This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (283)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in this journal  Topic Collections  • Review  • Thrombolysis  • Complementary and Alternative Medicine  • Adverse Effects  • Alert me on articles by topic

Selected Clinical Considerations Focusing on Known or Potential Drug-Herb Interactions

Lucinda G. Miller, PharmD, BCPS

Arch Intern Med. 1998;158:2200-2211.

Herbal medicinals are being used by an increasing number of patients who typically do not advise their clinicians of concomitant use. Known or potential drug-herb interactions exist and should be screened for. If used beyond 8 weeks, Echinacea could cause hepatotoxicity and therefore should not be used with other known hepatoxic drugs, such as anabolic steroids, amiodarone, methotrexate, and ketoconazole. However, Echinacea lacks the 1,2 saturated necrine ring associated with hepatoxicity of pyrrolizidine alkaloids. Nonsteroidal anti-inflammatory drugs may negate the usefulness of feverfew in the treatment of migraine headaches. Feverfew, garlic, Ginkgo, ginger, and ginseng may alter bleeding time and should not be used concomitantly with warfarin sodium. Additionally, ginseng may cause headache, tremulousness, and manic episodes in patients treated with phenelzine sulfate. Ginseng should also not be used with estrogens or corticosteroids because of possible additive effects. Since the mechanism of action of St John wort is uncertain, concomitant use with monoamine oxidase inhibitors and selective serotonin reuptake inhibitors is ill advised. Valerian should not be used concomitantly with barbiturates because excessive sedation may occur. Kyushin, licorice, plantain, uzara root, hawthorn, and ginseng may interfere with either digoxin pharmacodynamically or with digoxin monitoring. Evening primrose oil and borage should not be used with anticonvulsants because they may lower the seizure threshold. Shankapulshpi, an Ayurvedic preparation, may decrease phenytoin levels as well as diminish drug efficacy. Kava when used with alprazolam has resulted in coma. Immunostimulants (eg, Echinacea and zinc) should not be given with immunosuppressants (eg, corticosteroids and cyclosporine). Tannic acids present in some herbs (eg, St John wort and saw palmetto) may inhibit the absorption of iron. Kelp as a source of iodine may interfere with thyroid replacement therapies. Licorice can offset the pharmacological effect of spironolactone. Numerous herbs (eg, karela and ginseng) may affect blood glucose levels and should not be used in patients with diabetes mellitus.

From the Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Amarillo.

RELATED LETTERS

Probable False Authentication of Herbal Plants: Ginseng
H. C. George Wong and Lucinda G. Miller
Arch Intern Med. 1999;159(10):1142-1143.
EXTRACT | FULL TEXT  

Herbal Interactions With Cardiac Drugs
Tsung O. Cheng and Robert M. Feingold
Arch Intern Med. 2000;160(6):870-871.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Herb and Supplement Use Among the Retail Population of an Independent, Urban Herb Store
Archer and Boyle
J Holist Nurs 2008;26:27-35.
ABSTRACT  

Nonvitamin, Nonmineral Dietary Supplementation in HIV-Positive People
Sansevero et al.
Nutr Clin Pract 2007;22:679-687.
ABSTRACT | FULL TEXT  

Comment: Community Identification of Natural Health Product Drug Interactions
Dennehy
The Annals of Pharmacotherapy 2007;41:2073-2073.
FULL TEXT  

A Review of Dietary Supplement-Induced Renal Dysfunction
Gabardi et al.
CJASN 2007;2:757-765.
ABSTRACT | FULL TEXT  

Potential Interactions Between Pharmaceuticals and Natural Health Products in Canada
Singh and Levine
J Clin Pharmacol 2007;47:249-258.
ABSTRACT | FULL TEXT  

Herbal Products and Dietary Supplements: A Survey of Use, Attitudes, and Knowledge Among Older Adults
Marinac et al.
JAOA: Journal of the American Osteopathic Association 2007;107:13-23.
ABSTRACT | FULL TEXT  

Complementary and Alternative Medicine During Cancer Treatment: Beyond Innocence
Tascilar et al.
The Oncologist 2006;11:732-741.
ABSTRACT | FULL TEXT  

Long-Term Intake of North American Ginseng Has No Effect on 24-Hour Blood Pressure and Renal Function
Stavro et al.
Hypertension 2006;47:791-796.
ABSTRACT | FULL TEXT  

Do herbs increase the risk of herb-drug interactions for patients with arthritis? * Authors' reply
Thomsen et al.
Ann Rheum Dis 2005;64:1527-1528.
FULL TEXT  

