Re Herb-Drug interactions and adverse effects

[Guest guest]

Hi All,

 

Any volunteers to do a detailed Medline search for papers on:

(a) Drug-Herb interactions, and

(b) documented adverse events (undesirable side effects) of herbal

medicines?

 

For example, see the articles, below.

 

Best regards,

Phil

 

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

 

Miller LG. Herbal medicinals: selected clinical considerations

focusing on known or potential drug-herb interactions. Arch Intern

Med. 1998 Nov 9;158(20):2200-11. Comment in: Arch Intern Med.

1999 May 24;159(10):1142-3. Arch Intern Med. 1999 Sep

13;159(16):1957-8. Department of Pharmacy Practice, Texas Tech

University Health Sciences Center, Amarillo 79121, USA. Herbal

medicinals are being used by an increasing number of patients who

typically do not advise their clinicians of concomitant use. Known

or potential drug-herb interactions exist and should be screened

for. If used beyond 8 weeks, Echinacea could cause hepatotoxicity

and therefore should not be used with other known hepatoxic

drugs, such as anabolic steroids, amiodarone, methotrexate, and

ketoconazole. However, Echinacea lacks the 1,2 saturated necrine

ring associated with hepatoxicity of pyrrolizidine alkaloids.

Nonsteroidal anti-inflammatory drugs may negate the usefulness of

feverfew to treat migraine headaches. Feverfew, garlic, Ginkgo,

ginger, and ginseng may alter bleeding time and should not be

used concomitantly with warfarin sodium. Additionally, ginseng

may cause headache, tremulousness, and manic episodes in

patients treated with phenelzine sulfate. Ginseng should also not

be used with estrogens or corticosteroids because of possible

additive effects. Since the mechanism of action of St John wort is

uncertain, concomitant use with monoamine oxidase inhibitors and

selective serotonin reuptake inhibitors is ill advised. Valerian should

not be used concomitantly with barbiturates because excessive

sedation may occur. Kyushin, licorice, plantain, uzara root,

hawthorn, and ginseng may interfere with either digoxin

pharmacodynamically or with digoxin monitoring. Evening primrose

oil and borage should not be used with anticonvulsants because

they may lower the seizure threshold. Shankapulshpi, an Ayurvedic

preparation, may decrease phenytoin levels as well as diminish

drug efficacy. Kava when used with alprazolam has resulted in

coma. Immunostimulants (eg, Echinacea and zinc) should not be

given with immunosuppressants (eg, corticosteroids and

cyclosporine). Tannic acids present in some herbs (eg, St John

wort and saw palmetto) may inhibit the absorption of iron. Kelp as

a source of iodine may interfere with thyroid replacement therapies.

Licorice can offset the pharmacological effect of spironolactone.

Numerous herbs (eg, karela and ginseng) may affect blood glucose

levels and should not be used in patients with diabetes mellitus.

Publication Types: Review Review, Tutorial PMID: 9818800

[PubMed - indexed for MEDLINE]

 

Rigelsky JM, Sweet BV. Hawthorn: pharmacology and therapeutic

uses. Am J Health Syst Pharm. 2002 Mar 1;59(5):417-22. H. H.

McGuire Veterans Affairs Medical Center, Richmond, VA, USA.

The uses, pharmacology, clinical efficacy, dosage and

administration, adverse effects, and drug interactions of hawthorn

are discussed. Hawthorn (Crataegus oxyacantha) is a fruit-bearing

shrub with a long history as a medicinal substance. Uses have

included the treatment of digestive ailments, dyspnea, kidney

stones, and cardiovascular disorders. Today, hawthorn is used

primarily for various cardiovascular conditions. The cardiovascular

effects are believed to be the result of positive inotropic activity,

ability to increase the integrity of the blood vessel wall and improve

coronary blood flow, and positive effects on oxygen utilization.

Flavonoids are postulated to account for these effects. Hawthorn

has shown promise to treat New York Heart Association (NYHA)

functional class II congestive heart failure (CHF) in both

uncontrolled and controlled clinical trials. There are also

suggestions of a beneficial effect on blood lipids. Trials to establish

an antiarrhythmic effect in humans have not been conducted. The

recommended daily dose of hawthorn is 160-900 mg of a native

water-ethanol extract of the leaves or flowers (equivalent to 30-169

mg of epicatechin or 3.5-19.8 mg of flavonoids) administered in two

or three doses. At therapeutic dosages, hawthorn may cause a

mild rash, headache, sweating, dizziness, palpitations, sleepiness,

agitation, and gastrointestinal symptoms. Hawthorn may interact

with vasodilating medications and may potentiate or inhibit the

actions of drugs used for heart failure, hypertension, angina, and

arrhythmias. The limited data about hawthorn suggest that it may

be useful to treat NYHA functional class II CHF. Publication Types:

Review Review, Tutorial PMID: 11887407 [PubMed - indexed for

MEDLINE]

 

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

 

The EU Drug Boards assess issues of SAFETY, EFFICACY and

QUALITY-CONTROL in the registration process of new drugs. The

issue of SAFETY will be crucial for the official acceptance of herbal

medicines in the EU.

