Herbal Medicines Flashcards
Black cohosh
Indications:
Premenstrual symptoms, painful or difficult menstruation, and
neurovegetative symptoms (hot flashes) caused by menopause
Contraindications/precautions:
a. Pregnancy
c. Commission E recommends that length of use should not exceed 6 months.
d. Use caution in liver disease, such as hepatitis and fulminant liver failure.
Drug interactions:
a. Cisplatin (Platinol) efficacy may be reduced.
b. Theoretically, black cohosh may interact with hepatotoxic drugs such as acetaminophen
(Tylenol), carbamazepine (Tegretol), and isoniazid (Nydrazid) because it is an inhibitor of
cytochrome P450 3A4 (CYP3A4) and CYP2D6 isoenzymes.
Side effects:
a. Occasional intestinal problems may occur, such as nausea and vomiting; weight gain is possible.
b. Liver toxicity may occur; liver function tests should be monitored periodically.
c. Large doses of black cohosh may cause dizziness, nausea, severe headaches, stif ness, and
trembling limbs.
d. Does not seem to increase risk of endometrial hyperplasia.
Chaste tree berry
Indications:
Disorders of the menstrual cycle, breast swelling, and premenstrual symptoms
Contraindications/precautions
a. Pregnancy and lactation
b. Hormone-sensitive conditions
Drug interactions
a. Theoretically, chaste tree berry may interact with medications that increase dopaminergic
activity, such as bromocriptine (Parlodel) and levodopa.
b. Theoretically, it may interact with medications that decrease dopaminergic activity such as the
antipsychotics.
c. Theoretically, it may interact with hormone-replacement therapy and oral contraceptives.
Side effects
a. Mild gastrointestinal upset
b. Skin rash
c. Irregular menstrual bleeding
Cranberry
Indications:
Recurrent urinary tract infections
Contraindications/precautions
a. Nephrolithiasis
b. Cranberry juice contains high amounts of salicylic acid and may trigger an allergic reaction in
patients with an aspirin allergy or asthma.
c. Discontinue 2 weeks before surgery.
d. Ulcers, GERD
Drug interactions
a. Increased vitamin B12 absorption
b. Potential to enhance elimination of renally excreted drugs by changing urine pH
c. Cranberry juice may interact with warfarin, increasing the international normalized ratio (INR).
d. May inhibit cytochrome P450 2C9. Drugs that are metabolized by CYP2C9 include amitriptyline
(Elavil) and diazepam (Valium)
Side effects
a. Nausea, vomiting, diarrhea
b. Nephrolithiasis
Dong Quai
Focus on Drug interactions.
Does not help with hot flashes.
Indications:
Menstrual disorders, anemia, constipation, insomnia,
rheumatism, neuralgia, and hypertension
Contraindications/precautions
a. Pregnancy (uterine stimulant) and lactation
b. Diarrhea
c. Hemorrhagic disease; discontinue 2 weeks before surgery
d. Hypermenorrhea
e. Hypotension
f. During cold or f u
g. Allergy to parsley
h. Breast cancer
Drug interactions
a. Dong quai interacts with anticoagulants such as warfarin (Coumadin)
b. Antihypertensives (hypotension)
Side effects
a. Photodermatitis may occur in people collecting the plant.
b. Burping, flatulence, and headache
Echinacea
Indications:
a. Internal use: supportive therapy for infections of the upper respiratory tract (cold) and lower
urinary tract
b. External use: local application for the treatment of hard-to-heal superf cial wounds and ulcers
Contraindications/precautions:
a. Echinacea is contraindicated in infectious and autoimmune diseases such as tuberculosis,
leukosis, collagenosis, multiple sclerosis, AIDS, HIV, and lupus.
b. Caution should be used in patients who are allergic to members of the ragweed or chrysanthemum
family.
