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Ginseng, Cardiac Drugs Don't Mix: Herb Interactions You Should Know.

It's common knowledge that some medications interact with others, possibly with dire consequences. And many drugs do not mix well with foods, not to mention alcohol. Now, with sales of botanical products skyrocketing, caution is in order when mixing herbs with frequently prescribed medications.

Food, of course, interacts with medications in numerous ways. The mere presence of food in the stomach can inhibit absorption of a drug, resulting in a delay or reduction in the medication's effect. Some nutrients in foods can form a complex, or chelate, with the active compound in a medication, rendering it and the nutrient useless. On the other hand, some compounds in foods can enhance a drug's effect. Grapefruit juice has received much attention lately for this effect.

Conversely, medications can affect nutrients, either by limiting their absorption, increasing the body's need for the nutrient or causing excessive excretion of the nutrient.

Herbs can interact with drugs in similar ways. In some cases, the herb and medication share similar effects, and that can spell trouble. For instance, herbs like St. John's wort that cause the body to lose water and electrolytes can enhance the effect of a diuretic medication prescribed for high blood pressure. For people prone to dehydration, older people and those with certain illnesses, this can spell trouble. Dehydration and potassium loss can cause muscle weakness, cramping and irregular heartbeat.

Recently, the Food and Drug Administration's drug division teamed up with the National Consumers League to publish a list of foods people should avoid when taking common medications. For a copy of Food & Drug Interactions, call (800) 639-8140.

Information on herb interactions is harder to come by. But EN has consulted numerous sources to come up with a list of some common medications and potential interactions with popular herbs.

EN's Guide to Drug-Herb Interactions
Medication                           Indications for Use

Generic name (Brand names)

Cardiac medications

digitoxin (Crystodigin, Digitoxin)   Help regulate heart rate.
digoxin (Digoxin, Lanoxin)           Treat congestive heart
                                     failure.

propranolol HCI (Inderal)            Helps regulate heart rate.
                                     Lowers blood pressure.
Diuretics

chlorthalidone (Hygroton)            Lower blood pressure,
furosemide (Lasix)                   while causing potassium
hydrochlorothiazide                  depletion. Treat excessive
  (HydroDIURIL, Microzide)           fluid retention.
metolazone (Zaroxolyn)

spironolactone (Aldactone)           Lowers blood pressure,
                                     but holds on to potassium.

Calcium channel blockers

amlodipine (Norvasc)                 Dilate blood vessels.
diltaizem (Cardizem, Dilacor XR,     Lower blood pressure.
  Tiamate)
felodipine (Plendil)
isradipine (Dynacric)
nicardipine (Cardene)
nifedipine (Adalat, Procardia)
nisoldipine (Sular)
verapamil HCI (Calan, Isoptin)

Other blood pressure medications

bisoprolol fumarate (Zebeta)         Control high blood
clonidine (Catapres)                 pressure.
doxazosin mesylate (Cardura)
guanfacine HCI (Tenex)
hydralazine HCI (Apresoline)
labetalol HCI (Normodyne,
  Trandate)
metoprolol tartrate (Lopressor,
  Toprol XL)
nadolol (Corgard)
prazosin HCI (Minipress)
terazosin HCI (Hytrin)
valsartan (Diovan)

Psychotherapeutic medications

amitriptyline HCI (Elavil)           Treats depression.

chlordiazepoxide (Librium)           Treats anxiety,

chlorpromazine HCI (Thorazine)       Treats psychosis,

clomipramine HCI (Anafranil)         Treats obsessive-compulsive
                                     disorder.

lithium carbonate (Eskafith,         Treats manic depression,
  Lithobid, Lithonate, Lithotabs)

phenelzine sulfate (Nardil), a       Treats depression,
  monoamine oxidase
  inhibitor--known as MAOI.

Diabetes medications

acarbose (Precose)                   Lower blood glucose.
chlorpropamide (Diabinese)
effects.
glipizide (Glucotrol)
metformin HCI (Glucophage)

Miscellaneous medications

aspirin (Bufferin)                   Nonsteroidal anti-inflammatory
                                     pain reliever,

astemizole (Hismanal)                Antihistamines used to treat
hydroxyzine (Atarax, Vistaril)       allergies. Also treat anxiety
loratadine (Claritin)                and nausea.

bisacodyl (Dulcolax)                 Stimulant laxative.

caffeine (Caffedrine,                Methylxanthine-containing
  NoDoz, Vivarin)                    stimulant,

phenobarbital (Phenobarbital)        Treats convulsions, sedative.

tetracycline HCI (Achromycin-V,      Antibiotic used to treat
  Sumycin, Tetracycline)             infection.

theophylline (Theo-Dur)              Treats asthma.

