herbal - drug interactions...iii professional reference guide herbal - drug interactions a project...

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Professional Reference Guide

HERBAL - DRUG INTERACTIONSA project of the Multicultural Program, Royal Alexandra Hospital, Edmonton, Alberta (Adrienne Wiebe Ph.D. and Neil Elford Ph.D.), in collaboration with Prairie Deva College of Phytotherapy ( Robert Rogers B.Sc. Professional Member of the American Herbalist Guild) and The Department of Pharmacy, Royal Alexandra Hospital (Sherry Dielman B.Sc., Amy Gausvik B.Sc. and Faun Wilsey, B.Sc.).

The Royal Alexandra Hospital is a facility within the Capital Health Authority Organization of Alberta, Canada. www.cha.ab.ca

© 200 Capital Health Authority and Robert Rogers

Published by Mediscript Communications Inc.www.mediscript.net© Illustrations Mediscript Communications Inc.Design and layout: Adamson.

Professional reference guide. Herbs. Drugs. Herb-drug interaction.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means electronic, mechanical, photocopying, recording, or otherwise, without prior permission of the Capital Health Authority, Robert Rogers or Mediscript Communications Inc.

The publisher Mediscript Communications Inc. acknowledges the financial support of the Government of Canada through the Book Publishing Industry Development Program ( BPIDIP) for our publishing activities.

ISBN 1-55040-550-0Printed in Canada

2016

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General Notice and DisclaimerThis reference guide is for the use of authorized health care practitioners, cli-nicians, pharmacists, physicians and any other professionally trained persons who may provide medical treatment advice to patients or consumers. The information presented has been obtained from research of reference books, clinical and scientific published papers and other published works. The contributors and editors have made every possible attempt to verify the accuracy of the content of this book. It should be noted by the reader that constant changes in information resulting from ongoing research and clinical experience, differences in opinions among authorities, unique individual circumstances, translation misunderstandings and the possibility of human error in compiling this reference guide require that the reader use judgement and other resources when making decisions based on this material. Also many of the “interactions” depicted between a herb and a drug do not qualitatively or quantitatively describe the manner of interaction which should suggest caution and further research of the specific patient situation. We recommend the health care professional should regard the information as suggestive and not as authoritative. Consequently the contributors, editors, publishing company and distributors do not accept any responsibility for the accuracy of the information itself or the consequences from the use or misuse of the information in this book.

It must be also emphasized that this is not intended as a guide to self medica-tion by consumers. The lay reader is advised to discuss information contained herein with a physician, pharmacist, clinician, nurse or other authorized health care practitioner .

HDI072009ww

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The Purpose of the HandbookHerbal medicines are an integral part of the healthcare and healing practices in many ethnic and cultural communities today. In addition, a growing number of people are turning to herbal medicines when pharmaceutical medicines do not meet their needs.

A problem arises for physicians and pharmacists when they are unaware of herbal medicines that patients are taking, and prescribe pharmaceutical drugs as part of treatment. Unexpected interactions between medicines can occur. Even if the medical professional is aware of the patient’s use of herbal medicines, s/he is rarely knowledgeable about the interaction of these two types of medicines.

While a significant number of reference documents exist which identify medicinal plants and their uses, there is no comprehensive resource tool that compiles information regarding interactions between herbal medicines and pharmaceutical drugs.

To address this need for immediate information on herbal-drug interactions, the Multicultural Program of the Royal Alexandra Hospital (RAH) and Prairie Deva College, in collaboration with the Pharmacy Department of the RAH, worked together to produce this reference handbook. The existing literature and research on herbal medicine and pharmaceutical drug interactions was compiled and cross-referenced to provide easily accessible information.

We hope that this handbook will contribute to safe practices in prescribing and using both herbal and pharmaceutical medicines.

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How to Use the HandbookThe more than 100 herbal medicines most commonly used in North America are referenced in the handbook. Interactions are listed in alphabetical order of the herbal medicine. Beside each herbal medicine, classes of drugs for which research has been done are listed. The third column describes the type of interaction that occurs between the herbal medicine and the drug type. An index of pharmaceutical drugs appearing in the handbook is located at the back of the handbook, so that one can look up potential interactions with only the name of the pharmaceutical drug.

Each entry has a footnote that explains the reference source of the information if further information is required. A bibliography of these sources is included at the end of the handbook.

