Guest guest Posted November 7, 2001 Report Share Posted November 7, 2001 The following is a pretty good article-it also gives some sites to look up information on. gail Message: --------------------------------- The following is a Health Related Article from: ImmuneSupport.com <http://www.ImmuneSupport.com> Article Entitled: Drug and Supplement Interactions: What CFS and Fibromyalgia Patients Need to Know , Written W. Addington Many are aware of alcohol consumption warnings when prescribed certain medications. But not as well known is the interaction vitamins or herbs can have with some pharmaceutical drugs. This is a particular concern for many Chronic Fatigue Syndrome (CFS) and fibromyalgia (FM) patients. Individuals suffering with CFS and FM understandably are often seeking a variety of means to manage their symptoms, from more traditional medications to natural supplements. But as this article will detail, CFS and FM patients should be cognizant of the potential risks that exist when combining drugs and supplements. It is not surprising that those opposed to alternative remedies are the strongest advocates of the dangers of drug-supplement combinations. To put this discussion in perspective, it’s good to note that synthetic medications are much more likely to cause negative side effects, even when taken by themselves. As quoted in a recent Lancet article, " Poisons and medicines are oftentimes the same substances with different intents. " And, of course, adverse consequences from an interaction of two different drugs is fairly common. Conversely, natural supplements can often ameliorate the negative side effects of various medications. Searching the database of free articles at ImmuneSupport.com can be of great assistance in learning more about this topic. Another great free source of information is The Natural Pharmacist at www.tnp.com. Searching for any condition, drug, or supplement at that site, can lead you to natural supplements that may help you avoid adverse drug reactions. Especially beneficial at that site, however, is the " Drug Interactions " database, which includes useful explanations of supplements described as " Possible Helpful Interaction " or " Possible Dangerous Interaction. " Pain Medications There are a number of supplements which can potentially result in unwanted interactions with painkillers, depending on the combination taken. One study showed high amounts of acetaminophen (Tylenol) and vitamin C taken together might result in acetaminophen toxicity. Taking the herbs chaparral, comfrey, or coltsfoot with acetaminophen could also result in a toxic liver condition. NSAIDS such as aspirin, naproxen, Celebrex, or Troadol, can have possible harmful interactions with various supplements. While not particularly dangerous, taking any form of citrates (potassium, magnesium, or calcium) can decrease blood levels of NSAIDS and thus reduce their therapeutic benefits. Various herbs including St. 's Wort, and dong quai, when paired up with NSAIDS, can cause increased sensitivity to the sun. Further, since NSAIDS alone can be tough on the stomach, caution should be used when combining with arginine, an amino acid that increases stomach acid. Patients should also by very wary of combining aspirin with any supplement which can thin the blood, like ginkgo, or vitamin E. There have been various reports of these supplements causing spontaneous bleeding episodes when used with aspirin. However, there was a study which indicated not only that vitamin E and ginkgo are safe together, but also that vitamin E may help prevent some kinds of stroke. Tramadol (Ultram) can have possible dangerous reactions if taken with St. 's Wort, 5-HTP, or SAM-e. This is because all these substances increase serotonin levels. The result can be a dangerous, potentially fatal condition called serotonin syndrome, as described above. Sleeping Drugs One case report involves an individual who became semi-comatose after taking kava for three days in a row with his regularly-prescribed alprazolam (Xanax). Alprazolam is in a family of drugs called benzodiazepines, which includes clonazepam (Klonopin), diazepam (Valium), temazepam (Restoril), and triazolam (Halcion). Some believe it is wise not to combine these medications with any herb that produces sedation, because of the possibility and danger of excessive sedation. On the other hand, the hormone melatonin may be useful for those trying to discontinue using benzodiazepines. One study found that 2mg of melatonin at night was helpful when quitting such sleeping drugs. It would be best to consult with your physician before attempting this approach. Antidepressants SSRI antidepressants, such as Prozac, Paxil, or Zoloft, which have the primary effect of increasing availability of serotonin, can be dangerous if combined with the supplements St. 