Beware of mixing herbal remedies with prescriptions

PORTSMOUTH — Many people today take common herbal and over the counter medications, believing they are safe, and for the most part they are, but mixing them with prescription medications can have unexpected and sometimes dangerous results.

Herbal medications like melatonin, ginko biloba, garlic and St. John’s Wort are commonly found in medicine cabinets. While they are not regulated by the Food and Drug Administration, they are generally trusted as safe.

On their website, the Centers for Disease Control has the following statement on the use of supplements and their interaction with prescription drugs. “All medications can cause side effects, which may lead to new symptoms or worsen existing symptoms, so it is important to monitor routinely all prescription drugs, over-the-counter medicines, and supplements. It is also important to be mindful of possible interactions.”

Because many of them can have adverse reaction when combined with prescribed medication, doctors encourage their patients to let them know what supplements they are taking so they can discuss how they will react with a medicine the doctor is about to prescribe.

Dr. Kasra “DJ” Djalayer is an internist at Families First Health and Support Center, part of Greater Seacoast Community Health. He has practiced medicine in Europe, the Middle East and Canada and has vast experience in these herbal/prescription interactions. He is board certified in obesity and metabolic diseases.

Djalayer said it is very important for patients to tell their doctors everything they are taking, even herbal medicines that they assume are safe. He said some of the herbals can have side effects which can deteriorate a patient’s health. Plus, there are multiple interactions among herbal/OTC medications and medications prescribed by a doctor.

“Numerous interaction between herbal/OTC medicines and conventional drugs have been documented which can cause serious clinical consequences,” said Djalayer. “It ranges from toxic effects to direct harm to the patient.”

Djalayer said the risks are too many to discuss all. He said that makes it key to discuss what you are using with your doctor.

“The risks can be serious and can include spontaneous bleeding, decreased heart rate, increased heart rate and/or heart attack,” said Djalayer. “They can cause a rapid clearance of different medications from the patient’s body which is necessary for the patient health status, as well as decreased clearance of medication which has been prescribed by the physician in charge. This can cause serious side effects for the patient.”

“There can be increased seizure activity, high blood pressure, changes in kidney function, a manic state in the patient, intermenstrual bleeding, delirium insomnia, diarrhea, fever, headache, low blood sugar, increased off periods in Parkinson patients, confusion and coma and many more.”

Dr. Joshua Kahane from Core Physicians primary care in Exeter said another reason patients should discuss herbal and OTC supplements with their doctor is that it can be very difficult to know what is in these medications and how they might interact with other prescribed medications.

“But there is no chance of picking up on interactions if we are not aware of what folks are taking,” said Kahane. “This is especially important for patients on medications like Warfarin.”

Djalayer provided a few examples of the potential interactions between supplements and prescribed medication.

Garlic: Use of garlic with prescribed coumadin can cause bleeding and increase in the international normalized ratio(INR). There can be an increased risk of low blood sugar in those diabetic patients taking garlic and chlorpropamide. Garlic can influence paracetamol level in the body; it interacts with chlorpropamide, ritonavir and warfarin.

St. John’s Wort: Use with oral contraceptives can cause intermenstrual bleeding, delirium and confusion. Use with loperamide can cause fever, increased heart rate, palpitation, confusion and coma. St. John’s Wort reduces the plasma concentrations of Xanax, amitriptyline, Lipitor, cyclosporine, digoxin, erythromycin, indinavir, methadone, warfarin, and oral contraceptives.

Ginko Biloba: There can be spontaneous bleeding when combined with coumadin, raised blood pressure when combined with a thiazide diuretic and coma when combined with the sleep medication trazodone. It decreases the plasma concentration of omeprazole, ritonavir and tolbutamide and interacts with antiepileptics, aspirin, diuretics, Advil, risperidone, trazodone and warfarin.

Ginseng: Can induce a manic episode with headache and the inability to sleep when combined with phenelzine. It can also interact with Warfarin.

Kava: This can result in increases in “off” periods in Parkinson patients taking L-dopa and can cause a semi-comatose state when used with Xanax, cimetidine, and terazoine.

Doctors should be asking patients if they do not volunteer the information on their own.

“At physicals I tend to ask, ‘do you take any other medications not prescribed by a physician,’” said Kahane. “Often people say yes, I take supplements but don’t have a list of them with me. I would recommend patients carry a list of their supplements and dosages.”