Problems When Patients Hide Supplements – Part 4

Part 4 of 7 parts

Table 1 lists herbal supplements commonly used in the United States, their typical uses and known toxicities, as well as drug interactions of these herbals with prescribed and over-the-counter medications. Table 1 can be used by the clinician as a handy guide to the clinical signs and symptoms of supplement toxicity, including acute and chronic effects of use as well as idiosyncratic effects and interaction with prescription drugs.

Table 1. Uses, Toxicities, and Drug Interactions of Commonly Used Dietary Supplements

Herb	Common Use	Known Toxicities	Drug	Known Drug Interactions
Echinacea	Upper respiratory tract infection		Warfarin	Reduced plasma levels of warfarin
Garlic	Hypercholesterolemia	Chopped garlic at room temperature can result in botulism	Chlorpropamide	Bleeding, increase in international normalized ratio (INR)
Ginkgo biloba	Dementia, cognitive impairment; remedy for impotence and vertigo	Gastric disturbance, headache, dizziness, and bleeding	Warfarin	Bleeding
Saw palmetto	Benign prostatic hyperplasia
Ginseng	Physical performance	Can increase blood pressure	Warfarin	Decrease in INR
Grape seed extract	Venous insufficiency
Green tea	Cancer
St. John's wort	Depression	Can increase blood pressure, causes severe headache	Amitryptyline	Reduced plasma concentrations of amitryptyline
Bilberry	Vision impairment
Aloe	Dermatitis/wound healing (topical)	Excessive amounts may cause a laxative effect
Ma Huang (ephedra)	Weight loss	Hypertension and cardiovascular events
Goldenseal	Cough, upset stomach, and menstrual problems	Can increase blood pressure and cause gastrointestinal distress and nervous system effects
Feverfew	Migraine	Can increase blood pressure
Kava	Anxiolytic, analgesic, muscle-relaxing and anticonvulsant effects	Can potentiate CNS acting substances	Alprazolam	Increased sedation
Prickly chaff powder	Hypercholesterolemia	Bone marrow toxicity, abnormal electrolyte homeostasis
Evening primrose	Premenstrual syndrome, attention-deficit/hyperactivity disorder, diabetic neuropathy	Lowers seizure threshold of various anticonvulsants
Shankhpushpi	Dementia, cognitive impairment		Phenytoin	May have adverse effect on blood levels of phenytoin

Data from Pharmacy Times.