's Wort, 5-HTP, and SAM-e. The problem is that these natural supplements similarly increase serotonin levels, and this combination can lead to a condition called serotonin syndrome. Symptoms of this syndrome include sweating, agitation, confusion, diarrhea, lethargy, tremor, and muscle jerking. The journal U.S. Pharmacist states " Although serotonin syndrome can cause death, the condition is mild in most persons, and with supportive care alone they tend to recover completely. " Because of this problem, The Natural Pharmacist website recommends not taking SSRI medications and St. 's Wort at the same time. That source further states that " if you wish to switch from an SSRI to St. 's Wort, you may need to wait a few weeks for the SSRI to wash out of your system before it is safe to start taking the herb. " On the other hand, T. Murray, N.D., has a more conservative approach. He states, " My recommendation is that when using St. 's Wort in combination with standard antidepressant drugs, that patients be monitored closely for any symptoms suggestive of the serotonin syndrome. If these symptoms appear, elimination of one of the therapies is indicated. " A Swiss-based organization, Health and Age, states that " SAM-e may interact with certain antidepressant medications and increase the potential for side effects including headache, irregular or accelerated heart rate, anxiety, and restlessness. " A 1993 case report indicates serotonin syndrome occurred in a woman who was taking both SAM-e and the antidepressant clomipramine. However, one doctor implies SAM-e may not be the real culprit in this incident, since the majority of serotonin syndrome cases suspiciously involve the use clomipramine as opposed to any other antidepressant. Those on the class of antidepressants called MAO inhibitors know they must avoid foods like aged cheese, avocados, and wine, which contain tyramine. The herb ephedra should also be avoided in combination with MAO inhibitors, as this pairing can cause increased stimulation. This can result in increased heart rate, nervousness, tremors, and headaches. Other supplements that should probably not be combined with MAO inhibitors include St. 's Wort, 5-HTP, and SAM-e, for similar reasons as described above. As caffeine should be avoided when on MAO inhibitors, green tea should also not be combined with this class of antidepressants. One report demonstrated a negative reaction between ginseng and the MAO inhibitor, phenelzine. However, it is believed that the ginseng used was contaminated with caffeine, and this may have been the real source of the adverse reaction. Surgery/Anticoagulation Drugs While surgical procedures are not unique to CFS and FM patients, a number of herbs often taken by these individuals can produce negative consequences during or following an operation. For instance, the immune system stimulation from short-term use of echinacea could interfere with immunosuppressive drugs needed by patients facing organ transplants. On the other hand, extended echinacea use can cause immune system suppression, and thus contribute to postsurgical complications, such as poor wound healing and opportunistic infections. St. 's Wort can also reduce the effect of immunosuppressive drugs. In two reported cases, this herb was held at least partially responsible for heart transplant rejections. The Journal of the American Medical Association reported that St. 's Wort could speed up the breakdown of many " drugs, some of which are vital to the perioperative [during surgery] care of certain patients. " Doctors encourage patients to stop using St. 's Wort five days prior to surgery, whereas echinacea should be discontinued as far as possible in advance of surgery. Because garlic can inhibit platelet functioning needed for proper clotting, its use may encourage bleeding or accentuate the effect of medications specifically aimed at countering platelets. Ginkgo can also reduce platelet activation, and has been blamed for intracranial bleeding in a small number of patients. Similarly, ginseng may interfere with coagulation. Because of these complications, doctors encourage patients to discontinue use of garlic and ginseng at least seven days before surgery, and ginkgo at least three days prior to surgery. Both Kava and Valerian can increase the sedative effect of anesthetics used during surgery. It is thus recommended that their use be stopped at least 24 hours prior to surgery. Vitamin E's use is also discouraged prior to surgery. This is because in high doses, it can inhibit coagulation and thus increase the risk for abnormal bleeding. Additionally, like St. 