Conclusion

HMPs can be powerful medications which may cause both benefit and harm. In order to embark on reliable risk-benefit analyses, we need to know more about their clinical efficacy and about their adverse effects. An evidence-based approach to medical herbalism seems to be the most rational way ahead. This notion is in agreement with the opinion of 88 to 90% of users of HMPs who state that research into the safety and efficacy determines their product choice (Blumenthal, 2000).

TABLE 1.2

Examples of herb-drug interactions

Medicinal Herb

Interaction

Mechanism

Garlic

Increased effect of oral anticoagulants

Garlic has antiplatelet effects

Ginkgo biloba

Kava

St. John's wort

Increased effect of oral anticoagulants

Increased effect of other anxiolytic drugs

Increased breakdown of drugs metabolized in the liver

Ginkgo has antiplatelet effects

Synergistic action on central nervous system

Hepatic enzyme inducer

Note: For more details, see Ernst, E., Possible interactions between synthetic and herbal medicinal products. Part 1: a systematic review of the indirect evidence, Perfusion, 2000a, 134-6 ,8-15, and Ernst, E., Interactions between synthetic and herbal medicinal products. Part 2: a systematic review of the direct evidence, Perfusion, 2000b, 13:60-70.

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