herbal - drug interactions

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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


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.


23

Elder (Sambucus nigra)-Berry

Evening Primrose Oil(Oenothera biennis)-Seed

None reported 1,2,5,10


Beta-blockers 2,14

Corticosteroids 2,14

Epileptogenic drugs 2,4,9

e.g. Phenothiazines 2,5,9,14,19

Lithium carbonate 2

NSAIDs 2,14

Vasodilators 20

Interact, may reduce platelet aggregation and potentiate drug action

Decreases action of herb

Theoretically interact

Increases epileptic attacks

Decreases neurotoxicity

Theoretically interact

May potentiate effect of drug

Remedies: Colds, Herpes simplex, Sore throat, Flu, Inflammation.

Remedies: Arteriosclerosis, Diabetes, Eczema, Fibrocystic breast disease, PMS,Rheumatoid arthritis.

24

N O T E S

Fenugreek

Fenugreek was traditionally valued in Arabic medicine for “producing/stimulating an alluring roundness of the female breast”


25

Fenugreek (Trigonella foenum-graecum)-Seed

Feverfew (Tanacetum parthenium)-Leaf

All Drugs 3,5,9,20


Heart medications 10

Hormonal therapy 9,10

Hypoglycemic therapy 5,9

Insulin 3,20

MAOIs 9,10

Anticoagulants 2,4,12,13

e.g. Warfarin 2,4

Aspirin 12,13

Corticosteroids 2

Imitrex 12

NSAIDs 2,12

Tylenol 12

Absorption of all drugs may be affected due to mucilaginous fiber content and high viscosity in gut.

Interact

Interact

Interact

Interact

Dose may need adjustment due to hypoglycemic activity

Interact


Increases antithrombotic effect

Decreases effect of herb

Decreases efficacy of drug

Decreases effect of herb

Decreases efficacy of drug

Remedies: Lowering cholesterol and tryglyceride levels, Diabetes, Arteriosclerosis.

Remedies: Migraines.

26

N O T E S

A garlic shortage during the building of the Egyptian pyramids, resulted in the first world’s labour strike.

Garlic


27

Flax (Linum usitatissimum)-Seed

Forskohlii (Coleus forskohlii)

Root

Garlic (Allium sativum)-Bulb

All Drugs 1,3,4,5,13,20

Insulin 21

Laxatives 5

NSAIDs 4e.g. Indomethacin 4

Clonidine 23

Anticoagulants 2,4,5,7,9,19

e.g. Warfarin 1,3,11,12,16,19,20

Antiplatelet therapy 5

ASA 2,9,12

Diabetic therapy 2,9

e.g. Insulin 3

Absorption of drug delayed when herb used as a bulk laxative

Potentiates effect of drug due to delayed absorption of glucose

Increase in laxative actions of flax

Increases prevalence of stom-ach/intestinal ulcers

Potential interaction

Interact

Anticoagulant activity of drug Enhances (may double clotting time)

Enhances effects of antiplatelet therapyPotentiates the anti-thrombotic effect of ASA

Dose of drug may need adjusting due to hypoglycemic effects of herb

Remedies: Bone, Nail, Teeth, Skin health.

Remedies: Allergies, Asthma, Eczema, Irritable bowel syndrome, Menstrual cramps, High blood pressure, Glaucoma.

Remedies: Cardiovascular system, Congestive heart failure, Lowering cholesterol and triglceride levels.

28

N O T E S

Ginger

Native to India and China, ginger is also mentioned in the Koran, the sacred book of the Moslems, indicating it was known in Arab countries as far back as 650 A.D.


29

Ginger (Zingiber officinale)-Root

All drugs 3

Anticoagulants 2,4,5,9,11,19,20

Cardiac therapy 2,9

Cyclophosphamide 3

Diabetic therapy 2,9

Sulfaguanidine 3,4

Increases absorption of drug

Inhibitory effect on thrombox-ane synthesis

Interact

Side effect of vomiting pre-vented by prior administration of acetone extract of ginger or its component 6-gingerol (PO in Suncus/shrew)

Interact

Increases absorption of drug (rats)

Remedies: Anti-nausea, Anti-vomiting, Blood circulation, Indigestion.

30

N O T E S

Gingko

Ginko is the oldest surviving tree on the planet. Annual sales of the herb top over one half billion dollars in Germany alone.


31

Ginkgo(Ginkgo biloba)-Leaf

Anticoagulants 1,2,4,5,12,13,14,19

&Antiplatelet therapy 20

e.g. Aspirin 3,12,16,20

NSAIDs 4 Warfarin 16,20

Ticlopidine 20

MAOIs 3,20

Papaverine 3

SSRIs 20

Thiazide diuretic 16

Potentiates effect of drug - Monitor coagulation

May induce spontaneous bleedingInteractPotentiates effect of drug

May potentiate effects of drug

Potentiates effect of intracav-ernosal injection for impotence (in 20% of patients for whom previously ineffective)

Gingko may counter the sexual dysfunction that may be expe-rienced with SSRIs

Herb decreases effect of drug, the interaction causes hypertension

Remedies: Alzheimer’s disease, Blood circulatory diseases, Depression, Diabetes, Male impotence, Migraine, Multiple sclerosis, Tinnitus.

32

N O T E S

Ginseng

Ginseng is increasingly being used as an energy booster, anti-inflammatory and antioxidant due to its saponin content and capacity to increase circulation and balance the system -- plus it enhances sexual function in both men and women.


33

Ginseng North American(Panax quinquefolius)-Root

Anticoagulation therapy 3,4,12,16

e.g. Warfarin 20

Antihypertensives 4e.g. Diuretics 20

Digitalis12

Estrogen therapy 4,9

Oral Hypoglycemia therapy 4,5

Insulin 3

MAOIs 1,3,4,5,9,11,12, 20

Oral contraceptives 12

Psychotherapeutic medication 4,12/Antipsychotics 19

e.g. Phenelzine 4,9,16, 20

Steroids 12,19

InteractDecreases INR levels

InteractDecreases diuretic action

Increases toxicity

Interact

Interact

Dose adjustment due to hypo-glycemic effect

Interact

Interact

Interact

Interact

Remedies: Flu, Common cold, Sore throat, Chronic fatigue syndeome, Fibromyalgia, Alzheimer’s disease, Arteriosclerosis, Chemotherapy support, Male reproductive health,

Stress, Diabetes.


34

GinsengSiberian (Eleuthero coccus senticosus)-Root

Glucosamine Sulfate(2-Amino-2-deoxyglucose)

Anticoagulants 2,4

Antipsychotics 4,9

Barbiturates 2,4

e.g. Hexobarbital 3,5

Cardiac therapy 2,9

Diabetes therapy 2,4,9

Digioxin 2,5,16,19

Estrogen 4

Hypertension therapy 2,4

Hypotension therapy 2,9

Insulin 3

Monomycin & Kanamycin 3

Diabetic medication 15

Interact

Interact (Stimulant activity)

Potentiates effects of drugIncreases effect of drug due to inhibition of its metabolic breakdown

Interact

Interact

Increases serum digoxin levels


Contra-indicated

Interact

May need to adjust dose due to hypoglycemic effect

Increases efficacy in treating Shigella dysentry and Proteus enterocolitis probably due to enhancement of t-lymphocyte activity

Causes a decrease in insulin secretion and in insulin sensi-tivity (in animal studies)

Remedies: Alzheimer’s disease, Attention deficit disorder, Adjunctive chemotherapy, Chronic fatigue syndrome, Common cold, Diabetes, Flu, Fibromyalgia, Stress.

Remedies: Arthritis, Joint pain.


35

Goldenseal (Hydrastis canadensis)-Root

Grapefruit (Citrus paradisi)-Fruit/Juice


Antihypertensives 5e.g. Beta blockers 5 Calcium channel blockers 5

Barbiturates 2,4

e.g. Barbitu

Cardiovascular medications 4

e.g. Digoxin 5

CNS depressants 5e.g. Alcohol, benzodiazepines 5

Oral Hypoglycemia Therapy 22

All Drugs including:Benzodiazepines 3,18

e.g. Midazolam, triazolam, alprazolam 18

Buspirone 18

Calcium Antagonists 3,18

e.g. Amiodipine, verapamil, nisoldipine, nifedipine, nitrendipine, felodipine, nimodipine, nicardipine

Cavedilol 18

Cisapride 18

Clomipramine 18


Increases effect of drug

Increases sleeping times (rats)

InteractIncreases effect of drug

Enhances sedative effects

Herb lowers blood sugar levels

Increases bioavailabilityInhibits metabolism by cytochrome P450-3A enzymes

Remedies: Common cold, Chronic ear infections, Urinary tract infections, Chron’s disease.