's Wort and echinacea, vitamin E should not be taken when on drugs which suppress the immune system. Outside of the surgical arena, the anticoagulant drug warfarin (Coumadin) is often prescribed. This medication can prevent strokes, heart attacks, clots in the legs and lungs, and other disorders. The supplements CoQ10, ginseng, St. 's Wort, and vitamin C, can possibly counter the beneficial effects of warfarin. On the other hand, garlic, ginkgo, devil's claw, dong quai, and vitamins A and E, could over-accentuate warfarin's effect and lead to dangerous bleeding. Because of the numerous supplements that can interact with warfarin, The Natural Pharmacist states " If you are taking warfarin, we don't recommend taking any herb or supplement except on a physician's advice. " Conclusion Dr. e Fugh-Berman explains that one of the reasons there are relatively so few reports of herbal adverse events and interactions is " the benign nature of most herbs used. " Nonetheless, be aware that potentially dangerous supplement-drug interactions can occur. To prevent suffering such an interaction, it is recommended that you forthrightly inform your physician of all the supplements you are taking, including dosage. Yet some patients refrain from doing so out of fear of censure. As an article in the U.S. Pharmacist reports, " If patients sense that practitioners are judgmental, they may not always be willing to discuss herbal medicine use. An open-minded approach during patient visits is essential. " Regardless of whether an open discussion with your doctor is possible, education is the key. Investigating potential reactions in advance of using any new medication or health supplement will enable you to safely benefit from the best of both traditional and alternative remedies. Source Materials: The Natural Pharmacist, http://www.tnp.com Drug/Herb Interaction Chart, LifeBalm http://www.lifebalm.com/page.cgi?drug_herb1 Drug-Supplement Interaction, ACSH (Nov. 2000) http://www.acsh.org/publications/story/drug-suppl/ Sadenosylmethionine, Health and Age http://www.healthandage.com/html/res/com/ConsSupplements/SAdenosylmethionine SAMecs.html Anaizi, Drug-Food Interactions, The Drug Monitor (2001) http://www.home.eznet.net/~webtent/food-drug-interactions.html Ang-Lee, et al., Herbal Medicines and Perioperative Care, JAMA 286(2):208 (2001) Duke, The Herb Interaction Drug Peddlers, Better Nutrition 32 (March 2001) Fugh-Berman, Herb-drug Interactions, The Lancet 355:134 (2000) Knowlton, Investigating SAM-e for Depression, Psychiatric Times 18(5) (May 2001) Hendley, Drug and Food Interaction-Guide E-507, College of Agriculture Home Economics (1993) http://www.cahe.nmsu.edu/pubs/_e/e-507.html Laden, The Nutritional Importance of Coenzyme Q as a Dietary Supplement http://wwwchem.csustan.edu/chem4400/sjbr/laden98.htm Lambrecht, et al., A Review of Herb-Drug Interactions: Documented and Theoretical, U.S. Pharmacist 25(8) (2000) Murray, St. 's Wort Extract http://www.doctormurray.com/articles/worteditorial.htm Nolan, et al., Serotonin Syndrome: Recognition and Management, U.S. Pharmacist, 23(2) (1998) ImmuneSupport.com <http://www.ImmuneSupport.com> -Your Chronic Fatigue Syndrome Fibromyalgia Chronic Pain Specialist- Treatment Research Vitamins Supplements News Support Groups Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 7, 2001 Report Share Posted November 7, 2001 The following is a pretty good article-it also gives some sites to look up information on. gail Message: --------------------------------- The following is a Health Related Article from: ImmuneSupport.com <http://www.ImmuneSupport.com> Article Entitled: Drug and Supplement Interactions: What CFS and Fibromyalgia Patients Need to Know , Written W. Addington Many are aware of alcohol consumption warnings when prescribed certain medications. But not as well known is the interaction vitamins or herbs can have with some pharmaceutical drugs. This is a particular concern for many Chronic Fatigue Syndrome (CFS) and fibromyalgia (FM) patients. Individuals suffering with CFS and FM understandably are often seeking a variety of means to manage their symptoms, from more traditional medications to natural supplements. But as this article will detail, CFS and FM patients should be cognizant of the potential risks that exist when combining drugs and supplements. It is not surprising that those opposed to alternative remedies are the strongest advocates of the dangers of drug-supplement combinations. To put this discussion in perspective, it’s good to note that synthetic medications are much more likely to cause negative side effects, even when taken