Cited by 809Complementary and Alternative Medicine StudiesPhytochemistry Medicinal Plant ApplicationsMedicinal Plant Research

Herbal Medicinals: Selected Clinical Considerations Focusing on Known or Potential Drug-Herb Interactions

Miller, Lucinda G.·1998·Archives of Internal Medicine

Abstract

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 in the treatment of 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.

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Crossref · 10.1001/archinte.158.20.2200

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Authors
Miller, L. G.
Affiliations
Texas Tech University Health Sciences Center (US)
Corresponding author
Miller, Lucinda G.
Venue
Archives of Internal Medicine
Published
1998-11-09
Volume
158
Issue
20
Pages
2200
ISSN
0003-9926 (ISSN-L)
OpenAlex
W2060313926
Cited by
809
References
117
Citations by year
2026: 1 · 2025: 7 · 2024: 11 · 2023: 9 · 2022: 8 · 2021: 12 · 2020: 14 · 2019: 10 · 2018: 12 · 2017: 14 · 2016: 12 · 2015: 25 · 2014: 28 · 2013: 28 · 2012: 26
FWCI
104.66
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
  • Life Sciences › Agricultural and Biological Sciences › Plant Science › Phytochemistry Medicinal Plant Applications
  • Life Sciences › Agricultural and Biological Sciences › Plant Science › Medicinal Plant Research
Keywords
herbal medicine, herb-drug interactions, Echinacea, hepatotoxicity, pyrrolizidine alkaloids, feverfew, nonsteroidal anti-inflammatory drugs, migraine, warfarin, bleeding time, ginseng, phenelzine, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, Valeriana officinalis, digoxin, antiepileptic drugs, seizure threshold, kava, immunostimulants, immunosuppressants, licorice, iron absorption, thyroid hormone replacement, blood glucose, diabetes mellitus, Ayurvedic formulation, tannic acid
MeSH terms
Drug Interactions, Humans, Phytotherapy, Plant Extracts, Plants, Medicinal, Herb-Drug Interactions

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