HERBAL SUPPLEMENTS

Effi cacy, Toxicity, Interactions with Western Drugs, and Effects on Clinical Laboratory Tests

Edited by

AMITAVA DASGUPTA

CATHERINE A. HAMMETT-STABLER

A JOHN WILEY & SONS, INC., PUBLICATION

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HERBAL SUPPLEMENTS

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HERBAL SUPPLEMENTS

Effi cacy, Toxicity, Interactions with Western Drugs, and Effects on Clinical Laboratory Tests

Edited by

AMITAVA DASGUPTA

CATHERINE A. HAMMETT-STABLER

A JOHN WILEY & SONS, INC., PUBLICATION

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Copyright 2011 by John Wiley & Sons, Inc. All rights reserved

Published by John Wiley & Sons, Inc., Hoboken, New JerseyPublished simultaneously in Canada

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 750-4470, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008, or online at http://www.wiley.com/go/permission.

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Library of Congress Cataloging-in-Publication Data:Herbal supplements : efficacy, toxicity, interactions with western drugs and effects on clinical laboratory tests / edited by Amitava Dasgupta and Catherine A. Hammett-Stabler. p. ; cm. Includes bibliographical references and index. ISBN 978-0-470-43350-8 (cloth) 1. HerbsToxicology. 2. HerbsTherapeutic use. 3. Drug-herb interactions. I. Dasgupta, Amitava, 1958 II. Hammett-Stabler, Catherine A., 1952 [DNLM: 1. Plants, Medicinalchemistry. 2. Plants, Medicinaltoxicity. 3. Dietary Supplementstoxicity. 4. Herb-Drug Interactions. 5. Pathology, Clinicalmethods. 6. Phytotherapyadverse effects. QV 766 H5349 2011] RA1250.H47 2011 615.321dc22

2010019504

Printed in Singapore

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v

We dedicate this book to Alice and Tom.

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vii

CONTENTS

PREFACE xi

CONTRIBUTORS xiii

PART I INTRODUCTION AND OVERVIEW 1

1 Introduction to Complementary and Alternative Medicine 3Catherine A. Hammett-Stabler

2 Relatively Safe Herbal Remedies 19Angela M. Ferguson and Uttam Garg

3 Risk of Toxicity Associated with Unregulated Herbal Products 45Steven W. Cotten

PART II EFFECTS OF HERBAL REMEDIES ON SPECIFIC ORGAN SYSTEMS 73

4 Herbal Medicines with Immunomodulatory Effects 75Jeffrey K. Actor

5 Kelp and Thyroid Function 125Bruce Rosenzweig

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viii CONTENTS

6 Herbal Remedies and the Patient with Chronic Kidney Disease 135Mariana S. Markell

7 Abnormal Liver Function Tests Due to Hepatotoxic Herbs 155Amitava Dasgupta and Catherine A. Hammett-Stabler

8 Homeopathic Medicine: Principle, Effi cacy, and Toxicity 169Amitava Dasgupta

9 Indian Ayurvedic Medicines: An Introduction 193Amitava Dasgupta

10 Tradition and Perspectives of Greco-Arab and Islamic Herbal Medicine 209Bashar Saad and Omar Said

11 Licorice and Laboratory Tests 255Salvador F. Sena

PART III DRUG INTERACTIONS 273

12 Drug Interactions with St. Johns Wort 275Matthew D. Krasowski and John L. Blau

13 DrugHerb Interactions in Patients with HIV/AIDS 291Natella Y. Rakhmanina and John N. van den Anker

14 Interactions between Fruit Juices and Drugs 305Amitava Dasgupta

15 Drug Interactions with Ginkgo Biloba and Ginseng 321Ashok Tholpady and Semyon A. Risin

16 Drug Interactions with Garlic and Ginger Supplements 333Charbel Abou-Diwan and James Ritchie

PART IV CONTAMINATION 351

17 Heavy Metal Toxicity and Herbal Remedies 353Christine L. H. Snozek and Loralie J. Langman

18 Adulteration of Herbal Remedies with Conventional Drugs: Role of the Clinical Laboratory 369Uttam Garg and Angela M. Ferguson

19 Beyond Herbals: An Introduction to Poisonous Plants 387Catherine A. Hammett-Stabler

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CONTENTS ix

PART V ANALYTICAL IMPLICATIONS 405

20 Interferences of Herbal Remedies with Immunoassays for Therapeutic Drugs: Focus on Digoxin 407Amitava Dasgupta

21 Role of the Clinical Laboratory in Detecting Plant Poisoning 425Ronald W. McLawhon

INDEX 443

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xi

PREFACE

Today, a signifi cant percentage of Americans turn to complementary and alternative medicine (CAM) practices. These range from biological - based products, which include herbal remedies, supplements, and traditional medi-cines, to noninvasive modalities such as massage, acupuncture, meditation, and yoga. Although many alternative modalities such as massage, yoga, and medi-tation are safe and may also have effi cacy, there are signifi cant safety issues regarding the use of herbal supplements and many traditional medicines (e.g., Ayurvedic medicines). A number of herbal supplements have been found to cause organ - specifi c toxicity, while other herbal supplements are capable of interacting both pharmacodynamically and pharmacokinetically with many Western drugs. Contamination of some Asian herbal supplements and Indian Ayurvedic medicines with heavy metals and possibly with undisclosed Western drugs is a serious public health hazard. Numerous herbals have been used for many years as traditional medicines and many appear to be safe when used appropriately. Research has yet to show many to be as effective as pharma-ceuticals, and this is an area in which considerable work is needed.

We decided a book such as this was needed because of the cases of toxicity we have seen and the questions we each receive as clinical laboratory profes-sionals. While we present both safe and unsafe herbal supplements, we empha-size the pharmacological interactions identifi ed between Western drugs and herbal supplements and the effects of herbal supplements on clinical labora-tory tests. Other books and reviews discuss some of these issues, but there are few that discuss the effects of herbal supplements on clinical laboratory tests despite the fact that these tests are often the fi rst indicators of a problem, that is, toxicity or an unwanted drug herb interaction.

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xii PREFACE

This book is divided into fi ve parts. The fi rst part provides a general intro-duction to CAMs as well as an introduction to herbals considered safe versus those with a darker reputation. The second part provides more detailed infor-mation in an organ - or disease - based focus and delves into some of the tradi-tional practices of which most allopathic professionals have limited knowledge. These are by no means intended to provide all that is known about these practices but to give a sound overview that one could use to engage patients and others in discussions about their use of such practices. Part III is dedicated to the key interactions between herbal supplements and various pharmaceuti-cal drugs. Despite much play by the media several years ago, patients continue to mix herbals and pharmaceuticals without telling their allopathic providers. This often becomes