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Table 1 Original Chart in APEC

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