Black cohosh Uses: Relief of menopausal symptoms, menstrual cramps, and premenstrual syndrome

Nausea, diarrhea, dizziness, nervous system and visual disturbances, decreased heart rate, perspiration, spontaneous abortion

Potentiates the effects of antihypertensives, leading to hypotension; potentiates the hypoglycemic effects of insulin and oral hypoglycemics.

Contraindicated in pregnancy (may cause spontaneous abortion). Tell clients not to use in place of estrogen replacement therapy. Monitor blood pressure in clients taking antihypertensives.

Echinacea Uses: Treatment and prevention of colds, flu, other upper respiratory infections, and urinary tract and other mild infections. Topical echinacea, used for treatment of psoriasis, burns, eczema, and wounds.

Allergic reaction, nausea, vomiting, fever; hepatotoxicity when used for longer than 8 weeks

Decreases the effects of cyclosporine (Neoral, Sandimmune), methotrexate (Amethopterin, Folex PFS, Rheumatrex), anabolic steroids, and other cancer chemotherapeutic and immunosuppressant drugs. With extended use, increases the risk of liver toxicity when used with other hepatotoxic drugs, such as ketoconazole (Nizoral).

Contraindicated in clients with human immunodeficiency virus (HIV) infection, tuberculosis, and autoimmune diseases, such as lupus or multiple sclerosis. Tell clients not to use for longer than 8 weeks to prevent overstimulation of the immune system. Assess for signs and symptoms of liver toxicity such as jaundice, brown urine, clay colored stools, changes in liver function tests.

Ephedra (ma-huang) Uses: Treatment of colds, flu, asthma, bronchospasm, congestion, and bronchitis. Dieters use as an appetite suppressant, also used as a central nervous system (CNS) and cardiovascular stimulant.

Heart attack, seizures, stroke, kidney stones, dizziness, motor restlessness, tremors, irritability, insomnia, headache, anorexia, nausea, vomiting, flushing, tingling, tachycardia, increased blood pressure and blood glucose levels, weight loss, death

Increases the effects of theophyline, decongestants, monoamine oxidase inhibitors (MAOIs), caffeine, and other CNS stimulants. Increases blood glucose levels. Can cause cardiac arrythmias when administered with cardiac glycosides or halothane.

Should not be taken by clients with heart disease, hypertension, glaucoma, hyperthyroidism, diabetes mellitus, prostate enlargement, or psychiatric or seizure disorders because of sympathetic nervous system effects. Contraindicated in pregnancy (may cause uterine contractions). Should not be used with OTC products containing ephedra alkaloids Note: Products containing more than 10 mg/dose are banned in the United States. Stroke, MI, and death have occurred with high doses.

Feverfew Uses: Treatment of migraine, suppress inflammation, fever, GI upset, and stimulate menstruation.

Nausea, vomiting, diarrhea, abdominal pain

Increases the risk of bleeding with antiplatelet drugs and anticoagulants

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  Avoid chewing feverfew.

  
  
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  If allergic to ragweed, may also be allergic to feverfew.

Garlic Uses: Treatment of hypertension, hypercholesterolemia, atherosclerosis, colds, flu, gastrointestinal (GI) disturbances, rheumatism, asthma, diabetes mellitus; cancer prevention

Allergic reaction, headache myalgia, fatigue, halitosis, GI upset, diarrhea, nausea, vomiting; enhances bleeding

Increases the effects of anticoagulant, antiplatelet, and thrombolytic drugs, including abciximab (ReoPro), anegrelide HCL (Agrylin), clopidogrel bisulfate (Plavix) dipyridamole (Persantine), sulfinpyrazone (Anturane), ticlodipine HCL (Ticlid), tirofiban HCL (Aggrastat), warfarin sodium (Coumadin), and aspirin, increasing the risk of bleeding.

Teach clients to recognize signs and symptoms of bleeding, such as bruising and tarry stools. Tell clients not to substitute garlic for diabetes medications, antihypertensives, or cholesterol-reducing drugs.

Ginger Uses: Treatment of motion nausea, and vomiting (except in pregnancy), GI discomfort, flatulence, anorexia, arthritis, and other inflammatory conditions

Allergic reaction, dermatitis; large overdoses can cause CNS depression and cardiac arrhythmias; enhances bleeding

Increases the effects of anticoagulant and antiplatelet drugs. Decreases the effects of antihypertensives

Should be taken when nausea and vomiting are anticipated. Teach clients to recognize signs and symptoms of bleeding. Not indicated for morning sickness. Monitor blood pressure in clients taking antihypertensives. Contraindicated in clients with bleeding disorders.

