Herbs, Spice and Not Everything Nice… (June, 2015)
How many times do you think this: It’s just an herb or a spice; I can consume it and it’s not a problem with my medication, because it’s natural? We think of natural as safe… not dangerous. Sometimes our doctors don’t have all the answers about interactions that occur among drugs, herbs, spices, and nutrients. A recent conversation with a client reminded me that ginger interferes with her blood thinner. That conversation led me to the idea that examining the interactions among substances we ingest would be a good topic for my monthly insight. I proceeded to consult my professional notes in addition to my current edition of the Food-Medication Interactions Handbook. My beloved late mentor, Christine Hamilton Smith, Ph.D., always made sure I had the latest copy as she was on the advisory board for this information-rich handbook. Below I have charted selected herbs/spices along with some of the medications with which they are known to have interactions. The third column addresses the possible concerns and/or complications resulting from these interactions.
| This herb/spice… | …if consumed while taking this/these medication(s)/drug(s)… | ...could lead to this effect due to the potential interaction. |
|---|---|---|
| Cumin | Anticoagulant/Antiplatelet drugs such as aspirin, clopidogrel, warfarin, Plavix, Xarelto | Excessive bleeding |
| Antidiabetic drugs such as Metformin, Glimepiride, Glyburide, insulin & rosiglitazone | May have an additive effect and increase hypoglycemia | |
| Rifampin | May increase the bioavailability and plasma levels of rifampin and increase the drug’s effects and adverse effects | |
| Dill | Antidiabetic drugs such as glyburide, glimepiride, rosiglitazone, insulin | Hypoglycemia (dangerous drop in blood sugar) |
| Lithium | May reduce excretion and increase levels of lithium. Dill may have diuretic properties. | |
| Anise | Contraceptive drugs | May increase the risk of bleeding |
| Estrogens | May interfere with drugs through competition for estrogen receptors | |
| Tamoxifen | Might interfere with drug because of potential estrogenic effects | |
| Black Pepper/White Pepper | Phenytoin | Piperine component in pepper may increase absorption, slow elimination & increase levels of drug |
| Propranolol | Piperine component in pepper may increase absorption & slow elimination of drug | |
| Theophylline | May decrease drug levels | |
| Rifampin | Piperine component in pepper may increase absorption & serum levels of drug | |
| May Increase drug levels | ||
| Chemotherapeutic agents, antifungals, protease inhibitors, some calcium channel blocker, digoxin | ||
| Clove | Aspirin, Clopidogrel, Ticlopidine, Heparin, Warfarin, Xarelto | May increase the risk of bleeding |
| Cassia/Cinnamon | Antidiabetic drugs such as glyburide, insulin, metformin, rosiglitazone,& glimepiride | May lower blood glucose levels & have additive effects |
| Hepatotoxic drugs such as atorvastatin, fluvastatin, acarbose, gemfibrozil, niacin, tamoxifen , pravastatin | May cause hepatotoxicity | |
| Saffron | Antihypertensive drugs such as enalapril, losartan, diltiazem, furosemide, &captopril may have additive effects& increase the risk of HTN | May have additive effects & increase risk of hypotension |
| May cause additive heart dilation effects | ||
| Turmeric | Anticoagulant/antiplatelet drugs such as aspirin, heparin, warfarin (Coumadin)clopidogrel, ticlopidine, dalteparin, enoxaparin, Xarelto | May decrease platelet aggregation & lead to increased risk of bleeding |
| Antidiabetic drugs such as glimepiride, glyburide, insulin, pioglitazone, rosiglitazone | May increase the risk of hypoglycemia | |
| Rosemary | Tamoxifen | May inhibit platelet aggregation & increase risk of bruising & bleeding |
| Anticoagulant/antiplatelet drugs such as aspirin, clopidogrel, NSAIDS, ibuprofen, heparin, warfarin (Coumadin), Xarelto, naproxen, & enoxaparin may inhibit platelet aggregation & increase the risk of bruising & bleeding | May decrease the antiestrogenic effect of tamoxifen | |