by themselves. As quoted in a recent Lancet article, " Poisons and medicines are oftentimes the same substances with different intents. " And, of course, adverse consequences from an interaction of two different drugs is fairly common. Conversely, natural supplements can often ameliorate the negative side effects of various medications. Searching the database of free articles at ImmuneSupport.com can be of great assistance in learning more about this topic. Another great free source of information is The Natural Pharmacist at www.tnp.com. Searching for any condition, drug, or supplement at that site, can lead you to natural supplements that may help you avoid adverse drug reactions. Especially beneficial at that site, however, is the " Drug Interactions " database, which includes useful explanations of supplements described as " Possible Helpful Interaction " or " Possible Dangerous Interaction. " Pain Medications There are a number of supplements which can potentially result in unwanted interactions with painkillers, depending on the combination taken. One study showed high amounts of acetaminophen (Tylenol) and vitamin C taken together might result in acetaminophen toxicity. Taking the herbs chaparral, comfrey, or coltsfoot with acetaminophen could also result in a toxic liver condition. NSAIDS such as aspirin, naproxen, Celebrex, or Troadol, can have possible harmful interactions with various supplements. While not particularly dangerous, taking any form of citrates (potassium, magnesium, or calcium) can decrease blood levels of NSAIDS and thus reduce their therapeutic benefits. Various herbs including St. 's Wort, and dong quai, when paired up with NSAIDS, can cause increased sensitivity to the sun. Further, since NSAIDS alone can be tough on the stomach, caution should be used when combining with arginine, an amino acid that increases stomach acid. Patients should also by very wary of combining aspirin with any supplement which can thin the blood, like ginkgo, or vitamin E. There have been various reports of these supplements causing spontaneous bleeding episodes when used with aspirin. However, there was a study which indicated not only that vitamin E and ginkgo are safe together, but also that vitamin E may help prevent some kinds of stroke. Tramadol (Ultram) can have possible dangerous reactions if taken with St. 's Wort, 5-HTP, or SAM-e. This is because all these substances increase serotonin levels. The result can be a dangerous, potentially fatal condition called serotonin syndrome, as described above. Sleeping Drugs One case report involves an individual who became semi-comatose after taking kava for three days in a row with his regularly-prescribed alprazolam (Xanax). Alprazolam is in a family of drugs called benzodiazepines, which includes clonazepam (Klonopin), diazepam (Valium), temazepam (Restoril), and triazolam (Halcion). Some believe it is wise not to combine these medications with any herb that produces sedation, because of the possibility and danger of excessive sedation. On the other hand, the hormone melatonin may be useful for those trying to discontinue using benzodiazepines. One study found that 2mg of melatonin at night was helpful when quitting such sleeping drugs. It would be best to consult with your physician before attempting this approach. Antidepressants SSRI antidepressants, such as Prozac, Paxil, or Zoloft, which have the primary effect of increasing availability of serotonin, can be dangerous if combined with the supplements St. 's Wort, 5-HTP, and SAM-e. The problem is that these natural supplements similarly increase serotonin levels, and this combination can lead to a condition called serotonin syndrome. Symptoms of this syndrome include sweating, agitation, confusion, diarrhea, lethargy, tremor, and muscle jerking. The journal U.S. Pharmacist states " Although serotonin syndrome can cause death, the condition is mild in most persons, and with supportive care alone they tend to recover completely. " Because of this problem, The Natural Pharmacist website recommends not taking SSRI medications and St. 's Wort at the same time. That source further states that " if you wish to switch from an SSRI to St. 's Wort, you may need to wait a few weeks for the SSRI to wash out of your system before it is safe to start taking the herb. " On the other hand, T. Murray, N.D., has a more conservative approach. He states, " My recommendation is that when using St. 