Gingko biloba Uses: Treatment of dementia, cerebrovascular insufficiency. intermittent claudication, macular degeneration, vertigo, tinnitus. Improvement of memory and cognition

Allergic reaction, headache, nausea, vomiting, diarrhea, dizziness, palpitations, skin reaction, decreased fertility; enhances bleeding

Potentiates the effects of anticoagulant, antiplatelet, and thrombolytic drugs. Increases the effects of MAOIs

Teach clients to recognize signs and symptoms of bleeding.

Ginseng Uses: To improve physical and mental stamina, enhance athletic performance, treat erectile dysfunction, protect the heart, and lower blood pressure

Chest pain, nausea, vomiting, diarrhea, palpitations, hypertension, insomnia, pruritus, Stevens-Johnson syndrome, nervousness; enhances bleeding

Increases the effects of antidiabetic agents and insulin, causing hypoglycemia. Increases the effects of MAOIs, corticosteroids, and caffeine. Increases the risk of bleeding when used with antiplatelet agents of nonsteroidal anti-inflammatory drugs

Teach clients to recognize signs and symptoms of bleeding. Limit use to 3 weeks. Watch for ginseng abuse syndrome (insomnia, hypertension, edema, diarrhea, hypertonia) in clients also using other stimulants. Caffeine intake should be limited.

Kava kava Uses: Treatment of anxiety, restlessness, tension, nervousness

Liver damage and toxicity, jaundice, visual problems, dilated pupils, hangover, sedation, extrapyramidal effects (dyskinesia, torticolis, exacerbation of the symptoms of Parkinson’s disease)

Increased risk of liver toxicity when used with other hepatotoxic drugs. Increases the sedative effects of benzodiazepines, alcohol, and other CNS depressants. Coma has occurred when used with alprazolam (Xanax). Antagonizes levodopa (Dopar, Larodopa, L-Dopa)

Contraindicated in liver disease. Assess for signs and symptoms of hepatotoxicity. Tell clients not to drink alcohol, take other CNS depressants, or perform activities that require mental alertness when taking the herb. Limit use to 3 months or less to avoid psychological dependence. Should not be used by clients with Parkinson’s disease because it antagonizes dopamine.

Saw palmetto Uses: To relieve symptoms of benign prostatic hypertrophy, to manage urinary tract infection, and as a mild diuretic

GI upset, nausea, abdominal pain, hypertension, headache urinary retention, back pain

Reduces the absorption of iron. Decreases the effectiveness of hormone therapy, oral contraceptives (OCs), and adrenergic drugs

Tell men that the herb can cause false-positive prostate-specific antigen test results. Warn women that taking the herb can prevent birth control pills from working. Contraindicated in pregnancy due to its hormonal effects.

St. John’s wort Uses: Treatment of depression, anxiety, nervous unrest, excitability, neuralgia, and mood disturbances associated with menopause

Insomnia, vivid dreams, restlessness, anxiety, agitation, irritability, GI upset, fatigue, dizziness, headache, allergic reaction, confusion, dry mouth

Increases the adverse effects of antidepressants. Can cause serotonin syndrome (sweating, tremor, flushing, confusion, agitation) when taken with selective serotonin reuptake inhibitors (SSRIs). Increased risk of skin reactions when taken with other photosensitive drugs, such as tetracycline, thiazides, or sulfonamides. Decreases the absorption of iron. Reduces serum levels of digoxin (Lanoxin), cyclosporine, indinavir sulfate (Crixivan), amitriptyline HCL (Elavil), nortriptyline HCL (Aventyl, Pamelor), warfarin, and theophyline. Causes breakthrough bleeding when used with OCs. Reduces barbiturate-induced sleep times and prolongs narcotic-induced sleep times

Explain that the herb can take up to 6 weeks to work. Assess for suicidal ideation and worsening of depression. Tell clients not to take the herb with other antidepressants. Tell clients taking the herb with warfarin to advise the health care team if they plan to discontinue the herb’s use. Such discontinuation can cause a surge in warfarin levels. Instruct clients to avoid sun exposure. Make sure clients with HIV know that the herb can reduce the effectiveness of certain protease inhibitors.

Valerian root Uses: Treatment of insomnia, anxiety, agitation, restlessness

Allergic reaction, daytime drowsiness, dizziness, and depression

May increase the sedative effects of barbiturates

Tell clients not to drink alcohol, take other CNS depressants, or operate heavy machinery when taking this herb.

Reprinted with permission from RN Magazine. Getting a handle on herbals. RN-: Traveling Nursing Today. 2002; September:20-21.