Cautions, Contraindications, Side-Effects and Interactions of Alternative Medicines... 02:09 Oct 02 2013
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It is important to know what the cautions, contra-indications, side-effects and interactions are for herbal medicines. This section should help you understand what these terms mean, and give some examples of the cautions, contra-indications, side-effects and interactions for different herbs, vitamins and minerals.
Any information given in this website does not remove the requirement to consult a professional medical practitioner, whether a GP, herbalist or homeopath
http://www.woodlandherbs.co.uk/acatalog/cautions.html
Herbs are considered by many to be "PERFECTLY SAFE", because they are natural. While we believe that herbal medicines are safer than many medicines that originate from a laboratory, this is only true if they are used appropriately. Inappropriate use of some herbs could be dangerous, this includes combining them with prescription medicines or using them to treat serious illness without the help of a professional.
This section will highlight some of the key factors to consider, and also some of the herbs that are known to have contraindications or interactions with prescription medicines. Information is constantly being updated as new research is published, therefore this information cannot be considered as definitive.
Terminology
General
Pregnancy
Examples of Some Herbs
Examples of Some Vitamins
Examples of Some Minerals
Examples of Some Supplements
Examples of Some Essential Oils
Terminology
TERM MEANING
Contraindications A remedy's contraindications let you know when it is unsuitable to be used. Contraindications may include pregnancy, meaning the product should not be used during pregnancy, or a particular medicine, such as aspirin which should not be combined with some herbs.
Cautions A caution means that it is possible that the remedy may not be recommended in some circumstances, it is not as strong as a contraindication. Cautions include the fact that some herbs may irritate the stomach. It is up to the individual to decide if they mind the possibility of that side effect.
Side Effects Side effects of a medicine are effects which may occur to the body due to taking the medicine, in addition to the desired effect. Side effects may include effects that are seen in most people taking that medicine, or side effects that may have occurred only once!
Interactions An interaction occurs when the administration of one medication (whether herbal or not) affects the action of another medication. These interactions can occur either by one medication directly acting on the other, or through their effects on the human body. For example the herb St John's Wort (Hypericum perforatum) causes one of the processes in the liver (the P450 enzyme system) to be more efficient. Whilst this is not normally considered an issue in a healthy person not taking any medication, it does cause some drugs that are metabolised by the liver to be removed from the body more quickly - meaning that they would no longer be as effective. This includes the contraceptive pill!
General Considerations
In general, the key thing to consider is that if you are deciding to use herbal medication, vitamins and minerals by yourself then you are responsible for your own healthcare! If you are unsure then it is almost certainly worth obtaining the assistance of a medical professional. The following list indicates when you should be especially careful when using herbal remedies or vitamins and supplements.
Where the patient is young (i.e. from infant to approximately 11 years old)
If you are taking any prescription medicines
If you are treating a significant health complaint
If you are normally sensitive or allergic to substances.
If you do not have a diagnosis of what is wrong with you from a medical professional
Special Precautions are required during pregnancy
Pregnancy
During pregnancy and breastfeeding professional advice is essential. Please Click Here for further information on precautions during pregnancy.
Some Examples of Cautions and Contraindication Some Examples of Cautions and Contraindication
Knowledge of Herbal Medicine and the human body is growing all the time and as a result knowledge of the effects of different herbs and their constituents continues to develop. Advice may come from many different sources: purely theoretical considerations; the observed effects of the herb on patients through time, passed down throught the oral tradition; or modern studies on patients, ranging from results of a large clinical trials to a single case studies.
Cautions and Contraindications of Some Herbs
St John's Wort (Hypericum perforatum)
Contraindications: Pregnancy due to its ability to stimulate the uterus, and if breastfeeding.
If you are taking conventional anti-depressants or are suffering from severe depression.
Cautions: It is recommended that foods containing tyramine, such as cheese, wine, yeast and beer, are avoided whilst taking St. John's Wort.
If you are HIV positive and receiving treatment it is recommended that you consult a qualified medical practitioner before taking St. John's Wort.
Side-effects: Some individuals with fair skin have experienced an increased sensitivity to the sun whilst taking St. John's Wort. It is therefore recommended that you avoid excessive amounts of sun exposure and wear a good quality sunscreen (as you should do anyway!) if you anticipate being exposed to the sun for long periods of time.
Interactions: St John's Wort affects the function of a group of liver enzymes termed the Cytochrome P450 enzymes, and can therefore affect the metabolism of a variety of drugs by either clearing them more quickly or slowly from the body. This is of particular importance if you are taking the contraceptive pill, anti-coagulants (such as warfarin), digoxin, cyclosporine, theophylline tablets for asthma or chronic bronchitis, statin drugs, protease inhibitors, e.g. Indinavir, or medication for epilepsy or migraines as the herb may stop them from working properly.