36

N O T E S

Grape SeedExtract

A source of antioxidants, grape seed extract has been shown to remain in the body for up to 3 days, is 20 times more potent than vitamin C and 50 times stronger than vitamin E.


37

Grapefruitcon’t

Grape Seed Extract

Green Tea(Camellia sinensis)-Leaf

Coumarin 3

Cyclosporin 3,18

Ethinyl estradiol 3,18

HMG CoA reductase inhibitors 18

e.g. Atorvastatin, cerivastatin, lovastatin, simvastatin 18

Saquinavir 18

Tacrolimus 18

Terfenadine 3

None reported 5

All Drugs

Calcium 12

Doxorubicin 5

Increases bioavailabilityInhibits metabolism by cytochrome P450-3A enzymes

Green Tea has similar interac-tions as occur with caffeine

Decreases absorption ofcalcium

May enhance the antitumor activity of doxorubicin

Remedies: Apetite stimulant, Digestion, Diuretic.

Remedies: Good nutritional value.

Remedies: Stimulates immune system, Infections, Gum disease, some cancer risk reduction, Lowers cholesterol level, High blood pressure, High triglyceride levels.

38

N O T E S

The hawthorn has been regarded as the emblem of hope, and its branches are stated to have been carried by the ancient Greeks in wedding processions, and to have been used by them to deck the altar of Hymenaios.

Hawthorn


39

Hawthorn (Crataegus laevigata)-Aerial parts

Hops(Humulus lupulus)-Strobiles

Horse chestnut (Aesculus hip-pocastanum) Seed

Antihypertensives 5

Cardiac glycosides 3,5,12,19

e.g. Digitoxin ,Digoxin 3, Digitalis 1,3,4

Cardiac Medications 7,9

e.g. Nitrates 5

CNS depressants 5

Alcohol 2,9,14,20

CNS depressants 5

Cytochrome P450 metabolised drugs 2,5

Pentobarbital 3

Phenothiazine-type antipsychotics 5

Sedative-hypnotics 2,9,14,20

anticoagulants 3,5

ASA 3,5

Increases hypotension

Potentiates effect of drug (helps lower digoxin levels where toxicity is a concern)

InteractIncreases hypotension

Additive effects

Potentiates action of alcohol


Yet to be evaluated

Increases sleeping time (mice)

Combination of herb and drug increases hyperthermia


Increased risk of bleeding

Remedies: Angina, Arteriosclerosis, High blood pressure.

Remedies: Anxiety, Insomnia.

Remedies: Varicose veins, Hemorrhoids, Blood circulation.

40

N O T E S

Kava

Kava has been used safely in the South Pacific for centuries to relax muscles and calm the mind. Recent reports of liver toxicity may relate to either the modern preparation, or to the herb/drug interactions.


41

Horseradish (Armoracia rusticana)

Root

Juniper(Juniperus communis)-Berry

Kava (Piper methysticum)-Root

Thyroid medications 9

Diuretic therapy 2,9


Alcohol 1,2,3,5,7,12,14

Anticoagulants 19

Antidepressants 7,12

Antipsychotics 7

Barbiturates 1,2,4,5,7e.g. Hexobarbital 2e.g. Pentobarbital 3,5

Benzodiazepines 2,3,4,12,14,19/Tranquillizers12e.g. Alprazolam 2,5,20

Centrally acting drugs1,2,4,7,20

CNS depressants 3,5

Levadopa 3

Hepato toxic drugs

Interact



Potentiates action of herb

Interact

Interact

Interact

Potentiates action of barbituratesPotentiates effect of drug (animals)Potentiates effect of drug





Decreases efficacy


Remedies: Coughs, Diuretic, Sinus, Throat and lung problems.

Remedies: Urinary tract infections, water retention.

Remedies: Anxiety.

42

N O T E S

Deglycyrrhized Licorice has been shown effective in treating duodenal ulcers, according to the Irish Medical Journal.


43

Lemon Balm (Melissa officinalis)-Leaf

Licorice(Glycyrrhiza glabra)-Root

CNS depressants14

Hexobarbital 3

Pentobarbital 2,3,4 Thyroid medications 2,4,14

Agents that prolong the QT interval 5 e.g. procainamide, quinidine, terfenadine 5


Aspirin 3,20

Cardiac glycosides 2,3,11

e.g. Digitalis 1,3,12,20,

Digoxin5

Cardiovascular drugs 4

Cathartics 4e.g. Stimulant laxatives 3

Corticosteroids 3,4,5,11,20

e.g. Hydrocortisone 2,3,16,

Prednisolone 2,16

Diuretics 3,4,5,11,12,20

Interact

Enhances effect of drug

Promotes hypnotic action (mice)

Interact

May prolong the QT interval

Interact

Deglycyrrhizinated licorice decreases ulcer formation (rats) & gave greater protec-tion from ASA induced gastric mucosal damage when used with cimetidine(rats)

Affect potassium level-sIncreases toxicity due to decreases in potassium

Interact

InteractAdditive effect - increases potassium loss

InteractPotentiates effect of drugInhibit metabolism, increases plasma concentration

Affects potassium, potentiates

Remedies: Herpes simplex, Indigestion, Insomnia, Nerve pain, Hyperthyroidism.

44

N O T E S

Medicine Mask


45

Licoricecon’t

Lobelia (Lobelia inflata)-Aerial parts

Ma Huang (Ephedra sinica)-Aerial parts

e.g. Loop diuretics 2,11,

Potassium-sparing diuretics 2,

Potassium-excreting agents or amiloride 4,

Spironolactone 3,4,5,11

Thiazide 1,3,11

Hormonal therapy 4,9

e.g. Oral contraceptives 16

Estrogen & antiestrogen 4

Insulin 2,3,4,9

Nitrofurantoin 2

Nicotine therapy 5(smoking cessation treatments)

All Drugs 2

Anesthetics 4

Agents that influence urine pHe.g. Antacids 3,4, Acetazolamide 20

potassium depletion

InteractHypertension, edema, hypokalemia

Interact

Increases electrolyte distur-bances

Increases bioavailability

Contra-indicated - Nicotine and Lobelin are chemically similar in structure

Herb has similar interactions to those occurring with Ephedrine

Interact

Interact

Acetazolamide may cause Increases concentration of ephedrine due to alkalinization of the urine.

Remedies: Asthma, Bronchitis, Canker sores, Eczema, Herpes simplex, Indigestion, Heartburn, Peptic ulcer, Chronic fatigue syndrome.

Remedies: Coughs, Colds, Asthma, Bronchitis, Flu, cardiovascular, Epilepsy.

46

N O T E S

After the Mormons had arrived in Utah, the native people introduced them to a species of Ephedra, or Ma Huang, and they used the stems as a substitute for coffee and tea. However, this was considered to be a bitter-tasting tonic beverage. In the Old West, the same species used by the Mormons gained a reputation as a cure for syphilis and gonorrhea, although this cure was never actually proven to work!

Medicine Bottle


47

Ma Huangcon’t

Sodium Bicarbonate 20

ASA 4

B adrenergic blockers 4,5

Cardiac glycosides 1,4,11,13

e.g. Digitoxin 7

Corticosteroids 2e.g. Dexamethasone 3

Centrally actingmedications 2,4

e.g. Antidepressants 2 Antihypertensives 2,4 Clonidine 20

Ephedra alkaloids 5

Ergot alkaloid derivatives 11

Guanethidine1,2,4,7,11,13,20

Halothane1,2,11,13,20

MAOIs1,2,3,4,7,11,13

e.g. Tranylcypromine, selegiline, phenelzine, moclobamide 3,

isocarboxazid 20

Methyl Xanthines 3e.g. Theophylline 2,3,4,5,20

Oxytocin1,2,4,11,13

Ephedrine toxicity increases due to decreased elimination


Interact

Disturb heart rhythmInteract

InteractIncreases clearance and thereby reduces effect

Interact

InteractInteractClonidine may augment the pressor response to ephedrine

Hypertensive crisis

Interact

Increases sympathomimetic effect

Disturbs heart rhythm

Increases sympathomimetic effectSever hypertension

InteractInteract, increases side effects (GI and CNS) of both herb and drug

Hypertension

48

N O T E S

Meadowsweet has also been referred to as Queen of the Meadow, Pride of the Meadow, Meadow-Wort and Bridewort. In Chaucer’s The Knight’s Tale it is known as Meadwort and was one of the ingredients in a drink called “save.”


