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Herbs to Avoid Before Surgery

 

Common Name

 (Spanish)

Scientific Name/ Classification

 

Uses

 

Possible Complications/ Interactions

Comments

 

Algae

(Algas marinas)

Fucus vesiculosusand other species

Nutritional supplement, weight loss agent

Platelet inhibition

May potentiate anticoagulant activity of warfarin

Arnica

(Árnica europea)

Arnica montana

Applied externally for contusions, and bruises Internally: homeopathic preparations for nervous disorders

Contains compounds that could interfere with blood clotting

Ingestion can be toxic and could potentiate anticoagulant activity of warfarin

Arnica, Mexican*

(Árnica del país, falsa árnica)

Heterotheca inuloides

Applied externally for contusions, and bruises Tea made from flowers taken for gastric ulcers

Contains compounds that could interfere with blood clotting

Ingestion can be toxic and could potentiate anticoagulant activity of warfarin

Ashwagandha, “Indian Ginseng”

Withania somnifera

Sedative, adaptogenic

Sedative action May potentiate effects of barbiturates and benzodiazepinics

Bilberry

(Arándano)

Vaccinium myrtilus

Cataracts and other eye problems

Platelet inhibition

May potentiate anticoagulant activity of warfarin

Cat’s Claw

(Uña de gato)

 Uncaria tomentosa,

U. guianensis

Arthritis, cancer, immune- system stimulant, anti- inflammatory, contraceptive

 Immune stimulant

Possible tissue and organ transplant rejection

German Chamomile, Roman Chamomile

(Manzanilla)

 Matricaria recutita

Chamaemelum nobile

Colic, premenstrual syndrome, stomach upset, light sedative

Platelet inhibition (speculative)

Possible anticoagulant action

 Chitosan

Swertia chirayita

High cholesterol, obesity

Platelet inhibition

May potentiate anticoagulant activity of warfarin

Cinnamon

(Canela)

Cinnamomum verum

Rubefacient, diabetes

Essential oil from leaf and bark shows platelet inhibition due to eugenol content

May potentiate anticoagulant activity of warfarin

Clove

(Clavo de olor)

Syzygium aromaticum

Stomach ulcers, antiseptic /Essential oil applied topically for muscular pain

Essential oil shows platelet inhibition due to eugenol/methyleugenol content

May potentiate anticoagulant activity of warfarin

Cranberry

(Arándano agrio)

 Vaccinium macrocarpon

Juice taken for urinary infections

Platelet inhibition

Probable anticoagulant action if combined with warfarin

Dan Shen

Salvia miltiorrhiza

Antioxidant, anti-inflammatory

This herb may have induction effect on CYP3A and CYP1A2 enzymes

Probable anticoagulant action if combined with warfarin

 Dong Quai, Dang Gui, Chinese Angelica

(Angélica china)

Angelica sinensis

Menstrual complaints

The herb may inhibit CYP2C9 enzymes

Probable anticoagulant action

 Feverfew

(Tanaceto)

Tanacetum officinale

Migraine headaches, fever

Platelet inhibition

Possible anticoagulant action with aspirin and warfarin

Garlic

(Ajo)

Allium sativum

Lowers cholesterol, anti- thrombotic

Platelet inhibition

May potentiate warfarin action

Ginger

(Jengibre)

Zingiber officinale

Motion sickness, nausea and vomiting, digestive problems

Platelet inhibition

Probable anticoagulant action if combined with warfarin

Ginkgo

Ginkgo biloba

Memory enhancement, intermittent- claudication, senile dementia

Platelet inhibition

Possible anticoagulant action with aspirin and warfarin

Ginseng, American 

(Ginseng americano)

Panax quinquefolius

General tonic, adaptogen

Platelet inhibition lowers blood glucose

Probable anticoagulant action if combined with warfarin

Ginseng, Korean

(Ginseng coreano)

Panax ginseng

General tonic, adaptogen

Platelet inhibition lowers blood glucose, may cause hypertension in high doses

Probable anticoagulant action if combined with warfarin

Goji berry

Lycium barbarum

Anti-diabetic, anti-cancer, antioxdiant

Platelet inhibition lowers blood glucose

Possible interaction if used concurrently with warfarin

Grapefruit

(Toronja)

Citrus paradisiaca

Weight loss

Fruit and juice can potentiate the effects of certain statin drugs and calcium channel blockers

Grapefruit juice inhibits CYP1A2, among others. Possible interaction if used concurrently with warfarin

Green Tea 

(Té verde)

Camellia sinensis

Antioxidant

Platelet inhibition

Possible interaction if used concurrently with warfarin

Kava,

(Awa)

Piper methysticum

Sedative, anxiolytic

Certain compounds in kava may be potentially hepatotoxic, especially when combined with alcohol

May prolong effects of anesthesia and potentiate the effects of benzodiazepinic drugs

Meadowsweet

(Filipéndula)

Filipendula ulmaria

Essential oil applied for muscular pain and arthritis

Contains an anti- heparin complex that has in vitro fibrinolytic and anticoagulant properties

Salicylate compounds possess antiplatelet action/ could potentiate warfarin or heparin effects

Notoginseng

Panax notoginseng

General tonic, adaptogen

Platelet inhibition

Observe caution if patient is taking warfarin

Passion flower

(Pasiflora, Flor de la pasión)

Passiflora incarnata

Sedative, anxiolytic, generalized anxiety disorder

Sedative action

This herb could cause additive sedation in combination with CNS depressants

Soybean 

(Soya, soja)

Glycine max

Lower cholesterol, nutritional supplement

nhibitory effect of soy extracts on CYP2C9 and CYP3A4

Fermented soy products have a probable anticoagulant action if combined with warfarin

