Re: herbs caution

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Herbs and Over-the Counter or Prescription Drugs Don't Always Mix Well An article to remind of certain herbs and drugs not mixing well. Here is

is: ScienceWatch: Dangerous Liaisons: Herbs and over-the-counter or prescriptiondrugs don't always mix well: --- some combinations risk a patient's health. The patient did well on the cholesterol-lowering medication his doctor had prescribed for him --- until, without warning, he developed a painful inflammation of the muscles. His doctor ran a test: Inexplicably, the level of the drug in his blood, formerly stable, had shot sky-high. Puzzled and suspicious, the internist asked Dr. Frederick Teixeira of Emory University School of Medicine to take a second look at the case. Teixeira reviewed the records and uncovered a missed detail: The man was also taking a natural remedy he had bought in a health food store. According to the label, it contained 50 different herbs. "It was impossible to know which of them was interfering with the medication," Teixeira said. "But when he stopped taking the herbs, the side effect went away." Dangerous cross-reactions between herbs and drugs: It's not the first thing you think of when you pull memory-boosting ginkgo pills or flu-defeating echinacea extract off the drugstore shelf. But researchers in alternative medicine, watching the mushrooming enthusiasm for nontraditional remedies, are becoming increasingly concerned. With the best of intentions, they warn, Americans may be endangering their health. "How many of our patients are suffering from drug-herb interactions that we have not recognized?" Dr. Eisenberg of Harvard Medical School, one of the deans of alternative medicine research in the United States, asked at a recent medical conference. "That question haunts me." As with most alternative medicine in the United States, almost no data exist to confirm or calm the researchers' fears, but enough anecdotes have been gathered by individual clinicians to make experts nervous. Teixeira, a 34-year-old internist with a previous career in biochemistry,

developed a side interest in his patients' use of herbs after a friend's mother suffered a toxic reaction to a tea meant to make her hair grow. The herb she was using turned out to be chaparral, an antioxidant that the Centers for Disease Control and Prevention has found can destroy liver function at high doses. The unexplained hepatitis that had put her in the hospital cleared when she stopped drinking the tea --- just in time to save her from an expensive liver biopsy. Since that case, Teixeira has studied enough about herbs to develop a small specialty in them. He lectures to medical groups and is asked to consult on cases, including the out-of-state resident with the mysterious reaction to his cholesterol-lowering drugs and a woman already suffering from an autoimmune disease who he believes died from an allergic reaction to a common herbal remedy. Teixeira now asks all his patients what alternative remedies they are using: Half are experimenting with some untraditional method, he said, and at least one in four are using herbs. That unthinking enthusiasm --- if it's natural, it must be good for me --- profoundly troubles Dr. Duke, one of the premier botanical medicine experts in the United States. The former chief of the U.S. Department of Agriculture's Medicinal Plant Laboratory is writing an "herbal desk reference" modeled on the drug encyclopedias found in every doctor's office. "People just do not understand that herbs are drugs --- though they're often dilute drugs," he said. "So any herb may possibly interact --- sometimes synergistically, less often antagonistically --- with over-the-counter or prescription drugs." Among the little-known risky combinations listed in Duke's online database (www.arsgrin.gov/duke/index.html): Both grapefruit juice and the herb angelica (also called dang qui), with a long list of drugs such as antihistamines, anti-anxiety benzodiazepines, calcium channel blockers for blood pressure, and protease inhibitors for HIV; either the juice or the herb can triple the drugs' impact. Herbs that affect the circulation, such as ginkgo, garlic and ginger, with blood-thinning drugs; the combination can cause bleeding disorders. Mood-lifting herbs, such as St. 's wort and kava, with anti-depressantdrugs such as Prozac; the combination can significantly alter brain chemistry. Echinacea, which stimulates the immune system, with drugs for progressive systemic diseases such as multiple sclerosis and tuberculosis; the herb can amplify the drugs' effects in unpredictable ways. Unlike most European countries, the United States has no mainstream herbal tradition, so both the medical establishment and regulatory authorities have been slow to recognize the potential problem of patients who take both herbs and drugs. "We don't even have good figures to document how much herbal use is going on in the U.S. market right now," said Mark Blumenthal, executive director of the American Botanical Council in Austin, Texas. We may be up to 75 million Americans using some kind of herbal supplement."

