CARIBBEAN POISON CARIBBEAN POISON INFORMATION NETWORKINFORMATION NETWORK

THIRD ANNUAL SCIENTIFIC THIRD ANNUAL SCIENTIFIC CONFERENCE CONFERENCE

UHWI KINGSTON, JAMAICAUHWI KINGSTON, JAMAICAUHWI KINGSTON, JAMAICA UHWI KINGSTON, JAMAICA MAY 31MAY 31--JUNE 1,2008JUNE 1,2008

HERBAL REMEDIES :INTERACTIONS HERBAL REMEDIES :INTERACTIONS WITH CONVENTIONAL DRUGSWITH CONVENTIONAL DRUGSWITH CONVENTIONAL DRUGSWITH CONVENTIONAL DRUGS

BE CAREFUL!!!!!!! BE CAREFUL!!!!!!! BE CAREFUL!!!!!!! BE CAREFUL!!!!!!!

A LITERATURE REVIEWA LITERATURE REVIEW

A.LEVY, PHARMACOLOGY SECTIONA.LEVY, PHARMACOLOGY SECTIONBMS, UWIBMS, UWI

BACKGROUNDBACKGROUND

HerbHerb-- plant/plant material valued for medicinal, plant/plant material valued for medicinal, savory or aromatic qualitiessavory or aromatic qualitiesy qy q

H b l di iH b l di i d f d f Herbal medicinesHerbal medicines--prepared from one or more prepared from one or more herbsherbs

USE OF HERBAL REMEDIES HAS BEEN USE OF HERBAL REMEDIES HAS BEEN DOCUMENTED FOR AGES (In the midst of the DOCUMENTED FOR AGES (In the midst of the DOCUMENTED FOR AGES. (In the midst of the DOCUMENTED FOR AGES. (In the midst of the street of it ,and on either side of the river, there street of it ,and on either side of the river, there was the tree of life, which bare twelve manner of was the tree of life, which bare twelve manner of fruits: and the leaves of the tree were for the fruits: and the leaves of the tree were for the fruits: and the leaves of the tree were for the fruits: and the leaves of the tree were for the healing of the nations. revelation 22:2)healing of the nations. revelation 22:2)

BACKGROUNDBACKGROUND

•• THE ARAWAKSTHE ARAWAKS-- kola nutskola nuts

•• CHINESE EMPEROR SHEN NUNG C2700:Bc CHINESE EMPEROR SHEN NUNG C2700:Bc ––

-- Boiled hempBoiled hempBoiled hempBoiled hemp

-- GingerGinger

•• SIXTEENTH CENTURY SIXTEENTH CENTURY -- papaya papaya

BACKGROUNDBACKGROUND

• Herbal medicinal use ↑ in recent yearsin western societies *****

•USA- 1990 -1997 380%

• 1998-----$649million

•Rigorous clinical testing (-ve)

BACKGROUNDBACKGROUND

• USA- Herbal remedies; dietary supplements/food products under DSHEAsupplements/food products under DSHEA

• FDA- RULES GMPs MARCH 13 2003

• No standards regulating efficacy and safety

• In Jamaica no manufacturing standards regulate quality and production only now being regulate quality and production ,only now being implemented in USA

OBJECTIVE

To briefly describe mainly the adverse interactions that arise from co-administrationinteractions that arise from co administration of conventional drugs and some commonly used herbal remediesused herbal remedies.

ADVERSE EFFECTSADVERSE EFFECTS

INHERENTLY TOXIC HERBS INHERENTLY TOXIC HERBS (CROTOLARIA)(CROTOLARIA)

HERB OVERDOSES HERB OVERDOSES

IDIOSYNCRATIC REACTIONS IDIOSYNCRATIC REACTIONS (GARLIC, (GARLIC, GINGER)GINGER)GINGER)GINGER)

DRUGDRUG HERB INTERACTIONS (LOW TI)HERB INTERACTIONS (LOW TI)DRUGDRUG--HERB INTERACTIONS (LOW TI)HERB INTERACTIONS (LOW TI)

MECHANISMS OF DRUGMECHANISMS OF DRUG--HERB HERB INTERACTIONSINTERACTIONS

Altered drug absorption (ALOE VERA LEAF)Altered drug absorption (ALOE VERA LEAF)

Altered renal elimination of drugs (DANDELION Altered renal elimination of drugs (DANDELION and LITHIUM)and LITHIUM)