49

Ma Huangcon’t

Marshmallow (Althaea officinalis)-Root

Meadowsweet (Filipendula ulmaria)-Leaf/Flower

Phenothiazines 5

Reserpine 3,20

Secale alkaloid derivatives1,2

Stimulants 2

Sympathomimetic agents 4, 20

All drugs1,3,4,5,10

Dexamethasone 4


Insulin 5

Sulfonylureas 5

All Drugs 2,9

e.g. Anticoagulants 2

Hypotension

Indirect sympathomimetic effects of ephedrine are antagonized

Hypertension

Interact

Interact

Delays absorption of drug


Interact

Increases hypoglycemic effects

Increases hypoglycemic effects

Herb has similar interac-tions to those occurring with salicylates

Interact

Remedies: Breathing problems, Asthma, Nasal congestion.

Remedies: Peptic ulcer, Chrone’s disease, Diarrhea, Asthma, Common cold, Sore throat.

Remedies: Diarrhea, Stomach problems.

50

N O T E S

Milk Thistle

Milk thistle is derived from the milky, white veins on the dark green leaves. Silymarin, from the seeds, is one of the most potent natural protectants of hepatic health, with the ability to help regenerate new liver cells.


51

Milk Thistle(Silybum marianum)-Seed

Mistletoe (Viscum album)-Aerial parts

All drugs 2

Acetaminophen 4,19

ASA 3,4

Butyrophenones 20

Carbon tetrachloride 4,19

Cisplatin 3,4

Cyclosporine 4

Doxorubicin 4

Ethanol 4,19

Iron 4 Phenothiazines 4,20

Phenytoin 21

Anticoagulant therapies 9


Antidepressants 9,10

Increases live metabolism of all drugs

Reduces hepatotoxicity

Altered metabolism in people with liver cirrhosis might be improved

Reduces lipid peroxidation



Reduces hepatotoxicity, Synergistic antiproliferative effect on human ovarian and breast cancer cell lines.

Synergistic antiproliferative effect on human ovarian/breast cancer cell linesReduces hepatotoxicity




Interact

Increases hypotensive effects/ check blood pressure regularly

Interact

Remedies: Gallstones, Psoriasis, Liver health.

52

N O T E S

Calendula

Nettle root has been shown in European studies to reduce benign hypertrophy or inflammation of the prostate. The freeze dried leaves have been shown in one human study to possess antihistamine activity.


53

Mistletoe(cont)

Nettle (Urtica dioica)-Leaf

-Root

Cardiac drug 5,9,10

Coagulant therapies 9

CNS depressants 5

Hypotensive therapies 9

Immunosuppressants 5,9

MAOIs 4

Anticoagulants 4/Coagulant therapy 4


CNS depressants 4,9

Diabetic medication 2,4,9

Diclofenac (low dose) 3,4

Diuretics 2,5

Hypotension medication 4,9

Protatic Hyperplasia Therapy 22 e.g. Tamsulosin

Increases cardiac depression

Interact

Increases sedative effects

Interact

Cytotoxic and immunostimu-lant effects

Interact/monitor

Interact

Interact


Interact

Leaf extract enhances anti-inflammatory effect of diclofenacPotentiates effect of drug

Interact


Remedies: Blood pressure and heart, Mood, Migraine.

Remedies: BPH (enlarged prostate), hay fever.

54

N O T E S

Peppermint is generally regarded as “the world’s oldest medicine”, with archeological evidence placing its use at least as far back as ten thousand years ago.

Peppermint


55

Passionflower (Passiflora incarnata)

-Leaf

Pau D’arco (Tabebuia impetiginosa)

-Bark

Peppermint (Mentha xpiperita)-Leaf

Pine Bark Extract(Pinus maritima)

Barbiturates 4e.g. Hexabarbital, Pentabarbital 2,3

Centrally ActingMedications 2,4,5

CNS depressants 20

MAOI Antidepressants 5,7,9

Anticoagulants 5,20

Iron 5

Ulcer treatment e.g. H2 Receptor Blockers

None reported 4,5

Increases hypnotic actionIncreases sleeping time (animal)

Increases hypnotic action and potential for monoamine oxidase inhibition

Potential for additive effects and increases sedation

Interact

May potentiate effects of drug, prolongation of prothrombin time20

Decreases absorption of iron

May antagonize achlohydria

Remedies: Anxiety, Insomnia.

Remedies: Infections and yeast infections.

Remedies: Chronic venous insufficiency.

Remedies: Migraine, Nerves, Stomach disorder, Heartburn, Herpes, Abdominal cramps.

56

N O T E S

Psyllium

Psyllium is a fibre supplement used as a bulk-forming laxative to treat constipation. It may also be prescribed to people who’ve just had intestinal surgery, to treat chronic watery diarrhea, and may be used as part of a diet plan recommended by your doctor to lower cholesterol.


57

Propolis

Resin

Psyllium (Plantago psyllium)-Seed

Puncture Vine(Tribulus terrestris)

Tetracycline 24

All drugs 1,3

Anti-coagulants 21

Anti-Convulsantse.g. Carbamazepine 5, 20

Cardioactive drugs 5e.g. Beta blockers, calcium channel blockers, digitalis 5

Insulin 3

Lithium 3,5,16

None reported 4

Increases effectiveness

May delay absorption of drugs

Delays absorption of drug

Decreases absorption and concentration of drug

A possibility that the herb enhances digitalis effect of the drug (highly speculative)

Drug dosage must be adjusted due to slowing of dietary carbohydrate absorption

Decreases concentration due to reduction of drug absorption

Remedies: Anaemia, Skin healing, Respiratory problems, Immune system support, Digestion.

Remedies: Constipation, Diarrhea, hemorrhoids, Irritable bowel syndrome, Obesity, Artherosclerosis, High cholesterol, High triglyceride level, Psoriasis.

Remedies: Vitiligo (whitening of skin), Impotence, Female infertility, Urinary problems.

58

N O T E S

People in northern Africa and southwestern Asia have used senna as a laxative for centuries. It was considered a “cleansing” herb because of its cathartic effect. In addition, the leaves were sometimes made into a paste and applied to various skin diseases like ringworm and acne.

Senna


59

Pygeum(Prunus africana)-Bark

Red Clover(Trifolium pratense)-Blossoms

Red Raspberry (Rubus idaeus)-Leaf

Red Yeast rice

Antibiotics for prostate and bladder infections 4


e.g. Heparin, warfarin 5

Antiplatelet agents 5e.g. ASA, clopidogrel, ticlopidine 5

Hormone Replacement Therapy 9,10

Oral Contraceptives 5,9,10


lovastatin 23

Simvastatin 23

Atorvastatin 23

Enhances effectiveness of drug

May increase risk of bleeding

May increase risk of bleeding

Interact

May enhance action of drug by increasing estrogen components

Increases effectiveness of hypoglycemic action

Additive effects similar in (Cholestin)

Remedies: Urinary problems, Enlarged prostate.

Remedies: Coughs, Eczema, Possible cancer reduction..

Remedies: Menstrual problems, Diarrhea, Canker sores.

Remedies: Lowering cholesterol levels.

60

N O T E S

A review of 18 clinical studies on Saw Palmetto by JAMA (Journal of American Medical Association) concluded that the herb was more effective than a placebo, and just as effective as Finasteride in treating prostate problems.

Saw Palmetto


61

Rosehips(Rosa canina)

Rosemary (Rosmarius officinalis)-Leaf

Royal Jelly

Sage (Salvia officinalis)-Leaf

Saw Palmetto(Serenoa repens)-Berry

None reported 5

Disulfiram 5

Antidiabetic agents 5

Anticonvulsants 5,9


e.g. Insulin 5

Sedatives 9

Hormone replacement therapy 2,4,9

Oral contraceptives 2,4,9

Disulfiram reaction if herbal product contains alcohol

May lead to loss of glycemic control in diabetic patients

Lowers seizure threshold

Antagonizes glycemic control

Herb may potentiate sedative effects of other drugs

Interacts because of its anti-androgen and estrogenic activity

Interacts because of its anti-androgen and estrogenic activity

Remedies: Colds, Infection.

Remedies:Circulatory system, Heart problems, High blood pressure, Menstruation.

Remedies: Apetite stimulant, Chronic fatigue syndrome, Liver disease, Insomnia, Multiple sclerosis.

Remedies: Menopause, Tonsillitis, Fever.

Remedies: BPH (enlarged prostate.)

62

N O T E S

Saint John’s Wort was named by early Christians in honour of St John the Baptist; its blood red oil becoming a symbol of the Saint’s beheading. Pagans burned it on bonfires to drive away evil spirits and protect their crops.

