Common (Scientific) Name

Side effect/Drug interaction

Aloe vera (Aloe vera)

·       When taken internally, may deplete potassium stores

·       Do not use with thiazide (hydrochlorothiazide) or loop diuretics such as furosemide (Lasix^®)

·       Caution in patients who take cardiac glycosides like digoxin  

Cascara sagrada (Rhamnus pushiana)

·       Should not be combined with a conventional laxative because of the risk of severe diarrhea, fluid loss, and electrolyte imbalance

·       Loss of potassium could cause cardiac arrhythmias in patients taking cardiac glycosides (digoxin)  

Feverfew

(Tanacetum parthenium)

·       Inhibits human blood platelet aggregation

·       May prolong bleeding time

·       Avoid use with warfarin (Coumadin^®) and other anticoagulants

·       Do not use prior to or soon after surgery  

Garlic (Allium sativum)

·       Can lower blood pressure, particularly if taken with another drug that lowers blood pressure

·       Can slow blood clotting

·       Do not use prior to or soon after surgery

·       Use with caution in combination with aspirin, or warfarin, or any drug like aspirin with antiplatelet effects  

Ginger (Zingiber officinale)

·      Inhibits prostaglandin synthesis and reduces platelet aggregation

·       Combining ginger with an anticoagulant can prolong the bleeding time

·       Use with caution in combination with aspirin or warfarin, or any drug with antiplatelet effects

·       Excessive amounts can cause CNS depression and cardiac arrhythmias  

Ginkgo (Ginkgo biloba)

·       Inhibits platelet-activating factor

·       May cause bleeding when combined with NSAIDS, anticoagulants, and anti-platelet drugs  

Ginseng (Panax ginseng)

·       May decrease the effects of warfarin

·       Use with caution in combination with aspirin or warfarin, or any drug with antiplatelet effects  

Kava-kava (Piper methysticum)

·       May cause excessive drowsiness and disorientation

·       May cause a semicomatose state when combined with benzodiazepines such as lorazepam (Ativan^®), diazepam (Valium^®), or alprazolam (Xanax^®)

·       Do not use with barbiturates, antipsychotics, or alcohol

·       Sedation may be greater when combined with valerian  

Licorice (Glycyrrhiza glabra)

·       May cause lethargy, fatigue and weakness in high doses

·       Depletes potassium stores and may potentiate cardiac glycoside effects

·       Excessive intake of licorice may lead to sodium and fluid retention, hypertension, and inhibition of the renin-angiotensin system

·       EKG effects include prolongation of QT and PR intervals

·       Patients with kidney disease are at particular risk  

Senna (Cassia senna)

·       Should not be combined with a conventional laxative because of the risk of severe diarrhea, fluid loss, and electrolyte imbalance that may potentiate the effects of cardiac glycosides

·       May cause loss of potassium during chronic use, increasing the risk for cardiac arrhythmias

·       Avoid use with cardiac glycosides

·       Avoid use with potassium-depleting diuretics such as hydrochlorothiazide (Hydrodiuril^®), furosemide (Lasix^®), chlorthalidone (Hygroton^®), indapamide (Lozol^®), and bumetanide (Bumex^®)  

St. John’s Wort (Hypericum perforatum)

·       Sedation

·       May potentiate MAO inhibitors (Nardil^® or Parnate^®) and serotonin-based drugs (Effexor^®, Paxil^®, Prozac^®, or Zoloft^®)  

Valerian (Valeriana officinalis)

·       Cardiac complications and delirium associated with sudden withdrawal

·       Prolongs sedation from barbiturates

·       Additive effects with benzodiazepines such as lorazepam (Ativan^®), diazepam (Valium^®), or alprazolam (Xanax^®)