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

    This blog ran from 2006 to 2016 and was 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, 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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  • Recent Comments

    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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