Miller L G
Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Amarillo 79121, USA.
Arch Intern Med. 1998 Nov 9;158(20):2200-11. doi: 10.1001/archinte.158.20.2200.
Herbal medicinals are being used by an increasing number of patients who typically do not advise their clinicians of concomitant use. Known or potential drug-herb interactions exist and should be screened for. If used beyond 8 weeks, Echinacea could cause hepatotoxicity and therefore should not be used with other known hepatoxic drugs, such as anabolic steroids, amiodarone, methotrexate, and ketoconazole. However, Echinacea lacks the 1,2 saturated necrine ring associated with hepatoxicity of pyrrolizidine alkaloids. Nonsteroidal anti-inflammatory drugs may negate the usefulness of feverfew in the treatment of migraine headaches. Feverfew, garlic, Ginkgo, ginger, and ginseng may alter bleeding time and should not be used concomitantly with warfarin sodium. Additionally, ginseng may cause headache, tremulousness, and manic episodes in patients treated with phenelzine sulfate. Ginseng should also not be used with estrogens or corticosteroids because of possible additive effects. Since the mechanism of action of St John wort is uncertain, concomitant use with monoamine oxidase inhibitors and selective serotonin reuptake inhibitors is ill advised. Valerian should not be used concomitantly with barbiturates because excessive sedation may occur. Kyushin, licorice, plantain, uzara root, hawthorn, and ginseng may interfere with either digoxin pharmacodynamically or with digoxin monitoring. Evening primrose oil and borage should not be used with anticonvulsants because they may lower the seizure threshold. Shankapulshpi, an Ayurvedic preparation, may decrease phenytoin levels as well as diminish drug efficacy. Kava when used with alprazolam has resulted in coma. Immunostimulants (eg, Echinacea and zinc) should not be given with immunosuppressants (eg, corticosteroids and cyclosporine). Tannic acids present in some herbs (eg, St John wort and saw palmetto) may inhibit the absorption of iron. Kelp as a source of iodine may interfere with thyroid replacement therapies. Licorice can offset the pharmacological effect of spironolactone. Numerous herbs (eg, karela and ginseng) may affect blood glucose levels and should not be used in patients with diabetes mellitus.
越来越多的患者在使用草药，而他们通常不会告知临床医生自己同时还在使用其他药物。已知或潜在的药物与草药相互作用确实存在，应该进行筛查。如果紫锥菊使用超过8周，可能会导致肝毒性，因此不应与其他已知的肝毒性药物（如合成代谢类固醇、胺碘酮、甲氨蝶呤和酮康唑）同时使用。然而，紫锥菊缺乏与吡咯里西啶生物碱肝毒性相关的1,2饱和内酯环。非甾体抗炎药可能会抵消小白菊治疗偏头痛的效用。小白菊、大蒜、银杏、生姜和人参可能会改变出血时间，不应与华法林钠同时使用。此外，人参可能会使接受硫酸苯乙肼治疗的患者出现头痛、震颤和躁狂发作。由于可能存在相加作用，人参也不应与雌激素或皮质类固醇同时使用。由于圣约翰草的作用机制尚不确定，因此不建议与单胺氧化酶抑制剂和选择性5-羟色胺再摄取抑制剂同时使用。缬草不应与巴比妥类药物同时使用，因为可能会出现过度镇静。九心、甘草、车前草、乌萨拉根、山楂和人参可能会在药效学方面干扰地高辛或影响地高辛监测。月见草油和琉璃苣不应与抗惊厥药同时使用，因为它们可能会降低癫痫发作阈值。一种阿育吠陀制剂Shankapulshpi可能会降低苯妥英水平并削弱药物疗效。卡瓦与阿普唑仑同时使用会导致昏迷。免疫刺激剂（如紫锥菊和锌）不应与免疫抑制剂（如皮质类固醇和环孢素）同时使用。一些草药（如圣约翰草和锯叶棕）中含有的鞣酸可能会抑制铁的吸收。海带作为碘的来源可能会干扰甲状腺替代疗法。甘草会抵消螺内酯的药理作用。许多草药（如苦瓜和人参）可能会影响血糖水平，糖尿病患者不应使用。