Raspberry Leaf (Rubus idaeus)
Contraindications: Raspberry leaf is contraindicated in pregnancy, if the pregnant lady has a history of rapid labour.
Cautions: Raspberry leaf tea should be taken as a tea only during the last trimester of pregnancy (Week 28-36 and onwards).
Gingko Biloba
Contraindications: Ginko biloba is contraindicated if you are undergoing surgery. You should stop taking the herb at least 7 days prior to any surgery.
Interactions: Ginko biloba should not be used if aspirin or warfarin are being taken.
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Cautions and Contraindications of Some Vitamins
Vitamin A
Contraindications: Vitamin A supplementation is contraindicated if you are pregnant, or are likely to become pregnant, except on the advice of a qualified medical practitioner.
Cautions: Excessive supplementation with Vitamin A over extended periods of time can lead to toxicity as the vitamin is stored in the liver.
Vitamin B6
Cautions: Long-term daily intake of 500mg or a shorter-term daily intake of 2000mg vitamin B6 has been shown to cause nerve toxicity in some people.
Interactions: Supplementation with vitamin B6 should be avoided if you are taking Levodopa for Parkinson's Disease.
Vitamin D
Cautions: Vitamin D can also cause toxicity if taken for an extended period of time. It is therefore important that daily intake does not exceed 25µg (1000iu). (This includes Vitamin D from food sources).
Interactions: Vitamin D supplementation should not be taken if you are taking digoxin, thiazide diuretics, or calcitonin, unless supervised by a qualified medical practitioner.
Vitamin E
Contraindications: High doses of vitamin E are contraindicated prior to surgery or going into labour due to its anti-clotting effects.
Interactions: High doses of vitamin E should not be taken in combination with anti-coagulant drugs such as warfarin, aspirin or heparin as it may enhance their effects.
PABA (Para-aminobenzoic acid)
Interactions: PABA should not be taken at the same time as the sulfa-class of antibiotics (e.g. sulphadimidine, sulphadiazine) as it may interfere with their action.
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Cautions and Contraindications of Some Minerals
Calcium
Contraindications:Those with cancer or hyper-parathyroid disorder should not take calcium supplements.
Interactions:Calcium supplements should not be taken if you are taking blood pressure lowering drugs, digoxin or tamoxifen. Calcium may decrease the absorption of certain other drugs and should therefore be taken at least 2 hours away from taking other drugs.
Zinc
Interactions:Zinc supplementation should be avoided if taking amiloride, penicillamine, tetracycline, warfarin or fluoroquinolone antibiotics (e.g.ciprofloxacin).
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Cautions and Contraindications of Some Food Supplements
Evening Primrose Oil
Contraindications:Evening primrose oil should be avoided if you have epilepsy.
Side Effects:May cause headaches, nausea, or skin eruptions. These effects may be lessened by taking with food.
Interactions:It is recommmended that evening primrose oil is not taken in combination with drugs for schizophrenia.
Fish Oils
Side-effects:Nausea may be experienced if taking fish oils for the first time. This tends to ease off with time and can be lessened by taking with food.
Interactions:High doses of fish oils should be avoided if you are taking blood-thinning drugs such as heparin or warfarin.
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Cautions and Contraindications of Some Essential Oils
Although essential oils are not taken internally, they are readily absorbed by the body and because they do not go straight to the liver after absorption (as is the case for food or any drugs consumed orally) they are delivered directly to the bloodstream. This means that essential oils should be treated with caution.
The main ways in which essential oils are used are:
dermal - applied to the skin either by massage or by placing the oil in the bath
inhalational - breathed in and absorbed by the respiratory tract and lungs
(techniques that should only be followed with professional advice are are oral, rectal and vaginal)
Examples of oils that should not be used in specific circumstance include
Some oils are irritant to skin and are not recommended for damaged, diseased or hypersensitive skin (e.g. Citronella, Melissa, Thyme)
avoiding Ho Leaf, Camphor (White), Hyssop (and others) in anyone suspected of being vulnerable to epileptic seizures
caution requied with Indian Dill, Parsely leaf and Parsely seed in kidney disease
Herbal and Dietary Supplement–Drug Interactions in Patients with Chronic Illnesses
02:04 Oct 02 2013
Times Read: 450
PAULA GARDINER, MD, MPH, Harvard Medical School, Boston, Massachusetts
RUSSELL PHILLIPS, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts
ALLEN F. SHAUGHNESSY, PharmD, Tufts University Family Medicine Residency Program at Cambridge Health Alliance, Cambridge, Massachusetts
Am Fam Physician. 2008 Jan 1;77(1):73-78.
