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Did You Let Your Doctor Know?

Anna Sinz, PharmD Candidate
"Herbal products can provide Veterans with health benefits, IF used safely and correctly. Talk to your VA doctor or pharmacist first!" - Anna Sinz, PharmD Candidate

July is Herbal/Prescription Interaction Awareness Month. Do you take any herbal products? And more importantly, does your VA doctor know if you do?

Recent surveys have shown 1 in 3 U.S. citizens have used an herbal product before, with many admitting the herbal product they used was for self-management of their health.

With the increasing use of herbal products throughout the U.S., the need for awareness and management of herbal-drug interactions is booming. Herbal supplements are pharmacologically active agents and are to be included in a patient’s medication record. For this reason, it is important for Veterans to disclose any type of herbal products they are taking to their VA doctor.

Herbal-drug interactions can lead to changes in drug concentrations, affecting the pharmacological effects and can even cause dangerous toxicity. Starting use of an herbal product without medical supervision can be dangerous and lead to life altering complications. Not all herbal-drug interactions are unsafe, some are even considered beneficial, but they should always be monitored by your doctor!

The National Health Interview Survey (NHIS) identified the top 10 most commonly used natural products.  Nearly every one of the natural products they identified had a known interaction with at least one frequently used prescription drug. There are numerous reasons to discuss all supplements with your VA health care team, but most importantly...your safety! 

 If you take any of the following supplements, please be sure to discuss their use with your doctor.

  • Fish oil, Glucosamine/Chondroitin, Coenzyme Q-10/ubiquinone, Garlic, Cranberry, Ginseng, & Ginkgo Biloba all have reported interactions with antiplatelet (Aspirin, Clopidogrel [PLAVIX], Prasugrel) and anticoagulant (Warfarin, Apixaban [ELIQUIS], Rivaroxaban [XARELTO]) agents leading to an increased the risk of bleeding.
  • Melatonin has numerous drug interactions due to it metabolism.  It has been found to lower the antihypertensive effects of calcium channel blockers (Amlodipine [NORVASC], Diltiazem, Nifedipine, Verapamil, etc.). It has also been reported to enhance the sedative effects of benzodiazepines (Alprazolam [XANAX], Lorazepam [ATIVAN], Clonazepam [KLONOPIN], Diazepam [VALIUM]), Citalopram [CELEXA]), Oxycodone, & Nortriptyline .
  • Echinacea has been reported to decrease the serum concentration and diminish the therapeutic effects of corticosteroids (Prednisone, Cortisone, Dexamethasone, Hydrocortisone).
  • Garlic has also been reported to enhance the effects of hypoglycemic agents and antidiabetic agents (Metformin, Glipizide, Alogliptin, Dapagliflozin, Acarbose, and many more).
  • Ginseng, Ginkgo Biloba, & St. John’s Wort all have extremely high amounts of interactions with many different drug classes. If you plan to start any of these supplements and are on any prescription medications, you need to consult your doctor or pharmacist before starting.

 Herbal products can provide patients with considerable health benefits and positive outcomes, IF used safely and correctly. Before starting any kind of over-the-counter herbal supplement or medication please talk to your VA doctor, or contact the Butler VA Pharmacy: Pharmacy | VA Butler Health Care | Veterans Affairs