Table of Common Herbs

and Supplements
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Acai (ah-sigh-EE) Anti-cancer Allergic to acai or plants in palm family Juice, capsule, powder,
◆◆ Berry from South and Anti-oxidant May affect MRI results tablets
Central America Anti-inflammatory ADRs: Widely used, no specific
Hypertension dosing
No scientific studies done on use
for medical conditions GI bleeding
Ulcers
Aloe Vera “burn plant” Scientific studies show benefit *Toxicology study of oral whole leaf extract found risk Topical aloe only
“lily of the desert” for topical gel healing burns and of carcinogenicity in lab animals Use of oral aloe not rec-
◆◆ Leaves contain a clear gel that can abrasions; however, may not *Topical aloe has no known side effects ommended due to safety
be used topically work for deep surgical wounds or ADRs with oral aloe: concerns
◆◆
radiation wounds
Green part of leaf that surrounds Lowers blood sugar by stimulating insulin Use of IM and IV aloe
gel produces juice or dried Laxative affect taken orally Diarrhea/abd.cramps have been associated
substance (latex) that can be Inactivates HSV2 virus Arrhythmia from hypokalemia with death
taken orally Bacteriostatic properties Contac dermatitis, stinging, soreness Avoid if hx of allergies to
◆◆ Used back 6000 years to any member of Liliaceae
Contains sterols with Acute hepatitis, renal failure, nephritis
Egyptian times anti-inflammatory properties Abortifacent, may ↑uterine bleeding family (tulips, lilies, hya-
Avoid in pregnancy and lactation cinths, onions, asparagus,
and garlic)
Avoid perioperatively; has caused bleeding
Ashwaganda “withania somnifera” Uses: Adaptogen *Do not use in pregnancy: has been used as abortifacent In capsules, tablets, tea
Anti-arthritis ADRs: Tablets are standardized
Anti-aging ↓bp Dose: 1-6 g in capsule or
↓bs tea qd
Type 2 Diabetes Mellitus
↑WBC↑platelets Or 3-12 g in combination
Hyperlipidemia
↓ testosterone/FSH levels with other herbs
Parkinson’s disease DRUG INTERACTIONS: Pediatric dosage: (8-12
Alcohol, sedatives, anxiolytics↑ sedation years only) 2g qd for no
Avoid with diuretics-↑effects >60 days
Anticoagulants ↑bleeding
Antidiabetic agents ↑hypoglycemia
Antihypertensives ↑hypotension
Thyroid hormones-alter effect
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Asian Ginseng Uses: adaptogen, stamina, mental *Risk allergic reactions Root is dried for tablets,
“Korean ginseng” “Chinese ginseng” and physical performance *Not recommended in pregnancy/lactation due to capsules, extracts, teas
◆◆ Note: Siberian ginseng is not Hepatitis C ­hormonal and toxic effects, teratogen Tablet and capsule
­ginseng at all Menopause *↑ risk breast cancer-stimulates breast cancer cells ­standardized to 4 %
­ginsenosides (active
Erectile dysfunction *avoid in asthma, arrhythmia, HTN, psychiatric disorder
­ingredient)
Hypertension *stop pre-operatively due to bleeding effect
Short term use: up to
Diabetes mellitus ADRs: 2 g/day Panax ginseng
Studies: may lower blood glucose; H/A Long-term use: 1 g/day
may help immune function GI disturbance, appetite changes Panax ginseng
NCCAM research currently in Sleep disturbance Note: ginseng is added
­cancer and Alzheimer’s disease to many commercial
Arrhythmia
↑T cell and lymphocyte activity ­beverages currently
Anemia
May inhibit RNA type viruses
Stevens-Johnsons Syndrome
May have antioxidant properties
↑estrogenic effects
Menstrual changes, ↑bleeding
Mastalgia, breast growth
Mania in bipolar disorder
DRUG INTERACTIONS:
anticoagulants↑bleeding
antidiabetic agents ↑ or↓ bs
antihypertensives-alter effect
antipsychotics ↑sedation, ↑effect
estrogen ↑effect
sedatives ↑sedation
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Panax Ginseng “American ginseng” See Asian Ginseng See above See above
Uses: ADHD, chronic Hepatitis B,
CHF, dementia, CAD, hyperlipidemia,
menopausal symptoms, ITP, MRSA,
diabetic renal disease
Astralgus “milk vetch” Under study: potential benefits for *some astragalus species, mostly not found in Root used in teas, soups,
◆◆ Traditional Chinese Medicine for immune system, liver,heart, and dietary supplements used, might be toxic. Some capsules, extracts, tincture,
immunity, cancers, and hepatitis adjunctive cancer therapy species toxic levels of selenium and some contain IM and IV
◆◆ In legume family 2005 Cochrane study: some immune neurotoxin swainsonine which has caused “loco- No specific dosing
stimulation and ↓N/V in colorectal weed” poisoning in animals. ­recommendations
◆◆ 300 species grow in North Amer-
cancer Dietary supplement astralgus is generally considered Mostly used as dried root,
ica; some toxic to livestock
Antioxidant effects safe for most adults considered non-toxic
Used in CAD and DM DRUG INTERACTIONS
Used in hepatitis, HIV, may interact with immune suppressants, such
­hepatoprotection as cancer drug cyclophosphamide and organ
­transplant drugs.
Chemotherapy side effects
ADRs:
Mental performance
↓BS,↓HR, ↓BS
Smoking cessation
Diarrhea
URI, burns
Bleeding: interacts with anticoagulants
Avoid in pregnancy and lactation
Avoid in immune disorders, transplants,
bleeding disorders
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Bilberry “Huckleberry” Contains anthocyanosides (type ADR: In dried leaves, berries,
“European blueberry” of flavinoid):↑microcirculation, ↓BP extract, tincture, capsules,
◆◆ Related to blueberry antioxidant, platelet inhibitor, tablets
­anti-inflammatory,↓capillary ↓ or↑ blood sugar
◆◆ Berries or dried leaves No specific dosing
fragility, preserves endothelium Diarrhea, nausea
are medicinal ­recommendations
Atherosclerosis Hepatotoxicity
◆◆ Used for 1000 years in European

folk medicines, especially for scurvy Peripheral vascular disease Bleeding

and diarrhea Diabetes mellitus Drug interactions:
Peptic ulcer disease anticoagulants→↑bleeding
Diarrhea antidiabetic agents-↑↓ blood sugar
Cataracts and glaucoma antihypertensives→↓BP
Retinopathy estrogen-may↓absorption
4 studies showed no benefit for night Avoid in allergy to blueberries or same family
vision of berries
1 study showed possible antiprolif- Avoid in pregnancy and lactation
erative effects on colon cancer cells
Not enough scientific evidence for
other indications
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Black Cohosh “black snakeroot” Menopausal symptoms *United States Pharmacopeia: women should Extract from dried rhizome
“bugbane” “bugwort” most traditional ­discontinue use of black cohosh and consult a and root
◆◆ Not same as blue cohosh Study results mixed on this. health care practitioner if they have a liver d
­ isorder In caplets, capsules, pow-
◆◆ Contains salicylic acid ◆◆ NCCAM study—failed to relieve
or develop symptoms of liver trouble, such as dered root, dried rhizome,
abdominal pain, dark urine, or jaundice. tea, tincture
◆◆ Member of buttercup family night sweats and hot flashes
◆◆ NIH 2008—inadequate support
several case reports of hepatitis and liver failure; not OTC: Black Cohosh as
◆◆ Used in Native American and
known if black cohosh was cause
American folk medicine for for use Remifemin in dosage
Avoid in pregnancy/lactation; can induce labor 20mg bid
­menopausal sx, induction of ◆◆ German E Commission—approved

labor, rheumatism for menopausal sx, not >6 months ADRs: Other brands:
◆◆ North American Menopause Stomach pain,constipation Menopause Support
­Society (2004) recommends H/A, rash, dizziness Estroven (includes other
◆◆ Insufficient studies for safety Bleeding, bruising ingredients)
>6 months or for rheumatism ↑risk CVA
Mastalgia, uterine bleeding
↑risk hormone-associated female cancers
Hepatotoxicity
Drug Interactions
CYP 450 2D6 drugs
Anticoagulant drugs ↑ bleeding from
salicylate ingredient
Antihypertensives-↓BP
Hepatotoxic drugs→liver failure
Chemotherapeutic drugs
Tamoxifen, antiestrogens, HRT, OCP→estrogenic
effect
thyroid→hyperthyroidism
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Butterbur “Petadolex” Asthma DANGER: NATURAL PRODUCT CONTAINS Softgel, powder, tincture,
patented name Allergic rhinitis ­PYRROLIZIDINE ALKALOID(PA’S) →CAUSE extract, capsule
◆◆ perennial shrub LIVER DAMAGE AND RISK CARCINOGENICITY Extract is standardized
Migraine prophylaxis
◆◆ leaf, root and rhizome used for *Only butterbur products that have been Allergic rhinitis: Petasin
smooth muscle relaxant
extract processed to remove PAs and are labeled (Tesalin) 8mg up to QID
leukotriene and COX-2 inhibitor or certified as PA-free should be used.
