Risky herb & drug com­bi­na­tions

Many peo­ple be­lieve that all ‘nat­u­ral’ herbs and foods are safe with the con­cur­rent use of med­i­ca­tion. How­ever herbs and foods may in­ter­act with med­i­ca­tions, re­sult­ing in se­ri­ous ad­verse re­ac­tions.

Living Now - - Editorial - by Bec Farah

Con­trary to what many Aus­tralians be­lieve, some herbs and foods may in­ter­act with med­i­ca­tions, re­sult­ing in se­ri­ous ad­verse re­ac­tions.

You may have heard on the ra­dio that vi­ta­min E is a car­dio­pro­tec­tive, or seen a tele­vi­sion ad high­light­ing the im­mune boost­ing prop­er­ties of echi­nacea root, and then headed to your lo­cal phar­macy or health food store to pur­chase these glo­ri­ous sup­ple­ments. But would you have first asked your­self a cou­ple ques­tions, such as: “What med­i­ca­tions am I cur­rently tak­ing?” “Do I take these on an empty stom­ach, or with a meal?”

Many peo­ple be­lieve that all ‘nat­u­ral’ herbs and foods are safe with the con­cur­rent use of med­i­ca­tion. This is in­cor­rect. Herbs and foods may in­ter­act with med­i­ca­tion, re­sult­ing in se­ri­ous ad­verse re­ac­tions. Con­versely, while cer­tain med­i­ca­tions in­ter­act ad­versely with herbs and sup­ple­ments, there are some herb/drug com­bi­na­tions that can pro­duce ther­a­peu­tic ben­e­fits.


Some foods and bev­er­ages, even healthy ones, can re­duce the ther­a­peu­tic ef­fi­cacy of your med­i­ca­tion if in­gested con­cur­rently.

The pres­ence of food in the di­ges­tive tract may de­lay or de­crease the ab­sorp­tion of med­i­ca­tions. The ab­sorp­tion of the com­mon antibiotic azithromycin, for ex­am­ple, is de­creased when ad­min­is­tered with food, re­duc­ing its bioavail­abil­ity by 43%. It is there­fore of­ten rec­om­mended to take cer­tain med­i­ca­tions on an empty stom­ach or one to two hours af­ter eat­ing. In con­trast, some med­i­ca­tions are eas­ier to tol­er­ate when taken with food. Non­s­teroidal anti-in­flam­ma­to­ries (NSAIDS), oe­stro­gen, and choles­terol med­i­ca­tions are ex­am­ples of drugs that should be ad­min­is­tered with food to re­duce gut ir­ri­ta­tion and pos­si­ble nau­sea.


Di­etary fi­bre can af­fect med­i­ca­tion ab­sorp­tion. Sol­u­ble fi­bres such as pectin have been shown to slow down the ab­sorp­tion of ac­etaminophen, a com­mon painkiller. In­sol­u­ble fi­bres, in­clud­ing bran, have a sim­i­lar ef­fect on digoxin, a ma­jor heart med­i­ca­tion.


Com­pounds found in grape­fruit have been shown to in­hibit cy­tochrome P450, an en­zyme in the liver, lead­ing to in­creased blood lev­els of med­i­ca­tions and tox­i­c­ity. Ad­verse re­ac­tions such as light-head­ed­ness, headaches, and fa­cial flush­ing are com­mon, and raised blood pres­sure and heart rates can also re­sult. Grape­fruit and its juice are there­fore rec­om­mended to avoid com­pletely when tak­ing some med­i­ca­tions.


Soy milk, tofu, tem­peh and soy­con­tain­ing prod­ucts raise con­cerns as con­sump­tion has been as­so­ci­ated with re­duced ab­sorp­tion of thy­roid med­i­ca­tion.


The amino acid tyramine – found in aged cheeses, red wines, cured meats, and some fer­mented foods, reg­u­lates blood pres­sure. Monoamine ox­ides (MAO) in­hibitors, com­monly pre­scribed for de­pres­sion, are known to in­ter­act with foods con­tain­ing tyramine, lead­ing to se­vere hy­per­ten­sive emer­gency. There­fore, the above foods high in tyramine should be avoided al­to­gether with med­i­ca­tion ad­min­is­tra­tion.


Cof­fee, black tea, and even choco­late can have a stim­u­la­tory im­pact when taken with cer­tain med­i­ca­tions. Pa­tients tak­ing anti-ar­rhyth­mic drugs may ex­pe­ri­ence an ir­reg­u­lar heart­beat while con­sum­ing caffeine. Caffeine can in­crease anx­i­ety and re­duce drug ef­fec­tive­ness of ben­zo­di­azepines; re­vers­ing the need to sleep. It has been re­ported that caffeine has raised

serum lev­els of theo­phylline, a com­mon bron­chodila­tor, by 20-30%, caus­ing ner­vous­ness, tremor, or in­som­nia.


