Potential Interactions of Supplements, Drugs

Experts on herbs warn against combining the following supplements:

Evening primrose oil

Use: To lower blood cholesterol.

Caution: May lower thresholds for seizure, so should not be combined with anticonvulsants or some medications, such as Thorazine, prescribed for schizophrenia.

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Feverfew

Use: To prevent migraines.

Caution: Because of theoretical bleeding risks, should not be taken with nonsteroidal anti-inflammatory drugs such as Advil, Motrin and Aleve, anti-clotting drugs such as Coumadin, or blood-thinners such as aspirin, Plavix and Ticlid.

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Garlic

Use: For cardiovascular benefits such as lowering cholesterol and blood pressure.

Caution: Slows clotting by keeping blood platelets from clumping, so should not be taken with anti-clotting drugs such as Coumadin or blood-thinners such as aspirin, Plavix and Ticlid.

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Ginger

Use: To prevent motion sickness and nausea, particularly for patients who are postoperative or receiving chemotherapy. Sometimes used to improve digestion.

Caution: Because it keeps blood platelets from sticking together, ginger should not be taken with anti-clotting drugs such as Coumadin or blood-thinners such as aspirin, Plavix and Ticlid.

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Ginkgo

Use: For memory enhancement as well as a painful condition stemming from poor circulation in the legs.

Caution: Because it interferes with blood platelets’ clot-forming ability, use under supervision if taking anti-clotting drugs such as Coumadin or blood-thinners such as aspirin, Plavix and Ticlid. For related reasons, many experts recommend that ginkgo not be combined with nonsteroidal anti-inflammatory drugs such as Advil, Motrin and Aleve. The American Herbal Products Assn. cautions that ginkgo may interact with antidepressants called MAO inhibitors that include Eldepryl, Nardil and Parnate.

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Ginseng

Use: To increase energy and stamina.

Caution: May increase blood pressure and heart rate. Because it can increase blood sugar, diabetics should use ginseng only under medical supervision. May interfere with the action of the anti-clotting drug Coumadin.

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Kava kava

Use: To promote relaxation and sleep and to reduce anxiety.

Caution: Should not be combined with anti-anxiety drugs such as Xanax, Librium, Valium, Dalmane, Paxipam, Ativan and Restoril. In one case, the combination of kava kava and Xanax landed a man in the hospital in a “coma-like condition.” Also shouldn’t be combined with alcohol.

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Licorice

Use: To treat colds, coughs and respiratory infections; sometimes to treat ulcers because it inhibits secretion of stomach acid.

Caution: Licorice depletes the body of potassium and should not be combined with the heart drug Lanoxin because of the potential that potassium loss could disrupt the heart’s rhythm. The warning is even stronger if the patient also is taking a diuretic such as Lasix or hydrochlorothiazide that can deplete the body of potassium. Some preparations of licorice are modified to protect potassium levels.

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Ma huang

Use: To treat colds and nasal congestion; contains ephedrine, a powerful stimulant.

Caution: This Chinese herb should not be taken with a class of antidepressants called MAO inhibitors, such as Marplan, Nardil and Parnate, because the combination could dangerously elevate blood pressure. Also should not be taken with some heart medications such as Lanoxin because of risk of irregular heart rhythms or fast heartbeat.

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St. John’s wort

Use: To treat mild to moderate depression.

Caution: Should not be used with any prescription antidepressant; combining it with serotonin-boosting antidepressants such as Prozac, Paxil, and Zoloft could cause serotonin syndrome. Combining with other drugs like the antibiotic tetracycline can increase sensitivity to the sun.

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Valerian

Use: As a mild sedative, to ease anxiety and help with mild insomnia.

Caution: Should not be taken with sedatives or drugs that depress the central nervous system.

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There are several examples in which herbal supplements have positive interactions with prescription drugs, but they should be combined only after consulting a medical professional:

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Ginkgo

Use: For memory enhancement as well as a painful condition stemming from poor circulation in the legs.

Possible benefit: May help stem the decrease in sexual function caused by a class of antidepressants that include Prozac, Paxil and Zoloft.

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Stinging nettles

Use: As an anti-inflammatory and antiallergy agent.

Possible benefit: May make nonsteroidal anti-inflammatory medications such as Advil, Motrin and Aleve 50% more effective at the same dose.