Herb Descriptions
Chondroitin
| Name: | Chondroitin sulfate
|
Common Name:
| Chondroitin
|
| Description / Popular Uses: | Treatment of osteoarthritis
|
Pharmacological Effects:
| Chondroitin is a major cartilage building block called glycosaminoglycan such that if more of this it available, then cartilage repair may be improved.
|
Side Effects:
| Diarrhea; constipation; stomach pain
|
Drug Interactions:
| Aspirin and blood thinners (warfarin) |
| Perioperative Concerns: | Perioperative bleeding |
| Recommended Discontinuation: | 2 to 3 weeks before surgery |
Echinacea
| Name: | Echinacea
|
Common Name:
| Purple corn flower
|
| Description / Popular Uses: | Used as a cure all. Treatment for common cold; infections; arthritis; ulcers; prevent bruising
|
Pharmacological Effects:
| Immunostimulatory effects
|
Side Effects:
| Allergic reaction; hepatotoxicty; immunosupression
|
Drug Interactions:
| Hepatoxic drugs (i.e. anabolic steroids; methotrexate)
|
| Perioperative Concerns: | Hepatotoxic reaction in patients with existing liver disease often secondary to anesthesia administration or surgical manipulation
|
| Recommended Discontinuation: | 2 to 3 weeks before surgery |
Ephedra
| Name: | Ephedra sinica
|
Common Name:
| Ma-huang
|
| Description / Popular Uses: | Appetite suppressant; asthma
|
Pharmacological Effects:
| CNS stimulation
|
Side Effects:
| Headache; nervousness; hypertension; tachycardia, excitation, arrhythmia; seizures; heart attack; stroke; CSN excitement; stroke
|
Drug Interactions:
| MAOI; heart glycosides; halothane; oxytocin; stimulants; bronchodilators |
| Perioperative Concerns: | Hypertensive; arrhythmias with anesthetics |
| Recommended Discontinuation: | At least 1 day before surgery |
| Additional information / Warnings: | Ephedra is not recommended for humans or animals. FDA issued rule in 2003 to prohibit sale of ephedra.
|
Feverfew
| Name: | Tancetum parthenium
|
Common Name:
| Feverfew
|
| Description / Popular Uses: | Migraine, anti-inflammatory, fever reduction
|
Pharmacological Effects:
| Inhibits serotonin release from platelets and platelet aggregation
|
Side Effects:
| Mouth ulcers; GI upset; sudden cessation can lead to nervousness, insomnia, joint pains, tension headache, stiffness, extreme fatigue
|
Drug Interactions:
| Warfarin
|
| Perioperative Concerns: | Prolonged bleeding time
|
| Recommended Discontinuation: | 7 to 10 days before surgery |
| Additional information / Warnings: | If feverfew is taken for any length of time, sudden discontinuation can result in a withdrawal syndrome with headache, irritability, trouble sleeping and joint pain. It is contraindicated in pregnancy.
|
Fish Oil
| Name: | Eicosapentaenoic Acid
|
Common Name:
| Fish Oil
|
| Description / Popular Uses: | Arteriosclerotic disease prevention, hypertriglyceridemia, myocardial reinfarction prevention
|
Pharmacological Effects:
| Lipotropic agent
|
Side Effects:
| Rare: Abdominal Pain with Cramps, Blurred Vision, Diarrhea, Dizziness, Fatigue, Headache Disorder, Nausea
|
Drug Interactions:
| Warfarin (possible) |
| Perioperative Concerns: | Perioperative bleeding |
| Recommended Discontinuation: | 2 to 3 weeks before surgery |
Garlic
| Name: | Allium santivum
|
Common Name:
| Garlic; clove garlic; ajoy
|
| Description / Popular Uses: | Lipid lowering; blood pressure lowering
|
Pharmacological Effects:
| Antiplatelet, antioxidant and antithrombolytic qualities
|
Side Effects:
| Halitosis; increased bleeding time; hypotension
|
Drug Interactions:
| Aspirin; NSAIDS; blood thinners; hypoglycemic agents
|
| Perioperative Concerns: | Perioperative bleeding
|
| Recommended Discontinuation: | At least 1 week before surgery |
Ginger
| Name: | Zingiber officinale
|
Common Name:
| Black ginger; African ginger
|
| Description / Popular Uses: | Reduce nausea
|
Pharmacological Effects:
| Inhibits prostaglandin and leukotriene biosynthesis
|
Side Effects:
| Heartburn
|
Drug Interactions:
| Warfarin |
| Perioperative Concerns: | Inhibition of platelet aggregation may increase bleeding time |
| Recommended Discontinuation: | 7 to 10 days before surgery |
