Aloe

May potentiate K wasting of thiazides or steroids

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Bilberry fruit

May alter absorption rates
May decrease capillary permeability and inhibit platelet aggregation

Recommended Stop Date:
14 days prior to OR

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Black Cohosh

Sedative
Contains salicylic acid-may have platelet aggregation difficulty
Can produce hypotension at high doses

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Chamomile

May delay concurrent drug absorption form the gut

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Cayenne: (capsicum annum)

Common Names:
Cayenne; Chili Pepper; Paprika

Common Uses:
External: muscle spasm or soreness
Internal: GI Tract disorders

Side Effects/Interactions:
-External: potential for skin ulcerations & blistering w/ >2days use
-Internal: overdose may cause severe hypothermia; may increase vascular permeability, increased catecholamines

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Dong Quai Root
Interferes with platelet aggregation
May potentiate effects of coumadin and other antiplatelet agents

Recommended Stop Date:
14 days prior

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Echinacea: (echinacea purpurea)

Common Names:
Purple Cone flower

Common Uses:
Common colds; Wounds and Burns; Urinary tract infections; Coughs & bronchitis

Side Effects/Interactions:
-May cause hepatotoxicity, esp. when used w/ other hepatotoxic drugs, i.e., anabolic steroids or methotrexate
-May seen decreased effectiveness of corticosteroids
-May potentiate barbiturate toxicity

Recommended Stop Date:
As far in advance as possible

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Ephedra: (ephedra sinica)

Common Names:
Ma-Huang; Ephedrine; Chinese Joint Fir

Common Uses:
OTC Diet Aids; Bacteriostatic; Anittussive

Side Effects/Interactions:
-Heart glycosides or halothane: arrhythmias
-Guanethidine: enhanced sympathomimetic effects
-MAO Inhibitors: enhanced sympathomimetic effects. May interact with halothane or cardiac glycosides to cause dysrhythmias, life threatening interaction when used with MAOI’s
-Oxytocin: hypertension
-May cause catecholamine depletion; profound intraoperative hypotension, MI, cardiomyopathy or thrombotic stroke.

Recommended Stop Date:
At least 24 hours prior to OR

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Eleutherococcus; Siberian ginseng

May increase Digoxin levels; use in caution with stimulants
May predispose to hypoglycemia

Recommended Stop Date:
14 days prior

Evening Primrose Oil

May inhibit platelet aggregation
May decrease seizure threshold of anticonvulsants

Recommended Stop Date:
14 days prior

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Fenugreek

Tachycardia
May cause hypoglycemia
May decrease platelet aggregation

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Feverfew: (tanacetum parthenium)

Common Names:
Feverfew; Featherfew; Midsummer Daisy

Common Uses:
Migraine prophylactic; Antipyretic

Side Effects/Interactions:
-Platelet inhibition & increased bleeding. Avoid use in patients on warfarin or other anticoagulants
-Rebound headache w/ sudden cessation
-5-15% incidence of aphthous ulcers or GI tract irritation

Recommended Stop Date:
14 days prior

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Garlic: (allium sativum)

Common Names:
Clove garlic; Ajo

Common Uses:
Lipid lowering; Blood pressure lowering; has antiplatelet, antioxidant, antithrombolytic properties

Side Effects/Interactions:
-May potentiate warfarin; will increase INR (PT)
-Inhibits platelet aggregation
-Increases fibrinolysis
-May potentiate the effects of antihypertensives

Recommended Stop Date:
7 days prior

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Ginger: (zingiber officinale)

Common Names:
Black ginger; African ginger

Common Uses:
Antinauseant; Antispasmodic

Side Effects/Interactions:
-Potent inhibitor of thromboxane synthetase; may increase bleeding time
-Use caution when taking warfarin; may cause excessive bleeding
-May have an effect on platelet activating factor
-May have hypertensive effect

Recommended Stop Date:
14 days

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Gingko: (gingko biloba)

