Herbal Remedies and Sedation Medications: Know the Dangers

Do you know what patients have treated themselves with before arriving at your practice?

The NCHS reports that herbal remedies and supplements are on the rise, with nearly 17.9 percent of US adults using them as of 2012. While these supplements are often regarded as harmless self-care or placebos, research has revealed that numerous commonly-available supplements present unexpected and even dangerous interactions with many prescription medications and procedures.

Drug interaction tools such as Lexicomp have included new natural product information to keep up with America's supplement surge. Here are some of the supplements to watch for:

Valerian

A key ingredient in many calming or sedative supplements like tea, valerian has undesirable effects on benzodiazepine use, CNS depressants and blood clotting. Many people take valerian prior to experiences that cause them anxiety, such as visiting the dentist, and can consequently be over-sedated.

St. John's Wort

Often employed as an alternative treatment for depression, anxiety and insomnia, the safety of St. John's Wort has been called into question. A 2012 review of herb-drug interactions found St. John's Wort had a high risk of undesirable interactions with medication, significantly lowering the serum concentration of 20 different classes of drugs and reducing the efficacy of sedation.

Kava

Kava is one of the most popular and widely-used herbal supplements, lauded for its anxiolytic and analgesic properties. However, kava can accelerate the effects of sedatives, and when taken with NSAIDs or statins puts patients at risk of serious liver damage.

Feverfew

Feverfew is another common ingredient in therapeutic teas, usually appearing as a migraine treatment. This herb has the ability to slow blood clotting if taken continuously, so patients are advised to stop any feverfew consumption two weeks before any surgeries.

There are many other supplements and herbs that may change a patient's response to treatment. An accurate medical history depends on asking the patient, "Do you take any herbal remedies or supplements?" Patients may not even be aware that their favorite tea or boosted smoothie contains these products, so pre-operative information should include information about what to avoid before treatment.

Not all interactions have been adequately studied, so careful monitoring of vitals and blood clotting remains essential during procedures.

Sources:

CDC: http://www.cdc.gov/nchs/data/databriefs/db146.htm
Planta Medica: https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0031-1298331
MedScape Multi-Drug Interaction Checker: http://reference.medscape.com/drug-interactionchecker
issue_no: 
1
The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.