Page 59 - Numero20-2_2017

Theoretically these acidity-increasing herbs should not be used together with aminoglycosides antibiotics such as streptomyces, neomycin, kanamycin, gentimycine, or other antibiotics such as lincomycin, clindamycin, and Polymyxin B. When these antibiotics are used to treat urinary infections, the antibiotic effect of these drugs may be decreased in an acidic urine environment (decreased pH). (33,34)
Herbs that drain the dampness usually have diuretic effect; theoretically they may hasten renal clearance of the drugs.
3. Pharmacodynamic Interactions
The best way to prevent pharmacodynamic interactions is to exam the patient closely and to monitor all clinical responses including signs, symptoms and any abnormal reactions. Examples of pharmacodynamic interaction include additive and antagonistic interactions. Pharmacodynamic types of herb-drug interactions are best identified by analyzing the therapeutic effect of the herbs and drugs. Concomitant use of herbs and drugs with similar therapeutic actions will undoubtedly pose potential risk of herb-to-drug interactions. The increase in treatment effect interferes with optimal treatment outcome as the desired effect becomes more unpredictable and harder to obtain with precision. The highest risk of clinically- significant interactions occurs between herbs and drugs that have sympathomimic effects, cardiovascular effects, diuretic effects, anticoagulant effects, anti-diabetic effects, antidepressant effect, anticonvulsant effects, or antipsychotic effects. The results of these clinical significant interactions may be lethal, e.g., stroke, heart arrest due to serious arrhythmia, heart attack, serious bleeding, serious hypoglycemia or hyperglycemia, seizure, serious depression attack (suicide), etc. The following herbs and their interactions with drugs should be monitored more closely.
1 Herbs with aristolochic acid are banned in most countries due to their potentially nephrotoxicity. 2 Herbs that have the effect of blood thinning should be avoided in patients who are also treated with blood thinning drugs such as aspirin, Coumadin, heparin, and plavix. These herbs include: Zi Cao, Yin Xing, Shui Zhi, Dan Shen, Chi Shao Yao, Dang Gui, Ji Xue Teng, Chuan Xiong, Hong Hua, Yi Mu Cao, Yan Hu Suo, Wu Ling Zhi, and San Leng. When a patient is using regular blood thinning drug(s), the above mentioned herbs should be avoided.
3 Herbs that may increase the blood pressure should be avoided in patients who are treated with drugs that lower blood pressure. Herbs that may increase blood pressure include Fu Zi, Ma Huang, Kuan Dong Hua, Qin Pi, Ren Shen, Se Xiang, Zhi Shi and Gan Cao (especially in higher dosage). Those herbs should be avoided in all hypertensive patients. There is no much concern on herbs that lower the blood pressure such as Che Qian Zi, Da Ji, Di Gu Pi, Di Long, Du Zhong, Gou Teng, Huai Hua, Huang Lian, Ju Hua, Jue Ming Zi, Shan Zha, Xi Xian Cao, Xia Ku Cao, Xuan Shen, Yin Yang Huo, and Ze Xie. Monitor the blood pressure carefully when those herbs are used in patients who are treated with anti-hypertension drugs.
4 Some herbs may have estrogen-like effect. They should be used very cautiously in patients diagnosed with gynecological cancers, such as breast cancer, uterine cancer and ovarian cancer. According to studies in mice, it has been discovered that Bu Gu Zhi, Yin Yang Huo, Rou Cong Rong, Tu Si Zi, Dong Cong Xia Cao, Nu Zhen Zi, Gou Qi Zi, Dan Shen, Niu Xi, Bai Guo, Xiao Hui Xiang, She Chuang Zi, Bai Ji Li, Ge Gen, Xiang Fu and Sheng Ma have estrogen-like effects. (35,36)
5 Many herbs contain polysaccharides. The mechanism of digestion and actions of polysaccharides in Chinese herbs are not well understood. Currently there is no evidence indicating that polysaccharides in Chinese herbs will increase patients’ blood sugars dramatically like other simple sugars. Herbs that lower blood sugar should be used carefully in diabetic patients who are using anti-diabetic drugs. The synergetic hypoglycemic effect of herbs and drugs may cause a serious result of low blood sugar. Pharmacological studies suggest that the following herbs may lower blood sugar in diabetic patients: Huang Jing, Huang Lian, Bai Jiang Can, Nu Zhen Zi, Huang Qi, Dan Shen, Gou Qi Zi, Sheng Di Huang, Yu Mi Xu (corn silk), Zhi Mu, Chi Shao Yao, Dang Gui, and Ge Gen. In Chinese hospitals those herbs are used often in diabetic patients who are also taking diabetic drugs. No serious hypoglycemic result has been reported. However we still recommend more frequently and careful monitoring of patients blood sugars to prevent the hypoglycemia.
Several steps of checking and handling herb-to-drug interactions:
1 Establish a complete pharmaceutical and neutraceutical list of the patient;
2 Understand the pharmaceutical and neutraceutical products used by the patient;
3 Draft herbal prescription and research each Chinese herb in your formula, or check the ingredients in the patent products;
4 Understand the Chinese herbal medicines (both their traditional properties and application and their chemical, pharmaceutical and pharmacologic studies);
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