Herbal Supplements

This article was provided by CareKinesis, a PACE Partner and medication management and distribution company.

To the body, herbal products are medications, also.

As we age, health issues can arise that require us to take more medications concurrently. Studies show that individuals aged 65 and over use an average of seven medications, with 46% on medication regimens in which a multi-drug interaction is possible.1 A multi-drug interaction occurs when drugs are administered together, and the activity of one drug affects the other. It is estimated that the risk of an adverse drug event (ADE) stemming from a drug interaction is 13% when taking two medications simultaneously, 58% when taking five medications, and 82% when taking seven or more.2 However, the danger is not limited to prescription and over-the-counter medications; ADEs can occur when herbal supplements interact with prescription medications.

The National Health Statistics Reports data for 2012 reports that 17.7% of American adults use nonvitamin, nonmineral dietary supplements.3 The most commonly-used supplements are ginkgo, garlic, ginseng, St. John’s Wort, echinacea, saw palmetto, evening primrose oil, and ginger.4 While herbal supplements are widely available in pharmacies, nutritional stores, and supermarkets, it is important to know that they can cause multi-drug interactions when used with certain prescription medications. These interactions can result in headaches, restlessness, nausea, and irritability, and more serious symptoms such as blood glucose or blood pressure changes, anxiety, and dizziness.4

Herbal supplements are sometimes used to treat or prevent common conditions, such as diabetes. In 2015, 415 million adults were living with diabetes.5 Several herbal supplements are used either to prevent diabetes, or to enhance the effects of prescription medications taken for its treatment. While some herb-drug interactions can indeed enhance the effects of other diabetes medications, certain herbal supplements can decrease the effectiveness of medications or even cause adverse drug events.5 Studies have shown that gymnema (Gurmar) can decrease the amount of metformin circulating in the body and increase blood sugar levels, resulting in hyperglycemia, a condition associated with poor diabetes control.5 Andrographis paniculata, also known as green chiretta, has been shown to inhibit the body’s ability to process several antidiabetic medications, such as glibenclamide (Glynase), glimepiride (Amaryl), and glipizide (Glucotrol).5 This drug interaction results in an increase in the amount of antidiabetic medication circulating in the body, which in turn can cause lower than expected blood sugar levels resulting in hypoglycemia. Left unrecognized and untreated, hypoglycemia can lead to loss of consciousness, seizures, coma, and even death.

According to the World Health Organization, roughly 257 million people are living with hepatitis B, a type of chronic hepatitis. An increasing number of chronic hepatitis patients is seeking alternative medicine and herbal supplements to either replace or complement traditional treatments.6 Popular Chinese herbal formulas for the treatment and prevention of hepatitis are becoming more widely used in the U.S. These include single herb formulas such as silibinin, Scutellaria baicalensis, and Salvia miltiorrhiza, as well as multi-herb formulas such as Jia-Wei-Xiao-Yao-San, Long-Dan-Xie-Gan-Tang (LDXGT), Xiao-Chai-Hu-Tang, and Yin-Chen-Wu-Ling-San.6 Use of the multi-herb formulas can be particularly dangerous due to the lack of ingredient regulation by the U.S. Food and Drug Administration and the potential for multi-drug interactions. Potential for herb-drug interactions exists between LDXGT and lamivudine, a medication used to treat hepatitis B, which can lead to an increased concentration of lamivudine in the body and lengthen the amount of time it takes to eliminate it from the body.6

Up to 40% of people with cardiovascular disease have used alternative medicine, including herbal supplements.7 Warfarin is the most commonly used medication for the prevention of blood clots in people with cardiovascular risk, and it can potentially interact with other prescription medications and herbal supplements. St. John’s Wort and American ginseng have been shown to reduce warfarin’s effectiveness, while garlic and ginger exhibit similar effects to warfarin on their own, and their use alongside of warfarin has been shown to cause or contribute to spontaneous bleeding.7

In summary, up to 88% of older adults report using herbal supplements with prescription medications, yet most do not report such use to their healthcare providers.4 It is important to let your doctor or pharmacist know about all medications you are taking, including prescription, over-the-counter, and supplements, to avoid potential problems that may arise with the use of herbal supplements along with prescription medications. Your interdisciplinary PACE team and CareKinesis are here to help minimize risks that may come with the medications and supplements that you need to live a long and healthy life.

Want to learn more how CareKinesis and PACE work together?


CareKinesis is the first national PACE-centric, medication management and distribution pharmacy that focuses on reducing medication-related risk while enhancing economic, clinical, and humanistic outcomes. Visit the CareKinesis website for more information.

Reference list:

  1. Bjorkman IK, Fastbom J, Schmidt IK, Bernsten CB, Pharmaceutical Care of the Elderly in Europe Research (PEER) Group. Drug-drug interactions in the elderly. Ann Pharmacother. 2002 Nov;36(11):1675-81.
  2. Gujjarlamudi HB. Polytherapy and drug interactions in elderly. J Midlife Health. 2016 Jul-Sep;7(3):105-107.
  3. Clarke TC, Black LI, Stussman BJ, et al. Trends in the use of complementary health approaches among adults: United States, 2002–2012. National health statistics reports; no 79. Hyattsville, MD: National Center for Health Statistics. 2015.
  4. Agbabiaka TB, Wider B, Watson LK, Goodman. Concurrent Use of Prescription Drugs and Herbal Medicinal Products in Older Adults: A Systematic Review. Drugs Aging. 2017 Dec;34(12):891-905.
  5. Gupta RC, Chang D, Nammi S, Bensoussan A, Bilinski K, Roufogalis BD. Interactions between antidiabetic drugs and herbs: an overview of mechanisms of action and clinical implications. Diabetol Metab Syndr. 2017 Jul 26;9:59.
  6. Hsueh TP, Lin WL, Tsai TH. Pharmacokinetic interactions of herbal medicines for the treatment of chronic hepatitis. J Food Drug Anal. 2017 Apr;25(2):209-218. doi: 10.1016/j.jfda.2016.11.010.
  7. Choi S, Oh DS, Jerng UM. A systematic review of the pharmacokinetic and pharmacodynamic interactions of herbal medicine with warfarin. PLoS One. 2017 Aug 10;12(8):e0182794.