Health Questions and Answers

Question: What about interactions with prescription medication?

We have relatively little information about interactions of traditional herbal medicine with prescription drugs. It is estimated that 15 million adults in the United States are at risk for such interactions, including altered bioavailability and efficacy of the prescribed medication. Documented herb-drug interactions, which might be useful to the emergency physician, are listed in the Table.

Garlic Elevated cholesterol, hypertension ASA, anticoagulants Prolonged blood clotting time
Ginkgo biloba Vertigo, tinnitus, dementia ASA, NSAIDs,anticoagulants Increased risk of bleeding
Ginseng Lethargy Warfarin Decreased INR
Ma Huang Asthma, obesity CNS stimulants Increased herbal effect
St. John’s wort Depression Amitriptyline, cyclosporin, digoxin, indinavir

Paroxetine, sertraline

Decreased effectiveness owing to reduced serum drug concentrations   Additive serotonin effects
Valerian Anxiety, insomnia CNS depressants Increased CNS depression

ASA, acetylsalicylic acid; NSAIDs, nonsteroidal antiinflammatory drugs; INR, international normalized ratio; CNS, central nervous system.

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