Hyperkalemia: A Review
Evans and Greenberg
J Intensive Care Med 2005;20:272-290.
ABSTRACT  

North American Ginseng Exerts a Neutral Effect on Blood Pressure in Individuals With Hypertension
Stavro et al.
Hypertension 2005;46:406-411.
ABSTRACT | FULL TEXT  

The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products
Woodward
Hum Exp Toxicol 2005;24:219-233.
ABSTRACT  

Use of herbal remedies and potential drug interactions in rheumatology outpatients
Holden et al.
Ann Rheum Dis 2005;64:790-790.
FULL TEXT  

Natural Health Product Interactions with Medication
Boullata
Nutr Clin Pract 2005;20:33-51.
ABSTRACT | FULL TEXT  

Managing Hyperkalemia Caused by Inhibitors of the Renin-Angiotensin-Aldosterone System
Palmer
NEJM 2004;351:585-592.
FULL TEXT  

The antimicrobial potential of 14 natural herbal dentifrices: Results of an in vitro diffusion method study
LEE et al.
Journal of the American Dental Association 2004;135:1133-1141.
ABSTRACT | FULL TEXT  

Comparison of Natural Product Use Between Primary Care and Nephrology Patients
Grabe and Garrison
The Annals of Pharmacotherapy 2004;38:1169-1172.
ABSTRACT | FULL TEXT  

Herbal Remedies in the United States: Potential Adverse Interactions With Anticancer Agents
Sparreboom et al.
JCO 2004;22:2489-2503.
ABSTRACT | FULL TEXT  

Activation of Autoimmunity Following Use of Immunostimulatory Herbal Supplements
Lee and Werth
Arch Dermatol 2004;140:723-727.
ABSTRACT | FULL TEXT  

Incidence and Severity of Potential Drug-Dietary Supplement Interactions in Primary Care Patients: An Exploratory Study of 2 Outpatient Practices
Peng et al.
Arch Intern Med 2004;164:630-636.
ABSTRACT | FULL TEXT  

Are Patients With Diabetes Receiving the Same Message From Dietitians and Nurses?
Venters et al.
The Diabetes Educator 2004;30:293-300.
 

Oculocutaneous Albinism and Spurious Pulse Oximetry
Sen et al.
Anesth. Analg. 2004;98:553-553.
FULL TEXT  

Ginger-Associated Overanticoagulation by Phenprocoumon
Kruth et al.
The Annals of Pharmacotherapy 2004;38:257-260.
ABSTRACT | FULL TEXT  

Variations in Product Choices of Frequently Purchased Herbs: Caveat Emptor
Garrard et al.
Arch Intern Med 2003;163:2290-2295.
ABSTRACT | FULL TEXT  

Herbals and Botanicals in Geriatric Psychiatry
Desai and Grossberg
AJGP 2003;11:498-506.
ABSTRACT | FULL TEXT  

Improving Medication Use for Older Adults: An Integrated Research Agenda
Murray and Callahan
ANN INTERN MED 2003;139:425-429.
ABSTRACT | FULL TEXT  

Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices
Brown et al.
CA Cancer J Clin 2003;53:268-291.
ABSTRACT | FULL TEXT  

High Prevalence of Potentially Hepatotoxic Herbal Supplement Use in Patients With Fulminant Hepatic Failure
Estes et al.
Arch Surg 2003;138:852-858.
ABSTRACT | FULL TEXT  

An approach for integrating complementary- alternative medicine into primary care
Frenkel and Borkan
Fam Pract 2003;20:324-332.
ABSTRACT | FULL TEXT  

Regulation of CYP3A4 Expression in Human Hepatocytes by Pharmaceuticals and Natural Products
Raucy
Drug Metab. Dispos. 2003;31:533-539.
ABSTRACT | FULL TEXT  

Preoperative Considerations: Which Herbal Products Should Be Discontinued Before Surgery?
Heyneman
Crit Care Nurse 2003;23:116-124.
FULL TEXT  

Preoperative use of herbal medicines: a patient survey
Skinner and Rangasami
Br J Anaesth 2002;89:792-795.
ABSTRACT | FULL TEXT  

Interaction of herbal drugs with digoxin
Cheng
J Am Coll Cardiol 2002;40:838-839.
FULL TEXT  

Benefits, adverse effects and drug interactionsof herbal therapies with cardiovascular effects
Valli and Giardina
J Am Coll Cardiol 2002;39:1083-1095.
ABSTRACT | FULL TEXT  

Complementary and Alternative Medicine (CAM) Use by Older Adults: A Comparison of Self-Report and Physician Chart Documentation
Cohen et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2002;57:M223-227.
ABSTRACT | FULL TEXT  