Definition of TermsInteract - When an herbal-drug combination is described as “interact,” it means that the sources we consulted found an interaction but did not expand on the type of interaction, and further information was not available. Theoreti-cal, invitro, invivo, or anecdotal evidence provided the basis for indicating an interaction. We realize that this is limited, but this knowledge, hopefully, will help guide in decisions and monitoring medicine usage.

Aerial Parts - Those parts of the plant found above ground, such as leaves, flowers, bark, and fruit.

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Alfalfa (Medicago sativa) .......................................................3Aloe Vera.................................................................................3Anise (Pimpinella anisum) ......................................................5Astragalus (Astragalus membranaceus) ..................................5Basil (Ocimum basilicum) ......................................................5Bay Leaf (Laurus nobilis) .......................................................7Bearberry/Uva Ursi (Arctostaphylos uva-ursi) .......................7Balm (Melissa officinalis) .......................................................7Bee Pollen ...............................................................................7Bilberry (Vaccinium myrtillus) ...............................................7Birch (Betula) ..........................................................................9Black Cohosh (Actaea racemosa) ...........................................9Black Walnut (Juglans nigra) ..................................................9Blue Cohosh (Caulophyllum thalictroides) ............................9Borage (Borago officinalis) ...................................................11Broom (Cytisus scoparius) ....................................................11Bugleweed (Lycopus ssp) .....................................................11Bupleurum (Buplrurum ssp) .................................................11Burdock (Arctium lappa) ......................................................12Calendula (Calendula officinalis) .........................................12Catnip (Nepeta cataria) .........................................................12Cat’s Claw (Uncaria tomentosa) ...........................................13Cayenne Pepper (Capsicum frutescens) ................................13Chamomile, German (Matricaria recutita) ............................15Chaparral (Larrea tridentata) .................................................15Chasteberry/Chaste Tree (Vitex agnus-castus) .....................15Chondroitin Sulfate ...............................................................17

Contents: Herb - Drug Index

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Cinnamon (Cinnamomum zeylanicum) ................................17Cloves (Syzgium aromaticum) .............................................17Coltsfoot (Tussilago farfara) .................................................17Comfrey (Symphytum officinale) .........................................17Cranberry (Vaccinium macrocarpon) ....................................19Dandelion (Taraxacum officinale) ........................................19Devil’s Claw (Harpagophytum procumbens) .......................19Dong Quai (Angelica sinensis) .............................................21Echinacea (Echinacea species) .............................................21Elder (Sambucus nigra) .........................................................23Evening Primrose Oil (Oenothera biennis) ...........................23Fenugreek (Trigonella foenum-graecum) .............................25Feverfew (Tanacetum parthenium) .......................................25Flax (Linum usitatissimum) ..................................................27Forskohlii ( Coleus forskohlii) ..............................................27Garlic (Allium sativum) ........................................................29Ginger (Zingiber officinale) ..................................................29Ginkgo (Ginkgo biloba) ........................................................31Ginseng, North Americian (Panax quinquefolius) ................33Ginseng, Siberian (Eleutherococcus senticosus) ..................34Glucosamine (2-Amino-2-Deoxyglucose) ............................34Goldenseal (Hydrastis canadensis) .......................................35Grapefruit (Citrus paradisi) ...................................................35Grapeseed (Vitis semen) .......................................................37Green Tea (Camellia sinensis) ..............................................37Hawthorn (Crataegus laevigata) ...........................................39Hops (Humulus lupulus) .......................................................39Horse Chestnut (Aesculus hippocastanum) ..........................39Horse Radish (Armoracia rusticana) .....................................41Juniper (Juniperus communis) ..............................................41

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Kava (Piper methysticum) ....................................................41Lemon Balm (Melissa officinalis) ........................................43Licorice (Glycyrrhiza glabra) ...............................................43Lobelia (Lobelia inflata) .......................................................45Ma Huang (Ephedra sinica) ..................................................45Marshmallow (Althaea officinalis) .......................................49Meadowsweet (Filipendula ulmaria) ....................................49Milk Thistle (Silybum marianum) ........................................51Mistletoe (Viscum album) .....................................................51Nettle (Urtica dioica) ............................................................53Passionflower (Passiflora incarnata) .....................................55Pau D’arco (Tabebuia impetiginosa).....................................55Peppermint (Mentha x piperita) ............................................55Pine Bark Extract (Pinus maritima) ......................................55Propolis .................................................................................57Psyllium (Plantago Psyllium) ...............................................57Puncture Vine (Tribulus terrestris) ........................................57Pygeum (Prunus africana) .....................................................59Red Raspberry (Rubus idaeus) ..............................................59Red Yeast Rice ......................................................................59Rose Hips (Rosa canina) .......................................................61Rosemary (Rosmarius officinalis) .........................................61Royal Jelly ............................................................................61Sage (Salvia officinalis) ........................................................61Saw Palmetto (Serenoa repens) ............................................61Schisandra (S. chinensis) ......................................................63Scullcap (Scutellaria laterifolia) ...........................................63Scullcap, Chinese (Scutellaria baicalensis) ...........................63Senna (Cassia ssp) .................................................................63Slippery Elm (Ulmus rubra) ..................................................63