 

Failure of the herbal profession to address these issues head-on

will be another nail in the coffin of natural medicines in EU. We

cannot leave it to " our enemies " to do those assessments in a

totally fair and unbiased way.

 

Experts from the herbal profession must assess the SAME DATA

as our opponents, and interpret it fairly.

 

" Our interpretation " must highlight

(a) the risk-benefit ratios (in comparison to those of allopathic

treatments) and

(b) OTHER factors (such as pre-existing organ compromise, such

as liver cirrhosis, early renal- or heart- failure, etc) that may have

played a role in adverse outcomes to herbal Tx.

 

IMO, the SAFETY of herbal medicines will be assessed on two

main criteria: (1) The nature and frequency of adverse reactions in

subjects taking herbal medicines, and (2) Herb-Drug interactions.

 

If these issues are addressed professionally and scientifically, and

the data show risk levels at or below those from currently used

allopathic drugs, I believe that a very strong case may be made for

the acceptance of herbal medicine.

 

 

Best regards,

 

Email: <

 

WORK : Teagasc Research Management, Sandymount Ave., Dublin 4, Ireland

Mobile: 353-; [in the Republic: 0]

 

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

Tel : 353-; [in the Republic: 0]

WWW : http://homepage.eircom.net/~progers/searchap.htm

[Guest guest]

Hi Phil,

 

I uploaded an interesting article on herb-drug interaction from the

Lancet, in the files section a few days ago. Direct link is

http://health.Chinese Medicine/fil

es/Articles/Herbal/

 

Attilio

 

" " <@e...> wrote:

> Hi All,

>

> Any volunteers to do a detailed Medline search for papers on:

> (a) Drug-Herb interactions, and

> (b) documented adverse events (undesirable side effects) of herbal

> medicines?

>

> For example, see the articles, below.

>

> Best regards,

> Phil

>

> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

>

> Miller LG. Herbal medicinals: selected clinical considerations

> focusing on known or potential drug-herb interactions. Arch

Intern

> Med. 1998 Nov 9;158(20):2200-11. Comment in: Arch Intern Med.

> 1999 May 24;159(10):1142-3. Arch Intern Med. 1999 Sep

> 13;159(16):1957-8. Department of Pharmacy Practice, Texas Tech

> University Health Sciences Center, Amarillo 79121, USA. Herbal

> medicinals are being used by an increasing number of patients who

> typically do not advise their clinicians of concomitant use. Known

> or potential drug-herb interactions exist and should be screened

> for. If used beyond 8 weeks, Echinacea could cause hepatotoxicity

> and therefore should not be used with other known hepatoxic

> drugs, such as anabolic steroids, amiodarone, methotrexate, and

> ketoconazole. However, Echinacea lacks the 1,2 saturated necrine

> ring associated with hepatoxicity of pyrrolizidine alkaloids.

> Nonsteroidal anti-inflammatory drugs may negate the usefulness of

> feverfew to treat migraine headaches. Feverfew, garlic, Ginkgo,

> ginger, and ginseng may alter bleeding time and should not be

> used concomitantly with warfarin sodium. Additionally, ginseng

> may cause headache, tremulousness, and manic episodes in

> patients treated with phenelzine sulfate. Ginseng should also not

> be used with estrogens or corticosteroids because of possible

> additive effects. Since the mechanism of action of St John wort is

> uncertain, concomitant use with monoamine oxidase inhibitors and

> selective serotonin reuptake inhibitors is ill advised. Valerian

should

> not be used concomitantly with barbiturates because excessive

> sedation may occur. Kyushin, licorice, plantain, uzara root,

> hawthorn, and ginseng may interfere with either digoxin

> pharmacodynamically or with digoxin monitoring. Evening primrose

> oil and borage should not be used with anticonvulsants because

> they may lower the seizure threshold. Shankapulshpi, an Ayurvedic

> preparation, may decrease phenytoin levels as well as diminish

> drug efficacy. Kava when used with alprazolam has resulted in

> coma. Immunostimulants (eg, Echinacea and zinc) should not be

> given with immunosuppressants (eg, corticosteroids and

> cyclosporine). Tannic acids present in some herbs (eg, St John

> wort and saw palmetto) may inhibit the absorption of iron. Kelp as

> a source of iodine may interfere with thyroid replacement

therapies.

