Common Herbal Medicines
(condensed from ASA Brochure 8/2000; updated 2009

Use of herbal medicines is not necessarily a contraindication for anesthesia.

Cayenne
Ephedra*
Garlic
Gingko
Goldenseal 
Licorice
Saw Palmetto
tiratricol
*
Echinacea
Feverfew
Ginger
Ginseng
Kava-kava*
St. John's Wort*
Valerian
Items w/  * Particularly dangerous


Ginseng
: (panax ginseng)

Common Names:
American Ginseng; Chinese Ginseng; Korean Ginseng

Common Uses
Adaptogenic; Incr. Energy level (athletes); 
Antioxidant

Side Effects/Interactions:
-Ginseng Abuse Syndrome (>15g/day): sleepiness, hypertonia, edema
-Avoid use w/ other stimulants: may cause tachycardia or hypertension


*Ephedra
: (ephedra sinica) (banned 2004 by US Gov't)

Common Names:
Ma-Huang; Ephedrine; Chinese Joint Fir

Common Uses:
OTC Diet Aids; Bacteriostatic; Anittussive

Side Effects/Interactions:
-Heart glycosides or halothane: arrhythmias
-Guanethidine: enhanced sympathomimetic effects
-MAO Inhibitors: enhanced sympathomimetic effects
-Oxytocin: hypertension


Cayenne
: (capsicum annum)

Common Names:
Cayenne; Chili Pepper; Paprika

Common Uses:
External: muscle spasm or soreness; 
Internal: GI Tract disorders

Side Effects/Interactions:
-External: potential for skin ulcerations & blistering w/ >2days use
-Internal: overdose may cause severe hypothermia


Feverfew
: (tanacetum parthenium)

Common Names:
Feverfew; Featherfew; Midsummer Daisy

Common Uses:
Migraine prophylactic; Antipyretic

Side Effects/Interactions:
-Platelet inhibition & increased bleeding. Avoid use in patients on warfarin or other anticoagulants
-Rebound headache w/ sudden cessation
-5-15% incidence of aphthous ulcers or GI tract irritation


Garlic
: (allium sativum)

Common Names:
Clove garlic; Ajo

Common Uses:
Lipid lowering; Blood pressure lowering; has antiplatelet, antioxidant, antithrombolytic properties

Side Effects/Interactions:
-May potentiate warfarin; will increase INR (PT)


Valerian
: (valeriana offcinalis)

Common Names:
All-heal; Setwell; Vandal Root

Common Uses:
Mild sedative; Mild anxiolytic

Side Effects/Interactions:
-Will likely potentiate barbiturate effect
-May decrease sx of benzodiazepine withdrawal (benzodiazepine effects, but different receptors)


*Kava-kava:
(piper methysticum)

Common Names:
Ava; Kawa; Ava Pepper

Common Uses: 
Anxiolytic

Side Effects/Interactions:
-Potentiates barbiturates and benzodiazepines
-Can potentiate ethanol effects
-Incr. Suicide risk in patients w/ endogenous depression 
Hepatotoxic


Gingko:
(gingko biloba)

Common Names:
Maidenhair tree; Fossil tree

Common Uses:
Circulatory stimulant (?)

Side Effects/Interactions:
-May enhance bleeding in patients on anticoagulant or antithrombolytic therapy, i.e., aspirin, NSAIDS, warfarin, or heparin


St. John's Wort:
(hypericum perforatum)

Common Names:
Hardhay; Amber; Goatweed

Common Uses:
Depression, anxiety

Side Effects/Interactions:
-interferes with protease inhibitors
-May be a photosensitizing agent
-Possible interaction w/ MAO Inhibitors (not proven)
-May prolong effects of anesthesia


Licorice
: (glycyrrhiza glabra)

Common Names:
Licorice root; Sweet Root

Common Uses:
Gastric & duodenal ulcers; Gastritis; Cough/bronchitis

Side Effects/Interactions:
-Glycyrrhizic acid in licorice may cause high blood pressure, hypokalemia, & edema
-Contraindicated in many chronic liver conditions, renal insufficiency, hypertonia, hypokalemia


Echinacea
: (echinacea purpurea)

Common Names:
Purple Cone flower

Common Uses:
Common colds; Wounds and Burns; Urinary tract infections; Coughs & bronchitis

Side Effects/Interactions:
-May cause hepatotoxicity, esp. when used w/ other hepatotoxic drugs, i.e., anabolic steroids or methotrexate
-May seen decreased effectiveness of corticosteroids


Ginger
: (zingiber officinale)

Common Names:
Black ginger; African ginger; 

Common Uses:
Antinauseant; Antispasmodic

Side Effects/Interactions:
-Potent inhibitor of thromboxane synthetase; may increase bleeding time
-Use caution when taking warfarin; may cause excessive bleeding

Tiratricol (Triax Metabolic Accelerator)

Common Names:
Triax Metabolic Accelerator

Common Uses:
weight loss

Side Effects/Interactions:
heart attack, stroke


Saw palmetto
: (serenoa repens)

Common Names:
Sabal: Cabbage Palm

Common Uses:
Benign prostatic hypertrophy: Antiandrogenic; Antiexudative

Side Effects/Interactions:
-May see additive effects with other hormone therapies, i.e., birth control pills or estrogen therapy


Goldenseal
: (hydrastis canadensis)

Common Names:
Orange root; Yellow root: Ground raspberry: Turmeric root: Eye root

Common Uses:
Diuretic; Anti-inflammatory; Laxative; Hemostatic

Side Effects/Interactions:
-Functions as oxytocic
-Overdose may cause paralysis (amount not known)
-Functions as an aquaretic, not diuretic (no Na+ excreted, just free water)
-May worsen edema and / or hypertension