Herbs & their interactions

General considerations
• Herbal preparations are not regulated by government agencies & are generally classified as food or dietary supplements
• If mentioned herbs inquire about the amount of herbs & how it is used by the client.
• Determine if causes harmful interactions when combined with other drugs
• Know the potential interactions & the necessary response eg. delay surgery, change medication or dosing
• Contact pharmacy to determine possible drug to drug interaction in a client using herbal therapy
• Herbs are not routinely continued for short hospitalization, especially when used for comfort symptomatic relief
• Herbal therapy is usually stopped 2 to 3 weeks before any surgery

Herbs Indication S/E Interactions

Black Menopausal symptoms:  Thickening of uterine lining Hormonal therapy
Cohosh hot flashes  Liver injury Cardiac drugs
lower BP  CI: CHF & pregnant
blue cohosh menstrual irregularities 
Hawthrone HTN
extract Mild to moderate HF

St. mild to moderate Depression  dry mouth, dizziness  Serotonin syndrome with (SSRI/
John’s wort  HTN SNRI, MAOIs, TCA)
immune stimulation  Photosensitivity  Interferes with many
drugs (theophylline,immunosuppresants,
CI: HTN, immunosuppresants antiepileptic, tetracycline, digoxin,
oral contraceptives, warfarin))
  Interfere with absorption of iron & other
minerals

Saw BPH: improves urine few & mild: nausea, headache, GI no known drug interaction
Palmetto flow, maintains, healthy upset, HTN very safe
testosterone
metabolism, anti-inflammatory
Milk Thistle liver disorders, GI upset: nausea, loose stools reduce level of immunosuppresants, so donot give
liver detoxification & protect in liver transplant cases
from drug damage, antioxidant,
also affects aspirin, alcohol, cheotherapy
Evening Eczema Seizure
prime rose Skin irritation Anticoagulant effect

Ephedra (ma weight loss, stimulant (asthma) stimulant, insomnia, increase effects of stimulant: caffeine, MAOIs,
huang) considered toxic by FDA headache, nervousness, seizures, death decrease action of cardiac drugs, steroids,
Echinacea Cold, flu, bladder infection GI upset, rash,  Reduces immunosuppressant's action
Immune booster (cancer) Liver damage  Decrease effectiveness of antivirals,
blood purifier CI: pregnancy, antifungal, steroids,
immunosuppressed client, TB, methotrexate, amiodarone
Multiple sclerosis
Fever few Migraine Anticoagulant effect CI: bleedings, pregnant, < 2 years child, warfarin,
Menstrual pain Rebound headache aspirin, NSAIDS
HTN nervousness, insomnia, tiredness, GI
symptoms

Garlic  natural antimicrobial, Hypoglycemia anticoagulants, aspirin,

 Lower cholesterol, increase Low BP, GI upset, heartburn, sedation antihypertensives, NSAIDs,
HDL, reduce BP excessive thinning of blood
 Anticoagulant effect, CI: bleeding disorders
  sedative effect: anxiety
Ginger  Analgesic Anticoagulant effect  Decreases oral hypoglycemic effects
 Antioxidant: heartburn  increase anticoagulants effect
fever, congestion  take cautiously with cardiac & HTN drugs
 digestive aid, increase bile
 relieves nausea, motion
sickness or anesthesia
induced
 supports Cardiaovascular
Ginkgo CNS stimulant, GI upset, headache, indigestion, increase anticoagulant effect
biloba antiplatelet, antioxidant nervousness, palpitations, allergic decrease anticonvulsive effect
-improve attention & memory, reactions, Anticoagulant effect diuretics
delay progression
of Alzheimer’s disease

Ginseng  improve mental alertness, insomnia, increase BP, BLEEDING,  Digoxin, alcohol, anticoagulants,
 enhance immune system hypoglycemia, allergic reaction, MAOIs, insulin, antidepressants,
 boosts energy diarrhea, stimulant
 improve stamina & sexual CI: pregnant, HTN, bleeding, asthma, young
performance children
 raises good cholesterol
 prevent aging
 improve diabetes symptoms
Di huang  Oral hypoglycemic monitor serum glucose level  Reduce insulin or oral hypoglycemic doses
Kava root antianxiety, sedative, hypnotic, GI & liver problems, suicide, drowsy, caution w/ other antianxiety meds (sleeping aids,
muscle relaxant, allergic reaction antipsychotics, CNS suppressants, Parkinson’s
Kava Kava drugs)
treat insomnia
Licorice heal gastric ulcer HTN, headache, lethargy, steroids, thiazides, oral
root diuretic effect cardiac dysfunction contraceptives, antibiotics, NSAIDs, digoxin
steroid withdrawal CI: pregnant & lactation, glaucoma, HTN, stroke,
 heart disease
Melatonin  Jet lag & fatigue from  Use lowest possible dose & only
travelling across time zones for short time
 Taken once reaches the  Higher doses causes
destination Vivid dreams
 Starting prior to or during Night mares
air travel may actually slow
the recovery of jet lag,
energy & alertness

Valerian Quiets & calms neurological restlessness, headache, use cautiously with alcohol, barbiturates, sleeping
system giddiness, nausea, blurred vision tablets, benzodiazepines
promotes sleep CI: < 2 years
used for headache,
anxiety, nervousness