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Play Nice Pairing Herbs with Meds

Understand the most common herb-drug interactions, so you can add herbs to your wellness routine safely.

| November/December 2018

  • Take precautions to minimize the risk of combining herbal and conventional medicines.
    Photo by Adobe/olgasun
  • Older Americans are more likely to take multiple supplements and pharmaceuticals.
    Photo by Adobe/WONG SZE FEI
  • St. John’s wort, often used for mood stabilization, may interact with similar medicines.
    Photo by Adobe/Vesna Cvorovic
  • Licorice is so common that many folks don’t think of checking for interactions.
    Photo by Getty/mirzamlk
  • Black cumin seed may affect certain liver enzymes’ functions.
    Photo by Adobe/airborne77

Americans are popping more pills than ever, and the older we get, the more meds, herbs, and dietary supplements we take. Approximately 60 percent of all adults — and 90 percent of elders — take at least one pharmaceutical.

Meanwhile, 76 percent of adults use dietary supplements. Although most dietary supplement use consists of vitamins and minerals, one-fifth of Americans take medicinal herbs each year. Unfortunately, with greater consumption of all these substances in combination comes a greater risk for interactions. Fortunately, if you take pharmaceuticals, you can take a few steps to ensure safe herb use alongside them.

Herb-Drug Interactions in Perspective

Certainly, we should take herb-drug interactions seriously and do our best to avoid them. However, it helps to gain a little perspective on the fear and hype around herb-drug interactions. Though some serious interactions really do exist, the risk and severity of most herb-drug interactions appears to be relatively low and largely theoretical. On the contrary, with more Americans (particularly elders) taking several pharmaceuticals together, the risk for potentially severe drug-drug interactions is more likely.

Case in point: One study of nearly 500 outpatient veterans found that 43 percent were taking at least one dietary supplement alongside their prescription medications. The researchers analyzed the potential interactions these veterans were exposed to, and found that 45 percent had the potential for a drug-dietary supplement interaction — yet 94 percent of the interactions predicted were not expected to pose a serious danger. This left only 6 percent of the study participants (30 people) at risk of a serious drug-dietary supplement interaction. Meanwhile, drug-drug interactions represent nearly 20 percent of all drug-related adverse effects. The data for death due to dietary supplements is less thorough than that for death due to pharmaceutical drugs, but while more than 100,000 people die annually because of adverse drug effects in general, data from the American Association of Poison Control Centers attributes less than one death per year to the use of herbal and dietary supplements.

Herbs are overall quite safe compared with pharmaceutical drugs, but they can indeed have side effects, and some herb-drug interactions may be severe. Drugs for energy, weight loss, libido, and sports performance have the highest risk of severe side effects and interactions. Here are some steps you can take to safely combine herbal supplements with pharmaceuticals.

Common Herb-Drug Interactions

Some herbs and pharmaceuticals are more prone to interactions than others — and that’s not necessarily a bad thing. Synergistic interactions increase a drug’s activity or effects, while antagonistic interactions decrease them. Herbs may also affect a drug’s clearance from your system (or vice versa). We’re focusing here on how to avoid potentially damaging herb-drug interactions, but many positive herb-drug interactions also exist. For example, combining berberine derived from goldenseal with antibiotics reduces bacteria’s ability to become resistant to the medications; and studies have found that combining curcumin from turmeric with fluoxetine (commonly sold as Prozac) increases the drug’s efficacy in alleviating major depression.

By far, the two greatest areas of potential for real, detrimental herb-drug interactions surround blood-thinning medications (with many herbs) and St. John’s wort (with many drugs).

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