David Nelson Hand Surgery Greenbrae Marin hand specialist surgery of the hand orthopedics San Francisco

 

 

Why Choose Dr. Nelson?

For New Patients

For Surgery Patients

Hours | Directions

Just For Fun

Home


Back to Patient Home

Herbal Supplements

If you are taking herbal supplements, please let me know and read this page. If you are contemplating having surgery and are taking herbal supplements, it is your responsibility to let me know.

Commonly Used Herb Supplements & Their Potential Hazards

Herbal
Supplement

Common
Uses

Potential
Problems

Potential
Interactions with
Dong Quai
(Angelica)


 To treat
menopausal
symptoms,
PMS,
dysmenorrhea		 Enhances
bleeding;
Hypersensitivity to
sunlight		 Anticoagulants
Echinacea


 To treat colds,
flu, and mild
infections,
especially upper
respiratory
infections		 Hepatotoxicity;
Intestinal upset		 Other hepatotoxic
drugs; Anabolic
steroids;
Methotrexate
Ephedra
(Ma Huang,
Ephedrine
Pseudo-ephedrine)


 To treat asthma,
cough, and to
induce weight
loss		 Seizures;
Adverse
cardiovascular
events		 Cardiac glycosides;
General anesthesia;
MAO inhibitors;
Decongestants,
stimulants
Garlic


 To decrease
cholesterol and
blood clot
formation		 Enhances bleeding Anticoagulants
Ginger


 To relieve
nausea		 Enhances
bleeding; CNS
depression;
Hypotension;
Cardiac
Arrhythmia;
Hypoglycemia
 Anticoagulants;
Enhances the effects
of barbiturates;
Antihypertensives;
Cardiac drugs; Hypoglycemic drugs
Ginkgo Biloba


 To improve
circulation,
especially to
brain; For
memory loss,
dizziness, and
headache		 Enhances
bleeding; Cramps,
muscle spasms		 Anticoagulants
Ginseng


 To increase
energy and
reduce stress		 Enhances
bleeding;
Tachycardia and
hypertension;
Mania		 Anticoagulants;
Stimulants;
Antihypertensives;
Antidepressants/
Pheneizine; Digoxin;
Potentiates the
effects of
corticosteroids and
estrogens
Goldenseal


 Used as a mild
antibiotic to treat
sore throats and
upper
respiratory
infections		 Increases fluid
retention;
Hypertension;
Nausea;
Nervousness		 Diuretics;
Antihypertensives
Kava Kava

 To treat anxiety,
nervousness,
and insomnia
 Upset stomach;
Allergic skin
reaction, yellow
discoloration of
skin		 Potentiates the
effects of
antidepressants,
barbiturates, and
benzodiazepines;
Skeletal muscle
relaxants; Anesthetics
Licorice

 To treat hepatitis
and peptic ulcers
 Hypertension;
Hypokalemia;
Edema		 Antihypertensives;
Potentiates the
effects of
corticosteroids
SAM-e
(S-adenosyl-
L-methionine)


 To treat
depression or
osteoarthritis		 Mimics serotonin;
Nausea, upset
stomach		 Drugs that can
increase or mimic
serotonin, such as
antidepressants
St. John’s Wort


 To treat mild
depression,
anxiety, seasonal
affective
disorder		 Enhances bleeding Anticoagulants;
Antidepressants;
Decreases the
effectiveness of
cyclosporine, antiviral
drugs; Digoxin;
Dextrometorphan;
Prolongs the effects
of general
anesthetics; MAO
inhibitors

Valerian


 To treat
insomnia, anxiety		 Sedation;
Digestion
Problems		 Potentiates the
effects of barbiturates

References

Dong Quai

Page RL, Lawrence JD Potentiation of Warfarin by dong quai. Pharmacotherapy 1999;19:870-6


Echinacea

See DM, Broumand N, Sahl L, Tilles JG In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology 1997;35:229-235


Ephedra/Ma Huang

Haller CA, Benowitz NL Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000;343:1833-1838

Powell T, Hsu FF, Turk J, Hruska K Ma-huang strikes again: ephedrine nephrolithiasis. Am J Kidney Dis 1998;32:153-159

White LM, Gardner SF, Gurley BJ, Marx MA, Wang PL, Estes M Pharmacokinetics and cardiovascular effects of ma-huang (Ephedra sinica) in normotensive adults. J Clin Pharmacol 1997 Feb;37(2):116-22


Garlic

Srivastava KC Evidence for the mechanism by which garlic inhibits platelet aggregation. Prostaglandins Leukot Med 1986 Jun;22(3):313-21