Ginkgo
| Name: | Ginkgo biloba
|
Common Name:
| Maidenhair tree; fossil tree
|
| Description / Popular Uses: | Improve memory and mental function; increase blood circulation
|
Pharmacological Effects:
| Antioxidant effects; decreases red blood cell aggregation and blood viscosity; increases blood flow
|
Side Effects:
| Minor headache, nausea; rare reports of diarrhea, vomiting, muscle weakness, loss of muscle tone, restlessness, racing heart, rash, and mouth irritation
|
Drug Interactions:
| Aspirin; anticoagulants; thrombolytic agents; NSAIDs; insulin; hypoglycemic agents
|
| Perioperative Concerns: | Potential to cause prolonged bleeding; may affect blood sugar levels how the liver breaks down drugs; postoperative sedation
|
| Recommended Discontinuation: | 7 to 10 days before surgery |
Ginseng
| Name: | Panax ginseng
|
Common Name:
| American ginseng; Chinese ginseng; Korean ginseng
|
| Description / Popular Uses: | Antioxidant; energy enhancer; lowers blood glucose
|
Pharmacological Effects:
| Used as an "adaptogen": Thought to restore homeostasis and help the body adapt to stress
|
Side Effects:
| Hypertension; tachycardia ; headache; nervousness; high or low blood pressure; breast tenderness; vaginal bleeding; insomnia
|
Drug Interactions:
| Aspirin; NSAIDs; blood thinners; MAOI; diabetes drugs; diuretics; may decrease effectiveness of warfarin |
| Perioperative Concerns: | May cause hypertension and tachycardia during surgery especially in combination with cardiac stimulant drugs |
| Recommended Discontinuation: | 7 to 10 days before surgery |
Glucosamine
| Name: | Glucosamine sulfate
|
Common Name:
| Glucosamine
|
| Description / Popular Uses: | Osteoarthritis
|
Pharmacological Effects:
| Thought to strengthen cartilage and aid glycosaminoglycan synthesis
|
Side Effects:
| GI upset, photosensitivity; insomnia; skin reactions; nail toughening. Allergic reaction for people with shellfish allergies
|
Drug Interactions:
| Diuretics; insulin
|
| Perioperative Concerns: | Hypogycemia
|
| Recommended Discontinuation: | 2 to 3 weeks before surgery |
| Additional information / Warnings: | Generally well tolerated
|
Goldenseal
| Name: | Hydrastis canadensis
|
Common Name:
| Orange root; Yellow Root
|
| Description / Popular Uses: | Laxative; anti-inflammatory; postpartum hemorrhage
|
Pharmacological Effects:
| Functions as an oxytocic
|
Side Effects:
| Nausea; diarrhea; abdominal cramping
|
Drug Interactions:
| Anticoagulants: Beneficial effects of therapeutic anticoagulants may be offset. Avoid administration with goldenseal.
Antihypertensives: Goldenseal or its extracts may interfere with or increase hypotensive effects. Do not use together.
Beta blockers, calcium channel blockers, digoxin: May increase or interfere with cardiac effects of these drugs. Do not use together.
CNS depressants (alcohol; benzodiazepines): May increase sedative effects. Avoid administration with goldenseal. |
| Perioperative Concerns: | Volume depletion; postoperative sedation; May increase hypertension, edema, electrolyte imbalance |
| Recommended Discontinuation: | 2 to 3 weeks before surgery |
Kava
| Name: | Piper methysticum
|
Common Name:
| Kava-kava; ava; kawa; ava pepper
|
| Description / Popular Uses: | Anxiolytic; muscle relaxant
|
Pharmacological Effects:
| Acts on gamma-aminobutyric in amygdale; has direct effect on benzodiazepine receptors
|
Side Effects:
| Photosensitivity; gastrointestinal upset; allergic rash, mild headache
|
Drug Interactions:
| Benzodiazepines; barbiturates; alcohol; levadopa
|
| Perioperative Concerns: | Potentiates effects of barbiturates and benzodiazepines; potentiate effects of alcohol; may cause serious hepatoxicity
|
| Recommended Discontinuation: | At least 1 day before surgery |
Licorice
| Name: | Glycyrrhiza glabra L.
|
Common Name:
| Licorice root; sweet root
|
| Description / Popular Uses: | Stomach ulcers; gastritis; cough/bronchitis
|
Pharmacological Effects:
| Said to have anti-inflammatory, antiviral, antimicrobial, antioxidative, anticancer activities, immunomodulatory, hepatoprotective and cardioprotective effects.
