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Herb-drug interactions.

A Fugh-Berman1

  • 1George Washington University School of Medicine and Health Sciences, Department of Health Care Sciences, Washington, DC 20037, USA. fughberman@aol.com

Lancet (London, England)
|February 16, 2000
PubMed
Summary
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Concurrent use of herbal remedies and pharmaceuticals can lead to dangerous interactions. Healthcare providers should advise patients to avoid mixing herbs and drugs due to potential adverse effects.

Area of Science:

  • Pharmacology
  • Integrative Medicine
  • Herbal Medicine

Background:

  • Concurrent use of herbal products and pharmaceutical drugs is common.
  • Herbal remedies can interact with medications, altering their efficacy and safety.
  • Understanding these herb-drug interactions is crucial for patient care.

Purpose of the Study:

  • To review and summarize documented cases of herb-drug interactions.
  • To highlight potential adverse effects arising from combining herbs and pharmaceuticals.
  • To emphasize the importance of clinical awareness and patient counseling regarding herb-drug use.

Main Methods:

  • Literature review of reported herb-drug interactions.
  • Identification of specific herbs and their interacting pharmaceutical agents.

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  • Categorization of interactions based on clinical outcomes (e.g., bleeding, serotonin syndrome, altered bioavailability).

    • Main Results:

    • Concurrent use of warfarin with ginkgo, garlic, dong quai, or danshen may increase bleeding risk.
    • St John's wort can cause mild serotonin syndrome with SSRIs and decrease bioavailability of digoxin, theophylline, cyclosporin, and phenprocoumon.
    • Panax ginseng may induce mania in patients on antidepressants; betel nut can exacerbate extrapyramidal effects with neuroleptics.
    • Yohimbine may increase hypertension risk with tricyclic antidepressants; liquorice potentiates corticosteroids.
    • Certain Chinese and Ayurvedic preparations can decrease blood concentrations of specific drugs.

    Conclusions:

    • Herb-drug interactions pose significant risks, ranging from altered drug efficacy to severe adverse events.
    • Many reported interactions lack detailed analysis, necessitating cautious interpretation.
    • Healthcare practitioners must proactively counsel patients on the potential dangers of combining herbal products with prescription or over-the-counter medications.