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Herb & Drug Contraindications

Visit the BPhoenix Alternative Healing Advice Column.

Many people erroneously assume that just because something is "natural" it is safe for use by anyone, regardless of prescription medications being taken or medical conditions present. This is not true, and some herbal supplements contain active ingredients that may not safely mix with prescription or over-the-counter drugs. Please be certain to tell your doctor about any herbal supplements you are taking *before* your doctor sends you to the pharmacy with a new prescription.

Certain medical conditions may increase your risk of adverse effects if you take herbs or any form of natural supplement. Be certain to always discuss it with your doctor before taking any herbal products if you're pregnant or nursing or have any of the following medical conditions: high blood pressure, thyroid problems, depression or other psychiatric problems, Parkinson's disease, enlarged prostate gland, blood-clotting problem, diabetes, heart disease, epilepsy, glaucoma, history of stroke or history of transplant.

Below are 10 of the most commonly used herbs and a list of medications, both prescription and over the counter, that should not be taken with them:

Feverfew, Garlic, Ginger, Ginkgo:

  • Avoid mixing with:
    • Aspirin
    • Ticlopidine (Ticlid)
    • Clopidogrel (Plavix)
    • Dipyridamole (Persantine)
    • Warfarin (Coumadin)

These herbs may augment the anticoagulant effect of these drugs and may cause spontaneous and excessive bleeding.

St. John's Wort:

  • Avoid mixing with any prescription medications. In particular, avoid taking St. John's Wort and:
    • Antidepressants
    • Indinavir sulfate (Crixivan), a protease inhibitor used to treat the human immunodeficiency virus (HIV)
    • Digoxin (Lanoxicaps, Lanoxin), a drug used to increase the force of contraction of heart muscle and to regulate heartbeats
    • Theophylline (Slo-bid, Theo-Dur), an asthma medication
    • Cyclosporin (Neoral, Sandimmune, SangCya), an immunosuppressant
    • Chemotherapy

St. John's Wort has been shown to affect your body's metabolism of all of these drugs. Until more is known about St. John's Wort's ability to alter the metabolism of pharmaceutical medications, it is probably best not to combine such medications with St. John's Wort.

Also, the combination of St. John's Wort with some antidepressants, such as selective serotonin reuptake inhibitors, may cause an excess of serotonin (serotonin syndrome). Typical symptoms include headache, stomach upset and restlessness.


  • Avoid mixing with:
    • Caffeine
    • Decongestants
    • Stimulants
    • Heart drugs
    • Antidepressants

Ephedra appears to increase risk of heart attacks, strokes, seizures and death. When taken in combination with these medications the risk is even higher. Ephedra is a potent herb that is present in many products, including many supplements targeted at weight loss. It goes by many names, such as ma huang, herbal ecstasy, mahuang, and ma huang root. Suspect any "natural" product that claims to cause weight loss or increase energy to have ephedra in it, and review the product's contents with your doctor or pharmacist before assuming it doesn't.


  • Avoid mixing with:
    • Warfarin (Coumadin), an anticoagulant
    • Phenelzine sulfate (Nardil), an antidepressant
    • Digoxin (Lanoxicaps, Lanoxin), a drug used to increase the force of contraction of heart muscle and to regulate heartbeats

Used with warfarin, ginseng can increase risk of bleeding problems. Used with phenelzine sulfate, it may cause headache, trembling and manic behavior. Used with digoxin, it may interfere with the drug's pharmacologic action or the ability to monitor its activity.


  • Avoid mixing with:
    • Sedatives
    • Sleeping pills
    • Antipsychotics
    • Alcohol
    • Drugs used to treat anxiety or Parkinson's disease

Combined with these drugs, kava can produce deep sedation and, in some cases, even coma. Don't take kava if you have a history of liver problems, if you're depressed or if you take antidepressants or prescription sedatives.


  • Avoid mixing with:
    • Anabolic steroids
    • Amiodarone (Cordarone, Pacerone), used to treat arrhythmia
    • Methotrexate (Methotrexate), used to treat rheumatoid arthritis
    • Ketoconazole (Nizoral), an antifungal drug
    • Cyclosporine (Neoral, Sandimmune, SangCya), an immunosuppressant

Echinacea can be toxic to the liver and shouldn't be combined with other drugs that can cause liver damage. Because this herb stimulates the immune system, it can interfere with the effects of immunosuppressants.

Report any possible side effects to the Food and Drug Association MedWatch program by calling 800-332-0188.

All information contained in this web site is strictly for informational purposes only and is not intended as a substitute for consultation with your medical doctor or psychiatrist.
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This Site Updated 04/09/11