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St. John’s Wort (Hypericum perforatum) ..............................64Tea Tree Oil (Melaleuca alternifolia) ....................................65Thyme (Thymus vulgaris) .....................................................67Turkey Tail (Coriolus versicolor) ..........................................67Turmeric (Curcuma longa) ....................................................67Ulva Ursi ...............................................................................67Valerian (Valeriana officinalis) .............................................69Wild Yam (Dioscorea villosa) ...............................................69Willow (Salix) .......................................................................69Yarrow (Achillea millefolium) ..............................................70Yohimbe (Pausinystalia yohimbe) ........................................71

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All drugs IV ......................................................................... 75 All drugs oral ....................................................................... 75 ACE inhibitors .....................................................................75 Acetominophen ....................................................................75 Acetazolomide .....................................................................76Alpha-Adrenoceptor Blocking Agents .................................76Alpha-Methylnorepinephrine ...............................................76Alprazolamsee ......................................................................76Amiloride .............................................................................76Amlodipine ..........................................................................76 Amitriptyline ........................................................................76Amobarbital ..........................................................................77 Amphetamine .......................................................................77Analgesics ............................................................................77Anesthetics ...........................................................................77 Angina therapy ....................................................................77 Antacids ...............................................................................77 Antiarrhythmic agents ..........................................................77Antibiotics ............................................................................77 Anticoagulants .....................................................................78Anticonvulsants ....................................................................78Antidepressants ....................................................................79Antihypertensives ................................................................79

Contents: Drug-Herb Index

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Antihypotensives ..................................................................80 Antimanic agents .................................................................80Antiplatelet therapy ..............................................................80Antipyschotics ......................................................................80Antivirals ..............................................................................81Asthma therapy ....................................................................81Atorvastatin ..........................................................................81 Atropine ...............................................................................81 Barbiturates ..........................................................................81 Benzodiazepines ..................................................................82 Beta Blockers .......................................................................82Buspirone .............................................................................82 Butyrophenones ...................................................................82 Calcium ................................................................................82Cancer treatments .................................................................82 Carbamazepine .....................................................................82Carbon Tetrachloride ............................................................83 Cardiac glycosides ...............................................................83 Cardiac therapy ....................................................................83 Cavedilol ..............................................................................83 Central Nervous System (CNS) depressants ........................83Centrally acting medications ................................................84 Centrally Acting Antiadrenergic- Agents .............................84 Cerivastatin ..........................................................................84 Chlorproamzine ....................................................................84 Chlorprotixene .....................................................................84

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Cisapride ..............................................................................84 Cisplatin ...............................................................................85 Clorpramine .........................................................................85 Clomipramine ......................................................................85Clonidine ..............................................................................85 Clopidogrel ..........................................................................85 Coagulant therapies ..............................................................85 Cocaine ................................................................................85 Cortico-Adrenal Steroids ....................................................85 Cyclophosphamide ...............................................................85 Cyclosporine ........................................................................85Cytochrome P450 metabolized drugs .................................86 Dextromethorphan ...............................................................86Dexamethasone ....................................................................86 Diabetic medications ............................................................86Diazepam .............................................................................87 Dibenzapine derivatives .......................................................87 Diclofenac ............................................................................87 Digoxin/Digitoxin ................................................................87Disulfiram ............................................................................87 Diuretics ...............................................................................87 Dopamine .............................................................................88 Dopamine antagonists ..........................................................88 Dopamine - receptor antagonists .........................................88Doxepine ..............................................................................88 Doxorubicin .........................................................................88

