Herbal medicinal use in recent years in western societies ***** USA % $649million. Rigorous clinical testing (-ve)

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1 CARIBBEAN POISON INFORMATION NETWORK THIRD ANNUAL SCIENTIFIC CONFERENCE UHWI KINGSTON, JAMAICA MAY 31-JUNE 1,2008

2 HERBAL REMEDIES :INTERACTIONS WITH CONVENTIONAL DRUGS BE CAREFUL!!!!!!! A LITERATURE REVIEW A.LEVY, PHARMACOLOGY SECTION BMS, UWI

3 BACKGROUND Herb- plant/plant material valued for medicinal, savory or aromatic qualities Herbal medicines-prepared i d from one or more herbs USE OF HERBAL REMEDIES HAS BEEN DOCUMENTED FOR AGES. (In the midst of the street of it,and on either side of the river, there was the tree of life, which bare twelve manner of fruits: and the leaves of the tree were for the healing of the nations. revelation 22:2)

4 BACKGROUND THE ARAWAKS- kola nuts CHINESE EMPEROR SHEN NUNG C2700:Bc - Boiled hemp -Ginger SIXTEENTH CENTURY - papaya

5 BACKGROUND Herbal medicinal use in recent years in western societies ***** USA % $649million Rigorous clinical testing (-ve)

6 BACKGROUND USA- Herbal remedies; dietary supplements/food products under DSHEA FDA- RULES GMPs MARCH No standards regulating efficacy and safety In Jamaica no manufacturing standards regulate quality and production,only now being implemented in USA

7 OBJECTIVE To briefly describe mainly the adverse interactions that arise from co-administration of conventional drugs and some commonly used herbal remedies.

8 ADVERSE EFFECTS INHERENTLY TOXIC HERBS (CROTOLARIA) HERB OVERDOSES IDIOSYNCRATIC REACTIONS (GARLIC, GINGER) DRUG-HERB INTERACTIONS (LOW TI)

9 MECHANISMS OF DRUG-HERB INTERACTIONS Altered drug absorption (ALOE VERA LEAF) Altered renal elimination of drugs (DANDELION and LITHIUM) Additive effects or toxicities (pharmacodynamic interaction) Altered hepatic metabolism of drugs (ST JOHNS WORT AND ANTI-RETROVIRAL DRUGS)

10 GARLIC (Allium sativum Linn) WARFARIN and other antiplatelet drugs (TICLOPIDINE, CLOPIDOGREL, DYPIRIDAMOLE, NSAIDS) HYPOGLYCEMICS--- Serum insulin levels CLOROXAZONE Inhibits breakdown

11 NONI (Morinda citrifolia) ) Antiarrythmics: Antagonism due to hypokalemia Muscle relaxants: Potentiation Hypoglycemics: (low doses) Hyperglycemics: (high doses) Anti-hypertensives

12 GINGER (Zingiber ib officinale) i Antiplatelets (warfarin, heparin) Aspirin and other anti-coagulants

13 PAPAYA (Carica papaya) Warfarin- papain damages mucous membrane of git GREEN TEA and TUMERIC (Curcuma longa) also possess anti-platelet activity avoid with anticoagulants/antiplatelets

14 ALOE VERA (Aloe barbadensis) Thiazide diuretics and Cortico-adrenal steroids: Potentiates hypokalemia Cardiac glycosides and Anti-arrhythmic agents: effectiveness * :

15 GINSENG (Panax quinquefolius) q ) Warfarin Phenelzine and other MAOIs: manic episodes, headaches Stimulants and hormones: possible additive effects Diabetic patients caution!! alters blood glucose Diabetic patients caution!! alters blood glucose levels

16 CANNABIS (Cannabis sativa) Phenobarbital: bit blocks enzyme induction Chlolinomimetics li i (nicotine, physostigmine): i antagonism TCADS: additive hypertension, tachycardia and drowsiness A h t i dditi h t i ibl Amphetamines: additive hypertension, possible cardiotoxicity

17 GINKO BILOBA Warfarin, nsaids: bleeding Thiazides: hypertension Antipsychotics MAOIs

18 PRIMROSE OIL- anti-convulsants lowers Seizure threshold SARSAPARILLA-bismuth salicylate, digitalis and hypnotics absorption leading to toxicity

19 RECOMMENDATIONS TREAT HERBAL REMEDIES AS MEDICINAL PRODUCTS, MORE DOES NOT MEAN BETTER PERSONS WITH SERIOUS DISEASES, CONSULT A PHYSICIAN BEFORE USING HERBAL REMEDIES TELL YOUR DOCTOR IF YOU ARE USING DIETARY TELL YOUR DOCTOR IF YOU ARE USING DIETARY SUPPLEMENTS, OR SEEING A HERBALIST, ACUPUNCTURIST, NATUROPATHIC PRACTITIONER, OR NATURAL HEALER

20 DO NOT!!!!!!!: EXCEED RECOMMENDED DOSAGE USE FOR PROLONGED PERIODS OF TIME USE DURING PREGNANCY AND LACTATION UNLESS DIRECTED BY YOUR PHYSICIAN GIVE TO INFANTS OR YOUNG CHILDREN IF SIDE EFFECTS DEVELOP DISCONTINUE USE IF SIDE EFFECTS DEVELOP DISCONTINUE USE AND CONSULT PHYSISICIAN.

21 THANK YOU!