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

• Warfarin • 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

(Angelica 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.

• MAOI, caffeine, decongestants, • Ephedra and MAOI can

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

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• Primary use: Ma huang is well
known as a weight loss pill in
the West (i.e. herbal fen-phen),
but it is solely used in
traditional oriental medicine for
respiratory conditions such as
asthma, bronchitis, and
bronchospasm.
Feverfew (Tanacetum
parthenium)
• Primary use: migraine
prophylaxis
• Primary actions: vasoactive
effects, anti-inflammatory,
inhibit platelet aggregation
Garlic (Allium sativum)
• Primary use: reduce low
density (LDL) cholesterol,
elevate high density (HDL)
cholesterol, mildly reduce blood
pressure, and improve blood
circulation. Garlic is also been
used as an
antibacterial/antiviral (H.
pylori).
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• People with the following condition total of 24 mg per day) and
should not take Ephreda: Chest pains, not more than 7 days of
cardiovascular disease, anxiety, eating continuous use.
disorder, and thyroid problems. • Ephedra, by itself, is not
recommended for most
people. It is never used
alone in TCM.
• 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.
• Antiplatelet drugs • Potential antiplatelet
effects
• NSAIDS
• Ticlopidine • Antagonizes serotonin
release, may potentiate the
• Clonidine
effects of other serotonin
• Tricyclic antidepressants antagonists.
• Garlic can INCREASE the risk for • Garlic is generally safe for
bleeding when combined most adults.
with: Warfarin, aspirin, clopidogrel
(Plavix), and enoxaparin (Lenvenox).
• Raw garlic can cause: a
burning sensation in the
• Garlic may DECREASE the
mouth or stomach,
effectiveness of: cyclosporine, and heartburn, bad-breath,
BCP. gas, nausea, vomiting, and
diarrhea.
• Primary actions: inhibit
platelet nitric-oxide-synthase,
enhance fibrinolytic and
antiplatelet activity, and
antiviral & antibacterial
activities.

• Most people tolerate

Ginger (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 • Alcohol • Increased alcohol clearance

and longevity, MI, angina • Phenelzine; MAOI • headache, tremor, mania
pectoris, CHF, lowering blood
sugar.

• Primary action: It is thought

that ginseng 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,
including heart failure. • Digoxin, enalapril, metoprolol,
headache, and dizzines
nitroglycerin, propranolol,
Theophylline, caffeine, papverine.

• Primary action: increase

cardiac output, increase nerve
signal transmission, and relax
blood vessels.

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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
benzodiazepines. drugs. One should not take
• 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
• Kava-lactones are believed to antipsychotics.
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
• Licorice DECREASE high blood
(Glycyrrhiza glaba)
pressure medications such as:
procardia, cardizem, tenormin, lasix.
• Licorice is a very popular herb
In addition, it also decrease the
in TCM formulations, often used
effects of hormone therapies i.e.
to ameliorate or neutralize
estrogen, tamoxifen, birth control
potentially toxic herbs.
pills.
• Licorice INCREASE the side effects of
prednisone, and other steroid
medications, MAOI, insulin, ibuprofen,
naproxen, lovastatin ketoconazole,
Allegra, Halcion, Seconal, and other
• High dosage or long-term
use of licorice can lead to
high blood pressure, water
and sodium retention, and
decreased potassium in the
blood.
• Potassium depleting drugs
such as furosemide,
ethacrynic acid, grape fruit
juice, and laxatives can
increase the side effects of
licorice.

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 drugs that are metabolized by
CYP450.

Senna, cascara • Possible interference with any

• Decreased drug availability
(laxative) intestinally absorbed drug

St. John’s Wort

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