What our patients should know about herbal medicine

With the recent boom of herbal and holistic approaches to health, many consumers are left confused. To reduce that confusion and assist you in making educated decisions concerning your health and well-being, we have prepared the following information on herbal medications. Patients are advised to remember that any medication, herbal or prescription, is in fact a drug and should be taken with care, keeping in mind the possibility of side effects and interaction with other medicines.

Herbal Medications with Possible Anticoagulation Results (Blood Thinning Effect):

Dong Quai - contains coumadin* (powerful blood-thinning agent)
Willow bark - contains salicylates (blood-thinning agents)
Echinacea - inhibits platelet aggregation, similar to aspirin
Primrose
Cowslip
Jack-in-the-pulpit
Red root - causes clotting disorders
Garlic (in high doses) - inhibits platelet aggregation and can cause prolonged bleeding
Vitamin E (in high doses)
Gingko biloba (in high doses) - can cause prolonged bleeding
Feverfew - inhibits clotting and may cause prolonged bleeding
Ginger - reduces platelet aggregation

Herbal Medications with Possible Inhalant Allergy Cross-Reactivity:

Chamomile - long-term use can lead to ragweed allergy
Goldenseal - long-term use can lead to ragweed allergy
Echinacea - long-term use can lead to sunflower allergy

Photosensitization Concerns From Herbal Medicine (skin rash and sensitivity to sunlight):

St. John's Wort
Celery
Dong Quai
Yarrow

Herbal Medicine with Possible Diuretic Effects (water losing effect):

Elder - strong diuretic
Feverfew
Dandelion
Nettles

Herbal Medications with Possible Blood Pressure Concerns:

St. John's Wort (MAO inhibitor effect) - do not take with amphetamines, amino acids, asthma inhalers, caffeine, decongestants, beer, wine, yogurt, fermented or smoked foods (amino acid tyramine). Avoid narcotics due to high incidence of high fever with coma.
Ma Huang (ephedra) - avoid in MAO inhibitor use, glaucoma, anxiety, heart problems.
Goldenseal
Ginseng
Licorice root - causes fluid retention

Herbal Medicines with Possible Immune Dysregulation Effects:

Echinacea - may over stimulate immune system and lead to immune suppression, increases tumor necrosis factor, do not use in HIV, do not use for more than 2 weeks in a row. Certain herbs should not be used in patients with autoimmune problems like multiple sclerosis, arthritis, and others.

Problems with Production of Herbal Products:

L-Tryptophan contamination in 1989 led to several hundred cases of eosinophilia-myalgia syndrome, and at least one death.

Anticholinergic poisoning from herbal tea, yerba de mate (Paraguay tea) which was contaminated by Belladonna alkaloids from weeds overgrowing in the field.

Vitamin Toxicity:

Vitamin C - cramps, flatulence, bloating, diarrhea
Vitamin E - thins blood, reduces effectiveness of thyroid replacement (avoid high doses with high blood pressure, congestive heart failure, insulin dependent diabetes, and heart problems).

Uterine Stimulants:

Yarrow
Lady's mantle
Dong Quai
Chamomile
Cinnamon
Myrrh
Yam
Licorice root
Many others

Herbal Medicine with Possible Hormonal Effects:

Hops - high proportion of estrogens, can lead to loss of libido in men
Melatonin - acts as a contraceptive in high doses
Yohimbe - may increase testosterone - women should not use.

Other Cautions:

Do not use with fever: Astragalus (huang qi), goldenseal, others.

Folk remedy, chewing leaves of feverfew, can cause mouth sores.

Lobelia has "nicotine-like" effects - >50 gms can suppress breathing, depress blood pressure and even lead to coma.

Ginseng lowers blood sugar - do not use if hypoglycemic.

Nutmeg is toxic in high doses.

Sage has a chemical (thujone) that can trigger seizures in epileptics.

Melatonin - do not use if you suffer severe allergies, have an immune disorder or cancer.

Peppermint relaxes smooth muscles and can promote gastric acid reflux into the throat.