In being close with plants and using herbs daily I need to discuss the issue of herb-drug interactions. This subject has been given an extraordinary amount of attention over the twenty five years. There are countless articles in medical journals, the Internet, the press and books on these topics, but I have not seen any drug-herb interaction. I have seen drug-drug interactions. This is due to the fact that patients go from doctor to doctor. The doctor fails to ask about new medications especially if this is a long time patient of the primary physician. With the number of "articles" on herb-drug interaction you would think there would be an overwhelming high mortality. This is not the case. Once again, the media and medical paranoia has overblown this topic. Since I use all herbs I would like to comment on the cardiac herbs I use which could potentially have an interaction with some of the conventional drugs. Many of my cardiac patients are on a 'water pill' as furosemide or lasix. I use one herb and one amino acid as natural diuretics. these are dandelion and L-taurine. I use them with lasix and never have a problem. Sometimes I even decrease the lasix dose. I perform diligent blood test chemistry analysis to watch for lowering of the electrolytes as potassium and sodium. Since herbs are drugs I would use some of these herbs with the guidance of a health care professional. One of my favorite herbs/flowers are Convallaria, also known as Lily of the Valley. I use this herb for control or conversion of an arrhythmia, atrial fibrillation. The individual might also be on digoxin which also is a plant derivative called Foxglove. Since both are cardiac glycosides there can be an interaction and a lowering potentiation of the heart rate to rates less than 60
The one conventional drug I am careful with is warfarin also known as coumadin. Coumadin works on the hepatic (liver metabolism) using a special pathway. Coumadin thins the blood. Any other drug or even herb that works through the same mechanism can unbalance the thinning of the blood. The special pathway is the CYP450 pathway. It has been written that cranberry juice interferes with this pathway and can interact with coumadin. However studies indicate there is no inhibitory effect when the both are taken together.
When it comes to foods, as green leafy vegetables there is always concern. Not for me. Green leafy vegetables as broccoli, spinach, collard greens contain Vitamin K which can interfere. Instead of stopping all green leafy vegetables which are beneficial to your health, maintain a steady rate of consumption of the greens which taking the coumadin. There are some herbs with Vitamin K that I feel are important to know. These are Nettle's, Spirulina, Shepherd's Purse and Alfalfa all contain Vitamin K. I would not stop these herbs if a patient is on coumadin, but let the individual know of the interaction. I also let patient's know that the herbs, ginkgo and garlic,a s well as the nutrients oils, coenzyme Q10 and Vitamin E can thin the blood. These work through a different mechanism unlike the Vitamin K -coumadin interaction.
Some herbs have an mild to moderate inhibitory effect on this CYP450 pathway. Some of these herbs are ginger, garlic, tumeric, sage and thyme. There are others.
The take away point of knowledge today is this:
There is more of a chance of a drug-drug interaction, than a drug-herb interaction. It has been postulated that if an individual is on 6 of more conventional medications ( which is not uncommon ) the likelihood of an interaction approaches 100%
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Until tomorrow…