Interesting article + sites

November 7, 2001

The following is a pretty good article-it also gives some sites to look up

information on.

gail

Message:

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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

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November 7, 2001