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

Hi, I’m JR

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.