Herbs to Avoid Before Surgery
|Scientific name/ Classification||Uses||Possible Complication/ Interaction||Comments|
|Fucus vesiculosus and other species||Nutritional supplement, weight loss agent||Platelet inhibition||May potentiate anticoagulant activity of warfarin|
|Arnica montana||Applied externally for contusions, and bruises / Internally: homeopathic preparations for nervous disorders||Contains compounds that could interfere with blood clotting||Ingestion can be toxic and could potentiate anticoagulant activity of warfarin|
(Árnica del país, falsa árnica)
|Heterotheca inuloides||Applied externally for contusions, and bruises / Tea made from flowers taken for gastric ulcers||Contains compounds that could interfere with blood clotting||Ingestion can be toxic and could potentiate anticoagulant activity of warfarin|
|Ashwagandha, “Indian Ginseng”||Withania somnifera||Sedative, adaptogenic||Sedative action||May potentiate effects of barbiturates and benzodiazepinics|
|Vaccinium myrtilus||Cataracts and other eye problems||Platelet inhibition||May potentiate anticoagulant activity of warfarin|
(Uña de gato)
|Arthritis, cancer, immune- system stimulant, anti- inflammatory, contraceptive||Immune stimulant||Possible tissue and organ transplant rejection|
|German Chamomile, Roman Chamomile
|Colic, premenstrual syndrome, stomach upset, light sedative||Platelet inhibition (speculative)||Possible anticoagulant action|
|Chitosan||Swertia chirayita||High cholesterol, obesity||Platelet inhibition||May potentiate anticoagulant activity of warfarin|
|Cinnamomum verum||Rubefacient, diabetes||Essential oil from leaf and bark shows platelet inhibition due to eugenol content||May potentiate anticoagulant activity of warfarin|
(Clavo de olor)
|Syzygium aromaticum||Stomach ulcers, antiseptic / Essential oil applied topically for muscular pain||Essential oil shows platelet inhibition due to eugenol/methyleugenol content||May potentiate anticoagulant activity of warfarin|
|Vaccinium macrocarpon||Juice taken for urinary infections||Platelet inhibition||Probable anticoagulant action if combined with warfarin|
|Dan Shen||Salvia miltiorrhiza||Antioxidant, anti-inflammatory||This herb may have
induction effect on CYP3A and CYP1A2 enzymes
|Probable anticoagulant action if combined with warfarin|
|Dong Quai, Dang Gui, Chinese Angelica
|Angelica sinensis||Menstrual complaints||The herb may inhibit CYP2C9 enzymes||Probable anticoagulant action|
|Tanacetum officinale||Migraine headaches, fever||Platelet inhibition||Possible anticoagulant action with aspirin and warfarin|
|Allium sativum||Lowers cholesterol, anti- thrombotic||Platelet inhibition||May potentiate warfarin action|
|Zingiber officinale||Motion sickness, nausea and vomiting, digestive problems||Platelet inhibition||Probable anticoagulant action if combined with warfarin|
|Ginkgo||Ginkgo biloba||Memory enhancement, intermittent- claudication, senile dementia||Platelet inhibition||Possible anticoagulant action with aspirin and warfarin|
|Ginseng, American (Ginseng americano)||Panax quinquefolius||General tonic, adaptogen||Platelet inhibition / lowers blood glucose||Probable anticoagulant action if combined with warfarin|
|Panax ginseng||General tonic, adaptogen||Platelet inhibition / lowers blood glucose, may cause hypertension in high doses||Probable anticoagulant action if combined with warfarin|
|Goji berry||Lycium barbarum||Anti-diabetic, anti-cancer, antioxdiant||Platelet inhibition / lowers blood glucose||Possible interaction if used concurrently with warfarin|
|Citrus paradisiaca||Weight loss||Fruit and juice can potentiate the effects of certain statin drugs and calcium channel blockers||Grapefruit juice inhibits CYP1A2, among others. Possible interaction if used concurrently with warfarin|
|Green Tea (Té verde)||Camellia sinensis||Antioxidant||Platelet inhibition||Possible interaction if used concurrently with warfarin|
|Kava, Awa||Piper methysticum||Sedative, anxiolytic||Certain compounds in kava may be potentially hepatotoxic, especially when combined with alcohol||May prolong effects of anesthesia and potentiate the effects of benzodiazepinic drugs|
|Filipendula ulmaria||Essential oil applied for muscular pain and arthritis||Contains an anti- heparin complex that has in vitro fibrinolytic and anticoagulant properties||Salicylate compounds possess antiplatelet action/ could potentiate warfarin or heparin effects|
|Panax notoginseng||General tonic, adaptogen||Platelet inhibition||Observe caution if patient is taking warfarin|
(Pasiflora, Flor de la pasión)
|Passiflora incarnata||Sedative, anxiolytic, generalized anxiety disorder||Sedative action||This herb could cause additive sedation in combination with CNS depressants|
|Soybean (Soya, soja)||Glycine max||Lower cholesterol, nutritional supplement||Inhibitory effect of soy extracts
on CYP2C9 and CYP3A4
|Fermented soy products have a probable anticoagulant action if combined with warfarin|
|Betula lenta||Essential oil applied topically for muscular and arthritic pain||Platelet inhibition||Salicylate compounds may potentiate anticoagulant action of warfarin|
|St. John’s Wort
(Corazoncillo, Hipérico, Hierba de San Juan)
|Hypericum perforatum||Antidepressant||Increased clearance
of warfarin, possibly due to the induction of CYP enzymes, particularly
CY2C9 and 3A4
|St. John’s wort may potentiate the effects of clopidogrel, decrease plasma levels of phenprocoumon, and decrease drug levels of warfarin and INR|
|Valeriana officinalis||Sedative, anxiolytic||May alter metabolism of drugs which are substrates of CYP3A4 isozymes||The effects of anesthesia / sedatives could be enhanced|
|Gaultheria procumbens||Essential oil applied topically for muscular and arthritic pain||Platelet inhibition||Salicylate compounds may potentiate anticoagulant action of warfarin|
*Mexican arnica is part of a composite herbal tea known commercially as “Té Gastronól”, which is sold in herbal markets along the U.S. – Mexico border. This product was associated with prolonged bleeding time in a surgical patient (Rivera et al., 2009).
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