St. John’s Wort


63

Schisandra (S. chinensis) Berry

Scullcap(Scutellarialaterifolia)-Aerial parts

Scullcap, Chinese(Scutellaria baicalensis) -Root

Senna (Cassia ssp) leaf, pod

Slippery Elm(Ulmus rubra)-Aerial parts

Acetaminophen 23

Centrally-acting medications 2

Sedatives and tranquillizers 3,4

Immunosuppressives 5

Platelet aggregation inhibitors 3,4

Indomethacin 5

Calcium channel blockers 5

Digoxin 23

All Drugs 7



Interact

Possible interaction


Decreases drug levels

potentiates potassium depletion

Interacts

May interfere with the absorption of drugs taken simultaneously

Remedies: Infertility, Nerve disorders.

Remedies: Sore throat, Fevers, Heart problems.

Remedies: Gastritis, Chron’s disease, Cough, Common cold, Sore throat.

Remedies: Coughs, Asthma, Urinary problems, Tonic.


64

St. John’s Wort (Hypericum perforatum)-Aerial parts

All Drugs 21, 22

Antabuse 12

Antidepressants 4,5,12,17

e.g.Trazadone,nefazodone 16,17

see MAOIs & SSRIs below

Anti-epilepsy drugs 17

e.g. Phenytoin, carbamazepine, phenobarbital 17

Anti-retroviral drugs 17

e.g. Indinavir

Atypical antipsychotics12

e.g. Olanzapine,risperidone 12

Beta2 agonists12

Dextromethorphan 2,12

Dibenzazepine Derivatives 2e.g. Amitriptyline, doxepin, carbamazepine 2

Digoxin 5,16,17

Dopamine agonists12

Immunosuppressants17

e.g. Cyclosporine 16,17,20

Meperidine 2

Drugs metabolized by cytochrome P450 3A4 enzyme system have potential to interact

Interact

Serotonin syndrome

Interact

Interact

Interact

Interact

Interact

Interact

Interact

Interact

Interact - Decreases cyclosporine plasma concentration20

Interact


65

St. John’sWort(Hypericum perforatum)-Aerial parts

Tea Tree Oil(Melaleuca alternifolia)-Leaf

Metronidazole 12

Midodrine 20

Migraine therapies17

Monoamine Oxidase Inhibitors (MAOIs) 2,3,5,9,12,20

e.g.Phenelzine, tranylcypromine,isocarboxazid

Narcotics 5e.g. Morphine 2

Oral contraceptives16,17

Reserpine 3

Selective Serotonin Reuptake Inhibitors (SSRIs) 2,3,4,5,7,12,16,17,20

e.g. Fluoxetine, paroxetine 5, sertraline

Sympathomimetics 2,5,12

e.g. Ephedrine, methyldopa, dopamine, trytophan

Theophylline 4,12,16,17,20

Tyramine containing foods 2,5

Warfarin 17

None reported 2,4,5,12

InteractEnhances pressor effect

Interact

Interact

Interact

Interact-can make ineffective

Decreases effect of drug (mice)

Serotonin syndrome

Interact

Interact,

Decreases theophylline levels Interact (speculative)

InteractRemedies: Depression, Vitiligo (whitening of skin), Recurrent ear infections.

Remedies: Yeast infection, Vaginitis, Athletes foot, Acne.

66

N O T E S

In the 2nd century, the Greek physician Galen prescribed valerian for insomnia. In the 1500’s, it was used to treat nervousness, trembling, headaches, and heart palpitations and during World War II, it was used in England to relieve the stress of air raids.

Valerian


67

Thyme(Thymus vulgaris)-Leaf & Flower

Turkey tail (Coriolus versicolor)

Turmeric (Curcuma longa)-Root

Uva Ursi see Bearberry

None reported 1,2,5

Cyclophosamide 23

Anticoagulants 5

Immunosuppressants 5

NSAIDs 5

Reserpine and indomethacin 3

Cyclophosamide 23

Additive effects on platelets

Decreases effects of drug

Inhibits platelet function and increases risk of bleeding

Turmeric root solid alcoholic extract reduces the frequency of gastric and duodenal ulcer (rats)

Remedies: Digestion, Fever, Headache, High cholesterol, Skin problems.

Remedies: Respiratory problems, Mood, Tonic.

Remedies: Bursitis, Rheumatoid arthritis, Liver health, Arteriosclerosis.

Remedies: urinary tract infection.

68

N O T E S

Willow

Willow Bark contains salcin that is converted by intestinal bacteria into salicylic acid. Activity is slower but of a longer duration. Salicin does not inhibit platelet aggregation like ASA, but will still aggravate gout.


69

Valerian(Valerianaofficinalis)-Root

Wild Yam (Dioscorea villosa)-Root

Willow (Salix)-Bark

Alcohol 5,11,16

Anticonvulsants 12

Barbiturates 19

e.g. Pentobarbital, thiobarbital 3

Benzodiazepines 3,19

e.g. Diazepam 3

CNS depressants 2,5,14,19

Sedative medications 4,9,11,12,14

Oral Contraceptive 22

All Drugs 1,2,9

Anticoagulants 5,9

Antihypertensives 5

Diuretics 5

Potentiates effects of alcohol

Increases seizures

Increases sleeping time

May be helpful in withdrawal from benzodiazepines



Interact - May interfere with effectiveness of contraceptive

Willow has similar interactions to those occurring with salicy-lates Irreversible inhibition of platlet aggregation by aspirin cannot be induced by structur-ally different salicin 21

Increases bleeding

Reduces effect

Increases risk of salicylate toxicity (highly speculative)

Remedies: Insomnia

Remedies: High cholesterol, High tryglyceride levels, Abdominal cramps, menopause, Muscle pain and spasms.


70

Willow(cont)

Yarrow (Achillea millefolium)-Aerial parts

Methotrexate 9

Metoclopramide 9

NSAIDs 5,13

Phenytoin 9

Probenecid 9

Salicylates 9,13

Spironolactone 9

Valproate 9

Antacids 4

Anticoagulant therapy 4,5,9

CNS depressants 5

Diuretics 4

H2receptor antagonists 4

Hypertensive 4,5,9/Hypotensive therapy 4,9

Sedatives 4

Interact

Interact

Interact

Interact

Interact

Interact (no cases reported)

Interact

Interact

Interact

Interact

Increases sedation

Interact

Interact

Interact

Interact

Remedies: Headache, Pain, Backache, Nerve pain, Toothache.

Remedies: Inflamation, Improves blood clotting, Diuretic, Fever, Some inflamatory disorders.


71

Yohimbe(Pausinystalia yohimbe)-Bark

a-adrenoceptor blocking agents 3e.g. Phenoxybenazamine, phentolamine 3

Amobarbital 3

Antidepressants 5,7,20

Atropine 3

Beta-blockers 3e.g. Propranolol, penbutolol, metoprolol 3

Central a 2-adrenergic agonists 3e.g. Guanabenz, a-methylnorepinephrine 3

Clonidine 3

Hypotensive drugs 1,20

MAOIs1,3,20

Naloxone 3,20

Phenothiazines 3e.g. Chlorpromazine, promazine 3

Reserpine 3

Sedatives 5

SSRIs 5

Sympathomimetics 3,5,10

e.g. Epinephrine,

Increases toxicity of yohimbine

Interact

Interact

Interact

Protects against yohimbine toxicity (mice)

Reverses hypotensive effects

Reverses hypotensive effects

Potentiates

Potentiates

Affects synergistically Enhances


Interact


Increases stimulation



72

Yohimbe-Barkcon’t

ephedrine, amphetamine, cocaine 3

Thiozanthenes 3e.g. Chlorprotixene 3

Tricyclic anti-depressants 3,5,16

e.g. Clomipramine 3,20, imipramine, amitriptyline 3

Tyramine containing foods 5,20


Combination of herb and drug may cause hypertension

-Lower doses of yohimbine may have favorable effect in ortho-static hypotension induced by tricyclic anti-depressants

Increases blood pressure

Remedies: Depression, Male impotence.

