1. Herbal Safety and Interactions with Heart Disease Prescription Drugs

2. Introduction Due to the increased consumption of herbal medicines, health care professionals should be more aware and pay more attention to patients taking them. Furthermore, there has been very little research on the safety of herbal medicine in the United States. Patients need to understand that even though herbal medicines may be natural, these products are not always safe.

3. Why is it a concern? Drug Interactions  Active ingredients in herbal medicines that are potent chemicals.  Interactions with other products and adverse reactions are also likely for herbal medicine, which is something else that manufacturers need to address correctly. Not FDA Approved  According to the U.S. Food and Drug Administration (FDA), herbal medicines are put under the category of food. They have different regulations than over-the-counter drugs and are considered safe until proven unsafe.  Herbal medicines are not FDA approved nor are labeled with safety warnings. It is up to the manufacturers to make sure all claims and information on the product label are correct. (http://www.fda.gov/Food/DietarySupplements/)

4. Heart Disease and Herbal Medicines

5. Heart Disease  Leading cause of death in the United States A commonly taken prescription medication for reducing the risk of pulmonary embolism, deep vein thrombosis, preventing strokes and heart attacks in patients with atrial fibrillation or artificial heart valves is: Warfarin  Anticoagulant  Antagonizes vitamin K  Inhibits the clotting of blood

6. Common Warfarin-Herb Interactions

7. HerbCommon UsesPotential Effect Ginseng (Panax) Boosts energy, stamina, and the immune system, lowers LDL cholesterol and blood pressure Increase blood pressure and decreases the effect of warfarin when overused Garlic (Allium sativum) Lowers total and LDL cholesterol and blood pressure, used as a blood thinner and prevent atherosclerosis Increase the risk of bleeding associated with warfarin Ginkgo (Ginkgo biloba) Improves memory and prevents dementia and Alzheimer’s disease, used to treat asthma, sexual dysfunction, poor circulation Increase the risk of bleeding associated with warfarin Green Tea (Camellia sinensis) Weight loss, improves mental alertness, lowers cholesterol, prevents cancer Vitamin K can counteract the effect of warfarin Ginger (Zingiber officinale Roscoe) Treats various stomach ailments like nausea, diarrhea, and stomachache, used to treat joint and muscle pain Increases the risk of bleeding associated with warfarin For more information on herb interactions: Complementary and Alternative Medicine Guide (http://umm.edu/health/medical/altmed )

8. Safety Promotion

9.  Ask about your patients’ conditions and any prescription or over- the-counter medicines they take during past medical history.  Ask about your patients’ eating patterns and any nutritional or herbal supplements, including herbal teas.  Tell your patients to notify you before they change their nutritional supplements or eating pattern.  before you change your nutritional supplements or eating pattern.  Note exactly the amount of herbal medications taken by the patient. Include frequency of the medicines taken and for what purpose.  Educate and help patients on how to purchase reliable herbal medicines and look for companies with good manufacturing practice.

10. Reflective Note This is a presentation for nurses and physicians at clinics/hospitals or conferences on the topic of herbal medicine safety and its interactions with prescription drugs. One might come across this presentation during team meetings or conferences. It is extremely important to document herbal medicines used by patients, especially patients with heart conditions. Potential herb-drug interactions could occur and it is important to educate health care providers on how to prevent them. Physicians and nurses need to take more initiative in asking patients about specific details on the herbal medicines they are taking. It is also crucial for physicians and nurses to educate patients on how to purchase reliable herbal medicines and look for companies with GMP.

11. References  Bradley J, McEwen BJ. (2015). The influence of herbal medicine on platelet function and coagulation: a narrative review. Seminars in Thrombosis and Hemostasis, 41(3), 300-314.  Ge, B., Zhang, Z., & Zuo, Z. (2014). Updates on the Clinical Evidenced Herb- Warfarin Interactions. Evidence-Based Complementary and Alternative Medicine, 2014, 1-18.  [Untitled photograph of doctor patient relationship]. Retrieved from: http://i.huffpost.com/gen/1142793/images/o-DOCTOR-PATIENT-RELATIONSHIP- facebook.jpg  [Untitled photograph of heart anatomy]. Retrieved from: http://jesupdoctor.com/wp- content/uploads/2012/04/heart-disease-jesup-doctor-wayne-county-medical-clinic.jpg  [Untitled photograph of natural herbs]. Retrieved from: http://organicsmanufacturer.com/modules//smartblog/images/14-single-default.jpg  [Untitled photograph of natural medicine still life]. Retrieved from: http://www.acuhhs.com/wp-content/uploads/bigstock-Natural-Medicine-Still-Life- 7509941.jpg