Identifying Interactions
Between Prescription and
Herbal Medications
Lorraine W. Bock, MSN, CRNP, CEN
Page 1
Objectives:
At the completion of this program the learner will:
1.) Appreciate the magnitude of use of nonprescription herbs, vitamins, and supplements in
the United States today.
2.) Understand the use of common herbal
medications and supplements available on the
market.
3.) Recognize common pharmaceuticals that pose
of risk of drug/herb interactions.
Page 2
How many of you are currently
taking a non-prescription vitamin
herb or supplement on a regular
basis?
Page 3
Supplement Use in the US
• Nearly 20% of Americans use a vitamin, herb,
or supplement daily
• Over 50% of Americans admit to using a
vitamin, herb, or supplement in the last 30
days
• Over 17 billion dollars is spent annually by
consumers on the purchase of vitamins,
herbs, and supplements
National Center for Complimentary and Alternative Medicine - 2007
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What are we talking about?
• Any substance
intended to be taken
by mouth for the
purpose of
supplementing the
diet,contains one or
more of the
substances listed,
and is labeled as a
dietary supplement.
•
•
•
•
•
•
Vitamins
Minerals
Herbs
Botanicals
Amino Acids
“Natural Products”
Page 5
Most Commonly Used
Vitamins, Herbs, & Supplements
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Multivitamin/Multimineral
Fish Oils/Omega III/DHA
Glucosamine/Glucosamine Chondroitin
Echinacea
Flaxseed
Ginseng
Vitamins – B-complex, E, & C
Calcium
Page 6
Multivitamins/Multiminerals
• Used to provide the
addition of a variety
of vitamins and
minerals to one’s
diet.
• Supplement nutrition
Page 7
Interactions/Side Effects
• Avoid drinking milk to take MVI
• Avoid salt substitute products
• Avoid taking at the same time as antiacids
• Take only one MVI product at a time
• May alter the effect of:
diuretics, BP medications,
tretinoin/isotretinoin, bactrim/sulfa
drugs, & NSAIDS
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Fish Oils/Omega III/DHA
• Heart Health
– Decrease lipid levels
– Lower BP
– Dilate blood vessels
• Brain & Nervous
System Function
• Reduce
Inflammation
• Cancer Prevention
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Interactions/Side Effects
• Worsen diabetic control
• Immune suppression
• May alter the effects of:
NSAIDS, Plavix, Celebrex,
Heparin/Lovenox, Coumadin,
Xenical/Alli, Thrombolitics, BP
medications
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Glucosamine
Glucosamine Chondroitin
•
•
•
•
Osteoarthritis
Joint Pain/Swelling
Restore Cartilage
Irritable Bowel
Diseases
Page 11
Interactions/Side Effects
• Caution in those with Shellfish Allergies
• May alter the effects of:
NSAIDS, Diabetic agents including insulin,
Diuretics, K++ supplements, Anticoagulants
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Echinacea
• Shorten Viral
Infections
• Immune Booster
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Interactions/Side Effects
• May alter the effects of: corticosteriods,
antibiotics, diabetes medications,
chemotherapy drugs
• May worsen: MS, Immune Disorders,
TB, Leukemia, Lupus, Collagen
Diseases, Stomach Problems
• Do not use in: HIV, Organ Transplant
Patients, Pregnancy
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Flaxseed
• Anti-inflammatory
• Colon Health
– IBS, Crohn’s, Colitis
• Cancer Prevention
– Breast Cancer
• Heart Health
– Lower lipids
– Lower BP
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Interactions/Side Effects
• May slow the absorption of all drugs
• May alter the effects of: blood thinners,
diabetic medications, NSAIDS,
Contraceptives, Hormone Replacement
Therapies, Anti-hyperlipidemics
Page 16
Ginseng
• Battle Stress &
Fatigue
• Mental Clarity
• Emetic
• Stimulate Endocrine
Activity
• Lower Blood Sugar
Page 17
Interactions/Side Effects
• May alter the effects of: diabetes
medications, blood thinners, NSAIDS,
Thrombolytics, CA++ channel blockers,
antidepressants, antipsychotics, MAO
Inhibitors, Opiate Pain medications
• Should not be combined with caffeine
products
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Vitamin B Supplements
• Mental Clarity
• Fatigue
• Prevention of Neural
Tubal Birth Defects
• Treat Anemias
• Peripheral
Neuropathies
• Skin Disorders
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Interactions/Side Effects
• May alter the effects of: Tetracycline,
Anticonvulsants, Cholchicine,
Metformin, Bile Acid Sequestrants, H2
Blockers,Proton Pump Inhibitors,
Chemotherapeutic Agents,
Antidepressants, Levodopa,
Erythropoetin
Page 20
Vitamin E
• Skin Health/Scar
Reduction
• Menopausal
Symptoms
• Diabetes
• Cancer
• Heart Health
Page 21
Interactions/Side Effects
• May alter the effects of: Tricyclic
Antidepressants, Phenothiazines, AZT,
Beta Blockers, Bile Acid Sequestrants,
Statins, Cyclosporin, Tamoxifen, Female
Replacement Hormones,
