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Be Wary Of Mixing And Matching Herbs And Drugs

Posting Date: 01/31/2000

There is an unspoken "don't ask, don't tell" policy at work in most doctors' offices. Physicians don't ask and patients rarely tell about herbs and dietary supplements.

Many people worry that their doctors will disapprove of products such as ginseng or ginkgo, so they don't mention what they are taking. But their silence could be deadly.

Researchers are gradually uncovering dangerous interactions between herbs and medications. With millions of people taking herbs to improve memory, enhance energy and relieve depression or hot flashes, there is a tremendous potential for problems.

Even people who are candid about their use of alternative remedies may not get much useful advice from their health care providers. Very few physicians or pharmacists have received in-depth training in uses, side effects or interactions of medicinal plants.

In a recent issue of The Lancet (Jan. 8, 2000), Dr. Adriane Fugh-Berman discusses interactions reported in the medical literature. As she points out, "Concurrent use of herbs may mimic, magnify, or oppose the effect of drugs."

St. John's wort, for example, is taken by millions of people to treat winter blues, insomnia, mild depression, PMS or other problems. But people who take this herb along with a prescription antidepressant such as Desyrel, Paxil, Serzone or Zoloft may experience something called "serotonin syndrome." Possible symptoms include tremor, nausea, digestive tract upset, restlessness, headache, muscle pain and confusion.

The heart medicine Lanoxin (digoxin) may not work as well in combination with St. John's wort. Asthma drugs containing theophylline and oral contraceptives could also be less effective when taken with this herb.

People on the anticoagulant Coumadin (warfarin) are frequently cautioned about its potential for interacting with certain foods or other medicines. But they are rarely told that many herbs can adversely impact its action. Astragalus, dong quai, feverfew, garlic, ginkgo, ginseng, goldenseal, papaya and pau d'arco could be incompatible with Coumadin.

Licorice is a common ingredient in herbal teas and medicines. It is also a popular candy, but people should be cautious about combining licorice with medicines such as prednisone or hydrocortisone. Lanoxin and Lasix could be lethal if licorice depletes potassium from the body.

Even more alarming is the Chinese medicine ma huang (ephedra). This ingredient is cropping in energy pills and herbal diet formulations. When taken with certain migraine medicines or antidepressants, blood pressure can go sky high and lead to a stroke.

People who take both herbs and medications must do their homework. Our new book, The People's Pharmacy Guide to Home and Herbal RemediesThe People's Pharmacy Guide to Home and Herbal Remedies, discusses many of the most dangerous combinations.

It's time to end the conspiracy of silence surrounding herbal supplements. Physicians should inquire about their use. Patients should volunteer information on what alternative treatments they are trying. Together they may be able to prevent dangerous interactions.