The patient's page.

Warfarin and Herbal Medications

Warfarin is one of the most commonly prescribed cardiovascular medications in this country, which, when taken as prescribed, has very few side effects. There are, however, potential contraindications when taken in combination with herbal medications. The following herbs should be avoided if you are currently taking warfarin. Ginseng--A common and popular herb taken to combat fatigue and increase vitality. Danshen--Commonly used for various symptoms of coronary heart disease, including angina, myocardial infarction, and heart failure. Dong quai--Most frequently used for menopausal symptoms. Soy milk--Although soy milk is not an herb, it is widely advocated as a nutritional supplement for hypertension and hyperlipidemia, as an alternative to hormonal therapy.

As the interaction between these herbal remedies and warfarin may cause excessive or decreased anticoagulation, it is important that you speak to your physician if you are currently taking any of these supplements in addition to warfarin.

"Herbal Interaction with Warfarin"
By Dr. Tsung Chen
Southern Medical Journal, July 2005

The Dangers of Fishing

Catfish stings, caused by poisonous barbs on the pectoral fin, are usually considered to be no worse than an insect bite. Generally, treatment should consist of careful cleansing of the infected area, immersion in hot water (as the poison is likely sensitive to heat), administration of a long-acting anesthetic, and verification of a current tetanus shot. More serious complications following a catfish sting, however, are possible. If you are stuck by a catfish barb and develop weakness in your hands or fingers, contact your physician. Nerve damage may be caused by either the barb itself or the toxins injected into the body, and in some cases, surgery may be required.

"Ulnar Nerve Deficit after Catfish Sting"
By Dr. Jason Hess and colleagues
Southern Medical Journal, July 2005

Weight Gain, Diabetes, and Antipsychotic Medications

Although the newer antipsychotic medications have far fewer side effects than the previous generation of medications, they are not without risk. Antipsychotic medications, such as Clozaril (clozapine), Zyprexa (olanzapine), and Seroquel (quetiapine), have been associated with weight gain and an increased risk for diabetes mellitus and metabolic syndrome. Not all patients on these medications gained weight, however, or developed diabetes. If you are taking one of these medications and have noticed weight gain or symptoms of low blood sugar (shakiness, nervousness, tiredness, or lightheadedness), speak to your physician or psychiatrist about changing medications.

Weight gain: Clozaril, Zyprexa, and Seroquel are the most likely to cause weight gain, while Risperdal (risperidone), Geodon (ziprasidone), and Abilify (aripiprazole) have fewer weight-related side effects.

Diabetes mellitus: Although the Federal Drug Administration has recently required warning labels for patients with diabetes and hyperglycemia on all antipsychotic medications, initial studies indicate that the newest antipsychotic medications, Abilify and Geodon, do not show an increased risk for diabetes. If you have a family history of diabetes or other risk factors which place you at risk of developing this disease, discuss this with your physician.

Metabolic syndrome: Metabolic syndrome, which is characterized by abdominal obesity, elevated levels of triglycerides, high-density lipoprotein cholesterol, blood pressure, and fasting glucose, may be exacerbated by antipsychotic medications. If you have three or more of these symptoms, you may have metabolic syndrome and should discuss this with your physician.

"Metabolic Issues in Patients with Severe Mental Illness"
By Drs. Leslie Citrome, Lawrence Blonde, and Cristina Damatarca
Southern Medical Journal, July 2005