Skip to main content
SpringerLink
Log in

Herbal Medications and Vitamin Supplements

  • Chapter
  • First Online:
Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care

Abstract

The use of dietary supplements in North America has exploded over the last two decades. Some of the most commonly used supplements include multiple vitamins; B vitamins; vitamins C, E, and D; valerian; chamomile; garlic; ginkgo; St. John’s wort; evening primrose oil; soy; aloe; and echinacea. Many patients do not disclose their use of supplements to their healthcare providers. This is problematic because many supplements have the potential to interact with medications used during the perioperative period or in an acute care setting. Interactions can be either pharmacodynamic or pharmacokinetic. The level of evidence supporting these interactions varies substantially, ranging from in vitro studies to findings from reliable pharmacokinetic trials. In order to maintain patient safety, incorporating supplement-specific questions into patient interviews is crucial. Dietary supplements should be discontinued 2 weeks before elective surgical procedures to avoid potential perioperative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Significant amendments to the FD&C Act: Dietary Supplement Health and Education Act of 1994. U.S. Food and Drug Administration website. Available at: http://www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/SignificantAmendmentstotheFDCAct/ucm148003.htm. Accessed 28 Mar 2013.

  2. Consumer Union of US Inc. Dangerous supplements: what you don’t know about these 12 ingredients could hurt you. September 2010. Available at: http://www.consumerreports.org/cro/2012/05/dangerous-supplements/index.htm. Accessed 19 Jan 2013.

  3. Wu CH, Wang CC, Kennedy J. Changes in herb and dietary supplement use in the US adult population: a comparison of the 2002 and 2007 National Health Interview Surveys. Clin Ther. 2011;33(11):1749–58.

    Article  PubMed  Google Scholar 

  4. Barnes PM, Bloom B. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2008;12:1–23.

    PubMed  Google Scholar 

  5. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA. 2002;287(3):337–44.

    Article  PubMed  Google Scholar 

  6. Significant Amendments to the FD&C Act: Dietary Supplement and Nonprescription Drug Consumer Protection Act. U.S. Food and Drug Administration Web site. http://www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/SignificantAmendmentstotheFDCAct/ucm148035.htm. Accessed 3 Apr 2013.

  7. Kaye AD, Clarke RC, Sabar R, Vig S, et al. Herbal medicines: current trends in anesthesiology practice – a hospital survey. J Clin Anesth. 2000;12:468–71.

    Article  CAS  PubMed  Google Scholar 

  8. Grauer RP, Thomas RD, Tronson MD, Heard GC, Diacon M. Preoperative use of herbal medicines and vitamin supplements. Anaesth Intensive Care. 2004;32:173–7.

    CAS  PubMed  Google Scholar 

  9. Norred CL. Complementary and alternative medicine use by surgical patients. AORN J. 2002;76:1013–21.

    Article  PubMed  Google Scholar 

  10. Lucenterforte E, Gallo E, Pugi A, Giommoni F, et al. Complementary and alternative drugs use among preoperative patients: a cross-sectional study in Italy. Evid Based Complement Alternat Med. 2012;2012:527238.

    Google Scholar 

  11. Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA. 2001;286:208–16.

    Article  CAS  PubMed  Google Scholar 

  12. Denke MA. Dietary retinol–a double-edged sword. JAMA. 2002;287(1):102–4.

    Article  PubMed  Google Scholar 

  13. Jellin JM, Gregory PJ, eds. Natural Medicines Comprehensive Database. Therapeutic Research Center: Stockton, 2013. Available at: www.naturaldatabase.com. Accessed 28 Mar 2013.

  14. Pohanka M, Pejchal J, Snopkova S, et al. Ascorbic acid: an old player with a broad impact on body physiology including oxidative stress suppression and immunomodulation: a review. Mini Rev Med Chem. 2012;12(1):35–43.

    Article  CAS  PubMed  Google Scholar 

  15. Herr C, Greulich T, Koczulla RA, et al. The role of vitamin D in pulmonary disease: COPD, asthma, infection, and cancer. Respir Res. 2011;12:31.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Liu M, Wallmon A, Olsson-Mortlock C, Wallin R, Saldeen T. Mixed tocopherols inhibit platelet aggregation in humans: potential mechanisms. Am J Clin Nutr. 2003;77(3):700–6.

    CAS  PubMed  Google Scholar 

  17. Vermeer C, Schurgers LJ. A comprehensive review of vitamin K and vitamin K antagonists. Hematol Oncol Clin North Am. 2000;14:339–53.