|
Side Effects:
| Pseudoaldosteronism; high blood pressure; edema; muscle pain or numbness in the arms and legs; weight gain
|
Drug Interactions:
| Ace-inhibitors; diuretics; aspirin; digoxin; corticosteroids; insulin; laxatives; oral contraceptives |
| Perioperative Concerns: | Increase hypertension; electrolyte imbalance |
Milk Thistle
| Name: | Silybum marianum
|
Common Name:
| Milk thistle; Mary thistle; holy thistle
|
| Description / Popular Uses: | Treatment of liver cirrhosis; chronic hepatitis and gallbladder disorders
|
Side Effects:
| Laxative effect; upset stomach; diarrhea; bloating; occasionally milk thistle can produce allergic reactions
|
| Perioperative Concerns: | Volume depletion
|
| Recommended Discontinuation: | 2 to 3 weeks before surgery |
| Additional information / Warnings: | See http://www.ahrq.gov/CLINIC/epcsums/milktsum.htm
|
Saw Palmetto
| Name: | Seronoa repens
|
Common Name:
| Cabbage palm; sabal
|
| Description / Popular Uses: | Sedative; BPH; anti-inflammatory
|
Side Effects:
| Side effects uncommon; mild effects may include stomach pain, nausea, vomiting, bad breath, constipation, and diarrhea |
Drug Interactions:
| Aspirin; anticoagulants; anti-platelet drugs; NSAIDs; androgens such as finasteride or flutamide |
| Perioperative Concerns: | Perioperative bleeding |
| Recommended Discontinuation: | 2 to 3 weeks before surgery |
St. John’s Wort
| Name: | Hypericum perforatum
|
Common Name:
| Hardhay; amber; goatweed
|
| Description / Popular Uses: | Treatment for depression and anxiety
|
Pharmacological Effects:
| Inhibition of norepinephrine, serotoinin, and dopamine uptake
|
Side Effects:
| Upset stomach; dry mouth; fatigue; dizziness; confusion or anxiety; skin rash; photosensitivity; headache
|
Drug Interactions:
| Interferes with body's processing of many drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood in the short-term and/or decreased in the blood in the long-term. Medications that may be affected include carbamazepine, cyclosporin, irinotecan, lidocaine, midazolam, nifedipine, simvastatin, theophylline, warfarin, or HIV drugs such as non-nucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors (PIs); has potential to interact with andrenergic stimulants
|
| Perioperative Concerns: | May cause difficulty in inducing anesthesia with lidocaine and in promoting relaxation with midazolam; may prolong effects of anesthesia
|
| Recommended Discontinuation: | At least 5 days prior to surgery |
Valerian
| Name: | Valeriana officinalis
|
Common Name:
| All-heal; stewall; vandal root
|
| Description / Popular Uses: | Mild sedative; mild anxiolytic
|
Pharmacological Effects:
| Increases activity at gamma-aminobutyric acid receptors; inhibitor of cytochrome P450 3A4
|
Side Effects:
| Excessive sedation when combined with anesthetics; may occasionally cause headache, excitability, stomach upset, uneasiness, dizziness, unsteadiness, low body temperature
|
Drug Interactions:
| Anesthetics |
| Perioperative Concerns: | May cause post-operative sedation. Potentiate effects of barbiturates; abrupt withdrawal mimics benzodiazepine withdrawal in the post-operative period including delirium and arrhythmias |
| Recommended Discontinuation: | At least 1 week before surgery |
Vitamin E
| Name: | Vitamin E
|
Common Name:
| Vitamin E
|
| Description / Popular Uses: | Antioxidant; anti-aging; prevention of atherosclerosis; stroke prevention; cancer prophylaxis fibrocystic breast syndrome
|
Drug Interactions:
| Anticoagulants
|
| Perioperative Concerns: | May increase bleeding especially in conjunction with other anticoagulants; may affect thyroid function in otherwise healthy patients; may raise blood pressure in hypertensive patients at doses above 400 mg/day.
|
| Recommended Discontinuation: | 2 to 3 weeks before surgery |
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SourcesAng-Lee M et al. Herbal Medicines and Perioperative Care. JAMA 2001;286:208-16.
Ciocon JO, et al. Dietary supplements in primary care. Geriatrics. 2004;59:20-24.
Flanagan K. Perioperative Assessment: Safety Considerations for Patients Taking Herbal Products. Journal of PeriAnestheisa Nursing. 2001;16:19-26.
Gardiner P et al. Herbal and dietary supplement-drug interactions in patients with chronic illnesses. Am Fam Physician. 2008;77(1):73-78.
Heller et al. Top-10 list of herbal and supplemental medicines used by cosmetic patients: what the plastic surgeon needs to know. Plast. Reconstr. Surg. 2006;11:436-445.
Herbal Products and Supplements: What You Should Know. FamilyDoctor.org. December 2006. http://familydoctor.org/online/famdocen/home/otc-center/otc-medicines/860.printerview.html
Kaye AD et al. Herbal Medicines: Current Trends in Anesthesiology Practice—A Hospital Survey. Journal of Clinical Anesthesia. 2000;12:468-71.
Kost M. Moderate Sedation/Analgesia: Core Competencies for Practice, 2nd Ed. St. Louis, MO: Saunders, St. Louis; 2004, p.58.
Medical Reference – Complementary Medicine: Licorice. University of Maryland Medical Center. 2009. http://www.umm.edu/altmed/articles/licorice-000262.htm
Medline Plus: Drugs, Supplements, and Herbal Information. http://www.nlm.nih.gov/medlineplus/druginformation.html
Medscape Drug Interaction Checker. http://www.medscape.com/druginfo/druginterchecker
NCCAM Herbs at a Glance: Milk Thistle. National Center for Alternative and Complementary Medicine. NCCAM Publication No. D285. Created September 2005. Updated March 2008. http://nccam.nih.gov/health/milkthistle/ataglance.htm
What You Should Know About Your Patients' Use of Herbal Medicines and other Dietary Supplements. ASA. 2003.
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Last Updated October 16, 2009