Apitz-Castro R, Escalante J, Vargas R, Jain MK Ajoene, the antiplatelet principle of garlic, synergistically potentiates the antiaggregatory action of prostacyclin, forskolin, indomethacin and dypiridamole on human platelets. Thromb Res 1986;42:303-311

Silagy CA, Neil HA A meta-analysis of the effect of garlic on blood pressure. J Hypertens 1994 Apr;12(4):463-8


Ginger

Phillips S, Ruggier R, Hutchinson SE Zingiber officinale (ginger)–an antiemetic for day case surgery. Anaesthesia 1993 Dec;48(12):1118


Gingko Biloba

Le Bars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg AF A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia: North American EGb Study Group. JAMA 1997;278:1327-1332

Oken BS, Storzbach DM, Kaye JA The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease. Arch Neurol 1998;55:1409-1415


Ginseng

Janetzky K, Morreale AP Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 1997;54:692-693


Goldenseal

Rehman J, Dillow JM, Carter SM, Chou J, Le B, Maisel AS Increased production of antigen-specific immunoglobulins G and M following in vivo treatment with the medicinal plants Echinacea angustifolia and Hydrastis canadensis. Immunol Lett 1999 Jun 1;68(2-3):391-5


Kava Kava

Pittler MH, Ernst E Efficacy of kava extract for treating anxiety: systematic review and meta-analysis. J Clin Psychopharmacol 2000 Feb;20(1):84-9

Jappe U, Franke I, Reinhold D, Gollnick HPM Sebotropic drug reaction resulting from kava kava extract therapy: A new entitity? J Amer Acad Dermatol 1998; 38:104—6


Licorice

Fujisawa Y, Sakamoto M, Matsushita M, Fujita T, Nishioka K Glycyrrhizin inhibits the lytic pathway of complement–possible mechanism of its anti-inflammatory effect on liver cells in viral hepatitis Microbiol Immunol 2000; 44(9):799-804


SAM-e

Fava M, Giannelli A, Rapisarda V, Patralia A, Guaraldi GP Rapidity of onset of the antidepressant effect of parenteral S-adenosyl-L-methionine Psychiatry Res 1995 Apr 28;56(3):295-7


St. John’s Wort

Gaster B, Holroyd J St John’s wort for depression: a systematic review. Arch Intern Med 2000;160:152-156

Shelton RC, Keller MB, Gelenberg A, et al Effectiveness of St John’s wort in major depression. JAMA 2001;285:1978-1986

Lantz MS, Buchalter E, Giambanco V St. John’s wort and antidepressant drug interactions in the elderly. J Geriatr Psychiatry Neurol 1999;12:7-10


Valerian

Donath F, Quispe S, Diefenbach K, Maurer A, Fietze I, Roots I Critical evaluation of the effect of valerian extract on sleep structure and sleep quality Pharmacopsychiatry 2000 Mar;33(2):47-53

Other recommended journal articles regarding herbal supplements

Ang-Lee MK, Moss J, Yuan C Herbal Medicines and Perioperative Care JAMA 2001;286: 208-216

Kaye AD, Clarke RC, Sabar R, et al Herbal medications: current trends in anesthesiology practice—a hospital survey. J Clin Anesth 2000;12:468-471

Eisenberg DM, Davis RB, Ettner SL, et al Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up study. JAMA 1998;280:1569-1575

Blendon RJ, DesRoches CM, Benson JM, Brodie M, Altman DE American’s views on the use and regulation of dietary supplements. Arch Intern Med 2001;161:805-810

Miller LG Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998 Nov 9;158(20):2200-11

Klepser TB, Klepser ME Unsafe and potentially safe herbal therapies. Am J Health Syst Pharm 1999 Jan 15;56(2):125-38

Hensrud DD, Engle DD, Scheitel SM Underreporting the use of dietary supplements and nonprescription medications among patients undergoing a periodic health examination. Mayo Clin Proc 1999;74:443-447

Anesthesiologists warn: if you’re taking herbal products, tell your doctor before surgery. Available at: http://www.asahq.org/PublicEduction/herbal.html. Accessed May 10, 2001.

Full text of DSHEA at HealthWorld Online
http://www.healthy.net/public/legal-lg/fedregs/S784_ENR.HTM

Would you like to search the medical library of the National Library of Medicine for scientific papers on this topic? Just click on the Pub - Med image:
Remember the admonition from the Patient Education Links Page: the Internet has a lot of information, much of it incorrect. I have reviewed the sites that I have linked to, and have only linked to sites when I personally know the surgeon who posted it, or am a member of the organization that posted it. However, I may not agree with all that is on that site, and it may have changed since I reviewed it. If any of the information is not consistent with what I have told you, please download the material and bring it in.