    Article  CAS  PubMed  Google Scholar 

  18. Power ML, Heaney RP, Kalkwarf HJ, et al. The role of calcium in health and disease. Am J Obstet Gynecol. 1999;181(6):1560–9.

    Article  CAS  PubMed  Google Scholar 

  19. Vincent JB. The biochemistry of chromium. J Nutr. 2000;130:715–8.

    CAS  PubMed  Google Scholar 

  20. Dallman PR. Biochemical basis for the manifestations of iron deficiency. Annu Rev Nutr. 1986;6:13–40.

    Article  CAS  PubMed  Google Scholar 

  21. Saris NE, Mervaala E, Karppanen H, Khawaja JA, Lewenstam A. Magnesium: an update on physiological, clinical, and analytical aspects. Clin Chim Acta. 2000;294:1–26.

    Article  CAS  PubMed  Google Scholar 

  22. Klein AD, Penneys NS. Aloe vera. J Am Acad Dermatol. 1988;18:714–20.

    Article  CAS  PubMed  Google Scholar 

  23. Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause. 2006;13:185–96.

    Article  PubMed  Google Scholar 

  24. Giacalone M, Di Sacco F, Traupe I, Topini R, Forfori F, Giunta F. Antioxidant and neuroprotective properties of blueberry polyphenols: a critical review. Nutr Neurosci. 2011;14(3):119–25.

    Article  CAS  PubMed  Google Scholar 

  25. Wang Y, Tang H, Nicholson JK, et al. A metabonomic strategy for the detection of the metabolic effects of chamomile (Matricaria recutita L.) ingestion. J Agric Food Chem. 2005;53:191–6.

    Article  CAS  PubMed  Google Scholar 

  26. Avallone R, Zanoli P, Puia G, et al. Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla. Biochem Pharmacol. 2000;59:1387–94.

    Article  CAS  PubMed  Google Scholar 

  27. Lee YL, Owens J, Thrupp L, Cesario TC. Does cranberry juice have antibacterial activity? JAMA. 2000;283:1691.

    Article  CAS  PubMed  Google Scholar 

  28. Duthie GG, Kyle JA, Jenkinson AM, et al. Increased salicylate concentrations in urine of human volunteers after consumption of cranberry juice. J Agric Food Chem. 2005;53:2897–900.

    Article  CAS  PubMed  Google Scholar 

  29. Barrett B. Medicinal properties of Echinacea: a critical review. Phytomedicine. 2003;10:66–86.

    Article  CAS  PubMed  Google Scholar 

  30. Guivernau M, Meza N, Barja P, Roman O. Clinical and experimental study on the long-term effect of dietary gamma-linolenic acid on plasma lipids, platelet aggregation, thromboxane formation, and prostacyclin production. Prostaglandins Leukot Essent Fatty Acids. 1994;51:311–6.

    Article  CAS  PubMed  Google Scholar 

  31. Ali M, Thomson M, Afzal M. Garlic and onions: their effect on eicosanoid metabolism and its clinical relevance. Prostaglandins Leukot Essent Fatty Acids. 2000;62:55–73.

    Article  CAS  PubMed  Google Scholar 

  32. Kudolo G. Ingestion of Ginkgo biloba extract significantly inhibits collagen-induced platelet aggregation and thromboxane A2 synthesis. Altern Ther. 2001;7:105.

    Google Scholar 

  33. McElhaney JE, Gravenstein S, Cole SK, et al. A placebo-controlled trial of a proprietary extract of North American ginseng (CVT-E002) to prevent acute respiratory illness in institutionalized older adults. J Am Geriatr Soc. 2004;52:13–9.

    Article  PubMed  Google Scholar 

  34. Vuksan V, Stavro MP, Sievenpiper JL, et al. Similar postprandial glycemic reductions with escalation of dose and administration time of American ginseng in type 2 diabetes. Diabetes Care. 2000;23:1221–6.

    Article  CAS  PubMed  Google Scholar 

  35. Park HJ, Lee JH, Song YB, Park KH. Effects of dietary supplementation of lipophilic fraction from Panax ginseng on cGMP and cAMP in rat platelets and on blood coagulation. Biol Pharm Bull. 1996;19:1434–9.

    Article  CAS  PubMed  Google Scholar 

  36. Sievenpiper JL, Arnason JT, Leiter LA, Vuksan V. Decreasing, null and increasing effects of eight popular types of ginseng on acute postprandial glycemic indices in healthy humans: the role of ginsenosides. J Am Coll Nutr. 2004;23:248–58.

    Article  CAS  PubMed  Google Scholar 

  37. Calapai G, Crupi A, Firenzuoli F, et al. Serotonin, norepinephrine and dopamine involvement in the antidepressant action of hypericum perforatum. Pharmacopsychiatry. 2001;34:45–9.