Asthma: Petaforce
anticholinergic effect possible Avoid if allergic to ASteraceae family =ragweed, 50-150mg bid-tid prn
Studies show as much effectiveness as marigold, daisies, chrysanthemums
Migraine prevention:
antihistamine for allergies Avoid in pregnancy/lactation ­Petadolex 50-75mg bid
Some studies show effectiveness for ADRs: up to 4 months
migraine treatment
Belching, abd pain, N/V/D
Conflicting results on asthma
Depression
Urinary retention
Rash, pruritus
Pruritus eyes, asthma
drowsiness
Drug Interactions
Calcium channel blockers
Anticholinergics ↑sx
Vasodilators (vasodilates)
Testosterone↓ it
Chronotropes and isotropes→negative activity
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Cat’s Claw Studies show possible benefit in rheu- *some preparations from Peru may be Capsule, tablet, tincture,
◆◆ Central and South America matoid arthritis and osteoarthritis ­contaminated with fungus, other herbs, tea, bark/leaves/roots
◆◆ Dates to use by Incas In vitro study: possible use as aerobes and be toxic in dried, cut or
­antiviral, antitumor agent ADRs: powdered forms
immunostimulant Sedation General use: 250-1000mg
1-3 x/day
Anti-inflammatory effect ↓BP
Freeze dried extract:
Enhances DNA repair ↓estradiol and progesterone
100mg/day
↑phagocytosis One report renal failure in SLE patient
Other forms available
Free radical scavenger Avoid in pregnancy/lactation; traditional use
Possible research on Alzheimer’s as abortifacent
­disease benefit Avoid with hx autoimmune disease, hypotension,
renal transplant, renal disease, immunosuppression,
bleeding disorders
DRUG INTERACTIONS:
CYP 3A4 ↑levels
antihypertensives↓BP
antiarrhythmics: ↑ arrhythmias
anticoagulants:↑bleeding risk
calcium channel blockers: ↑effect
immunosuppressants:↓levels
nephrotoxic drugs: →renal failure
iron:↓absorption
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Chamomile Studies: *Avoid in allergies to daisy family: ragweed, chrysan- Flowers used to make tab-
◆◆ German chamomile is more ◆◆ indicate some benefit for general- themums, marigolds, and daisies: risk of anaphy- lets, extract, tea, creams,
­common for supplements ized anxiety disorder laxis or other allergic reaction mouth rinse, bath additives
◆◆ benefit for infant colic, children’s *avoid with allergies to onions, garlic, and artemesia Tea: up to 8g dried flowers
diarrhea, GI upset *avoid taking with alcohol Capsules: up to
◆◆ benefit for mouth ulcers in radia- ADRs: 1600 mg/day
tion or chemotherapy Sedation Cream: 2%-10%
Common uses for radiation skin chamomile extract
↓BP, BS, ↑heart rate
issues, wound healing, anxiety
Vomiting
Anti-inflammatory and
anti-spasmodic effects Asthma
Sedative effects may be from binding Alter menses
to benzodiazepine receptors ↑ bleeding risk
DRUG INTERACTIONS:
CYP450 interactions
CNS depressants: ↑sedation
Warfarin:↑INR
Antidiabetic agents: ↓ BS
Anticoagulants: ↑bleeding risk
Antiarrhythmics: ↑ heart rate
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Dandelion Uses: liver or kidney tonics *some allergies/anaphylaxis to dandelions Leaves and roots or whole
◆◆ used in Native American and Diuretics *some reports of GI upset with use plant, used fresh or dried
­Arabic medicine in teas, capsules, or
GI disturbances *do not use with gallbladder disease as ↑bile secretion
extracts.
High Vitamin A content and high ADRs:
Dandelion leaves used in
potassium content in dried herb Asthma exacerbation salads or as cooked green
Studies: no scientific evidence for ↓platelets Flowers used for wine
medical conditions
↑potassium
May have diuretic and immune-
V tach, V fib
modulating effects
↓bs
May have antioxidant effects
Alters estrogen, progesterone, FSH
DRUG INTERACTIONS:
Antidiabetic agents, estrogens (↑effect), diuretics
(↑effect), niacin (↑effect);
antiarrhythmics ↑ arrhythmia
Dong Quai Menopausal symptoms *avoid in pregnancy/lactation; can cause uterine Root used for capsule
◆◆ from Angelica sinensis plant Menstrual H/A ­contractions and congenital malformations or tablets
Dysmenorrheal Possible anti-inflammatory, *avoid in bleeding disorders, do not use with Medicinal use safety
­antioxidant effects ­anticoagulants is unclear
Possible antispasmodic, GI *possible carcinogenic potential
­stimulant effects ADRs:
Possible antiplatelet effect Sedation
(coumarin derivative) ↓bp
Antiarrhythmic effect GI symptoms
Bleeding
DRUG INTERACTIONS:
Anticoagulants
Hormonal medications
antihypertensives
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Echinacea Immune-stimulant *Potential anaphylactic or allergic reactions, asthma, Plant and roots used to
“purple coneflower” Used for URIs and other infections, especially with allergy to daisy family: marigolds, make juice (expressed),
including wounds chrysanthemums, daisies, ragweed. teas, extracts, other forms.
