Posted by Sunnely on November 10, 2000, at 23:56:58
In reply to Drug Interaction Info - Your Wisdom Please, posted by GLYN on November 9, 2000, at 6:58:10
Hi Glyn,
If I may add, caution with the regular use of the "G" herbs if you are also on a "blood thinner" such as warfarin (Coumadin), ASA acetylsalicylic acid (aspirin), valproate (Depakote, Depakene), and may be even the SSRI antidepressants (Prozac, Paxil, Zoloft, Luvox, Celexa).
The "G" herbs are comprised of Gingko, Ginseng, Garlic, Ginger, Guarana. These herbs have potential anticoagulant (blood thinning) and/or anti-platelet effects which may increase the risk of bleeding in some people, especially those on "blood thinner." This can lead to serious bleeding tendencies including stroke.
Theoretically, the concurrent use of these "G" herbs with SSRI antidepressants may also increase the risk of bleeding. The SSRIs, which enhance the action of serotonin have been reported to cause abnormal menstrual bleeding and other bleeding tendencies such as ecchymoses (easy bruising), petechaie (reddish small skin spots), epistaxis (spontaneous nose bleeding), gastrointestinal bleeding (bleeding ulcers), melena (blackish stool), and bleeding hemorrhoids. The mechanism as to how SSRIs increase bleeding tendencies may be related to their effect on serotonin. Under normal circumstances, platelets (blood particles responsible for clotting) release serotonin at the site of blood vessel tears, leading to further platelet aggregation and vasodilation (blood vessels enlarge). This permits sealing of the tear stopping the bleeding. It appears that the SSRIs block the reuptake of serotonin into the platelets which lead to a decrease in serotonin to be released by the platelets into the site of bleeding.
Incidentally, regular use of other herbs may also increase the risk of bleeding in some people and these include Dong quai, feverfew, licorice, vitamin E.
You should also be aware that Surgeons and Anesthesiologists advise that herbs be stopped at least 2 weeks prior to surgery.
Re: St. John's Wort (SJW):
There are several drugs (psych and nonpsych) that may interact badly with SJW. We still don't know the exact mechanism as to how SJW works as an antidepressant. It was suggested that it may have monoamine oxidase inhibition. However, some studies found that SJW possesses no inhibition of this enzyme. At least one study suggests that SJW inhibits the transport of serotonin similar to the SSRIs. To further the confusion, SJW contains many active ingredients but nobody knows exactly which one(s) is specifically involved in its antidepressant effect. Some authors opined that "hypericin" is the responsible ingredient while others suggest it is "hyperforin." Nonetheless, whatever the mechanism, it appears that SJW elevates the serotonin level as an end result. This elevation of brain serotonin may lead to "serotonin syndrome" when SJW is combined with other drugs with similar effect. This is a form of "pharmacodynamic" drug-herb interaction.
It has recently been determined that SJW induces (enhances) the action of a liver enzyme, CYP3A4, which can further enhance the metabolism of drugs that mainly depend on it for metabolism. This is a form of "pharmacokinetic" drug-herb interaction.
Based on the above forms of interactions, the following drugs (not complete list) theoretically, can lead to the following condition/effects if combined with SJW:
1. SSRIs (Prozac, Paxil, Zoloft, Luvox, Celexa) + SJW ----- > serotonin syndrome
2. MAOIs (Parnate, Nardil, Marplan) + SJW ---- > serotonin syndrome
3. TCAs (Elavil, Tofranil, Norpramin, Pamelor, etc.) + SJW ---- > serotonin syndrome
4. Carbamazepine (Tegretol) + SJW ---- > loss of anti-manic or anti-convulsant effect ---- > manic relapse, breakthrough seizure
5. Quetiapine (Seroquel) + SJW ---- > loss of antipsychotic effect ---- > psychotic relapse
6. Donepezil (Aricept) + SJW ---- > loss of Aricept effect
7. Piroxicam (Feldene), tetracycline + SJW ---- > increased skin sensitivity to sun
8. Warfarin (Coumadin) + SJW ----- > loss of blood thinning effect (risk of blood clot)
9. Digoxin + SJW ---- > loss of digixon effect ---- > heart failure
10. Theophylline + SJW ---- > loss of anti-asthma effect ---- > breakthrough asthma
11. Cyclosporine (Sandimmune) + SJW ---- > tissue rejection
12. "Triptans" for migraine (Imitrex, Zomig, Maxalt) + SJW ---- > serotonin syndrome
13. Anti-HIV drugs (Norvir, etc.) ---- > flaring up of HIV
14. Oral contraceptives + SJW ---- > loss of contraceptive effect ---- > risk of pregnancy, breakthrough bleeding
Re: SAMe, 5-HTP, , Tryptophan, Yohimbe, Passionflower, Ephedra:
1. Potential for serotonin syndrome if combined with SSRIs
2. Potential for serotonin syndrome and hypertensive crisis if combined with MAOIs.
Re: Kava, Melatonin, Valerian, Passionflower:
1. Potential for prolonged sedation even stupor if combined with benzodiazepines and nonbenzodiazepine sedative-hypnotics. (A case of semi-coma was reported due to combined use of Xanax and Kava.)
2. Kava + Anti-parkinsonian drugs ---- > worsening of parkinson's
symptomsRe: Caffeine:
1. Lithium + Caffeine (in excess) ---- > loss of lithium effect ---- > manic relapse
2. Clozaril, Zyprexa + Caffeine (in excess) ---- > increased blood level of Clozaril, Zyprexa ---- > increased side effects of Clozaril and Zyprexa
Re: MAOIs:
1. Foods rich in tyramine + MAOI ---- > hypertensive crisis
2. Tryptophan + MAOI ---- > serotonin syndrome
3. SRI (serotonin reuptake inhibitors) + MAOI ---- > serotonin syndrome
4. "Ecstacy" + MAOI ---- > serotonin syndrome
5. Meperidine (Demerol) + MAOI ---- > serotonin syndrome
6. Dextromethorphan (Robitussin DM) + MAOI ---- > serotonin syndrome
7. Colds tablets (with phenylpropanolamine, pseudoephedrine) + MAOI ---- > hypertensive crisis (even stroke)
Re: Char-broiled foods, broccoli, Brussels sprouts and cigarettes ("smokes and sprouts" reaction):
1. Clozaril, Zyprexa + "smokes and/or sprouts" ---- > potential loss of antipsychotic effect ---- > psychotic relapse.
poster:Sunnely
thread:48523
URL: http://www.dr-bob.org/babble/20001102/msgs/48657.html