Herb Drug Interactions

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More attention and research is being directed toward drug-herb interactions. Most of the focus in the media is based on negative interactions, but there are positive interactions as well. Comparing herbs to drugs is kind of like comparing apples to oranges. Drugs are synthetic agents, but herbs are more akin to foods, containing a multitude of compounds. When considering herb/drug interactions, looking at food/drug interactions becomes part of the picture.

There is a well-documented interaction between grapefruit juice and calcium channel blockers. Calcium channel blockers are a class of drugs used to treat high blood pressure. Chasing these drugs down with a cup of grapefruit juice increases their blood levels. There are other drugs whose levels can be increased by taking them with grapefruit juice too, so it is a good idea to just avoid taking medication with grapefruit juice. Other citrus juices donÕt do this, so itÕs OK to take your pills with orange juice.

Spicy foods such as chiles and pepper increase stomach blood flow, consequently increasing the absorption rate of many drugs. Curiously there is some evidence that peppers, including chiles, protect the stomach from the adverse effect of irritation caused by aspirin, if taken 30 minutes before the aspirin. I donÕt know, maybe your stomach is already irritated and just doesnÕt know left from right.

On the other hand, mucilaginous foods like oatmeal decrease the absorption rate of drugs if taken at the same

time. Mucilaginous herbs such as Slippery Elm, Marshmallow, and Malva also have this effect. This is because these foods and herbs coat and protect the stomach, so there is a delay in absorption. This quality is also what makes them helpful in treating an inflamed stomach.

Coffee and tobacco enhance the elimination of many drugs by increasing their metabolism through the liver. Mustard also tends to increase metabolism.

Bromelain is a food supplement made from the pineapple. It is used to aid digestion and is anti-inflammatory. Like grapefruit juice it can increase blood levels of some drugs, such as tetracycline and some chemotherapy drugs if taken together. Hawthorne is a popular heart tonic herb, and can slightly increase the levels of heart medications like Lanoxin. Siberian Ginseng has been shown to enhance the efficacy of the drugs monomycin and kanamycin when treating gastrointestinal infections.

A number of Chinese and Ayurvedic (east Indian) herbs have been used with chemotherapeutic drugs for cancer to decrease the incidence of chemotherapy related side effects.

Valerian and Kava are two of a number of anxiety reducing herbs. There is likely an additive effect between these herbs and sedating drugs like the benzodiazepines (Valium, Xanax, Ativan). By the way, the Kava scare in the media several months ago was greatly exaggerated. Only about one person in 170,000 lacks the enzyme involved in metabolizing Kava, and yes, excessive use of Kava over a long period, on a daily basis, can cause liver toxicity. Actually, most drugs are metabolized by the liver, and some such as birth control pills, and anticonvulsants are harder on the liver. Acetaminophen (Tylenol) has been responsible for far more deaths from liver failure that Kava. Chaparral (Larrea Tridentada ) can also be toxic to the liver when taken too frequently or excessively. The caution to keep in mind is if your liver is already overloaded or compromised, donÕt use Kava, Chaparral, or drugs that add more load to your liver. In any case, exercise moderation. Milk Thistle comes in handy here because it is protectant to liver cells, and can offset potential liver overload while not altering the drugsÕ effectiveness.

St. JohnÕs Wort has been the recipient of considerable research. Interactions of note are, only use it in combination with other antidepressants (Paxil, Prozac, etc.) with the supervision of a knowledgeable clinician. A high dose of either of these together may cause dangerously elevated levels of the neurotransmitter, Serotonin. Because of similar metabolic pathways, St. JohnÕs Wort can interfere with the effectiveness of birth control pills, calcium channel blockers, some anticonvulsant drugs and antiretroviral drugs used to treat HIV and AIDS.

Ginkgo Biloba, garlic, and ginger thin the blood and shouldnÕt be used with anticoagulants like Coumadin, or for that matter with aspirin too as the combinations can thin the blood too much, potentially causing hemorrhage.

MaHuang is a frequent addition to weight loss formulas. It is traditionally used in Chinese medicine for the treatment of allergies and asthma. MaHuang is also energizing, but must be used with care, and only when appropriate. It should not be used by anyone with high blood pressure or anyone on heart medications. It can cause anxiety and palpitations and has been implicated in dangerous overheating when used to increase energy during heavy exercise, especially in the heat.

Licorice root is another herb to use only in moderation. Excessive or prolonged use can cause mineral imbalance, water retention and high blood pressure. Taken correctly however, Licorice root and Siberian Ginseng are protective to the adrenal glands. They are helpful to nourish the adrenals back to health after chronic exhaustion or after corticosteroid therapy.

The additive effects of many of these drugs combined with herbs can be used to advantage. When prudently combined and monitored a lower drug dose can often be achieved resulting in therapeutic effectiveness and reduced side effects. Doctors in Germany commonly combine Hawthorne with the heart drug Lanoxin for this purpose.

Antibiotics are another example of positive interactions. Antibiotics kill bacteria, the good and the bad. Yeast infections are a common result of antibiotic use. Taking acidophilus and other probiotics re-establish normal flora, reducing the incidence of opportunistic yeast infections. Echinacea is good to take with antibiotics too because while antibiotics are busy trying to kill bacteria, Echinacea strengthens the immune system. This is becoming more important in this era of antibiotic resistant bacteria. It is just as important to have a strong immune system to fight off infection, as it is to rely on drugs to kill the infection. Herbs are well suited to building an adequate immune response.

Lastly, a general rule. An additive effect may occur if an herb and a drug have similar actions. Antagonistic effects are likely to occur if a drug and an herb have opposing actions.

Deborah Brandt is a clinical herbalist at From the Ground Up in Las Cruces.

Filed Under: herbs Botanicals

Tags: absorption rate, adverse effect, drug interactions, grapefruit juice, marshmallow