Al­co­hol in­ter­acts with al­most ev­ery med­i­ca­tion and should there­fore be avoided with con­cur­rent use. It af­fects med­i­ca­tions through its abil­ity to change the liver’s ca­pac­ity to fil­ter med­i­ca­tion through the body by ei­ther in­creas­ing or de­creas­ing its ef­fect. Al­co­hol can en­hance the cen­tral ner­vous sys­tem’s de­pres­sant ef­fects of ben­zo­di­azepines and an­tide­pres­sants, pro­duc­ing ex­ces­sive drowsi­ness and in­co­or­di­na­tion. As a gut ir­ri­tant, al­co­hol, in com­bi­na­tion with other ir­ri­tants, in­clud­ing NSAIDS, may in­crease the risk of gas­tro-in­testi­nal bleed­ing.


Vi­ta­mins, min­er­als, es­sen­tial fatty acids, and amino acids gen­er­ally have fewer risks in con­junc­tion with med­i­ca­tion ad­min­is­tra­tion as they are nor­mally found in the body, where they are re­quired for phys­i­o­log­i­cal func­tions.

Ex­ceed­ing dosages of cer­tain nu­tri­tional sup­ple­ments, how­ever, raises con­cerns for con­cur­rent use of cer­tain med­i­ca­tions.


5-hy­drox­ytryp­to­phan (5HTP) is a nat­u­rally oc­cur­ring amino acid and pre­cur­sor to sero­tonin and mela­tonin. If it’s com­bined with se­lec­tive sero­tonin re-up­take in­hibitor (SSRIS) med­i­ca­tions (com­monly pre­scribed anti-de­pres­sants), or even St John’s wort, can re­sult in sero­tonin syn­drome. This is a po­ten­tially life-threat­en­ing drug re­ac­tion from ex­cess sero­tonin pro­duc­tion and can cause symp­toms that range from mild - shiv­er­ing and di­ar­rhoea – to se­vere, such as mus­cle rigid­ity, fever, and seizures.


Vi­ta­min E nat­u­rally ex­hibits blood­thin­ning ef­fects. Daily ad­min­is­tra­tion ex­ceed­ing 1000IU in­creases the risk of ex­cess bleed­ing and should there­fore be used with cau­tion when com­bined with blood-thin­ning med­i­ca­tion in­clud­ing war­farin.


Sup­ple­men­ta­tion and/or di­ets high in vi­ta­min K such as green leafy veg­eta­bles (kale, spinach, broc­coli and brus­sels sprouts) can coun­ter­act the ef­fec­tive­ness of blood thin­ning med­i­ca­tion, in­creas­ing the risk of a stroke. It is rec­om­mended to check nu­tri­tional sup­ple­ment lists to avoid the mis­take of dou­bling up. As war­farin in­ter­acts with vi­ta­min K in the body, it is im­por­tant to keep vi­ta­min K in­take, sup­ple­men­tal or di­etary, con­sis­tent each day.


Sim­i­larly, sup­ple­men­ta­tion and/or di­ets high in io­dine, in­clud­ing sea­weed and seafood, can lower thy­roid drugs’ ef­fi­cacy. Cau­tion is war­ranted when taken with thy­roid med­i­ca­tion.


As herbs have sim­i­lar ac­tions to med­i­ca­tions and can po­ten­tially cause tox­i­c­ity and ad­verse re­ac­tions, it is rec­om­mended for in­di­vid­u­als to be un­der the care of a health­care prac­ti­tioner with clin­i­cal ex­pe­ri­ence in herbal medicine.

Lax­a­tives in­clud­ing senna, cas­cara, and aloe in­crease gut motil­ity, thereby ac­cel­er­at­ing the elim­i­na­tion of drugs. Seda­tives such as kava, hops, and va­le­rian po­ten­ti­ate fur­ther seda­tive ef­fects.

In some cases, how­ever; herbs and med­i­ca­tions have shown to have a syn­er­gis­tic ef­fect or pre­vent ad­verse re­ac­tions. Gin­ger, for ex­am­ple, can be used to avoid drug-in­duced nau­sea, while St Mary’s this­tle can be taken to pro­tect the liver from tox­i­c­ity as­so­ci­ated with drugs. Gar­lic also proves to pre­vent toxic me­tab­o­lites pro­duced from parac­eta­mol.


Com­monly known for the treat­ment of anx­i­ety, in­som­nia, and as a ‘nat­u­ral an­tide­pres­sant’, St John’s wort stim­u­lates the pro­duc­tion of liver en­zymes, re­sult­ing in lower con­cen­tra­tions of med­i­ca­tion in the body, there­fore should be avoided with any type of med­i­ca­tion. In­ter­ac­tions with SSRIS, such as Prozac, can po­ten­tially lead to sero­tonin syn­drome. Ad­min­is­ter­ing St John’s wort with war­farin can in­crease your sus­cep­ti­bil­ity to blood clot­ting, strokes, and heart at­tack. Ac­ti­va­tion of liver en­zymes by St John’s wort re­duces choles­terol med­i­ca­tion lev­els, el­e­vat­ing choles­terol in the blood. It also re­duces

the lev­els of oral con­tra­cep­tives – which can po­ten­tially lead to ac­ci­den­tal preg­nan­cies.


Renowned for im­prov­ing cog­ni­tive func­tion and circulation, ginkgo can thin the blood, in­ter­act­ing ad­versely with blood thin­ning med­i­ca­tions in­clud­ing war­farin and as­pirin. High doses of ginkgo have also been re­ported to re­duce the ef­fec­tive­ness of an­ti­con­vul­sant med­i­ca­tions to con­trol seizures. Cau­tion is thereby war­ranted when taken with med­i­ca­tions that thin the blood and are cen­tral ner­vous sys­tem de­pres­sants.


Sim­i­lar to ginkgo, gar­lic con­tains prop­er­ties that can also thin the blood, so cau­tion is ad­vised when tak­ing with blood thin­ning med­i­ca­tions.


Don’t get too ex­cited! This is not re­fer­ring to the sweet treat, but rather the root of a liquorice plant that can be used for var­i­ous ail­ments from cold sores to stom­ach ul­cers and sooth­ing a sore throat. Liquorice has the po­ten­tial to in­crease wa­ter re­ten­tion by af­fect­ing lev­els of sodium and potas­sium in the body. Use cau­tion when tak­ing it with di­uretic (urine-pro­duc­ing) med­i­ca­tions. Liquorice can also in­ter­act with digoxin used for con­ges­tive heart fail­ure and reg­u­lat­ing heart rhythms, in­creas­ing the risk of digoxin tox­i­c­ity.


Uni­ver­sally used for treat­ing the com­mon cold and acute in­fec­tions, echi­nacea can in­ter­act with fex­ofe­na­dine; used for al­lergy symp­toms, itra­cona­zle; an an­ti­fun­gal med­i­ca­tion, as well as lo­vas­tatin; a com­monly pre­scribed choles­terol med­i­ca­tion. In­creas­ing the ef­fects of these med­i­ca­tions can make you more sus­cep­ti­ble to liver tox­i­c­ity, and echi­nacea re­duces their ef­fec­tive­ness in the body.


Korean gin­seng, a Chi­nese medic­i­nal herb com­monly used for boost­ing phys­i­cal and men­tal per­for­mance, as well as erec­tile dys­func­tion, can in­ter­act with pain-re­liev­ing med­i­ca­tion, var­i­ous di­uret­ics, and blood pres­sure med­i­ca­tion, re­duc­ing the ef­fec­tive­ness of pain per­cep­tion as well blood pres­sure lev­els. Korean gin­seng has also been found to re­duce the ef­fects of war­farin and met­formin, a com­monly pre­scribed blood su­gar med­i­ca­tion; so take care with con­cur­rent use.


Kava has had a long his­tory of use for stress, in­som­nia, and anx­i­ety. It has been found to have ad­di­tive ef­fects with cen­tral ner­vous sys­tem de­pres­sants in­clud­ing ben­zo­di­azepines and an­tipsy­chotics, mak­ing you prone to feel­ing lethar­gic and dis­ori­ented. Avoid­ance of kava with cen­tral ner­vous sys­tem de­pres­sants is there­fore ad­vised. ■

Ref­er­ences for this ar­ti­cle are to be found on the web­site ver­sion: www.liv­ing­now.com.au Con­nect with other read­ers & com­ment on this ar­ti­cle at www.liv­ing­now.com.au Bec is a natur­opath, nu­tri­tion­ist, herbal­ist, fit­ness in­struc­tor and founder of ‘Bec to Na­ture Natur­opa­thy’, whose mis­sion is to ed­u­cate peo­ple on how to get back to the ba­sics, by get­ting back to na­ture. Her pas­sion is to adopt food as medicine and to leave her clients sali­vat­ing for their next meal. When she isn’t prac­tis­ing, you’ll find Bec climb­ing moun­tains and cre­at­ing raw brownie recipes.

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