Key points about commonly used herbals

Dr. Darrell Hulisz from Case Western Reserve University School of Medicine in Cleveland, Ohio has written a continuing education article on herbals.

Here are the author’s take-away points, with additional references added.

Echinacea purpurea and the common cold

• Modestly effective for prevention in those at risk (people in contact with sick people).
• Unclear if it can reduce the duration of cold symptoms.
• The Cochrane review draws different conclusions.
• Patients allergic to ragweed, or with progressive autoimmune disorders (eg, rheumatoid arthritis), and taking drugs that can be toxic to the liver should avoid echinacea.

Garlic and cardiovascular disease

• Use cautiously if taking blood pressure medicine, and monitor blood for orthostatic hypotension (eg, large decrease in blood pressure and possibly fainting when standing).
• Avoid in the following situations
• People with a history of orthostatic hypotension or unexplained dizziness.
• Taking drugs that can increase bleeding, such as aspirin, warfarin and ibuprofen.
• Dosing is not well defined, but to lower cholesterol, 600 to 1200 mg of garlic powder daily in divided doses, or up to 4 g of raw garlic daily may be taken.
• A more negative perspective on garlic is here.

Ginkgo biloba and Alzheimer’s disease

• Reasonable to take by patients with Alzheimer’s disease who are also receiving medical care.
• Its antiplatelet activity may make it inappropriate for people with a bleeding disorder or taking antiplatelet or anticoagulation drugs.
• More info here.

St. John’s wort and depression

• OK for mildly depressed patient with an aversion to prescription drugs.
• Depressed people should take it under medical supervision.
• Check for drug interactions.
• Recently published reviews of drug interactions with St. John’s wort are discussed here
• The most studied dose for depression is 300 mg taken 3 times a day.
• More info here.

Valerian, chamomile, ginger and calming effects

• Safe for most people.
• Modest effectiveness.
• People with chronic anxiety and insomnia should be under the care of a healthcare professional.
• Here’s a summary of drugs and herbals to treat insomnia.

Ginseng and energy

• Lack of good study data.
• Don’t exceed the labeled dosage since adverse effects may occur.
• Caution in people who are on blood thinners, and those with cardiovascular or metabolic disease, such as high blood pressure and diabetes.
• I’ll add there is concern about its effect on the hormone system coupled with a lack of data about its safety in long-term use.

Saw palmetto and the prostate

• Men with obstructive urinary symptoms or benign prostatic hypertrophy (BPH) should not self-medicate with saw palmetto.
• BPH symptoms can mimic more serious disorders — prostate cancer and prostatitis.

Black cohosh and hot flashes

• Results of studies are conflicting.
• It appears to be safe, but use should be limited to not more than 6 months and should not be used in those with a history of estrogen-dependent tumors.
• I’ll add there are different points of view on its liver effects here and here.

1/5/08 18:53 JR