Review of Herb-Drug Interactions
Abstract & Commentary
Synopsis: Herbal medicinals are being used by an increasing number of patients who typically do not advise their clinicians of current use. Many interactions are possible.
Source: Miller LG. Arch Intern Med 1998;158:2200-2211.
Herbal medicinals are being used by an increasing number of patients who typically do not advise their clinicians of current use. Known or potential drug-herb interactions exist and should be screened for. For example, feverfew, garlic, ginkgo, ginger, and ginseng may alter bleeding time and should not be used concomitantly with warfarin sodium. Ginseng should not be used with estrogens or corticosteroids because of possible additive effects. Valerian should not be used with barbiturates because excessive sedation may occur. Kava when used with alprazolam has resulted in coma.
Comment by JOHN La PUMA, MD, FACP
In this unusual review article, Miller catalogs commonly used herbal medicinals and associated drug-herb interactions, both theoretical and actual. She first briefly recounts evidence for the effectiveness of chamomile, echinacea, feverfew, garlic, ginger, ginkgo, ginseng, saw palmetto, St. John’s wort, and valerian. She then identifies drugs with a narrow therapeutic window and several herbal interactions with them. Finally, she lists more drugs, herbs, and minerals "with known or potential drug-herb interactions with commonly used herbal medicinals."
This article reads like an impatient life sciences catalog: Miller has a lot of information and wants to get it all out. But it’s often difficult to differentiate between basic science and clinical cases without referring to the 171 references, which are largely bench laboratory observations and single case reports. (Dr. La Puma is Adjunct Professor of Nutrition, Kendall College, Director, C.H.E.F. Clinic, C.H.E.F. Skills Research, Alexian Brothers Medical Center, Elk Grove, IL.)
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