Herbs, vitamins, and other dietary supplements may augment or antagonize the actions of prescription and nonprescription drugs. St. John's wort is the supplement that has the most documented interactions with drugs. As with many drug-drug interactions, the information for many dietary supplements is deficient and sometimes supported only by case reports. Deleterious effects are most pronounced with anticoagulants, cardiovascular medications, oral hypoglycemics, and antiretrovirals. Case reports have shown a reduction in International Normalized Ratio in patients taking St. John's wort and warfarin. Other studies have shown reduced levels of verapamil, statins, digoxin, and antiretrovirals in patients taking St. John's wort. Physicians should routinely ask patients about their use of dietary supplements when starting or stopping a prescription drug, or if unexpected reactions occur.
About one in four persons taking prescription medication also take a dietary supplement.1,2 According to the National Center for Complimentary and Alternative Medicine (NCCAM), a dietary supplement can be a vitamin, a mineral, an herb or other botanical, an amino acid, or other such substances or their constituents. These supplements have demonstrated pharmacologic action used to produce therapeutic results.3 Even supplements that do not have a documented pharmacologic action can affect the absorption, metabolism, and disposition of other drugs.
The research literature regarding interactions between each of these supplements and other medications is rapidly and continually evolving. This review focuses on the use of dietary supplements in patients with chronic conditions, in whom the risk for dietary supplement–drug interaction is the greatest (Table 1).4–30 The information is based on a review of several sources, including the Medline, Embase, and Cinahl databases and an authoritative drug interaction reference.31 Table 2 lists resources available to check for drug interactions with dietary supplements.
Table 1 Herbal and Dietary Supplement–Drug Interactions
View Table
Asthma, insomnia, depression, chronic gastrointestinal disorders, pain, memory problems, and menopausal symptoms are the medical conditions for which supplements are most commonly used.32,33 Patients at high risk for interactions, such as those with seizure disorders, cardiac arrhythmia, or congestive heart failure, often report dietary supplement use.2 These patients tend to take more prescription medications, especially medications with a narrow therapeutic index.
Regulation of Dietary Supplements
Dietary supplements are not subjected to the same rigorous safety and efficacy trials and premarketing approval process required of prescription drugs. As a result, there is often incomplete knowledge regarding interactions between dietary supplements and drugs, especially among patients with chronic diseases.
Marketed products containing dietary supplements may vary significantly. Even different batches of the same product from the same manufacturer may differ in content and potency. Previously in the United States, dietary supplement products may not have contained what they were labeled to contain. However, in June 2007 the U.S. Food and Drug Administration (FDA) released “good manufacturing practices” for the dietary supplement industry.34
Table 2 Sources of Information About Herbal and Dietary Supplement–Drug Interactions
View Table
Types of Interactions
Interactions with dietary supplements can be of two types. Pharmacodynamic interactions occur when the intrinsic action of a dietary supplement augments or antagonizes the activity of another drug. Pharmacokinetic interactions result from changes in metabolism, excretion, or (infrequently) absorption or protein binding of the active aspect of the dietary supplement or the drug, resulting in more-pronounced or diminished pharmacologic activity.
The evidence supporting dietary supplement–drug interactions, just as with drug-drug interactions, varies widely. There is no process for systematic evaluation of dietary supplement products for possible interactions with prescription medications. As a result, our knowledge of interactions is incomplete and based on animal studies, case reports, case series, historical contraindications, extrapolation from basic pharmacology data, or the rare clinical trial. Many recommendations regarding dietary supplement–drug interactions are based on conjecture rather than research.
Interaction Risks in Specific Patient Populations
The following section reviews potential effects of dietary supplements in patients taking anticoagulants, cardiovascular medications, psychiatric medications, laxatives, diabetes medications, or medications for human immunodeficiency virus (HIV) infection.
PATIENTS RECEIVING ANTICOAGULANTS
Case reports have shown interactions between the anticoagulant warfarin (Coumadin) and St. John's wort, ginkgo, garlic, and ginseng.11,17 Studies have demonstrated that St. John's wort increases the metabolism of warfarin, leading to diminished serum levels.18,35–37 However, the clinical response to the combination has not been quantified.