Botanical medicine experts are concerned that new herb consumers are experimenting without doing advance research, but those looking for information face significant hurdles. Until recently, the best reference books on herbs --- the British Herbal Compendium and monographs by the German government's Commission E and the European Scientific ative on Phytotherapy --- were not available in the United States. (They are now being distributed by the American Botanical Council; also, the American Herbal Products Association, a trade group, has published a "Botanical Safety Handbook" classifying herbs in four categories of risk.) In addition, a 1994 change in federal law reclassified herbs as "food supplements." That shift exempted herb manufacturers from meeting the rigorous standards required of pharmaceuticals, but it also prevented them from putting any information about usefulness, effectiveness or dosage on herb labels. And because it took herbs out of the same legal category as drugs, it kept any problems with herbs from being listed in the "adverse event" database the Food and Drug Administration maintains on drug reactions. Herb-friendly physicians say the lack of information makes it critical that patients using herbs talk to their doctors to alert them to possible problems. "There are cases where I would like to recommend herbs to patients, but I can't in good conscience," Teixeira said. "That change in the law leaves patients operating completely at their own risk." CROSS-REACTIONS: A SAMPLER Herbal medications are natural, but that is no guarantee they are safe. Because many prescription and over-the-counter drugs are based on laboratory-purified versions of the same chemical compounds found in plants, people who take both herbs and drugs may risk dangerous cross-reactions. Here are some examples. Herb name: Echineacea Usual use: To boost the immune system in colds and flu Not advised: In auto-immune diseases such as multiple sclerosis; may also interfere with drugs taken for HIV and TB. Herb name: Ginseng Usual use: Stimulant Not advised: In hypertension; may

diminish the effect of drugs to lower blood pressure. Herb name: Garlic Usual use: Reduce blood cholesterol Not advised: Can magnify the effect of blood-thinning medications such as Coumadin. Herb name: Cascara sagrada, Senna, Buckthorn Usual use:

Stimulant laxatives Not advised: In cases of cardiac irregularity; may reduce blood levels of potassium and increase the effect of drugs to regulate heart rhythm such as Lanoxin. Herb name: St. 's wort Usual use: Anti-depressant. Not advised: When taking a selective serotonin re-uptake inhibitor such as Prozac or a monoamine-oxidase inhibitor such as Nardil; the combination can cause serotonin intoxication, with fever, confusion and muscle spasms. Herb name: Ginger Usual use: Calms nausea. Not advised: When taking blood-thinning medication

such as Coumadin; ginger may amplify the drugs' action and cause bleeding disorders. Herb name: Valerian Usual use: Mild sedative Not advised: When already taking anti-depressants or sedatives; because it depresses the central nervous system, it can magnify the effect of those drugs. Herb name: Licorice Usual use: Reduces cough and may help stomach ulcers Not advised: Reduces levels of potassium in the blood; when combined with diuretics such as Lasix or cardiac stimulants such as Lanoxin, can cause muscle weakness and irregular heartbeat. Herb name: Kava kava Usual use: Anti-anxiety. Not advised: Increases the effectiveness of alcohol, barbiturates and psychoactive

drugs. For more information about herb-drug cross-reactions, consult: "The Green Pharmacy," Dr. A. Duke (Rodale Press, $27.95) "The Healing Herbs," Castleman (Bantam Books, $6.99) "Deadly Drug Interactions, The People's Pharmacy Guide," Joe Graedon and Graedon, Ph.D. (St. 's , $14.95) "The Alternative Medicine Handbook," Barry R. Cassileth, Ph.D. (Norton, $25) Sources: The American Botanical Council and the Herb Research Foundation Copyright 1998, The Atlanta Journal and Constitution M.A.J. McKenna, ScienceWatch: Dangerous Liaisons: Herbs and over-the-counter or prescription drugs don't always mix well: --- some combinations risk a patient's health.., The Atlanta Journal and Constitution, 06-07-1998, pp 04.

