Drug Nutrient Interactions

Herb

Type of Interaction

Alfalfa

(Medicago sativa)

-Leaf

Anticoagulants

e.g. Warfarin ³

Interact

Reduces drug action due to Vitamin K content in alfalfa Interact

Aloe Vera-

(A. vera)

Latex Powder

Antiarrythmic agents ^{5, 11, 12}

e.g. Quinidine

Cardiac glycosides ^2,3,5,11,12

e.g. Digoxin ⁵

Diuretics ³

e.g. Loop Diuretics ⁵

e.g. Thiazide diuretics ^{5, 11}

Increases potassium loss

Interact

Interact

Aloe Vera-

Gel or Juice

Anise or Aniseed

(Pimpinella ansium)

-Seed

Astragalus

(Astragalus membranceus)

-Root

Basil

(Ocimum basilicum)

-Leaf

Bay

(Laurus nobilis)

-Leaf

Herb enhances hypoglycemic actions -may increase insulin's effects more than three fold⁵

Bearberry

Ulva Ursi

(Arctostaphylos uva-ursi)

-Leaf

Drugs that acidify the urine^3,4,5,7

e.g. Vita. C (Absorbic Acid)

May decrease the urinary antimicrobial action

Antidiabetic agents⁵

Hypoglycemic agents⁵

Insulin ³

Interact- May promote hyperglycemia

Bilberry

(Vaccinium myrtillus)

-Fruit

Anticoagulants⁵

e.g. Warfarin^4,20

Increases risk of bleeding

Increases bleeding time

Bilberry

-Leaves

May cause hypoglycemia

Birch

(Betula)

-Leaf

Black Cohosh

(Actaea racemosa)

-Root

Augments antiproliferative action (in vitro)

Black Walnut

(Juglans nigra)

(bark, leaf hull)

Interact

decreased absorption

Remedies: Candida, Skin problems.

Blue Cohosh

(Caulophyllum thalictroides)

-Root

Decreases effect of drug, increases blood pressure

Borage

(Borago officinalis)

-Seed Oil

Broom

(Cytisus scoparius)

Aerial parts

MAOI's²³

Contains tyramine

Bugleweed

(Lycopus ssp)

Aerial parts

Remedies: Hyperthyroidism, Mood, Overactive heart.

Bupleurum

(Burpleurum spp)

Root

Burdock

(Arctium lappa)

-Fruit & Roots

-Leaves

Calendula

(Calendula officinlis)

-Flowers)

Catnip

(nepeta cataria)

Aerial parts

Cat's Claw

(Uncaria tomentosa)

-Rootbark

Cayenne Pepper

(Capsicum frutescens)

-Fruit

Centrally acting adrenergic agents⁵

e.g. Clonidine, Methyldopa⁵

Chamomile, German

(Matricaria recutita)

-flowers

Chapparal

(Larreta tridentata)

-Aerial Parts

Chasteberry

(Vitex agnus-castus)

Berry

Dopamine-receptor antagonists^1,4,13

e.g. Antipsychotics & Metclopramide¹⁴

Cinnamon

(Cinnamomum Zeylanicum)

-Bark

Cloves

(Syzgium aromaticum)

-Buds

Coltsfoot

(Tussilago farfara)

-Leaf

Comfrey

(Symphytum officinale)

-Leaf or Root

Cranberry

(Vaccinium macrocarpon)

-Berry

May increase elimination of some drugs excreted in the urine.

Remedies: Urinary tract infections.

Dandelion

(Taraxacum officinale)

-Root

-Leaf

Potentiates the diuretic action of drug (Herb is rich in potassium)

Devil's Claw

(Harpagophytum procumbens)

-Root

Dong Quai

(Angelica sinesis)

-Root

Echinaccea

(Echinacea species)

-Root/Leaf

Immunosuppressive agents^2,4,9

e.g. Corticosteroids & Cyclosporine⁴

Elder

(Sambucus nigra)

-Berry

Evening Primrose

Oil(Oenothera biennis)

-Seed

Interact, may reduce platelet aggregation and potentiate drug action

Epileptogenic drugs^2,4,9

e.g. Phenothiazines^2,5,9,14,19

Fenugreek

(Trigonella foenum-graecum)

-Seed

Feverfew

(Tanacetum parthenium)

-Leaf

Flax

(Linum usitatissimum)

-Seed

NSAIDs⁴

e.g. Indomenthacin⁴

Forskohlii

(Coleus forskohlii)

Root

Garlic

(Allium sativum)

-Bulb

Anticoagulants^2,4,5,7,9,19

Enhances effect of antiplatelet therapy

Potentiates the anti-thrombotic effect of ASA

Diabetic therapy^2,9

e.g. Insulin³

Ginger

(Zingiber officinale)

-Root

Ginkgo

(Ginkgo biloba)

-Leaf

Anticoagulants^{1,2,4,5,12,13,14,19}

Potentiates effect of drug

-Monitor coagulation

e.g. Aspirin^3,12,16,20

NSAIDs⁴ Warfarin^16,20

Ticlopidine²⁰

May induce spontaneous bleeding

Interact

Potentiates effect of drug

Ginseng

North American

(Panax quinquefolius)