73

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

76

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

77

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

78

Anticoagulants see Alfalfa, ..................................... 3(see also antiplatelet Anise, ....................................... 5therapy, ASA) Astragalus, ............................... 5 Bilberry, ................................... 7 Cat’s Claw, ............................... 13 German Chamomile, ................ 15 Chaparral, ................................. 15 Chondroitin Sulfate, ................. 15 Cloves, ..................................... 17 Devil’s Claw, ............................ 19 Dong Quai, ............................... 21 Echinacea, ................................ 21 Evening Primrose Oil, .............. 23 Fenugreek, ................................ 25 Feverfew, .................................. 25 Garlic, ....................................... 29 Ginger, ...................................... 29 Ginkgo,..................................... 31 Ginseng-North American, ........ 33 Ginseng-Siberian, ..................... 34 Goldenseal, ............................... 35 Grapefruit, ................................ 35 Kava, ........................................ 41 Meadowsweet, ......................... 49 Mistletoe, ................................. 51 Nettle, ....................................... 53 Pau D’arco, .............................. 55 Red Clover, .............................. 59 St. John’s Wort, ........................ 64 Turmeric, .................................. 67 Willow, ..................................... 69 Yarrow, ..................................... 70

Anticonvulsants see Grapefruit, ................................ 35(see also barbiturates, Hops, ........................................ 39 benzodiazepines) Meadowsweet, ......................... 49 Psyllium, .................................. 59 Sage, ........................................ 61

79

Anticonvulsants con’t see St. John’s Wort, ........................ 64 (see also barbiturates, Valerian, ................................... 69 benzodiazepines) Willow, ..................................... 69

Antidepressants see Anise, ....................................... 5(see also SSRIs, tricyclic Cayenne Pepper, ....................... 13 antidepressants) Chaparral, ................................. 15 Ginkgo,..................................... 31 Ginseng-North American, ........ 33 Grapefruit, ................................ 35 Hops, ........................................ 39 Kava, ........................................ 41 Ma Huang, ................................ 45 Mistletoe, ................................. 51 Passionflower, .......................... 55 St. John’s Wort, ........................ 64 Yohimbe, .................................. 71

Antihypertensives see Black Cohosh, .......................... 9(see also ACEIs, Blue Cohosh, ............................ 9beta blockers, Cat’s Claw, ............................... 13 calcium channel blockers, Cayenne Pepper, ....................... 13 diuretics, loop Coltsfoot, .................................. 17diuretics, nitrates) Dandelion, ................................ 19 Devil’s Claw, ............................ 19 Siberian Ginseng, ..................... 34 Evening Primrose Oil, .............. 23 Fenugreek, ................................ 25 Ginseng-North American, ........ 33 Goldenseal, ............................... 35 Grapefruit, ................................ 35 Hawthorn, ................................. 39 Licorice, ................................... 43 Ma Huang, ................................ 45 Meadowsweet, ......................... 49 Mistletoe, ................................. 51

80

Antihypertensives Nettle, ....................................... 53con’t Turmeric, .................................. 67 Willow, ..................................... 69 Yarrow, ..................................... 70 Yohimbe, .................................. 71

Antihypotensives see Devil’s Claw, ............................ 19(see also dopamine) Ginseng-Siberian, ..................... 34 Ma Huang, ............................... 35 Mistletoe, ................................. 51 Nettle, ....................................... 53 Yarrow, ..................................... 70 Yohimbe, .................................. 71

Antimanic Agents see Dandelion, ................................ 19(see also antimanic agents) Evening Primrose Oil, .............. 23 Psyllium ................................... 59

Antiplatelet Therapy see Astragalus, ............................... 5(see also anticoagulants, Chaparral, ................................ 15ASA) Evening Primrose Oil, .............. 23 Feverfew, ................................. 25 Garlic, ....................................... 29 Gingko,..................................... 31 Red Clover, .............................. 59 Scullcap, ................................... 63

Antipsychotics see Borage, ..................................... 11(see also antimanic agents) Chasteberry, ............................. 15 Ginseng-North American, ........ 33 Ginseng-Siberian, ..................... 34 Hops, ........................................ 39 Kava, ........................................ 41 Milk Thistle, ............................. 51 St. John’s Wort, ........................ 64 Yohimbe, .................................. 71

81

Antiretrovirals see Grapefruit, ............................... 35 St. John’s Wort, ........................ 64

Aspirin (ASA) see Bilberry, ................................... 7(see also anticoagulants, Chaparral, ................................. 15antiplatelet therapy) Dong Quai, ............................... 21 Feverfew, .................................. 25 Garlic, ....................................... 29 Ginkgo,..................................... 31 Licorice, .................................. 43 Ma Huang, ................................ 45 Milk Thistle, ............................. 51 Red Clover, .............................. 59 Willow, ..................................... 69

Asthma Therapy see Cayenne Pepper, ....................... 13 Ma Huang, ................................ 45 St John’s Wort, ......................... 64 Atorvastatin see Grapefruit, ................................ 35 (see also lipid lowering agents)

Atropine see Yohimbe, .................................. 71

Barbiturates see Calendula, ................................ 12(see also anticonvulsants, Cayenne Pepper, ....................... 13CNS depressants, Chaparral .................................. 15sedative-hypnotics) Ginseng-Siberian, ..................... 34 Goldenseal, ............................... 35 Hops, ........................................ 39 Kava, ........................................ 41 Passionflower, .......................... 55 St. John’s Wort, ........................ 64 Valerian, ................................... 69 Yohimbe, .................................. 71

82

Benzodiazepines see Goldenseal, ............................... 35(see also anticonvulsants, Grapefruit, ................................ 35CNS depressants) Kava, ........................................ 41 Valerian, ................................... 69

Beta Blockers see Evening Primrose Oil, .............. 23 (see also cardiac therapy) Goldenseal, ............................... 35 Grapefruit, ................................ 35 Ma Huang, ................................ 45 Psyllium, .................................. 59 Yohimbe, .................................. 71

Buspirone (see also sedative-hypnotics) see Grapefruit, ................................ 35

Butyrophenones see Milk Thistle, ............................. 51 (see also antimanic agents, antipsychotics, centrally acting medications)

Calcium see Green Tea, ................................ 37

Calcium Channel Blockers (CCB) see Evening Primrose Oil, .............. 23(see also antiarrythmic agents, Goldenseal, ............................... 35antihypertensives, Grapefruit, ................................ 35 cardiac therapy) Psyllium, .................................. 59

Cancer Treatments see Astragalus, ............................... 5 Black Cohosh, .......................... 9 Echinacea, ................................ 21 Ginger, ...................................... 29 Green Tea, ................................ 37 Milk Thistle, ............................. 51

Carbamazepine see Psyllium, .................................. 57(see also anticonvulsants, St. John’s Wort, ........................ 64 antimanic agents)

83

Carbon Tetrachloride see Milk Thistle, ............................. 51

Cardiac Glycosides see Aloe Vera.................................. 3 (see also digoxin) Ginseng-North American, ........ 33 Ginseng-Siberian, ..................... 34 Hawthorn .................................. 39 Licorice, ................................... 43 Ma Huang, ................................ 45 Psyllium, .................................. 59 St. John’s Wort, ........................ 64

Cardiac Therapy see Coltsfoot, .................................. 17(see also ACEIs, Angina Therapy, Devil’s Claw, ............................ 19Antihypertensives, Beta Blockers, Evening Primrose Oil, .............. 23CCB, Cardiac Glycosides, Fenugreek, ................................ 25Diuretics) Ginger, ...................................... 29 Ginseng-North American, ........ 33 Ginseng-Siberian, ..................... 34 Goldenseal, ............................... 35 Grapefruit, ................................ 35 Hawthorn .................................. 39 Licorice, ................................... 43 Ma Huang, ................................ 45 Mistletoe, ................................. 51 Psyllium, .................................. 59 St. John’s Wort, ........................ 64

Cavedilol see Grapefruit, ................................ 35 (see also antihypertensives, beta blockers)

Central Nervous System see Goldenseal, ............................... 35(CNS) Depressants Hawthorn, ................................. 39(see also Alcohol, Hops, ........................................ 39Barbiturates, Kava, ........................................ 41Benzodiazepines) Lemon Balm, ........................... 43 Ma Huang, ................................ 45

84

Central Nervous System see Mistletoe, ................................. 51 (CNS) Depressants Nettle, ....................................... 53con’t Passionflower, .......................... 55 Sage, ......................................... 61 Scullcap, ................................... 63 St. John’s Wort, ........................ 64 Valerian, ................................... 69 Yarrow, ..................................... 70 Yohimbe, .................................. 71

Centrally Acting see Milk Thistle, ............................. 51Medications Passionflower, .......................... 55(see also CNS Scullcap, ................................... 63depressants) Centrally Acting see Cayenne Pepper, ....................... 13Antiadrenergic Agents Ma Huang, ................................ 45 St. John’s Wort, ........................ 64 Turmeric, .................................. 67 Yohimbe, .................................. 71

Cerivastatin see Grapefruit, ................................ 35(see also lipid lowering agents)

Chlorpromazine see Yohimbe, .................................. 71(see also antipsychotic agents)

