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The Essential Herb-Drug-Vitamin Interaction Guide: The Safe Way to Use Medications and Supplements Together Paperback – April 17, 2007

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About the Author

George T. Grossberg, M.D., is a professor of geriatric psychiatry at St. Louis University School of Medicine. He has been cited by his peers in Best Doctors in America and America’s Top Docs since their inception.

Barry Fox, Ph.D., is the bestselling author and coauthor of numerous health books, including the New York Times number-one bestseller The Arthritis Cure, as well as The Side Effects Bible and Alternative Cures That Really Work.  

Excerpt. © Reprinted by permission. All rights reserved.

Chapter One
The Warning You Haven’t Heard


Herbs have been used since ancient times to relieve numerous ailments. In the past, people didn’t understand how herbs worked; they only knew that they did. Today we know a lot more about herbs, their contents and chemistry, their mechanisms and uses. We know that when used properly, numerous herbs can be useful health aids. We also know that they cannot be indiscriminately mixed with medications, for herbs and drugs do interact, and the interactions can be harmful.

For example, let’s say that, like many other people, you take St. John’s wort to relieve depression. Then you go to your doctor, who prescribes a medication to deal with a different health issue. No problem, right?


• Not if a birth control pill has been prescribed. Taking birth control pills when you’re already taking St. John’s wort can cause breakthrough bleeding and unplanned pregnancy.

• Not if an antidepressant, such as Zoloft, has been prescribed. St. John’s wort plus Zoloft can trigger serotonin syndrome, which can cause confusion, fever, hallucinations, nausea, shaking, sweating, vomiting—possibly even coma.

• Not if Lanoxin, a medication used to treat heart failure, has been prescribed. St. John’s wort can weaken the drug’s effectiveness and allow your heart to “fade away.”


Suppose you’re one of the many people who take echinacea on a regular basis to prevent colds and other upper respiratory tract infections. It’s a safe and natural way to ward off a stuffy nose, scratchy throat, and endless bouts of coughing, right?


• Not if you’re taking Tylenol for pain, or statin drugs, such as Zocor and Lipitor, for elevated cholesterol. Combining any of these medicines with echinacea can severely damage your liver.

• Not if you ever want to use aspirin, ibuprofen, Celebrex, or other widely used painkillers. Mixing echinacea with these popular pills can increase the likelihood of dangerous uncontrolled bleeding.

• Not if your doctor prescribes Lodine for your arthritis. Lodine plus echinacea can lead to severe gastrointestinal problems, including nausea, vomiting, and gastritis.


Eager to keep your mind sharp and ward off Alzheimer’s disease, you diligently take ginkgo biloba every day. A wise precaution, right?


• Not if you ever need to use Glucotrol, DiaBeta, or certain other drugs to treat diabetes. Ginkgo biloba can interfere with the action of these medicines and send your blood sugar out of control.

• Not if you ever need to take antidepressants like Elavil or Norpramin, or antibiotics such as Cipro. Mixing any of these drugs with ginkgo biloba makes you more likely to have a seizure.


Herbs can be wonderful health aids. But dire results may ensue when certain herbs and standard medications are mixed. Odds are you’re not aware of the thousands of herb–drug combinations that can be harmful. And, unfortunately, your doctor may not be aware of the risks either.


It's Not a Trivial Problem

It’s estimated that 60 million Americans are taking herbs for their headaches, back pain, arthritis, menstrual difficulties, insomnia, depression, anxiety, menopausal symptoms, sexual difficulties, and numerous other problems. Millions of these people are also taking medications with their herbs.

The frightening truth is that an estimated 15 million Americans are at risk of dangerous herb–drug interactions. But who’s informing them of the potential dangers? Typically, no one. An article appearing in the Journal of the American College of Cardiology in 2002 noted that one–third of patients use herbs, “yet most practicing physicians have little knowledge of herbal remedies or their effects.”


The Vital Information Few Health Professionals Know

An alarm has been quietly ringing for years. Articles warning of potentially dangerous interactions between common herbs and standard drugs—both prescription and over–the–counter—periodically appear in cardiology journals, cancer journals, family practice journals, anesthesia journals, nursing journals, emergency medicine journals, pharmacology journals, even dental journals. Over and over again, the authors of these articles emphasize the problems that can arise when drugs are prescribed for people who take herbs, then lament the fact that most doctors know so little about herbs and what happens when they are mixed with medicines. But few seem to be listening.

