Drug-Herb interactions
Many patients would like to try alternative medicine but they are worry about the interaction between the herbs and western drugs. Anything over dosage will cause problem, even over drink water can cause death. What should we look out for? What is the general rule of prescript herbal medicine?
Drugs that are highly protein bound and therefore open to these types of interactions include Warfarin, Phenytoin, oral contraceptive pills, and non-steroidal, anti-inflammatory drugs (NSAIDs). One of the biggest targets of interactions within the realm of metabolism is the Cytochrome p450 (CYP) system. This system is involves with liver Metabolism. Some substances may inhibit this system while others promote this system. This is why patients on statin drugs (coronary artery disease (CAD), lower cholesterol) should not drink grapefruit juice. Herbs have strong inhibition of cyp3A4 are Wu Bei Zi, Shi Liu Pi, Tian Hua Fen. Other herbs that may interfere with cyp include Bai Zhi, Da Suan ( garlic), Guan Ye Lain ( St. John’s wort).
The most significant factor in determining interactions is how a substance affects clearance. Patients on dialysis or who have a kidney elimination from the kidneys. Diuretics can increase clearance form the kidney.
Rules of using Chinese medicinal formula:
- Starting at a reasonably low dose ( typically, 2-4 days)
- If no adverse reactions, prescribe a one- week dose.
- If still no adverse reactions, in crease the dose to the level you believes in appropriate for the patient
- Monitor the patient regularly and make adjustments as necessary.
- be available to the patient for emergencies in some manner
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