Dangers of Weight Loss Herbs and Other Drugs Interactions, Side Effects and Ephedra
Posted by in Uncategorized on August 13, 2011
When we wrote The People’s Guide to Deadly Drug Interactions, we included a section on herb-drug combinations. We were concerned about the possibility that many people would take herbs along with their medications without realizing that there could be a risk of incompatibility.
We have become even more alarmed about this potential danger as we have collected the information for this book. Many herbs impact a variety of biochemical systems and could have a profound effect on the way drugs exert their activity. Unfortunately, drug companies have little incentive to do the research that would tell us more about such interactions. And herb manufacturers rarely have the resources or the inclination to explore this crucial area themselves. With 60 million people now regularly taking herbs and dietary supplements and also utilizing prescription and over-the-counter medicines, the possibility for dangerous interactions is great.
Each herb summary in the last section of this book contains information on interactions. We encourage you to consult this information before combining any drugs with herbal remedies. Please recognize that not all interactions have been discovered or reported in the literature. Knowledge in this field is constantly changing, so there may be interactions we have not been able to include. Here are just a few of the more alarming combinations:
LICORICE AND LANOXIN
Licorice may seem like an innocuous candy, but the herb has very powerful hormone like effects. Regular use of this herbal medicine can deplete the body of potassium. In combination with the heart drug Lanoxin, a low potassium level could disrupt the heart’s regular rhythm. This interaction is especially dangerous if a person is also taking diuretics such as hydrochlorothiazide or Lasix that cause potassium loss. Strong herbal laxatives such as senna, cascara sagrada, or aloe could also throw body electrolytes like potassium out of balance and make the combination of licorice and Lanoxin potentially deadly. Even without Lanoxin, taking licorice with aloe or senna could trigger a life-threatening arrhythmia.
KAVA AND XANAX
Kava-kava is one of the most sedating herbs people can use to help them sleep or cope with anxiety. One person thought he would switch to this herb but started using kava while he was still taking Xanax (alprazolam). He experienced a coma like episode as a consequence of this combination and ended up in the hospital. Kava might interact in a similar way with other anti anxiety drugs such as chlordiazepoxide (Librium), diazepam (Valium), flurazepam (Dalmane), halazapam (Paxipam), lorazepam (Ativan), and temazepam (Restoril). Valerian, another herbal sedative, may also interact with these drugs or with kava-kava. We recommend against mixing either of these herbs with each other, with alcohol, or any other sedating compound, including diphenhydramine. This is found in many nighttime pain formulas such as Tylenol PM.
ST. JOHN’S WORT AND PAXIL
St. John’s wort definitely modifies brain chemistry. Its effectiveness as an antidepressant depends on such activity. One woman who took Paxil together with St. John’s wort became groggy and incoherent. She was also nauseated, weak, and so tired she could hardly get out of bed. With millions of people taking antidepressants such as Prozac, Paxil, and Zoloft, we fear that this interaction may become more common. It is potentially dangerous. Please do not combine St. John’s wort with any prescription antidepressants unless a knowledgeable health professional is carefully monitoring your progress. St. John’s wort may also affect the metabolism of medications such as olanzapine (Zyprexa) and other antidepressants like amitriptyline (Elavil) and imipramine (Tofranil). Other drugs that may be affected by this herb include caffeine, clozapine (Clo-zaril), haloperidol (Haldol), theophylline (Theo-Dur), warfarin (Coumadin), and zileuton (Zyflo). Ginkgo, kava, and valerian may also affect these drugs. Blood levels of the medications may rise, potentially increasing the risk of reactions. We are very concerned about another interaction with St. John’s wort, with light rather than medication. Joan Roberts, Ph.D., of Fordham University, has been studying the effects of light and drugs on the eye for decades. She has discovered that hypericin, an ingredient in St. John’s wort, reacts to ultraviolet and visible light. When activated, hypericin becomes toxic to the lens and retina of the eye, increasing the risk of cataracts or macular degeneration over time. Because sunglasses don’t screen out visible light, they can’t protect people from this danger. We suggest that people taking St. John’s wort stay out of bright light completely.