-Root

Anticoagulation therapy^3,4,12,16

e.g. Warfarin²⁰

Interact

Decreases INR levels

Antihypertensives⁴

e.g. Diuretics²⁰

Interact

Decreases diuretic action

Oral Hypoglycemia therapy^4,5

Psychotherapeutic medication^4,12/Antipsychotics¹⁹

Ginseng Siberian

(Eleuthero coccus senticosus)

-Root

Barbiturates^2,4

e.g. Hexobarbital

Potentiates effects of drug

Increases effect of drug due to inhibition of its metabolic breakdown

Glucosamine Sulfate

(2-Amino-2-deoxyglucose)

Goldenseal

(Hydrastis canadensis)

-Root

Antihypertensives⁵

e.g. Beta blockers⁵

Calcium channel blockers⁵

Barbiturates^2,4

e.g. Barbitu

Cardiovascular

medications⁴

e.g. Digoxin⁵

Interacts

Increases effect of drug

CNS depressants⁵

e.g. Alcohol,

benzodiazepines⁵

Grapefruit

(Citrus paradisi)

-Fruit/Juice

All Drugs including:

Benzodiazepines^3,18

e.g. Midazolamm triazolam, alprazolam¹⁸

Buspirone¹⁸

Increases bioavailability Inhibits metabolism by cytochrom

P450-3A enzymes

Calcium Antagonists^3,18

e.g. Amiodipine, verapamil, nisoldipine, nifedipine, nitrendipine, felodipine, nimodipine, nicardipine

Increases bioavailability Inhibits metabolism by cytochrom

P450-3A enzymes

HMG CoA reductase inhibitors¹⁸

e.g. Atorvastatin, cerivastatin, lovastatin, simvastatin¹⁸

Green Tea

(Camellia sinensis)

-Leaf

Hawthorn

(Crataegus laevigata)

-Aerial parts

Cardiac glycosides^3,5,12,19

e.g. Digitoxin, Digoxin³, Digitalis^1,3,4

Cardiac Medications^7,9

Interact

Increases hypotension

Hops

(Humulus lupulus)

-Strobiles

Horse chestnut

(Aesculus hippocastanum)

Seed

anticoagulants^3,5

ASA^3,5

Horseradish

(Armoracia rusticana)

Root

Juniper

(Juniperus communis)

-Berry

Diuretic therapy^2,9

Kava

(Piper methysticum)

-Root

Barbiturates^1,2,4,5,7

e.g. Hexobarbital²

e.g. Pentobarbital^3,5

Potentiates action of barbiturates

Potentiates effect of drug (animals)

Potentiates effect of drug

Benzodiazepines^{2,3,4,12,14,19}

Tranquillizers¹²

e.g. Alprazolam^2,5,20

Potential interaction

Potentiates effect of drug

Lemon Balm

(Melissa officinalis)

-Leaf

Licorice

(Glycyrrhiza glabra)

-Root

Agents that prolong the QT interval⁵

e.g. procainamide, quinidine, terfenadine⁵

Cardiac glycosides^2,3,11

e.g. Digitailis^1,3,12,20

Digoxin5

Carthartics⁴

e.g. Stimulant laxatives³

Interact

Additive effect-increases potassium loss

Corticosteroids^3,4,5,11,20

e.g. Hydrocortisone^2,3,16

Prednisolone^2,16

Interact

Potentiates effect of drug

Inhibit metabolism, increases plasma concentration

Diuretics^{3,4,5,11,12,20}

e.g. Loop diuretics^2,11

Potassium-sparing diuretics²

Potassium-excreting agents or amiloride⁴

Spironolactone^3,4,5,11

Thiazide^1,3,11

Hormonal therapy^4,9

Interact

Hypertension, edema, hypokalemia

Lobelia

(Lobelia inflata)

-Aerial parts

Nicotine therapy⁵

(smoking cessation treatments)

Ma Huang

(Ephedra sinica)

-Aerial parts

Agents that influence urine pH

e.g. Antacids^3,4

Acetazolamide²⁰

Interact

Acetazolamide may cause Increases concentration of ephedrine due to alkalinization of the urine

Cardiac glycosides^1,4,11,13

Disturb heart rhythm

Interact

Corticosteroids²

e.g. Dexamenthasone³

Interact

Increases clearance and thereby reduces effect

Centrally acting medications^2,4

e.g. Antidepressants²

Antihypertensives^2,4

Clonidine²⁰

Interact

Interact

Clonidine may augment the

pressor response to ephedrine

MAOIs^{1,2,3,4,7,11,13}

e.g. Tranylcypromine, selegiline, phenelzine, moclobamide³, isocarboxazid²⁰

Methyl Xanthines³

e.g. Theophylline^2,3,4,5,20

Marshmallow

(Althaea officinalis)

-Root

Hypoglycemic therapy^9,10

Meadowsweet

(Filipendula ulmaria)

