drug and her interactionsGIULIA CRISCUOLO, BPHARM, qualified as a pharmacist and has a diploma in homeopathy. Involved in education and training on all matters related to supplementation, health and wellness, she joined OTC Pharma in 2009. Giulia is passionate about exploring all dimensions of awareness and the flowering of the human spirit. She enjoys spending time in nature and loves dance and movement, Tantra, hiking, trail running, mountain biking, adventure racing and yoga.
Interactions between drugs and herbs are not common, and some may even be beneficial. However, if you are combining the two, you need to be aware of any potential clashes.
Many people taking conventional (often also referred to as allopathic) drugs want to change over to complementary medicines, often because of the many side-effects that accompany their medication intake.
Sometimes this switch is possible (and I am always in favour of it), but there are also situations when it is not, and one has to manage the side-effects as best as one can.
If you are one of those people with a foot in both camps (i.e. allopathic and complementary), it is an extremely good thing to be aware that interactions between herbs and drugs can and do occur, and this is what I will be sharing with you here. I will also take a brief look at the positive interactions that are possible between drugs and herbal formulations.
Bear in mind that drug-drug interactions are a much more serious problem than either herb-drug or herb-herb interactions. This is because drugs are high doses of single, active unstable chemicals, while herbs contain multiple ingredients, some of which are natural buffers.
THE EFFECT OF HERBS Herb-drug interactions are not chemical interactions between a drug and a herb component, producing something toxic. Rather, herbs can modify drug absorption and/or elimination, which may lead to an increase or decrease in the amount of drug in the blood.
Some herbs may improve absorption and elimination of drugs, altering the blood levels of drugs and their rate of change. Herbs can also inhibit enzyme systems and result in much higher levels of drugs in the bloodstream and longer persistence of the drugs.
On the whole, herbs and nutritional supple-ments have excellent safety profiles. While herb, nutrient and drug interactions do happen, they are rare and mostly not serious. WHAT HERBS MAY CAUSE PROBLEMS? These are some of the well-known herbs to be aware of (also see table at end of article). St John’s wort interacts ad-versely with oral contracep-tives (causing break-through bleeding that may lead to contraceptive discontinuation and pregnancy), selective serotonin reuptake inhibitors (causing hy-pertension and serotonin syndrome), and cyclosporin (causing decreased plasma concentrations and organ rejection).
Gingko biloba, a popular herb widely used to help reduce age-related problems such as poor circulation, heart disease, tinnitus and impotence, is best known as an effective herbal ‘brain booster’ against memory deterioration. While generally very safe, ginkgo’s blood-thinning effects can interact with some anticoagulants such as warfarin and antiplatelet drugs, and over-the-counter drugs like aspirin or ibuprofen. It is not advisable to take ginkgo before surgery without medical supervision.
Echinacea preparations are used to prevent and treat upper respiratory tract infec-tions. As a therapy alone, echinacea appears to be safe. Studies have reported conflicting results on the effect of echinacea on the activity of cytochrome P450 (CYP, among the body’s most powerful detox enzymes). It was suggested that the discrepancies in findings could be due to the different species and parts of the plant used, different dosages and varying durations of treatment. The authors conclude that the ‘currently available evidence suggests that echinacea is unlikely to pose serious health threats for patients combining it with conventional drugs’.1
Garlic capsules combined with diabetes medications can cause a dangerous de-crease in blood sugar. Some people who are sensitive to garlic may experience heartburn and flatulence. Garlic also has anti-clotting properties, so you should check with your doctor if you are taking anticoagulant drugs, such as warfarin.
Asian ginseng (Panax gin-seng) in combination with phenelzine (a monoamine oxidase inhibitor or MAOI) has been reported to cause headache, tremor and mania.
Liquorice (Glycyrrhiza glabra) may amplify the effects of corticosteroids. Yohimbine(Pausinystalia yohimbe) in combination with tricyclic antidepressants can cause hypertension.
Guar gum (Cyamopsis tetra-gonaloba) and laxatives such as senna and cascara may interfere with the absorption of intestinally absorbed drugs. Milk thistle (Silybum maria-num) may interfere with me-dications that lower blood sugar levels and enhance their hypoglycaemic effect.
Patients with clotting disorders, on anti-coagulation drugs such as warfarin or awaiting surgery should not take ginkgo (Ginkgo biloba), danshen (Salvia miltior-rhiza), dong quai (Angelica sinensis), papaya (Carica papaya), garlic (Allium sativum) or arnica. These herbs interfere with the function of platelets, and may cause excessive bleeding.
FOOD AND DRUG INTERACTIONS There are some food and drug interactions of which it’s useful to be aware.
Alcohol interacts with almost every medication, especially antidepressants and other drugs that affect the brain and nervous system. Alcohol tends to increase the depressive effects of medications such as benzodiazepines, antihistamines, antidepressants, antipsychotics, muscle relaxants, narcotics, or any drug with sedative actions.
Grapefruit juice can interact with pre-scription drugs. It causes some drugs to be absorbed too quickly – a dangerous effect if you are taking medications with a high potential for toxicity or serious side-effects. Don’t drink grapefruit juice if you take calcium channel blockers for high blood pressure. The combination can be fatal! Grapefruit juice can also have dangerous interactions with drugs for allergies, such as antihistamines, and with drugs for high blood pressure. Grapefruit juice may interact with organ transplant drugs, oestrogens and oral contraceptives, anti-anxiety medications, methadone, Viagra, HIV drugs, seizure drugs and statin drugs for high cholesterol. Note: While it’s grapefruit juice that has the reputation for interactions, the fruit may have the same effect if consumed in large amounts. ■ Large amounts of broccoli, spinach, and other green leafy vegetables high in vitamin K, which promotes the formation of blood clots, can counteract the effects of heparin, warfarin, and other drugs given to prevent clotting. Eat them in moderation if taking these medications.
POSITIVE INTERACTIONS Although there are some negative interactions that can occur between drugs and herbs, research has also discovered positive interactions between drugs and herbal formulas. In China, for example, it is common for herbs to be combined with drugs. Their combination is sometimes incidental, but is often intentional. The general sense among Chinese doctors has been that certain herbs reduce the side-effects of drugs and help them to perform their function better; in turn, drugs will make a herb formula work more strongly and quickly. Together, herbs and drugs may produce a more desirable result than either taken alone.
AVOIDING INTERACTIONS The following suggestions are useful to help avoid potential drug-herb interactions. ■ It’s a very good idea to take herbs at least 1½ hours before or after taking drugs (preferably take the drug first). By doing so, you’ll ensure that the metabolism of the drug is already underway by the time the herbs can inhibit enzyme systems. ■ Avoid using herbs with strong laxative or diuretic action while taking cardiac drugs. To compensate for mild diuretic or laxative treatments, consume high-potassium foods. ■ When the drug therapy is already addressing a particular therapeutic goal, avoid adding a potent herbal therapy with the same goal. Intensify monitoring of blood conditions affected by the drugs. In conclusion, although interactions between drugs and herbs are uncommon, if you are combining the two you need to be aware of any potential clashes that may occur. Stay informed, as ultimately YOU are responsible
for your health and wellbeing, and for supporting your body in maintaining its natural state of harmony and the good energy flow of your vital force.
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