Patient Guide to Herb and

Supplement Use

~Table of Contents~

Introduction ..........................................................1

Unsafe Herbs and Supplements ...........................1

Herbs .....................................................................3

Supplements ........................................................10

Drug Interactions................................................14

Buyer Beware ......................................................40

General Safety Guidelines ..................................40

Resources ............................................................41

Websites ...............................................................41

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Introduction:

The use of alternative medicines, including herbs and supple-ments is wide spread. This pamphlet is designed to assist inproviding general information about herbs and supplements.The currently reported uses are based on historic informationand are not an endorsement of safety and effectiveness.

The following Herb and supplementsare considered unsafe by the FDA:

Herbs:Ephedra ( ma huang and Chinese ephedra)Comfrey (Symphytum species)Germander (Teucrium chamaedris)Willow bark

Supplements:Gamma butyolactone (precursor to the “date rape” drug, GBH)L-tryptophan (an amino acid)Geranium supplementsSelenium (in doses of about 800 mcg to 1,000 mcg per day)Niacin (in slow-release dosages of 500 mg or more per day or immedi-ate-release dosages of 750 mg or more per day)Vitamin A (in dosages of 25,000 or more IU per day)Vitamin B6 (Pyridoxine) (in dosages exceeding 100 mg per day)

The following is an additional red flag list: These substances are tootoxic as currently marketed to recommend. Although not all are welldocumented, they may have potentially life-threatening adverse effectsassociated with their use.

Aconite (Aconitum species)Arnica (Arnica montana)Calamus [Acorus calamus (European, Indian varieties)]Alfalfa seeds (Medicago sativa)Aristolochia (Aristolochia fangchi)Bitterroot (Apocynum)

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Red Flag List (continued):

Borage (Borago officinalis)Chaparral (Larrea tridentata)Coltsfoot (Tussilago farfara)Deadly Nightshade (Atropa Belladonna)Dong quai (Angelica archangelica)Heliotropium speciesJimson Weed (Datura Stramonium)Khat (Catha edulis)Kombucha home-brewed teasLobelia (Lobelia inflata)Mandrake or Mayapple (Podophyllum peltatum)Mistletoe (Phoradendron)Paraguay tea (Ilex paraguayensis)Pau d’Arco (Tabebuia heptaphylla)Pennyroyal (Mentha pulegium)Petasites hybridusPokeweed (Phytolacca Americana)Rue (Ruta graveolens)Sassafrass (Sassafras albidum)Skullcap (Scutellaria lateriflora)Sencecio speciesSophora flavenscensWormwood (Artemisia absinthium)

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Herbs:

Warnings, Precautions, SideEffects: There are no knownacute toxic effects of echinacea.Allergic reactions are possible.Often it causes a tingling sensationon the tongue. If nausea or diar-rhea occur use less or stop using it.Do not take Echinacea if you havean autoimmune disease, arepregnant or breast-feeding. Limituse to short intervals suchas a few days to two weeks.

See drug interactions section.

Echinacea:(Echinacea purpurea)

Use: Echinacae is a nativeAmerican plant. Echinaceais commonly used topicallyas a wound healing agent, andis taken internally to stimulate theimmune system to prevent coldsand upper respiratory infections.

Feverfew:(Tanacetum parthenium)

Use: Commonly used for mi-graines. Sometimes used forinflamed joints or psoriasis.

Warnings, Precautions, SideEffects: Contraindicated inpeople with ragweed allergies.Nervousness, tension, headaches,insomnia, and tiredness have beenreported from feverfew. The mostcommon side effect reported ismouth sores. Do not take if youare pregnant or breast-feeding.

See drug interactions section.

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Flaxseed Oil(Linum usitatissimum):

Use: Flaxseed is used for arthritis,preventing heart disease, forcancer, anxiety, benign prostatichypertrophy, constipation, vagini-tis, and weight loss.

Warnings, Precautions, SideEffects: Seeds are contraindicatedin bowel obstruction, throatstrictures and bowel inflammation.Flax seed may delay absorption ofdrugs. Therefore, do not takemedications with flax seed.

Herbs: (continued)

Garlic:(Allium sativum)

Use: Garlic is a common herbused in cooking. It is used to slowthe process of atherosclerosis,reduce cholesterol, control highblood pressure, as an antibacterialagent and to reduce bloodsugar levels.

Warnings, Precautions, SideEffects: Garlic reduces bloodsugar and may effect glucosecontrol in diabetic patients. Garlicmay also cause burning of themouth, esophagus, and stomach;nausea; sweating and light-headedness. Garlic dust caninduce an asthmatic reaction. Maycause colic in infants if breastfeeding.

See drug interactions section.

Ginkgo:(Ginkgo biloba)

Use: The ginkgo is the oldestliving tree species in the world.An extract of the leaves has beenused for cerebral insufficiency,memory impairment, circulatorydisorders such as Raynaud’sdisease, asthma, anxiety/stress,dementias, and tinnitus.

Warnings, Precautions, SideEffects: Possible side effectsof ginkgo include headache,irritability and restlessness,dizziness, heart palpitations andgastrointestinal and skin reactions.Severe side effects are rare withingestion of ginko extracts.

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Warnings, Precautions, SideEffects: Contact with the fleshyfruit pulp causes an allergicdermatitis, similar to poison ivy.Ginkgo should not be used if youare pregnant or breast-feeding.

See drug interactions section.

Herbs: (continued)

Ginkgo:(Ginkgo biloba) (continued)

Ginseng:(Panax ginseng) –Korean ginseng

Use: Ginseng is promoted forits anti-stress effects. It has beenused for atherosclerosis; bloodand bleeding disorders; colitis;and to relieve symptoms of aging,cancer, and senility; and to boostthe immune system.

