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Antech News
September • 2002
 
DRUG-HERBAL INTERACTIONS
 

Veterinarians are becoming more aware and accepting of the growing trend in society to embrace alternative and complementary approaches to modern, conventional medicine. This holistic medicine can serve as a useful and important adjunct for providing successful medical care. One popular area of holism is herbal or botanical medicine, and many of our clients use herbs and other supplements themselves and give them to their pets. However, not all of these “natural” or “health food” products are beneficial or safe, especially when used by the uninformed or given in conjunction with certain drugs.

As many drugs are also derived from plants or synthesized to match their structure, interactions can occur between them and certain plant-derived herbal products. These combinations can be both beneficial (synergistic), and harmful (antagonistic) or may have no interactive effect at all.

As medical professionals taking a medical history, we need to review any use of herbal or other supplements taken by our animal patients. Herbs interact with drugs pharmacokinetically and pharmacodynamically, although currently available data are incomplete and much is anecdotal. The table below summarizes some specific herbs and their potential drug interactions:

 
Herb Potential Drug Interaction
  can...
Aloe vera increase potential toxicity with cardiac glycosides and antiarrhythmic agents.
Astragalus impair immunosuppressive effects of cyclosporine, azathioprine, and methotrexate, and increase immune-stimulating effects of interleukin -2 and acylovir.
Bromelain potentiate antibiotics and improve efficacy of some chemotherapeutic agents like vincristine and 5-fluorouracil.
Burdock have hypoglycemic effect and necessitate adjustment in insulin dosage.
Cayenne protect stomach from adverse effects of aspirin, and enhances absorption of theophylline.
Echinacea decrease effects of immunosuppressive drugs, enhance phagocytic immune function.
Garlic same as burdock, and have effective antiplatelet activity, like gingko.
Ginger help decrease nausea associated with chemotherapy.
Gingko increase antiplatelet effect of aspirin.
Ginseng potentiate corticosteroids.
Goldenseal increase or decrease cardiac effects with cardiac glycosides, and increase or decrease blood pressure effects of antihypertensive agents.
Hawthorn same as goldenseal for cardiac glycosides.
Kava Kava potentiate substances acting on CNS.
Licorice increase potassium loss with steroids and diuretics, increase sensitivity and potentiate toxicity with cardiac glycosides, reduce ulcer formation from aspirin, potentiate corticosteroid treatment.
Ma Huang (ephedra) cause excessive nervous stimulation and weight loss when taken with theophylline, cause dangerous hypertension when combined with selegiline, and increase clearance of dexamethasone.
Marshmallow delay absorption of drugs taken simultaneously.
Milk Thistle prevent liver damage and promote liver support with hepatotoxic medications like acetaminophen, and anticonvulsants, and prevent nephrotoxicity from cisplatin.
Nettles enhance anti-inflammatory effect of drugs.
Rehmannia antagonize suppressant effects of steroids.
St. John's Wort decrease digoxin, theophylline, and cyclosporine levels.
Valerian potentiate effects of barbiturates.
Adapted from: Carson, KM. Vet Pract News 14(6):36, 2002, with permission.
 
 
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