 Sweet birch

(Abeto)

Betula lenta

Essential oil applied topically for muscular and arthritic pain

Platelet inhibition

Salicylate compounds may potentiate anticoagulant action of warfarin

 St. John’s Wort

(Corazoncillo, Hipérico, Hierba de San Juan)

Hypericum perforatum

Antidepressant

Increased clearance of warfarin, possibly due to the induction of CYP enzymes, particularly CY2C9 and 3A4

St. John’s wort may potentiate the effects of clopidogrel, decrease plasma levels of phenprocoumon, and decrease drug levels of warfarin and INR

Valerian root

(Valeriana)

Valeriana officinalis

Sedative, anxiolytic

May alter metabolism of drugs which are substrates of CYP3A4 isozymes

The effects of anesthesia / sedatives could be enhanced

Wintergreen

(Gaulteria)

Gaultheria procumbens

Essential oil applied topically for muscular and arthritic pain

Platelet inhibition

Salicylate compounds may potentiate anticoagulant action of warfarin

 

*Mexican arnica is part of a composite herbal tea known commercially as “Té Gastronól”, which is sold in herbal markets along the U.S. – Mexico border. This product was associated with prolonged bleeding time in a surgical patient (Rivera et al., 2009).

Bibliography

 

  • Bone K, Mills S. Principles and Practice of Phytotherapy 2nd Ed.
    London: Churchill Livingstone; 2013.
  • Brinker F.  Herb Contraindications and Drug Interactions 4th Ed.
    Sandy, Oregon: Eclectic Medical Publications; 2010.
  • Cassileth B, Yeung KS, Gubili J. Herb-Drug Interactions in Oncology 2nd ed.
    Shelton, CT: People’s Medical Publishing House; 2010.
  • Chen XW, Sneed KB, Pan SY, Cao C, Kanwar JR, Chew H, Zhou SF.
    Herb-drug interactions and mechanistic and clinical considerations.
    Curr Drug Metab. 2012; 13(5):640-51.
  • Chen XW, Serag ES, Sneed KB, Liang J, Chew H, Pan SY, Zhou SF.
    Clinical herbal interactions with conventional drugs: from molecules to maladies.
    Curr Med Chem. 2011; 18 (31):4836-50.
  • Chua YT, Ang XL, Zhong XM, Khoo KS1. Interaction between warfarin and Chinese herbal medicines. Singapore Med J. 2015;56(1):11-8.
  • Desmard M, Hellmann R, Plantefève G, Mentec H. [Severe overdose in vitamin K antagonist secondary to grapefruit juice absorption].[Article in French]
    Ann Fr Anesth Reanim. 2009; 28(10):897-9.
  • Gardner Z, McGuffin M (Editors).  Botanical Safety Handbook 2nd ed.
    Boca Raton, FL; CRC Press; 2013.
  • Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions.
  • Evid Based Complement Alternat Med. 2014; 2014:957362.
  • González-Stuart A. Herbal product use by older adults.
    Maturitas. 2011; 68(1):52-5.
  • Loya AM, González-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States-Mexico border: a descriptive, questionnaire-based study.
    Drugs Aging. 2009; 26(5):423-36.
  • Meletis C, Jacobs T. Interactions between Drugs and Natural Medicines 2nd ed.
    Sandy, Oregon: Eclectic Medical Publications; 2005.
  • Milic N, Milosevic N, Golocorbin Kon S, Bozic T, Abenavoli L, Borrelli F.
    Warfarin interactions with medicinal herbs. Nat Prod Commun. 2014; 9(8):1211-6.
  • Mills S, Bone K. Essential Guide to Herbal Safety.
    St. Louis, MO: Churchill-Livingstone/Elsevier; 2005.
  • Norwood DA, Parke CK, Rappa LR. A Comprehensive Review of Potential Warfarin-Fruit Interactions. J Pharm Pract. 2015; 28(6):561-71.
  • Paoletti A, Gallo E, Benemei S, Vietri M, Lapi F, Volpi R, Menniti-Ippolito F, Gori L, Mugelli A, Firenzuoli F, Vannacci A. Interactions between Natural Health Products and Oral Anticoagulants: Spontaneous Reports in the Italian Surveillance System of Natural Health Products. Evid Based Complement Alternat Med. 2011; 2011:612150.
  • Rivera JO, González-Stuart A, McLean S, Tyroch A.  Profound hemorrhage in a patient taking herbal products. Am Surg. 2009; 75(4):346-7.
  • Srinivas NR. Cranberry juice ingestion and clinical drug-drug interaction potentials; review of case studies and perspectives. J Pharm Pharm Sci. 2013; 16(2):289-303.
  • Stargrove M, Treasure J, McKee D. Herb, Nutrient, and Drug Interactions.
    St. Louis, MO: Mosby/Elsevier; 2008.
  • Tisserand R, Young R. Essential Oil Safety 2nd ed.
    London: Churchill-Livingstone/Elsevier; 2014.
  • Tsai HH, Lin HW, Simon Pickard A, Tsai HY, Mahady GB. Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review. Int J Clin Pract. 2012;66(11):1056-78.
  • Veitch N, Smith M, Barnes J, Anderson L, Phillipson D. Herbal Medicines 4th ed.
    London: Pharmaceutical Press; 2013.
  • White R C.  Elsevier’s Dictionary of Plant Names of North America including Mexico. Amsterdam, The Netherlands: Elsevier; 2003.
  • Williamson E, Driver S, Baxter K. Stockley’s Herbal Medicines Interactions 2nd ed. London: Pharmaceutical Press; 2013.