Studies: conflicting studies on useful- *Allergies more common in those who are atopic, Dose: URI 500-1000mg tid
ness for treating URIs, some positive with eczema or asthma Dose: pediatric dosing
NCCAM studying usefulness for *Avoid in people needing immunosuppression usually weight-based, see
immunity *Avoid in pregnancy/lactation other sources
German E commission approved for *Discontinue before surgery or may affect wound
treatment of colds, chronic respira- healing and infection rate
tory and GU tract infections *Avoid in autoimmune disease, collagen vascular
Used for genital herpes disease, HIV, liver disease, MS, TB
May have anti-inflammatory, antifun- ADRs:
gal, and free radical scavenger effects Rashes
May be immune suppressant or GI side effects
immune stimulant
Dizziness, nervousness, H/A
Atrial fibrillation, palpitations
HTN
Asthma exacerbation
May aggravate autoimmune disease or increase
immune response
DRUG INTERACTIONS:
Amoxicillin: rhabdomyolysis, death
Anticoagulants:↑bleeding
Corticosteroids:↓immunosuppressive effect
Statins, acetaminophen:↑risk hepatotoxicity
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Ephedra “ma huang” Uses: *US banned sale of dietary supplements with Dried stems and leaves
◆◆ evergreen shrub that has been used Weight loss ­ephedra in 2004 make tablets, tinctures,
5000 years in India and China *reports of stroke, MI, sudden death capsules, teas
Energy supplement
◆◆ powerful stimulant of nervous *can worsen diabetes, CVD, renal disease Ephedra still allowed in
Athletic performance
­0system and heart used to treat Chinese herbal remedies
Amphetamine-like; primary compo- *can cause seizures
respiratory conditions, flu, and teas
nent is ephedrine *Do not use in pregnancy/lactation
asthma, fever
Studies: higher rate of calls to poison ADRs:
control centers about severe side Anxiety, psychosis, tremors
effects
Dry mouth, GI irritation, nausea
Studies: ↑risk stroke, HTN, cardiac
problems, GI side effects HTN, arrhythmia, heart damage
Risks of benefit for short term weight Urinary obstruction
loss is outweighed by risks Sleep problems
DRUG INTERACTIONS:
Anesthetics-alter effect, ↑bp
ETOH-psychosis with caffeine
Caffeine-↑toxicity
Antidiabetic agents↓effect
anticonvulsants↓effect
ergot alkaloids↑hypertensive crisis
phenothiazines↑arrhythmia, death
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Evening Primrose Oil (EPO) Uses: eczema, inflammation *Not for pregnancy/lactation: ↑risk complications, Oil extracted from seeds
Yellow flower: Mastalgia, PMS rupture of membranes and put in capsules
◆◆ contains gamma-linolenic acid ADRs: Products standardized
Menopause symptoms
(GLA), essential fatty acid, GI upset for 8% GLA and 72%
required by the body and Cancer
­linoleic acid
obtained from the diet. Diabetes mellitus H/A
Studies: show some benefit for Rash
­rheumatoid arthritis, eczema, Depression
PMS, mastalgia Seizures in pts without seizure risk
May have anti-inflammatory, DRUG INTERACTIONS:
­vasodilatory, and anti-platelet
Anesthesia: ↓seizure threshold
effects
Anticoagulants:↑bleeding risk
Antihypertensives:↓bp
TCAs: ↓seizure threshold
Antiseizure agents:↑risk seizures
Fenugreek Used in cooking *Avoid in pregnancy Seeds are ground and
◆◆ used back to Egyptian times Used for diabetes mellitus ADRs: taken orally or put in
◆◆ Used to induce childbirth
paste for skin
Hyperlipidemia Bloating, flatulence, diarrhea
◆◆ Used to help digestion and
Dose: 25 g seed powder
Loss of appetite Hypoglycemia
daily in divided doses
­menopause symptoms Stimulates milk production Hypokalemia
Miscarriage
DRUG INTERACTIONS:
Alcohol-↓hepatotoxicity
Analgesics-additive effects
Anticoagulants-↑bleeding risk
Antidiabetic agents-↑hypoglycemia
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Feverfew “bachelor’s buttons” Migraine headaches *Allergic risk with ragweed, chrysanthemum allergies Dried leaves primarily used
“wild chamomile” Psoriasis *Not for use in pregnancy/lactation, can cause Stems and roots some-
◆◆ Used as antipyretic by ­miscarriage, premature birth times used
Asthma
ancient Greeks *Avoid in children Extracts, tablets, capsules
Tinnitus
*Avoid prior to surgery or dental procedures
N/V Standardized dose: up to
ADRs: 250mg daily
Studies: Canker sores, sore tongue
Take with food
Suggest may help prevent (not Loss of appetite
acutely treat) migraine headaches Nausea/GI symptoms
and rheumatoid arthritis pain Risk worsened depression
Dizziness, fatigue,anxiety
Palpitations, ↑heart rate
DRUG INTERACTIONS:
Anticoagulants: ↑bleeding risk
Vasodilators:↑ vasodilitation
Garlic Uses: hyperlipidemia *safe for most adults Raw, cooked, dried,
◆◆ edible herb from Lily family CAD, HTN *does have blood-thinning effect; stop pre-operatively powdered
Colon and gastric cancer *mild risk allergy, mostly raw form; cross-allergies with Dose: 600-900 mg garlic
onions, leeks, chives powder (in standardized
URI prevention 1.3% allicin active ingredi-
ADRs:
PVD Raw: halitosis,GI upset, body odor ent) daily in divided doses
Studies: on lowering cholesterol, Contact dermatitis, blisters Or 3-5mg allicin daily
had varying benefit Bleeding (equivalent to 2-5 g
Studies: positive for Asthma, rhinitis fresh garlic)
decreasing BP and DRUG INTERACTIONS:
decreasing atherosclerosis
Anticoagulants ↑bleeding
Study: shows affects dilation and Antihypertensives ↓bp
constriction of blood vessels
Antidiabetic agents ↓ or ↑bs
Anesthetics prolong effect
Acetaminophen-alters effect
Protease inhibitors ↓effect
OCP with estrogen ↓effect
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Ginger Uses: post-surgical and *Avoid in lactation/safety not established Fresh, powder, tablets
◆◆ tropical plant often used in motion nausea *Avoid peri-operatively due to bleeding risk Dose: up to 4 g/day in
Asian medicine GI upset *Avoid in CAD, arrhythmia history divided doses
Chemotherapy nausea ADRs:
Pregnancy nausea Mostly with powdered ginger: bloating, gas,
(hyperemesis gravidarum) heartburn, nausea
Arthritis pain, muscle pain Depression
Studies: short-term effectiveness in Arrhythmias
pregnancy nausea, variable effective-
↑ bleeding risk
ness in other forms nausea
DRUG INTERACTIONS:
Studies: on inflammation ongoing
Calcium channel blockers↓bp
May inhibit serotonin 5-HT3
­receptors in GI tract Antidiabetic agents ↓bs
May inhibit platelet aggregation Cardiac agents-may alter effect
May have lipid-lowering, anticoagulants↑bleeding risk
­antihypertensive effect antiarrhythmics ↑risk
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Gingko “Japanese silver apricot” Uses: memory enhancement *Possible severe allergic reactions Gingko leaf abstracts used
“fossil tree” Prevention Alzheimer’s disease *Avoid pre-operatively or before dental procedures, in tablets, capsules, teas
◆◆ seeds of Gingko tree used for and dementias increased bleeding risk and skin preparations
­thousands of years in Traditional Ischemic stroke *No raw gingko seeds, contain toxin that can cause Also in nutrition bars,
Chinese Medicine seizures and death ­sublingual spray
Decrease intermittent claudication
ADRs: Standardized extracts
MS
H/A, dizziness Dose: 80-240mg/day
Tinnitus
divided in bid-tid
Sexual dysfunction GI symptoms
Studies: most studies show no ↑bleeding risk
improvement for memory or preven- DRUG INTERACTIONS
tion of dementia or decreasing BP Antidiabetic agents: ↑bs
Studies: minimal benefit possible for Anticoagulants ↑bleeding
intermittent claudication and tinnitus
(variable); being studied for electric Anticonvulsants ↓effect
shock memory loss Antihypertensives ↓bp
Antipsychotics can cause priapism
Estrogens may have estrogenic effect
Nifedipine ↑concentrations
Prilosec ↓levels
SSRIs↑ serotonin syndrome
Trazadone risk coma
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Goldenseal “yellow root” URI’s *Avoid in pregnancy/lactation; contains berberine Stems and roots dried for
◆◆ Native American remedy Digestive disorders, diarrhea which can cause jaundice extracts and teas
◆◆ Now grown commercially due to Some cancers *Not for infants or young children Mouth rinses
short supplies Vaginitis ADRs: Sometimes combined with
Arrhythmias, Bradycardia Echinacea for URIs
Wounds
H/A,↓BP Tablets/capsules
Canker sores
0.5-1g po tid
Chloroquine resistant malaria ↓blood sugar
Extract: 0.3ml-1ml
Hyperlipidemia GI irritation, nausea
Also IV and ophthalmic
Stimulates immune system Dry mucous membranes
forms
Studies: show some antibacterial Seizures
effect and lipid-lowering effect; DRUG INTERACTIONS:
Studies: possible benefit for diarrhea Antiplatelet agents
and eye infections Antilipemic agents ↑effect
Antimalarials-additive effects
Beta blockers-changes effect
Phenylephrine-↑effects
Warfarin-↓effects
