Common herbal supplements and drug interactions

1. HERBAL SUPPLEMENTS
INTERACTIONS WITH PRESCRIPTION DRUGS
THELESHA GRAY & VALERIE MILLER

2. HERBAL SUPPLEMENTS
• Herbs are generally defined as any form of plant or
plant product
• Herbs have been used for thousands of years
throughout the east and has recently gained
popularity among westerners
• About 15 million Americans currently use some form
of herbal supplement
• The total number of visits to Complementary and
Alternative Medicine (CAM) clinics far exceed visits to
Primary Care Providers
• Herbs are not subjected to the scrutiny by the FDA

3. CHAMOMILE
Indications
-Insomnia
-Anxiety
-Gastrointestinal irritation—
upset stomach, diarrhea
-Upper respiratory tract inflammation
Common Drug Interactions
• -Barbiturates
• -Benzodiazepines
• -Narcotics
• -Antidepressants
• -Additive effect with anticoagulants
• such as Coumadin

4. ALOE VERA
Indications
-Wound healing
-Reduce radiation induced skin injury
-Eczema, psoriasis
-Sunburn
-Relieve constipation
-Acne
Common Drug Interactions
-Loop diuretics (furosemide):
increases potassium loss
-Digoxin toxicity
-Additive effects with antidiabetic
agents
-May increase bleeding with warfarin

5. ECHINACEA
Indications
-Stimulates immune function
-Resolution of infection such as
urinary, vaginal & ear
-Improves wound healing
-Shorten duration of the
common cold
Common Drug Interactions
-Reduces the effect of
immunosuppressant drugs
-Avoid in patients with organ
transplant
-Increases antifungal effect of
ketoconazole

6. GARLIC
Indications
-Lowers cholesterol levels
-Antihypertensive qualities
-Prevents atherosclerosis
-Common cold
-Jock itch/athletes foot
Common Drug Interactions
-Increases with aspirin, warfarin,
NSAIDs
-Decreases the effect of isoniazid
-Decreases drug effects of
saquinavir

7. GINGKO BILOBA
Indications
-Memory
-Alzheimer’s Disease
-Dementia
-COPD/Asthma
-Intermittent claudication
tinnitus
Common Drug Interactions
-Increases the effects of anticoagulants
-Increases effects of antihypertensive
drugs
-Decreases effect of anticonvulsants
-Increases effect of SSRIs causing
serotonin syndrome

8. GINGER
Indications
-Nausea/vomiting—chemotherapy,
-Surgery
-Diarrhea
-Morning sickness
-Arthritis
-Joint/muscle pain
Common Drug Interactions
-Increases bleeding when combined
with
-NSAIDs, Coumadin, Heparin
-Increases effect of insulin and oral
hypoglycemic drugs

9. GINSENG
Indications
-Increases physical endurance
-Stimulates the immune function
-Anti-diabetic agent
Treat infections such as Hepatitis C
Common Drug Interactions
-Increases the effect of insulin/oral
hypoglycemic drugs
-Decreases the effect of
immunosuppressant drugs, steroids
-Increases digoxin levels
-Increases PT causing bleeding
when combined with NSAIDs &
warfarin

10. SAW PALMETTO
Indications
-Benign prostate hyperplasia/BPH
symptoms
-Renal disorders
-Pelvic pain
-Bladder disorders
-Hormonal imbalance
Common Drug Interactions
-Additive effects when combined
with Proscar
-Increases the effect of
anticoagulants
-Decrease the effect of
HRT/contraceptives—unplanned
pregnancy

11. ST. JOHN’S WORT
Indications
-Depression
-Anxiety
-Sleep disorders
-Common cold
-Herpes/HIV
-PMS—premenstrual syndrome
Common Drug Interactions
-Increases the side effects of
antidepressants
-Serotonin syndrome taken with SSRIs
-Interacts with antihistamines by
reducing levels e.g. Allegra
-Reduces the effect of digoxin
Increases the effects of sedatives

12. CASE STUDY
While taking the history of Mr. J.D, a 65 year old male patient, he explains to
you that he is experiencing increased exacerbations of Psoriasis despite
using his medications. Upon reviewing his medications you notice that Mr.
J.D. is currently taking EMBREL (anti-inflammatory) for treatment of
Psoriasis. Further questioning reveals that the patient enjoys Echinacea juice
which buys from a local food store.
1. What is the relationships between Echinacea and the inflammatory
response?
2. What information would be important for the
patient to know?
3. What advice would you give to the patient at
this time ?

13. CASE STUDY
Ms. S.P. reports to the ER with complaints of nausea and vomiting.
While observing Ms. P you notice that she is agitated with a labile
mood. The patient denies a history of hypertension and states that
she is currently taking sertraline (Zoloft) for depression. She explains
to you that she doesn’t think her depression has improved so she
recently stated taking St. John’s Wort to help with her depression.
Vital signs
Heart Rate=130
Blood Pressure= 170/90
Temperature = 102.4
+4 DTR
1. What side effect is the patient currently
experiencing?
2. How is St. John’s Wort related to the patients
signs and symptoms?
3. What advice would you give to the patient at this
time?