Warnings, Precautions, SideEffects: The most common sideeffects of Ginseng are nervousnessand excitation. Over use cancause headache, insomnia, andpalpitations. Use with caution inpatients with high blood pressure.The inability to concentrate hasalso been reported with long-termuse. Ginseng may lower bloodglucose in diabetic patients.Ginseng should not be used if youare pregnant or breast-feeding.

See drug interactions section.

Goldenseal:(Hydrastis canadensis)

Use: Goldenseal has been usedtraditionally to treat mucusmembrane inflammation andgastrointestinal upset. The plantpossesses astringent and weakantiseptic properties which may

Warnings, Precautions, SideEffects: Do not take if you arepregnant, breast-feeding, or havehigh blood pressure, heart disease,diabetes, or glaucoma. High dosescan be toxic causing nausea,

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Goldenseal:(Hydrastis canadensis)(continued)Use: be modestly effectivein treating minor oral problems.Goldenseal does not mask urinedrug screens. The topical useof goldenseal extracts in sterileeyewashes persists althoughthere is little clinical evidencefor its effectiveness.

Warnings, Precautions, SideEffects: vomiting diarrhea, central nervous system stimula-tion and respiratory failure.Goldenseal has also been reportedto cause numbness and tinglingsensation, decrease white bloodcells and stimulate or relax theuterus.Use for short periods of time.

See drug interactions section.Grape seed(Vitis vinefera):

Use: Grape seed is used forcirculatory disorders, includingvaricose veins, atherosclerosis,inflammation, heart disease,and stroke.

Warnings, Precautions, SideEffects: None at this time.

See drug interactions section.

Herbs: (continued)

Kava-Kava:(Piper methysticum)

Use: Kava-Kava is knownas a popular drink in the SouthPacific. It is generally usedas a sedative for sleep enhance-ment and controlling anxiety.

Warnings, Precautions, SideEffects: Kava-Kava can effect thecentral nervous system witha reduction in anxiety and sleepenhancement. Heavy use can leadto poor health, including dry skinand changes in vision. High dosescan lead to muscle weakness andthere is some evidence that it maycause high blood pressure in thelungs. It should not be used if youare pregnant or nursing. It shouldnot be taken for greater than 3months.

See drug interactions section

Herbs: (continued)

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Saw Palmetto:(Serenoa repens)

Use: Saw Palmetto is used forurination problems in the manage-ment of prostatic enlargement(benign prostatic hypertrophy)stages 1 & 2.

Warnings, Precautions, SideEffects: Adverse effects are rarelyexperienced with the useof saw palmetto extract. Rarely,stomach problems and headacheshave been reported. Largeamounts of the berry are reportedto cause diarrhea.

St. John’s Wort:(Hypericum perforatum)

Use: St. John’s Wort has beentraditionally used as an herbaltreatment in the managementof anxiety and depression, asa diuretic, for gastritis, and insom-nia.

Warnings, Precautions, SideEffects: Photosensitivity and rashare the most common side effects.Some people experience fatigue,stiff neck or gastrointestinalsymptoms. Large amounts ofSt. John’s Wort may interactwith tyramine containing foods;therefore avoid eating thefollowing foods high intyramine:AcidophilusAged or dried meats and fishAnchovies (canned)Avocado (ripe)Banana (ripe)Beer/ale (regular & alcohol free)BolognaBroad beans and podsCanned meats, poultry & fishCheese *ChocolateFava beansFrankfurtersLiver, (esp. chicken & beef)

Herbs: (continued)

St. John’s Wort:(Hypericum perforatum)(continued)

Warnings, Precautions, SideEffects:Meat extractsMeat tenderizer or meats mari-nated over 24 hoursMonosodium glutamateMushrooms (pickled, canned)Peanut butterPickled herring or kipperRaspberriesSalamiSardinesSauerkrautSausages/pepperoniSour creamSoybeansSoy sauceVanilla concentrateWine (red, chianti, port, sherry, vermouth)Yeast extractYogurt* Especially brie, camembert,cheddar, swiss (emmentaler),gouda, gruyere, mozzarella,parmesan, processed american,provolone, romano, roquefort, andstilton.

See drug interactions section.

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Herbs: (continued)

Valerian:(Valeriana officinalis)

Use: Valerian is used for restless-ness and as a sedative, sleep aid.

Warnings, Precautions, SideEffects: This appears to bea relatively safe herb. The fewreported side effects includemorning grogginess, headaches,excitability, uneasiness, heartdisturbances and insomnia,especially if taken regularly fortwoto three weeks without a break.

See drug interactions section.

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Carnitine(Levocarnitine):

Use: Levocarnitine administra-tion may enhance energy balancein skeletal and heart muscle.Levocarnitine may improvewalking distance in patients withintermittent claudication; limiteddata suggest beneficial effects indiabetic vascular changes andcongestive heart failure. Carnitinehas been used to enhance athleticperformance, chronic fatigue,Alzheimer’s dementia, anorexia,low blood sugar, correct lipopro-teins in patients on hemodialysisand kidney failure, angina pecto-ris, coronary vascular disease,heart failure, diabetes, highcholesterol, high triglycerides,peripheral vascular disease.

Warnings, Precautions, SideEffects: Adverse effects oflevocarnitine include nausea,vomiting, stomach pain, andweakness or loss of strength.

Supplements:

Cholestin:

Use: Cholestin is a Chinese herbalremedy that is used to lowercholesterol levels. It is made fromrice and fermented with red yeast.The active ingredient in Cholestinis chemically identicalto lovaststin (which is sold byprescription as Mevacor®).Cholestin appears to lower choles-terol levels about as much asMevacor® and other statin drugsand it is less costly. It should beused in conjunction with a low-fatdiet and exercise.

