quick tips

avoid medication mix-ups

some combos require caution

Herbs and other natural therapies, by and large, are safe to use by themselves and even in combination with many items in your medicine cabinet. But herbs can, in a few cases, interact adversely with prescription and over-the-counter drugs.

When you have questions about how to safely use conventional medications with herbal supplements, it makes sense to rely on the expertise of someone like Patrick Fratellone, MD. Dr. Fratellone is both a physician with offices in New York City and Fairfield, CT, and a registered herbalist with the American Herbalists Guild. In terms of conventional medicine and traditional remedies, he stands with a foot in each world.

As Dr. Fratellone puts it: “One should realize that herbs are drugs.” This is because many of our conventional medicines—metformin and digoxin, for example—first came from plants. In addition, many items considered foods also serve as herbs with medicinal qualities: Think of garlic, parsley, ginger, and thyme.

It’s always prudent to let your doctor or pharmacist know about all herbs and dietary supplements you are taking to guard against potential interactions.

Potential interactions

One medication that always tops the list of potential herb interactions is the blood thinner Coumadin (warfarin). Caution should be taken with herbs that also thin the blood. These include garlic and ginkgo, as well as omega-3 oils.

The birth control pill is another medication that warrants consideration. Women taking the pill who also use St. John’s wort can experience breakthrough bleeding and the possibility of ovulation—which means the risk goes up for unintended pregnancy. Thus, taking oral contraceptives for birth control (as opposed to using the pill for management of periods, acne, or a condition such as polycystic ovarian syndrome) would mean that St. John’s wort should definitely be avoided.

Another red flag, according to Dr. Fratellone, concerns the Parkinson’s disease medication levodopa. “Studies have shown that kava kava, an herb used for anxiety, can reduce the effects of levodopa,” he says. ●

SELECTED SOURCES “Co-administration of St John’s wort and hormonal contraceptives: A systematic review” by E.N. Berry-Bibee et al., Contraception, 2016 • Personal communication: Patrick Fratellone, 2019

Victoria Dolby Toews, MPH, is an evidence-based, integrative medicine journalist. She received her Master of Public Health from OHSU-PSU School of Public Health. She is the author or co-author of numerous books.

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