GINKGO AND COUMADIN
Ginkgo has an impact on blood clotting by affecting something called PAF (platelet activating factor). We fear that combining ginkgo and Coumadin, a powerful anticoagulant, may increase the risk for bleeding. In fact, several cases have been reported in which people taking ginkgo and Coumadin have suffered hemorrhages. Other herbs that may also increase the action of Coumadin include cayenne, chamomile, dong quai, echinacea, feverfew, garlic, ginger, hawthorn, horse chestnut, juniper, and licorice. Herbs that may counteract Coumadin include ginseng, goldenseal, and pau d’arco. Anyone taking Coumadin and herbs needs to have very careful blood monitoring frequent tests for blood clotting (prothrombin times and INR).
Aspirin has blood-thinning power and might also interact with many herbs, including ginkgo, garlic, feverfew, ginger, hawthorn, juniper, and licorice. One man began bleeding inside his eye after starting on ginkgo in addition to his regular aspirin therapy.
MA HUANG AND ANTIDEPRESSANTS
Ma huang, also known as ephedra, must never be combined with MAO inhibitors such as Marplan, Nardil, or Parnate, used to treat depression. This interaction could send blood pressure dangerously high. Do not take ma huang within two weeks of using an MAO inhibitor. Deaths have been reported with use of ma huang. Yohimbe, an herbal treatment for impotence, is also potentially dangerous with MAO inhibitors. Ma huang is incompatible with heart medicines such as Lanoxin and with the anesthetic halothane. Serious disruption of heart rhythm may occur. Ma huang must not be combined with ergot or its derivative ergotamine (Cafergot), or blood pressure could become very elevated.
GLUCOMANNANAND DIABETA
Glucomannan, a dietary fiber sometimes recommended for weight loss, can lower blood sugar. Diabetics using this fiber need to monitor blood sugar more closely. The dose of diabetes medicines such as DiaBeta, Diabinese, Dymelor, Glucotrol, Glynase, Micronase, Orinase, Tolamide, or Tolinase may need to be adjusted. Another diabetes pill, Glucophage, may not be absorbed as well if it is taken before a meal containing a different dietary fiber, guar gum. This thickener is used in salad dressing, frozen yogurt, and other low-fat foods to improve their texture.
Medroxyprogesterone Acetate Information – Drug Interactions, Uses and Benefits
Posted by in Uncategorized on August 13, 2011
Type of Drug:
Female hormone; birth control injection; contraceptive injection.
How the Drug Works:
This hormone, when administered at the recommended dose, prevents ovulation by suppressing the follicle stimulating hormone (FSH) and the utilizing hormone (LH). These changes result in endometrial thinning.
Drug Interactions:
Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with medroxyprogesterone. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. Aminoglutethimide (Cytadren) interacts with medroxyprogesterone.
Side Effects:
Every drug is capable of producing side effects. Many medroxyprogesterone users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy and individual susceptibility. Possible side effects include:
Urinary and Reproductive Tract: Menstrual irregularities; decreased sex drive; failure to experience orgasm; vaginal infection; pelvic pain; breast pain; vaginal discharge.
Digestive Tract: Stomach pain/discomfort; nausea; bloating.
Nervous System: Headache; nervousness; dizziness; weakness; depression; sleeplessness.
Other: Weight changes; backache; leg cramps; acne; no hair growth or hair loss; rash; edema (fluid retention); hot flashes.
Guidelines for Use:
Patient labeling available with product.
Menstrual cycle may be disrupted and irregular when beginning treatment. This should decrease to the point of an absence of menstruation as treatment continues.
Notify your doctor if there is a sudden partial or complete loss of vision, double vision or if migraine occurs.
Uses Of Herbs And Drug Interactions In Cardiovascular Patients
Posted by in Uncategorized on August 13, 2011
More and more consumers are taking herbal supplements as an alternative treatment for their diseases. It is estimated that more than 15 million people in the US consume herbal remedies or high-dose vitamins, and the total number of visits to the complementary medicine providers far exceeds those to primary physicians.
Lack of efficacy and adverse effects associated with prescription medicines lead many patients to explore herbal medicines. Uses of herbal medicines, however, are not without any risks. Although most of these herbal medicines have good safety profile, some herbal medicines have not been shown to be efficacious. Some even interact with western medicines, leading to life-threatening consequences. (Table 1)
The purpose of this paper is to equip cardiovascular patients with the latest uses of commonly used herbal medicines and the potential interaction of these herbal medicines with prescription medicines. Patients are advised to inform their primary care physicians and their specialists of the herbal supplements they are taking and to limit the use of herbal medicines to a shorter time period.