Warnings, Precautions, SideEffects: Not known.

Supplements (continued):

Chromium:

Use: Chromium is a trace elementthat is required for normal meta-bolic function. Is used for weightloss, glucose control in diabetes,lowering cholesterol and enhanc-ing athletic performance.

Warnings, Precautions, SideEffects: Certain forms of chro-mium are associated with thedevelopment of topical skinirritation. Chromium can causeliver and kidney disease and blooddisorders. Chromium may lowerblood glucose in diabetic patients.

See drug interactions section.

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CoEnzyme Q-10 (Co-Q10):

Use: C0-Q10 is used for conges-tive heart failure, angina, diabetes,high blood pressure, breast cancer,Huntington’s disease, reducetoxicity from doxorubicin chemo-therapy, exercise intolerance,chronic fatigue symptoms, stimu-lating the immune system inAIDS,and male infertility. Co-Q10 isoften used as a supplement withLipid lowering drugs.

Warnings, Precautions, SideEffects: Taking Coenzyme Q-10can lead to gastritis, loss ofappetite, nausea and diarrhea.When taking large amounts liverenzyme tests may be effected.

See drug interactions section.

Creatine:

Use: Creatine is promotedto enhance creatine muscle stores,improve muscle performance, andimprove muscle appearance.Benefits are most likely to beobserved in athletes in powersports (such as power lifting) andsprinters, but not in endurancesports.

Warnings, Precautions, SideEffects: Nausea and diarrheahave been occasionally reportedwith creatine. High doses maycarry risk of kidney and liverdamage. Long-term safetydata is not available. Largequantities may increase serumcreatinine levels.

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Supplements (continued):

DHEA:

Use: Dehydroepiandrosterone(DHEA) is a steroid hormoneproduced by the adrenal glands.DHEA is promoted as an anti-aging, anti-cancer miracle supple-ment.

Warnings, Precautions, SideEffects: DHEA SHOULD NOTbe regarded as a dietary supple-ment, but as a potent drug thatmay increase risk of cancer andheart disease.

Glucosamine/Chondroitin:

Use: Is used to treat osteoarthritis,to reduce joint pain from cartilagefailure.

Warnings, Precautions, SideEffects: Glucosamine is well-tolerated. Short-term use can causemild stomach problems includingnausea, heartburn, diarrhea, andconstipation, drowsiness, skinreactions, and headache.

See drug interactions section.

Melatonin:

Use: Melatonin is a hormonethat has recently been the subjectof research for use in insomnia,overcoming jet lag, improvingeffectiveness of the immunesystem, cancer prevention, anduse as an anti-oxidant. It’s usein short-term treatment of insom-nia shows promise.

Warnings, Precautions, SideEffects: Side affects associatedwith Melatonin use include head-ache, heavy head, and transientdepression, daytime fatigue,drowsiness, dizziness, abdominalcramps and irritability. Melatoninhas aggravated depressive symp-tomsin psychiatric patients. Long-termuse of melatonin has not beenstudied, therefore the potentialfor adverse effects is unknown.

See drug interactions section.

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Supplements (continued):

Niacin(Vitamin B

3):

Use: For use in people with highcholesterol that don’t respondsufficiently to diet and weight loss,peripheral vascular disease andcirculation disorders. To correctniacin acid deficiency, prevent andtreat pellagra.

Warnings, Precautions, SideEffects: Contraindicated inpeople with liver disease, pepticulcer, severe low blood pressure,and allergy to niacin. Use withcaution in people with gout. Largedoses should be administered withcaution to patients with unstableangina, coronary artery disease,gall bladder disease, liver disease,and diabetes. Can cause flushing,headache, bloating, flatulence,nausea, changes in liver function,tingling or burning of the extremi-ties. Rarely rapid heart rate,fainting, dizziness, rash, blurredvision, and wheezing.

See drug interactions section.

Vitamin E(alpha-tocopherol):

Use: Vitamin E is used forimproving physical endurance,increasing energy, preventingallergies, for asthma, infections,protection against negative effectsof air pollution, preventing aging,for Alzheimer’s disease, nightcramps, inflammatory skin disor-ders, burns, reducing risk ofcoronary artery disease, preventingheart disease, improving circula-tion, for angina, intermittentclaudication, cystic fibrosis,

Warnings, Precautions, SideEffects: Vitamin E is seldomassociated with adverse effects.Rarely, vitamin E causes nausea,diarrhea, intestinal cramps,fatigue, weakness, headache,blurred vision, rash, gonadaldysfunction, and creatinuria.Topical application of vitamin Ehas been associated with contactdermatitis, inflammatory reactions,and eczematous lesions.

Supplements (continued):

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Vitamin E(alpha-tocopherol)(continued):Use: preventing cancer, premen-strual syndrome, infertility,impotence, chronic cystic mastitis,mammary dysplasia, peptic ulcers,Parkinson’s disease, tardivedyskinesia, neuromusculardisorders, and cataracts.

Warnings, Precautions, SideEffects: Absorption is increasedwhen taken with a meal.

See drug interactions section.

The following pages list potential drug-herb or supplement interactionsthat should be considered when using herbs or supplements withprescription or over-the-counter medications. The lists of drugs maynot list all medications in a class. You should consult your physician ifyou have questions about specific medications that may have interac-tions listed.

Drug Interactions:Description:

Alfalfa(Medicago sativa)

Warfarin (Coumadin): Exces-sive use may decrease theanticoagulant (blood thinningeffects) of warfarin.

Oral Contraceptives or Hor-mone Therapy: Excessive dosesof alfalfa may interfere withhormone therapy.

