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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by GLYN on November 9, 2000, at 6:58:10
I've decided to build a web site which has info on the interactions and possible problems which can arise between prescription meds and the little known herbal remedies. I reckon people on prescription meds want to know which herbals are safe with what prescription meds - any wisdom, experience or knowledge of existing sources of this info would be appreciated.
ANybody had a bad interaction between certain herbs and AD's? Personal experiences and scientific knoledge please.
Glyn
Posted by Cam W. on November 9, 2000, at 7:17:44
In reply to Drug Interaction Info - Your Wisdom Please, posted by GLYN on November 9, 2000, at 6:58:10
Glyn -
http://www.vitamins.com/encyclopedia/Index/DRUGX.HTM\
This site has fairly comprehensive drug/dietary supplement interaction info, but I haven't used it as much as I would have liked. There are a couple of others that I can't think of right now. - Cam
Posted by shar on November 9, 2000, at 11:24:34
In reply to Drug Interaction Info - Your Wisdom Please, posted by GLYN on November 9, 2000, at 6:58:10
I've read that St. John's Wort (hypericum) works in ways similar to an MAOI and may have some of the same interactions as an MAOI and other meds and some of the eating restrictions may apply if you take SJW.
Unfortunately, I don't recall where I read this. It was a while back.
Shar
> I've decided to build a web site which has info on the interactions and possible problems which can arise between prescription meds and the little known herbal remedies. I reckon people on prescription meds want to know which herbals are safe with what prescription meds - any wisdom, experience or knowledge of existing sources of this info would be appreciated.
>
> ANybody had a bad interaction between certain herbs and AD's? Personal experiences and scientific knoledge please.
>
> Glyn
Posted by Cam W. on November 9, 2000, at 12:18:49
In reply to My info says St. John's Wort = MAOI mimic, posted by shar on November 9, 2000, at 11:24:34
> I've read that St. John's Wort (hypericum) works in ways similar to an MAOI and may have some of the same interactions as an MAOI and other meds and some of the eating restrictions may apply if you take SJW.
>
Shar - Actually, the MAOI activity reported in St.John's wort was due to a contaminant in the testing procedure. SJW has very little, if any, MAOI activity. - Cam
Posted by stjames on November 9, 2000, at 15:34:43
In reply to Drug Interaction Info - Your Wisdom Please, posted by GLYN on November 9, 2000, at 6:58:10
Good luck in your search, there is not a lot of interaction info on herbs. With the most common herbs we do know what the major actives are but herbs contain many substances, some are know and many are unknown. For this reason it is a grave mistake to assume herbs are safe in terms of interactions. We just do not know. If one takes
Comudin, an anticoagulant, herbs drastically effect the Comudin levels, lowering them. Many take Comudin because they have replacement heart valves. Without the correct level of Comudin there is a risk of clotting, heart attack, ect. This can be a deadly interaction.james
Posted by Sunnely on November 10, 2000, at 0:48:23
In reply to Drug Interaction Info - Your Wisdom Please, posted by GLYN on November 9, 2000, at 6:58:10
Hi Glyn,
Try this website specific for interaction between St. John's Wort (SJW) and other drugs including antidepressants.
http://www.citizen.org/eletter/ARTICLES/stjohnswort.htm
You may want to check this excellent website on grapefruit juice which include a section on its interactions with certain drugs. Also has link to other sites re: food/drug interactions.
http://powernetdesign.com/grapefruit/
Good luck.
Posted by JohnL on November 10, 2000, at 4:14:42
In reply to Drug Interaction Info - Your Wisdom Please, posted by GLYN on November 9, 2000, at 6:58:10
> I've decided to build a web site which has info on the interactions and possible problems which can arise between prescription meds and the little known herbal remedies. I reckon people on prescription meds want to know which herbals are safe with what prescription meds - any wisdom, experience or knowledge of existing sources of this info would be appreciated.
>
> ANybody had a bad interaction between certain herbs and AD's? Personal experiences and scientific knoledge please.
>
> Glyn
Glyn,
I've tried all kinds of herbs with all kinds of meds. You name it, I've probably tried it. There were only three situations that were troublesome.
