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Last updated January 1, 2014

An Ideal Match?

Drugs and herbs can be useful healing tools, but combining them sometimes does more harm than good.

Lauri M. Aesoph, ND. Originally published by

When Clarence, a 43-year-old patient, came to see me for depression, one of the first things I did was review his list of medications and supplements. It's standard procedure in my consulting practice to take special notice of potential drug and herb interactions. In Clarence's case, I noted that along with his antidepressant medication and a tranquilizer, he was taking kava root (Piper methysticum), which is known for its sedating and anti-anxiety effects. While there is no established interaction between kava and the specific antidepressant and tranquilizer he was on, I suggested to Clarence and his prescribing doctor that he discontinue taking kava with these medicines.

I made this recommendation based on studies examining the interaction between drugs and herbs. At least one report in the medical literature I reviewed and several anecdotal case reports describe patients falling into a stupor while taking kava with antidepressants (Annals of Internal Medicine, 1996, vol. 125).

More than 95 percent of us rely on conventional medicine for our primary care (Journal of the American Medical Association, 1998, vol. 279). But increasingly, patients are combining conventional medicines with herbs. In 1993, the New England Journal of Medicine (vol. 328) published a landmark survey headed by David Eisenberg, M.D., stating that one-third of the people interviewed had used at least one alternative therapy in 1990.

This often-cited report opened the eyes of mainstream medicine to the growing popularity of alternative practices. In 1997, Sacramento, Calif.­based Landmark Healthcare conducted its own nationwide survey and found that more than four out of 10 adults -- 25 percent more than in Eisenberg's report -- had used some form of alternative medicine in the past year and planned to continue doing so. Almost three-quarters of this group intended to use alternative medicine along with conventional health care.

This increase in popularity is good news, except for one fact: The pairing of alternative with conventional often happens without physician supervision. Used alone, herbs can be beneficial; used in combination with drugs, there can be negative interactions. As always, be sure to check with your health care practitioner if you plan to use herbs with your medication.

Drugs with Herbs: Be Cautious
Paul Saunders, Ph.D., N.D., chair of the Botanical Department at the Canadian College of Naturopathic Medicine in Toronto, is acutely aware of the pros and cons of combining drugs and herbs. He notes that people should be especially careful about using herbs with three types of drugs: cardiac medications, antidepressants and anticoagulants (blood thinners).

Licorice, for instance, increases the toxicity of heart medications like digitalis. And taking a natural blood thinner like vitamin E, willow bark, ginkgo or fish oil with the anticoagulant warfarin, says Saunders, might cause excessive bleeding if the patient isn't monitored by a doctor. Discontinuing the natural substance is one way to curtail bleeding, but another option is to monitor bleeding with a prothrombin test (PTT) and adjust medications as required.

Less is known about the interactions of many herbs and drugs, however. Francis Brinker, N.D., author of Herb Contraindications and Drug Interactions, second edition (Eclectic Institute), cautions that the study of herb-drug interactions is a controversial and developing area. "Much of this information is based on a single case, animal studies or test-tube research," says Brinker, "so we must be careful not to assume that taking certain herbs with certain drugs is risky in all situations. Most of the information at this point is suggestive or speculative and merely underlines potential problems."

Unless there is a well-established interaction between a drug and an herb, you might still safely take these substances together as long as a doctor is monitoring you. Saunders concurs: "I tell other doctors to introduce herbs gradually and increase them slowly for their patients using drugs."

The key is to manage the simultaneous use of herbs and drugs. Christine Girard-Couture, N.D., who works alongside M.D.s at the Griffin Hospital in Derby, Conn., recalls a young quadriplegic taking medications for intense motor spasms and pain who came to see her because his medicines weren't working. In cooperation with the allopathic physician, Girard-Couture developed a treatment plan that gradually decreased the patient's medication and slowly introduced herbs. By taking this conservative approach, the doctors discovered that cramp bark and kava gave the patient relief -- without any adverse reactions

Talking with Your Doctor
How do you go about using herbs and drugs together in an effective way? Saunders' first suggestion to patients using both types of medicines is to be honest with your doctor about what you're taking. It's estimated that as few as 25 to 60 percent of individuals tell their practitioners they're using alternative medicines. Saunders also warns people to be careful of self-prescribing. If an adverse reaction occurs, report it to a physician so it can be checked out, he says.

