Dr. Darrell Hulisz from Case Western Reserve University School of Medicine in Cleveland, Ohio reviews popular herbals.

Let’s focus on safety issues.

Echinacea

• Common side effects include unpleasant taste and allergic reactions.
• Because the flower is related to ragweed, cross allergenicity may occur in people allergic to ragweed.
• Not recommended in patients with progressive or autoimmune disorders.

Garlic

• Might lower blood pressure in people with hypertension.
• Use cautiously in people with bleeding disorders or in those taking antiplatelet therapy.
• Monitor for deceased blood levels of warfarin (Coumadin).
• Malodorous breath and garlic-like body odor.

Ginkgo biloba

• Mild gastrointestinal side effects and headache.
• Avoid in patients using anticoagulants (eg, warfarin; Coumadin) or antiplatelet therapy (eg, aspirin or clopidogrel [Plavix]), or in those with active bleeding such as peptic ulcer disease.
• Not recommended in patients with seizure disorders.

St. John’s wort

• Should not be taken with serotonin uptake inhibitors (SSRIs), as symptoms of serotonin syndrome might occur (headache, sweating, dizziness, and agitation)
• Avoid during pregnancy.
• Associated with photosensitivity.
• Can reduce blood levels of digoxin (Lanoxin) and indinavir (Crixivan).
• Cases of heart transplant rejection were associated with a reduction in cyclosporine (Sandimmune) blood levels.
• Breakthrough bleeding and unwanted pregnancies reported in women who also took oral contraceptives.

Valerian

• Restlessness and palpitations.
• Additive effect with other central nervous system depressants.
• Caution if operating machinery when starting treatment.
• Headaches, excitability, and uneasiness.

Chamomile

• Allergic reaction.
• Sedative effects — use with caution when taking drugs with sedative side effects, or with alcohol.

Ginger

• Prolonged bleeding
• Caution in people taking anticoagulants.
• Mild gastrointestinal upset, including heartburn, diarrhea, and mouth irritation.

Ginseng

• Avoid in people with heart disease who take other stimulants.
• Rarely associated with reversible breast pain and tenderness, and postmenopausal bleeding.
• Overuse associated with diarrhea, hypertension, nervousness, dermatologic eruptions, and insomnia.
• Don’t use in people with active bleeding.
• Use cautiously with anticoagulants and/or antiplatelet medications.

Saw Palmetto

• Headache and intestinal upset.

Black cohosh

• Rash or intestinal upset.
• Don’t use in lactating or pregnant women.
• Avoid in women with a history of estrogen-dependent tumors or endometrial cancer.

The bottom line?
Many of the side effects listed here are supported by limited data. Check with the article for more details and guidelines.

11/25/08 22:22 JR