Chinese and Western Herbal Medicine: A Guide to Potential Risks and Drug Interactions Herbs Drug Interactions Adverse potential

Bupleurum spp. • None Known (Chinese Thorough wax, Chai Hu) • Some side effects of this herb include increased • Primary use: symptoms bowel movement, and associated with common cold, drowsiness. flu, liver disorders…

• Primary action: Bupleurum stimulates the immune system

• • Decreases warfarin Danshen (Salvia miltiorrhiza) clearance and increases its bioavailability. Case Primary usage: promotes • report of hemorrhage. blood flow and treat cardiovascular diseases i.e. angina pectoris, acute MI.

• Primary actions: scavenges free radicals, inhibit platelets aggregation, and promote vasoactive.

Dong Quai • Warfarin ( Sinensis, Dong Gui, Dong Quai is safe for most Chinese Angelica, Tan Kuei) adults. Women who are pregnant or breast-feeding • Primary use: It is most often should not take it without used in oriental medicine for consulting their healthcare menstrual problems. provider.

• Dong Quai can also be widely • Women with hormone found in traditional formulation sensitive cancers such as for pain. breast, uterine, or ovarian cancer and those with endometriosis or uterine fibroids should also exercise caution.

• Ephedra and MAOI can Ephedra Sinensis • MAOI, , decongestants, cause dangerously high (Cao Mahuang, Ma huang, Yellow stimulants blood pressure. FDA astringent) proposed a dosage limit of 8 mg every 6 hours (or a

https://ethnomed.org/resource/chinese-and-western-herbal-medicine-a-guide-to-potential-risks-and-drug-interactions/ • Primary use: Ma huang is well • People with the following condition total of 24 mg per day) and known as a weight loss pill in should not take Ephreda: Chest pains, not more than 7 days of the West (i.e. herbal fen-phen), cardiovascular disease, anxiety, eating continuous use. but it is solely used in disorder, and thyroid problems. • Ephedra, by itself, is not traditional oriental medicine for recommended for most respiratory conditions such as people. It is never used asthma, bronchitis, and alone in TCM. bronchospasm. • Risks of prolonged usage and high dosages consumption include high blood pressure, stroke, heart attacks, seizures, irregular heart beat, loss of consciousness, and death. • Less severe adverse symptoms include: dizziness, restlessness, anxiety, irritability, heart pounding, headache, a loss of appetite, nausea, and vomiting.

Feverfew (Tanacetum parthenium) • Antiplatelet drugs • Potential antiplatelet effects • NSAIDS • Primary use: migraine prophylaxis • Ticlopidine • Antagonizes serotonin release, may potentiate the • Clonidine effects of other serotonin • Tricyclic antidepressants antagonists. • Primary actions: vasoactive effects, anti-inflammatory, inhibit platelet aggregation

• can INCREASE the risk for • Garlic is generally safe for bleeding when combined Garlic (Allium sativum) most adults. with: Warfarin, aspirin, clopidogrel (Plavix), and enoxaparin (Lenvenox). • Primary use: reduce low • Raw garlic can cause: a density (LDL) cholesterol, burning sensation in the • Garlic may DECREASE the elevate high density (HDL) mouth or stomach, effectiveness of: cyclosporine, and cholesterol, mildly reduce blood heartburn, bad-breath, BCP. pressure, and improve blood gas, nausea, vomiting, and circulation. Garlic is also been diarrhea. used as an antibacterial/antiviral (H. pylori).

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• Primary actions: inhibit

platelet nitric-oxide-synthase, enhance fibrinolytic and antiplatelet activity, and antiviral & antibacterial activities.

• Most people tolerate (zingiberis rhizome) ginger well. Increase risk of bleeding when • • Primary Use: a spice, ginger is combined with blood thinners such as used for sea-sick and motion warfarin, and aspirin. sickness, and loss of appetite Ginger may interfere with medications • for controlling blood sugar, blood pressure, and stomach acid.

Ginseng (Panax species) • Warfarin • Decreased INR

• Primary use: vigor, well-being • • Increased alcohol clearance and longevity, MI, angina • Phenelzine; MAOI • headache, tremor, mania pectoris, CHF, lowering blood sugar.

• Primary action: It is thought that contains a variety of chemicals called ginsenosides that are responsible for its effects. In herbal therapy, Ginseng is often used as an adaptogenic herb,

which means that it can regulate a hypo or hyper functioning system.

