Herbal medicines drug interactions with

III.d.5. Drug Interactions with Herbal and Traditional Medicines... 

D Arcy PF. Adverse reactions and interactions with herbal medicines. Part 2. Drug interactions. Adverse Drug React Toxicol Rev 1993 12 147-162. 

However, the information derived from a detailed pharmacokinetic study will help to anticipate potential botanical product-drug interactions, to optimize the bioavailability, the quality, and hence the efficacy of herbal medicines, to support evidence for the synergistic nature of herbal medicines, and to better appreciate the safety and toxicity of the plant. Because pharmacokinetic studies with herbal medicines are often complicated by their chemical complexity and by the fact that the active compounds are often unknown, it could be one future issue to assess bioavailability by measuring surrogate parameters in plasma or tissue instead of directly assaying putative active compounds in the blood. In summary, to use HMPs in an evidence-based approach and to achieve the status rational phytomedicine, more experimental studies are needed to characterize the bioavailability and pharmacokinetics of botanical products. 

Interactions of antidepressants with herbal medicines have been reported (62). Herbal medicines are widely used for their psychotropic properties and patients sometimes take herbal formulations in addition to conventional psychotropic drugs, such as antidepressants. Ginseng has been reported to cause mania, tremor, and headache in combination with conventional MAO inhibitors. 

NUCLEAR RECEPTORS AND DRUG-DRUG INTERACTIONS WITH PRESCRIPTION AND HERBAL MEDICINES... 

Herb-drug interactions may be clinically relevant [6, 7]. The dosage and the duration of treatment with herbal preparations should be taken into account to assess the possible interaction risks with regular pharmacotherapy. Special attention should be given to active substances with a narrow therapeutic window when combined with herbal medicines. 

As already discussed, the same cannot be said for natural products used as dietary supplements. In most cases, those drugs have not heen subjected to the programs of testing required for FDA approval. As a result, products may pose a hazard to human health. Those hazards usually fall into one of four categories (1) the product may prevent a person from receiving other forms of FDA-approved medication that may he more beneficial to them (2) it may interact with other herbal medicines, prescribed drugs, and over-the-counter medications, with harmful effects (3) it may have no effect at all on a person s health or well-being or (4) it may actually cause harm to a person s health. 

Herbal medicines are becoming more and more popular, and indeed some herbal products may be considered to benefit people with liver disease, e.g. Silybum marianum (milk thistle), Picrorhiza kurroa, Phyllanthus, etc. Herbal hepatotoxicity is increasingly being recognised, for example, with kava kava, black cohosh, and many traditional Chinese remedies. The range of liver injury includes minor transaminase elevations, acute and chronic hepatitis, steatosis, cholestasis, zonal or diffuse hepatic necrosis, veno-occlusive disease and acute liver failure. In addition to the potential for hepatotoxicity, herb-drug interactions may affect the safety and efficacy of concurrent medical therapy [15]. 

Take a careful drug history. Bear in mind the possibility of interaction with substances the patient may be taking without your knowledge, such as herbal or other nonprescribed remedies, old drugs taken from the medicine cabinet or drugs obtained from friends. 

Herbal drugs have many unknown and undocumented risks, side effects, and drug interactions. Like contemporary, rigorously tested pharmaceuticals, herbal medicines have some risk associated with their consumption. The fact that a plant is completely natural does not necessarily make that plant entirely risk-free. Several plants, when consumed in their most natural form, can cause grave illness or even death to humans and animals. A partial list of some of these natural herbal agents with the potential to harm is listed in Table 2. Herbalists, scientists, and the general public routinely avoid many of the plants listed in Table 2 because of their impending risks. However, hundreds of additional herbs and alternative medicines... 

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