Recommendations

Avoid — there may be insufficient information available to be able to advise using the two substances safely together, so avoid until more is known. The drug may have a narrow therapeutic index and there is sufficient evidence to suggest that the interaction may be clinically significant. Consider an alternative treatment that is unlikely to produce an undesirable interaction.

Avoid use unless under medical supervision — harmful effects of the potential interaction can be avoided if doses are altered appropriately under professional supervision or the patient is closely monitored. Some of these interactions can be manipulated to the advantage of the patient. Changes to the dosage regimen may be required for safe combined use.

Caution — the possibility exists of an interaction that may change effects clinically; be aware and monitor. It is prudent to tell patients to be aware and 2_Herb/nutrient-drug interac-

seek advice if they are concerned. tions 1419

Observe — interaction may not be clinically significant at the usual recommended doses and theoretical; however, the clinician should be alert to the possibility of an interaction.

Beneficial interaction possible — prescribing the interacting substance may improve clinical outcomes; for example, reducing drug requirements, complementing drug effects, reducing drug side-effects, counteracting nutritional deficiencies caused by drugs, alleviating drug withdrawal symptoms, and enhancing patient wellbeing.

2 — Herb/nutrient—drug interactions 1420

Key to the Table by Herb/Supplement

Adhatoda

Codeine

Theophylline

Albizia

Antidepressants including SSRIs, SNRIs, tricyclics and MAOIs ..

Antihistamines and mast-cell-stabilising drugs

Barbiturates

Aloe vera

Helicobacter pylori triple-therapy

Hypoglycaemic (e.g. metformin)

Topical corticosteroids (e.g. hydrocortisone)

Andrographis

Alcohol

Anticoagulants (e.g. warfarin)

Antiplatelet drugs

Barbiturates

Hepatotoxic drugs

Hypoglycaemic (e.g. metformin)

Paclitaxel

Paracetamol

Tricyclic antidepressants

Astragalus

Nitroglycerin/ glyceryl trinitrate (e.g. anginine)

Paclitaxel

Baical skullcap

Antihistamines and mast-cell-stabilising drugs

Interferon

Paclitaxel

Beta-carotene

Cholestyramine (e.g. Questran lite, colestipol [e.g. Colestid]) .. Bilberry

Antiplatelet drugs

Hypoglycaemic (e.g. metformin)

Bitter melon

Hypoglycaemic (e.g. metformin)

Brahmi

Tacrine

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