A) Aconite
Uses
Traditional Chinese practitioners use aconite for pain relief caused by trigeminal and intercostal neuralgia, rheumatism, migraine, and general debilitation.
Drug interaction
Long term use might increase the risk of atrial or ventricular fibrillation.
B) Black cohosh
Uses
Black cohosh has been used to relief symptoms of menopause, pre-menstrual tension and other gynecologic problems.
Drug interaction
Black cohosh should not be used with estrogen replacement therapy (ERT) since the combination of black cohosh and ERT has been shown to increase the risk of cardiovascular events and breast cancer. Pregnant and lactating women should avoid taking black cohosh.
C) Danshen
Uses
Danshen is used in traditional Chinese medicine for the treatment of coronary artery disease and menstrual abnormalities.
Drug interaction
Danshen reduces the elimination of warfarin and increases the bleeding risk associated with warfarin. It also interferes with digoxin essay.
D) Echinacae
Uses
Echinacae is used to strengthen the immune system to prevent infections. Side effects of Echinacae include nausea, dizziness, dyspnea, rash, and dermatitis.
Drug interaction
Long term use may increase the liver toxicity of other medications (e.g., statins(Zocor, Lipitor, Crestor), fibrates (Bezalip, Lopid and Tricor), niacins (niaspan), or amiodarone(codarone)).
E) Ginseng
Uses
Ginseng is advertised as an immune system stimulant that increases vigor, sexual potency and longevity. It is also used to treat myocardial infarction, congestive heart failure (CHF), angina pectoris and hyperglycemia in diabetic patients.
Drug interaction
Concomitant use of ginseng and warfarin results in an increase in bleeding time while use of ginseng and digoxin causes an increase in digoxin level. Pregnant women or women receiving hormone replacement therapy are advised not to use Ginseng since ginseng contains ingredients similar to estrogen. Also, long use of ginseng might result in reduced responsiveness to loop diuretics.
F) Ginkgo
Uses
Ginkgo is used for cardiovascular disease, cerebrovascular or peripheral vascular insufficiency, importance, inner ear dysfunction, retinopathy, pre-menstrual syndrome, stress, depression, and dementia.
Drug interaction
The concurrent use of ginkgo with antiplatelet (aspirin, Plavix, Effient, Aggrrastat and ReoPro), anticoagulant (warfarin) or antithrombotic agents (Streptase) increases the risk of bleeding. In clinical trials, ginkgo has also been shown to reduce the effectiveness of antihypertensive nicardipine (Cardene).
G) Garlic
Uses
Garlic has been used to treat infectious conditions since 1550 BC, due to its antimicrobial and immune-enhancing properties. Garlic has also been promoted to prevent cardiovascular disease because of its cholesterol-lowering, antihypertensive, antiplatelet and fibrinolytic properties.
Drug Interaction
Patients taking anticoagulant or antiplatelet agents should avoid taking garlic supplements since garlic increase the risk of bleeding. Patients taking aspirin, warfarin and garlic supplements are advised to discontinue the garlic supplements for at least 10 days before elective therapy
H) Grapefruit juice
Uses
Grapefruit juice is used as a dietary intervention to lose weight and to improve cardiovascular health.
Drug interaction
Grapefruit juice increases the blood level of calcium-channel blockers (Norvasc, Plendil, Cardif and Cardene), cyclosporine (Sandimmune, Neoral, Cicloral and Gengraf), statins (Lipitor, Zocor, Crestor), midazolam (Dormicum, Versed and Hypnovel), estrogen and terazoin (Hytrin).
I) Gynura
Uses
Gynura is used widely in Chinese medicine to improves microcirculation and relieve pain.
Drug interaction
Gynura interacts with angiotensin-converting enzyme drugs (e.g. Vasotec, Altace, Accupril, Zestril, Prinivil, Lotensin, Cozaar, Diovan, Benicar, Avapro and Micardis ). Long term use has been associated with hepatic toxicity.
J) Hawthorn
Uses
Hawthorn extract is used mostly to treat angina, CHF, bradyarrhythmia and cerebral insufficiency.
