Herb-Drug Interactions

Question 1

What herb interacts with PPIs and why?

Answer 1

Achillea millefolium, Arctium lappa, Artemisia absinthium/vulgaris, Berberis aquifolium/vulgaris, Coleus, Cynara

D/t bitter properties and stimulation of HCl in the gut

Question 2

What herbs can decrease drug absorption d/t increasing GI motility?

Answer 2

Achillea millefolium, Aloe vera latex, Arctium lappa, Artemisia absinthium/vulgaris, Berberis aquifolium/vulgaris, Cassia, Cynara

Question 3

What herbs are contraindicated when combined with HRT can lead to estrogen excess?

Answer 3

Actaea racemosa (black cohosh), ***

Question 4

What herb can decrease hot flashes caused by Tamoxifen?

Answer 4

Actaea racemosa

Question 5

What herb(s) can cause hypoglycemic effects when combined with oral hypoglycemic meds (i.e. Metformin, Glyburide, Rosiglitazone, Insulin)?

Answer 5

Allium cepa/sativum, Aloe vera gel (internally), Arctium lappa, Artemisia vulgaris, Coleus, Commiphora myrrha

Question 6

What herb(s) can potentiate (INC) anticoagulation therapy (I.e. Warfarin)?

What herb(s) can antagonize or block anticoagulation therapy (i.e. Warfarin)?

Answer 6

Allium cepa/sativum, Angelica sinensis, Capsella, Capsicum, Chamaelirium, Curcuma

Blocks - Ceanothus, Equisetum

Question 7

What herbs can decrease drug absorption d/t polysaccharide action?

Answer 7

Aloe vera gel
Althea officinalis
Astragalus membranaceus

Question 8

What herbs must avoid hypokalemic drugs?

And what are hypokalemic drugs?

Answer 8

Aloe vera latex, Cassia
Cathartics, Convallaria, Digitalis, Equisetum

Diuretics (Furosemide, HCTZ)
Corticosteroids (Hydrocortisone, Prednisone, Dexamethasone)
Cardiac glycosides (Digoxin, Convallaria, Digitalis, Leonarus)
Anti-Arrhythmias (atenolol, propranolol, amiodarone)
Pseudoephedrine
Glycyrrhiza

Question 9

What herbs should be avoided if undergoing anti-PLT therapy d/t anti-PLT action?

Answer 9

Angelica sinensis

Question 10

What herb is less effective when urine is acidified by Vit. C or cranberry?

Answer 10

Arctostaphylos uva ursi

Question 11

What herb is more effective when combined with iron?

Answer 11

Artemisia annua

Question 12

What herbs interact with cardiac glycosides (digoxin, convallaria, digitalis, leonarus)?

Answer 12

Asclepias tuberosa, Coleus, ***

Question 13

What herbs can increase the action of Acyclovir and Interferon 1 and 2?

Answer 13

Astragalus membranaceus

Question 14

What herbs can decrease the action of corticosteroids (hydrocortisone, prednisone, dexamethasone?

Answer 14

Astragalus membranaceus

Question 15

What herbs can increase the action of anticholinergic drugs (i.e. atropine, bupropion, dextromethorphan, dicyclomine, diphenhydramine, tiotropium bromide, tolterodine, TCAs, amantadine)?

Answer 15

Atropa belladonna

Datura

Question 16

What herb(s) induce CYP450?

Answer 16

Bacopa, Capsicum, Commiphora mukul,

Question 17

What herb(s) INC thyroid hormone and potentiates (INC) Levothyroxine?

Answer 17

Bacopa

Question 18

What herb(s) potentiate CCBs (i.e. Amlodipine)?

Answer 18

Bacopa

Question 19

What herb(s) potentiate Sedative drugs?

What herb(s) antagonize sedative drugs?

What are some sedative drugs?