Hawthorn (Crataegus oxyacantha) • Hawthorn is safe for most people. Occasional • Primary use: Hawthorn is • Hawthorne may increase the effects of reactions to Hawthorn often prescribed for cardiovascular medication such as: include: nausea, stomach cardiovascular problems upset, fatique, sweating, • Digoxin, enalapril, metoprolol, including heart failure. headache, and dizzines nitroglycerin, propranolol, Theophylline, caffeine, papverine.

• Primary action: increase cardiac output, increase nerve

signal transmission, and relax blood vessels.

https://ethnomed.org/resource/chinese-and-western-herbal-medicine-a-guide-to-potential-risks-and-drug-interactions/ Kava kava (Piper methysticum) • The potential for herb- • Primary use: sedative, drug interaction is much anxiety, reducing withdrawal greater when Kava is symptoms from combined with western drugs. One should not take benzodiazepines. Kava can INCREASE SIDE • Kava while one is pregnant EFFECTS of the following drugs: or breastfeeding, alcohol, sedatives, sleeping pills, and depressed, or have liver antipsychotics. • Kava-lactones are believed to disease such as hepatitis. affect the central nervous -diazepam (Valium),

system. -alprazolam (Xanax), -Halcion, Phenobarbital

• Kava may INCREASE RISKS of liver damage when combined with a

number of medications: acarbose, amiodarone, atorvastatin, diclofenac, isoniazid, itraconazole, ketoconazole, leflunomide, lovastatin, methotrexate, nevirapine, niacin, nifampin, ritonavir, simvastatin, tacrine, tamoxifen, terbinafine, valproic acid, zileuton…

• Kava can INCREASE the risk of

abnormal muscle movements when combined with certain meds: chlorpromazine, fluphenazine, haloperidol, metoclopramide, thioridazine, and thiothixene.

• Kava can DECREASE the effectiveness of dopamine.

Licorice • High dosage or long-term (Glycyrrhiza glaba) • Licorice DECREASE high blood pressure medications such as: use of licorice can lead to procardia, cardizem, tenormin, lasix. high blood pressure, water • Licorice is a very popular herb In addition, it also decrease the and sodium retention, and in TCM formulations, often used effects of hormone therapies i.e. decreased potassium in the to ameliorate or neutralize estrogen, tamoxifen, birth control blood. potentially toxic herbs. pills. • Potassium depleting drugs • Licorice INCREASE the side effects of such as furosemide,

prednisone, and other steroid ethacrynic acid, grape fruit juice, and laxatives can medications, MAOI, insulin, , naproxen, lovastatin ketoconazole, increase the side effects of Allegra, Halcion, Seconal, and other licorice.

https://ethnomed.org/resource/chinese-and-western-herbal-medicine-a-guide-to-potential-risks-and-drug-interactions/ drugs that are metabolized by CYP450.

• Possible interference with any Senna, cascara • Decreased drug availability (laxative) intestinally absorbed drug

St. John’s Wort (Hypericum perforatum) • By far, SJW has been the • Primary use: mild-moderate most commonly reported depression, possibly effective • SJW can significantly decrease herb causing herb/drug for anxiety. availability and absorption of many interactions. Short-term drugs by inducing liver enzyme CYP use appears to be safe for • Primary actions: hyperforin 450 and inhibiting, including drugs most consumers. In some and hypericin act on chemical for: patients, SJW can cause receptors to regulate mood. • SSRI’s insomnia, restlessness, vivid dreams, anxiety, • AIDS • Anxiety irritablility, stomach upset, • Asthma fatigue, dry mouth, • Birth control (OCP) dizziness, headache, and • Cholesterol lowering tingling. • Depression • Heart • SJW can cause skin to become extra sensitive to • Phenobarbital, dilantin, tegretol, Xanax. the sun, especially in light- • SJW can increase side effects of many skinned individuals. drugs, for example:

• Allergy (Allerga)

• Depression (Zoloft, MAOIs, Paxil,

Serone) • Migraine (Imitrex, Frova, Amerge,

Maxalt)

• SJW has also been reported to interact with anesthesia. It is recommended

that patients discontinue SJW two

weeks prior to surgery.

Yohimbine • Tricyclic antidepressants • Hypertension (sexual dysfunction)

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