| Fennel | Ciprofloxacin | May reduce effectiveness of ciprofloxacin |
| Aspirin, heparin, Coumadin, Xarelto may increase the risk of bleeding | May increase the risk of bleeding | |
| Cytochrome P450 3A4 (CYP3A4) substrates drugs that may be affected by this system include calcium channel blockers, chemo agents, antifungals, glucocorticoids, & may inhibit CYP4A4 enzyme activity & increase levels of drugs metabolized by enzyme, increase drugs effect & adverse effects | May have estrogenic activity that could interfere with contraceptive drugs | |
| Estrogens may interfere with hormone replacement therapy | May inhibit CYP3A4enzyme activity & increase of drugs metabolized by enzyme, increasing drugs effects & adverse effects | |
| Tamoxifen | May interfere with hormone replacement therapy. May decrease the antiestrogenic effect of tamoxifen | |
| Ginger | Anticoagulant/antiplatelet drugs such as aspirin, clopidogrel, enoxaparin, warfarin, Xarelto | May increase risk of bleeding |
| Nifedipine | Inhibits platelet aggregation | |
| Warfarin (aka: Coumadin) | May inhibit thromboxane synthetase & decrease platelet aggregation | |
| Garlic | Aspirin, clopidogrel, enoxaparin (aka: Lovenox), warfarin, Xarelto | May increase prothrombin time (PT time). Might enhance the effects & adverse effects of anticoagulant & antiplatelet drugs |
| HTN drugs such as verapamil, diltiazem, felodipine, nifedipine, | May cause additive hypotensive effects | |
| Contraceptive drugs | May decrease effectiveness of contraceptive drugs | |
| Cyclosporine drugs | May decrease effectiveness of cyclosporine | |
| Cytochrome P450 2E1 (CYP2E1) substrates drugs metabolized by CYP2E1 include acetaminophen, chlorzoxazone, ethanol, theophylline & some anesthetics | May inhibit CYP2E1 activity | |
| Garlic | Cytochrome P450 3A4 (CPY3A4) substrate drugs that may be affected by this system include calcium channel blockers, chemo agents, antifungals, glucocorticoids, alfentanil | May induce activity of CYP3A4 |
| Isoniazid | May reduce isoniazid levels | |
| Non-nucleoside reverse transcriptase, or NNRTIs (antiretroviral drugs such as nevirapine, delavirdine, efavirenz) | May decrease plasma concentrations of protease inhibitor saquinavir & affect activity of CYP3A4 | |
| Saquinavir & possibly other protease inhibitors such as nelfinavir, ritonavir, amprenavir | May decrease concentrations of saquinavir, may affect activity of CYP3A4 | |
| Coumadin | May increase prothrombin time (PT time) and increase risk of bleeding | |
| licorice, plantain, uzara root, hawthorn & ginseng | Digoxin | Requires monitoring because herbs interfere with digoxin |
| Ginseng | Estrogens, corticosteroids | Interferes with estrogens & corticosteroids |
| Echinacea | immunosuppressants such as cyclosporine | Herb Interferes with these medications |
| St. John’s Wort & Saw Palmetto | Iron | May inhibit the absorption |
| Feverfew, garlic, ginkgo biloba, & ginseng | Coumadin (aka warfarin) | Interferes with these herbs; may alter bleeding time & should not be used. |
The chart clearly shows that spices and herbs are much more interactive than we may have thought. Of course, they can interact with each other to create delicious dishes packed with wonderful flavors. But when we add prescribed or even some over-the-counter (OTC) medications to the equation the resulting interaction can be a serious threat to health.
If either you or your physician has any doubt about the safety of taking a prescribed or OTC medication with some of the herbs and spices you use routinely in your cuisine, take a little time to consult a reference. The accompanying chart is a good place to begin, but you can find considerably more information in the references below.
Here’s to a meal that is flavorful, delicious, and free of harmful interactions, Bon Appetite!
References
1. Pronsky, Z., Crowe, J. Food-Medication Interactions Handbook 17th Edition. Food-Medication Interactions.
2. Natural Medicines Comprehensive Data Base: http://naturaldatabase.therapeuticresearch.com/
