Long Island Medical Care Services
Medical Information
Information About Some Common Herbal Medications
| Herb | Purported Effect/Use | Drug Interactions | Interaction Effect | Other Considerations |
| Echinacea | Short-term immune system stimulation | Anabolic steroids Amiodarone Methotrexate Ketoconazole |
Addictive hepatotoxic effects | -May worsen metabolic control in patients with diabetes -Not recommended for use in patients with altered immune function because of altered immunomodulation -Should be avoided by patients receiving immunosuppressive therapy |
| Feverfew | Migraine prophylaxis | NSAIDs | Decreased herbal effect | -May suppress prostaglandin and thrombone
production -Contraindicated in patients with an allergy to ragweed or other plants in the daisy family |
| Anticoagulants | Addictive platelet inhibition | |||
| Garlic | Treatment of elevated blood pressure or cholesterol | Aspirin Anticoagulants |
Reduced blood clotting time | -Should be avoided by anticoagulated patients due to
interference with thromboxane synthesis, leading to decreased platelet aggregation -Should be taken with food to minimize GI upset |
| Ginkgo | Improved circulation and cognitive function | Anticoagulants Aspirin NSAIDs |
Increased risk of bleeding | -Case reports indicate that this agent may
increase the risk of bleeding -Patients at risk for developing an intracranial hemorrhage are advised to avoid this agent |
| Anticonvulsants Tricyclic antidepressants |
Decreased seizure threshold | |||
| Ginseng | Wide variety (energy and immune system enhancer) | MAO inhibitors | Headache, tremors, and mania | -Given widespread mislabeling,
ingredients not listed in ginseng products may be responsible for therapeutic or adverse
effects -Individuals with hypertension, diabetes, psychological disorders, or insomnia should avoid or cautiously use ginseng |
| Corticosteroids | Increased steroid toxicity | |||
| Warfarin | Decreased INR | |||
| Kava | Anxiolytic | Benzodiazepines | Additive CNS depression | -The active pyrones work as muscle relaxants and
anticonvulsants -The potential for abuse should be closely evaluated |
| Ma Huang (ephedra) |
Nonselective adrenergic agonist; a potent CNS stimulant | Antidepressants CNS stimulants |
Increased herbal effect | -Numerous multi-ingredient products marketed for weight loss
or energy contain ma huang -Individuals with cardiovascular disease, diabetes, or thyroid disease should avoid this agent, as should those consuming theophylline, cardiac glycosides, or MAO inhibitors |
| Saw palmetto | Treatment of benign prostatic hyperplasia | Estrogen | Increased herbal effect | -The extract has estrogenic as well as antiandrogenic
properties -May induce side effects similar to those with pharmacologic doses of estrogen |
| St. John's wort | Use in managing mild depressive disorder; also used to treat viral infections | Piroxicam Tetracyclines |
Increased phototoxicity | -A two-week washout period may be necessary between
other antidepressant therapies -Not recommended for use in patients under 18 years of age or in pregnant women -Closely monitor the INR of individuals taking warfarin due to potential interaction |
| Antidepressants CNS stimulants |
Additive effects | |||
| Theophylline | Decreased xanthine levels | |||
| Warfarin | Decreased warfarin effect | |||
| Valerian | Sedative and anxiolytic | CNS depressants | Additive CNS depression | -Potential withdrawal syndrome with cardiac abnormalities and
delirium has been reported -Patients should be alerted to precautions regarding alertness |