SirMaximus (Penis Enlargement)
…continued
St. John’s Wort, perhaps the greatest source of recent concern among herbals, used for nervous symptoms — though more for its potential interactions with non-psychiatric medications — has long had very widespread use as a prescription antidepressant in Germany, and is also gaining wide use in the United States, where over 7.5 million people are said to take it for depression and anxiety, though without the prescription control of this probably effective agent as used in Europe. In the case of one prescription antidepressant, amitriptyline (Elavil), it has caused decreased blood levels and therefore presumably decreased effects. Likewise, it may reduce blood levels and effects of medicines prescribed to prevent seizures. Yet another effect of this sort applies to the drug cyclosporin (Neoral, Sandimmune), used to prevent transplant rejection. These interactions appear to depend on its effects on liver enzymes that break down many drugs. Another example is oral contraceptives. A different source of concern lies in the so-called serotonin syndrome (fever, tremor, restlessness, delirium) in combination with serotonin reuptake inhibitor antidepressants like Zoloft (sertraline). In contrast, St. John’s Wort has had some reassuring study in combination with sleeping medications like Temazepam (Restoril), Zolpidem (Ambien) and Zopiclone (Sonata).
In addition, St. John’s Wort should raise the same concern about additive antidepressant effects that one would have when combining any antidepressant drugs.
Valerian, used to combat insomnia and anxiety may, surprisingly, reduce alcohol effects, though effects of other sedatives may be increased.
Yohimbine, used as an aphrodisiac to combat sexual dysfunction, especially in diabetic men and sometimes in cases of impaired sexual function due to SSRIs, and as a stimulant, may risk hypertension when combined with antidepressants of the tricyclic type (such as imipramine — Tofranil). It can also cause hypertension on its own.
From the perspective of someone already taking a prescription psychoactive medication, this list may make the risks of adding an herbal preparation seem too varied to keep in mind. However, it is clear that most of these warnings stem from a very small amount of data. Some represent mere conjecture.
Most of the newer antidepressants present less risk in combination with herbals than the older, tricyclic or MAOI antidepressants. The interactions concern excessive mood elevation or stimulation-a probably reversible side effect-with ginkgo and ginseng. On the other hand, the newer and very widely used Specific Serotonin Reuptake Inhibitors, present the more dangerous if yet not wholly proven effect called the serotonin syndrome when combined with St. John’s Wort.
Anyone taking the MAOI type of antidepressants must exercise special caution in combining these with a wide range of medications. Probably the best policy for such people is to check with the doctor prescribing the MAOI before taking anything else, prescription or herbal, in combination with the antidepressant. There is risk of both dangerous rises of blood pressure and the serotonin syndrome.
Excessive stimulation can also result from combining stimulant herbals, including Ephedra with any other stimulant, including even caffeine.
The risk of high blood pressure, with or without combination with other drugs, should be recognized for Yohimbine and Ephedra.
The consumer should be especially wary of combination herbals, which can contain several of the above ingredients. Mahuang is one notorious example.
In general, it seems questionable to combine two agents of a similar type, whether they are herbals or prescription medications. This would mean, for example, two antidepressants or two anti-anxiety medications. For one thing, the results may exceed those expected or desired; for another thing, it may make more sense to adjust dosage of one or the other to determine its therapeutic effects and, if these prove insufficient even at maximal dosage, try something different instead of adding something else.
Finally, the consumer of any medications, prescription or herbal, should bear in mind that drug-drug interactions are everywhere, and most of them do not represent real dangers. Rather, they usually represent mechanisms, often involving decrease or increase in the activity of drug-metabolizing enzymes in the liver, which can cause corresponding mild to moderate increase or decrease in blood levels and/or effects of one or the other medications being taken in combination.
Dr. Ayd quotes the eminent psychopharmacological researcher, Dr. James Jefferson, who pointed out that “drug interactions themselves are mindless; they have no inherent evil intent, yet there is the potential for great harm unless they are recognized and properly managed.”
When the interactions involve over-the-counter agents like herbals, it is up to the consumer, as well as the doctor, to recognize the potential for interactions — and alert the doctor to their use.
Tags: drug-herbal interactions, prescription antidepressant, sleeping medications
