Drug – Herb Interactions

by Shihan Mary Bolz,
Licensed Acupuncturist & Herbalist
Master Martial Arts Instructor

Is it safe to combine drug and herbal therapy simultaneously? It is important that people who are taking medications and wish to opt for a safer route, consult with a qualified, professional herbalist. A Traditional Chinese Medicine practitioner is educated and qualified in Chinese herbal pharmacology as well as acupuncture. It involves a long and thorough study of not only the art and science of understanding the herbs properties, actions and effects on the human body, but of deriving an accurate diagnosis for the cause or imbalance underlying the patient’s disease or feeling of ill health. A Western pharmacology course is also included in the education. An degree in Oriental medicine is a four-year academic program at a specialized school, after undergraduate studies. Allopathic medicine doctors (M.D.’s) and pharmacists do not have an education in herbal medicine (unless they also went to Oriental medicine school). Because of this, there are allopathic medicine practitioners who advise their patients not to take herbs while on medication. That may be good advice if the patient is prescribing their own herbal therapy without any formal training. It may be significantly poor advice if it is preventing the patient from using herbs under the guidance of a qualified herbalist. In fact, the patient may miss out on a wonderful opportunity for a great state of health and the possibility of becoming drug free. The Oriental medicine doctor and the allopathic medicine doctor can both be great guides for improving people’s health and both can work together.
How can you, as a heatlh-conscious person work with your Oriental medicine doctor and your allopathic medicine doctor? It is not difficult. A professional Oriental medicine doctor will, in the process of their consultation and exam, want you to supply them with a list of all the prescription and over-the-counter (OTC) medication that you are taking, any vitamins or other supplements and herbs, as well as your basic dietary and liquid consumption habits (coffee, tea, sodas, energizing drinks, alcohol, etc.) and whether you smoke. An Oriental medicine herbalist will be aware of any major possible toxic side effects with certain medications, as well as positive and synergistic effects. Most of the time, it is quite safe to combine herbal and medication therapy as long as you take the herbs at least 2-3 hours apart from the drugs; 4 hours is even better. You must remember that herbs are whole food-they are not merely constituent chemical components like drugs or vitamins. With this understanding, you may realize that there are drug-food interaction possibilities as well. There are herb-herb and food-food adverse interactions. In Traditional Oriental Medicine (TCM), these food-food and herb-herb interactions are well-known.

One of the most powerful over-the counter (OTC) drugs which many people consume daily is coffee. It is greatly underestimated or unknown by many people the negative effect of consuming this beverage. It is not only the caffeine. Due to the unique nature of coffee, it is a great consumer of nutrients and inhibitor of nutrient resorption, since it eats away the villi of the intestines. It is well-known among nutritionists that it significantly inhibits the absorption of calcium inside the human body. (Soft drinks and diuretic medications also do this.) The acids in coffee cause as much problem as the caffeine. Women who consume coffee on top of a high-fat diet have a larger risk of mammary and bladder cancer according to the Journal of the American Chemical Society, page 253, 1407, 1995. It would be well for perimenopausal and menopausal women to realize this-the connection between hormones and anxiety; calcium depletion and osteoporosis. Coffee can provoke real havoc!

When it comes to substance interaction, there are basically two general categories of how these interactions are classified: pharmacokinetic of interactions and the pharmacodynamics of interaction.

Pharmacokinetic refers to the study of a drug from the moment it enters the body to the moment it leaves the body. Examples of pharmacokinetic interactions include: 1. Absorption: Concomitant administration of herbs and drugs may either increase or decrease absorption of herbs and/or drugs. For example, the absorption of herbs may be affected when given together with some drugs which changes the pH in the stomach ultimately decreasing the absorption of herbs. Examples include antacids; Tagamet, Pepcid, Axid, Zantac, Prilosec and Pravacid. 2. Distribution: How the prescribed drug is distributed through the body. Some drugs are highly bound to protein and have a narrow therapeutic range. The drug that is most susceptible to improper distribution is Coumadin. 3. Metabolism: Some drugs stimulate or suppress metabolism of drugs or herbs in the body. Most herbs and drugs are metabolized by the liver to inactive derivatives. The rate in which the liver metabolizes these herbs and drugs would determine the duration in which these herbs and drugs stay effective in the body. Examples of drugs that speed up liver metabolism include Dilantin, Tegretol. The dosage of herbs may need to be increased in order to maintain the same effectiveness. Examples of drugs that slow down or inhibit liver metabolism include but are not limited to Tagamet, Erythromycin, Ethanol. These drugs slow down or inhibit metabolsim-therefore the dosage of herbs may ned to be decreased to prevent from overdosing he patient.

Pharmacodynamic refers to the study of drugs as to how they actually behave inside the human body. Pharmacodynamic interactions are generally more difficult to predict and prevent. Most of these interactions known now are documented through actual cases. The best way to prevent pharmacodynamic interactions is to follow the patient closely and monitor all clinical responses and signs.

It is virtually impossible to know every possible adverse interaction for any professional, but the safety of consuming whole herbs and food with drugs is likely far safer than drug-drug interactions. Most people are aware of drug-drug interactions, but it seems they grossly underestimate just how powerful these medications are. I am suggesting that whole herbs are much safer an interaction with drugs than drugs, including OTC drugs.

A responsible Oriental medicine doctor does not advise the stopping of any medication cold turkey and if the patient wishes to stop, it should be gradual, with both the Oriental and allopathic medicine doctors’ monitoring.

Some examples of possible negative drug-herb interactions: Herb Siberian ginseng with drug Digoxin. Antipsychotic agents with kava and St. John’s wort.
Asian ginseng with antihypertensive medications. Beta-blockers are used to treat high blood pressure as well as a variety of heart conditions. They work by blocking nerve signals that cause the heart to beat faster and blood pressure to rise. The drugs in this family are too numerous to list. You may ask your doctor what kind of blood pressure medication yours is. It appears that one of these drugs, altenolol, may form an unabsorbable complex with calcium in the intestine, leading to reduced blood levels of the drug. One may avoid calcium supplementation when taking this drug.

Dietary incompatibilities fall into two categories. Those foods which should specifically be avoided by patients taking certain medicinal substances and those who should avoid certain foods and certain food combinations related to specific symptoms or diseases. For example, traditionally in China, patients with fever were taught to avoid greasy foods or oils of any type. Some prohibitions are more general, such as when taking herbs patients should avoid raw, cold, greasy, or other relatively hard-to-digest foods. These can upset the digestive tract and disturb the effects of the herbs. Many times when people think they have the stomach flu, it really can be the result of having consumed bad food or having consumed the wrong food combinations., or merely too much!

It is not in the patient’s best interest to abandon herbal treatment simply for the fear of possible interactions. The solution to such a problem is in the understanding of drug-drug and drug-herb interactions. With understanding of the mechanisms, one can recognize potential interactions and take proper actions to prevent their occurrences.

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