If your wish is to have a doctor sympathetic to your interest in using herbs, ask up front if he or she has enough expertise in alternative medicine to offer guidance. If not, make an appointment with someone who does or ask if your health care practitioner would be willing to work with you as you both learn more about the process

Fortunately, your chances of finding a health care practitioner trained in integrative medicine are increasing. Courses on alternative medicine are now commonplace for the conventional practitioner, and according to the Journal of the American Medical Association, 75 of America's 125 medical schools now offer instruction in alternative care -- up from 33 in 1995 (1998, vol. 279).

For doctors unfamiliar with herbs, a team approach to treatment -- including a physician skilled in prescribing drugs and an experienced herbalist -- gives the patient the best of both worlds.


The Future of Integration
The intentional use of herbs with conventional medicine offers exciting possibilities in health care. Yet this idea is not new in other cultures. More than 20 years ago, the American Journal of Chinese Medicine (1975, vol. 3) published an article documenting "a new medical trend in China" in which Chinese practitioners were blending traditional Chinese medicine with other modalities -- treating heart disease with a combination of Western drugs and Chinese herbs, for example.

Europe has also led the way. In Germany, approximately 600 to 700 "plant drugs" are sold in pharmacies and stores, and about 70 percent of general practice doctors prescribe herbs for their patients.

European research is also forging new ground in the study of drug and herb interactive medicine. An Italian study found that volunteers who took ginseng before and after receiving a flu shot had fewer colds and flus and a stronger immune response compared with those who got the shot alone (Drugs and Experimental Clinical Research, 1996, vol. 22). A Russian study found that aloe can enhance the antitumor effects of chemotherapeutic drugs like 5-fluorouracil and cyclophosphamide (Vopr Onkol, 1986, vol. 32). In other words, adding herbs to chemotherapy could mean that smaller amounts of toxic drugs are needed for the same therapeutic effect and fewer side effects.

In this country, too, there's a growing effort to develop our knowledge about medicinal plants and how drugs and herbs interact. Laboratories continue to systemically analyze individual herbs for their active constituents. Pharmaceutical companies are part of the research effort, as they search for new plants with medicinal qualities. The National Center for Complementary and Alternative Medicine (formerly the Office of Alternative Medicine), part of the National Institutes of Health, offers research grants, lending credibility to the study of herbs. Along with studies in the lab, clinical observation and case studies have become equally important to our growing wisdom.

Research, education and cooperation among different practitioners are also central to the safe and effective combining of herbs and pharmaceutical drugs. Overseeing practitioners must monitor and document all effects -- both good and bad -- and share their results.

Individuals seeking this kind of care must choose a provider -- whether an M.D., a nurse, a nurse practitioner, a naturopathic physician or a D.O. -- or a team of providers who can make sense of potential interactions. "In the end, the best thing we can do," says Girard-Couture, "is to encourage a dialogue between patients and practitioners."

This is a learning time for all of us.


Double-Check Your Multivitamin
It may not always be immediately obvious that you're taking herbs, as they are sometimes included as ingredients in over-the-counter supplements. Gone are the days of the simple multiple vitamin and mineral supplement. An increasing number of these supplements contain herbs. While this is good news, it's important to be aware of what you're taking along with the vitamins you're after, so be sure to read labels carefully. You may have an allergic reaction to one of the herbs or be taking a medication that interacts negatively with an herb. Whether taking a prescription or an over-the-counter product, always check with your pharmacist or doctor about potential problems between your conventional medicine and the herbs in your multi.

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