1. Paxil+SJW can produce a situation very similar to serotonin syndrome, with extreme stupor, oversedation, and diarrhea. This never happened with any other ADs, even with doses of SJW up to 1500mg per day. Oddly, it only took 600mg+10mg Paxil to result in the horrible reaction, which occurred within 12 hours of dosing.
2. Yohimbe typically causes agitation, nervousness, angriness, anxiety. It's almost an agitated pyschosis-like condition. This can happen with or without drugs. But since it is an adrenergic herb, any AD that works on norepinephrine will increase these side effects. I think in very low doses Yohimbe could actually be a good potentiator of ADs. But in normal doses it is often just too much to handle.
3. Ma Huang. Since this is like taking ephedrine, it also increases the anxiety-like side effects that can be caused by elevated norephinephrine. Though it works by a different mechanism, the overall result is similar to the comments on Yohimbe.I've never had any problems combining Ginkgo, various Ginsengs, Valerian or anything else I can think of with ADs. But the above three examples warrant extra caution.
The PDR book used by physicians also has a volume for herbs. It states known reactions for each herb when combined with drugs. If you could get your hands on this book, it could be useful. I mean, for example, combining aspirin and ginkgo is not a cool idea. Another example, SJW can reverse the desired effects of H.I.V. medicines.
I was also browsing through one of those paperback all-about-herbs kind of books at a local pharmacy and it too had listed known contraindications of herb/drug combinations. But neither of the books I've mentioned are at all complete. They could however at least allow your own research to match equally what is available on the market, and then your own private research could add to it.
You could also go to www.mentalhealth.com and do research there. In the medication research section, you could erase the name of the medication and type in whatever herb you are interested in. If any studies on that herb have been done, you'll get to read abstracts of them. They often describe case reports of bad interactions of certain herbs with certain drugs. There is one such case describing exactly what I experienced on Paxil+SJW.
I wish researchers would put the effort into learning this stuff as much as you are. You deserve a lot of credit for your work.
John
Posted by Sunnely on November 10, 2000, at 23:56:58
In reply to Drug Interaction Info - Your Wisdom Please, posted by GLYN on November 9, 2000, at 6:58:10
Hi Glyn,
If I may add, caution with the regular use of the "G" herbs if you are also on a "blood thinner" such as warfarin (Coumadin), ASA acetylsalicylic acid (aspirin), valproate (Depakote, Depakene), and may be even the SSRI antidepressants (Prozac, Paxil, Zoloft, Luvox, Celexa).
The "G" herbs are comprised of Gingko, Ginseng, Garlic, Ginger, Guarana. These herbs have potential anticoagulant (blood thinning) and/or anti-platelet effects which may increase the risk of bleeding in some people, especially those on "blood thinner." This can lead to serious bleeding tendencies including stroke.
Theoretically, the concurrent use of these "G" herbs with SSRI antidepressants may also increase the risk of bleeding. The SSRIs, which enhance the action of serotonin have been reported to cause abnormal menstrual bleeding and other bleeding tendencies such as ecchymoses (easy bruising), petechaie (reddish small skin spots), epistaxis (spontaneous nose bleeding), gastrointestinal bleeding (bleeding ulcers), melena (blackish stool), and bleeding hemorrhoids. The mechanism as to how SSRIs increase bleeding tendencies may be related to their effect on serotonin. Under normal circumstances, platelets (blood particles responsible for clotting) release serotonin at the site of blood vessel tears, leading to further platelet aggregation and vasodilation (blood vessels enlarge). This permits sealing of the tear stopping the bleeding. It appears that the SSRIs block the reuptake of serotonin into the platelets which lead to a decrease in serotonin to be released by the platelets into the site of bleeding.
Incidentally, regular use of other herbs may also increase the risk of bleeding in some people and these include Dong quai, feverfew, licorice, vitamin E.
You should also be aware that Surgeons and Anesthesiologists advise that herbs be stopped at least 2 weeks prior to surgery.