warfarin sodium (Coumadin)           Anticoagulant (inhibits blood
                                     clotting),

Medication                           Selected Herb Interactions

Generic name (Brand names)           Common name (Latin name)

Cardiac medications

digitoxin (Crystodigin, Digitoxin)   The following enhance the
digoxin (Digoxin, Lanoxin)           drugs' effects, risking
                                     digitalis toxicity--irregular
                                     heartbeat--as occurs
                                     in poisoning from foxglove
                                     (Digitalis purpurea):
                                      * senna (Cassia senna)
                                      * Siberian ginseng
                                     (Eleutherococcus senticosis)

                                     Diuretic herbs may exacerbate
                                     potassium depletion and cause
                                     digitalis toxicity:
                                      * dandelion (Taraxcum
                                        officinale)
                                      * hydrangea (Hydrangea
                                        aborescens)
                                      * parsley (Camm petroselenium)
                                      * St. John's wort (Hypericum
                                        perforatum)
                                      * uva ursi or bearberry
                                        (Arctostaphlyos uva-ursi)

                                     May aggravate drugs' side
                                     effect of swollen and tender
                                     breasts:
                                      * ginseng (Panax ginseng)
                                      * rauwolfia (Rauwolfia
                                        serpentina)

propranolol HCI (Inderal)            Natural licorice (Glycyrrhiza
                                     glabra) may increase heart
                                     rate and raise blood pressure,
                                     countering drug's effects.

                                     American mistletoe
                                     (Phorandendron) (leaves used
                                     in teas) may raise blood
                                     pressure, countering drug's
                                     effects.

                                     European mislleloe (Viscus
                                     album) may lower blood
                                     pressure, enhancing drug's
                                     effects.

Diuretics

chlorthalidone (Hygroton)            Stimulant laxatives can
furosemide (Lasix)                   exacerbate drugs'
hydrochlorothiazide                  potassium-depleting effect,
 (HydroDIURIL, Microzide)            contributing to confusion,
metolazone (Zaroxolyn)               weakness and irregular
                                     heartbeat:
                                      * aloe (Aloe barbadensis)
                                      * cascara sagrada (Rhamnus
                                        pershianus)
                                      * senna (Senna alexandrine)

                                     Diuretic herbs may exacerbate
                                     drugs' effects on potassium
                                     depletion;
                                      * dandelion (Taraxcum
                                        officinale)
                                      * hydrangea (Hydrangea
                                        aborescens)
                                      * parsley (Camm
                                        petroselenium)
                                      * St. John's wort (Hypericum
                                        perforatum)
                                      * uva ursi or bearberry
                                        (Arctostaphlyos uva-ursi)

                                     May counteract drugs' effects:
                                      * natural licorice
                                        (Glycyrrhiza glabra)
                                      * yohimbe (Pausinystalia
                                        yohimbe)

spironolactone (Aldactone)            * yohimbe (Pausinystalia
                                        yohimbe) may counteract
                                        drug's effects.

Calcium channel blockers

amlodipine (Norvasc)                 May counteract drugs' effects:
diltaizem (Cardizem, Dilacor XR,      * natural licorice
  Tiamate)                              (Glycyrrhiza glabra)
felodipine (Plendil)                  * yohimbe (Pausinystalia
isradipine (Dynacric)                   yohimbe)
nicardipine (Cardene)
nifedipine (Adalat, Procardia)       American mistletoe
nisoldipine (Sular)                  (Phorandendron) (leaves used
verapamil HCI (Calan, Isoptin)       in teas) may raise blood
                                     pressure, countering
                                     drugs' effects.

                                     European mistletoe (Viscus
                                     album) may lower blood
                                     pressure, enhancing drugs'
                                     effects.

                                     May aggravate drugs' side
                                     effect of swollen and tender
                                     breasts:
                                      * ginseng (Panax ginseng)
                                      * rauwolfia (Rauwolfia
                                        serpentina)

Other blood pressure medications

bisoprolol fumarate (Zebeta)         May counteract drugs' effects:
clonidine (Catapres)                  * natural licorice
doxazosin mesylate (Cardura)            (Glycyrrhiza glabra)
guanfacine HCI (Tenex)                * yohimbe (Pausinystalia
hydralazine HCI (Apresoline)            yohimbe)
labetalol HCI (Normodyne,
  Trandate)                          American mistletoe
metoprolol tartrate (Lopressor,      (Phorandendron) (leaves used
  Toprol XL)                         in teas) may raise blood
nadolol (Corgard)                    pressure, countering
prazosin HCI (Minipress)             drugs' effects.
terazosin HCI (Hytrin)
valsartan (Diovan)                   European mistletoe (Viscus
                                     album) may lower blood
                                     pressure, enhancing drugs'
                                     effects.