Ginkgo does not interact with warfarin or aspirin directly, but has demonstrated antiplatelet activity.12,38 In combination with nonsteroidal anti-inflammatory drugs, especially aspirin, ginkgo has been reported to cause severe bleeding, including intracranial bleeding.39–41
Garlic has intrinsic antiplatelet activity. However, one clinical trial has demonstrated that garlic is safe and poses no serious hemorrhagic risk for monitored patients taking warfarin.10
A low-quality clinical study found no effect of Asian ginseng (Panax ginseng) in combination with warfarin.18 American ginseng (Panax quinquefolius), a separate plant, decreases warfarin serum levels in humans, resulting in less anticoagulation.16 Eleuthero (Eleutherococcus senticosus) has not been studied; however, it contains a constituent that inhibits platelet aggregation. [corrected]
Vitamin E and fish oil are often mentioned in reviews of supplement-drug interactions.42,43 In a clinical study of 16 patients, fish oil (3 to 6 g daily) did not affect coagulation status in patients receiving warfarin.8
Vitamin E may have an effect on bleeding time. In vitro studies demonstrate potentiation of the antiplatelet effect of aspirin by vitamin E.44 However, clinical trials with and without warfarin and vitamin E show no increased risk of bleeding even though high doses of vitamin E may antagonize vitamin K.20,45,46
Cranberry juice, although implicated in case reports, has not been shown to affect coagulation in a controlled study.4
Given the narrow therapeutic index of warfarin and the serious consequences associated with small changes, the anticoagulation status in patients taking dietary supplements should be carefully monitored whenever they initiate or stop taking any supplement, or when a new bottle of the same product is used, until the effect in the individual patient is known. Specifically, patients receiving American ginseng should be monitored when changing products or even bottles of the same product.47
PATIENTS RECEIVING CARDIOVASCULAR MEDICATIONS
Of all the supplements used by patients who have cardiac disease, St. John's wort, used to treat mood disorders, is associated with the most interactions. It decreases serum levels of verapamil (Calan) and statins.23,24,48 Blood pressure and lipid levels, respectively, should be monitored closely if a patient is taking one of these drugs and St. John's wort.
The suspected mechanisms of St. John's wort interactions are by the induction of cytochrome P450 (CYP450) isoenzymes CYP3A4, CYP2C9, and CYP1A2, and the transport protein P-glycoprotein, leading to decreased concentration of medications.36 In one study, St. John's wort decreased digoxin blood levels by 25 percent, most likely by inducing the P-glycoprotein, which decreases the bioavailability of digoxin.22,49 Ginseng is another commonly used herb that has been reported to cause an increase in digoxin serum levels in a case report of one patient.21 Digoxin levels should be monitored in patients taking eleuthero or St. John's wort. [corrected]
PATIENTS RECEIVING PSYCHIATRIC MEDICATIONS
Although it probably is not its inherent mechanism of action in the treatment of depression, St. John's wort may have an effect on serotonin levels. It has been associated with serotonin syndrome in patients also receiving a selective serotonin reuptake inhibitor (SSRI).50 St. John's wort should be tapered off when an SSRI is initiated.51 Patients should be cautioned not to initiate St. John's wort when receiving these drugs.
St. John's wort decreases serum levels of psychiatric medications metabolized by the CYP450 enzyme system. It has been shown to affect serum levels of benzodiazepines and tricyclic antidepressants, although these changes may not result in a clinical effect.27,28,30
PATIENTS TAKING BULK LAXATIVES
Psyllium and related bulk-forming laxatives are dietary supplements often not considered to be medications by many patients. However, they can slow or diminish absorption of many drugs. Psyllium can reduce carbamazepine (Tegretol) absorption and serum levels.52 Additionally, there is a case report showing that psyllium decreased the absorption of lithium.53 As a general rule, bulk laxatives such as psyllium should not be taken at the same time as other medications; their use should be separated by several hours to allow absorption to occur.
PATIENTS RECEIVING DIABETES MEDICATIONS
Supplement-drug interactions are not well documented in patients being treated for diabetes. However, a number of supplements have intrinsic effects on serum glucose. Ginseng has hypoglycemic activity in patients with diabetes, and this effect might be additive in patients taking oral hypoglycemics or insulin. Chromium and psyllium also have hypoglycemic effects.54–56 The effect of these supplements is unpredictable in individuals, and no specific changes in hypoglycemic doses are needed unless blood glucose changes occur.
