UPDATES AND ADDITIONS for Herbal Contraindications & Drug Interactions plus Herbal Adjuncts with Medicines FOURTH EDITION by Francis Brinker, N.D. Copyright 2016 All rights reserved. Last updated: December 6, 2016 NEW FEATURE: An index for the Updates and Additions is now included at the end. This document and its contents may not be reproduced for distribution or sale in any form. NOTICE Information provided in the book or these updates and additions is not intended as recommendations for self treatment or to substitute for instructions provided by one’s own doctor or health care provider. Combining herbal use with medications should only be done after consultation with a knowledgeable physician. Preliminary research data on potentially beneficial combinations of herbals and drugs is provided to educate pharmacists and physicians and encourage further clinical research. Information provided in the book and in these updates is not intended as recommending self treatment or to replace instructions provided by one’s own doctor or health care provider. Disclaimer The author and publisher, in attempting to prepare the book with the utmost accuracy from thousands of sources, make no guarantees of any kind on the reliability of the references used and assume no responsibility for any errors or omissions in citing these references. They assume no liability for any damages in connection with the information contained in the book or in the updates and additions or arising from application of the information to oneself or others. Where the bracketed phrase [Note CORRECTION:] appears before numbers or information in ALL CAPS in these Updates and Additions, it denotes an error found in early printings of the book (those prior to 2013). The corrections were made in ongoing printings and the Kindle version (2013) of the book. It is recommended that if the noted corrections have not been made in the book in your possession, that you make the appropriate changes directly in your hard copy and/or insert a copy of the compilation of all CORRECTIONS that is given before the Index at the end of these Updates after the References. KEYS TO INTERPRETING THE CONTENT IN THE BOOK AND AT THIS SITE The following terms are used to describe the different means of determining botanical effects. [At www.eclecticherb.com/emp/herb-contraindications-drug-interactions/ a free, printable, tri-fold bookmark with the following designations is available in pdf format.] Where contradicting data exists for a particular item in any category, this is noted by an indentation, and the sentence will begin with the capitalized word, 'HOWEVER'. 1 Contraindications I. clinical – (empirical observations, human research, or case reports) II. pre-clinical – (indirect in vitro or in vivo laboratory studies (speculative outcomes for humans) Drug Interactions Ia. human studies – published research done on healthy individuals human clinical studies – published research from therapeutic trials on patients being treated for a condition Ib. empirical – traditional knowledge or consensus based on experience from extensive use human case reports – published individual responses to using herbal products human case series – published responses from several patients using a preparation of the same herb II. in animals (types listed) – laboratory tests using live animals (in vivo) and various modes of administering the herb or herbal component(s) III. ex vivo –laboratory interaction finding on cells, tissue, or organs from animals or humans who were administered the herbal agent (as contrasted to in vivo when studies are done on the living organisms themselves) in vitro –laboratory interaction finding with cell or tissue samples from animals or humans speculative – using pharmacological evidence from in vitro research, animal studies, or human studies to infer probable or potential interactions or effects in humans IV. [dubious interactions], as shown in brackets with the drugs underlined rather than in bold type, are based on preliminary findings, speculation, inaccurate information, and/or false assumptions that have been contradicted by established evidence. Complementary Adjuncts Conditions, symptoms, or markers impacted or the drug adverse effects reduced are designated by bold underline. Ia. human clinical trials Ib. case reports, empirical observations IIa. in vivo animal studies IIb. in vitro laboratory research Abbreviations for the various modes of administration are used as follows: IM (intramuscular) – injected into a large skeletal muscle IP (intraperitoneal) – injected into the peritoneal cavity IV (intravenous) – injected into a vein PO (per os) – by mouth; orally or through a feeding tube; b.i.d. = 2x/day, t.i.d. = 3x/day SC (subcutaneous) – injected under the skin * An asterisk in front of an herb’s scientific name denotes toxic effects from over-consumption of that herb or a major active component. ADDITIONAL INFORMATION IS AVAILABLE IN THESE UPDATES AND ADDITIONS FOR THE FOLLOWING LISTED HERBS AND APPENDICES, AS DESIGNATED: + denotes new contraindication(s), interaction(s), and/or complementary adjuncts not previously listed in the book for the herb ^ denotes new herb with contraindication(s), interaction(s) and/or complementary adjuncts in body of text or an entirely new appendix section If none of the above are present in the list below, further elaborations have been made to information already included in the book. 2 HERBAL AGENTS The following list are those herbs that are new (^), or have new categories added (+), or have information updated. Aloe American ginseng + Amla ^ Anise + Arjuna + Arnica + Ashwagandha + Asian ginseng + Astragalus + Barberry + Bilberry + Bitter melon Bitter orange Black cohosh Black cumin + Black pepper + Black raspberry ^ Boldo + Borage + Burdock + Calamus + Cannabis + Cassia + Cat's claw + Cayenne + Celandine Chaga ^ Chamomile Chili ^ Chinese hibiscus [formerly Hibiscus] Chinese rhubarb + Chinese skullcap + Chokeberry + Cinchona Cinnamon + Clove + Cocoa + Cola + Coptis + Corn silk ^ Cranberry Crucifers + Dan shen + Dog rose + Dong Quai + Echinacea angustifolia Echinacea pallida + Echinacea purpurea + 3 English plantain + Eucalyptus + Evening primrose + Fenugreek + Fo-ti Frankincense + French maritime pine + Garlic + Ginger + Ginkgo Goldenseal + Grapefruit + Guarana + Guggul + Hawthorn + Hibiscus ^ Hops + Horse chestnut + Jujube + Kava Kudzu + Kutaki + Larch ^ Licorice + Long pepper + Lycium + Maca Maitake + Milk thistle + Oat Olive + Oregon grape + Passion flower Pau d'Arco + Pelargonium ^ Peppermint + Pomegranate + Prickly pear Psyllium Quassia (Surinam) + Raspberry + Roman chamomile Saffron + Sage + Sanch ginseng ^ Saw palmetto + Schisandra + Shiitake ^ Silk tree + Southern schizandra ^ Soy + 4 St. John's wort Stinging nettle Sweet annie + Sweet cherry ^ Tart cherry ^ Tea + Tea tree + Thunder god vine Tibetan rhodiola ^ Tulsi ^ Turmeric + Valerian + Wild yam + Yohimbe APPENDICES The following are entirely new sections and subsections. A.8 Bioactivations of Phytochemical Procarcinogens and Potential Toxins ^ A.8.1 Bioactivations by Cytochrome P450 Isozymes (CYPs) and Sulfotransferases (STs) ^ B.7.1.d Influence on Constitutive Androstane Receptor (CAR) B.7.3.f Influence on Activity of Estrogen Sulfotransferases (SULT1E1) B.7.4.i 11beta-Hydroxysteroid Dehydrogenase type 1 Conversion of Cortisone to Cortisol ^ B.7.4.j Sterol 27-Hydroxylase (CYP27A1) Conversion of Cholesterol to Bile Acids and Bioactivation of Vitamin D3 ^ E.5.9 Potential Herbal Prevention of Dermal Photocarcinogenesis ^ E.5.10 Herbal Prevention of Acute UV-induced Erythema ^ E.5.11 Herbal Protection Against Radioiodine Therapy Adverse Effects ^ E.6.11 Botanicals reducing adverse effects caused by antimicrobial agents ^ The following are those sections and subsections for which new information has been added. B.1 Modifying Intestinal Absorption of Medicines and Phase III Metabolism B.1.1 Slowed and/or Reduced Absorption by Herbal Components B.1.2 Enhancement of Absorption B.4 Modifying Blood Sugar In Diabetics B.4.1 Hypoglycemic and/or Antihyperglycemic Herbals B.4.2 Antihyperglycemic Botanicals Enhancing Oral Hypoglycemic Drugs in Humans B.5 Modifying the Effects of Anticoagulants B.5.1 Increasing Potential for Hemorrhage B.5.2 Increasing Potential for Coagulation B.7 Modifying Enzyme Activities in Metabolic Conversions B.7.1 Unspecified Influences of Herbal Agents on Substrate Pharmacokinetics B.7.2 Influences of Herbal Agents in Phase I on Specific Cytochrome P450 Isozymes B.7.3 Specific Enzyme Influences of Herbal Agents on Phase II Conjugation B.7.4 Specific Enzyme Influences of Herbal Agents on Steroid Metabolism C.1 During Pregnancy C.1.1 Herbals That May Impact the Uterus or Fetal Development 5 E.1 Potentially Beneficial Combinations of Herbals with Drugs E.1.1 Herbs and Those Drugs Which May Potentially Be Complemented E.2 Herbal Aids for Modifying Substance Abuse E.2.1 Botanical Adjuncts for Reducing Recreational Drug Use and/or Damage E.3 Complementing Treatment of Inflammations E.3.2 Enhancing Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) E.3.3 Enhancing Outcomes When Using Analgesics E.3.4 Protecting Against NSAID-induced Ulcers E.3.5 Protecting Against Acetaminophen-induced Liver Toxicity E.4 Enhancing Chemotherapy and Chemoprevention or Reducing the Adverse Effects E.4.1 Enhancing therapeutic effects of chemotherapy E.4.2 Reducing adverse effects of chemotherapy E.4.4 Promoting and/or Enhancing Chemoprevention of Selective Cancers E.4.5. Reducing Transforming