Appendix K

COMMON HERBAL REMEDY - DRUG REACTIONS

Adverse Events When Herbs are Taken with certain drugs

GINKGO BILOBA (Alzheimer's and vascular dementia; peripheral vascular disease, erectile dysfunction, and tinnitus)

Aspirin - Spontaneous hyphema
Warfarin (Coumadin) - Intracerebral hemorrhage
Thiazide diuretic - Hypertension
Acetaminophen and ergotamine/ caffeine - Subdural hematoma

ST. JOHN'S WORT (mild depression)

Protease inhibitors, cyclosporine (Sandimmune), theophylline, warfarin - Induction of CYP450 3A4 system with decreased levels of drugs available
Digoxin (Lanoxin) - Decreased drug absorption from the gut
Selective serotonin-reuptake inhibitors - Lethargy / incoherence/mild serotonin syndrome

SAW PALMETTO (benign prostatic hypertrophy)

No specific drug interactions
Headaches, GI upset

GINSENG (cure-all herb)

Warfarin - Decreased INR
Alcohol - Increased alcohol clearance
Phenelzine (Nardil); MAOI) - Headache, tremor, mania

YOHIMBINE (sexual dysfunction)

Tricyclic antidepressants - Hypertension

SENNA, CASCARA (laxative)

Possible interference with any intestinally absorbed drug - Decreased drug availability

CYP450 = cytochrome P-450; GI = gastrointestinal; INR = International Normalized Ratio;
MAOI = monoamine oxidase inhibitor

Information from Fugh-Berman A. Herb-drug interactions. Lancet 2000;355:134-8.

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