INTERACTIONS WITH PRESCRIPTION DRUGS

THELESHA GRAY & VALERIE MILLER

HERBAL SUPPLEMENTS

HERBAL SUPPLEMENTS

•Herbs are generally defined as any form of plant or plant product•Herbs have been used for thousands of years throughout the east and has recently gained popularity among westerners•About 15 million Americans currently use some form of herbal supplement•The total number of visits to Complementary and Alternative Medicine (CAM) clinics far exceed visits to Primary Care Providers•Herbs are not subjected to the scrutiny by the FDA

CHAMOMILEIndications-Insomnia -Anxiety-Gastrointestinal irritation—upset stomach, diarrhea-Upper respiratory tract inflammation

Common Drug Interactions• -Barbiturates• -Benzodiazepines• -Narcotics• -Antidepressants• -Additive effect with anticoagulants • such as Coumadin

ALOE VERAIndications-Wound healing-Reduce radiation induced skin injury-Eczema, psoriasis-Sunburn-Relieve constipation-Acne

Common Drug Interactions-Loop diuretics (furosemide): increases potassium loss-Digoxin toxicity-Additive effects with antidiabetic agents-May increase bleeding with warfarin

ECHINACEAIndications-Stimulates immune function-Resolution of infection such as urinary, vaginal & ear-Improves wound healing-Shorten duration of the common cold

Common Drug Interactions-Reduces the effect of immunosuppressant drugs-Avoid in patients with organ transplant-Increases antifungal effect of ketoconazole

GARLICIndications-Lowers cholesterol levels-Antihypertensive qualities-Prevents atherosclerosis-Common cold-Jock itch/athletes foot

Common Drug Interactions-Increases with aspirin, warfarin, NSAIDs-Decreases the effect of isoniazid-Decreases drug effects of saquinavir

GINGKO BILOBAIndications-Memory-Alzheimer’s Disease-Dementia-COPD/Asthma-Intermittent claudicationtinnitus

Common Drug Interactions-Increases the effects of anticoagulants-Increases effects of antihypertensive drugs-Decreases effect of anticonvulsants-Increases effect of SSRIs causing serotonin syndrome

GINGERIndications-Nausea/vomiting—chemotherapy, -Surgery-Diarrhea-Morning sickness-Arthritis-Joint/muscle pain

Common Drug Interactions-Increases bleeding when combined with -NSAIDs, Coumadin, Heparin-Increases effect of insulin and oral hypoglycemic drugs

GINSENGIndications-Increases physical endurance-Stimulates the immune function -Anti-diabetic agentTreat infections such as Hepatitis C

Common Drug Interactions-Increases the effect of insulin/oral hypoglycemic drugs-Decreases the effect of immunosuppressant drugs, steroids -Increases digoxin levels-Increases PT causing bleeding when combined with NSAIDs & warfarin

SAW PALMETTOIndications-Benign prostate hyperplasia/BPH symptoms-Renal disorders-Pelvic pain -Bladder disorders-Hormonal imbalance

Common Drug Interactions-Additive effects when combined with Proscar -Increases the effect of anticoagulants-Decrease the effect of HRT/contraceptives—unplanned pregnancy

ST. JOHN’S WORTIndications-Depression-Anxiety-Sleep disorders-Common cold -Herpes/HIV-PMS—premenstrual syndrome

Common Drug Interactions-Increases the side effects of antidepressants-Serotonin syndrome taken with SSRIs-Interacts with antihistamines by reducing levels e.g. Allegra-Reduces the effect of digoxinIncreases the effects of sedatives

CASE STUDYWhile taking the history of Mr. J.D, a 65 year old male patient, he explains to you that he is experiencing increased exacerbations of Psoriasis despite using his medications. Upon reviewing his medications you notice that Mr. J.D. is currently taking EMBREL (anti-inflammatory) for treatment of Psoriasis. Further questioning reveals that the patient enjoys Echinacea juice which buys from a local food store.

1. What is the relationships between Echinacea and the

inflammatory response?

2. What information would be important for the

patient to know?

3. What advice would you give to the patient at

this time ?

Ms. S.P. reports to the ER with complaints of nausea and vomiting. While observing Ms. P you notice that she is agitated with a labile mood. The patient denies a history of hypertension and states that she is currently taking sertraline (Zoloft) for depression. She explains to you that she doesn’t think her depression has improved so she recently stated taking St. John’s Wort to help with her depression.

Vital signsHeart Rate=130Blood Pressure= 170/90Temperature = 102.4 +4 DTR

1. What side effect is the patient currently experiencing?2. How is St. John’s Wort related to the patients signs and symptoms?3. What advice would you give to the patient at this time?

CASE STUDY