Chlorpromazine: Excessivedoses of alfalfa may increasethe risk of drug-induced photo-sensitivity.

Problems:

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Aloe(Aloe barbadensis):

Antiarrhythmic drugs (Drugsfor irregular heart beat): Over-use of aloe can increase risk ofdrug toxicity.

Digoxin (Lanoxin): Overuse ofaloe can increase risk of digoxintoxicity.

Diuretics (Chorthalidone,Furosemide,Hydrochlorthiazide,Metolazone): Overuse maycompound potassium lossby diuretic and contributeto confusion, weakness,and irregular heartbeat.

Bisacodyl (Dulcolax): Canexacerbate laxative effect, leadingto potassium loss and contributeto confusion, weakness, or irregu-lar heartbeat.

Drug Interactions (continued):

Description: Problems:

Diabetes Therapy: May lowerblood sugar and alter bloodglucose control.

Insulin: Insulin dosage adjust-ments can be necessary dueto blood glucose lowering effectsof bitter melon.

Bitter melon or Bitter Gourd(Momordica charantia):

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Problems:Description:

Drug Interactions (continued):

Carnitine (Levocarnitine, l-carnitine):

Warfarin (Coumadin): Theanticoagulant (blood thinning)effects may enhance the effectsof warfarin, increasing the riskof bleeding.

Digoxin (Lanoxin): Overuseof Cascara sangrada can increaserisk of digoxin toxicity.

Diuretics (Chorthalidone,Furosemide,Hydrochlorthiazide,Metolazone): May cause potas-sium loss and contribute to confu-sion, weakness, and irregularheartbeat.

Bisacodyl (Dulcolax): Canexacerbate laxative effect, leadingto potassium loss and contribute toconfusion, weakness, or irregularheartbeat.

Cascara sagrada(Rhamnus pershianus):

Warfarin (Coumadin): Theanticoagulant (blood thinning)effects may enhance the effectsof warfarin, increasing the riskof bleeding.

Chamomile, German(Matricaria recutita):

Central nervous system (CNS)depressants [alcohol, benzodiaz-epines, barbiturates, antihista-mines (including over thecounters), and other herbs thatproduce CNS depression]:Chamomile may produce additiveeffects, increasing the drowsinessand fatigue side effect of themedication.

Problems:Description:

Drug Interactions (continued):

Chromium: Insulin: May lower blood sugarand alter blood glucose control.

Niacin (Vitamin B3): May en-

hance chromium’s effecton lowering blood glucose.

Vitamin C: May increase chro-mium absorption.

Zinc: May decrease chromiumabsorption.

Chrondroitin: Hyaluronic acid: Use togethercan cause increased effectsof hyaluronic acid duringcataract surgery.

CoEnzyme Q-10 (Co-Q10): Diabetes Therapy: Drugs that aretaken by mouth to control diabetescan reduce levels and effects ofCoEnzyme Q-10.

HMG-CoA Reductase Inhibitors[cervastatin (Baycol),atorvastatin (Lipitor), lovastatin(Mevacor), pravastatin(Pravachol), ans simvastatin(Zocor)]: HMG-CoA reductaseinhibitors can reduce levels andeffects of CoEnzyme Q-10.

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Problems:Description:

Drug Interactions (continued):

Dandelion entire plant (Taracumofficiale):

Digoxin: May lead to lossof potassium depletion andcause digoxin toxicity.

Diuretics (Chorthalidone,Furosemide,Hydrochlorthiazide,Metolazone): May cause potas-sium loss and contribute to confu-sion, weakness, and irregularheartbeat.

Diabetes Therapy: May lowerblood sugar and alter bloodglucose control.

Lithium (Eskalith): Overusetheoretically can cause sodiumloss and possibly lithium toxicity.

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Echinacea(Echinacea purpurea)

Immunosupressant medications[Cyclosporine (Neoral,Sandimmune), Corticosteroids(Prednisone, Prednisolone):Immunostimulant effects ofEchinacea may counteract thera-peutic effects of these medications.

Anabolic steroids, amiodarone(Cordarone), methotrexate,ketoconazole (Nizoral): Do nottake with these medications knownto be potentially toxic to the liver.

Warfarin (Coumadin): Theanticoagulant (blood thinning)effects of warfarin may be de-creased, reducing the effectivenessof warfarin.

CoEnzyme Q-10 (Co-Q10)(Continued):

Problems:Description:

Drug Interactions (continued):

Feverfew(Tanacetum perthanium):

Anticoagulants [Warfarin(Coumadin)] : The anticoagulant(blood thinning) effects mayenhance the effects of warfarin,increasing the risk of bleeding.

Antiplatelet drugs [Aspirin,Ticlopidine (Ticlid), clopidogrel(Plavix)]: Feverfew may enhancethese drugs effects and increasethe risk of bleeding.

Non-steroidal antiinflammatoryagents (aspirin or ibuprofen) :May reduce the effectivenessof this herb.

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Garlic(Allium sativum):

Antiplatelet drugs [Aspirin,Ticlopidine (Ticlid), clopidogrel(Plavix)]: Garlic may enhancethese drugs effects and increasethe risk of bleeding.

Anticoagulants [Warfarin(Coumadin)]: The anticoagulant(blood thinning) effects mayenhance the effects of warfarin,increasing the risk of bleeding.

Diabetes Therapy: May lowerblood sugar and alter bloodglucose control.

Insulin: Insulin dosage adjust-ments can be necessary dueto blood glucose lowering effectsof garlic.

Problems:Description:

Drug Interactions (continued):

Ginger(Zingiber offinicinale):

Antiplatelet drugs [Aspirin,Ticlopidine (Ticlid), clopidogrel(Plavix)]: Ginger may enhancethese drugs effects and increasethe risk of bleeding.

