HERBAL SUPPLEMENTSINTERACTIONS WITH PRESCRIPTION DRUGS THELESHA GRAY & VALERIE MILLER
HERBAL SUPPLEMENTS• Herbs are generally defined as any form of plant or plant product• Herbs have been used for thousands of years throughout the east and has recently gained popularity among westerners• About 15 million Americans currently use some form of herbal supplement• The total number of visits to Complementary and Alternative Medicine (CAM) clinics far exceed visits to Primary Care Providers• Herbs are not subjected to the scrutiny by the FDA
CHAMOMILEIndications -Insomnia -Anxiety -Gastrointestinal irritation— upset stomach, diarrhea -Upper respiratory tract inflammationCommon Drug Interactions• -Barbiturates• -Benzodiazepines• -Narcotics• -Antidepressants• -Additive effect with anticoagulants• such as Coumadin
ALOE VERAIndications-Wound healing-Reduce radiation induced skin injury-Eczema, psoriasis-Sunburn-Relieve constipation-AcneCommon Drug Interactions-Loop diuretics (furosemide):increases potassium loss-Digoxin toxicity-Additive effects with antidiabeticagents-May increase bleeding with warfarin
ECHINACEAIndications-Stimulates immune function-Resolution of infection such asurinary, vaginal & ear-Improves wound healing-Shorten duration of thecommon coldCommon Drug Interactions-Reduces the effect ofimmunosuppressant drugs-Avoid in patients with organtransplant-Increases antifungal effect ofketoconazole
GARLICIndications-Lowers cholesterol levels-Antihypertensive qualities-Prevents atherosclerosis-Common cold-Jock itch/athletes footCommon Drug Interactions-Increases with aspirin, warfarin,NSAIDs-Decreases the effect of isoniazid-Decreases drug effects ofsaquinavir
GINGKO BILOBAIndications-Memory-Alzheimer’s Disease-Dementia-COPD/Asthma-Intermittent claudicationtinnitusCommon Drug Interactions-Increases the effects of anticoagulants-Increases effects of antihypertensivedrugs-Decreases effect of anticonvulsants-Increases effect of SSRIs causingserotonin syndrome
GINGERIndications-Nausea/vomiting—chemotherapy,-Surgery-Diarrhea-Morning sickness-Arthritis-Joint/muscle painCommon Drug Interactions-Increases bleeding when combinedwith-NSAIDs, Coumadin, Heparin-Increases effect of insulin and oralhypoglycemic drugs
GINSENGIndications-Increases physical endurance-Stimulates the immune function-Anti-diabetic agentTreat infections such as Hepatitis CCommon Drug Interactions-Increases the effect of insulin/oralhypoglycemic drugs-Decreases the effect ofimmunosuppressant drugs, steroids-Increases digoxin levels-Increases PT causing bleedingwhen combined with NSAIDs &warfarin
SAW PALMETTOIndications-Benign prostate hyperplasia/BPHsymptoms-Renal disorders-Pelvic pain-Bladder disorders-Hormonal imbalanceCommon Drug Interactions-Additive effects when combinedwith Proscar-Increases the effect ofanticoagulants-Decrease the effect ofHRT/contraceptives—unplannedpregnancy
ST. JOHN’S WORTIndications-Depression-Anxiety-Sleep disorders-Common cold-Herpes/HIV-PMS—premenstrual syndromeCommon Drug Interactions-Increases the side effects ofantidepressants-Serotonin syndrome taken with SSRIs-Interacts with antihistamines byreducing levels e.g. Allegra-Reduces the effect of digoxinIncreases the effects of sedatives
CASE STUDYWhile taking the history of Mr. J.D, a 65 year old male patient, he explains toyou that he is experiencing increased exacerbations of Psoriasis despiteusing his medications. Upon reviewing his medications you notice that Mr.J.D. is currently taking EMBREL (anti-inflammatory) for treatment ofPsoriasis. Further questioning reveals that the patient enjoys Echinacea juicewhich buys from a local food store.1. What is the relationships between Echinacea and the inflammatory response?2. What information would be important for the patient to know?3. What advice would you give to the patient at this time ?
CASE STUDYMs. S.P. reports to the ER with complaints of nausea and vomiting.While observing Ms. P you notice that she is agitated with a labilemood. The patient denies a history of hypertension and states thatshe is currently taking sertraline (Zoloft) for depression. She explainsto you that she doesn’t think her depression has improved so sherecently stated taking St. John’s Wort to help with her depression. Vital signs Heart Rate=130 Blood Pressure= 170/90 Temperature = 102.4 +4 DTR1. What side effect is the patient currently experiencing?2. How is St. John’s Wort related to the patients signs and symptoms?3. What advice would you give to the patient at this time?