Ginsenoside variability in American ginseng samples
Yuan et al.
Am. J. Clin. Nutr. 2002;75:600-601.
FULL TEXT  

Herbal Medicine Use in Parturients
Hepner et al.
Anesth. Analg. 2002;94:690-693.
ABSTRACT | FULL TEXT  

Herbal Therapy in Dermatology
Bedi and Shenefelt
Arch Dermatol 2002;138:232-242.
ABSTRACT | FULL TEXT  

Use of Herbal Medications Before Surgery
Betz et al.
JAMA 2001;286:2542-2544.
FULL TEXT  

The Prevalence and Predictors of the Use of Alternative Medicine in Presurgical Patients in Five California Hospitals
Leung et al.
Anesth. Analg. 2001;93:1062-1068.
ABSTRACT | FULL TEXT  

Herbal Medicines and Perioperative Care
Ang-Lee et al.
JAMA 2001;286:208-216.
ABSTRACT | FULL TEXT  

Awareness of CAM Among Residents: A Long Way to Go
Murtaza et al.
Arch Intern Med 2001;161:1679-1680.
FULL TEXT  

President's page: complementary and alternative medicine: ignore at doctors' and patients' peril
Zipes
J Am Coll Cardiol 2001;37:2166-2169.
FULL TEXT  

A Review of the Evidence for the Use of Phytoestrogens as a Replacement for Traditional Estrogen Replacement Therapy
Glazier and Bowman
Arch Intern Med 2001;161:1161-1172.
ABSTRACT | FULL TEXT  

Herbal Therapy: What Every Facial Plastic Surgeon Must Know
Pribitkin and Boger
Arch Facial Plast Surg 2001;3:127-132.
ABSTRACT | FULL TEXT  

Dietary Supplement Use: Consumer Characteristics and Interests
Greger
J. Nutr. 2001;131:1339S-1343.
ABSTRACT | FULL TEXT  

Transplacental Chemical Exposure and Risk of Infant Leukemia with MLL Gene Fusion
Alexander et al.
Cancer Res. 2001;61:2542-2546.
ABSTRACT | FULL TEXT  

Significant Drug Interactions in the HIV Patient
Conry
Journal of Pharmacy Practice 2000;13:499-514.
ABSTRACT  

Surgery and Herbal Therapy: Essential Guidelines on Bleeding, Skin Reactions, and Wound Healing
Pribitkin and Boger
Complementary Health Practice Review 2000;6:29-40.
ABSTRACT  

A Review of Herbal Medicines for Psychiatric Disorders
Beaubrun and Gray
Psychiatr. Serv. 2000;51:1130-1134.
ABSTRACT | FULL TEXT  

Use of alternative medicine by patients undergoing cardiac surgery
Liu et al.
J. Thorac. Cardiovasc. Surg. 2000;120:335-341.
ABSTRACT | FULL TEXT  

Complementary/Alternative Medicine Use in a Comprehensive Cancer Center and the Implications for Oncology
Richardson et al.
JCO 2000;18:2505-2514.
ABSTRACT | FULL TEXT  

American Ginseng (Panax quinquefolius L) Reduces Postprandial Glycemia in Nondiabetic Subjects and Subjects With Type 2 Diabetes Mellitus
Vuksan et al.
Arch Intern Med 2000;160:1009-1013.
ABSTRACT | FULL TEXT  

Herbal Interactions With Cardiac Drugs
Cheng and Feingold
Arch Intern Med 2000;160:870-871.
FULL TEXT  

The Herbal History of Digitalis: Lessons for Alternative Medicine
Ritter et al.
JAMA 2000;283:884-886.
FULL TEXT  

Herbs in Pediatric and Adolescent Medicine
Gardiner and Kemper
Pediatr. Rev. 2000;21:44-57.
FULL TEXT  

Herbal Medicinals: Selected Clinical Considerations, Focusing on Known or Potential Drug-Herb Interactions
Fugh-Berman and Miller
Arch Intern Med 1999;159:1957-1959.
FULL TEXT  

Herbal Medications and Breastfeeding
Kopec
J Hum Lact 1999;15:157-161.
 

Probable False Authentication of Herbal Plants: Ginseng
Wong and Miller
Arch Intern Med 1999;159:1142-1143.
FULL TEXT  

PDR for Herbal Medicines
Marty
JAMA 1999;281:1853-1854.
FULL TEXT  

"Conventional" and "Unconventional" Medicine: Can They Be Integrated?
Dalen
Arch Intern Med 1998;158:2179-2181.
FULL TEXT