Key points about commonly used herbals
Dr. Darrell Hulisz from Case Western Reserve University School of Medicine in Cleveland, Ohio has written a continuing education article on herbals.
Here are the author’s take-away points, with additional references added.
Echinacea purpurea and the common cold
- Modestly effective for prevention in those at risk (people in contact with sick people).
- Unclear if it can reduce the duration of cold symptoms.
- The Cochrane review draws different conclusions.
- Patients allergic to ragweed, or with progressive autoimmune disorders (eg, rheumatoid arthritis), and taking drugs that can be toxic to the liver should avoid echinacea.
Garlic and cardiovascular disease
- Use cautiously if taking blood pressure medicine, and monitor blood for orthostatic hypotension (eg, large decrease in blood pressure and possibly fainting when standing).
- Avoid in the following situations
- People with a history of orthostatic hypotension or unexplained dizziness.
- Taking drugs that can increase bleeding, such as aspirin, warfarin and ibuprofen.
- Dosing is not well defined, but to lower cholesterol, 600 to 1200 mg of garlic powder daily in divided doses, or up to 4 g of raw garlic daily may be taken.
- A more negative perspective on garlic is here.
Ginkgo biloba and Alzheimer’s disease
- Reasonable to take by patients with Alzheimer’s disease who are also receiving medical care.
- Its antiplatelet activity may make it inappropriate for people with a bleeding disorder or taking antiplatelet or anticoagulation drugs.
- More info here.
St. John’s wort and depression
- OK for mildly depressed patient with an aversion to prescription drugs.
- Depressed people should take it under medical supervision.
- Check for drug interactions.
- Recently published reviews of drug interactions with St. John’s wort are discussed here
- The most studied dose for depression is 300 mg taken 3 times a day.
- More info here.
Valerian, chamomile, ginger and calming effects
- Safe for most people.
- Modest effectiveness.
- People with chronic anxiety and insomnia should be under the care of a healthcare professional.
- Here’s a summary of drugs and herbals to treat insomnia.
Ginseng and energy
- Lack of good study data.
- Don’t exceed the labeled dosage since adverse effects may occur.
- Caution in people who are on blood thinners, and those with cardiovascular or metabolic disease, such as high blood pressure and diabetes.
- I’ll add there is concern about its effect on the hormone system coupled with a lack of data about its safety in long-term use.
Saw palmetto and the prostate
- Men with obstructive urinary symptoms or benign prostatic hypertrophy (BPH) should not self-medicate with saw palmetto.
- BPH symptoms can mimic more serious disorders — prostate cancer and prostatitis.
Black cohosh and hot flashes
- Results of studies are conflicting.
- It appears to be safe, but use should be limited to not more than 6 months and should not be used in those with a history of estrogen-dependent tumors.
- I’ll add there are different points of view on its liver effects here and here.
1/5/08 18:53 JR