Re: St. John's Wort (SJW):
There are several drugs (psych and nonpsych) that may interact badly with SJW. We still don't know the exact mechanism as to how SJW works as an antidepressant. It was suggested that it may have monoamine oxidase inhibition. However, some studies found that SJW possesses no inhibition of this enzyme. At least one study suggests that SJW inhibits the transport of serotonin similar to the SSRIs. To further the confusion, SJW contains many active ingredients but nobody knows exactly which one(s) is specifically involved in its antidepressant effect. Some authors opined that "hypericin" is the responsible ingredient while others suggest it is "hyperforin." Nonetheless, whatever the mechanism, it appears that SJW elevates the serotonin level as an end result. This elevation of brain serotonin may lead to "serotonin syndrome" when SJW is combined with other drugs with similar effect. This is a form of "pharmacodynamic" drug-herb interaction.
It has recently been determined that SJW induces (enhances) the action of a liver enzyme, CYP3A4, which can further enhance the metabolism of drugs that mainly depend on it for metabolism. This is a form of "pharmacokinetic" drug-herb interaction.
Based on the above forms of interactions, the following drugs (not complete list) theoretically, can lead to the following condition/effects if combined with SJW:
1. SSRIs (Prozac, Paxil, Zoloft, Luvox, Celexa) + SJW ----- > serotonin syndrome
2. MAOIs (Parnate, Nardil, Marplan) + SJW ---- > serotonin syndrome
3. TCAs (Elavil, Tofranil, Norpramin, Pamelor, etc.) + SJW ---- > serotonin syndrome
4. Carbamazepine (Tegretol) + SJW ---- > loss of anti-manic or anti-convulsant effect ---- > manic relapse, breakthrough seizure
5. Quetiapine (Seroquel) + SJW ---- > loss of antipsychotic effect ---- > psychotic relapse
6. Donepezil (Aricept) + SJW ---- > loss of Aricept effect
7. Piroxicam (Feldene), tetracycline + SJW ---- > increased skin sensitivity to sun
8. Warfarin (Coumadin) + SJW ----- > loss of blood thinning effect (risk of blood clot)
9. Digoxin + SJW ---- > loss of digixon effect ---- > heart failure
10. Theophylline + SJW ---- > loss of anti-asthma effect ---- > breakthrough asthma
11. Cyclosporine (Sandimmune) + SJW ---- > tissue rejection
12. "Triptans" for migraine (Imitrex, Zomig, Maxalt) + SJW ---- > serotonin syndrome
13. Anti-HIV drugs (Norvir, etc.) ---- > flaring up of HIV
14. Oral contraceptives + SJW ---- > loss of contraceptive effect ---- > risk of pregnancy, breakthrough bleeding
Re: SAMe, 5-HTP, , Tryptophan, Yohimbe, Passionflower, Ephedra:
1. Potential for serotonin syndrome if combined with SSRIs
2. Potential for serotonin syndrome and hypertensive crisis if combined with MAOIs.
Re: Kava, Melatonin, Valerian, Passionflower:
1. Potential for prolonged sedation even stupor if combined with benzodiazepines and nonbenzodiazepine sedative-hypnotics. (A case of semi-coma was reported due to combined use of Xanax and Kava.)
2. Kava + Anti-parkinsonian drugs ---- > worsening of parkinson's
symptomsRe: Caffeine:
1. Lithium + Caffeine (in excess) ---- > loss of lithium effect ---- > manic relapse
2. Clozaril, Zyprexa + Caffeine (in excess) ---- > increased blood level of Clozaril, Zyprexa ---- > increased side effects of Clozaril and Zyprexa
Re: MAOIs:
1. Foods rich in tyramine + MAOI ---- > hypertensive crisis
2. Tryptophan + MAOI ---- > serotonin syndrome
3. SRI (serotonin reuptake inhibitors) + MAOI ---- > serotonin syndrome
4. "Ecstacy" + MAOI ---- > serotonin syndrome
5. Meperidine (Demerol) + MAOI ---- > serotonin syndrome
6. Dextromethorphan (Robitussin DM) + MAOI ---- > serotonin syndrome
7. Colds tablets (with phenylpropanolamine, pseudoephedrine) + MAOI ---- > hypertensive crisis (even stroke)
Re: Char-broiled foods, broccoli, Brussels sprouts and cigarettes ("smokes and sprouts" reaction):
1. Clozaril, Zyprexa + "smokes and/or sprouts" ---- > potential loss of antipsychotic effect ---- > psychotic relapse.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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