Drug interactions
a. Unknown if echinacea interacts with immunosuppressants
b. Echinacea inhibits cytochrome P450 1A2. Some drugs metabolized by CYP1A2 are caf eine
(Cafcit) and theophylline.
c. Echinacea induces and inhibits CYP3A4.
Side effects
a. Nausea, vomiting, dizziness, tiredness
b. Allergic reactions, acute asthma, leukopenia, and anaphylaxis
c. May interfere with male fertility
Feverfew
We use this for prevention of migraines.
Indication:
Prophylaxis of migraine headaches
Contraindications/precautions
a. Feverfew should be avoided in pregnancy, lactation, and children “ 2 years of age.
b. Contraindicated in individuals with allergies to chrysanthemums or ragweed.
c. Contraindicated in patients with bleeding disorders. Discontinue 2 weeks before surgery.
5. Drug interactions
a. Feverfew may interact with anticoagulants, increasing the risk of bleeding.
b. Feverfew may inhibit the following cytochrome P450 isoenzymes
Side effects:
a. Gastric discomfort on oral consumption
b. Contact dermatitis
c. Minor ulcerations of oral mucosa, irritation of tongue, and swelling of lips may occur when
fresh leaves are chewed.
d. Palpitations
Fish Oil
Purported uses:
Hypertension, hyperlipidemia, mental health, bipolar, psychosis, depression, anticoagulant, coronary heart disease, stroke
Contraindications/precautions:
Seafood allergy, bipolar disorder, bleeding, cardiac disease, depression, diabetes mellitus, hypertension, immunodeficiency
Drug interactions:
a. Anticoagulants/antiplatelets/thrombolytics. Increase bleeding
b. Antihypertensives. Additive blood pressure reduction
c. Xenical, Alli, Orlistat. Decreased fish oil absorption. Recommended to separate by 2 hrs.
Side effects
a. Bleeding, ecchymosis (bruising), epistaxis (nosebleeds)
b. Hypervitaminosis A, hypervitaminosis D
c. Rash
d. Dyspepsia, eructation (burping), nausea/vomiting, diarrhea
e. Halitosis, dysgeusia (taste perversion)
Flaxseed
Alternative to fish oil. Derived from plant.
Purported uses:
Constipation, diarrhea, diabetes, menopause, hypertension, hyperlipidemia, coronary artery disease
Contraindications/precautions:
Bleeding disorders, diabetes, gastrointestinal obstruction, and hormone-sensitive cancers
Drug interactions
a. Anticoagulants/antiplatelets. Theoretically may have additive effects.
b. Antidiabetic agents. Theoretically may have additive effects.
c. Estrogens. Theoretically may have competitive effects.
d. Flaxseed may decrease the absorption of oral drugs. It is recommended to administer medications
an hour before or 2 hrs after taking flaxseed.
Side effects
a. Soluble f ber causes bloating, flatulence, abdominal pain, diarrhea, constipation, dyspepsia,
nausea.
b. Allergic reactions
Garlic
Lowers blood pressure. Can be like a weak statin, lowers cholesterol.
Indications:
Supports dietary measures for the treatment of hyperlipo-proteinemia and to prevent age-related changes in the blood vessels (arteriosclerosis).
Contraindications/precautions
a. Caution in diabetes. Garlic may increase the release of insulin or enhance the response to insulin.
b. Caution in pregnancy (emmenagogue and abortifacient) and lactation
c. Caution in peptic ulcer disease and gastroesophageal ref ux
d. Caution in bleeding disorders. Discontinue 2 weeks before surgery
Drug interactions:
a. Anticoagulants (increased bleeding)
b. Protease inhibitor, saquinavir (decreased ef cacy)
c. Nonnucleoside reverse transcriptase inhibitors, such as nevirapine, efavirenz (decreased efficacy)
d. Antihypertensives (hypotension)
e. Antidiabetic agents (hypoglycemia)
f. May induce the following cytochrome P450 isoenzymes: 2C9, 2C19, 3A4, 2D6, and 2E1.
