Drug interactions:

June 9, 2000

I would like to start a thread on drug /herbal interactions (if it

hasn't already recently been discussed.) I personally have no experience in

this area and would like to learn how to start studying this field. I am interested not only in single herb

interactions but formula interactions.

In the most simple sense, I would assume that (for example) a patient on

hypertensive medication should not be given a formula that raises yang(?).

I believe that ren shen is contraindicated for HBP, what about a formula

with ren shen (i.e. four gentlemen) (is this also C.I.), what about a patient

who has no HBP with medication?

It seems like this is a huge concern, especially since we are moving

towards a more mainstream clientele.

Most mainstream patients will probably be on numerous medications. If M.D.s barely understand how their

pharmaceuticals are interacting, how do we go about prescribing herbs for these

people?

Maybe we can start with something simple as one pharmaceutical class

(i.e. anti-hypertensives) or one specific drug (i.e. Coumadin.) or just a

general theoretical discussion on how to think about these interactions would

be nice.

John Chen (Lotus herbs) divides herb-drug interactions into two

categories:

pharmacodynamic

interactions (the study of how drugs actually behave inside the human

body)

pharmacodynamic

interactions (the fluctuation in bioavailability of herb/drug molecules in

the body and a result of changes in absorption, distribution, metabolism

and elimination.

(The former being much more complicated and harder to

predict)

I know Z’ev has some experience in this area. Maybe some of the more experienced

practitioners can give us (/ me) some insight.

-

June 9, 2000

Jason,

I have written a book on the subject if you're interested. It's called "Interactions Between Drugs and Natural Medicines: What the Physician and Pharmacist Must Know about Drugs, Herbs...." (Eclectic Medical Publications, c1999 -available at B & N.com and Amazon). The next edition, due sometime Decemberish, will have considerably more information on Chinese herbs (current edition has some scientific documentation on Chinese herbs but mainly focusses on Western dietary supplements and herbs) and will go into greater detail as to how to predict on your own potential interaction problems.

By the way, pharmacokinetic interactions is what you meant in B., the fluctuation in bioavailability/ absorption and distribution, metabolism and elimination. You wrote:

pharmacodynamic interactions (the fluctuation in bioavailability of herb/drug molecules in the body and a result of changes in absorption, distribution, metabolism and elimination.

-

traditional chinese herbs

Friday, June 09, 2000 12:03 PM

Drug interactions:

I would like to start a thread on drug /herbal interactions (if it hasn't already recently been discussed.) I personally have no experience in this area and would like to learn how to start studying this field. I am interested not only in single herb interactions but formula interactions. In the most simple sense, I would assume that (for example) a patient on hypertensive medication should not be given a formula that raises yang(?).

I believe that ren shen is contraindicated for HBP, what about a formula with ren shen (i.e. four gentlemen) (is this also C.I.), what about a patient who has no HBP with medication?

It seems like this is a huge concern, especially since we are moving towards a more mainstream clientele. Most mainstream patients will probably be on numerous medications. If M.D.s barely understand how their pharmaceuticals are interacting, how do we go about prescribing herbs for these people?

Maybe we can start with something simple as one pharmaceutical class (i.e. anti-hypertensives) or one specific drug (i.e. Coumadin.) or just a general theoretical discussion on how to think about these interactions would be nice.

John Chen (Lotus herbs) divides herb-drug interactions into two categories:

pharmacodynamic interactions (the study of how drugs actually behave inside the human body)

pharmacodynamic interactions (the fluctuation in bioavailability of herb/drug molecules in the body and a result of changes in absorption, distribution, metabolism and elimination.

(The former being much more complicated and harder to predict)

I know Z’ev has some experience in this area. Maybe some of the more experienced practitioners can give us (/ me) some insight.

-

Chronic Diseases Heal - Chinese Herbs Can Help

June 9, 2000

Jason,

To answer you question about drug-herb interactions in hypertensive patients I will provide a brief outline of considerations.

1. Hypertension (a "sign" easily measured with a modern sphygmomanometer and a stethescop) is not a known diagnosis in TCM, per se. It's "symptoms" (those experiences which the patient senses), however, are most commonly attributed to the uprising of yang and/or yin deficiency.

2. Use formulas from the classic literature which match the patients constitution and presenting signs and symptoms.

3. Herbs known to be anti-hypertensive according to modern research should be given if "classic" research (i.e. literature) backs it up for the symptoms and signs they are experiencing.

4. Herbs known to be antihypertensive according to modern research but have little indicated use according to the classics should be used very cautiously.

5. When delving into polypharmacy -i.e. adding herbs to an existing drug regimine- introduce the herbs slowly by graduating the dosage over a period of two weeks. This procedure will help to avoid undesired drug effects.

When it comes to Coumadin (A.K.A. warfarin), run!!! This is a very sensitive drug to handle with a very narrow range of safety. It can react with tons of things that will either increase or decrease its activity. Either situation can be dangerous; either too little clotting/excessive bleeding time or too much clotting/thromboses. Patient education must be THOROUGH! They absolutely HAVE TO stick with the herb AND drug routine in order to maintain a precise level of blood clotting stability. Generally, speaking, follow these rules:

1. Educate the patient of the dangers associated with changing anything they do in terms of medication (drug or herbs) and -yes- even diet (e.g. an increase or decrease in green leafy vegetables and/or other vitamin K containing diet sources will throw their clotting out of whack).

2. Be sure that they are following the advice given them by their primary doc regarding monthly blood testing.

3. If herbs are to be given, then begin giving them at a smaller than usual dose one week before their next test so that their Coumadin can be adjusted accordingly. (One week before, not three -that's too much time to gamble with a potential problem occurring). Only increase dosages in following months, again, one week before testing.

4. Follow the patient closely and look out for any signs and symptoms of either hemorrhage or thromboses (see Internal Medicine text if you don't know what these are).

If I've left anything out (anyone) let me know. I'm shooting from the hip here and I've got time constraints....these are the biggies. New considerations seem to come out yearly. Good luck.

Thaddeus Jacobs, N. D.