Herbal remedy checklist

Herbal products may have side effects or adverse interactions with over-the-counter or prescription drugs. This checklist will help health care providers and patients can determine the best strategy for HIV treatment.

Herb that the Food and Drug Administration specifically recommends not be used by HIV patients who are taking protease inhibitors or nonnucleoside reverse transcriptase inhibitors:

St. John’s Wort

Herbs with known adverse effects or drug interactions:

Asian ginseng: may interact with digoxin, increasing levels of digoxin in blood

Black cohosh: may cause hypotension, weight gain, nausea, and may interact poorly with antihypertensives and interfere with hormonal medications

Blue cohosh: may increase blood pressure and provoke angina

Cayenne: may cause stomach upset, diarrhea; should be monitored when a person is on antiplatelet drugs

Chamomile tea: people with ragweed allergies may be allergic to this

Chaparral: believed to be carcinogenic

Chaste tree berry: also called chasteberry and monk’s pepper, the herb may cause gastrointestinal and lower abdominal complaints, headache, allergic reactions, and increased menstrual flow

Comfrey: potentially causes liver damage

Echinacea (Purple cone flower): cross-sensitivity in patients allergic to sunflower seeds and daisy pollen; not recommended to people using immunosuppressants

Evening primrose oil: not recommended for use when a person is taking drugs that lower seizure threshold; should be monitored when a person is on antiplatelet drugs

Feverfew: when leaves are chewed, they may cause aphthous ulcers; should be monitored when a person is on antiplatelet drugs

Garlic: may cause gastrointestinal (GI) irritation and may not be recommended when a person is taking antihypertensives; should be monitored when a person is on antiplatelet drugs

Ginger: high doses cause GI discomfort; should be monitored when a person is on antiplatelet drugs

Ginkgo biloba: may cause GI discomfort and headache; should be monitored when a person is taking antiplatelet drugs

Ginseng: may cause breast tenderness, nervousness, excitation; should be monitored when a person is taking anticoagulant drugs

Grapeseed extract: should be monitored in patients on antiplatelet drugs

Guarana: possibly carcinogenic with long-term use; also may cause same symptoms as caused by caffeine, which it contains: restlessness, nervousness, excitement, insomnia, diuresis, GI disturbances, cardiac arrhythmias, fibrocystic breast disease, and tachycardia; may render benzodiazepines less effective, may lower lithium levels, and may increase blood pressure if used with decongestants

Kava kava: may cause GI discomfort, allergic reactions; may not be recommended when person is taking sedatives, antianxiety drugs, and antidepressants

Milk thistle: may cause allergic reaction

Peppermint: may cause skin rash, heart burn, muscle tremor

Saw palmetto: may cause headache, mild abdominal pain, nausea, dizziness

Soy: may interfere with absorption of supplemental thyroid hormones

Valerian: may cause drowsiness, headache, excitability, dizziness, cardiac disturbances; could have additive effect with other central nervous system depressants and should be monitored when a person is taking blood pressure medications

Additional herbs used as remedies:

Absinthe

Agrimony

Aloe vera

Angelica

Anise

Balm

Balm of Gilead

Basil

Bearberry

Betony

Bistort

Black elderberry

Black haw

Black poplar

Burdock

Centaury

Cloves

Dandelion

Elderberry (black)

Eucalyptus

Fennel

Gentian

Hawthorne

Hibiscus

Hops

Ivy

Juniper

Lady’s mantle

Lavender

Lovage

Mallow

Marigold

Mexican tea

Milk thistle

Nettle

Orrisroot

Parsley

Peppermint

Poppy

Prickly lettuce

Rosemary

Sage

Senna

Thyme

Uva Ursa

Willow

Yarrow

These herbs are believed to be toxic and potentially fatal, and therefore should be avoided:

American bittersweet, American holly, American yew, Baneberry, Belladonna, Black locust, Bloodroot, Blue flag, Bracken fern, Buckeye, Buttercup, Canada moonseed, Cedar (Northern white), Celandine, Chokecherry, Common nightshade, Corn cockle, Dogbane, Fern (Bracken), Flag (Blue), Foxglove, Heart-leaved four o’clock, Hellebore, Horsechestnut, Horse nettle, Jessamine (Yellow), Jimsonweed, Lambkill, Leatherwood, Lily of the Valley, Locust (Black), Lupine (Wild), Mayapple, Mistletoe, Moonseed (Canada), Mountain Laurel, Pasqueflower, Pink-root, Poison Hemlock, Pokeweed, Rhododendron, Skunk cabbage, Staggerbush, Strawberry bush, Tansy, Virgin’s bower, Virginia creeper, Wahoo, Wormseed

Sources: Pharmacy Today, August 1999; Klepser T, Nisly N. Chaste tree berry for premenstrual syndrome. Alternative Medicine Alert 1999; 2:64-66; Doug Murray, PharmD, Director of Pharmacy and Clinical Services, Kershaw County Medical Center, Camden, SC; Medicinal Herbs Online (www.egregore.com/herb/herbindx.htm).