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Drugs that acidify urine .......................................................88Drugs that affect urine PH ...................................................88 Drugs that interact with caffeine ..........................................88Drugs that interact with salicylates ......................................88 Drugs that interact with hydroquinone ................................88 Econazole Nitrate cream ......................................................88Ephedrine .............................................................................88 Epinephrine ..........................................................................89Epileptogenic drugs .............................................................89Ergot alkaloids .....................................................................89Estrogen ...............................................................................89Ethinyl Estradiol ..................................................................89 Felodipine ............................................................................89 Fluoxetine ............................................................................89Gammalinolenic Acid ..........................................................89Glibenclamide ......................................................................89 Glyburide .............................................................................89 Gout therapy .........................................................................90Guanabenz ............................................................................90 Guanethidine ........................................................................90Halothane .............................................................................90 Heparin .................................................................................90Hepatoxic drugs ...................................................................90 Hexobarbitol ........................................................................90 Hormone Replacement therapy ............................................90Hydrocortisone .....................................................................91

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Imipramine ...........................................................................91 Imitrex .................................................................................. 91 Immunosuppressives ............................................................91Indinavir ...............................................................................91 Indomethacin ........................................................................91 Insulin ..................................................................................91 Iron .......................................................................................92 Isocarboxid ...........................................................................92 Kanamycin ...........................................................................92 Laxatives ..............................................................................92 Levodopa ..............................................................................92 Lipid lowering agents ..........................................................92Lithium .................................................................................92Loop diuretics ......................................................................93 Lortadine ..............................................................................93 Lovastin ................................................................................93 Meperidine ...........................................................................93 Methotrexate ........................................................................93 Methyldopa ..........................................................................93 Metoclopramide ...................................................................93 Metoprolol ............................................................................93 Metronidazole ......................................................................93 Midazolam ...........................................................................93 Midodrine .............................................................................94Migraine therapy ..................................................................94Moclobamide .......................................................................94

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Monoamine Oxidase ............................................................94 Monomycin ..........................................................................94 Morphine ..............................................................................94 Naloxone .............................................................................. 94 Narcotics ..............................................................................94Nefazodone ..........................................................................95 Nicardipine ...........................................................................95Nicotine ................................................................................95 Nifedipine ............................................................................95 Nimodipine ..........................................................................95Nisoldipine ...........................................................................95Nitrates .................................................................................95 Nitrendipine .........................................................................95 Nitrofurantoin ......................................................................96 Non Steroidal Anti-Inflammatory Drugs (NSAID) ..............96 Olanzapine ...........................................................................96 Oral Contraceptives .............................................................96 Oral Hypoglycemics ............................................................96 Oxytocin ...............................................................................96 Papaverine ............................................................................96 Paroxetine ............................................................................97 Penbutalol ............................................................................97 Pentobarbital ........................................................................97 Phenelzine ............................................................................97Phenobarbital .......................................................................97 Phenothiazines .....................................................................97

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Phentolamine ........................................................................97 Phenoxybenzamine ..............................................................98 Phenytoin .............................................................................98 Platelet aggregation inhibitors .............................................98Prednisolone .........................................................................98 Probenecid ............................................................................98Procainamide ........................................................................98 Promazine ............................................................................98 Propanolol ............................................................................98 Quinidine ..............................................................................98 Reserpine ..............................................................................99 Risperidone ..........................................................................92 Saquinavir ............................................................................92Secale alkaloid derivatives ...................................................92 Sedative-hypnotics ...............................................................92 Selective Seratonin Reuptake Inhibitors ..............................92 Selegiline ..............................................................................92 Sertraline ..............................................................................92 Simvastatin ...........................................................................92 Sodium Bicarbonate ...........................................................100 Spironolactone ...................................................................100Stimulants ..........................................................................100Sulfaguanidine ...................................................................100 Sulfonylureas .....................................................................100 Sumatriptan ........................................................................100 Sympathomimetics .............................................................100

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Tacrolimus ..........................................................................100 Tamoxifen ..........................................................................100 Terfenadine .........................................................................100Thenophyline .....................................................................101 Thiazide diuretics ...............................................................101 Thiobarbital ........................................................................101 Thioxanthenes ....................................................................101 Thyroid therapy ..................................................................101 Ticlopidine .........................................................................101Tranylcyproamine ..............................................................101 Trazadone ...........................................................................101Triazolom ...........................................................................101 Tricyclic Antidepressants ...................................................101 Tryamine ............................................................................102 Trytophan ...........................................................................102 Ulcer treatment ...................................................................102 Vaccines .............................................................................102 Valproate ............................................................................102 Verapamil ...........................................................................102 Warfarin .............................................................................102 Xenobiotics ........................................................................102

References .........................................................................103Order Form ......................................................................105Authors and Contributors ...............................................107Relevant Web Sites ............................................................108

DIRECTORYThis book may contain important patient notes and follow-up activity.