Caution should be used with contraceptive medications, cyclosporine, diltiazem, and verapamil
(decreased ef cacy).
g. Isoniazid. Decreased efficacy.
Side effects: Gastrointestinal discomfort (heartburn, flatulence), sweating, light-headedness, allergic reactions, and menorrhagia
Ginger
Indications:
Dyspepsia and prophylaxis of symptoms of travel sickness
Contraindications/precautions:
a. Bleeding disorders. Discontinue 2 weeks before surgery
b. It is contraindicated for gallstone pain.
c. It is recommended by the American College of Obstetricians and Gynecologists (ACOG) for
use in pregnancy “ 17 weeks of gestation with the following cautions: Ginger is a uterine
relaxant in low doses and a uterine stimulant in high doses.
d. Diabetes (hypoglycemia)
e. Heart conditions may worsen because ginger has positive inotropic activity.
Drug interactions:
a. Antiplatelets and anticoagulants (increased bleeding)
b. Diabetic agents (hypoglycemia)
c. Calcium-channel blockers (hypotension)
Side effects:
Dermatitis, heartburn, and diarrhea.
Ginkgo
Indications:
a. Treatment for cerebral circulatory disturbances resulting in reduced functional capacity and vigilance (vertigo, tinnitus, weakened memory, and mood swings accompanied by anxiety)
b. Treatment of peripheral arterial circulatory disturbance such as intermittent claudication
Contraindications/precautions:
a. Epilepsy. Ginkgotoxin may cause neurotoxicity and seizures.
b. Bleeding disorders. Discontinue 2 weeks before surgery
c. Diabetes (hypoglycemia)
d. Infertility. Caution in dif culty conceiving.
Drug interactions:
a. Ginkgo may potentiate the bleeding properties of antiplatelets/anticoagulants.
b. Aminoglycosides (increased ototoxicity)
c. T iazide (increases blood pressure)
d. Trazodone (Desyrel) (coma)
e. Seizure threshold lowering drugs
f. Anticonvulsants (decreased ef cacy)
g. Antidiabetic drugs (hypoglycemia)
h. Ginkgo may mildly affect the cytochrome P450 isoenzymes
Side effects:
a. Gastric disturbances, headache, dizziness, and vertigo
b. Toxic ingestion may produce tonic–clonic seizures and loss of consciousness
c. Spontaneous bleeding; mild to severe (intracerebral hemorrhage)
Asian Ginseng
Remember: 28 active ingredients. Could be more. They isolated these to see what they do to the body, all hypocritical, some raise and some lower BP, cholesterol etc.
Don’t know exactly what ingredients you will get.
Indications:
Tonic to combat feelings of lassitude and debility, lack of energy, and ability to concentrate
Contraindications/precautions
a. Pregnancy and lactation
b. Children
c. Avoid in patients with hypertension, emotional/psychological imbalances, headaches, heart
palpitations, insomnia, asthma, inflammation, or infections with high fever.
d. Caution should be used in patients with a history of bleeding. Discontinue 2 weeks before surgery.
e. Diabetes (hypoglycemia)
f. Schizophrenia
g. Caution should be used in patients with a history of breast cancer. Ginseng may stimulate
breast cancer cells.
5. Drug interactions
a. Ginseng may interact with phenelzine (Nardil), producing hallucinations and psychosis.
b. Ginseng may decrease the INR of warfarin (Coumadin).
c. Ginseng may interact with stimulants, including caffeine
d. Ginseng may interact with oral hypoglycemic and insulin, causing hypoglycemia.
f. It may inhibit cytochrome P450 2D6. Caution should be used with drugs that are metabolized
via cytochrome P450 2D6, such as amitriptyline (Elavil) and f uoxetine (Prozac).
g. It may interfere with immunosuppressants such as cyclosporine (Sandimmune) or tacrolimus
(Prograf).