Drug interaction
Hawthorn enhances the effect of digitalis (Digoxin) and increases the risk of bleeding in patients taking antiplatelet or anticoagulant agents. Patients who take digitalis, antiplatelet, anticoagulant and Hawthorn need to monitor for potential toxic effects.
K) Licorice
Uses
Licorice is used as an expectorant. Long term use might result in pseudoaldosteronism, hypokalemia, hypertension, ventricular arrhythmia, hyperglycemia and edema.
Drug interaction
Licorice increases the effects of spironolactone (Aldactone) and digoxin. It also interacts with antiplatelet, anticoagulant and antidiabetes agents (e.g. Lantus, Amaryl, Januvia, Metformin, Diamicron, Actos, Glucophage, Byetta and Advandia), rendering these agents less effective.
L) Motherwort
Uses
Motherwort is use in both European and Asian traditional medicine to treat cardiac weakness, rapid heart beat, anxiety, insomnia, hypertension, amenorrhea, and edema.
Drug interaction
When taken with benzodiazepines for insomnia, motherwort increases the sedative effect of benzodiazepines and might result in coma.
M) Saw Palmetto
Uses
Saw Palmetto is used for the treatment of benign prostatic hypertrophy (BPH), hypertension and urinary infections.
Drug interaction
Saw Palmetto increases the risk of bleeding in patients taking warfarin. When use in long term, saw palmetto might increase in the risk of cholestatic hepatitis, acute pancreatitis and intro-operative floppy iris syndrome.
N) St. John’s wort
Uses
St. John’s wort is typically used to treat depression, anxiety, sleep disorders, common cold, herpes, ulcerative colitis, pain and the human immunodeficiency virus.
Drug interaction
Since St. John’s wort decreases the prothrombin time of warfarin and increase the risk of stroke, people taking warfarin who have a history of stroke, thrombosis, atrial fibrillation or prosthetic cardiac valves should avoid the use of St. John’s wort.
Also, patients who take ethinyl estradiol, indinavir (Crixivan), cyclosporine, statins and digoxin will have the level and efficacy of these drugs reduced.
Lastly, patients who take antidiabetes agents and St. John’s wort should watch out for hypoglycemia since St. John’s wort potentiate the glycemic effects of antidiabetes agents.
O) Tetrandrine
Uses
In Chinese medicine, tetrandrine is used to treat hypertension and angina.
Drug interaction
Tetrandrine lower glucose level and might cause hypoglycemia in diabetic patients. Long term use might cause hepatotoxicity and renal toxicity.
P) Yohimbine
Uses
Yohimbine is used for the treatment of sexual disorders and exhaustion.
Drug interaction
Yohimbine reduces the efficacy of antihypertensive and diuretics. Yohimbine is contraindicated in patients with hypertension, angina, and renal impairment.
Conclusions
Use of herbal remedies is widespread and is increasing dramatically. These remedies, however, are not subjected to the same regulations as prescription drugs. Thus, the purity, efficacy and safety of herbal products are not always known and some products may not even contain the amount of active ingredients listed on the label. Furthermore, some of these herbal remedies posses serious drug interaction with prescription medicines.
Cardiovascular patients who are taking prescription medicines with narrow therapeutic index such as digoxin and warfarin are advised to consult their physicians before taking any herbal medicines and to take these herbal medicines for a short period of time.
Drug Class and Brand Names
Angiotensin-converting enzyme drugs = Vasotec, Altace, Accupril, Zestril, Prinivil, Lotensin, Cozaar, Diovan, Benicar, Avapro and Micardis
Anticoagulant = warfarin
Antidiabetes agents = Lantus, Amaryl, Januvia, Metformin, Diamicron, Actos, Glucophage, Byetta and Advandia
Antiplatelet = aspirin, Plavix, Effient, Aggrrastat and ReoPro
Antithrombotic agents = Streptase
Calcium-channel blockers = Norvasc, Plendil, Cardif and Cardene
Cyclosporine = Sandimmune, Neoral, Cicloral and Gengraf
Digitalis = Digoxin = Lanoxin
Indinavir = Crixivan
Midazolam = Dormicum, Versed and Hypnovel
Spironolactone = Aldactone
Statins = Lipitor, Zocor, Crestor
Terazoin = Hytrin