Name: Organization: Address: Telephone No.

Please return to:

Other Important Contact Telephone NumbersName: Organization: Telephone #

IMPORTANT CONTACTS: Poison Centre: (phone)

Contact:(name) (phone) Hospital Emergency:(phone)

Taxi:(phone)

1

HerbDrug Class

Type of Interaction

2

N O T E S

Alfalfa is from Arabic AL FAL FAH, meaning “the father of all foods”

Alfalfa

Herb Drug Class Type of Interaction

3

Alfalfa (Medicago sativa)-Leaf

Aloe Vera - (A. vera)Latex Powder

Aloe Vera -Gel or Juice

Anticoagulants 2,4,9

e.g. Warfarin 3

Hormone replacement therapy 2,4,9

Oral contraceptives 2,4,9

Xenobiotics 3

All drugs 12

Antiarrythmic agents 5,11,12

e.g. Quinidine

Cardiac glycosides 2,3,5,11,12

e.g. Digoxin 5

Cortico-adrenal steroids 5,11

Diuretics 3e.g. Loop diuretics 5e.g. Thiazide diuretics 5,11

Laxatives, stimulant 20

Oral drugs 3,11

Glyburide 4

Glibenclamide 3,4

InteractReduces drug action due to Vitamin K content in alfalfaInteract

Interact

Increases rate of metabolism

Aloe latex will bind all drugs

Interact

Increases toxicity, Increases effect due to potassium loss, hypokalemia

Increases potassium deficiency

Increases potassium lossInteractInteract

Increases diarrhea, abdominal pain and fluid loss

Decreases absorption of drug due to reduction in bowel transit time

Increases hypoglycemic effect

Increases hypoglycemic effect

Remedies: Nutritional support, retained water, Cholesterol, menopause, addiction, urinary bowel problems.

Remedies: Immune system, Cancer, Heartburn, Arthritis.

4

N O T E S

Astragalus is a plant native to China. The Chinese name of the herb, huang qi, means “yellow leader”, because the root is yellow and it is one of the most important herbs in Chinese medicine.

Astragalus


5

Anise orAniseed(Pimpinella anisum)-Seed

Astragalus (Astragalus membranceus)-Root

Basil (Ocimum basilicum)-Leaf

Anticoagulants 9

Hormone Replacement Therapy 9

Iron 5

Oral Contraceptives 9

MAOIs 9

Acycloir 20

Aldesleukin20

Anticoagulants/Antiplatelet20

Antidiabetic agents 5Insulin 5Sulfonylureas5

Excessive doses of Anise may interact with anticoagulants

Excessive doses of Anise may interact with HRT

Enhances iron absorption across the intestinal mucosa

Excessive doses of Anise may interact

Excessive doses of Anise may interact with MAOI therapy

Drugs incompatible with herb

Astragalus with low dose Aldesleukin resulted in a 10-fold potentiation of Aldes-leukin’s tumour cell killing activity with decreased side effects.

Increases risk of bleeding

May enhance hypoglycemic effects.

Remedies: Digestion, Infection, Respiratory problems and infections, Menopause.

Remedies: Alzheimer’s, Common cold, Sore throat, Chemotherapy support.

Remedies: Digestion, Stomach cramps, Vomiting, Constipation, Anxiety, Headaches.

6

N O T E S

Bilberry

Pilots flying missions during World War II swore that eating Blueberry (bilberry) pie helped their night vision. Modern research has proved them right.


7

Insulin5

Drugs that acidify the urine 3,4,5,7

e.g. Vita. C (Absorbic Acid)

Drugs known to interact with hydroquinone 2

Diuretics 5

Antidiabetic agents 5Hypoglycemic agents 5Insulin 5

Anticoagulants 5e.g. Warfarin 4, 20

ASA 4

Insulin3

Bay (Laurus nobilis)-Leaf

BearberryUva Ursi (Arctostaphylos uva-ursi)-Leaf

Bee Pollen

Bilberry(Vaccinium myrtillus)-Fruit

Bilberry-Leaves

Herb enhances hypoglycemic actions -may increase insulin’s effects more than three fold5

May decrease the urinary antimicrobial action

Theoretically, caution should be exercised

Enhances electrolyte loss

Interact - May promote hyper-glycemia

Increases risk of bleedingIncreases bleeding time

Interact

May cause hypoglycemia

Remedies: Stomach problems, Rheumatism.