Anticoagulants [Warfarin(Coumadin)]: The anticoagulant(blood thinning) effects mayenhance the effects of warfarin,increasing the risk of bleeding.

Blood Pressure Therapy: Mayinterfere with blood pressure drugtherapy by increasing or loweringblood pressure.

Diabetes Therapy: May lowerblood sugar and alter bloodglucose control.

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Ginkgo leaf extract(Ginkgo biloba):

Antiplatelet drugs [Aspirin,Ticlopidine (Ticlid), clopidogrel(Plavix)]: Ginkgo may enhancethese drugs effects and increasethe risk of bleeding.

Anticoagulants [Warfarin(Coumadin)]: The anticoagulant(blood thinning) effects mayenhance the effects of warfarin,increasing the risk of bleeding.

Problems:Description:

Drug Interactions (continued):

Monoamine oxidase inhibitors[Phenelzine (Nardil), tranyl-cypromine (Parnate)]: Ginkgomay potentiate these drugs’effects.

Selective Serotonin reuptakeinhibitors [Paroxetine (Paxil),Sertraline (Zoloft), Fluoxetine(Prozac), Fluvoxamine (Fluvox),Citalopram (Celexa)]: Ginkgomay potentiate these drugs’effects. Ginkgo extract canreverse fluoxetine and sertraline –induced sexual dysfunction.

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Ginkgo leaf extract(Ginkgo biloba) (continued):

Ginseng, panax(Panax ginseng):

Digoxin: May aggravate drug’sside effect of swollen and tenderbreasts.

Calcium Channel Blockers[Amlodipine (Norvasc),diltiazem (Cardizem, Dilacor,Tiamate), felodipine (Plendil),israpidine (Dynacirc),nicardipine (Cardene),nifedipine (Adalat, Procardia),nisoldipine (Sular), verapamil(Calan, Isoptin)]: May aggravatedrug’s side effects of swollen andtender breasts.

Problems:Description:

Drug Interactions (continued):

Ginseng, panax(Panax ginseng)(continued):

Amitriptyline (Elavil), chlor-diazepoxide (Librium), chlor-promazine (Thorazine),clomipramine (Anafranil),lithium carbonate (Eskalith,Lithobid, Lithonate, Lithotabs),phenelzine (Nardil), tranyl-cypromine (Parnate): Maycounteract the drug’s effects.

Anticoagulants [Warfarin(Coumadin)]: May increasethe anticoagulant (blood thinning)effects of Warfarin, and riskof bleeding.

Antiplatelet drugs [Aspirin,Ticlopidine (Ticlid), clopidogrel(Plavix)]: Ginseng may enhancethese drugs effects and increasethe risk of bleeding.

Diabetes Therapy: May lowerblood sugar and alter bloodglucose control.

Hormone Therapy: Ginseng mayinterfere with steroid and hormonedrugs.

Insulin: Insulin dosage adjust-ments can be necessary dueto blood glucose lowering effects.

Caffeine (Tea, Coffee, Colas,etc.) and stimulant drugs:Ginseng, may potentiate stimulanteffects of these drugs.

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Problems:Description:

Drug Interactions (continued):

Alcohol: Avoid taking together.

Antiplatelet drugs [Aspirin,Ticlopidine (Ticlid), clopidogrel(Plavix)]: Ginseng may enhancethese drugs effects and increasethe risk of bleeding.

Anticoagulants [Warfarin(Coumadin)]: The anticoagulant(blood thinning) effects mayenhance the effects of warfarin,increasing the risk of bleeding.

Diabetes Therapy: May lowerblood sugar and alter bloodglucose control.

Insulin: Insulin dosage adjust-ments can be necessary dueto blood glucose lowering effects.

Antipsychotic drugs: Avoid usingtogether.

Hormones: Avoid using together.

Barbiturates: Use with barbitu-rate may cause additive effects andside effects.

Sedative drugs: Use with sedativedrugs may cause additive effectsand side effects.

Ginseng, Siberian(Eleutherococcus senticosus):

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Problems:Description:

Drug Interactions (continued):

Goldenseal(Hydrastis canadensis):

Heparin: The anticoagulant(blood thinning) activity ofheparin, may be opposed byberberine, which is a componentin Goldenseal root.

Grape seed(Vitis vinefera):

Warfarin (Coumadin): Theanticoagulant (blood thinning)effects may enhance the effectsof warfarin, increasing the riskof bleeding.

Guarana(Paullinia cupana):

Caffeine (Caffedrine, NoDoz,Vivarin): Avoid use together asboth have very high amounts ofcaffeine.

Adenosine (Adenocard): Shouldbe avoided 12 hours before the useof adenosine because it can inhibitthe cardiac effects of adenosine.

Barbiturates (Phenobarbital):Can decrease effects of guarana.

Benzodiazepines [alprazolam(Xanax), chlordiazepoxide(Librium), diazepam (Valium),clonazepam (klonopin),flurazepam (Dalmane),Lorazepam (Ativan), Midazolam(Versed), Oxazepam (Serax),temazepam (Restopril),triazolam (Halcion)]: Guaranacan reduce sedative effects of thebenzodiazepines.

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Beta-adrenergic agonists[albuterol (Proventil, Ventolin,Volmax), metaproteranol(Alupent), terbutaline (Bricanyl,Brethine), isoproterenol (Isuprel,Norisodrine)]: Guarana mightincrease heart effects of thesedrugs.

Beta-blockers [propranolol(Inderal), metoprolol(Lopressor)]: Might increaseblood pressure and reduce effec-tive.

Cimetidine (Tagamet):Cimetidine can increase effectsof guarana.

