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An increasing number of us are seeking an holistic approach to our companion animals’ health (as well as our own). Along with other holistic products, we are buying herbs for our animals’ use. In many people’s minds, herbs are “natural”, and “natural” equates with “harmless”. This is not always the case.


Many drugs are derived from plants. Plants/herbs contain powerful substances which can work to the good - or harm - of our furry friends, especially if these herbs are combined with drugs. If you’ve put your dog or cat on any herbal supplements, be sure to inform your veterinarian of this when he/she prescribes a drug.


The study of herb-drug interactions is a fairly new field. At this point a lot of the information is anecdotal or based on empirical pharmacological knowledge (1), but there is reliable research being done, as reported in The Complete German Commision E Monographs (2), the Botanical Safety Handbook (3), and Herb Contraindications and Drug Reactions (4).


Herbs interact with drugs in two general ways: pharmacokinetic interactions and pharmacodynamic interactions. As John Medveckis says, “Pharmacokinetic interactions will change the absorption, distribution, metabolism or elimination of herbs or drugs. This results in either an increase or a decrease in the amount of drug available to have an effect.


“Each interaction will vary according to the dosage, the patient’s sensitivity, body weight and metabolic rate.


“Pharmacodynamic interactions will alter the way in which a drug or herb affects a tissue or organ system. This will result in either a synertistic or antagonistic action. These interactions are often more difficult to predict and prevent than pharmacokinetic interactions. One should look at the therapeutic effect of both the herb and drug to decide what combinations are potentially dangerous.” (1)


Listed below are specific herbs along with potential drug interactions. This list is not meant to be a complete one by any means. It’s meant to begin to acquaint you, the reader, with how some commonly used herbs can interact, both positively and negatively, with some of the drugs we use in veterinary medicine:

Aloe Vera can increase potential toxicity with cardiac glycosides and anti-arrhythmic agents.


Astragalus can impair immuno-suppressive effects of cyclosporine, azathioprine, and methotrexate as well as increase immune-stimulating effects of interleukin-2 and acyclovir.


Bromelain can potentiate (make more powerful) antibiotics; improves the efficacy of some chemotherapeutic agents such as vincristine and 5-fluorouracil.


Burdock can have a hypoglycemic effect (lower blood sugar) and can necessitate anadjustment in the dose of insulin.


Cayenne can protect the stomach from the adverse effects of aspirin; it also enhances the absorption of theophylline.


Echinacea can decrease the effects of immunosuppressant drugs.


Garlic can have an hypoglycemic effect and may necessitate an adjustment of insulin dosage.


Ginger can help decrease nausea associated with chemotherapy.


Ginko can increase the inhibition of platelet aggregation with aspirin (therefore making bleeding more likely).


Ginseng can potentiate corticosteroids.


Goldenseal can increase or decrease cardiac effects with cardiac glycosides and can increase or decrease potential for blood pressure increase with antihypertensive agents.


Hawthorn can increase or decrease cardiac effects with cardiac glycosides.


Kava Kava can potentiate substances acting on the CNS (central nervous system or brain and spinal cord).


Licorice can increase potential of potassium loss with steroids and diuretics; can increase sensitivity with cardiac glycosides; can reduce ulcer formation from aspirin; can potentiate corticosteroid treatment; and can potentiate toxicity of cardiac glycosides.


Ma Huang (Ephedra) can cause excessive nervous stimulation and weight loss when given with theophylline; can cause dangerous levels of blood pressure when combined with selegiline; increases the clearance, and thereby reduces the effect, of dexamethasone.


Marshmallow may delay absorption of drugs taken simultaneously.

Milk Thistle can help prevent liver damage from hepatotoxic medications such as acetaminophen and helps prevent nephrotoxicity (kidney toxicity) from cisplatin.


Nettles can enhance the anti-inflammatory effect of drugs.


Rehmannia can antagonize the suppressing effects of steroids.


St. John’s Wart can decrease drug levels of digoxin, theophylline, and cyclosporine.


Valerian can potentiate the effects of barbiturates. (1) (4)


For those interested in delving into this subject in more depth, I have several resources listed below. We veterinary practitioners need to do all we can to inform ourselves on this subject and to apply what pressure we can to increase the number of scientific studies in this increasingly important
field.


BIBLIOGRAPHY/RECOMMENDED INFORMATION SOURCES:

1.) Medveckis, L.Ac., John, “A Discussion on Potential Drug-Herb Interactions” from Herbal Crossroads, an information resource from Kan Herb Company, Scotts Valley, CA; June 2001.

2.) Blumenthal, M., Busse, W.R., Goldberg, A., Gruenwald, J., Hall, T., Riggins, C.W., Rister, R.S. (Eds.), The Complete German Commission E. Monographs: Therapeutic Guide to Herbal Medicines, Klein, S. and Rister, R.S., translators. Austin, Texas: American Botanical Council; Boston, Mass.: Integrative Medicine Communications; 1998.


3.) McGuffin, J., Hobbs, C., Upton, R. et al, American Herbal Products Associations Botanical Safety Handbook, Boca Raton, Florida: CRC Press; 1997.


4.) Brinker, F.J., Herb Contraindications and Drug Interactions, Eclectic Medical Publications, Sandy, Oregon, 1998.


RECOMMENDED WEBSITES & ORGANIZATIONS

1.) Dr. Phil Rogers’ Website (Jam-packed with lots on information on herbs, including herb-drug information):
http://homepage.eircom.net/~progers/herblink.htm

2.) American Botanical Council:
http://www.herbalgram.org/

Dr. Kathleen Carson, DVM
Veterinarian & Author

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