Additive effects or toxicities (pharmacodynamic Additive effects or toxicities (pharmacodynamic interaction) interaction)

Altered hepatic metabolism of drugs (ST JOHNS Altered hepatic metabolism of drugs (ST JOHNS WORT AND ANTIWORT AND ANTI RETROVIRAL DRUGS)RETROVIRAL DRUGS)WORT AND ANTIWORT AND ANTI--RETROVIRAL DRUGS)RETROVIRAL DRUGS)

GARLIC(Alli ti Li )(Allium sativum Linn)

WARFARIN d h i l l d (• WARFARIN and other antiplatelet drugs (TICLOPIDINE ,CLOPIDOGREL, DYPIRIDAMOLE, NSAIDS)

• HYPOGLYCEMICS--- ↑ Serum insulin levels

• CLOROXAZONE –Inhibits breakdown

NONI(Morinda citrifolia)( f )

• Antiarrythmics: Antagonism due to hypokalemia

• Muscle relaxants: Potentiation

• Hypoglycemics: (low doses)

• Hyperglycemics: (high doses)

• Anti-hypertensives

GINGER(Zi ib ffi i l )(Zingiber officinale)

• Antiplatelets (warfarin, heparin)

• Aspirin and other anti-coagulantsAspirin and other anti coagulants

PAPAYA(Carica papaya)(Carica papaya)

• Warfarin- papain damages mucousmembrane of gitmembrane of git

GREEN TEA and TUMERIC (Curcuma longa)

also possess anti-platelet activity avoid with anticoagulants/antiplateletsanticoagulants/antiplatelets

ALOE VERA(Aloe barbadensis)(Aloe barbadensis)

• Thiazide diuretics and Cortico-adrenal steroids:

Potentiates hypokalemia

•Cardiac glycosides and Anti-arrhythmic agents:

↑ effectiveness * :

GINSENG(Panax quinquefolius) ( q q f )

• WarfarinWarfarin

• Phenelzine and other MAOIs: manic episodesPhenelzine and other MAOIs: manic episodes, headaches

• Stimulants and hormones: possible additive effectseffects

• Diabetic patients caution!! alters blood glucoseDiabetic patients caution!! alters blood glucose levels

CANNABIS(C bi i )(Cannabis sativa)

Ph b bit l bl k i d ti• Phenobarbital: blocks enzyme induction

Chl li i ti ( i ti h ti i )• Chlolinomimetics (nicotine, physostigmine):antagonism

• TCADS: additive hypertension, tachycardia and d idrowsiness

A h t i dditi h t i ibl• Amphetamines: additive hypertension, possible cardiotoxicity

GINKO BILOBA

• Warfarin, nsaids: bleeding

• Thiazides: hypertension• Thiazides: hypertension

• Antipsychotics

• MAOIs• MAOIs

• PRIMROSE OIL- anti-convulsants→lowers Seizure threshold

• SARSAPARILLA-bismuth salicylate, digitalis and hypnotics↑ absorption leading to ↑ toxicity

RECOMMENDATIONSRECOMMENDATIONS

• TREAT HERBAL REMEDIES AS MEDICINALPRODUCTS, MORE DOES NOT MEAN BETTER

• PERSONS WITH SERIOUS DISEASES , CONSULT A PHYSICIAN BEFORE USING HERBAL REMEDIESPHYSICIAN BEFORE USING HERBAL REMEDIES

• TELL YOUR DOCTOR IF YOU ARE USING DIETARYTELL YOUR DOCTOR IF YOU ARE USING DIETARY SUPPLEMENTS, OR SEEING A HERBALIST, ACUPUNCTURIST, NATUROPATHIC PRACTITIONER, OR NATURAL HEALER

DO NOT!!!!!!!:

• EXCEED RECOMMENDED DOSAGE

• USE FOR PROLONGED PERIODS OF TIME• USE FOR PROLONGED PERIODS OF TIME

• USE DURING PREGNANCY AND LACTATION UNLESS DIRECTED BY YOUR PHYSICIAN

• GIVE TO INFANTS OR YOUNG CHILDREN

IF SIDE EFFECTS DEVELOP DISCONTINUE USEIF SIDE EFFECTS DEVELOP DISCONTINUE USE AND CONSULT PHYSISICIAN.

THANK YOU !