Drug Herb Interactions: Pulling weeds

According to a 2008 survey collected by The National Center for Complementary and Alternative Medicine, 38% of Americans are choosing Complementary and Alternative Medicine (CAM). The Survey included 23,393 people, of diverse ethnic/racial, age, and economic backgrounds.

While 23,000 is only a small peek into the nation’s population, it does represent a portion of the 34 billion dollars spent on CAM in 2007, which is 1.5% of total health care expenditures in the United States. We live in an exciting time when traditional therapies that were thought to be ineffective or “woo woo” by western or allopathic medicine are becoming researched, validated, and integrated into mainstream medicine. We now have an opportunity to choose a health care plan that may actually prevent disease and encourage a better quality of life.

Even culinary herbs can be "low dose" herbal remedies.
Even culinary herbs can be “low dose” herbal remedies.

There are responsibilities that come with participating in a holistic health care plan, primarily because you are in charge of the direction that you take — and you can get lost. For starters, natural medicine is readily available. There are an overwhelming array of products to choose from in every grocery, health food and drug store. While there are many qualified practitioners now available to guide the consumer, such as naturopathic physicians, herbalists, chiropractors and acupuncturists, we are at the same time being inundated with advice from invisible sources that may not be accurate or safe. Mixing drugs, herbs and food can be dangerous if done haphazardly.

Naturopathic medicine is rooted in identifying a unique and individualized diagnosis and treatment rather than a one size fits all approach.

Running to the store to grab an herb, supplement, or pharmaceutical to treat an ailment may not always result in the desired outcome.

The media is abuzz with concern for safety and efficacy regarding herbal medicine. It would be a mistake, however, to ignore the demonstrated benefits of traditional herbal medicine due to fear. With so much information available, both good and bad, we need to pull the weeds. First, plant medicine has a very rich history and in the case of drugs such as digoxin and pseudoephedrine – it is the origin of medications that are being prescribed by mainstream medicine. Also know that, people are ingesting very low “doses” of herbs in the form of seasoning, herbal tea, and remedies that are not typically considered a therapeutic dose, everyday. Most people do not consume enough to cause harm, even when taken in combination with a pharmaceutical.

We also need to consider that our bodies are very different from one another and just because a medicine is found to have “no side effects” or  “safe” does not mean it will be true for you. This is true with synthetic as well as natural medicines. Herbal remedies are traditionally harvested conscientiously, used in a whole plant form, and “prescribed” by a practitioner or herbalist who is well versed in the use of herbs; but when products are bought right off the shelf, willy nilly, from unknown sources, it’s a case of buyer beware.

Therefore, finding a provider to help you sort through the products and information is key to developing a safe and effective care plan.

According to a 1998 Meta analysis published in the Journal of the American Medical Association, adverse drug reactions (ADR) account for 100,000 deaths per year, making ADR one of the leading causes of death in the United States. The reactions range from mild to severe for more than 2 million people each year. This data certainly suggests that ADR’s are a serious clinical issue. Even the less drastic reactions, such as change in mood, loss of appetite, and nausea may seriously diminish quality of life.

Most herb reactions produce mild symptoms of rash or upset stomach. Herb-Drug Interactions (HDI) are typically also very mild. The more serious include the herb enhancing or decreasing the efficacy of the pharmaceutical. The most serious risk exists in the realm of anesthesia-related HDI interactions. Adding to the complexity and possibility for HDI, phytochemists continue to find herbs elusive. They are able to determine certain effects on the body, both positive and negative, and identify many of the constituents but, for most plants, the mechanism of action is unknown. Hence, the risk for HDI certainly exists but the severity, danger, and risk remains individualized, dose dependent, poorly documented, and deserves more attention from researchers.

I have great respect for the power of herbs. While I am curious and versed in the science of herbal medicine, I am most passionate about the energetic properties of herbs. The energetic property is the thing that grabbed the attention of ancient healers in the first place, and for me it is most intriguing and comforting. Often the appearance, the smell, or the taste is attractive, but so is the way plants make me feel when I meditate on the wisdom and the healing power of nature. I use plants regularly, for nourishment and healing with my patients and with my family.

My approach to the use of herbal medicine in my practice is guided by traditional practices, science, and some general rules that I learned in medical school:

1.  If someone is taking any drug and wishes to take herbs as well, it is best they seek the advice of a professional trained in herbal therapy.

2.  I am very careful with drugs that have a narrow therapeutic window such as digoxin, warfarin, anti-rejection drugs, and many anti-HIV drugs

3.  I am always cautious with the following patients: the elderly, those with impaired health, liver and/or kidney function, those with metabolic and/or biochemical abnormalities, and those who are potassium depleted.

4.  I recommend taking drugs and herbs at different times of day. Always separate them by at least an hour, preferably more.

5.  I recommend that patients stop all herbs about one-two weeks prior to surgery and discuss a pre/post operative plan with your CAM provider.

6.  I research any herbal supplement I wish to prescribe to see if there are known (not-speculative) HDI.

7.  I instruct my patients to report any suspected HDI to me.

8.  I remind my patients that some drugs require careful control for their effects to be maintained, such as antihypertensive and anti-diabetic drugs, and that herbs can change the metabolism of these drugs, decreasing and/or increasing their efficacy.

9.  The use of antioxidants (including herbs) in conjunction with chemotherapy and radiotherapy for cancer is controversial. I use herbs that may compliment therapy and always recommend discontinuing herbs 48 before and after chemotherapy.

10.  I use reliable sources for HDI and I take into consideration the potential HDI according to the level of evidence behind them.

11.  I take into consideration that HDI will be dose-related.

12.  I always educate patients about buying by quality herbs and supplements.

image courtesy: word ridden