Hoodia “kalahari cactus” Appetite suppressant (weight loss) Drug risks, interactions, adverse effects have not Often combined with green
◆◆ Kalahari bushmen ate this to while elevating energy been studied tea or chromium
­suppress hunger and thirst Studies: none published Avoid in pregnancy Dried extracts from stems
while hunting and roots make capsules,
extracts, powders, teas,
chewable tablets
Dose: Dried extract up to
800mg/day
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Horse Chestnut “buckeye” Used for chronic venous insufficiency *Contraindicated in hepatic and renal impairment; Dose: 300 mg extract bid
◆◆ Only seed extract is safe Used for ankle edema, inflammatory bowel disease Topical gel 3-4 x/day
night leg cramps *Contraindicated in latex allergy
◆◆ Do not use any other parts of Use for short term only
plant, which may be toxic Studies show it is as effective for Avoid in pregnancy/lactation
Standardized for
venous insufficiency as supportive ADRs: calf spasm
15-20% escin
compression stockings GI upset
Bleeding
Renal/liver damage
DRUG INTERACTIONS:
anticoagulants↑bleeding
antidiabetic agents ↑hypoglycemia
antihypertensive ↑ hypotension
Kava “kava kava” Uses: anxiety *Risk of severe liver damage, including liver failure Root and rhizome make
◆◆ Member of pepper family Insomnia and hepatitis beverages, capsules,
◆◆
*Risk dystonia (abnormal muscle movements) ­tablets, extracts,
Ceremonial beverage in Menopausal symptoms topical solutions
South Pacific ADRs:
NCCAM studies halted due to risk
Drowsiness
of severe liver damage
Ataxia
Earlier studies showed some benefit
Dizziness, dyskinesia
with anxiety, but dangers
outweigh risks H/A
Tachycardia
May impact cerebellar and
GABA functions Contact dermatitis, kava dermopathy (rash from
long-term with yellow discoloration)
GI upset, ↑transaminases
Parkinsonism
DRUG INTERACTIONS:
Acetaminophen ↑liver toxicity
Psychotropics-altered mental status
ETOH ↑toxicity
Anxiolytics ↑effect
Sedatives ↑effect
Opioids ↑sedation, CNS depression
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Lavender “English lavender” Uses: anxiety, depression *Avoid in pregnancy/lactation Dried lavender teas or
Insomnia ADRs: extracts can be taken orally
GI upset H/A, photosensitivity Essential oils can be made
from flowers and used
Alopecia GI symptoms
­topically and in aroma-
Topical antiseptic Skin pigment changes therapy; poisonous if
aromatherapy DRUG INTERACTIONS taken internally
Studies: do not confirm any benefits Anxiolytics ↑side effect
for certain except for alopecia used Sedatives↑ side effect
topically
Antidepressants ↑ side effect
Licorice Root Uses: stomach ulcer, hepatitis *glycyrrhizin can→ low potassium, high blood Use DGL form instead—
◆◆ Glycyrrhizin is most dangerous Sore throat, bronchitis ­pressure, salt and water retention, all risks for much safer
compound CVD: AVOID
Studies: none show significant effec-
◆◆ Declycyrrhizinated form “DGL” tiveness except IV form for Hepatitis *high levels of licorice affect cortisone
is safer C, not available in US *Not for pregnancy—can cause preterm labor
*Not for hypertension or CAD
ADRs:
DRUG INTERACTIONS:
Avoid with medications that affect potassium,
diuretics, prednisone
Antiarrhythmics-↑risk
Anticoagulants ↑bleeding
Immunosuppressants ↓effect
Antidiabetics alter effect
Antihypertensives ↓effect
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Milk Thistle “holy thistle”, Uses: chronic hepatitis *Avoid in allergies in daisy family: ragweed, Silymarin, active ingredi-
“silymarin” Cirrhosis ­chrysanthemums, daisies, marigold. ent, from seeds used to
◆◆ Used for thousands of years for *Not recommended in pregnancy/lactation make tinctures, capsules,
Liver damage from drugs and toxins;
liver assistance extracts
alcoholic liver disease ADRs:
Generally considered safe
Hyperlipidemia ↓bs
Dose: 230-800mg/day
Decrease insulin resistance if have GI side effects
divided in 2-3 doses
DM and cirrhosis H/A, insomnia
Anti-breast, cervical, prostate cancer Exacerbates hemochomatosis
Studies: prior studies showed benefit arthralgia
protecting and promoting growth
of liver cells; later studies conflicting DRUG INTERACTIONS
results Alcohol↓alcohol-induced hepatoxicity
Study: benefit in Hepatitis C showed Statins-inhibits effects
fewer, milder liver disease symptoms Antineoplastic drugs ↑effects
but no affect on amount of viral load Antidiabetic agents ↓bs
Noni “Indian mulberry” Used in juice as health tonic *Risk of liver toxicity Fruit used in fruit juices,
◆◆ History of topical use for joint pain Used for chronic conditions e.g. *High in potassium-avoid in renal disease mostly with grape
and dermatological issues ­diabetes, cardiovascular disease *Not for use in pregnancy (has been Fruit and leaves can make
Used for cancer, hearing loss traditional abortifacent) tablets, capsules, teas
Studies: early studies show ADRs: Dose: up to 2 oz twice
anti-cancer effect, antioxidant, daily x 3 months
↓bp
and immune-stimulating effects
DRUG INTERACTIONS:
NCCAM study-on prostate cancer
Anticoagulants-contains Vitamin K in some,
NCI study-on breast cancer not all preparations
­prevention
ACE inhibitors ↑potassium
Numerous others that affect potassium
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Peppermint Oil Seasoning and medicinal *Oil is safe in small doses Essential oil of peppermint
◆◆ Cross between spearmint Nausea, GI upset, indigestion *Not for pregnancy/lactation In small doses in capsules
and watermint IBS ADRs: or liquids
URI, H/A Heartburn In teas
asthma Abdominal pain Mixed with other ingredi-
ents in topical preparations
Muscular, antispasmodic or Acute renal failure
nerve pain Dosing:
Contact dermatitis
Halitosis PO digestive: 0.2-0.4 ml tid
Burning mouth syndrome
(average qd is 6-12 gtts)
Nasal congestion DRUG INTERACTIONS:
Capsules: 1-2 caps po tid
Studies: peppermint may help IBS Antacids/H2 blockers/PPIs—may prematurely ½ hour ac.
Studies: peppermint with caraway ­dissolve enteric coating
Teas with dried leaves
might help indigestion CYP450 interactions possible
Topical preparations
Red Clover Used for menopausal symptoms *Pregnancy/lactation: unsafe in medicinal amounts Flowers used in tablets,
“meadow clover” Mastalgia *may increase risk of breast cancer or other capsules, teas, extracts
◆◆ Legume family ­hormone-sensitive cancers Dose: 40-80mg red clover
Osteoporosis
◆◆ Contains phytoestrogens which ADRs: isoflavones/day
Benign prostatic hypertrophy
act like estrogen Mastalgia
Hyperlipidemia
◆◆ Past use pertussis, asthma,
Studies: not enough evidence for Menstrual changes
­bronchitis, cancer
effectiveness or safety in menopause Vaginal spotting
Studies: NCCAM studying how it H/A, rash
affects prostate cells DRUG INTERACTIONS:
Study: if causes endometrial anticoagulants↑bleeding
cancer risk
Tamoxifen-altered effect
Estrogens-altered effect
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Rhodiola Used for energy and exercise Avoid in pregnancy/lactation Capsules: 100-4g daily
◆◆ considered adaptogen enhancement ADRs:
Fatigue Insomnia
generalized anxiety disorder ↑BP
bladder cancer Dermatitis
hypoxia Irritability
Dry mouth
Leukocytosis
DRUG INTERACTIONS:
Antidepressants—additive effects
Anxiolytics—additive effects
CNS depressants—additive effects
Opioids—additive effects
Antihypertensives—additive effects
Sage Spice and seasoning *safe,but some varieties contain THUJONE which can Dried leaves, essential
◆◆ Fertility drug in ancient Egypt Used for mouth inflammation affect nervous system, causing restlessness, tremor, oils, sprays, extracts
◆◆ Cleansed and stopped bleeding in and sore throats ­seizures, renal toxicity Menopausal sx:
ulcers/wounds in ancient Greece Used for indigestion Ingesting sage powder can cause asthma 120mg qd
Inflammation with skin contact Pharyngitis: 15% spray
Used for menopausal symptoms
*Avoid in pregnancy-risk abortifacent and hormonal effects Mood enhancement:
Used to improve mood and boost
memory/performance *Contraindicated in seizure disorders dried leaf,
ADRs: 300-600mg qd
Studies: show mental and mood
improvements; memory boosting Seizures Alzheimer’s:
in older adults Contact dermatitis essential oils
Studies: show thinking/ Hypertension
learning improvement in Sedation
­Alzheimer’s disease DRUG INTERACTION:
Studies: show essential oil has Antidiabetic drugs↑hypoglycemia
antimicrobial properties Anticonvulsants-altered effects
Thyroid hormones-altered effects
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Saw Palmetto “dwarf palm” Uses: prostate (BPH) problems *Mild GI symptoms can be ↓ by taking with food Whole or ground berries or
native to US prostatitis *Do not use in pregnancy/lactation due to dried fruit.
“cabbage palm” Pelvic pain hormonal effects In liquid extracts, tablets,
◆◆ Seminole Native Americans used ADRs capsules, as infusion or
Bladder problems
for urinary symptoms tea, topical for alopecia
Prostate cancer Abdominal pain
Dose of capsule: 320mg qd
Libido issues Diarrhea
Ground, whole or dried
Alopecia N/V
berries—1 or 2 qd
Increases testosterone Fatigue
May be anti-inflammatory and Sexual dysfunction
immune stimulant DRUG INTERACTIONS:
Studies: conflicting reports of Antibiotics (Cipro, Azithromycin especially)—additive
benefits on BPH symptoms effects
Does not affect PSA on studies Androgens—↓effect
Being studied for affect on Anticoagulants—↑bleeding
prostate cancer Anti-inflammatories­—additive effects
German E Commission approves
for BPH early stages I and II
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
SAMe Alcoholic liver disease→liver Avoid in pregnancy and lactation Tablet only in US
S-adenosylmethionine ­disease has ↓hepatic SAMe which ADRs: Poor bioavailability due to
­↓glutathione needed for hepatic first pass effect
Methionine is converted to SAMe Dizziness, H/A, palpitations
detoxification and prevention of
with enzyme methionine adenosyl Diaphoresis, rash, itchy or hot ear Dose: 800-1600 mg/day in
­oxidative liver damage
transferase (MAP) 2-3 divided doses
Depression Anxiety, insomnia, fatigue
Monitor glucose, LFTs
Osteoarthritis Anorexia, constipation, N/V/D, dry mouth
ADHD AVOID IN BIPOLAR DISEASE→MANIA
Fibromyalgia OR HYPOMANIA
Analgesic, anti-inflammatory AVOID IN CAD, THROMBOEMBOLISM, RISK
HOMOCYSTEINEMIA
SAMe transmethylation necessary
to synthesize and metabolize neu- MAY WORSEN PARKINSONS SX
rotransmitters, proteins, hormones, DRUG INTERACTIONS:
and membrane phospholipids Serotoninergic/SSRI→serotonin syndrome
Production of SAMe associated with St. John’s Wort→serotonin syndrome
adequate B12 and folate levels
Tricyclic antidepressants→serotonin syndrome
SAMe converted to S-adenosyl­
Tramadol→serotonin syndrome
homocysteine which →glutathione
liver antioxidant MAOI→serotonin syndrome, hypertensive crisis
Can ↑dopamine and norepinephrine Dextromethorphan→serotonin syndrome
2006 Cochrane: no evidence for or Meperidine→serotonin syndrome
against use in alcoholic liver disease Levodopa↓effect
2008 Cochrane: review on OA
use pending
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
St. John’s Wort “hypericum” Used for depression, anxiety and *Avoid use with other antidepressants; can lead to Flowering tops used
“goat’s weed” sleep disorders serotonin syndrome. Do not use with MAOIs. for teas, tablets,
◆◆ Flower blooms around feast time Used for PMS, seasonal affective *STOP 5-14 days pre-operatively capsule, extracts,
of St. John the Baptist in late June. ­disorder, somatoform disorders. liquids, topical agents
*Do not use with suicidal ideation
◆◆ used for centuries to treat mental Used for ADHD, burning mouth Standardized extract
*Do not use in pregnancy/lactation
disease, nervousness, as sedative ­syndrome, OCD. dose: 300 mg po tid
ADRs: for 4-6 weeks
◆◆ used to treat malaria, and was Studies show: there may not be
balm for wounds, burns, and any more effectiveness than Drowsiness Sudden discontinuation
insect bites. placebo for major depression GI symptoms may cause adverse reaction
of moderate severity Hypertension/hypertensive crisis
Another study NCCAM and NIMH (could act like MAOI)
showed neither antidepressant Mania
nor St. John’s Wort treated mild
Serotonin syndrome
­depression any more effectively
than placebo Delirium
Cochrane review 2008: better than Confusion
placebo and similar to standard anti- psychosis
depressants with fewer side effects MI
Hyperforin component inhibits Palpitations
­neuronal uptake of dopamine,
­serotonin, norepinephrine, GABA ↑TSH
and L-glutamate ↑ACTH
Photosensitivity
Dry mouth
dizziness
(continues)
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
St. John’s Wort (continued) DRUG INTERACTIONS:
Anesthetics
SSRI antidepressants-serotonin syndrome
Anticancer drugs
anticoagulants↓effect
antihypertensives ↑bp
alcohol-↑sedation\ oral contraceptives-
↓contraception, possibly break-through bleeding
Cyclosporin and transplant drugs↓
Digoxin-↓serum level
Statins-↓ level
HIV drugs-may affect
Seizure drugs-may affect
OTC cold/flu meds—may ↑MAO inhibition
Tea Tree Oil Uses: athlete’s foot (tinea pedis), nail *Do not take orally; poisonous, can lead to coma, Used topically, 5%-100%
◆◆ Used by Australian aborigines for fungus (onychomycosis) especially in children oil, safer in adults
centuries wounds, and infections *Can be topical irritant or cause contact dermatitis Topical use in young boy
◆◆ From tea tree acne *Can be used topically in pregnancy according of styling gel and shampoo
to Ulbright caused breast growth
dandruff
ADRs: Is in some mouthwashes,
lice
but based on the concerns
oral candidiasis Contact dermatitis
with oral use, do not
skin lesions Skin dryness ­recommend
antibacterial;antifungual; anti-MRSA Ototoxicity if instilled in ear
Study: showed benefit for treatment DRUG INTERACTIONS:
of wounds of MRSA Topical drying agents ↑dryness
Studies: have shown some positive Tretinoin ↑ dryness
benefit for acne, onychomycosis,
tinea pedis and dandruff
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Thunder God Vine Uses include MS, SLE, rheumatoid *HIGHLY POISONOUS LEAVES, FLOWERS AND Extracts made from
◆◆ Found in China arthritis(RA) SKIN OF ROOT SKINNED root
◆◆ Used in Traditional Chinese Used for excessive menses *Avoid in pregnancy/lactation No consistent, high-quality
­Medicine for overactivity of HIV/AIDS ADRs: products are made in the
immune system or inflammation US yet; Chinese products
Hyperlipidemia GI symptoms
may not be reliable
osteoarthritis URI symptoms
May have immune stimulant effects, Loss of bone mineral density
too Decrease male fertility
Studies: show anti-cancer and anti- Alopecia, rash, H/A
inflammatory effects
DRUG INTERACTIONS;
Studies: show suppression of immune
system effect Antihypertensives-alter effect
Studies: showed benefits for RA pain DMARDs (anti-inflammatories)-↑effect
as good as sulfasalazine Immunosuppressants-↑effects
Turmeric “Indian saffron” Topically, used for wound healing *High doses or long term use have caused: Rhizomes (underground
◆◆ Related to ginger, bitter taste, and eczema GI problems and liver issues stems) ( dried and uses as
gold color Used orally for ulcers, cancer, *Do not use if have gallbladder disease; can worsen oral powder, in capsules,
◆◆ Used for spice and color GI problems, inflammation, teas, or liquid extracts.
