The hidden problem of herb‐drug interactions

Abstract

Potentially harmful interactions between herbs and prescription medicines are common, yet healthcare professionals often do not ask about herbal remedies when prescribing and patients do not volunteer that they are taking them. This article discusses the types of herb‐drug interaction that can occur and how they can be recognised and avoided.

Leonurus cardiaca L. as a Source of Bioactive Compounds: An Update of the European Medicines Agency Assessment Report (2010)

“…L. cardiaca also potentiates antithrombotic and antiplatelet effects, increasing the risk of bleeding. When administered concomitant with benzodiazepines, motherwort can also have a synergistic sedative effect resulting in coma [73].…”

Adverse drug reactions: prescribing's twilight zone

“…Based on Yellow Card reports, the MHRA warned that patients taking warfarin should limit or avoid drinking cranberry juice and that St John's wort could reduce the efficacy of concurrent hormonal contraceptives medicines and implants. 3 Although the Yellow Card Scheme began with ADRs, the system now encompasses adverse incidents related to medical devices, including concerns about the performance of diagnostic assays and technologies. The Yellow Card Scheme also includes counterfeit and defective medicines (those that are not of an acceptable quality), and from May 2016, safety concerns associated with e-cigarettes.…”

Understanding the relevance of herb–drug interaction studies with special focus on interplays: a prerequisite for integrative medicine

“…Modern system of medicine has emerged as the primary choice for the treatment of nearly all types of health-related issues, although, it is mainly based on the nonholistic/bug killing/target-based approach, which ultimately leads to future side effects (notable in case of chronic disorders such as cancer, diabetes, arthritis, etc). 1–3 However, patients with such chronic illnesses directly/indirectly undergo combinational/multimodal therapy with or without the knowledge of physicians, leading to potential herb–drug interactions (HDIs). 1 The MD Anderson Cancer Centre, in USA, reported that 52% of their cancer patients had used at least one form of complementary and alternative medicine (CAM), and 77% of those were using herbs.…”

“…1–3 However, patients with such chronic illnesses directly/indirectly undergo combinational/multimodal therapy with or without the knowledge of physicians, leading to potential herb–drug interactions (HDIs). 1 The MD Anderson Cancer Centre, in USA, reported that 52% of their cancer patients had used at least one form of complementary and alternative medicine (CAM), and 77% of those were using herbs. 4 While, according to the World Health Organization (WHO) and other reviews >80% world's population uses CAM for their health care needs and particularly in western countries CAM has become increasingly popular over the last few decades.…”

“…5–8 However, concomitant usage of herbs and conventional medicines globally could be much higher as healthcare professionals often do not ask about herbal remedies when prescribing and patients do not volunteer that they are taking them. 1,9–11 Indeed, such a scenario of concomitant usage of herbs/CAM and conventional medicines brings with it the potential problem of HDIs and this issue has emerged as a major hurdle/problem in our journey toward integrative medicine (IM). 1,12,13 IM refers to the blending of conventional and evidence-based complementary medicines and therapies with the aim of using the most appropriate of either or both modalities for efficient patient care.…”