Chlorprotixene see Yohimbe, .................................. 71

Cisapride see Grapefruit, ................................ 35(see also ulcer treatment) Hops, ........................................ 39(*investigational/emergency release drug)

85

Cisplatin see Milk Thistle, ............................. 51(see also cancer treatments)

Clomipramine see Grapefruit, ................................ 35(see also antidepressants, Yohimbe, .................................. 71tricyclic antidepressants)

Clonidine see Cayenne Pepper, ....................... 13(see also centrally acting Ma Huang, ................................ 45anti-adrenergic agents) Yohimbe, .................................. 71

Clopidogrel see Red Clover, .............................. 59(see also anticoagulants, antiplatelet agents)

Coagulant Therapies see Mistletoe, ................................. 51(see also anticoagulants) Nettle, ....................................... 53

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

Cortico-Adrenal Steroids see Aloe Vera.................................. 3(see also immunosuppressives) Echinacea, ................................ 21 Evening Primrose Oil, .............. 23 Feverfew, .................................. 25 Ginseng-North American, ........ 33 Licorice, ................................... 43 Ma Huang, ................................ 45 Marshmallow, ........................... 49

Cyclophosphamide see Ginger, ...................................... 29(see also cancer treatments)

Cyclosporine see Echinacea, ................................ 21(see also cancer treatments) Grapefruit, ................................ 35 Milk Thistle, ............................. 51 St. John’s Wort, ........................ 64

86

Cytochrome P450 see Grapefruit, ................................ 35Metabolised Drugs Hops, ........................................ 39(see also antibiotics, anticonvulsants, antidepressants, cisapride,lipid lowering agents, tricyclic antidepressants)

Dextromethorphan see St. John’s Wort, ........................ 64

Dexamethasone see Ma Huang, ................................ 45(see also cortico-adrenal Marshmallow, ........................... 49steroids, immunosuppressives) Diabetic Medications see Aloe Vera.................................. 3 Basil, ........................................ 5 Bay Leaf, .................................. 7 Bee Pollen, ............................... 7 Bilberry, ................................... 7 Burdock, ................................... 12 Cat’s Claw, ............................... 13 Dandelion, ................................ 19 Siberian Ginseng, ..................... 33 Fenugreek, ................................ 25 Garlic, ....................................... 29 Ginger, ...................................... 29 Ginseng-North American, ........ 33 Glucosamine, ........................... 34 Juniper, ..................................... 41 Licorice, ................................... 43 Marshmallow, ........................... 49 Meadowsweet, ......................... 49 Nettle, ....................................... 53 Psyllium, .................................. 59 Royal Jelly, ............................... 61 Red Raspberry, ......................... 59 Sage, ......................................... 61 Willow, ..................................... 69

87

Diazepam see Valerian, .................................. 69(see also anticonvulsants, benzodiazepines)

Dibenzazepine see Ma Huang, ................................ 45Derivatives Psyllium, .................................. 59(see also anticonvulsants, St. John’s Wort, ........................ 64benzodiazepines) Diclofenac see Nettle, ....................................... 53(see also analgesics, NSAIDs) Willow, ..................................... 69

Digoxin/Digitoxin see Aloe Vera,................................. 3(see also antiarrythmics, Ginseng-North American, ........ 33cardiac glycosides, Ginseng-Siberian, ..................... 34cardiac therapy) Goldenseal, ............................... 35 Hawthorn, ................................. 39 Licorice, ................................... 43 Ma Huang, ................................ 45 Psyllium, .................................. 59 St. John’s Wort, ........................ 64

Disulfiram see Rosemary, ................................. 61 St. John’s Wort, ........................ 64

Diuretics see Aloe Vera,................................. 3(see also antihypertensives, Bearberry, ................................. 7loop diuretics) Dandelion, ................................ 19 Ginkgo,..................................... 31 Ginseng-North American, ........ 33 Juniper, ..................................... 41 Licorice, ................................... 43 Meadowsweet, ......................... 49 Nettle, ....................................... 53 Willow, ..................................... 69 Yarrow, ..................................... 70

88

Dopamine see St. John’s Wort, ........................ 64(see also antihypotensives)

Dopamine Agonists see St. John’s Wort, ........................ 64

Dopamine-Receptor Antagonists see Chasteberry, ............................. 15(see also anti psychotics) St. John’s Wort, ........................ 64 Yohimbe, .................................. 71

Doxepine see St. John’s Wort, ........................ 64(see also antidepressants,tricyclic antidepressants)

Doxorubicin see Green Tea, ................................ 37(see also cancer treatment) Milk Thistle, ............................. 51

Drugs That Acidify see Bearberry, ................................. 7 the Urine Ma Huang, ................................ 45

Drugs That Affect see Bearberry, ................................. 7 Urine pH Ma Huang, ................................ 45 Yarrow, ..................................... 70

Drugs That Interact see Green Tea, ................................ 37 With Caffeine Drugs That Interact see Meadowsweet, ......................... 49 With Salicylates Willow, ..................................... 69 (see also ASA) Drugs That Interact see Bearberry, ................................. 7 With Hydroquinone

Econazole Nitrate Cream see Echinacea, ................................ 21(see also antibiotics)

Ephedrine see Ma Huang, ................................ 45(see also antihypotensives, St. John’s Wort, ........................ 64stimulants) Yohimbe, .................................. 71

89

Epinephrine see Yohimbe, .................................. 71

Epileptogenic Drugs see Borage, ..................................... 11 Evening Primrose Oil, .............. 23

Ergot Alkaloids see Ma Huang, ................................ 45

Estrogen see Black Cohosh, .......................... 9(see also hormone Dong Quai, ............................... 21replacement therapy, Ginseng-North American, ........ 33oral contraceptives) Ginseng-Siberian, ..................... 34 Licorice, ................................... 43

Ethinyl Estradiol see Grapefruit, ................................ 35(see also hormone replacement therapy, oral contraceptives)

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

Fluoxetine see St. John’s Wort, ........................ 64(see also antidepressants, SSRIs)

Gammalinolenic Acid see Evening Primrose Oil, .............. 23

Glibenclamide see Aloe Vera,................................. 3(see also diabetic medications)

Glyburide see Aloe Vera,................................. 3(see also diabetic medications)

90

Gout Therapy see Feverfew, .................................. 23(see also Analgesics, Meadowsweet, ......................... 49NSAIDs) Willow, ..................................... 69

Guanabenz see Yohimbe, .................................. 71(not available in Canada)(see also anti-hypertensives)

Guanethidine see Ma Huang, ................................ 45(see also antihypertensives)

Halothane see Ma Huang, ................................ 45

Heparin see Red Clover, .............................. 59(see also anticoagulants)

Hepatotoxic Drugs see Echinacea, ................................ 21

Hexobarbital see Calendula, ................................ 13(see also barbiturates, Cayenne Pepper, ....................... 13sedative-hypnotics) Ginseng-Siberian, ..................... 34 Kava, ........................................ 41 Lemon Balm, ............................ 43 Passionflower, .......................... 55

Hormone Replacement Therapy see Alfalfa, ..................................... 3(see also estrogen, Anise, ....................................... 5oral contraceptives) Black Cohosh, .......................... 9 Cat’s Claw, ............................... 13 Chasteberry, ............................. 15 Dong Quai, ............................... 21 Fenugreek, ................................ 25 Ginseng- North American, ....... 33 Ginseng-Siberian, ..................... 34 Grapefruit, ................................ 35 Licorice, .................................. 43 Red Clover, .............................. 59 Saw Palmetto, .......................... 61

91

Hydrocortisone see Licorice, ................................... 43(see also cortico-adrenal steroids, immunosuppressives)

Imipramine see Yohimbe, .................................. 71(see also antidepressants,tricyclic antidepressants)

Imitrex see Feverfew, .................................. 25(see also migraine therapy)

Immunosuppressives see Cat’s Claw, ............................... 13 Echinacea, ................................ 21 Grapefruit, ................................ 35 Milk Thistle, ............................. 51 Mistletoe, ................................. 51 Scullcap, ................................... 63 St. John’s Wort, ........................ 64 Tumeric, ................................... 67

Indinavir see St. John’s Wort, ........................ 64

Indomethacin see Flax, ......................................... 27(see also analgesics, Turmeric, .................................. 67NSAIDs) Willow, ..................................... 69

Insulin see Basil, ........................................ 5(see also diabetic Bay Leaf, .................................. 7medications) Bee Pollen, ............................... 7 Bilberry. ................................... 7 Cat’s Claw, ............................... 13 Siberian Ginseng, ..................... 34 Fenugreek, ................................ 25 Garlic, ....................................... 29 Ginseng-North American, ........ 34 Licorice, ................................... 43 Marshmallow, ........................... 49