*Considered safe as spice in pregnancy, but can
◆◆ Used in Traditional Chinese Medi-
and gallstones stimulate uterus in high doses, so unsafe there. Turmeric paste used
Studies: curcumin chemical in on skin.
cine and Ayurvedic Medicine for ADRs:
liver function, digestion, menstrual ­turmeric has anti-inflammatory, Dose: root 1.5-7g in
­anti-cancer, and antioxidant GI problems
regulation and arthritis pain divided daily doses
­properties in early studies Hypotension
Tea: 1-1.5 g dried root
NCCAM funding studies on: ARDS, Alopecia steeped 15 minutes in
osteoporosis and liver cancer Contact dermatitis 150ml water bid
DRUG INTERACTIONS:
anticoagulants↑bleeding
antidiabetic agents↑hypoglycemia
antihypertensives↓BP excessive
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Valerian “all heal”; Used for sleep disorders *Studies show safe for short periods, Roots and rhizomes
“garden heliotrope” Anxiety up to 4-6 weeks use (underground stems)
◆◆ Used back to ancient Greece *Not for use in pregnancy-possible make tablets, teas,
Depression
and Rome teratogenic effects ­capsules, liquid extracts
H/A
◆◆ Described by Hippocrates and ADRs: Use ½ to 2 hours before
Arrhythmia bed if for sleep
Galen (for insomnia) Morning fatigue
May be adenosine agonist Monitor LFTs
GI upset
May be GABA receptor modulator Dose:
Dizziness
May have CNS neuroprotective Anxiety: 80-300mg po qd
effects H/A
Insomnia: 400-900 mg
NCCAM researching affect on Hallucinations
30-60 min. before hs
sleep in older adults and Ataxia
Parkinson’s patients ↓HR, ↓BP
Studies: suggest helps insomnia, not Dry mouth
enough research on anxiety
and depression Muscle relaxation
German E Commission approved to One report of withdrawal sx
treat sleep disorders from nervous DRUG INTERACTIONS:
conditions and restlessness Alcohol ↑effect
antidepressants↑effect
benzodiazepines ↑effect
CNS depressants ↑effect
Antihypertensives ↓BP
 COMMON NAME OF HERB/ DESIRABLE MEDICINAL CONTRAINDICATIONS AND RISKS USUAL DOSING
BIOLOGICAL NAME OF HERB ACTIONS OF HERB (Adverse Drug Reactions or ADRs) OF HERB OF HERB
Yohimbe “yohimbe bark” Yohimbe hydrochloride form has *Avoid in pregnancy: fetal toxicity, uterine relaxation Some products contain
◆◆ From bark of African been studied for erectile dysfunction *Do not use in lactation very little yohimbe
evergreen tree Used for female libido, SSRI-induced *Do not use with MAO inhibitors, caution with Bark used in capsules,
libido issues other antidepressants and phenothiazines ­tablets, tea
Used for sexual dysfunction, *Do not use with psychiatric or renal disorders— Standardized yohimbe
­aphrodisiac can exacerbate available by prescription
Used for athletic performance *one report hypertensive crisis Dose: 5-50 mg in
Studies: no adequate studies done divided doses for
*overdose-severe effects, possibly fatal
erectile dysfunction
Contains alpha-2 ADRs:
blocker→↑norepinephrine Monitor BP, HR
Insomnia
↑cholinergic and↑sympathetic tone
↑ or↓ BP
Irritability, psychosis
N/V
Anxiety
H/A
Renal failure
Lupus-like syndrome
DRUG INTERACTIONS:
antidiabetic↓bs
benzodiazepines ↑sedation
ETOH↑intoxication
Naloxone/naltrexone ↑yohimbine toxicity,
alter opioid withdrawal sx
CNS stimulants↑effect
Anticoagulants ↑bleeding
Central sympathomimetics ↑yohimbine toxicity
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
Acidophilus Maintain or restore microbial balance *may cause morbidity or mortality if patients dosage varies depending
◆◆ Main types: lactobacillus species in GI and GU tracts; immunocompromised or debilitated. on number of living organ-
(acidophilus, casei, plantarum, may produce bacteriocins and Avoid in PREGNANCY (risk amnionitis, isms in product
delbrueckii) lactic acid which impair growth sepsis,endometritis) some yogurts with
◆◆ Bifidobacterium species (brevis, of pathogens Avoid with artificial heart valves, radiation therapy, live cultures
infantis, longum) oral surgery, GI surgery, heme+ diarrhea, immuno- liquids, capsules, powders,
compromised, debilitated tablets, milk, vaginal and
anal suppositories
Some are kept refrigerated
Take 2 hours after
­antibiotics
Do not take with immuno-
suppressants
Alpha Lipoic Acid (ALA) Diabetes mellitus, cataracts, *avoid in thiamine deficiency (alcoholism especially) Oral
◆◆ Found especially in potatoes, ­retinopathy, peripheral neuropathy, Avoid in pregnancy and lactation IV
­spinach, liver and broccoli and nephropathy from DM
Caution with bleeding disorders
HIV, cirrhosis, glaucoma
Interactions with anticoagulants, antiplatelets,
Lead toxicity NSAIDs/ASA may ↑bleeding risk
Ischemic injury liver, brain, heart May ↓ effectiveness chemotherapy
Burning mouth syndrome May ↓ blood sugar and worsen hypoglycemia
ACTION: IMPROVES Vertigo, h/a, N/V, rash
MICROCIRCULATION IN
PERIPHERAL NEUROPATHY
IN DM
ACTION: ANTIOXIDANT
ACTION: ↑ INSULIN-STIMULATED
GLUCOSE USE IN DM
ACTION: ↑ CD4 AND CD8 LEVELS
IN HIV
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
Arginine ACTION: PRECURSOR OF NITRIC *ANAPHYLAXIS TO IV ARGININE IN CHILDREN; Sufficient amounts made
◆◆ Semi-essential amino acid OXIDE, A VASODILATOR *ATRIOVENTRICULAR BLOCK in body
◆◆ Especially in corn, dairy, oats, ACTION: ↑RELAXATION OF h/a, dizziness, atypical chest pain If supplemented, cream,
meat, grains, brown rice, nuts, SMOOTH MUSCLE ↑ bleeding risk capsule, IV, nutrient bar
chocolate, raisins ACTION: ↓WBC ADHESION, ↑ or ↓ blood sugar No established standards
PLATELET AGGREGATION,
FIBRIN FORMATION ↓bp
IMMUNE STIMULANT Avoid in pregnancy and lactation
Avoid after acute MI
CAD, CHF, HTN, PVD, hyper­
lipidemia, breast cancer, asthma Avoid IV forms in acidosis or hypotension
Bee Pollen Athletic performance *Allergic reactions: anaphylaxis, edema, Capsules, tablets, liquid,
◆◆ Flower pollen collected on bodies Memory booster shortness of breath, prurutis, eosinophilia, granules, extracts, food
of worker bees mixed with nectar risk asthma exacerbation supplements
Multiple sclerosis
and bee saliva ADRs: No standardized products
Menopause and PMS
◆◆ Commercial bee pollen may be just N/V/D, abdominal pain Often in combination
pollen harvested from plants Reduce cancer chemotherapy
Hepatitis products
side effects
◆◆ NOT same as honey or royal jelly Pollen content varies
Antioxidant H/A, malaise
◆◆ Contains: essential amino acids, depending on plant and
Immune stimulant Photosensitivity
essential fatty acids, hormones, geographic location
minerals, vitamins B and C coen- Antifungal Vertigo
zymes, sterols, lipids, carbohy- Hayfever
drates, and more Decreased memory
Avoid in pregnancy/lactation
Contraindicated in allergy to pollens
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
Capsicum “cayenne” “chili pepper” Uses: clotting disorders *risk allergic reactions Powder, topical creams,
“paprika” “capsaicin” GI disorders ADRs: intranasal spray
◆◆ Possibly capsaicin releases sub- Zostrix cream contains
Cluster headache ↑HR, ↑BP transiently
stance P from neurons, which 0,025% capsaicin
Musculoskeletal pain Topical burning on skin, contact dermatitis
decreases pain sensation Law enforcement uses in
Neuropathic pain Pharyngitis, rhinorrhea (nasal)
pepper spray
Postoperative N/V Eye burning and tearing
Perennial rhinitis Sweating, flushing
May be immunosuppressant, DRUG INTERACTIONS
­anti-inflammatory, antimicrobial ACE inhibitors ↑cough
Antiarrhythmics ↑HR
Anticoagulants ↑bleeding
Antidiabetic agents ↓bs,↑insulin
Antiulcer agents ↑stomach acid
Chondroitin Sulfate Uses: *avoid in shellfish allergy In capsules or combined
◆◆ Glucuronic acid and galactosamine Osteoarthritis, especially of hip *avoid in bleeding disorder, preoperatively with glucosamine
molecule and knee ADRs: May be able to dose
◆◆ Found in mammalian cartilage, Psoriasis ­intermittently
↑or↓ BP
