Herbal Supplements Won’t Hurt Me, Right?

By John Nicely, PharmD, MBA

Herbal remedies have been around for thousands of years. Most people think they cannot hurt you because they are sold over the counter. What people don’t realize is that there are some major issues that can affect the health of those taking herbs. Before you add an herbal supplement to your medicine cabinet, familiarize yourself with some basic knowledge about interactions and side effects.

Herbal supplements, sometimes referred to as “botanicals,” have been used as health remedies for centuries because of their benefits and availability — they’re made from naturally-occurring plants. Herbal supplements continue to gain popularity today because of the popular belief that plants are healthier than chemicals (prescription drugs). These supplements are marketed for the prevention and management of many diseases and ailments. Currently, an estimated 75 percent of the world’s population has used or is using some type of herbal supplement. While there is clearly a place for these types of supplements, they are not for everyone.

In the United States, an estimated one in five adults has used at least one natural product in the past year. Examples of some of the most common herbal supplements sold in this country include echinacea, flaxseed, ginseng, ginkgo, saw palmetto, St. John’s wort, black cohosh, evening primrose, milk thistle and garlic.

As the popularity of supplements continues to increase, some people choose to use them in place of traditional medications. Before you do, your physician and pharmacist should have a conversation on your behalf. There are several factors to consider prior to using supplements. While those listed above are considered to be natural supplements, they may still cause several types of drug/supplement interactions and serious adverse effects. They may also worsen certain medical conditions.

Are herbal supplements safe? The Food and Drug Administration (FDA) regulates herbs and other dietary supplements differently from traditional medications. The standards of safety and effectiveness that traditional medications have to meet before gaining approval to be marketed do not apply to these types of supplements. Thanks to the Dietary Supplement Health and Education Act, manufacturers don’t have to seek FDA approval before putting dietary supplements on the market.  And it’s the FDA that usually determines whether what you’re eating is safe.

The FDA does monitor the effects of supplements and can remove any from the market if they are found to be unsafe. So, if the herb you’re considering has been on the market a while, it’s pretty safe to assume it’s not going to harm you by itself. Keep in mind, however, that because many supplements contain active ingredients that have strong effects in the body, these products can pose unexpected risks.

Many herbal supplements may interact with both prescription and non -prescription medications and can cause some very serious interactions and adverse effects. For example, the herbal supplement St. John’s wort is known to interact negatively with numerous medications such as antidepressants, blood thinners, allergy medications, drugs that suppress the immune system, birth control pills and cardiovascular drugs like digoxin. The herbal supplements feverfew, ginger and ginkgo can interact with some drugs used for breast cancer and a host of other medications. See more examples below.

  • Anticoagulants (warfarin, Pradaxa, Eliquis and aspirin) and nonsteroidal anti-inflammatory medications (aspirin, ibuprofen and Naprosyn) interact with garlic, ginkgo, St. John’s wort, ginseng, saw palmetto, ginger and cranberry.
  • Hypoglycemic agents (glipizide, metformin and glyburide) interact with garlic, ginkgo, ginseng and cranberry.
  • Anticonvulsants (phenytoin and Depakote) interact with ginkgo, St. John’s wort and valerian.
  • Digoxin (Lanoxin) interacts with St. John’s wort, ginseng and ginger.
  • Antiviral medications for HIV infection interact with garlic, St. John’s wort, ginseng and cranberry.
  • Oral contraceptives interact with St. John’s wort and kava.
  • Chemotherapy interacts with St. John’s wort, ginseng, kava and cranberry.

Below is a list of common herbal supplements along with their possible side effects:

  • Echinacea: fatigue, dizziness, headache and gastrointestinal symptoms.
  • Garlic: nausea; burning sensation in mouth, throat and stomach; halitosis and body odor.
  • Ginkgo biloba: nausea, acid indigestion, headache and heart palpitations.
  • Saw palmetto: headache and diarrhea.
  • Ginseng: anorexia, rash, changes in blood pressure and headache.
  • St. John’s wort: photosensitivity, dry mouth, dizziness and confusion.
  • Bilberry: no adverse effects reported in literature.

If you have allergies to plants, weeds or pollen, you should consult your primary health care provider and pharmacist before taking any herbal supplements. It is very important for older adults to consult with their physician and pharmacist before using any herbal supplements, since they are more likely to have multiple medical conditions and to take several medications.

Remember; always check with your pharmacist or health care provider before starting an herbal remedy. Your life depends on it.

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