Medbendazole, Orlistat, Warfarin
Page 22
Vitamin C
• Immune Builder
• Menopausal
Symptoms
• Enhance Iron
Absorption
• Cancer Prevention
• Lyme Disease
Treatment
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Interactions/Side Effects
• May alter the effects of: NSAIDS,
Acetaminophen, Barbiturates,
Aluminum-containing antiacids, Nitrates,
Chemotherapy drugs, Female Hormone
Supplements, Crixivan, Tetracycline,
Warfarin
• Enhances iron absorption
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Calcium
• Prevention of
Osteoporosis
• Weight Loss
• Muscle Cramps
• Menopausal/PMS
Symptoms
• Heart Health
Page 25
Interactions/Side Effects
• May alter the effects of: Alendronate,
Aluminum Containing Antiacids, Beta
Blockers, Ca++ Channel Blockers, Bile
Acid Sequestrants, Corticosteriods,
Digoxin, Estrogen Supplements,
Gentamycin, Quinalones, Tetracycline,
Anticonvulsants, Thiazide Diuretics,
Lithium, Thyroid Supplements
Page 26
Pharmaceuticals with High
Potential for Interactions
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Coumadin
Thiazide Diuretics
Phenytoin
Phenobarbitol
Lithium
Thyroid
Medications
•Oral Diabetic Agents
•Corticosteriods
•BP Medications
•Cyclosporin
•NSAIDS
•Digoxin
Page 27
Coumadin/Warfarin
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Cayenne
Feverfew
Garlic
White Willow Bark
St. John’s Wort
Ginkgo Biloba
Alfalfa
Dong Qui
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Vitamin A, K, C, E
Quinine
Papain
Devils Claw
Green Tea
Danshen
Coenzyme Q10
Page 28
Thaizide Diuretics
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Artichokes
Dandelion
Celery Seed
Goldenseal
Juniper
Horsetail
Buckthorne
Gingko Biloba
Cleavers
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Folic Acid
Magnesium
Potassium
Zinc
Uva-Ursa
Buchu
Licorice
Digitalis
Gravel Root
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Phenytoin
• Evening Primrose
Oil
• Shankapulshpi
• St. John’s Wort
• Black Cohosh
• Ginkgo Biloba
• Kava Kava
• Valerian Root
Page 30
Phenobarbital
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Thujones
Vitamin B6
Woodworm
Evening Primrose
Oil
• Gingko Biloba
• Passion Flower
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Kava Kava
Valerian Root
Folate
Biotin
Vitamin D
Dong Quai
Glutamine
Page 31
Lithium
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Butchers Broom
Dandelion
Bochu
Juniper
Folic Acid
L-tryptophan
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Essential Fatty Acids
Coffee
Psyllium Fiber
Sodium
Page 32
Thyroid Medications
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Horseradish
Kelp
Iodine
Calcium
Soy
Bugleweed
Lemon Balm
• Iron
Page 33
Oral Diabetic Agents
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Butchers Broom
Bochu
Dandelion
Juniper
Devil’s Claw
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Gymnema
Sylvestri
MSM
Karela
Chromium
Vanadium
Magnesium
Page 34
Corticosteroids
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Astragalus
Echinacea
Licorice Root
Alfalfa
Zinc
Horny Goat Weed
Buckthorne
Grapefruit Juice
Pomegranate Juice
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Selenium
Potassium
Melatonin
Magnesium
N-acetyl Cysteine
(NAC)
• Vitamins A, D, B6
• Zinc
Page 35
BP Medications
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Magnesium
Niacin
Calcium
Grapefruit Juice
Alistrol
Coenzyme Q
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Garlic
Hawthorne
Fish Oil
Folic Acid
Page 36
Cyclosporin
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Grapefruit Juice
St. Johns Wort
Chinese Skullcap
Gingko Biloba
Omega III Fatty
Acids
• Grapefruit
• Quercetine
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Vitamin E
Magnesium
Red Wine
Potassium
Milk
Pomegranate
Apple
Page 37
NSAIDS
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Glossypol
Coffee Arabica
Cola
Uva-Ursi
Alcohol
• White Willow Bark
Page 38
Digoxin
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Aloe Vera
Yellow Foxglove
Siberian Ginseng
Quinine
Licorice
Psyllium Fiber
• Hawthorne Berry
• Eleutherococcus
Senticosus
Page 39
Conclusion
Over 50% of Americans will utilize
vitamins, herbs, and supplements to
treat a health concern in the next 30
days. Many of these natural therapies
will interact either positively or
negatively with another substance the
person is taking. Knowing some of the
more common interactions may help
prevent or minimize health concerns
related to drug-herb interations.
Page 40
Contact Information
Lorraine W. Bock, MSN, CRNP, CEN
Bock Family Healthcare
1773 West Trindle Road
Carlisle PA 17015
(717) 920-9579 – office
(717) 443-9970 – cell
lorrainecrnp@kuhncom.net- email
Page 41
Resources
• Nursing Herbal Medicine Handbook, 3rd
Edition. ©2006. Lippincott, Williams, &
Wilkins
• National Center for Complimentary and
Alternative Medicine
• Holistic Online.com
• National Institutes of Health Database
Page 42