's Wort in combination with standard antidepressant drugs, that patients be monitored closely for any symptoms suggestive of the serotonin syndrome. If these symptoms appear, elimination of one of the therapies is indicated. " A Swiss-based organization, Health and Age, states that " SAM-e may interact with certain antidepressant medications and increase the potential for side effects including headache, irregular or accelerated heart rate, anxiety, and restlessness. " A 1993 case report indicates serotonin syndrome occurred in a woman who was taking both SAM-e and the antidepressant clomipramine. However, one doctor implies SAM-e may not be the real culprit in this incident, since the majority of serotonin syndrome cases suspiciously involve the use clomipramine as opposed to any other antidepressant. Those on the class of antidepressants called MAO inhibitors know they must avoid foods like aged cheese, avocados, and wine, which contain tyramine. The herb ephedra should also be avoided in combination with MAO inhibitors, as this pairing can cause increased stimulation. This can result in increased heart rate, nervousness, tremors, and headaches. Other supplements that should probably not be combined with MAO inhibitors include St. 's Wort, 5-HTP, and SAM-e, for similar reasons as described above. As caffeine should be avoided when on MAO inhibitors, green tea should also not be combined with this class of antidepressants. One report demonstrated a negative reaction between ginseng and the MAO inhibitor, phenelzine. However, it is believed that the ginseng used was contaminated with caffeine, and this may have been the real source of the adverse reaction. Surgery/Anticoagulation Drugs While surgical procedures are not unique to CFS and FM patients, a number of herbs often taken by these individuals can produce negative consequences during or following an operation. For instance, the immune system stimulation from short-term use of echinacea could interfere with immunosuppressive drugs needed by patients facing organ transplants. On the other hand, extended echinacea use can cause immune system suppression, and thus contribute to postsurgical complications, such as poor wound healing and opportunistic infections. St. 's Wort can also reduce the effect of immunosuppressive drugs. In two reported cases, this herb was held at least partially responsible for heart transplant rejections. The Journal of the American Medical Association reported that St. 's Wort could speed up the breakdown of many " drugs, some of which are vital to the perioperative [during surgery] care of certain patients. " Doctors encourage patients to stop using St. 's Wort five days prior to surgery, whereas echinacea should be discontinued as far as possible in advance of surgery. Because garlic can inhibit platelet functioning needed for proper clotting, its use may encourage bleeding or accentuate the effect of medications specifically aimed at countering platelets. Ginkgo can also reduce platelet activation, and has been blamed for intracranial bleeding in a small number of patients. Similarly, ginseng may interfere with coagulation. Because of these complications, doctors encourage patients to discontinue use of garlic and ginseng at least seven days before surgery, and ginkgo at least three days prior to surgery. Both Kava and Valerian can increase the sedative effect of anesthetics used during surgery. It is thus recommended that their use be stopped at least 24 hours prior to surgery. Vitamin E's use is also discouraged prior to surgery. This is because in high doses, it can inhibit coagulation and thus increase the risk for abnormal bleeding. Additionally, like St. 's Wort and echinacea, vitamin E should not be taken when on drugs which suppress the immune system. Outside of the surgical arena, the anticoagulant drug warfarin (Coumadin) is often prescribed. This medication can prevent strokes, heart attacks, clots in the legs and lungs, and other disorders. The supplements CoQ10, ginseng, St. 's Wort, and vitamin C, can possibly counter the beneficial effects of warfarin. On the other hand, garlic, ginkgo, devil's claw, dong quai, and vitamins A and E, could over-accentuate warfarin's effect and lead to dangerous bleeding. Because of the numerous supplements that can interact with warfarin, The Natural Pharmacist states " If you are taking warfarin, we don't recommend taking any herb or supplement except on a physician's advice. " Conclusion Dr. e Fugh-Berman explains that one of the reasons there are relatively so few reports of herbal adverse events and interactions is " the benign nature of most herbs used. " Nonetheless, be aware that potentially dangerous supplement-drug interactions can occur. To prevent suffering such an interaction, it is recommended that you forthrightly inform your physician of all the supplements you are taking, including dosage. Yet some patients refrain from doing so out of