What exactly can go wrong? Herbs can “harm” drugs by interfering with their absorption, reducing their effectiveness inside the body, increasing their effectiveness (which is like taking a drug overdose), and/or boosting their harmful side effects. They can also:


• combine with drugs (or other herbs) to create new side effects
• alter the results of many laboratory tests
• worsen existing diseases
• trigger potentially dangerous interactions with foods and other supplements

Yet most people are completely unaware of this.


If You’re Taking an Herb, Beware the Medicine

If you’re taking chaparral, comfrey, echinacea, kava kava, or scullcap, an alarm bell should ring if your doctor prescribes a statin drug for your elevated cholesterol. Mixing Lipitor with any of these herbs can trigger potentially fatal liver damage.

If you’re taking chamomile, feverfew, garlic, ginger, or passion flower, beware of using NSAIDs for your arthritis pain. Combining NSAIDs with any of these herbs can cause intestinal bleeding.

If you’re taking borage seed oil, fennel oil, ginkgo biloba, St. John’s wort, or wormwood, think twice before taking antidepressants. When antidepressants are mixed with any of these herbs, your risk of seizures can increase markedly.

If you’re taking aloe, buckthorn, cascara, Chinese rhubarb, licorice, or senna, beware if your doctor prescribes Vascor for your angina. Adding Vascor to any of these herbs can trigger an irregular heartbeat, which is a potentially fatal condition.


And There’s More You Need to Know

Herb–drug interactions are only the beginning of what you need to know to use herbs safely. Many herbs can also alter the outcome of lab tests and interact in harmful ways with existing diseases, foods, and other supplements.

Herbs and Lab Tests
Taking certain herbs can cause various lab values to rise or fall—and even if it’s only a minor, temporary change, it can distort a doctor’s diagnosis or treatment plan. Here are just a few of the herbs that can alter the results of lab tests.


• Black psyllium, used for constipation, can lower the results of tests of blood sugar levels.

• Bladderwrack, used for arthritis and thyroid disorders, can increase the results of tests of thyroid-stimulating hormone levels.

• Cascara, used as a laxative, can discolor urine, interfering with tests dependent on the color of urine when it's exposed to various substances.

• Green tea, used for stomach upset, diarrhea, and headaches, can increase bleeding time and prompt false–positive results on tests for serum urate and certain cancers.

• Juniper, used for stomach upset, heartburn, and urinary tract infections, can interfere with urine tests by discoloring the urine.

• Lavender, used for insomnia and loss of appetite, can depress the results of cholesterol tests.

• Mate, used for depression, ulcers, and inflammation, causes false readings in laboratory tests of uric acid and creatinine in the blood, and tests for the tumors known as neuroblastoma and pheochromocytoma.

• Motherwort, used for heart problems, can lower the results of thyroid tests.


Herbs and Diseases
And what if you’re already sick? Did you know that taking herbs might make your condition worse? For example:

• Capsicum (cayenne), which is often used to improve digestion, can irritate the gastrointestinal tract. This makes the herb potentially dangerous for those with infectious or inflammatory gastrointestinal problems, such as irritable bowel syndrome.

• Echinacea, used for colds, viruses, and other problems, can pump up the autoimmune process. This makes the herb potentially harmful for those suffering from multiple sclerosis and other diseases involving immune system reactions and inflammation. Echinacea can also be detrimental to those with diabetes, HIV infections, or allergies.

• Guarana, used for weight loss and fatigue, may aggravate gastric and duodenal ulcers.

• Licorice root, used for ulcers, bronchitis, colic, and numerous other ailments, can make it harder for diabetics to keep their blood sugar under control, rob potassium stores, and worsen both hypertension and erectile dysfunction.

• Panax ginseng, used for anxiety, nerve pain, and insomnia, can lower blood sugar, which may be dangerous for diabetics. The herb can also interfere with blood coagulation, which can be detrimental to those with bleeding conditions, such as hemophilia. Siberian ginseng can increase blood pressure, which is harmful to those who already have hypertension, and it can increase the severity of both mania and schizophrenia.


Herbs and Foods
Then there are herb–food interactions that can harm you in subtle ways. For example:


• Blond psyllium, used for constipation, can decrease the absorption of nutrients from the foods you eat by speeding food through the digestive tract and cutting back on the time available for nutrient absorption.

• Guar gum, used as a laxative and a cholesterol–reducing agent, can a...

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