Remedies: Arthritis, Urinary problems, Diarrhea, Bronchitis, Fever, Hemorroids.

Remedies: Prevent cataracts, Enhance night vision, Blood circulation, Diarrhea, Liver & stomach problems.

8

N O T E S

Black Cohosh was an original ingredient, along with Fenugreek, in the famous 1876 patent medicine, Lydia E. Pinkham’s Vegetable compound for menstrual problems.

Black Cohosh


9

Birch (Betula)-Leaf

Black Cohosh(Actaea racemosa)-Root

Black Walnut (Juglans nigra) (bark,leaf hull)

Blue Cohosh (Caulophyllum thalictroides)-Root

None reported 5,10

Antihypertensives 5

Estrogen 7,12

Hormone treatments 14

Tamoxifen 4

Atropine 23

Codeine 23

Angina therapy 4,5,9

Antihypertensives 5

Nicotine 5

Increases hypotensive effects

Interact

Interact

Augments antiproliferative action (in vitro)

Interactdecreased absorption

Interact

Decreases effect of drug, increases blood pressure

Increases effects of nicotine

Remedies: lessens inflamation, Diuretic, Joint pain, Urinary tract infections.

Remedies: PMS, Menstruation problems, Hot flashes.

Remedies: Candida, Skin problems.

Remedies: Muscle spasms, Menstrual disorders, Nervous & memory disorders.

10

N O T E S

Burdock

The medieval German priestess / herbalist Hildegard de Bingen suggested using Burdock Root to treat cancer back in the 13th century. Today it is the main ingredient in both Hoxsey and Essiac formulas suggested for the same condition.


11

Borage (Borago officinalis)-Seed Oil

Broom (Cytisus sco-parius) Aerial parts

Bugleweed (Lycopus ssp) Aerial parts

Bupleurum (Bupleurum spp) Root

Epileptogenic drugs 20

Phenothiazines 9

MAOI’s 23

beta blockers 5Antihypertensives 5

Thyroid therapy 23

beta blockers 5

Interferon 23

May manifest seizures (theo-retical)

Interact

Contains tyraminePotentiates drugInteract

InteractMay mask symptoms

May lead to serious lung disease.

Remedies: Skin & nail health.

Remedies: Diuretic, Emetic, Purgative.

Remedies: Hyperthyroidism, Mood, Overactive heart.

Remedies: Liver disease, Haemorrhoids, Digestion.


12

Increases hypoglycemia

Hypoglycemic effect

Increases hyperglycemia

Extends duration of drug action (rats)

Potentiates effect of drug

Burdock(Arctium lappa) -Fruit & Roots -Leaves

Calendula (Calendula officinalis)-Flowers

Catnip (Nepeta cataria)

Aerial parts

Oral hypoglycemics 2,4,5,9

Insulin 3,5

Oral hypoglycemics 4

Hexobarbitol 2,3

dextromethorphan 23

Remedies: Acne, Psoriasis, Rheumatoid arthritis.

Remedies: Eczema, Gastritis, Sunburn, Minor burns and wounds.

Remedies: Sedation, Colic.


13

Potentiates effect of drugPotentiates effect of drugMay antagonize effect of drugMay antagonize effect of drug

May antagonize effect of drug InteractInteract

Interact

Increases hepatic metabolism

Interact

May increase cough

Decreases effect of Drug

Increases plasma concentration and sleep with acute use and decreases with chronic use (rats)

Interact, hypertensive crisis

Increases absorption and bioavailability of drug

Cat’s Claw (Uncaria tomentosa)-Rootbark

Cayenne Pepper(Capsicum frutescens)-Fruit

Anticoagulants 5

Antihypertensives 5

Oral contraceptives 4

Hormone replacement therapy 4,7

Immunosuppressives 4

Insulins 7

Ulcer medications 10

Vaccines 7

All Drugs 2

Antihypertensives 2,5,9

ACE Inhibitors 3,16

Centrally acting adrenergic agents 5e.g. Clonidine, Methyldopa 5

Hexobarbital 3

MAOI 2,5,9

Theophylline 3,16

Remedies: Stimulates immune system(taken by HIV and cancer patients), Rheumatism, Gastric, Ulcers, Tumors & Dysentery.