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Good article,, herbs and conventional prescriptions dont mix well,, that is true!Hillbilly Tim <knoxweb1@...> wrote: Herbs and Over-the Counter or Prescription Drugs Don't Always Mix Well An article to remind of certain herbs and drugs not mixing well. Here is is: ScienceWatch: Dangerous Liaisons: Herbs and over-the-counter or prescriptiondrugs don't always mix well: --- some combinations risk a patient's health. The patient did well on the cholesterol-lowering medication his doctor had prescribed for him --- until, without warning, he

developed a painful inflammation of the muscles. His doctor ran a test: Inexplicably, the level of the drug in his blood, formerly stable, had shot sky-high. Puzzled and suspicious, the internist asked Dr. Frederick Teixeira of Emory University School of Medicine to take a second look at the case. Teixeira reviewed the records and uncovered a missed detail: The man was also taking a natural remedy he had bought in a health food store. According to the label, it contained 50 different herbs. "It was impossible to know which of them was interfering

with the medication," Teixeira said. "But when he stopped taking the herbs, the side effect went away." Dangerous cross-reactions between herbs and drugs: It's not the first thing you think of when you pull memory-boosting ginkgo pills or flu-defeating echinacea extract off the drugstore shelf. But researchers in alternative medicine, watching the mushrooming enthusiasm for nontraditional remedies, are becoming increasingly concerned. With the best of intentions, they warn, Americans may be endangering their health. "How many of our patients are suffering from drug-herb interactions that we have not recognized?" Dr. Eisenberg of Harvard Medical School, one of the deans of alternative medicine research in the United States, asked at a recent medical conference. "That question haunts me." As with most alternative medicine in the United States, almost no data exist to confirm or calm the researchers' fears, but enough anecdotes have been gathered by individual clinicians to make experts nervous.

Teixeira, a 34-year-old internist with a previous career in biochemistry, developed a side interest in his patients' use of herbs after a friend's mother suffered a toxic reaction to a tea meant to make her hair grow. The herb she was using turned out to be chaparral, an antioxidant that the Centers for Disease Control and Prevention has found can destroy liver function at high doses. The unexplained hepatitis that had put her in the hospital cleared when she stopped drinking the tea --- just in time to save her from an expensive liver biopsy. Since that case, Teixeira has studied enough about herbs to develop a small specialty in them. He lectures to medical groups and is asked to consult on cases, including the out-of-state resident with the mysterious reaction to his cholesterol-lowering drugs and a woman already suffering from an autoimmune disease who he believes died from an allergic reaction to a common herbal remedy. Teixeira now asks all his patients what alternative remedies they are using: Half are experimenting with some untraditional method, he said, and at least one in four are using

herbs. That unthinking enthusiasm --- if it's natural, it must be good for me --- profoundly troubles Dr. Duke, one of the premier botanical medicine experts in the United States. The former chief of the U.S. Department of Agriculture's Medicinal Plant Laboratory is writing an "herbal desk reference" modeled on the drug encyclopedias found in every doctor's office. "People just do not understand that herbs are drugs --- though they're often dilute drugs," he said. "So any herb may possibly interact --- sometimes synergistically, less often antagonistically --- with over-the-counter or prescription drugs." Among the little-known risky combinations listed in Duke's online database (www.arsgrin.gov/duke/index.html): Both grapefruit juice and the herb angelica (also called dang qui), with a long list of drugs such as antihistamines, anti-anxiety benzodiazepines, calcium channel blockers for blood pressure, and protease inhibitors for HIV; either the juice or the herb can triple the drugs' impact. Herbs that affect the circulation, such as

ginkgo, garlic and ginger, with blood-thinning drugs; the combination can cause bleeding disorders. Mood-lifting herbs, such as St. 's wort and kava, with anti-depressantdrugs such as Prozac; the combination can significantly alter brain chemistry. Echinacea, which stimulates the immune system, with drugs for progressive systemic diseases such as multiple sclerosis and tuberculosis; the herb can amplify the drugs' effects in unpredictable

ways. Unlike most European countries, the United States has no mainstream herbal tradition, so both the medical establishment and regulatory authorities have been slow to recognize the potential problem of patients who take both herbs and drugs. "We don't even have good figures to document how

much herbal use is going on in the U.S. market right now," said Mark Blumenthal, executive director of the American Botanical Council in Austin, Texas. We may be up to 75 million Americans using some kind of herbal supplement." Botanical medicine experts are concerned that new herb consumers are experimenting without doing advance research, but those looking for information face significant hurdles. Until recently, the best reference books on herbs --- the British Herbal Compendium and monographs by the German government's Commission E and the European Scientific ative on Phytotherapy --- were not available in the United