Clozapine (Clozaril): Use to-gether can cause exacerbatepsychotic symptoms. Gurana mayalso increase side effects andtoxicity of clozapine.

Central Nervous System (CNS)Depressants: Can increase toxiceffects guarana.

Diabetes Therapy: May raiseblood sugar and alter bloodglucose control.

Dipyridamole (Persantine): Willinterfere with dipyridamole testfor blood flow in the heart.

Problems:Description:

Drug Interactions (continued):

Guarana(Paullinia cupana)(continued):

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Problems:Description:

Drug Interactions (continued):

Guarana(Paullinia cupana)(continued):

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Disulfiram: Can increase effectsof guarana.

Ephedrine: Use with guarana canincrease agitation, tremors andinsomnia.

Iron: Avoid taking at the sametime.

Monoamine oxidase inhibitors[Phenelzine (Nardil), tranyl-cypromine (Parnate)]: Whentaken together can cause severehigh blood pressure.

Oral contraceptives: Can in-crease effects and side effects ofguarana.

Phenylpropanolamine: Usetogether can increase bloodpressure and agitation.

Phenytoin (Dilantin): Phenytoincan enhance the breakdown andreduce effects of guarana.

Quinolones [Ciprofloxacin(Cipro) and grepafloxacin(Raxar)]: Can increase effectsand side effects of guarana.

Riluzole (Rilutek): Avoidtaking together.

Problems:Description:

Drug Interactions (continued):

Guarana(Paullinia cupana)(continued):

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Theophylline [ Theodur, Slo-Bid]: Guarana can increasetheophylline’s levels, effects,and side effects.

Verapamil (Calan, Isoptin,Verelan, Covera): Can increaseguarana effects and risk of sideeffects.

Zinc: Avoid taking guarana onehour before or two hours after.

Digoxin (Lanoxin): Use togethermight increase digoxin toxicity.

Coronary Vasodilators (Theo-phylline, caffeine, papaverine,sodium nitrate, adenosine, andepinephrine): Might causeadditive dilation of blood vessels.

Cardiovascular drugs for heartfailure, high blood pressure,angina, and arrhythmias:Hawthorn may interfere withtherapy.

CNS depressants: Hawthorn mayhave additive depressant effects.

Hawthorn(Crataegus species):

Problems:Description:

Drug Interactions (continued):

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Central nervous system (CNS)depressants [alcohol, benzodiaz-epines, barbiturates, antihista-mines (including over thecounters), and other herbs thatproduce CNS depression]: Hopsmay produce enhanced effects,increasing the drowsiness andfatigue side effect of the medica-tion.

Hops(Humulus lupulus):

Kava-kava(Piper methysticum):

Amitripyline (Elavil), chlordiaz-epoxide (Librium), chlorprom-azine (Thorazine), clomipramine(Anafranil), lithium carbonate(Eskalith, Lithobid, Lithonate,Lithotabs), phenelzine (Nardil),tranylcypromine (Parnate): Canexacerbate drug’s effects on thecentral nervous system, causingdrowsiness and slowed breathing.

Central nervous system (CNS)depressants [alcohol, benzodiaz-epines, barbiturates, antihista-mines (including over-the-counters), and other herbs thatproduce CNS depression]:Kava-kava may produce enhancedeffects, increasing the drowsinessand fatigue side effect of themedication.

Problems:Description:

Drug Interactions (continued):

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Blood pressure medications:Licorice may increase bloodpressure counteracting the effectsof blood pressure medications.

Corticosteroids: Licorice mayincrease the duration of activityof these drugs.

Diabetes Therapy: Licorice mayinterfere with glucose control.

Digoxin: May lead to lossof potassium increase riskof digoxin toxicity.

Diuretics (Chorthalidone,Furosemide,Hydrochlorthiazide,Metolazone): Overuse maycompound potassium loss bydiuretic and contribute to confu-sion, weakness, and irregularheartbeat. Licorice may alsoreduce medication effectiveness.

Hormones: Licorice may interferewith estrogen and anti-estrogentherapy.

Licorice(Glycyrrhniza glabra):

Problems:Description:

Drug Interactions (continued):

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Ma huang(Ephedra sinica):

Amitriptyline (Elavil), chlor-diazepoxide (Librium), chlor-promazine (Thorazine),clomipramine (Anafranil),lithium carbonate (Eskalith,Lithobid, Lithonate,Lithotabs), phenelzine(Nardil), tranylcypromine(Parnate): Can enhance drug’stoxic effects.

Caffeine (Caffedrine, NoDoz,Vivarin): Can exacerbate toxiceffects of caffeine.

Diabetes Therapy: May raiseblood sugar and alter bloodglucose control.

Theophylline (Theo-Dur, Slo-Bid, Theolair, Slophyllin) : Canexacerbate rapid heart rate,anxiety and high blood pressure.

Melatonin: Immunosupressant medications[Cyclosporine (Neoral,Sandimmune), Corticosteroids(Prednisone, Prednisolone)]:Immunostimulant effects ofmelatonin may effect the therapeu-tic effects of these medications.

Central nervous system (CNS)depressants [alcohol, benzodiaz-epines, barbiturates, antihista-mines (including over thecounters), and other herbs thatproduce CNS depression]:

Problems:Description:

Drug Interactions (continued):

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Melatonin may produce enhancedeffects, increasing the drowsinessand fatigue side effect of themedication.

Verapamil (Calan, Isoptin,Verelan, Covera): Can increasethe elimination of melatonin fromthe body.

Melatonin:

Nettle, Stinging Leaves(Urtica dioica):

Anticoagulants [Warfarin(Coumadin)]: The anticoagulant(blood thinning) effects of war-farin may be decreased due to thevitamin K content of nettle.

