From: Evaluation and implications of natural product use in preoperative patients: a retrospective review
Herb | Pharmacological Effect | Perioperative Concerns | Preoperative Discontinuation |
---|---|---|---|
Echinacea | Activation of cell-mediated immunity | Allergic reactions, decreased effectiveness of immunosuppressants; potential for immunosuppression with long-term use | No data |
Ephedra (ma huang) | Increased HR and BP through direct and indirect sympathomimetic effects | Risk of MI and stroke from tachycardia and htn; ventricular arrhythmias with halothane; long-term uses depletes endogenous catecholamines and may cause intraoperative hemodynamic instability; life-threatening interaction with MAOI's | At least 24 hours before surgery |
Garlic | Inhibition of platelet aggregation, increased fibrinolysis, equivocal antihypertensive activity | Potential to increase risk of bleeding, especially when combined with other medications that inhibit platelet aggregation | At least 7 days before surgery |
Ginkgo | Inhibition of platelet-activating factor | Potential to increase risk of bleeding, especially when combined with other medications that inhibit platelet aggregation | At least 36 hours before surgery |
Ginseng | Lowers blood glucose; inhibition of platelet aggregation; increased PT-PTT in animals; varied others | Hypoglycemia; potential to increase risk of bleeding; potential to decrease anticoagulation effects of warfarin | At least 7 days before surgery |
Kava | Sedation, anxiolysis | Potential to increase sedative effect of anesthetics; potential for addiction, tolerance, and withdrawal after abstinence unstudied | At least 24 hours before surgery |
St. John's Wort | Inhibition of neurotransmitter reuptake, MAO inhibition unlikely | Induction of P450 enzymes (CYP 3A4) affecting cyclosporine, warfarin, steroids, protease inhibitors, and possibly benzo's, calcium channel blockers, and many other drugs; decreased serum digoxin levels | At least 5 days before surgery |
Valerian | Â | Â | Â |