Psychotherapeutic medications

amitriptyline HCI (Elavil)           ginseng (Panax ginseng) may
                                     counteract the drug's effects.

                                     kava (Piper methysticum) can
                                     exacerbate drug's effects on
                                     the central nervous system,
                                     causing drowsiness and slowed
                                     breathing.

                                     ma huang (Ephedra) can enhance
                                     drug's toxic effects.

                                     psyllium (Plantago) can
                                     decrease drug's effects.
                                     yohimbe (Pausinystalia
                                     yohimbe) drug can increase
                                     toxicity of herb (if taken at
                                     same time).

chlordiazepoxide (Librium)           same as above

chlorpromazine HCI (Thorazine)       same as above

clomipramine HCI (Anafranil)         same as above

lithium carbonate (Eskafith,         same as above
  Lithobid, Lithonate, Lithotabs)

phenelzine sulfate (Nardil), a       same as above
  monoamine oxidase                  St. John's wort (Hypericum
  inhibitor--known as MAOI.          perforatum) is a weak MAOI,
                                     and may exacerbate drug's
                                     effects.

Diabetes medications

acarbose (Precose)                   bitter melon or karela
chlorpropamide (Diabinese)           (Morordica charantia) can
glipizide (Glucotrol)                lower blood sugar,
metformin HCI (Glucophage)           exacerbating drugs' effects.

Miscellaneous medications

aspirin (Bufferin)                   garlic (Allium sativum)
                                     contains allicin, an
                                     anticoagulant. Five to 20
                                     cloves of raw garlic is as
                                     potent as aspirin and could
                                     exacerbate its effects.

                                     wintergreen (Gaultheria
                                     procumbens) contains
                                     salicylates, the active
                                     compound in aspirin,
                                     and could cause toxicity.

astemizole (Hismanal)                May have sedative action,
hydroxyzine (Atarax, Vistaril)       exacerbating drowsiness and
loratadine (Clafftin)                fatigue side effects of drug:
                                      * hops (Humulus lupulus)
                                      * kava (Piper methysticum)
                                      * passion flower (Passiflora
                                        incamata)
                                      * scopolia (Scopolia
                                        camiolica)
                                      * valerian (Valeriana
                                        officinalis)
bisacodyl (Dulcolax)                 Stimulant laxatives can
                                     exacerbate potassium loss and
                                     contribute to confusion,
                                     weakness or irregular
                                     heartbeat:
                                      * aloe (Aloe barbadensis)
                                      * cascara sagrada (Rhamnus
                                        pershianus)
                                      * senna (Senna alexandrina)

                                     anthraquinone-containing herbs
                                     can exacerbate laxative
                                     effect:
                                      * aloe (Aloe barbadensis)
                                      * cascara sagrada (Rhamnus
                                        pershianus)
                                      * senna (Senna alexandrina)
                                      * yellow dock (Rumex crispus)

caffeine (Caffedrine,                guarana (Paullinia cupana) is
  NoDoz, Vivarin)                    very high in caffeine.

                                     ma huang (Ephedra) can
                                     exacerbate toxic effects of
                                     caffeine.

phenobarbital (Phenobarbital)        Herbs that exacerbate liver
                                     toxicity (and are not even safe
                                     to use alone):
                                      * chaparral (Larrea
                                        tridentata)
                                      * coltsfoot (Tussilago
                                        farfara)
                                      * comfrey (Symphytum
                                        officinale)
tetracycline HCI (Achromycin-V,      St. John's wort may exacerbate
Sumycin, Tetracycline)               drugs' side effect of increased
                                     sensitivity to the sun.

theophylline (Theo-Dur)              ma huang (Ephedra) can
                                     exacerbate rapid heart rate,
                                     anxiety and high blood
                                     pressure.

warfarin sodium (Coumadin)           Herbs with anticoagulant
                                     effects that may exacerbate
                                     drugs' effects, possibly
                                     triggering postoperative
                                     bleeding or a bleeding stroke
                                     in susceptible people:
                                      * chamomile (Matricaria
                                        recutita)
                                      * feverfew (Tanacetum
                                        parthenium)
                                      * garlic (Allium sativum)
                                      * ginseng (Panax ginseng)
                                      * ginger (Zingiber
                                        officinale)
                                      * ginkgo (Ginkgo biloba)
                                      * seaweed (Fucus and other
                                        species)


Sources: An original compilation of information from journal articles, reference texts and experts in the field.

Catherine Golub, M.S., R.D.
COPYRIGHT 1999 Belvoir Media Group, LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1999 Gale, Cengage Learning. All rights reserved.

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Author:Golub, Catherine
Publication:Environmental Nutrition
Geographic Code:1USA
Date:Jan 1, 1999
Words:1326
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