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Presented by: UT El Paso / Austin Cooperative Pharmacy Program & Paso del Norte Health Foundation

Herbs to Avoid Before Surgery

Common name

(Spanish)

Scientific name/ Classification Uses Possible Complication/ Interaction Comments
Algae

(Algas marinas)

Fucus vesiculosus and other species Nutritional supplement, weight loss agent Platelet inhibition May potentiate anticoagulant activity of warfarin
Arnica

(Árnica europea)

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
Arnica, Mexican*

(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
Bilberry

(Arándano)

Vaccinium myrtilus Cataracts and other eye problems Platelet inhibition May potentiate anticoagulant activity of warfarin
Cat’s Claw

(Uña de gato)

Uncaria tomentosa,

U. guianensis

Arthritis, cancer, immune- system stimulant, anti- inflammatory, contraceptive Immune stimulant Possible tissue and organ transplant rejection
German Chamomile, Roman Chamomile

(Manzanilla)

Matricaria recutita

 

Chamaemelum nobile

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
Cinnamon

(Canela)

Cinnamomum verum Rubefacient, diabetes Essential oil from leaf and bark shows platelet inhibition due to eugenol content May potentiate anticoagulant activity of warfarin
Clove

(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
Cranberry

(Arándano agrio)

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

(Angélica china)

Angelica sinensis Menstrual complaints The herb may inhibit CYP2C9 enzymes Probable anticoagulant action
Feverfew

(Tanaceto)

Tanacetum officinale Migraine headaches, fever Platelet inhibition Possible anticoagulant action with aspirin and warfarin
Garlic

(Ajo)

Allium sativum Lowers cholesterol, anti- thrombotic Platelet inhibition May potentiate warfarin action
Ginger

(Jengibre)

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
Ginseng, Korean

(Ginseng coreano)

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
Grapefruit

Toronja

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
Meadowsweet

(Filipéndula)

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
Notoginseng

 

Panax notoginseng General tonic, adaptogen Platelet inhibition Observe caution if patient is taking warfarin
Passion flower

(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
Sweet birch

(Abeto)

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
Valerian root

(Valeriana)

Valeriana officinalis Sedative, anxiolytic May alter metabolism of drugs which are substrates of CYP3A4 isozymes The effects of anesthesia / sedatives could be enhanced
Wintergreen

(Gaulteria)

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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