> Licorice can offset the pharmacological effect of spironolactone.

> Numerous herbs (eg, karela and ginseng) may affect blood glucose

> levels and should not be used in patients with diabetes mellitus.

> Publication Types: Review Review, Tutorial PMID: 9818800

> [PubMed - indexed for MEDLINE]

>

> Rigelsky JM, Sweet BV. Hawthorn: pharmacology and therapeutic

> uses. Am J Health Syst Pharm. 2002 Mar 1;59(5):417-22. H. H.

> McGuire Veterans Affairs Medical Center, Richmond, VA, USA.

> The uses, pharmacology, clinical efficacy, dosage and

> administration, adverse effects, and drug interactions of hawthorn

> are discussed. Hawthorn (Crataegus oxyacantha) is a fruit-bearing

> shrub with a long history as a medicinal substance. Uses have

> included the treatment of digestive ailments, dyspnea, kidney

> stones, and cardiovascular disorders. Today, hawthorn is used

> primarily for various cardiovascular conditions. The

cardiovascular

> effects are believed to be the result of positive inotropic

activity,

> ability to increase the integrity of the blood vessel wall and

improve

> coronary blood flow, and positive effects on oxygen utilization.

> Flavonoids are postulated to account for these effects. Hawthorn

> has shown promise to treat New York Heart Association (NYHA)

> functional class II congestive heart failure (CHF) in both

> uncontrolled and controlled clinical trials. There are also

> suggestions of a beneficial effect on blood lipids. Trials to

establish

> an antiarrhythmic effect in humans have not been conducted. The

> recommended daily dose of hawthorn is 160-900 mg of a native

> water-ethanol extract of the leaves or flowers (equivalent to 30-

169

> mg of epicatechin or 3.5-19.8 mg of flavonoids) administered in

two

> or three doses. At therapeutic dosages, hawthorn may cause a

> mild rash, headache, sweating, dizziness, palpitations,

sleepiness,

> agitation, and gastrointestinal symptoms. Hawthorn may interact

> with vasodilating medications and may potentiate or inhibit the

> actions of drugs used for heart failure, hypertension, angina, and

> arrhythmias. The limited data about hawthorn suggest that it may

> be useful to treat NYHA functional class II CHF. Publication

Types:

> Review Review, Tutorial PMID: 11887407 [PubMed - indexed for

> MEDLINE]

>

> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

>

> The EU Drug Boards assess issues of SAFETY, EFFICACY and

> QUALITY-CONTROL in the registration process of new drugs. The

> issue of SAFETY will be crucial for the official acceptance of

herbal

> medicines in the EU.

>

> Failure of the herbal profession to address these issues head-on

> will be another nail in the coffin of natural medicines in EU. We

> cannot leave it to " our enemies " to do those assessments in a

> totally fair and unbiased way.

>

> Experts from the herbal profession must assess the SAME DATA

> as our opponents, and interpret it fairly.

>

> " Our interpretation " must highlight

> (a) the risk-benefit ratios (in comparison to those of allopathic

> treatments) and

> (b) OTHER factors (such as pre-existing organ compromise, such

> as liver cirrhosis, early renal- or heart- failure, etc) that may

have

> played a role in adverse outcomes to herbal Tx.

>

> IMO, the SAFETY of herbal medicines will be assessed on two

> main criteria: (1) The nature and frequency of adverse reactions

in

> subjects taking herbal medicines, and (2) Herb-Drug interactions.

>

> If these issues are addressed professionally and scientifically,

and

> the data show risk levels at or below those from currently used

> allopathic drugs, I believe that a very strong case may be made

for

> the acceptance of herbal medicine.

>

>

> Best regards,

>

> Email: <@e...>

>

> WORK : Teagasc Research Management, Sandymount Ave., Dublin 4,

Ireland

> Mobile: 353-; [in the Republic: 0]

>

> HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

> Tel : 353-; [in the Republic: 0]

> WWW : http://homepage.eircom.net/~progers/searchap.htm

[Guest guest]

Hi Attilio

 

> I uploaded an interesting article on herb-drug interaction from

> the Lancet, in the files section a few days ago. Direct link is

> http://health.Chinese Medicine/f

> iles/Articles/Herbal/

 

Attilio, many thanks. I got it earlier today.