92

Insulin Meadowsweet, ......................... 49 con’t Psyllium ................................... 59 Sage, ......................................... 61 Willow, ..................................... 69

Iron see Anise, ....................................... 5 Milk Thistle, ............................. 51 Pau D’arco, .............................. 55

Isocarboxazid see Ma Huang, ................................ 45(see also antidepressants, St. John’s Wort, ........................ 64MAOIs, Tyramine-foods high in) Kanamycin see Ginseng-Siberian, ..................... 34(see also antibiotics)

Laxatives see Aloe Vera.................................. 3 Flax, ......................................... 27 Licorice, ................................... 43

Levodopa see Kava, ........................................ 41(see also dopamine receptor agonists)

Lipid Lowering Agents see Grapefruit, ................................ 35(see also atorvastatin, Hops, ........................................ 39lovastatin, simvastatin) Lithium see Dandelion, ................................ 19(see also Evening Primrose Oil, .............. 23antimanic agents) Psyllium, .................................. 59

93

Loop Diuretics see Aloe Vera,................................. 3(see also antihypertensives, Licorice, ................................... 43diuretics)

Loratadine see Licorice, .................................. 43

Lovastatin see Grapefruit, ................................ 35(see also lipid lowering agents)

Meperidine see St. John’s Wort, ........................ 64(see also analgesics, narcotics) Methotrexate see Meadowsweet, ......................... 49(see also Willow, ..................................... 69immunosuppressives) Methyldopa see Cayenne Pepper, ....................... 13(see also antihypertensives) St. John’s Wort, ........................ 64

Metoclopramide see Chasteberry, ............................. 15 Meadowsweet, ......................... 49 Willow, ..................................... 69

Metoprolol see Yohimbe, .................................. 71(see also antihypertensives, beta blockers)

Metronidazole see St. John’s Wort, ........................ 64(see also antibiotics)

Midazolam see Grapefruit, ................................ 35(see also benzodiazepines)

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Midodrine see Ma Huang, ................................ 45(see also antihypotensives,sympathomimetics)

Migraine Therapy see Feverfew, .................................. 25(see also sumatriptan) Ma Huang, ................................ 45 St. John’s Wort, ........................ 64 Yohimbe, .................................. 71

Moclobamide see Ma Huang, ................................ 45(see also antidepressants,MAOIs, tyramine-foods high in) Monoamine Oxidase see Anise, ....................................... 5Inhibitors (MAOIs) Cayenne Pepper, ....................... 13(see also antidepressants, Chaparral, ................................. 15tyramine-foods high in) Fenugreek, ................................ 25 Ginkgo,..................................... 31 Ginseng-North American, ........ 33 Ma Huang, ................................ 45 Mistletoe, ................................. 51 Passionflower, .......................... 55 St. John’s Wort, ........................ 64 Yohimbe, .................................. 71

Monomycin see Ginseng-Siberian, ..................... 34(see also antibiotics)

Morphine see St. John’s Wort, ........................ 64(see also analgesics, narcotics)

Naloxone see Yohimbe, .................................. 71

Narcotics see St. John’s Wort, ........................ 64(see also analgesics, meperidine, morphine)

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Nefazodone see St. John’s Wort, ........................ 64(see also antidepressants,cytochrome P450 metabolised drugs)

Nicardipine see Grapefruit, ................................ 35(see also antihypertensives, calciumchannel blockers)

Nicotine see Blue Cohosh, ............................ 35 Lobelia, .................................... 39

Nifedipine see Grapefruit, ................................ 35(see also antihypertensives, calciumchannel blockers)

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

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

Nitrates see Blue Cohosh, ............................ 9(see also angina therapy, Evening Primrose Oil, .............. 23antihypertensives, Hawthorn, ................................. 39cardiac therapy) Nitrendipine see Grapefruit, ................................ 35(see also antihypertensives, calciumchannel blockers)

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Nitrofurantoin see Licorice, ................................... 43(see also antibiotics)

Nonsteriodal Anti- see Evening Primrose Oil, .............. 23inflammatory Drugs Feverfew, .................................. 25(NSAIDs) Flax, ......................................... 27(see also analgesics) Ginkgo,..................................... 31 Nettle, ....................................... 53 Turmeric, .................................. 67 Willow, ..................................... 69

Olanzapine see St. John’s Wort, ........................ 64

Oral Contraceptives see Alfalfa, ..................................... 3(see also estrogen) Anise, ....................................... 5 Cat’s Claw, ............................... 13 Chasteberry, ............................. 15 Dong Quai, ............................... 21 Ginseng-North American, ........ 33 Grapefruit, ................................ 35 Licorice, ................................... 43 Red Clover, ............................. 59 Saw Palmetto, .......................... 61 St. John’s Wort, ........................ 64

Oral Hypoglycemics see Aloe Vera.................................. 3(see also diabetic Basil, ........................................ 5medications) Bee Pollen, ............................... 7 Burdock, ................................... 12 Marshmallow, ........................... 49 Meadowsweet, ......................... 49 Ginseng-North American, ........ 33 Willow, ..................................... 69

Oxytocin see Ma Huang, ................................ 45

Papaverine see Ginkgo,..................................... 31

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Paroxetine see St. John’s Wort, ........................ 64(see also antidepressants, SSRIs)

Penbutolol see Yohimbe, .................................. 71(see also beta blockers, antihypertensives)

Pentobarbital see Hops, ........................................ 39(see also barbiturates, Kava, ........................................ 41CNS depressants, Lemon Balm, ............................ 43sedative-hypnotics) Passionflower, .......................... 55 Valerian, ................................... 69

Phenelzine see Ginseng-North American, ........ 33(see also antidepressants, Ma Huang, ................................ 45MAOIs, tyramine-foods St. John’s Wort , ....................... 64high in) Phenobarbital see St. John’s Wort, ........................ 64(see also barbiturates, CNS depressants, sedative-hypnotics)

Phenothiazines see Borage, ..................................... 11(see also antipsychotics) Evening Primrose Oil, .............. 23 Hops, ........................................39 Ma Huang, ................................ 45 Milk Thistle, ............................. 51 Yohimbe, .................................. 71

Phentolamine see Yohimbe, .................................. 71(see also alpha-adrenergic blocking agents, antihypertensives)

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Phenoxybenzamine see Yohimbe, .................................. 71(see also alpha-adrenergic blocking agents, antihypertensives)

Phenytoin see St. John’s Wort, ........................ 64(see also anticonvulsants) Meadowsweet, ......................... 49 Milk Thistel, ............................. 51 Willow, ..................................... 69

Platelet Aggregation see Garlic, ....................................... 29Inhibitors Red Clover, .............................. 59(see also antiplatelet therapy) Scullcap, ................................... 63

Prednisolone see Licorice, ................................... 43(see also corticoadrenal steroids, immunosupressives)

Probenecid see Meadowsweet, ......................... 49(see also gout therapy) Willow, ..................................... 69

Procainamide see Licorice, ................................... 43(see also antiarrythmic agents)

Promazine see Yohimbe, .................................. 71 (see also antipsychotics)

Propranolol see Yohimbe, .................................. 71(see also beta blockers, antihypertensives)

Quinidine see Aloe Vera,................................. 3(see also Licorice, ................................... 43antiarrythmic agents)

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Reserpine see Ma Huang, ................................ 45(see also antidepressants) St. John’s Wort, ........................ 64 Turmeric, ................................. 67 Yohimbe, .................................. 71

Risperidone see St. John’s Wort, ........................ 64(see also antipsychotics, dopamine-receptor antagonists)

Saquinavir see Grapefruit, ................................ 35(see also antiretrovirals)

Secale Alkaloid see Ma Huang, ................................ 45Derivatives

Sedative-Hypnotics see Hops, ........................................ 39(see also barbiturates, Sage, ......................................... 61benzodiazepines, centrally Scullcap, ................................... 63acting medications, CNS Valerian, ................................... 69depressants) Yarrow, ..................................... 70 Yohimbe, .................................. 71

Selective Serotonin see Gingko,..................................... 31Reuptake Inhibitors St. John’s Wort, ........................ 64(SSRIs) Yohimbe, .................................. 71(see also antidepressants) Selegiline see Ma Huang, ................................ 45(see also MAOIs)

Sertraline see St. John’s Wort, ........................ 64(see also antidepressants,SSRIs)

Simvastatin see Grapefruit, ................................ 35(see also lipid lowering agents)