Remedies: Digestion, Blood circulation, Arthritis, Colds, Sore throat, Sinus problems.

14

N O T E S

Chamomile is one of the oldest garden herbs. The daisy-like flowers of the chamomile plant reminded the ancient Egyptians of the sun, and so they called it “Herb of the Sun”.

Chamomile


15

Chamomile, German (Matricaria recutita)-flowers

Chaparral (Larrea tridentata)-Aerial Parts

Chasteberry (Vitex agnus-castus)Berry

All Drugs 5

Anticoagulants 5,9

Anticoagulants 20

Barbiturates 4

MAOIs 9

Dopamine-receptor antagonists 1,4,13

e.g. Antipsychotics & Metclopramide 14

Dopaminergic drugs Hormone therapy 4

Oral contraceptives 3,4

Decreases absorption of drugs secondary to Chamomile antispasmodic activity in GI tract

Large doses of herb may interact

Chaparral has been shown to interact with platelet adhesion and aggregation in aspirin-treated patients.

Inhibits metabolism

Excessive doses of Chaparral may interact with MAOI therapy

Decreases therapeutic effect of drug (animal)

Interact

Interact

Interact with efficacy of drug

Remedies: Digestion, Diuretic, Sleep aid, Colitis, Diverticulosis, Fever, Headaches, Stress

Remedies: Diuretic, Laxative.

Remedies: Colds, Coughs.

16

N O T E S

Cloves, along with nutmeg and pepper, were highly prized in Roman times, and Pliny the Elder once famously complained that “there is no year in which India does not drain the Roman Empire of fifty million sesterces”.


17

Chondroitin sulfate

Cinnamon (Cinnamomum Zeylanicum)-Bark

Cloves (Syzgium aromaticum)-Buds

Coltsfoot(Tussilago farfara)-Leaf

Comfrey (Symphytum officinale)-Leaf or Root

Anticoagulants 5

None reported 1,5

Anticoagulants 9

Antihypertensives 4,5,9

Cardiovascular therapy 4,9

None reported 4,5

Potentiates effects of drug

Potentiates anticoagulant effects of drug

Interact

Interact

Remedies: Diarrhea, nausea, Blood circulation, Fungal infection, Digestion.

Remedies: Antiseptic, Anti parasitic, Digestive aid, Dental problems.

Remedies: Coughs, respiratory ailments, Diabetes.

Remedies: Wound and many skin problems.

Remedies: Joint health, Arthritis.

18

N O T E S

Dandelion

Dandelion greens growing in areas without herbicides or pesticides, are a great source of of vitamins A and C. One study showed that dandelion leaves possess a diuretic effect comparable to furosemide, and are rich in potassium.


19

Cranberry(Vaccinium macrocarpon)-Berry

Dandelion (Taraxacum officinale)-Root

-Leaf

Devil’s Claw (Harpagophy-tumprocumbens)-Root

Renally excreted drugs 5

Antidiabetic agents 5,9

Antihypertensives 5

Lithium 3,4

Diuretics 2,4,5,9

Cardiac therapy 2,9

Antiarrhythmic drugs 2,4,5

Hypo/hypertensivetherapy 2,9

Warfarin 16

May increase elimination of some drugs excreted in the urine.

May potentiate effects of drug, promoting hypoglycemia

Additive or synergistic hypo-tensive effect

Toxic effects of lithium worsened

Potentiates the diuretic action of drug (Herb is rich in potas-sium)

Interact

Theoretical possibility of inter-action due to herb’s protective action against arrhythmia

Interact

Increases risk of Purpura

Remedies: Urinary tract infections.

Remedies: Constipation, Indigestion, Water retention, Alcoholism.

Remedies: Indigestion, Heartburn and Arthritis.

20

N O T E S

Echinacea

The Plains Indians used various species of echinacea to treat poisonous insect and snake bites, toothaches, sore throats and wounds, as well as mumps, smallpox and measles.


21

Dong Quai (Angelica sinensis)-Root

Echinacea(Echinaceaspecies)-Root/Leaf

Anticoagulants 2, 5,12

ASA 12

Warfarin 4, 20

HRT - Hormone Therapy 22

Cancer treatments 4

Econazole nitrate cream 3

Immunosuppressive agents 2,4,9

e.g. Corticosteroids & Cyclo-sporine 4

Hepatotoxic drugs 12

Warfarin 4

Interact

Interact

Herb may enhance the antico-agulant effect of drug.