-Leaf/Flower

All drugs^2,9

e.g. Anticoagulants²

Herb has similar interactions to those occurring with salicylates

Interact

Milk Thistle

(Silybum marianum)

-Seed

Synergistic antiproliferative effect on human ovarian/breast cancer cell lines

Reduces hepatotoxcity

Mistletoe

(Viscum album)

-Aerial parts

Nettle

(Urtica dioica)

-Leaf

Anticoagulants⁴/Coagulant therapy⁴

Protatic Hyperplasia Therapy²²

e.g. Tamsulosin

Passionflower

(Passiflora incarnata)

-Leaf

Barbiturates⁴

e.g. Hexabarbital, Pentabarbital

Increases hypnotic action

Increases sleeping time (animal)

Pau D'arco

(Tabebuia impetiginosa)

-Bark

Peppermint

(Mentha x piperita)

-Leaf

Ulcer treatment e.g. H2

Receptor Blockers

Pine Bark Extract

(Pinus maritima)

Propolis

Resin

Psyllium

(Plantago psyllium)

-Seed

Anti-convulsants

e.g. Carbamazepine^5,20

Decreases absorption and concentration of drug

Cardioactive drugs⁵

e.g. Beta blockers, calcium channel blockers, digitalis⁵

Puncture Vine

(Tribulus terrestris)

Pygeum

(Prunus africana)

-Bark

Red Clover

(Trifolium pratense)

-Blossoms

Anticoagulants^5,9,10

e.g. Heparin, warfarin⁵

Antiplatelet agents⁵

e.g. ASA, clopidogrel, ticlopidine⁵

Red Raspberry

(Rubus idaeus)

-Leaf

Iovastatin²³

Simuvastatin²³

Atorvastatin²³

Rosehips

(Rosa canina)

Rosemary

(Rosmarius officinalis)

-Leaf

Royal Jelly

Sage

(Salvia officinalis)

-Leaf

Anticonvulsants^5,9

Antidiabetic agents^5,9

e.g. Insulin⁵

Sedatives⁹

Lowers seizure threshold

Antagonizes glycemic control

Herb may potentiate sedative effects of other drugs

Saw Palmetto

(Serenoa repens)

-Berry

Schisandra

(S. chinensis)

Berry

Scullcap

(Scutellaria laterifolia)

-Aerial parts

Scullcap, Chinese

(Scutellaria baicalensis)

-Root

Senna

(Cassia ssp)

leaf, pod

Slippery Elm

(Ullmus rubra)

-Aerial parts

St. John's Wort

(Hypericum perforatum)

-Aerial parts

Antidepressants^4,5,12,17

e.g. Trazadone nefazodone^16,17

see MAOIs & SSRIs below

Anti-epilepsy drugs¹⁷

e.g. Phenytoin, carbamazepine, phenobarbital¹⁷

Anti-retroviral drugs¹⁷

e.g. Indinavir

Atypical antipsychotics¹⁷

e.g. Olanzapine, risperidone¹²

Dibenzazepine Derivatives¹²

e.g.Amitriptyline, doxepin, carbamazepine²

Immunosuppressants¹⁷

e.g. Cyclosporine^16,17,20

Metronidazole¹²

Midodrine²⁰

Interact

Enhances pressor effect

Monoamine Oxidase

Inhibitors (MAOIs)^{2,3,5,9,12,20}

e.g. Phenelzine, tranylcpromine, isocarboxazid

Narcotics⁵

e.g. Morphine²

Selective Serotonin

Reuptake Inhibitors

(SSRIs)^{2,3,4,5,7,12,16,17,20}

e.g. Fluoxetine, paroxetine⁵, sertraline

Sympathomimetics^2,5,12

e.g. Ephedrine, methyldopa, dopamine, trytophan

Decreases theophylline levels

Interact (speculative)

Tea Tree Oil

(Melaleuca alternifolia)

-Leaf

Thyme

(Thymus vulgaris)

-Leaf & Flower

Turkey tail

(Coriolus versicolor)

Turmeric

(Curcuma longa)

-Root

Turmeric root solid alcoholic extract reduces the frequency of gastric and duodenal ulcer (rats)

Uva Ursi

see Bearberry

Valerian

(Valeriana officinalis)

-Root

Barbiturates¹⁹

e.g. Pentobarbital, thiobarbital³

Benzodiazepines

e.g. Dizepam³

Wild Tam

(Dioscorea villosa)

-Root

Willow

(Salix)

-Bark

Yarrow

(Achillea millefolium)

-Aerial parts

Yohimbe

(Pausinystalia yohimbe)

-Bark

a-adrenoceptor bloacking agents³

e.g. Phenoxybenazamine, phentolamine³

Beta-bloackers³

e.g. Propranolol, penbutolol, metoprolol³

Central a²-adrenergic agonists³

e.g. Guanabenz, a-methylnorepinephrine³

Phenothiazines³

e.g. Chlorpromazine, promazine³

Sympathomimetics^3,5,10

e.g. Epinephrine, ephedrine, amphetamine, cocaine³

Thiozanthenes³

e.g. Chlorprotixene³