States. (They are now being distributed by the American Botanical Council; also, the American Herbal Products Association, a trade group, has published a "Botanical Safety Handbook" classifying herbs in four categories of risk.) In addition, a 1994 change in federal law reclassified herbs as "food supplements." That shift exempted herb manufacturers from meeting the rigorous standards required of pharmaceuticals, but it also

prevented them from putting any information about usefulness, effectiveness or dosage on herb labels. And because it took herbs out of the same legal category as drugs, it kept any problems with herbs from being listed in the "adverse event" database the Food and Drug Administration maintains on drug reactions. Herb-friendly physicians say the lack of information makes it critical that patients using herbs talk to their doctors to alert them to possible problems. "There are cases where I would like to recommend herbs to patients, but I can't in good conscience," Teixeira said. "That change in the law leaves patients operating completely at their own risk." CROSS-REACTIONS: A SAMPLER Herbal medications are natural, but that is no guarantee they are safe. Because many prescription and over-the-counter drugs are based on laboratory-purified versions of the same chemical compounds found in plants, people who take both herbs and drugs may risk dangerous cross-reactions. Here are some examples. Herb name: Echineacea Usual use: To boost the immune system in colds and flu Not advised: In auto-immune diseases such as multiple sclerosis; may also interfere with drugs taken for HIV and TB. Herb name: Ginseng Usual use: Stimulant Not advised: In hypertension; may diminish the effect of drugs to lower blood pressure. Herb name: Garlic Usual use: Reduce blood cholesterol Not advised: Can magnify the effect of blood-thinning medications such as Coumadin. Herb name: Cascara sagrada, Senna, Buckthorn Usual use: Stimulant laxatives Not advised: In cases of cardiac irregularity; may reduce blood levels of potassium and increase the effect of drugs to regulate heart rhythm such as

Lanoxin. Herb name: St. 's wort Usual use: Anti-depressant. Not advised: When taking a selective serotonin re-uptake inhibitor such as Prozac or a

monoamine-oxidase inhibitor such as Nardil; the combination can cause serotonin intoxication, with fever, confusion and muscle spasms. Herb name: Ginger Usual use: Calms nausea.

Not advised: When taking blood-thinning medication such as Coumadin; ginger may amplify the drugs' action and cause bleeding disorders. Herb name: Valerian Usual use: Mild sedative Not advised: When already taking anti-depressants or sedatives; because it depresses the central nervous system, it can magnify the effect of those drugs. Herb name: Licorice Usual use: Reduces cough and may help stomach ulcers Not advised: Reduces levels of potassium in the blood; when combined with diuretics such as Lasix or cardiac stimulants such as Lanoxin, can cause muscle weakness and irregular heartbeat. Herb name: Kava kava Usual use: Anti-anxiety. Not advised: Increases the effectiveness of alcohol, barbiturates and psychoactive drugs. For more information about herb-drug cross-reactions, consult: "The Green Pharmacy," Dr. A. Duke (Rodale Press, $27.95) "The Healing Herbs," Castleman (Bantam Books, $6.99) "Deadly Drug Interactions, The People's Pharmacy Guide," Joe Graedon and Graedon, Ph.D. (St. 's , $14.95) "The Alternative Medicine

Handbook," Barry R. Cassileth, Ph.D. (Norton, $25) Sources: The American Botanical Council and the Herb Research Foundation Copyright 1998, The Atlanta Journal and Constitution M.A.J. McKenna, ScienceWatch: Dangerous Liaisons: Herbs and over-the-counter or prescription drugs don't always mix well: --- some combinations risk a patient's health.., The Atlanta Journal and Constitution, 06-07-1998, pp 04. Talk is cheap. Use Messenger to make PC-to-Phone calls. Great rates starting at 1¢/min. It's a pleasure having you join in our conversations. We hope you have found the support you need with us. If you are using email for your posts, for easy access to our group, just click the link-- Hepatitis C/Happy Posting Jackie