fear of censure. As an article in the U.S. Pharmacist reports, " If patients sense that practitioners are judgmental, they may not always be willing to discuss herbal medicine use. An open-minded approach during patient visits is essential. " Regardless of whether an open discussion with your doctor is possible, education is the key. Investigating potential reactions in advance of using any new medication or health supplement will enable you to safely benefit from the best of both traditional and alternative remedies. Source Materials: The Natural Pharmacist, http://www.tnp.com Drug/Herb Interaction Chart, LifeBalm http://www.lifebalm.com/page.cgi?drug_herb1 Drug-Supplement Interaction, ACSH (Nov. 2000) http://www.acsh.org/publications/story/drug-suppl/ Sadenosylmethionine, Health and Age http://www.healthandage.com/html/res/com/ConsSupplements/SAdenosylmethionine SAMecs.html Anaizi, Drug-Food Interactions, The Drug Monitor (2001) http://www.home.eznet.net/~webtent/food-drug-interactions.html Ang-Lee, et al., Herbal Medicines and Perioperative Care, JAMA 286(2):208 (2001) Duke, The Herb Interaction Drug Peddlers, Better Nutrition 32 (March 2001) Fugh-Berman, Herb-drug Interactions, The Lancet 355:134 (2000) Knowlton, Investigating SAM-e for Depression, Psychiatric Times 18(5) (May 2001) Hendley, Drug and Food Interaction-Guide E-507, College of Agriculture Home Economics (1993) http://www.cahe.nmsu.edu/pubs/_e/e-507.html Laden, The Nutritional Importance of Coenzyme Q as a Dietary Supplement http://wwwchem.csustan.edu/chem4400/sjbr/laden98.htm Lambrecht, et al., A Review of Herb-Drug Interactions: Documented and Theoretical, U.S. Pharmacist 25(8) (2000) Murray, St. 's Wort Extract http://www.doctormurray.com/articles/worteditorial.htm Nolan, et al., Serotonin Syndrome: Recognition and Management, U.S. Pharmacist, 23(2) (1998) ImmuneSupport.com <http://www.ImmuneSupport.com> -Your Chronic Fatigue Syndrome Fibromyalgia Chronic Pain Specialist- Treatment Research Vitamins Supplements News Support Groups Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2001 Report Share Posted November 11, 2001 good article Gail! I always try to watch the herbs I use with and without my meds. For instance, I stopped the Gingko/Ginseng/White Willow Bark combo I take at work several days before surgery so I wouldn't bleed to death. When the doc told me about his concerns for blood clots in my legs (and I have to wear these support hose things) I said gee doc why didn't ya tell me, I would have kept up the herbs lol. and man these hose are so very stylish ....................... NOT!!! unless you are going to a Polish Festival where lederhosen (sp) would be appropriate hahhahaha Now I'm kinda keeping tabs on how long it'll take to bounce back from surgery cuz of my hep c/fibro/fatigue thing. I told the oncologist that it might make me a little slow to get my energy back but hopefully not interfere with my basic physical healing. Everyone I think, needs to keep in mind what they are taking that is not prescribed and work WITH their doc not AGAINST their doc on anything. Dats my 2 cents worth lol alley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2001 Report Share Posted November 11, 2001 good article Gail! I always try to watch the herbs I use with and without my meds. For instance, I stopped the Gingko/Ginseng/White Willow Bark combo I take at work several days before surgery so I wouldn't bleed to death. When the doc told me about his concerns for blood clots in my legs (and I have to wear these support hose things) I said gee doc why didn't ya tell me, I would have kept up the herbs lol. and man these hose are so very stylish ....................... NOT!!! unless you are going to a Polish Festival where lederhosen (sp) would be appropriate hahhahaha Now I'm kinda keeping tabs on how long it'll take to bounce back from surgery cuz of my hep c/fibro/fatigue thing. I told the oncologist that it might make me a little slow to get my energy back but hopefully not interfere with my basic physical healing. Everyone I think, needs to keep in mind what they are taking that is not prescribed and work WITH their doc not AGAINST their doc on anything. Dats my 2 cents worth lol alley Quote Link to comment Share on other sites More sharing options...
Guest Posted June 22, 2015 Report Share Posted June 22, 2015 See the Harvard study on rutin (just google it). You will find a great supplement to take pre- and post-surgery.....and all the time!!! I love bioflavonoids, and this one especially. Run this study by your docs. http://news.harvard.edu/gazette/story/2012/05/flavonoid-compound-can-prevent-blood-clots/ Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.