para>Ginkgo and St. John's wort account for most herb-drug interactions described in the medical literature.
- Herbs with possible adverse effects
- Serious adverse events from herbal remedies remain uncommon.
- Some ethnic medicines, as those prescribed by practitioners of Ayurveda or traditional Chinese medicine, may intentionally contain heavy metals or other toxic substances. These are usually listed by their pharmacopeial names, for example, Qian Dan = lead oxide.
- Bitter orange (Citrus sinensis): sympathomimetic; increases heart rate (HR), BP
- California poppy (Eschscholzia californica): may cause respiratory depression, drowsiness; contains opioids
- Cascara sagrada (Frangula purshiana): depletes serum potassium
- Chaparral (Larrea tridentata): hepatotoxic
- Ephedra (Ephedra spp.): sympathomimetic; increases HR, BP; insomnia, gastric distress
- Ginkgo (Ginkgo biloba): extravasation, increased bleeding time
- Guarana (Paullinia cupana): tachycardia, hypertension; contains caffeine
- Kava (Piper methysticum): decreases use of niacin; possibly hepatotoxic
- Licorice (Glycyrrhiza spp.): Long-term use depletes serum potassium.
- Lily of the valley (Convallaria majalis): contains cardiac glycosides
- Poke root (Phytolacca species): strong gastric irritant, may cause sedation
- Senna (Cassia senna): depletes serum potassium
- Snakeroot (Aristolochia spp.): nephrotoxic
- St. John's wort (Hypericum perforatum): numerous drug interactions; induces CYP(3a4) pathway, speeding metabolism of many drugs
- Wormwood (Artemisia absinthium): elevates serotonin level, may raise BP
- Yohimbe (Pausinystalia yohimbe): elevates BP
Geriatric Considerations
Gingko biloba commonly interacts with Coumadin.
Pediatric Considerations
Iron is a leading cause of accidental poisoning in children <6 years of age. Minerals (i.e., potassium, calcium, magnesium, zinc, copper, and selenium) may cause toxicity.
REFERENCES
11 Peregoy JA, Clarke TC, Jones LI, et al. Regional variation in use of complementary health approaches by U.S. adults. NCHS data brief, no 146. Hyattsville, MD: National Center for Health Statistics; 2014.22 Anderson JW, Liu C, Kryscio RJ. Blood pressure response to transcendental meditation: a meta-analysis. Am J Hypertens. 2008;21(3):310-316.33 Manheimer E, White A, Berman B, et al. Meta-analysis: acupuncture for low back pain. Ann Intern Med. 2005;142(8):651-663.44 Park JJ, Kang M, Shin S, et al. Unexplained infertility treated with acupuncture and herbal medicine in Korea. J Altern Complement Med. 2010;16(2):193-198.55 Mortazavi SH, Khaki S, Moradi R, et al. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet. 2012;286(1):19-23.66 Tobias DK, Zhang C, van Dam RM, et al. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care. 2011;34(1):223-229.77 Kavanagh J, Kelly AJ, Thomas J. Breast stimulation for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2005;(3):CD003392.88 AlFaleh K, Anabrees J, Bassler D, et al. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2011;(3):CD005496.99 Guillemard E, Tondu F, Lacoin F, et al. Consumption of a fermented dairy product containing the probiotic Lactobacillus casei DN-114001 reduces the duration of respiratory infections in the elderly in a randomised controlled trial. Br J Nutr. 2010;103(1):58-68.1010 Hojsak I, Snovak N, Abdović S, et al. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: a randomized, double-blind, placebo-controlled trial. Clin Nutr. 2010;29(3):312-316.1111 Johnston BC, Supina AL, Ospina M, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2007;(2):CD004827.1212 Hickson M, D'Souza AL, Muthu N, et al. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial. BMJ. 2007;335(7610):80.1313 McFarland LV. Meta-analysis of probiotics for the prevention of traveler's diarrhea. Travel Med Infect Dis. 2007;5(2):97-105.1414 Makariou S, Liberopoulos EN, Elisaf M, et al. Novel roles of vitamin D in disease: what is new in 2011? Eur J Intern Med. 2011;22(4):355-362.
CODES
ICD10
Z76.89 Persons encountering health services in other specified circumstances
ICD9
V57.9 Care involving unspecified rehabilitation procedure
SNOMED
- 225423004 Complementary therapy
- 182548004 Chiropraxy (regime/therapy)
- 440644000 Holistic massage therapy (regime/therapy)
- 350084001 alternative medicines (navigational concept)
- 182968001 homeopathic therapy (regime/therapy)
- 445196004 probiotic therapy (regime/therapy)
- 182549007 Osteopathy (regime/therapy)
CLINICAL PEARLS
- Oral probiotics reduce respiratory and diarrheal infections and reduce mortality in preterm infants.
- Acupuncture is effective for back pain, headaches, and infertility.
- Yoga and breast stimulation shorten labor.
- Ginkgo and St. John's wort account for most herb-drug interactions described in the medical literature.