supplement derived from bovine, May have anti-inflammatory 200-400mg/d in divided
shark, or synthetic material Euphoria, H/A
or one dose
May be protective of joint Asthma exacerbation
◆◆ Caution with bovine type: risk

bovine spongiform encephalopathy Bleeding risk, ↓hemoglobin

(Mad Cow Disease) DRUG INTERACTIONS
anticoagulants↑bleeding
Iron ↑absorption
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
Chasteberry “vitex” Uses: menopause symptoms *Do not take in pregnancy /lactation secondary to Dry commercial extract:
◆◆ Used by monks to decrease sexual Breast milk production hormonal effect up to 40mg/day
desire, thought to promote chastity PMS symptoms *Do not take with dopamine medications Liquid commercial extract:
(some antipsychotics, Parkinson’s drugs) 1.8ml/day
Infertility
because affects dopamine Dried fruit-up to
Acne
*Do not take with oral contraceptives or hormone- 600mg/day
Studies: possible benefit for breast related cancer (e.g. breast cancer)
pain, infertility, PMS, but needs
ADRs:
more study
Acne
GI symptoms
Dizziness
Depression, fatigue
DRUG INTERACTIONS
Antipsychotic agents as above
Dopamine agents as above
Cinnamon Uses: diabetes mellitus *Avoid consuming large amounts of cassia Powders, extracts,
From bark of cinnamon tree Bronchitis ­cinnamon, because it contains coumarin, ­capsules, teas
of the anticoagulant family Doses: Type II diabetes
Many varieties; Ceylon and Chinese GI symptoms, loss of appetite
(cassia) cinnamon most common *Allergic/hypersensitivity reaction mellitus up to 6g/day
Angina, CAD
ADRs: for 40 days
Studies: lacking support
Asthma
Glossitis, gingivitis, stomatitis
DRUG INTERACTIONS
Antidiabetic agents ↓bs
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
Cranberry Uses: treat urinary tract infections *excess cranberry juice can cause GI upset Beverage, sauces
◆◆ No longer thought to acidify urine Treat H.pylori stomach infections *use cautiously if taking concomitant anticoagulants and jellies
◆◆ Instead, contains proantho­ that cause ulcers or aspirin, or medications that affect liver Tablets, capsules
cyanidins which prevent Antioxidant ADRs: Dose: capsules 200-800mg
bacterial adhesion in bladder Anticancer ↑risk bleeding daily in divided doses
Prevent dental plaque DRUG INTERACTIONS Dose: juice cocktail—
500ml/day
Studies: dispute that cranberries can Antibiotics –additive
treat urinary tract infections, but they Anticoagulants ↑bleeding
may help PREVENT them
Aspirin ↑ bleeding
Studies: may prevent E.coli organisms
from adhering in urinary tract walls
and may prevent H.pylori organisms
from surviving in stomach
Studies: possible antioxidant proper-
ties; possibly prevents dental plaque
Creatine Use: athletic performance *Avoid in bipolar, arrhythmia, DM Avoid with caffeine
◆◆ Produced in body from ­enhancement ADRs: ­products
amino acids Studies: conflicting reports about H/A, sedation, seizures Dose: up to 25g/daily
◆◆ Stored in muscles possible renal dysfunction by mouth
Arrhythmia, edema
Studies: effects only in short duration
GI symptoms
physical activity
Muscle cramping
Aggression, irritability, mania in bipolar,
depression, anxiety
DRUG INTERACTIONS:
Antiarrhythmics ↑arrhythmia
Antidiabetic agents alter bs
Diuretics ↑effect
NSAIDS ↑nephrotoxicity
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
DHEA Uses: adrenal insufficiency ADRs: Tablets, capsules, creams
◆◆ Produced by adrenals, liver, Depression Deepening voice
testes, neurons Obesity Arrhythmia, HTN
◆◆ Converted to DHEAS-S, can
Increase strength GI symptoms
be converted to estrogens
Studies: Agitation, confusion, depression, psychosis
and androgens
No benefit for improving memory Insulin resistance
or for diseases DRUG INTERACTIONS
Banned substance: by National Antihypertensives ↑bp
­Collegiate Athletic Association
Antipsychotics ↑mania
Lithium ↑mania
Antidiabetic agents ↑insulin resistance
Fish Oil “omega 3 oils” DHA/EPA Uses: *avoid in fish allergy Dose: 2-4 g
◆◆ From oily fish Hypertriglyceridemia *avoid perioperatively due to bleeding risk EPA+DHA daily
◆◆ Contains DHA omega 3 fatty acid Prevention CAD *avoid in pregnancy/lactation due to risk of
(docosahexaenoic acid) and EPA May be antithrombogenic mercury contamination
(eicosapentaenoic acid) *avoid in bleeding disorders
Mild ↓BP
↓atherosclerotic plaque ADRs:
↓triglyceridemia ↓BP, ↑LDL
May be anti-arrhythmic ↑Alt in cystic fibrosis
↑risk mania
Fishy taste, belching
DRUG INTERACTIONS
Anticoagulants ↑bleeding
Antihypertensives ↓bp
Vit A and D may cause toxicity with cod liver oil
Vit E:↑ bleeding
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse Drug Reac- USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT tions or ADRs) OF SUPPLEMENT SUPPLEMENT
Flaxseed oil/seed Uses: menopause symptoms *Not for pregnancy due to risk of spontaneous delivery Flaxseed oil is in liquid or
“linseed oil” Laxative *Risk allergy, type I hypersensitivity capsule form
◆◆ Flaxseed contains lignans, Flaxseed whole or crushed
Arthritis ADRs:
or phytoestrogens can be mixed with water
Hyperlipidemia Severe diarrhea
◆◆ Flaxseed oil does not or used with food; also in
­contain any lignans Cancer Abdominal pain, bowel obstruction powder form
Studies: suggest help lower lipids if ↓platelet aggregation Take both seed and oil in
lipids are elevated ↑ triglycerides sufficient water to avoid
Studies: suggest alpha-linoleic acid May affect sex hormones intestinal obstruction and
(type of omega 3 fatty acid) con- constipation
DRUG INTERACTIONS:
tained within helps heart disease Do not take same time
acetaminophen↓absorption as any other medications
Studies: mixed results on hot flashes
Studies: suggest might reduce some
anticoagulants ↑ bleeding or supplements, as may
cancers’ risks, unclear antidiabetic agents ↑ or ↓ bs decrease absorption
antihypertensives ↓ bp Dose: oil up to 2g/daily
furosemide↓absorption Dose: powder/flour up to
60g/daily, divided doses
with liquid up to 4 weeks
Glucosamine Uses: osteoarthritis, *Avoid in pregnancy/lactation Takes average 2-4 weeks
rheumatoid arthritis *avoid with hx of shellfish or iodine allergy as some for benefit
TMJ ­preparations from marine exoskeletons Dose: 500mg tid for up to
Diabetes mellitus *caution in DM-may↑bs 6 months
Chronic venous insufficiency ADRs:
Most studies use glucosamine sulfate, Dizziness, H/A, somnolence
some with chondroitin ↑bp,↑heart rate, palpitations
Cochrane review: shows good GI side effects
­evidence for minimal improvement
Asthma exacerbation
in pain of O/A knee/hip
DRUG INTERACTIONS:
Antihypertensives ↓effect
Anticoagulants ↑bleeding
Antidiabetic agents ↓insulin production or ↑insulin resistance
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
Grapeseed Extract Uses: atherosclerosis, CAD *Avoid in perioperative periods Dose: up to 300mg/d
◆◆ Leaves and fruit of grapes Hyperlipidemia *Avoid in pregnancy/lactation by mouth in capsules
have been used medicinally or tablets
HTN *Avoid with bleeding disorders, iron deficiency
since ancient Greece
Circulatory issues from diabetes, ADRs: H/A, dizziness
◆◆ Extract made from grape seeds
in eyes (macular degeneration and HTN
­leftover from wine-making vascular disease), periphery
Itchy scalp
Cancers
GI symptoms
edema
DRUG INTERACTIONS:
Studies: show efficacy for chronic
venous insufficiency and extremity Anticoagulants ↑bleeding
edema Antihypertensives ↑effect
Studies: benefit for diabetic retino­ Antidiabetic agents ↓bs
pathy and antioxidant effects Iron ↓ amount
Studies in process are looking at
breast, prostate, colon cancer preven-
tion, Alzheimer’s treatment
Green Tea “Chinese Tea” Uses: mental alertness *Avoid if on anticoagulants as contains Vitamin K Primarily used as
“Japanese Tea” Weight loss *Avoid if caffeine-sensitive beverage by steaming
◆◆ Active ingredient is EGCG green tea leaves.
