How to Avoid Dangerous Drug-Herb Interactions, Part 1 by Brian B. Carter, MS, LAc

Sometimes herbs and acupuncture can neutralize the effect of pain drugs. For example, patients on neurontin or morphine need to be treated differently. Acupuncture in these patients should be of shorter duration with less stimulation and subtler point selections (like eight extra points, e.g.). Moxibustion is a helpful alternative.

2. Chinese Licorice

Gan cao (chinese licorice) is sometimes problematic… it is in many herb formulas, but in low dosages. Higher dosages can lead to fluid retention. Gan cao can also reduce the absorption of oral tetracycline and some other meds, and can offset the pharmacological effect of spironolactone. The rule of separating the dosage times of herbs and drugs solves this problem.

3. Tannins

Tannins are insoluble with antibiotics. A few herbs such as Da Huang (rhubarb), He Zi, and Mo Yao (Myrrh) contain tannins. Tannic acids may inhibit the absorption of iron.

4. Glycosides

Glycosides, which are active ingredients in many herbs, are neutralized by acidic drugs. That means that, for example, Vitamin C (ascorbic acid) and nicotinic acid could prevent your herbs from working.

5. Blood-thinners

Patients on warfarin (coumadin) are most at risk for problems from drug-herb interactions. Warfarin is given to thin the blood, thus preventing the likelihood of clots blocking blood vessels in the heart, lungs, or brain. Warfarin's dosage needs to be quite exact to work, so we don't want any herbs affecting it. Herbs and herbal formulas that contain blood movers must be avoided. This includes, among others, herbs dan shen (salvia), dang gui (angelica), and yan hu suo (corydalis), and herb formulas like xue fu zhu yu tang, di dan tang, and tao he cheng qi tang. Feverfew, garlic, Ginkgo, ginger, and ginseng may alter bleeding time, and so they also should be avoided by patients on warfarin.

6. Dan Shen (Salvia)

Salvia (see #5) can also reduce the effectiveness of anti-ulcer drugs.

7. Surgery and Herbs

It's a good idea to stop taking herbs 5 days before surgery, and then after surgery take herbs only to rebuild the body.

8. Drugs for the Heart

Ma Huang (ephedra) should not be taken (even in an herbal formula) if your are on digitalis or any other heart drugs. It also reduces the effectiveness of anti-anxiety and sedative drugs, and increases the cardiovascular effects of caffeine. Kyushin, gan cao (licorice), plantain, uzara root, shan zha (hawthorn), and ren shen (ginseng) may interfere with digoxin.

9. St. John's Wort

Studies have shown that patients who take St. John's Wort while on a Selective Serotonin Re-uptake Inhibiting (SSRI) anti-depressant end up with varying blood levels of drugs. This means it interferes with the effectiveness of your anti-depressant. Because its mode of action is not understood, it should be avoided with monoamine oxidase inhibitors and SSRI's.

It also appears to reduce blood levels of cyclosporin, a drug taken to prevent the body's rejection of transplanted organs. And it reduces the effectiveness of the AIDS drug indinavir. It's not yet clear whether it interferes with the metabolism of all drugs, or just some. It may be difficult for your medications to work effectively if you take St. John's Wort.

10. Ginseng

Ginseng plus phenelzine sulfate may cause headache, tremulousness, and manic episodes. Ginseng should not be used with estrogens or corticosteroids.

Continued in Part 2!

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BIO:

Acupuncturist, herbalist, and medical professor Brian B. Carter founded the alternative health megasite The Pulse of Oriental Medicine (http://www.PulseMed.org/). He is the author of the book "Powerful Body, Peaceful Mind: How to Heal Yourself with Foods, Herbs, and Acupressure" (November, 2004). Brian speaks on radio across the country, and has been quoted and interviewed by Real Simple, Glamour, and ESPN magazines.

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