Diabetes Therapy: May alterblood glucose control in diabetes.

Blood Pressure medications:Excessive amounts of nettle mayeffect medications to control highand low blood pressure.

Central nervous system (CNS)depressants [alcohol, benzodiaz-epines, antihistamines (includingover the counters), and otherherbs that produce CNS depres-sion]: May produce enhancedeffects, increasing the drowsinessand fatigue side effect of themedication.

Problems:Description:

Drug Interactions (continued):

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Niacin (Vitamin B3): Diabetes Therapy: May lower

blood sugar and alter bloodglucose control.

Carbamazepine (Tegretol):Can decrease elimination ofcarbamazepine and increase risk oftoxicity.

HMG-CoA Reductase Inhibitors[cervastatin (Baycol),atorvastatin (Lipitor), lovastatin(Mevacor), pravastatin(Pravachol), ans simvastatin(Zocor)]: Use together canincrease risk of myopathy (muscledamage).

Bile Acid Sequesterants[cholestyramine (Questran)and colestipol (Colestid)]: Canreduce niacin absorption.

Nicotine, transdermal(Nicoderm, Nictotrol, Habitrol):Can increase therisk of flushing and dizziness with niacin.

Anticoagulants [Warfarin(Coumadin)]: The anticoagulant(blood thinning) effects of War-farin may be decreased due to theVitamin K content of parsley.

Parsley Leaf, Root(Carum petroselenium):

Passion flower(Passiflora incarnata):

Central nervous system (CNS)depressants [alcohol, benzodiaz-epines, antihistamines (includingover the counters), and otherherbs that produce CNS depres-sion]: May produce enhancedeffects, increasing the drowsinessand fatigue side effect of themedication.

Monoamine oxidase inhibitors[Phenelzine (Nardil), tranyl-cypromine (Parnate)]: Passionflower may potentiate thesedrugs’ effects.

Problems:Description:

Drug Interactions (continued):

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Psyllium(Plantago):

Drugs taken by mouth: Takedrugs by mouth one hour beforeor four hours after Psyllium toavoid decreased or delayedabsorption.

Digoxin (lanoxin): Reduceabsorption and therefore effectof digoxin.

Problems:Description:

Drug Interactions (continued):

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Central nervous system (CNS)depressants [alcohol, benzodiaz-epines, antihistamines (includingover the counters), and otherherbs that produce CNS depres-sion]: May produce enhancedeffects, increasing the drowsinessand fatigue side effect of themedication.

Scopolia (Scopolia carniolica):

Anticoagulants [Warfarin(Coumadin)]: The anticoagulant(blood thinning) effects mayenhance the effects of warfarin,increasing the risk of bleeding.

Antiplatelet drugs [Aspirin,Ticlopidine (Ticlid), clopidogrel(Plavix): Seaweed may enhancethese drugs effects and increasethe risk of bleeding.

Seaweed-Kelp (Fucus and other species):

Senna(Cassia senna, Sennaalexandrina):

Digoxin (Lanoxin): Overusecan increase risk of digoxintoxicity.

Diuretics (Chorthalidone,Furosemide,Hydrochlorthiazide,Metolazone): May cause potas-sium loss and contribute to confu-sion, weakness, and irregularheartbeat.

Problems:Description:

Drug Interactions (continued):

Antidepressants: Use togethermay increase actions and sideeffects of medications.

Barbiturates (Phenobarbital):May increase sleep time withthese drugs.

Bromocriptine (Parlodel):Taking with St. John’s wort cancause serious high blood pressurereactions.

Central nervous system (CNS)stimulants [many cold andhayfever medications, deconges-tants, methylphenidate,dexedrine, diet pills, beta-agonists (found in many asthmainhalers), caffeine (teas, cola,coffee), theophylline]: Takingtogether may cause serious highblood pressure reactions.

Digoxin: May lead to lossof potassium and increase riskof digoxin toxicity.

St John’s Wort(Herpicum perforatum):

Senna(Cassia senna, Sennaalexandrina) (continued):

Bisacodyl (Dulcolax): Canexacerbate laxative effect, leadingto potassium loss and contributeto confusion, weakness, or irregu-lar heartbeat.

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Diuretics (Chorthalidone,Furosemide,Hydrochlorthiazide,Metolazone): May cause potas-sium loss and contribute to confu-sion, weakness, and irregularheartbeat.

Monoamine oxidase inhibitors[Phenelzine (Nardil), tranyl-cypromine (Parnate)]: Mayexacerbate drugs effects.

Narcotics: May increase sleeptime of these drugs.

Photosensitizing drugs: Mayexacerbate drugs’ side effectof increased sensitivity to the sun.

Selective Seratonin-ReuptakeInhibitors [Paroxetine (Paxil),Sertraline (Zoloft), Fluoxetine(Prozac), Fluvoxamine (Fluvox),Citalopram (Celexa)]: Do not usetogether due to risk of serotonin -syndrome with headache, dizzi-ness, sweating and agitation,confusion, shivering, musclespasms, shaking and coma.

Reserpine: Can counteractreserpine drug effects.

St John’s Wort(Herpicum perforatum)(continued):

Problems:Description:

Drug Interactions (continued):

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Problems:Description:

Drug Interactions (continued):

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Digoxin: May lead to lossof potassium depletion andcause digoxin toxicity.

Diuretics (Chorthalidone,Furosemide,Hydrochlorthiazide,Metolazone): May causepotassium loss and contributeto confusion, weakness, andirregular heartbeat.

