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Eported interactions between herbal medicines and synthetic drugs are small in number; however, interactions do exist and can have serious clinical consequences. Healthcare professionals should inquire about herbal product use and consider the possibility of herb-drug interactions. Case reports of interactions with the seven most commonly used herbal medicines are summarized below. [Ref: Izzo AA, Ernst E; Drugs 2001 61 15 ; : 2163-75] St John's wort Hypericum perforatum ; lowers blood concentrations of cyclosporine, amitriptyline, digoxin, indinavir, warfarin, and theophylline. Mechanism: induction of hepatic isoenzyme CYP 3A4 and increased P-glycoprotein activity ; intermenstrual bleeding when used with oral contraceptives ethinylestradiol desogestrel ; episode of delirium in one patient when used with loperamide and valerian mild serotonin syndrome when used with SSRIs sertaline, paroxetine, nefazodone ; Ginkgo Ginkgo biloba ; bleeding complications when combined with warfarin or aspirin increased blood pressure in an elderly patient when combined with a thiazide diuretic coma in an Alzheimer's patient when combined with trazodone Ginseng Panax ginseng ; possible interaction with warfarin leading to decreased INR induction of mania with concomitant phenelzine Garlic Allium sativum ; noted to alter the pharmacokinetics of acetominophen increased INR when combined with warfarin potential increased risk of post-operative bleeding complications Kava Piper methysticum ; increased 'off' periods in a Parkinson's patient taking levodopa increased sedation when given concomitantly with alprazolam No reports of interactions were found for echinacea Echinacea angustifolia, E. purpurea, E. pallida ; or saw palmetto Serenoa repens and amphetamine.
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