formula causing tachycardia?

November 28, 2008

On Thu, Nov 27, 2008 at 10:59 PM, Sami Rank LAc <herbsnacupnxrwrote:

> I'm sure these things make me a stronger practitioner but I get

> nervous about prescribing to over-sensative patients. any input is

> welcome.

>

Your patient may be having an unforeseen reaction to one or more of the

herbs for whatever reason. However, I would propose also that this is a

nocebo reaction. Nocebo is just like placebo, only it is a " side-effect " .

I can't say for sure, but I'll bet that a racing heart as a response to

herbs has become a greater issue since the ma huang scare came and went.

In this case, I think that you're doing the right thing, drop the dosage,

then slowly bring it back up to your therapeutic goal dosage. it's just a

matter of letting your patient get comfortable with the herbs. Neither

placebo nor nocebo effects seem to last more than ten days, at least in my

experience. The hard part is getting your patient back on the horse.

-al.

--

, DAOM

Pain is inevitable, suffering is optional.

November 29, 2008

Hi Sami & All,

> I have a patient in whom I want to clear heat, nourish heart & yin,

> calm shen. western dx is hyperthyroidism/graves dz. from her sx I gave

> her a round of Tian Wan Bu Xin Dan, 3 caps 2x/day to start (from

> Evergreen so I know the source to be pure). She reported after a day

> that she feels they are making her heart race. I had her lower the dose

> temporarily to 3 caps 1x/day to allow her system to get used to them.

> Meanwhile I appeal to you... perhaps the ren shen? another possiblity

> is the rehmennia.

> I had a patient a long time ago who reported heart racing who I had

> given a formula created around Si Wu Tang. Since I had given the

> formula in raw form I was able to remove one herb at a time and

> intuitively I started with the rehmennia(something about it being

> foxglove made me suspect it). In that case it turned out to be the

> rehmennia, though according to our materia medica tachycardia should

> not have been a side effect. This patient responded, I'd say,

> homeopathically to the herb. has anyone experienced this?

> I'm sure these things make me a stronger practitioner but I get

> nervous about prescribing to over-sensitive patients. any input is

> welcome. (this message is repeated on Chinese Herbal Acadamy so forgive

> the repeat if you saw it there as well...I want as much input as

> possible) Thank you, Sami

See Pubmed for (herbs OR herbal) AND Adverse AND (tachycardia OR

arrythmia): http://tinyurl.com/67vvk8

??Coffee? See: Baghkhani L, Jafari M. Cardiovascular adverse reactions

associated with Guarana: is there a causal effect? J Herb Pharmacother.

2002;2(1):57-61. Western University of Health Sciences, College of

Pharmacy, Pomona, CA, USA. Herbal supplements have been used as

adjuncts to medical therapy for many years by various cultures. Many

consumers believe that because herbal supplements are natural products,

they are somewhat safer or more effective than traditional prescribed

medications. This is also one reason that alternative medicine is growing

and gaining more popularity. On the other hand, adverse reactions to herbal

supplements or their interactions with patients' current medications are no

different than pharmaceutical medicines. We report a case of premature

ventricular contraction associated with two herbal supplements. These

products contained multiple different herbs and both included large doses of

guarana. Guarana, which is found in some supplements marketed in U.S.,

contains a substantial amount of caffeine. Although the exact cause of

tachycardia in our report is not proven, a large amount of caffeine

consumption is thought to be a possible causal effect. The purpose of this

report is to remind health care professionals to evaluate and educate

patients on the use of herbal products and any potential adverse reactions,

drug interactions, or possible toxicities. PMID: 15277107 [PubMed]

Many antipsychotic drugs and stimulant herbs can cause tachycardia in

sensitive clients. Ginseng and other Qi Tonic herbs are best used in Xu

paients and best avoided in Shi (Excess) cases.

http://tinyurl.com/6mjtvs says:

Herbs that could cause Heart Palpitations: Herbs that stimulate cardiac

rhythm. Herbs in high doses that may cause heart palpitations include

cuscuta, ephedra, ginkgo biloba, ginseng, guarana, horny goat weed,

rhodiola, yohimbe, tongkat ali, LJ100, and other tonic herbs. Usually high

doses of these herbs cause the cardiac arrhythmia.

Nutrients that can cause Heart Palpitations: Nutrients that can cause an

arrhythmia include tyrosine, phenylalanine, high doses of SAM-e.

Hormones that could cause Heart Palpitations: Hormones than can cause

arrhythmia include high doses of thyroid hormones, DHEA and

pregnenolone, and probably high doses of progesterone or other hormones.

Prescription drugs that cause heart palpitations: There are many prescription

drugs that cause heart rhythm disturbances. I will list more over time.

The risk of developing a serious irregular heartbeat, resulting in

hospitalization or death, is substantially higher among bisphosphonate

users. These include:

Alendronate (Fosamax)

Clodronate (Bonefos)

Etidronate (Didronel)

Ibandronate (Boniva)

Neridronate

Olpadronate

Pamidronate (APD, Aredia)

Risedronate (Actonel)

Tiludronate (Skelid)

Zoledronate (Zometa)

Any chance that your patient also smokes marijuana? It can cause severe

heart fluttering and near syncope. See:

http://linkinghub.elsevier.com/retrieve/pii/S0196064403004268

Passion flower can also cause tachycardia [ http://tinyurl.com/5b3vto ], as

can Eleutherococcus Senticosus (Siberian Ginseng) [

http://tinyurl.com/5e22gx ]

Best regards,

November 30, 2008

thanks, Hugo, I hadn't looked at the situation that way, which is the

most obvious way one should look at it. I appreciate it.

sami

December 1, 2008

I had a patient who decided he didn't want to refill his long-standing atenolol

prescription, until one day I told him his pulse was racing and irregular. As

soon as he resumed taking it, his pulse reverted to his previous, medicated

" normal " . I'd be willing to bet her lack of meds is a significant factor.

Andrea Beth

Traditional Oriental Medicine

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