Interacts

Herb stimulates immune system

Recurrence rate of vaginal candida infection decreases when the herb juice is used simultaneously

Herb stimulates immune system

Increases liver toxicity with other hepatotoxic drugs

Increases bleeding time (anec-dotal reports)

Remedies: Breast cysts, Menopause and PMS symptoms.

Remedies: Boost immune system to prevent colds, flu, ear infections, sore throats, mouth ulcers (cankers), gingivitis and yeast infections.

22

N O T E S

Feverfew

The feverfew leaf’s main modern use is in the prevention of migraine headaches. It is not a painkiller and cannot be used to treat a headache in progress, but when taken continuously it can gradually (over a period of months) reduce both the number and severity of the migraines, with few side effects.

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Drug - HerbInteraction

Index

75

Drug-Herb Interaction IndexThis index contains a list of the interactions described in the preceding pages. The interactions are listed by category or class of drug. Where the name of drug is referred to specifically in the interactions it is listed under the drug name in this list. If the interaction is less specific it will only be listed under the drug class.

Please check the list by the drug name and class for the most complete reference.

All Drugs, IV see Cat’s Claw, ............................... 13 Cayenne Pepper, ...................... 13 Cranberry, ................................ 19 Lobelia, ................................... 45 Milk Thistle, ............................ 51

All Drugs, Oral see Aloe Vera, ................................ 3 Cayenne Pepper, ...................... 13 German Chamomile,................ 15 Cranberry, ................................ 19 Fenugreek, ............................... 25 Flax, ......................................... 27 Ginger, ..................................... 29 Lobelia, .................................... 45 Marshmallow, .......................... 49 Milk Thistle, ............................ 51 Psyllium, .................................. 59 Slippery Elm, ........................... 63

ACE Inhibitors see Cayenne Pepper, ...................... 13 (see also antihypertensives, Dandelion, ............................... 19 diuretics) Evening Primrose Oil, ............. 23 Acetaminophen see Feverfew, ................................. 25 (see also analgesics) Milk Thistle, ............................ 51

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Acetazolamide see Ma Huang, ................................ 45 (see also drugs that affect urine pH)

Alcohol see Bilberry, .................................. 7 Goldenseal, ............................... 35 Hops, ........................................ 39 Kava, ........................................ 41 Milk Thistle, ............................. 51 Red Raspberry, ......................... 59 Scullcap, ................................... 63 Valerian, .................................. 69 Yarrow, ..................................... 70

Alpha-Adrenoceptor see Yohimbe, .................................. 71 Blocking Agents

Alpha- see Yohimbe, .................................. 71Methylnorepinephrine

Alprazolamsee see Grapefruit, ............................... 35(see also benzodiazepines) Kava, ........................................ 41

Amiloride see Licorice, ................................... 43(see also antihypertensives, diuretics)

Amlodipine see Grapefruit, ................................ 35(see also antihypertensives, calcium channel blockers)

Amitriptyline see Ma Huang, ................................ 45 (see also antidepressants, St. John’s Wort, ........................ 64tricyclic antidepressants) Yohimbe, .................................. 71

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Amobarbital see Yohimbe, ................................. 71 (see also barbiturates, CNS depressants, sedative-hypnotics)

Amphetamine see Yohimbe, .................................. 71(see also stimulants)

Analgesics see Feverfew, .................................. 25 (see also acetaminophen, Milk Thistle, ............................. 51 narcotics, NSAIDs) St. John’s Wort, ........................ 64 Willow, ..................................... 69

Anesthetics see Ma Huang, ................................ 45 (see also barbiturates, halothane)

Angina Therapy see Blue Cohosh, ............................ 9(see also nitrates) Evening Primrose Oil, .............. 23

Antacids see Ma Huang, ................................ 45 (see also ulcer treatment) Yarrow, ..................................... 70

Antiarrythmic Agents see Aloe Vera,................................. 3 (see also beta blockers, Devil’s Claw, ............................ 19calcium channel blockers, Licorice, ................................... 43cardiac glycosides) Antibiotics see Alfalfa, ..................................... 3 Echinacea, ................................ 21 Ginger, ...................................... 29 Ginseng-Siberian, ..................... 34 Grapefruit, ................................ 35 Hops, ........................................ 39 Licorice, ................................... 43 Pygeum, ................................... 59 St. John’s Wort, ........................ 64

herbal - drug interactions...iii professional reference guide herbal - drug interactions a project...

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