Issue #7

2000

Peter C. Laker C.H., C.H.P., .C.C.Ir

Q:  I am trying to find a health practitioner who can give me advice on taking herbs along with drugs. My hope is that if possible I can eventually wean off of the drugs and onto herbs or at least combine them both safely and beneficially. I feel that I need the care of my medical doctor while I make the transition but he doesn’t appear to know much about herbs especially the interaction between herbs and drugs. Basically my fear is that the herbs and drugs taken together may cause a reaction.

A:  Because of the concern for potential side effects from combining herbs with certain drug medications it would be wise to consult a qualified practitioner who is knowledgeable in both areas. Professional herbalists are trained to understand the interactions of herbs and drugs, but medical doctors unfortunately have very little knowledge of herbs and their therapeutic effects and consequently their interaction with drugs. The answer to this dilemma, in the best interest of the patient, would be for doctors and herbalists to work together.

Most herbs cause no reactions when taken individually or even when combined properly with other herbs, but when combined with some drugs the story may change. Many drugs do not interact favourably with other medications herbal or otherwise. This is a big problem in the natural health industry where health products are recommended over the counter for just about every problem under the sun. Few store clerks are qualified enough to give an expert evaluation before recommending a product, and they certainly have little or no knowledge of herb and drug interactions. Most would not even think to ask if the customer is taking medication, how much, and for what condition. Drug stores also sell many herbal products but pharmacists have little or no training in the area of herbal constituents and so can offer little advice.

Certainly in the last few years there have been some attempts to educate health food store employees and even pharmacists on the virtues of herbs. Improvements in this area were initiated by the Canadian Health Food Association CHFA with expert advice from herbalists, naturopaths and nutritionists.

For those trained in herbal medicine the lack of scientific studies of drug/herb interactions is a major concern. The obvious reason being lack of funds for research in this area. Besides a few documented cases most of the information is anecdotal, from one’s experience. Because of this lack of information patients wanting to try the more natural alternative may do so at a great risk.

The problem for some is the process of weaning off drugs while introducing herbs, for others it is trying to compliment the drugs with herbs. If the patient wishes to eliminate the drugs and work with herbs, weaning off the drugs while taking herbs should be monitored by a skilled professional. Stopping drugs cold turkey can be dangerous with some types of drug medications so seek expert medical advice first. Some patients could be taking several medications, which may further increase the risk of a reaction.

Although many herbs are safe in combination with drugs I would say that there are some instances where care must be taken. Herbs that would create a serious problem when combined with drugs are usually quite toxic, and illegal, such as aconite, belladonna, Jimson henbane, and are not used by herbalists.

Other herbs that may cause a reaction when combined with drugs are few and far between. Below I will discuss those that have been considered to be a potential risk when combined with certain drugs, but bear in mind it is mostly anecdotal information.

St. John’s Wort

Used for mild to medium cases of depression, is contraindicated for those taking mono amine oxidase (MAO) inhibitors, because it is believed this herb has a similar action and may compound the effect of the drug if taken simultaneously.

Hawthorn

Although this herb is probably the best heart tonic with no side effects some care should be taken if patient is taking hawthorn along with digitalis (foxglove). Hawthorn appears to potentiate (increase potency) cardioglycoside action of digitalis, which could cause a severe reaction.

Kava Kava

This herb has been used successfully for stress and anxiety and is considered an effective substitute for benzodiazepine drugs such as Valium, but may cause some serious reactions if taken together. Kava also contains MAO inhibitors and should be avoided when taking some anti-depressant drugs.

Liquorice

There are some concerns that this herb may have a p0-tentiating effect on hydrocortisone, cortisone sprays (inhaled), and prednisone. Potassium loss caused by liquorice may increase the effects of cardiovascular drugs like digoxin, which causes the heart to beat slower and stronger. Potassium loss may be increased when taking certain diuretics such as lasix, and hydrochlorothiazide. Diuretics that hold potassium in the body such as amiloride, and spironolactone may cause abnormally high levels of potassium when taken with liquorice. The phyto-estrogens found in liquorice may increase the effects of estrogenic drugs, which could cause hypertension. Liquorice may also have a monoamine oxidase inhibiting (MAOI) effect and when combined with an MAOI drug, it could cause severe hypertension along with headaches, sweating, heart palpitations, and stiff neck and dilated pupils. Liquorice can also speed the elimination of acetaminophen (Tylenol).

An area of major concern is the interactions of herbs and drugs that have an anti-coagulant effect. Herbs with a potential blood thinning effect must not be combined with drugs of a similar nature such as Coumadin, Warfarin, Heparin, and even ASA. These herbs include Sweet Clover, Red Clover, Birch, Red Root, Feverfew, Ginseng, Ginkgo, Horse chestnut, Chrysanthellum americium, Willow and Aspen.

As I mentioned earlier most herbs available through health food stores are considered tonic in nature with no side effects and I see no harm in people using them especially for minor conditions. For some disorders expert advice is needed. Unfortunately contraindications and possible herb/drug interactions are not allowed on product labels but this may soon change with the new natural products division of Health Canada.

I would recommend that anyone wishing to try herbal medicine should procure professional advice or at the very least do some research. If your doctor has prescribed drugs let him/her know that you are taking herbs. If he has no knowledge of herbs recommend he or she connects with a qualified herbal practitioner. A good place to start is either a college of herbal medicine such as Living Earth School of Natural Therapies or Dominion Herbal College, or an herbal group such as the Central Canadian Herbal Practitioners Association. The modern herbalist has both a scientific and traditional training and is aware of herb and drug interactions.

Peter Laker is a practicing Clinical Herbalist and Iridologist at Herbs and Health in North York, Ont. He is also, the President of The Central Canadian Herbal Practitioner ‘s Association.

Books:

 Design News2News.com • Toronto • 2000