Common Names:
Maidenhair tree; Fossil tree

Common Uses:
Circulatory stimulant

Side Effects/Interactions:
-May enhance bleeding in patients on anticoagulant or antithrombolytic therapy, i.e., aspirin, NSAIDS, warfarin, or heparin
-Inhibits platelet activating factor
-May stimulate endothelial releasing factor and prostacyclin

Recommended Stop Date:
36 hours prior
14 days optimum

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Ginseng: (panax ginseng)

Common Names:
American Ginseng; Chinese Ginseng; Korean Ginseng

Common Uses: Adaptogenic; Incr. Energy level (athletes); Antioxidant

Side Effects/Interactions:
-Ginseng Abuse Syndrome (>15g/day): sleepiness, hypertonia, edema
-Avoid use w/ other stimulants: may cause tachycardia or hypertension
-May alter homeostasis
-Contraindicated in renal failure

Recommended Stop Date:
7 days prior

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Goldenseal: (hydrastis canadensis)

Common Names:
Orange root; Yellow root: Ground raspberry: Turmeric root: Eye root

Common Uses:
Diuretic; Anti-inflammatory; Laxative; Hemostatic

Side Effects/Interactions:
-Functions as oxytocic
-Overdose may cause paralysis (amount not known)
-Functions as an aquaretic, not diuretic (no Na excreted, just free water)
-May worsen edema and/or hypertension
-Tachycardia/hypertension (18gm - very high dose)
-May oppose the action of heparin
-May alter liver enzymes
-High doses may cause bradycardia or hypotension (2-3g)

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Gotu Kola

CNS depressant

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Hawthorn

May increase Digoxin levels
-Vasodilator
-Cardiotonic (tends to increase the efficiency or the force of myocardial contractions)
-May interact with ACE inhibitors

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Kava-kava: (piper methysticum)

Common Names:
Ava; Kawa; Ava Pepper

Common Uses:
Anxiolytic

Side Effects/Interactions:
-Potentiates barbiturates and benzodiazepines (modifies GABA receptors in the brain)
-Analgesia through non-opiate pathways
-May prolong anesthesia
-May have diuretic effect
-Can potentiate ethanol effects
-Incr. Suicide risk in patients w/ endogenous depression

Recommended Stop Date:
24 hours

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Licorice: (glycyrrhiza glabra)

Common Names:
Licorice root; Sweet Root

Common Uses:
Gastric & duodenal ulcers; Gastritis; Cough/bronchitis

Side Effects/Interactions:
-Glycyrrhizic acid in licorice may cause high blood pressure, hypokalemia, & edema
-Contraindicated in many chronic liver conditions, renal insufficiency, hypertonia, hypokalemia
-May alter platelet aggregation

Recommended Stop Date:
14 days prior

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Lobelia

Tachycardia

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n-3 Fatty Acids

Decreases platelet aggregation

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Passion Flower

Tranquilizer/sedative

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Saw palmetto: (serenoa repens)

Common Names:
Sabal: Cabbage Palm

Common Uses:
Benign prostatic hypertrophy: Antiandrogenic; Antiexudative

Side Effects/Interactions:
-May see additive effects with other hormone therapies, i.e., birth control pills or estrogen therapy

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St. John’s Wort: (hypericum perforatum)

Common Names:
Hardhay; Amber; Goatweed

Common Uses:
Depression, anxiety

Side Effects/Interactions:
-May be a photosensitizing agent
-Possible interaction w/ MAO Inhibitors (not proven)
-May prolong effects of anesthesia, enhance sleepiness induced by narcotics
-Blocks effects of reserpine and decrease effects of indinavir
-Induces cytochrome P450 enzymes
-May alter Digoxin levels

Recommended Stop Date:
5 days

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Valerian: (valeriana offcinalis)

Common Names:
All-heal; Setwell; Vandal Root

Common Uses:
Mild sedative; Mild anxiolytic

Side Effects/Interactions:
-Will likely potentiate barbiturate effect
-May decrease sx of benzodiazepine withdrawal (benzodiazepine effects, but different receptors)
-May prolong anesthesia; may increase certain antiseizure medications

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Yohimbe bark

CNS stimulatory activity, HTN, Tachycardia

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