    Article  CAS  PubMed  Google Scholar 

  38. Normen L, Dutta P, Lia A, et al. Soy sterol esters and B-sitostanol ester as inhibitors of cholesterol absorption in human small bowel. Am J Clin Nutr. 2000;71:908–13.

    CAS  PubMed  Google Scholar 

  39. Houghton PJ. The scientific basis for the reputed activity of Valerian. J Pharm Pharmacol. 1999;51:505–12.

    Article  CAS  PubMed  Google Scholar 

  40. Montorsi F, Strambi LF, Guazzoni G, et al. Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study. Urology. 1994;44:732–6.

    Article  CAS  PubMed  Google Scholar 

  41. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials. J Urol. 1998;159:433–6.

    Article  CAS  PubMed  Google Scholar 

  42. Thompson PD, Clarkson P, Karas RH. Statin-associated myopathy. JAMA. 2003;289:1681–90.

    Article  CAS  PubMed  Google Scholar 

  43. Turunen M, Olsson J, Dallner G. Metabolism and function of coenzyme Q. Biochim Biophys Acta. 2004;1660:171–99.

    Article  CAS  PubMed  Google Scholar 

  44. Nestel PJ. Fish oil and cardiovascular disease: lipids and arterial function (abstract). Am J Clin Nutr. 2000;71:228S–31.

    CAS  PubMed  Google Scholar 

  45. Calder PC. N-3 polyunsaturated fatty acids, inflammation and immunity: pouring oil on troubled waters or another fishy tale? Nutr Res. 2001;21:309–41.

    Article  CAS  Google Scholar 

  46. Sherman AL, Ojeda-Correal G, Mena J. Use of glucosamine and chondroitin in persons with osteoarthritis. PM R. 2012;4(5 Suppl):S110–6.

    Article  PubMed  Google Scholar 

  47. Gupta V, Garg R. Probiotics. Indian J Med Microbiol. 2009;27:202–9.

    Article  CAS  PubMed  Google Scholar 

  48. Rosenbaum JF, Fava M, Falk WE, et al. The antidepressant potential of oral S-adenosyl-l-methionine. Acta Psychiatr Scand. 1990;81:432–6.

    Article  CAS  PubMed  Google Scholar 

  49. Bottiglieri T. S-Adenosyl-L-methionine (SAMe): from the bench to the bedside–molecular basis of a pleiotrophic molecule. Am J Clin Nutr. 2002;76:1151S–7.

    CAS  PubMed  Google Scholar 

  50. Rozenfeld V, Crain JL, Callahan AK. Possible augmentation of warfarin effect by glucosamine-chondroitin. Am J Health Syst Pharm. 2004;61:306–7.

    PubMed  Google Scholar 

  51. Knudsen J, Sokol GH. Potential glucosamine-warfarin interaction resulting in increased international normalized ratio: case report and review of the literature and MedWatch database. Pharmacotherapy. 2008;28:540–8.

    Article  CAS  PubMed  Google Scholar 

  52. Yue QY, Strandell J, Myrberg O. Concomitant use of glucosamine may potential the effect of warfarin. The Uppsala Monitoring Centre. Available at: www.who-umc.org/graphics/9722.pdf. Accessed 28 Apr 2008.

  53. Benjamin J, Muir T, Briggs K, Pentland B. A case of cerebral haemorrhage-can Ginkgo biloba be implicated? Postgrad Med J. 2001;77:112–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Rowin J, Lewis SL. Spontaneous bilateral subdural hematomas with chronic Gingko biloba ingestion. Neurology. 1996;46:1775–6.

    Article  CAS  PubMed  Google Scholar 

  55. Miller LG, Freeman B. Possible subdural hematoma associated with Ginkgo biloba. J Herb Pharmacother. 2002;2:57–63.

    Article  PubMed  Google Scholar 

  56. Bent S, Goldberg H, Padula A, Avins AL. Spontaneous bleeding associated with Ginkgo biloba: a case report and systematic review of the literature. J Gen Intern Med. 2005;20:657–61.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Meisel C, Johne A, Roots I. Fatal intracerebral mass bleeding associated with Ginkgo biloba and ibuprofen. Atherosclerosis. 2003;167:367.

    Article  CAS  PubMed  Google Scholar 

  58. Vale S. Subarachnoid haemorrhage associated with Ginkgo biloba. Lancet. 1998;352:36.

    Article  CAS  PubMed  Google Scholar 

  59. Kellermann AJ, Kloft C. Is there a risk of bleeding associated with standardized ginkgo biloba extract therapy? A systematic review and meta-analysis. Pharmacotherapy. 2011;31:490–502.

