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Identifying Interactions Between Prescription and Herbal MedicationsLorraine W. Bock, MSN, CRNP, CEN
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Objectives:
1.) Appreciate the magnitude of use of non-prescription herbs, vitamins, and supplements in the United States today.
2.) Understand the use of common herbal medications and supplements available on the market.
3.) Recognize common pharmaceuticals that pose of risk of drug/herb interactions.
At the completion of this program the learner will:
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How many of you are currently taking a non-prescription vitamin herb or supplement on a regular basis?
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Supplement Use in the US
• Nearly 20% of Americans use a vitamin, herb, or supplement daily
• Over 50% of Americans admit to using a vitamin, herb, or supplement in the last 30 days
• Over 17 billion dollars is spent annually by consumers on the purchase of vitamins, herbs, and supplements
National Center for Complimentary and Alternative Medicine - 2007
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What are we talking about?
• Vitamins• Minerals• Herbs• Botanicals• Amino Acids• “Natural Products”
• Any substance intended to be taken by mouth for the purpose of supplementing the diet,contains one or more of the substances listed, and is labeled as a dietary supplement.
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Most Commonly Used Vitamins, Herbs, & Supplements
• Multivitamin/Multimineral• Fish Oils/Omega III/DHA• Glucosamine/Glucosamine Chondroitin• Echinacea• Flaxseed• Ginseng• Vitamins – B-complex, E, & C• Calcium
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Multivitamins/Multiminerals
• Used to provide the addition of a variety of vitamins and minerals to one’s diet.
• Supplement nutrition
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Interactions/Side Effects
• Avoid drinking milk to take MVI
• Avoid salt substitute products
• Avoid taking at the same time as anti-acids
• Take only one MVI product at a time
• May alter the effect of:
diuretics, BP medications, tretinoin/isotretinoin, bactrim/sulfa drugs, & NSAIDS
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Fish Oils/Omega III/DHA
• Heart Health– Decrease lipid levels– Lower BP– Dilate blood vessels
• Brain & Nervous System Function
• Reduce Inflammation
• Cancer Prevention
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Interactions/Side Effects
• Worsen diabetic control
• Immune suppression
• May alter the effects of:
NSAIDS, Plavix, Celebrex, Heparin/Lovenox, Coumadin, Xenical/Alli, Thrombolitics, BP medications
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GlucosamineGlucosamine Chondroitin
• Osteoarthritis• Joint Pain/Swelling• Restore Cartilage• Irritable Bowel
Diseases
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Interactions/Side Effects
• Caution in those with Shellfish Allergies
• May alter the effects of:NSAIDS, Diabetic agents including insulin,
Diuretics, K++ supplements, Anticoagulants
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Echinacea
• Shorten Viral Infections
• Immune Booster
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Interactions/Side Effects
• May alter the effects of: corticosteriods, antibiotics, diabetes medications, chemotherapy drugs
• May worsen: MS, Immune Disorders, TB, Leukemia, Lupus, Collagen Diseases, Stomach Problems
• Do not use in: HIV, Organ Transplant Patients, Pregnancy
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Flaxseed
• Anti-inflammatory• Colon Health
– IBS, Crohn’s, Colitis
• Cancer Prevention– Breast Cancer
• Heart Health– Lower lipids– Lower BP
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Interactions/Side Effects
• May slow the absorption of all drugs
• May alter the effects of: blood thinners, diabetic medications, NSAIDS, Contraceptives, Hormone Replacement Therapies, Anti-hyperlipidemics
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Ginseng
• Battle Stress & Fatigue
• Mental Clarity• Emetic• Stimulate Endocrine
Activity• Lower Blood Sugar
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Interactions/Side Effects
• May alter the effects of: diabetes medications, blood thinners, NSAIDS, Thrombolytics, CA++ channel blockers, antidepressants, antipsychotics, MAO Inhibitors, Opiate Pain medications
• Should not be combined with caffeine products
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Vitamin B Supplements
• Mental Clarity• Fatigue• Prevention of Neural
Tubal Birth Defects• Treat Anemias• Peripheral
Neuropathies• Skin Disorders
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• May alter the effects of: Tetracycline, Anticonvulsants, Cholchicine, Metformin, Bile Acid Sequestrants, H2 Blockers,Proton Pump Inhibitors, Chemotherapeutic Agents, Antidepressants, Levodopa, Erythropoetin
Interactions/Side Effects
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Vitamin E
• Skin Health/Scar Reduction
