How to Avoid Dangerous Drug-Herb Interactions, Part 2

11. Valerian
Valerian should not be combined with barbituates.

12. Kelp
Kelp as a source of iodine may interfere with thyroid replacement therapies.

13. Echinacea

Echinacea could cause liver toxicity and therefore should not be used with other known liver toxic drugs, such as anabolic steroids, amiodarone, methotrexate, and ketoconazole

14. Nonsteroidal anti-inflammatory drugs may negate the usefulness of feverfew in the treatment of migraine headaches

15. Kava when used with alprazolam has resulted in coma

16. Evening primrose oil and borage should not be used with anticonvulsants because they may lower the seizure threshold.

17. Both Rhubard and Aloe cause loss of potassium through the stool... this may increase the side effects of cardiac glycosides and antiarrhythmic drugs.

18. Astragalus (huang qi) may oppose immunosupressive drugs, because it tends to improve immune function.

Some of these herbs are not chinese herbs (feverfew, gingko, valerian, kava, echinacea, everning primrose, borage). If you saw a Chinese herbalist, they wouldn't be an issue. Plus, chinese herbalists prescribe more balanced formulas, not single herbs, so potential interactions with the single herbs are reduced.

Positive Drug Herb Interactions

Gan cao increases the effectiveness of prednisone. This benefit can be used to reduce the dosage of prednisone in patients who have to take it long term. This reduces the serious long-term side effects (bone density loss, adrenal insufficiency, etc.).

In typhoid fever, research showed that those given an herbal formula (xue yang mei) plus a sulfa drug did better than those just given the sulfa drug. Both groups had a 100% cure rate, but the combination group experienced few or no side effects.

In mastitis, those given a heat and toxin clearing herbal formula (jin yin hua, pu gong ying, yu jin, chi shao, dan shen, qing pi) plus penicillin/streptomycin injections did much better than those only given the injection.

In adult primary nephrotic syndrome, one group was simply given corticosteroids, while another group was also given an herb formulas (dan shen, di gu pi, gui ban, han lian cao, hong hua, nu zhen zi, gou qi zi, sheng di, zhi mu). The steroid only group had a recovery rate of 56%, while the combined group's recovery rate was 85%. In another study with nephritic patients, patients given predisone, zhi mu (anemarrhena), shu di huang (rehmannia), and gan cao (licorice) experienced less of the corticosteroid side effects.

Late-stage gastric cancer patients were studied. All patients were given a drug chemotherapy combo of either methotrexate, fluoroacil and vinblastine, or methotrexate, MFC, and fluorocil. One of the two groups was also given herbs (huang qi, tai zhi shen, caulis banthalobi, ji xue tang, bai zhu, fu ling, niu zhen zi, gou qi zi, tu su zi). Side effects were cut in half or eliminated in the chemo plus herbs group.

Solving the Multi-Drug Problem with Herbs

Many patients are on multiple drugs. We have had success reducing these medications over time with the assistance of herbal formulas. An appropriate herbal formula is begun weeks or months ahead of time. This gives the patient a 'cushion,' so to speak. Then the drug dosage is slowly reduced. The herbal prescription is modified as the patient progresses. MD's often cooperate with us in this effort since they know as well as anyone the dangers of poly-pharmacy (taking multiple drugs at once)… especially in the elderly. They say a good geriatric doctor stops more medications than he starts.

Herbs are more likely to correct an imbalance permanently (we call that "healing"). Drugs' therapeutic effects are almost always temporary. It takes more time to do this with herbs… but it's worth it.

Other Situations that are Helped by Herbal Formulas:

Quitting HRT…
Instead of just stopping cold (or hot, as the case may be), an herbal formula such as zhi bai di huang wan may be given weeks or months ahead of time. Then the patient's system is more balanced when the HRT is stopped, and rebound symptoms are less likely and less severe.

Breaking the Antibiotic Cycle…
Some patients perpetually take round after round of antibiotics. Approaches based on the Shang Han Lun (Cold Damage Classic) such as use of the herb formula Xiao Chai Hu Tang (Minor Bupleurum) have been known to get the patient well and away from the constant need for antibiotics.

Complementing Diuretic Therapy…
While Chinese Herbs should never be used to add to the diuretic effect of concurrent drug therapy, they can boost the system. Diuretic drugs reduce the excess fluids, but they do not solve the underlying deficiency. Herbal formulas can be prescribed to strengthen the Spleen and Kidney systems.

Quitting SSRI Anti-Depressants…
Of course this can be dangerous, and should be done with a psychiatrist and an herbalist. Herbs such as St. John's Wort (SJW) could be used as a cushion while quitting. SJW does not replace SSRI's… studies show that it must have some other mode of action. Herbal formulas are better anyway. See a Chinese Herbalist.

Quitting Corticosteroids...
As we saw in positive interaction #4 above, herbal formulas can be used in conjunction with corticosteroid treatment (for conditions like lupus, rheumatoid arthritis, primary nephrotic syndrome, etc.). A chinese herbal formula, Bupleurum and Hoelen Combination (Chai Ling Tang) can be used for withdrawal from corticosteroid therapy. Subsequently, it can be used in place of the steroids for continued treatment.

General Rules for Taking Herbs, Vitamins and Drugs:

Take them at different times. Most drugs are taken with meals to limit Stomach irritation. Take herbs between meals (at least 1 hour before and after a meal…2-3 hours would be best) for optimal digestion.

Don't take ascorbic (vitamin C) or salicylic acid (aspirin) at the same time as herbs. The acids will neutralize many of the saponins. Vit C will alter and neutralize herbs… so don't drink any orange or citrus juices with herbs either.

Don't take herbs that are supposed to do the same thing as a drug you're on. For example, don't take blood movers like dan shen or dang gui with warfarin. Don't take diuretics like fu ling with diuretic drugs.

You can take an herbal formula to complement the drugs you have to take. This can reduce or eliminate side effects. It really requires a professional… see a Chinese Medicine practitioner. This works well in chemotherapy to protect the body. However, in Hepatitis C, the interferon/ribavirin treatment requires some of the uncomfortable symptoms of fever and feeling ill to work. Stopping those side effects with herbs has been known to inhibit the drugs' effects. In the case of Hep C, you can opt for Chinese Herbal therapies instead of the western drug cocktail.

References:
Kelvin Chan, Lily Cheung. Interactions Between Chinese Herbal Medicinal Products and Orthodox Drugs. Dunitz Martin Ltd. 2000. (Most of the positive drug-herb studies mentioned above were summarized in this source. At least one of them came from the Beijing Journal of Traditional Chinese Medicine.)
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. Review.
Dharmananda, S. The Interactions of Herbs and Drugs. June, 2001. Institute for Traditional Medicine. http://www.itmonline.org.