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Sodium Bicarbonate see Bearberry, ................................. 7(see also drugs that Ma Huang, ................................ 45affect urine pH) Yarrow, ..................................... 70

Spironolactone see Licorice, ................................... 43(see also Meadowsweet, ......................... 49antihypertensives, diuretics) Willow, ..................................... 69

Stimulants see Ma Huang, ................................ 45 Yohimbe, .................................. 71

Sulfaguanidine see Ginger, ............................... 29(see also antibiotics)

Sulfonylureas see Basil, ........................................ 5(see also diabetic medications, Marshmallow, ........................... 49oral hypoglycemics) Meadowsweet, ......................... 49 Willow, ..................................... 69

Sumatriptan see Feverfew, .................................. 25(see also migraine therapy)

Sympathomimetics see Ma Huang, ................................ 45 St. John’s Wort, ........................ 64 Yohimbe, .................................. 71

Tacrolimus see Grapefruit, ................................ 35(see also immunosuppressives)

Tamoxifen see Black Cohosh, .......................... 9

Terfenadine see Grapefruit, ................................ 35 Licorice, ................................... 43

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Theophylline see Cayenne Pepper, ....................... 13(see also asthma therapy, Ma Huang, ................................ 45stimulants) St. John’s Wort, ........................ 64

Thiazide Diuretics see Aloe Vera,................................. 3(see also antihypertensives, Ginkgo,..................................... 31diuretics) Licorice, ................................... 37

Thiobarbital see Valerian, ................................... 69(see also barbiturates, CNS depressants, sedative-hypnotics)

Thioxanthenes see Yohimbe, .................................. 71(see also antipsychotics, dopamine-receptor antagonists)

Thyroid Therapy see Lemon Balm, ............................ 35

Ticlopidine see Ginkgo,..................................... 31(see also Red Clover, .............................. 59antiplatelet therapy) Tranylcypromine see Ma Huang, ................................ 45(see also antidepressants, St. John’s Wort, ........................ 64MAOIs) Trazadone see St. John’s Wort, ........................ 64(see also antidepressants)

Triazolam see Grapefruit, ................................ 35(see also CNS depressants, sedative-hypnotics)

Tricyclic Antidepressants See Grapefruit, ................................ 35(see also antidepressants) Hops, ........................................ 39

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Tricyclic Antidepressants Ma Huang, ................................ 45con’t St. John’s Wort, ........................ 64 Yohimbe, .................................. 71

Tyramine, Foods High In see St. John’s Wort, ........................ 64(see also MAOIs) Yohimbe, .................................. 71

Tryptophan see St. John’s Wort, ........................ 64

Ulcer Treatment see Cat’s Claw, ............................... 13(see also antacids, Grapefruit, ................................ 35cisapride) Ma Huang, ................................ 45 Yarrow, ..................................... 70

Vaccines see Cat’s Claw ............................... 13

Valproate see Meadowsweet, ......................... 49(see also anticonvulsants) Willow, ..................................... 69

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

Warfarin see Alfalfa, ..................................... 3(see also anticoagulants) Bilberry, ................................... 7 Devil’s Claw, ............................ 19 Dong Quai, ............................... 21 Echinacea, ................................ 21 Feverfew, .................................. 25 Garlic, ....................................... 29 Ginkgo,..................................... 31 Ginseng- North American, ....... 33 Grapefruit, ................................ 35 Red Clover ............................... 59 St. John’s Wort, ........................ 64

Xenobiotics see Alfalfa, ..................................... 3(see also antibiotics)

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References1. Blumenthal, Mark, Goldberg, Alicia, & Brinckmann, Josef. (2000). Herbal medicine: Expanded commission E monographs. Newton, MA: Integrative Medicine communications.

2. Boon, Heather, & Smith, Michael. (1999). The botanical pharmacy: The pharmacology of 47 common herbs. Kingston, ON: Quarry Press Inc.

3. Brinker, Francis. (1998). Herb contraindications and drug interactions: With appendices addressing specific conditions and medicines (2nd ed.). Sandy, OR: Eclectic Medical Publications.

4. Chandler, Frank. (Ed.). (2000). Herbs: Everyday reference for health pro fessionals. Ottawa, ON: Canadian Pharmacists Association and the Canadian Medical Association.

5. Fetrow, Charles W., & Avila, Juan R. (1999). Professional’s handbook of complementary and alternative medicines. Springhouse, PA: Springhouse Corp.

6. Karch, Steven B. (1999). The consumer’s guide to herbal medicine. New York: Advanced Research Press Inc.

7. Lininger, Schuyler W. Jr., Gaby, Alan R., Austin, Steve, Brown, Donald J., Wright, Jonathan V., & Duncan, Alice. (1999). The natural pharmacy (2nd ed.). Rocklin, CA: Prima Publishing.

8. [Interactions not included in manual due to time constraints] Miller, Lucinda G., & Murray, Wallace J. (Eds.). (1998). Herbal medicinals: A clinician’s guide. New York: Pharmaceutical Products Press.

9. Newall, Carol A., Anderson, Linda A., & Phillipson, J. David. (1996). Herbal medicines: A guide for health-care professionals. London: Pharmaceutical Press.

10. Peirce, Andrea. (1999). The American pharmaceutical association practical guide to natural medicines. New York: William Morrow and Company Inc.

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11. World Health Organization. (1999). WHO monographs on selected medicinal plants- Volume 1. Geneva

12. Kuhn, Merrily A. (1999). Complementary therapies for health care providers. Baltimore, MD: Lippincott Williams and Wilkins.

13. Gruenwald, Joerg, Brendler, Thomas, & Jaenicke, Christof. (Eds.) (1998). PDR for herbal medicines (1st ed.). Montvale, New Jersey: Medical Economics Company.

14. Wong, Albert H. C., Smith, Michael, & Boon, Heather. (1998). Herbal remedies in psychiatric practice. Archives of General Psychiatry 55, 1033-1044.

15. Bedard, Mario. (2000). Glucosamine. CPJ 133, 5, 22-23.

16. Fugh-Berman, Adriane. (2000). Herb-drug interactions. The Lancet 355, 9198, 134-138.

17. Health Canada. (April 7, 2000). Advisory letter to health care professionals.

18. Canadian Pharmacists Association. (2000). CPS (35th ed.). Ottawa

19. Nemecz, George, & Combest, Wendell L. (2000). Herbal Remedies. In Loyd V. Allen Jr., Rosemary R. Berardi, Edward M. DeSimone II, Janet P. Engle, Nicholas G. Popovich, Wendy Munrow Rosenthal, & Karen J. Tietze (Eds.), Handbook of Non-Prescription Drugs (2nd ed., pp. 953-982). Washington: American Pharmaceutical Association.

20. AltMedDex System: Complementary and Alternative Monographs. [Electronic database]. (2000). Micromedex, Inc

21. Blumenthal, M Herbalgram 49, 2000

22. Rogers, Robert, Evidence Gathered in Clinical Practice,

23. 23 Meletis, Chris (2001) Instant Guide to Drug herb Interactions, New York, Dorling Kindersley Publishing.

24. W. Krol et al, Journal of Ethnolpharmacology 1996. Vol.55

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107

THE AUTHORS AND CONTRIBUTORS

Robert Dale Rogers B.Sc. has been studying herbal medicine for over 30 years and a clinical practice for 18 years. Robert is a member of the American Herbalist Guild and is currently Dean of Prairie Deva College where he teaches courses on Advanced Herbology, Aromatherapy and Flower Essences. Robert is a guest lecturer at other colleges and is an instructor on Herb Drug Interactions for the physicians “Continuing Medical Education “ programs. Robert is the author of eight books on medicinal plants and is a consultant to the research and development department of a major medicinal herb industry network organization and the nutraceutical and herbal industries.

Robert Rogers worked in collaboration with a team from the Royal Alexandra Hospital that included staff from the Pharmacy Department and Multicultural Services to prepare this handbook. All data gathered in the comprehensive review of existing information on interactions between herbal medicines and pharmaceutical drugs was assessed by both herbalists and pharmacists to ensure accuracy and legitimacy.

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RELEVANT WEB SITES FOR HEALTH CARE PROFESSIONALS

Alternative Medicine Foundationwww.herbmed.org

American Herbal Products Association www.ahpa.org

American Nutraceutical Association www.americanutra.com

Association of Natural Medicine Pharmacistswww.anmp.org

Canadian Health Food Association www.chfa.ca

Canadian Heath Network www.canadian-health-network.ca

Healthy Ontario www.healthyontario.com

National Center for Complementary & Alternative Medicine www.nccam.nih.gov

National Nutritional Foods Association www.nnfa.org

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