Hyperlipidemia *Avoid using concentrated green tea extracts if have
or develop liver issues; some risk liver toxicity Can be made into capsules
Cancer treatments—gastric,
or put with other products.
breast, skin ADRs:
Some topical products.
Studies: mixed results on prevention Caffeine-related: insomnia, irritability, palpitations,
Dose: 250-950ml tea
or slowing of some cancers GI upset, urinary frequency, ↑psychiatric symptoms
po qd up to 4 weeks for
Study: improves mental alertness, CAD benefits
likely from caffeine
Dose: 400ml tid for
mental alertness
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
Guarana Uses: cognitive and *Not to be used in pregnancy/lactation due to high Dry extract doses should
◆◆ Has among highest caffeine mood enhancement percentage of caffeine and associated risks miscar- not be >3g/day
­content of all plants obesity riage, IUGR Found in Brazilian sodas,
◆◆ Guarana=2.5%-7% caffeine *not to be used with anticoagulants, as it decreases and increasingly in US
◆◆ Coffee=1%-2% caffeine
platelet aggregation energy products and
ADRs: energy drinks.
Related to caffeine content
Agitation, anxiety, insomnia
Arrhythmia, hypertension
H/A, GI symptoms
Tachycardia, psychosis, others
↓platelet aggregation
DRUG INTERACTIONS:
Alcohol ↑effect
Analgesics ↑effect
Anticoagulants ↑bleeding
antihypertensives↓effect
antibiotics alter effect
CNS depressants-antagonistic
Ephedrine-additive
Dopaminergic-additive
Betablockers-antagonistic
others
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
Kelp “seaweed” Uses: anticoagulant *Iodine may cause hypersensitivity rash including Aqueous extract, powder,
◆◆ Brown seaweed has been used for Antiviral angioedema, TTP, death granules, capsules, tablets
food and medicine Wound repair *Not for pregnancy/lactation-abortifacent effect No standardization of
◆◆ Contains sodium alginate ADRs: iodine content
goiter
↓bp in some species
Weight loss
Increase or decrease thyroid
Cancer
Laxative effect
Evidence antioxidant and
­antibacterial actions Bleeding
Anticoagulant effect in lab Peripheral neuropathy from arsenic content
Nephrotoxicity
DRUG INTERACTIONS
Laxatives ↑effect
Antidiabetic agents ↓bs
Anticoagulants ↑bleeding
Antihypertensives ↓bp in some
Estrogens-antiestrogenic effect
Melatonin Use: sleep disorders *Do not use in pregnancy/lactation Not approved for safety
Neurohormone secreted by pineal ADHD ADRs: confusion over >3 months use
gland due to darkness Alzheimer’s disease Depression (transient) Dose: 0.1-5 mg
Influences circadian rhythm and in evening po
May impact brain sleep center Dizziness
sleep initiation Dream disturbance
Immune stimulant
Antioxidant Drowsiness
Jet lag Irritability
Neurobehavioral alteration
DRUG INTERACTIONS
Anticoagulants ↓effectiveness
Antihyperlipidemics ↑atherosclerosis
Antiseizure drugs ↑seizure risk
Sedatives ↑sedation
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
Policosanol Use: hypercholesterolemia ADRs Capsules, tablets
◆◆ Alcohols from sugar cane wax Inhibits cholesterol synthesis in liver Antiplatelet effect Dose: 5-80mg/day up to
LDL degradation H/A, dizzy, ↓BP 3 years
Antioxidant DRUG INTERACTIONS
Studies: many from Cuba, source of Antidiabetic agents↓bs
sugar cane, some conflicting data Antihypertensives ↓bp
from non-Cuban studies
Antiparkinsonians ↑dyskinesias
Anticoagulants ↑bleeding
Nitrates ↓bp
Red Yeast Rice Use: hyperlipidemia *avoid in pregnancy/lactation Gel capsules
◆◆ Extract from fermenting rice Contain sterols, fatty acids, ADRs Do not take with grapefruit
with yeast ­isoflavones Rash, anaphylaxis juice or alcohol
◆◆ FDA banned sale in US due to Anti-inflammatory potential Dizziness, H/A,
violation, supplement contained
↓bp
lovastatin (prescription statin)
◆◆ FDA warns not to buy on internet ↓bs
due to lovastatin component GI symptoms
↓Hgb, ↓BUN
DRUG INTERACTIONS
Alcohol ↑liver toxicity
CoQ10 ↓, needs supplement
Antidiabetic ↓ or ↑ bs
Antihyperlipidemics ↑risk adverse effects
Statins ↑ risk adverse effects
↑risk rhabdomyolysis with azalides, cyclosporine,
nefazodone, others
 DESIRABLE MEDICINAL ACTIONS CONTRAINDICATIONS AND RISKS (Adverse USUAL DOSING OF
NATURAL SUPPLEMENTS OF SUPPLEMENT Drug Reactions or ADRs) OF SUPPLEMENT SUPPLEMENT
Soy Uses: menopausal symptoms *Rare allergies Soybeans, tofu, soy milk
◆◆ Soybeans contain isoflavones, HTN *Avoid soy in hormone-related cancers or risk of Powders, capsules, supple-
similar to estrogen Hyperlipidemia cancers (breast, endometrial, ovarian) ments and nutrition bars
Osteoporosis ADRs: Dose: 10-106g po bid
Breast and prostate cancer (may be Mild GI symptoms Dose: 25 g soy daily for
now contraindicated in breast cancer) H/A CAD risk
Studies: reduces LDL cholesterol DRUG INTERACTIONS
Studies: reduces hot flashes Anticoagulants ↑bleeding
Antihypertensives ↓bp
Tamoxifen interferes with effects
Estrogen interferes with effects
Spirulina “blue-green algae” Uses: diabetes, hyperlipidemia *avoid in pregnancy/lactation Dose: DM 1 g po bid
Allergic rhinitis ADRs: H/A, N/V with meals
Weight loss hepatotoxicity Dose: allergic rhinitis
1000-2000mg
qdx12 weeks
Wild Yam Uses: hyperlipidemia *avoid in pregnancy/lactation Topical-vaginal creams
Menopausal symptoms ADRs: Capsules: 250mg 1-3x/day
GI upset, contact dermatitis
DRUG INTERACTIONS
Antidiabetic agents ↓bs
Hormones altered effects
n References: Sanoski, C.A., & Sucich, M.I. (2011). Herbal Notes: A
Complementary & Alternative Medicine Pocket Guide.
Herbs At A Glance. (2013). NIH National Center
Philadelphia: F.A. Davis.
for Complementary and Alternative Medicine
retrieved at http://nccam.nih.gov/health/herbs Ulbright, C. (2011). Davis’ Pocket Guide to Herbs and Sup-
ataglance.htm (Natural Standard Database Web plements. Philadelphia: F.A. Davis. (Note: author is
site and Natural Medicines Comprehensive Data- founder of Natural Standard Research Collabora-
base Web site are resources) tion and Chief Editor, Journal of Dietary Supplements).