• Menopausal Symptoms
• Diabetes• Cancer• Heart Health
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Interactions/Side Effects
• May alter the effects of: Tricyclic Antidepressants, Phenothiazines, AZT, Beta Blockers, Bile Acid Sequestrants, Statins, Cyclosporin, Tamoxifen, Female Replacement Hormones, Medbendazole, Orlistat, Warfarin
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Vitamin C
• Immune Builder• Menopausal
Symptoms• Enhance Iron
Absorption• Cancer Prevention• Lyme Disease
Treatment
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Interactions/Side Effects
• May alter the effects of: NSAIDS, Acetaminophen, Barbiturates, Aluminum-containing antiacids, Nitrates, Chemotherapy drugs, Female Hormone Supplements, Crixivan, Tetracycline, Warfarin
• Enhances iron absorption
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Calcium
• Prevention of Osteoporosis
• Weight Loss• Muscle Cramps• Menopausal/PMS
Symptoms• Heart Health
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Interactions/Side Effects
• May alter the effects of: Alendronate, Aluminum Containing Antiacids, Beta Blockers, Ca++ Channel Blockers, Bile Acid Sequestrants, Corticosteriods, Digoxin, Estrogen Supplements, Gentamycin, Quinalones, Tetracycline, Anticonvulsants, Thiazide Diuretics, Lithium, Thyroid Supplements
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Pharmaceuticals with High Potential for Interactions
• Coumadin
• Thiazide Diuretics
• Phenytoin
• Phenobarbitol
• Lithium
• Thyroid Medications
•Oral Diabetic Agents
•Corticosteriods
•BP Medications
•Cyclosporin
•NSAIDS
•Digoxin
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Coumadin/Warfarin
• Cayenne• Feverfew• Garlic• White Willow Bark• St. John’s Wort• Ginkgo Biloba• Alfalfa• Dong Qui
• Vitamin A, K, C, E• Quinine• Papain• Devils Claw• Green Tea• Danshen• Coenzyme Q10
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Thaizide Diuretics
• Artichokes• Dandelion• Celery Seed• Goldenseal• Juniper• Horsetail• Buckthorne• Gingko Biloba• Cleavers
• Folic Acid• Magnesium• Potassium• Zinc• Uva-Ursa• Buchu• Licorice• Digitalis• Gravel Root
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Phenytoin
• Kava Kava• Valerian Root
• Evening Primrose Oil
• Shankapulshpi• St. John’s Wort• Black Cohosh• Ginkgo Biloba
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Phenobarbital
• Thujones• Vitamin B6• Woodworm• Evening Primrose
Oil• Gingko Biloba• Passion Flower
• Kava Kava• Valerian Root• Folate• Biotin• Vitamin D• Dong Quai• Glutamine
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Lithium
• Butchers Broom• Dandelion• Bochu• Juniper• Folic Acid• L-tryptophan
• Essential Fatty Acids
• Coffee• Psyllium Fiber• Sodium
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Thyroid Medications
• Horseradish• Kelp• Iodine• Calcium• Soy• Bugleweed• Lemon Balm
• Iron
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Oral Diabetic Agents
• Butchers Broom• Bochu• Dandelion• Juniper• Devil’s Claw
• Gymnema• Sylvestri• MSM• Karela• Chromium• Vanadium• Magnesium
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Corticosteroids
• Astragalus• Echinacea• Licorice Root• Alfalfa• Zinc• Horny Goat Weed• Buckthorne• Grapefruit Juice• Pomegranate Juice
• Selenium• Potassium• Melatonin• Magnesium• N-acetyl Cysteine
(NAC)• Vitamins A, D, B6• Zinc
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BP Medications
• Magnesium• Niacin• Calcium• Grapefruit Juice• Alistrol• Coenzyme Q
• Garlic• Hawthorne• Fish Oil• Folic Acid
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Cyclosporin
• Grapefruit Juice• St. Johns Wort• Chinese Skullcap• Gingko Biloba• Omega III Fatty
Acids• Grapefruit• Quercetine
• Vitamin E• Magnesium• Red Wine• Potassium• Milk• Pomegranate• Apple
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NSAIDS
• Glossypol• Coffee Arabica• Cola• Uva-Ursi• Alcohol
• White Willow Bark
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Digoxin
• Aloe Vera• Yellow Foxglove• Siberian Ginseng• Quinine• Licorice• Psyllium Fiber
• Hawthorne Berry• Eleutherococcus
Senticosus
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Conclusion
Over 50% of Americans will utilize vitamins, herbs, and supplements to treat a health concern in the next 30 days. Many of these natural therapies will interact either positively or negatively with another substance the person is taking. Knowing some of the more common interactions may help prevent or minimize health concerns related to drug-herb interations.
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Contact Information
Lorraine W. Bock, MSN, CRNP, CEN
Bock Family Healthcare
1773 West Trindle Road
Carlisle PA 17015
(717) 920-9579 – office
(717) 443-9970 – cell
[email protected] email
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Resources
• Nursing Herbal Medicine Handbook, 3rd Edition. ©2006. Lippincott, Williams, & Wilkins
• National Center for Complimentary and Alternative Medicine
• Holistic Online.com
• National Institutes of Health Database