Answer 19

Bacopa (INC)

Camellia (DEC)

Antihistamines: Diphenhydramine, Hydroxyzine
Barbiturates: Phenobarbital
Benzos: Alprazolam/Diazepam
Opiates: Codeine, Hydrocodone, Morphine, Oxycodone, Methadone
Trazadone
Zolpidem

Question 20

What herb(s) potentiate (INC) Barbiturates (Phenobarbitol)?

Answer 20

Bacopa

Berberis vulgaris

Question 21

What herb(s) enhance NSAIDs (aspirin, ibuprofen, naproxen, celecoxib)?

Answer 21

Boswellia
Camellia
Coleus

Question 22

What herb dec iron absorption?

Answer 22

Camellia

Question 23

What herb(s) enhance the action of acetaminophen, clopidogrel, doxorubicin and warfarin?

Answer 23

Camellia

Question 24

What herb(s) INC CNS stimulants?

What are CNS stimulants?

Answer 24

Camellia

i.e caffeine, dextroamphetamine MDMA, methylphenidate, modafinil, pseudoephedrine

Question 25

Camellia when combined with what drug can lead to HTN?

Answer 25

MAOIs (Phenelzine)

Question 26

What 3 drugs can effect caffeine with Camellia and in what way?

Answer 26

Ciprofloxacin (inhibits caffeine elimination) Phenytoin (INC elimination of caffeine) OCPs INC caffeine effects

Question 27

What 2 drugs inhibit metabolism and INC/enhances action of Camellia?

Answer 27

Inhibit: Clozapine Enhance: Amitriptyline

Question 28

What herb(s) INC action of opiates and barbiturates?

Answer 28

Cannibis

Question 29

Capsicum has a specific interaction with an Anti-HTN medicine, whats the med and interaction?

Answer 29

Enhances cough SE with ACEi (Lisinopril)

Question 30

What herbs(s) can interfere with angina tx and why?

Answer 30

Caulophyllum d/t vasoconstrictive action to heart vessels

Question 31

Cineraria has a synergistic effect with what kind of drugs?

Answer 31

Hepatotoxic

Question 32

What herbs when taken with other Tannins can DEC absorption?

Answer 32

Cinnamomum, Crataegus

Question 33

What does the essential oil form of cinnamomum deplete in the liver with long term use?

Answer 33

Glutathione

Question 34

What other 2 medications (1 category and 1 individual med) interact with Coleus? (NOT cardiac glycosides, hypoglycemics, NSAIDs, PPIs)

Answer 34

Levothyroxine | Antihistamines

Question 35

What 2 drugs have decreased bioavailability when combined with Commiphora mukul?

Answer 35

Propranolol | Diltiazem

Question 36

What class of drugs interacts with Convallaria and Digitalis and can potentiate or INC their action?

Answer 36

Beta-blockers

Question 37

What drug does Cordyceps INC?

Answer 37

Epinephrine

Question 38

What drug class interacts with Cordalis as the have similar MOA?

Answer 38

CCBs

Question 39

What drug class can cause HTN with given with Crataegus?

Answer 39

B-blockers

Question 40

What class of drugs does Cynara interact with and INC effects? (not PPIs)

Answer 40

Atorvastatin (Statins)

Question 41

What herbs can antagonize or work against immune suppressive therapy (Adalimumab, Cyclosporine, Corticosteroids - Hydrocortisone, Prednisone, Dexamethasone)?

Answer 41

Echinacea | Eleutherococcus

Question 42

What herb(s) work against or antagonize the effects of alpha and beta-blockers?

Answer 42

Ephedra

Question 43

What herb(s) potentiate or INC sympathomimetics (Albuterol, Epinephrine, Phenylephrine, Pseudoephedrine, Salbutamol), caffeine, dextroamphetamine, methylphenidate, and MOAIs (Phenelzine)?

Answer 43

Ephedra

Question 44

What 2 drug classes does Eschscholzia INC or potentiate?

Answer 44

MAOIs (Phenelzine) | SSRIs (Fluoxetine)

Question 45

What drug does Ephedra INC clearance of?

Answer 45

Dextamethasone