Uva ursi or bearberry(Arctostaphlyos uva-ursi):

Valerian(Valeriana officinalis):

Central nervous system (CNS)depressants [alcohol, benzodiaz-epines, Barbiturates (Phenobar-bital), antihistamines (includingover the counters), and otherherbs that produce CNS depres-sion]: May produce enhancedeffects, increasing the drowsinessand fatigue side effect of themedication.

Vitamin E(alpha-tocopherol):

Warfarin (Coumadin): Theeffects of vitamin E on vitaminK production may enhance theanticoagulant (blood thinning)effects of warfarin, increasingthe risk of bleeding.

Bile Acid Sequesterants[cholestyramine (Questran)and colestipol (Colestid)]: Mayreduce vitamin E absorption.

Problems:Description:

Drug Interactions (continued):

Aspirin (Bufferin): Containssalicylates, the active compound inaspirin, and could cause toxicity.

Warfarin (Coumadin): Couldincrease risk of bleeding due tosystemic absorption of salicylates.

Wintergreen (Gaultheria procumbens):

Digoxin: May lead to lossof potassium and increase riskof digoxin toxicity.

Bisacodyl (Dulcolax): Canexacerbate laxative effect.

Yellow dock(Rumex crispus):

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Yohimbine(Pausinystalia yohimbine):

Diuretics (Chorthalidone,Furosemide,Hydrochlorthiazide,Metolazone): May counteractdrugs effect.

Spironolactone: May counteractdrug’s effects.

Calcium Channel Blockers[Amlodipine (Norvasc),diltiazem (Cardizem, Dilacor,Tiamate), felodipine (Plendil),israpidine (Dynacirc),nicardipine (Cardene),nifedipine (Adalat, Procardia),nisoldipine (Sular), verapamil(Calan, Isoptin)]: May counteractdrugs effects.

Problems:Description:

Drug Interactions (continued):

Blood Pressure Medications:May counteract the drug’s effects.

Amitriptyline (Elavil), chlor-diazepoxide (Librium), chlor-promazine (Thorazine),clomipramine (Anafranil),lithium carbonate (Eskalith,Lithobid, Lithonate, Lithotabs),phenelzine (Nardil), tranyl-cypromine (Parnate): Thesedrugs can increase toxicity of theherb (if taken at the same time).

Yohimbine(Pausinystalia yohimbine)(continued):

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Buyer Beware. . .Before starting a dietary supplement or herb you should check with yourmedical doctor. It is especially important for people who are:

Ø Pregnant or breast feedingØ Chronically illØ Elderly or under 18 years of ageØ Taking prescription or over-the counter medications.

General Safety Guidelines:When you are asked “What medications are you taking?” youshould always inform your physician, pharmacist, nurse or hospitalof any herbs or supplements you are or have recently used.Ø Do not take any herbs on a daily basis for a prolonged period of time.Ø Do not take large quantities of any one herbal preparation.Ø Do not take any herbs or supplements that may be harmful. (See

page 1.)Ø Buy only preparations when plants and their quantities are listed

on the package (no guarantee of safety).Ø Look for ingredients in products with U.S.P. notation (U. S. Pharma-

copoeia).Ø Some herbal products may interfere with anesthesia and should

be stopped 2 to 3 weeks prior to surgery to ensure product is clearedfrom your body.

In addition to your physician, other health professionals, such as Regis-tered Dietitians/Nutritionists and Registered Pharmacists may be auseful source of information.

Nutrition Health Line: (518) 926 – 2610

Pharmacy: (518) 926 – 2500 or (518) 926 – 2530

Report adverse reactions to FDA MedWatch: 1-800-FDA-1088

Poison Control Centers: 1. New York City Poison Control Center: (212) 340-4494

2. National Capital Poison Center,Washington, D.C.: (202) 625 -3333

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Educational Resources: The following listed resources representa wide range of opinions and perspectives. This list does not representan endorsement. Several sources should be consulted before drawingconclusions on the safety and effectiveness of particular herb or supple-ment.

Organizations & Web sites:

http://dietary-supplements.info.nih.govNational Institute of Health (NIH) Office of Dietary Supplements:http://odp.od.nih.gov/ods/databases/ibids.htmlAmerican Botanical Council, PO Box 144345, Austin, TX 78714; 512-926-4900; http://www2.outer.net/herbalgram/herbalgram.htmlAmerican Herbal Pharmacopoeia, PO Box 5159, Santa Cruz, CA 95063;8130461-6317; www.herbal-ahp.orgUnited States Pharmacopeia, 12601 Twinbrook Pkwy., Rockville, MD20852; 301-881-0666; www.usp.orgFederal Trade Commission; www.ftc.gov

Books:Blumenthal M, Busse WR, Goldberg A et al., eds. The CompleteGerman Commission E Monographs: Therapeutic Guide to HerbalMedicines. Austin, Tex.: American Botanical Council. 1998.Guide to Natural Products. St. Louis, MO.: Facts & Comparison. 1999.Hocking GM. A Dictionary of Natural Products. 2nd ed. Medford, N.J.:Plexus. 1997.LaValle JB, Krinsky DL, Hawkins EB et al. Natural Therapeutic PocketGuide. Hudson, Ohio: Lexi-comp. 1999.Peirce A. The American Pharmaceutical Association Practical Guide toNatural Medicine. New York, NY.; Stonestong Press. 1999.The Review of Natural Products [formerly The Lawrence Review].St. Louis, MO.: Facts & Comparisons; updated monographs on naturalproducts.Tyler VE and Foster S. Tyler’s Honest Herbal: A Sensible Guideto the Use of Herbs and Related Remedies. 5th ed. New York, N.Y.:Haworth Press. 1999.Tyler VE and Robbers JE. Herbs of Choice: The Therapeutic Useof Phytomedicinals. Binghamton, N.Y.; Haworth Herbal Press. 1999.

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