    Article  CAS  PubMed  Google Scholar 

  60. Aruna D, Naidu MU. Pharmacodynamic interaction studies of Ginkgo biloba with cilostazol and clopidogrel in healthy human subjects. Br J Clin Pharmacol. 2007;63:333–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Kim BH, Kim KP, Lim KS, et al. Influence of Ginkgo biloba extract on the pharmacodynamic effects and pharmacokinetic properties of ticlopidine: an open-label, randomized, two-period, two-treatment, two-sequence, single-dose crossover study in healthy Korean male volunteers. Clin Ther. 2010;32:380–90.

    Article  CAS  PubMed  Google Scholar 

  62. Gregory PJ. The perioperative use of natural medicines. Therapeutic Research Center: Stockton, 2012. Available at: www.naturaldatabase.com. Accessed 28 Mar 2013.

  63. Donovan JL, DeVane CL, Chavin KD, et al. Multiple night-time doses of valerian (Valeriana officinalis) had minimal effects on CYP3A4 activity and no effect on CYP2D6 activity in healthy volunteers. Drug Metab Dispos. 2004;32:1333–6.

    Article  CAS  PubMed  Google Scholar 

  64. Irefin S, Sprung J. A possible cause of cardiovascular collapse during anesthesia: long-term use of St. John’s wort. J Clin Anesth. 2000;12:498–9.

    Article  CAS  PubMed  Google Scholar 

  65. Kaye AD, Baluch A, Kaye AM. Mineral, vitamin, and herbal supplements. In: Fleisher LA, editor. Anesthesia and uncommon diseases. 6th ed. Philadelphia: Elsevier; 2012. p. 477.

    Google Scholar 

  66. Kaye AD, Baluch A, Kaye AJ, Frass M, Hofbauer R. Pharmacology of herbals and their impact in anesthesia. Curr Opin Anaesthesiol. 2007;20:294–9.

    Article  PubMed  Google Scholar 

  67. Bauer S, Stormer E, Johne A, et al. Alterations in cyclosporin A pharmacokinetics and metabolism during treatment with St. John’s wort in renal transplant patients. Br J Clin Pharmacol. 2003;55:203–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  68. Mandelbaum A, Pertzborn F, martin-Facklam M, Wiesel M. Unexplained decrease of cyclosporine trough levels in a compliant renal transplant patient. Nephrol Dial Transplant. 2000;15:1473–4.

    Article  CAS  PubMed  Google Scholar 

  69. Morschella C, Jaber BL. Interaction between cyclosporine and Hypericum perforatum (St. John’s wort) after organ transplantation. Am J Kidney Dis. 2001;38:1105–7.

    Article  Google Scholar 

  70. Gurley BJ, Gardner SF, Hubbard MA, et al. Cytochrome P450 phenotypic ratios for predicting herb-drug interactions in humans. Clin Pharmacol Ther. 2002;72:276–87.

    Article  CAS  PubMed  Google Scholar 

  71. Piscitelli SC, Burstein AH, Welden N, et al. The effect of garlic supplements on the pharmacokinetics of saquinavir. Clin Infect Dis. 2002;34:234–8.

    Article  PubMed  Google Scholar 

  72. Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther. 2005;77:415–26.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  73. Cole MR, Fetrow CW. Adulteration of dietary supplements. Am J Health Syst Pharm. 2003;60(15):1576–80.

    PubMed  Google Scholar 

  74. Kaye AD, Kucera L, Sabar R. Perioperative anesthesia clinical considerations of alternative medicine. Anesthesiol Clin N Am. 2004;22:125–39.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Kansas & Evidence-Based Practice, Creighton University, Omaha, NE, USA

    Philip Gregory PharmD & Darren Hein PharmD

  2. Drug Information Center, University of Kansas, Lawrence, KS, USA

    Andrew Abe PharmD

Authors
  1. Philip Gregory PharmD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Abe PharmD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Darren Hein PharmD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip Gregory PharmD .

Editor information

Editors and Affiliations

  1. Departments of Anesthesiology and Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, Stockton, California, USA

    Adam M. Kaye

  3. Center for Perioperative Management and Medical Informatics, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

Chemical Structures

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Gregory, P., Abe, A., Hein, D. (2015). Herbal Medications and Vitamin Supplements. In: Kaye, A., Kaye, A., Urman, R. (eds) Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8948-1_33

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8948-1_33

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8947-4

  • Online ISBN: 978-1-4614-8948-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation