The C.A.M. Report
Complementary and Alternative Medicine: Fair, Balanced, and to the Point
  • About this web log

    This blog is intended as an objective and dispassionate source of information on the latest CAM research. Since my background is in pharmacy and allopathic medicine, I view all CAM as advancing through the development pipeline to eventually become integrated into mainstream medical practice. Some will succeed while others fail. But all are treated fairly here.

  • About the author

    John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at www.Vicus.com, a complementary and alternative medicine website.

  • Common sense considerations

    The material on this weblog is for informational purposes. It is not medical advice or counsel. Be smart, consult your health professional before using CAM.

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    Risk of taking herbals in people with heart disease

    Researchers from the Mayo Clinic in Minnesota and Arizona collaborated to review the risks of herbal:drug interactions.

    The abstract is a bit skimpy on details, but the American Pharmaceutical Association has a nice summary, which will be summarized further here.

    First, the details.

    • 16 herbal products are potential problems.

    And, the results.

    • St John’s wort
      • Induces cytochrome P450 (CYP)3A4, an enzyme involved in the metabolism of more than 50% of all prescription medications, including many used to treat heart arrhythmias, high blood pressure, and high cholesterol.
    • Motherwort
      • Inhibits the ability of blood to clot and increases the risk of bleeding.
    • Ginseng
      • Potentially toxic to the kidneys
      • May lower or raise blood pressure
      • Interacts with the blood thinner, warfarin (Coumadin), which increases the risk of bleeding
    • Ginkgo biloba
      • Increases the risk of bleeding when used with antiplatelet, anticoagulant, or antithrombotic agents (blood thinners)
    • Garlic
      • Increases the risk of bleeding in patients using anticoagulant or antiplatelet drugs
    • Grapefruit juice and black cohosh
      • Inhibit CYP3A4, which increases blood levels of…
        • Calcium-channel blockers
        • Cyclosporine
        • Statins
        • Midazolam (Versed)
        • Estrogen (Premarin)
        • Terazosin (Hytrin)
    • Hawthorn
      • Enhances the activity of digoxin (Lanoxin), which could cause toxicity
      • Increases the risk of bleeding from thromboxane A2
    • Saw palmetto
      • Increases the antiplatelet effects of warfarin, which increases bleeding risk
    • Danshen
      • Increased antiplatelet effects and bleeding risk
    • Echinacea
      • Increases the risk of liver toxicity from…
        • Statins
        • Fibrates (Atromid, Tricor, Lopid)
        • Niacin (Nicobid)
        • Amiodarone (Cordarone)
        • Tetrandrine (an alkaloid extracted from a Chinese medicinal herb traditionally used o treat high blood pressure)
      • Interferes with calcium channel blockers and may cause liver and/or kidney toxicity
    • Aconite
      • Can cause cardiac arrhythmias, ranging from slow heart rate and low blood pressure to fatal ventricular arrhythmias
    • Yohimbine
      • Decreases the effect of blood pressure drugs, including diuretics
    • Gynura
      • Associated with liver toxicity
      • Decreased activity of angiotensin-converting enzyme
    • Licorice
      • Potentiates the effects of spironolactone (Aldactone) and digoxin
      • Also, a risk of ventricular arrhythmias, including torsades de pointes (sudden death)

    The bottom line?

    Many drugs used to treat cardiovascular disease have a narrow therapeutic range. In other words, small changes in dosing or drug metabolism can lead to significant side effects.

    If you’re a healthcare professional, you need to ask.

    If you’re a patient, you need to tell the doctor what you are taking — including herbals.

    4/5/10 15:29 JR

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