 

You have some great stuff on the TCM Files area. I must

congratulate you for that work.

 

 

Best regards,

 

Email: <

 

WORK : Teagasc Research Management, Sandymount Ave., Dublin 4, Ireland

Mobile: 353-; [in the Republic: 0]

 

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

Tel : 353-; [in the Republic: 0]

WWW : http://homepage.eircom.net/~progers/searchap.htm

[Guest guest]

Hi Phil,

 

Also uploaded a list of toxic herbs which shouldn't be given to

patients with renal disorders. Had it translated from Chinese, so

hope the PinYin is ok. Same link as before will take you there.

 

Attilio

 

" " <@e...> wrote:

> Hi Attilio

>

> > I uploaded an interesting article on herb-drug interaction from

> > the Lancet, in the files section a few days ago. Direct link is

> >

http://health.Chinese Medicine/f

> > iles/Articles/Herbal/

>

> Attilio, many thanks. I got it earlier today.

>

> You have some great stuff on the TCM Files area. I must

> congratulate you for that work.

>

>

> Best regards,

>

> Email: <@e...>

>

> WORK : Teagasc Research Management, Sandymount Ave., Dublin 4,

Ireland

> Mobile: 353-; [in the Republic: 0]

>

> HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

> Tel : 353-; [in the Republic: 0]

> WWW : http://homepage.eircom.net/~progers/searchap.htm

[Guest guest]

--- Here is something I rec'd from a friend in China when I was doing

some research on Herb Drug interactions. He is still working on his

English.

 

Heather

 

¡°¡Á¡± means ¡°can't be used together¡±

 

1£¬Chinese herbs which have calcium£¨For exmaple plaster.£© ¡Á

Acheomycin

Because the calcium ions/Ca2+ can cause the acheomycin not easy to be

absorbed.

 

2£¬Chinese herbs Zhu Sha£¨vermilion£© which have mercury in it ¡Á The

medicine which have bromine, for example Mixture Tribromide,potassium

sodium,potassium calcium,potassium bromide

Because bromine ions combine with mercury ions can create potassium

mercury which can lead vomit, nausea ,bellyache, diarrhea.

 

3£¬Chinese herbs Shan Zha,Wu Mei, Wu Wei Zi,and the patents which

have these herbs ¡Á Sulfa

Because these herbs are acidic, can cause the urine become

acidity,and the sulfa is easy to become crystal rime in the

acidity.Crystal rime can stimulate the urethra, can cause hematuria,

urodynia and anuresis.

 

4£¬Chinese herbs Da Huang, Wu Bei Zi, Shi Liu Pi ¡Á Vitamin B1

Because these herbs have Acidum Tannicum which combined with Vitamin

B1 can create a kind of alkaloid and make the Vitamin B1 lost its

effect.

 

5£¬Chinese herbs Gan Cao,Lu Rong ¡Á Aspirin

Because it can aggravate the damage on the gastric mucosa, and create

a lot of gastric acid and aggravate the gastric ulcer.

 

6£¬Chinese herbs Dan Shen and the patent which have Dan Shen ¡Á

strychnin£¬ephedrine£¬lobeline£¬vitamine B1,B6

Because it can decrease the curative effect

 

7£¬Chinese herbs Chuan Wu,Cao Wu,Fu Zi ¡Á

streptomycin£¬Gentamycin£¬Kanamycini

Because it can make vestibulocochlear nerve injury(tinnitus or

deafness)

 

8£¬Chinese herbs Ban Mao, Zhu Sha, Ba Dou ¡Á antibacterial,

antipyretic analgesics

Because it can damage the function of the alimentary tract

 

9£¬Chinese herbs Ma Huang, Zhi Shi ¡Á ephedrine£¬adrenalin

Because it can cause urinary retention

 

10£¬Chinese herbs Kun Bu, Hai Zao ¡Á isoniazid

Because it can make isoniazid lost the function of Anti-tuberculous

 

11£¬Chinese herbs Bei Mu ¡Á Aminophylline

Because it may cause poisoning

 

12£¬Chinese herbs Ren Shen ¡Á Phenobarbital, Chloral Hydrate

Because it can further the restraint of nerve centre

 

 

13£¬Chinese patent SheDanChuanBeiYe ¡Á morphine, dolantin, codein

Because it can cause respiratory failure

 

14£¬Chinese herbs Da Huang ¡Á Erythromycin£¬atropin, reserpine

Because it can decrease the curative effect

 

15£¬Chinese herbs Ma Huang ¡Á Furazolidone, Daonil (Glybenzoylamide)

Because it can increase the blood pressure¡¡