Get a Handle on Herb-Drug Combinations

What’s safe, what’s not? We help you sort out your medicine chest.


| November/December 2005


Lately, some scary headlines have warned that simultaneous use of medicinal herbs and common drugs can be dangerous. Well, yes and no. Herb users should certainly understand the potential risks of botanical medicines and take care to avoid some herbs before surgery and while taking certain pharmaceuticals. But despite the nerve-rattling headlines, the problem of herb-drug interactions is a minor issue compared with the problems caused by prescription drug side effects.

In 2004, a team of research pharmacists at the University of Pittsburgh surveyed 458 Veterans Administration (VA) hospital patients in Pittsburgh and Los Angeles about their use of drugs and supplements (vitamins and herbs). Almost half of the respondents said they took supplements while also taking prescription medications. Most VA patients are older men. Their most common herbs included garlic (Allium sativum), ginkgo (Ginkgo biloba), Asian ginseng (Panax ginseng) and saw palmetto (Serenoa repens), the best herb for preventing and treating prostate enlargement. The researchers noted that about half of those mixing drugs and supplements faced potentially risky interactions. However, of the herb-supplement interactions they analyzed, a whopping 94 percent were not found to be serious.

Contrast this with what University of Toronto researchers discovered in a 1998 review of serious drug side effects among U.S. hospital patients spanning 30 years (1966 to 1996). This study did not look at drug overdoses or prescribing errors but serious side effects from drugs taken as prescribed. The researchers estimated that more than 2 million hospital patients a year suffered serious drug side effects; these side effects killed 106,000 patients annually, making drug side effects the nation’s fifth leading cause of death.

These two studies clearly show that from a public health perspective, pharmaceuticals are the problem, not herbs or herb-drug interactions. That said, however, herbs should be used carefully and safely — and herb users should understand interactions that might cause problems.

The Main Problem: Anticoagulant Herbs Before Surgery

The woman had breast cancer, and surgeons at the University of Colorado Health Sciences Center in Denver performed a mastectomy that should have been routine. But shortly after she was sewn up, this woman hemorrhaged and required additional surgery — traumatic and expensive — to close the bleeding blood vessels in her chest. Why did she bleed so unexpectedly and so profusely? Prior to surgery, she’d taken ginkgo, ginseng and dong quai (Angelica sinensis) — without knowing that all three herbs impair blood clotting, and without telling her doctors.

At M.D Anderson Cancer Center in Houston, a man had surgery to remove a brain tumor. Afterward, he bled profusely and required two additional surgeries to stop the bleeding. The surgical team could not figure out why the man bled. Then, during a follow-up appointment, the patient’s wife casually mentioned that her husband drank a lot of ginseng tea, which is anticoagulant. All of the trauma, time and expense of those additional surgeries could have been avoided if someone had asked him about his herb use — and told him to stop using ginseng two weeks before surgery.





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