antidepressants should take valerian only under medical supervision. The usual dosage of the extract is 2-3 g, one to several times per day.
Warning: Until more research is done, pregnant or nursing women, and children should not take herbal treatments without consulting a health care practitioner.
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