PATIENTS RECEIVING HIV MEDICATIONS
Most antiretrovirals are metabolized via the CYP3A4 and P-glycoprotein systems. Dietary supplements that induce these systems may decrease serum levels of the antiretrovirals. St. John's wort is the dietary supplement with the most evidence of an effect on these systems.57 Limited clinical research has demonstrated reductions in antiretroviral serum concentrations in patients taking garlic and vitamin C.58,59 Milk thistle, Echinacea species, and goldenseal inhibit CYP450 enzymes in vitro, but not to a clinically relevant effect.57,60 The effectiveness of HIV therapy should be monitored in patients taking these supplements, particularly St. John's wort. Because of the risk of a dangerous interaction, patients taking antiretrovirals should be discouraged from using St. John's wort.
General Considerations with Dietary Supplements
Physicians should advise patients about the safety and effectiveness of the products they are using or are considering using. Most patients do not realize the great variability among dietary supplements. Several groups have set up standards for production, bioavailability, and purity of dietary supplements, including the United States Pharmacopeia Convention, Consumer Labs, and the NSF International. [corrected] Products approved by any of these organizations will be marked with their seal.
Two out of three patients taking prescription medications and supplements do not tell their physician about their dietary supplement use, perhaps because they do not consider supplements to be legitimate drugs or to carry risks.2 Therefore, all patients should be asked about their use of dietary supplements. Rather than closed, yes or no questions, physicians should ask, “What vitamins, herbs, and other supplements do you use? What about teas, tinctures, or natural products?” These supplements should be treated as other drugs and recorded in the patient record.
Six natural alternatives to Ibuprofen
02:00 Oct 02 2013
Times Read: 451
Boswellia
The saying used to be, “Take two aspirin and call me in the morning,” but many people turn to ibuprofen to relieve inflammation, pain, and fever. This nonsteroidal anti-inflammatory drug (NSAID), available both over the counter and by prescription, is commonly used to treat arthritis, menstrual symptoms, headache, general aches and pains, and various inflammatory conditions.
Side effects of ibuprofen
Although many people think of ibuprofen as being rather benign, it is associated with an increased risk of heart and circulation problems, including stroke and heart attack, as well as gastrointestinal problems, such as bleeding or perforation of the stomach or intestinal tract. These risks increase the longer you take the drug, although the length of time until it affects any one individual varies depending on their overall health, use of other medications, age, and other factors.
Curcumin
Natural alternatives to ibuprofen
Many studies have been done on various natural pain killers and anti-inflammatories that can be used as alternatives to ibuprofen. They generally have mild to no side effects. Here are a few you may want to consider. You should always consult a knowledgeable health-care professional before starting a new treatment program.
Boswellia: This anti-inflammatory remedy comes from the Boswellia serrata tree that grows in India. The anti-inflammatory properties of boswellia are attributed to the boswellic acids that it contains. These acids improve blood flow to the joints and prevent inflammatory white cells from entering damaged tissue. Also known as “Indian frankincense,” boswellia is available as a supplement and a topical cream. For pain and inflammation, a suggested dose is 450 to 750 mg daily for three to four weeks.
Capsaicin: The active component of chili peppers, capsaicin is often used topically to nerve, muscle, and joint pain. It works by interfering with substance P, a chemical that helps transmit pain signals to the brain. It is available as a topical cream or gels in several different potencies (most often, 0.025% to 0.075%) and is usually applied three to four times daily. It can cause some stinging and burning initially, but it typically subsides with use.
Cat’s claw: Uncaria tomentosa, or cat’s claw, also known as una de gato, grows in South America. It contains an anti-inflammatory agent that blocks the production of the hormone prostaglandin, which contributes to inflammation and pain. Suggested doses are 250 to 1,000 mg capsules one to three times daily. Taking too high a dose may cause diarrhea.
Curcumin: Curcumin is a component of the herb turmeric, and it is a potent painkiller that can block proteins in the body that cause inflammation and also stops the neurotransmitter called substance P from sending pain message to the brain. Studies show that curcumin is effective in easing the chronic pain of rheumatoid arthritis. A suggested dose is 400 to 600 mg of curcumin taken three times daily for pain and inflammation.
Omega-3 fatty acids: The omega-3 fatty acids have anti-inflammatory properties that have proven beneficial for people who suffer with arthritis, other inflammatory joint conditions, and inflammatory bowel diseases. Omega-3s also reduce cardiovascular risk, which is especially helpful for people with rheumatoid arthritis, which carries an increased risk for cardiovascular disease. A suggested dose of omega-3 fatty acids as fish oil is 1,000 mg daily.
White willow bark: This herb is the predecessor of aspirin. White willow bark contains salicin, which converts to salicylic acid in the stomach. White willow bark is much less irritating to the stomach than the synthetic drug, aspirin, while it works to relieve pain, inflammation, and fever. A suggested dose is 1 to 2 dropperfuls of white willow bark tincture daily.
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