Side effects:
a. Nervousness, excitation, insomnia
b. Inability to concentrate with long-term use
c. Dif use mammary nodularity and vaginal bleeding may be caused by ginseng’s estrogen-like
ef ect in women.
d. Hypertension, euphoria, restlessness, nervousness, insomnia, skin eruptions, edema, and diarrhea
Milk Thistle
Indications:
Chronic inflammatory liver conditions and cirrhosis
Contraindications/precautions
a. Avoid in pregnancy
b. Allergy to chrysanthemums/ragweed
c. Hormone-sensitive cancers
Drug interactions
a. Milk thistle may inhibit cytochrome P450
Side effects:
include diarrhea and other gastrointestinal reactions (nausea, dyspepsia, flatulence) and allergic reactions
Saw Palmetto
Indications:
Treatment of micturition difficulties associated with benign prostatic hyperplasia
Contraindications/precautions: a. Avoid in pregnancy b. Avoid in children c. Discontinue 2 weeks before surgery 5. Drug interactions a. T eoretically, saw palmetto may interact with anticoagulants or antiplatelets. b. T eoretically, saw palmetto may interact with contraceptive drugs or hormone replacement therapy.
Side effects:
a. Intraoperative hemorrhage
b. Headache
c. Stomach upset, nausea, vomiting, diarrhea, constipation
d. Acute hepatitis and pancreatitis
St. Johns Wort
Indications:
In supportive treatment for anxiety and depression
Contraindications/precautions
a. Caution in fair-skinned persons when exposed to bright sunlight
b. Caution in pregnancy (emmenagogue and abortifacient)
c. No negative inf uence on general performance or the ability to drive a car or operate heavy
machinery has been reported.
d. Psychiatric conditions such as bipolar and schizophrenia may be exacerbated.
e. Alzheimer disease. St. John’s wort may induce psychosis
f. Hypothyroidism. St. John’s wort may increase thyroid-stimulating hormone.
g. Anesthesia. St. John’s wort may cause cardiovascular collapse.
h. Surgical procedures. Discontinue 2 weeks before.
i. Infertility. St. John’s wort may inhibit oocyte fertilization and alter sperm DNA.
Drug interactions
a. Antidepressants such as paroxetine (Paxil), sertraline (Zolof ), and nefazodone have been
reported to cause serotonin syndrome when taken with St. John’s wort.
b. Antiretroviral (protease inhibitors and nonnucleoside reverse transcriptase inhibitors) levels
may decrease.
c. St. John’s wort may decrease the ef cacy of barbiturates.
d. St. John’s wort may increase the ef cacy of clopidogrel (Plavix).
e. Cyclosporine (Sandimmune) levels may decrease.
f. St. John’s wort may interact with other drugs metabolized through the cytochrome P450
isoenzymes 1A2, 2C9, 2C19, and 3A4.
g. Digoxin (Lanoxin) levels may decrease.
h. Irinotecan (Camptosar) and imatinib (Gleevec) levels may decrease.
i. Methadone (Dolophine) levels may decrease.
j. St. John’s wort may decrease the ef cacy of omeprazole (Prilosec).
k. Oral contraceptives may have a decreased ef ect.
l. St. John’s wort may decrease the ef cacy of HMG coenzyme reductase inhibitors (simvastatin).
m. Tacrolimus (Prograf) levels may decrease.
n. T eophylline levels may decrease.
o. Triptans. T eoretically, St. John’s wort may interact with the triptans.
p. Verapamil (Calan, Covera-HS, Isoptin, Verelan) levels may decrease.
q. St. John’s wort may decrease the INR of warfarin (Coumadin).
r. Serotonergic agents such as dextromethorphan, fenf uramine, narcotics. Anticonvulsants. Phenytoin, phenobarbital, mephenytoin.
Side effects:
a. Photodermatitis, allergic reactions
b. Gastrointestinal irritations
c. Tiredness, restlessness, sleep disturbances
d. Elevated thyroid-stimulating hormone
e. Elevated blood pressure
f. Mania or hypomania
g. May cause infertility
