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Adverse Interactions between Herbal And Dietary Substances and Prescription Medications: A Clinical Survey

Thomas M. Bush, MD; Keith S. Rayburn, MD; Sandra W. Holloway, PharmD; Deanna S. Sanchez-Yamamoto, RNP; Blaine L. Allen, RN;
Tiffany Lam, PharmD; Brian K. So, PharmD; De H. Tran, MD; Elizabeth R. Greyber, MD; Sophia Kantor, MD; Larry W. Roth, MD

The use of herbal and dietary substances (herein referred to as herbal medicines) in the United States has increased substantially during the last decade. National telephone surveys documented an increase in the percentage of respondents using herbal remedies from 2.5% in 1990 to 18.8% in 2002.1,2 The common use of herbal medicines has been confirmed in smaller clinical studies, with use by 22% of patients in an internal medical clinic and 18% of patients in an arthritis clinic.3,4 Approximately 16% of patients combine herbal medicines with prescription medications.5 Herbal medicines have been associated with a variety of adverse herb-drug interactions;6,7 however, the actual incidence of adverse herb-drug interactions in patients using multiple herbal and prescription medications has not been measured.

A variety of herb-drug toxicities have been described in case reports and small studies. Fugh-Berman collected 108 case reports of suspected herb-drug interactions, including 18 with warfarin and 54 with St John’s wort.8 St John’s wort has been…

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