List of Muscle relaxants — Generics Only

Muscle relaxants

Contents

What are Muscle relaxants?

Muscle relaxants (also called skeletal muscle relaxants) are a diverse group of medicines that have the ability to relax or reduce tension in muscle. Some (such as baclofen, methocarbamol, and tizanidine) work in the brain or spinal cord to block over-excited neuronal (nerve) pathways. Others (such as dantrolene and botulinum toxin) act directly on muscle. Cannabis extract is thought to have a dual effect.

Muscle relaxants treat two main conditions: spasticity (stiff, rigid muscles) caused by conditions such as cerebral palsy, multiple sclerosis, and stroke; or muscle spasms which are typically temporary and associated with conditions such as tension headache, low back pain, or fibromyalgia.

Only three muscle relaxants — baclofen, dantrolene, and tizanidine are FDA approved to treat spasticity; however, six (carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine) are approved to treat muscle spasm. Botulinum toxin is only approved to treat spasticity in certain muscle groups of the upper and lower limbs. Many other medications are also used to treat spasticity or muscle spasm although most are not approved for this indication.

Evidence supporting the effectiveness of skeletal muscle relaxants for muscle spasm is sparse; most trials are old and not of good quality. For this reason, skeletal muscle relaxants should only be used to treat muscle spasm if other treatments fail.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Types of Muscle relaxants

Please refer to the drug classes listed below for further information.

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Fish Oil

Generic Name: omega-3 polyunsaturated fatty acids (oh MAY ga 3 POL ee un SAT yoo ray ted FAT ee AS ids)
Brand Names: Animi-3, Cardio Omega Benefits, Divista, Dry Eye Omega Benefits, EPA Fish Oil, Fish Oil, Fish Oil Ultra, Flex Omega Benefits, Icar Prenatal Essential Omega-3, Lovaza, Marine Lipid Concentrate, MaxEPA, MaxiTears Dry Eye Formula, MaxiVision Omega-3 Formula, Mi-Omega NF, Mom’s Omega Advantage, Omega Essentials, Sea-Omega, Sea-Omega 30, TheraTears Nutrition, TherOmega, Vascazen

Medically reviewed by Drugs.com. Last updated on Jun 25, 2019.

What is Fish Oil?

Fish Oil capsules contain omega-3 polyunsaturated fatty acids. Omega-3 polyunsaturated fatty acids are found in oils from certain types of fish, vegetables, and other plant sources. These fatty acids are not made by the body and must be consumed in the diet. Omega-3 polyunsaturated fatty acids work by lowering the body’s production of triglycerides. High levels of triglycerides can lead to coronary artery disease, heart disease, and stroke.

Fish Oil are used together with diet and exercise to help lower triglyceride levels in the blood.

Fish Oil may also be used for purposes not listed in this medication guide.

Important information

Take Fish Oil exactly as directed on the label, or as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended.

Swallow the Fish Oil capsule whole. Do not puncture or open the capsule.

Fish Oil is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

There may be other drugs that can interact with Fish Oil. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Stop using Fish Oil and get emergency medical help if you think you have used too much medicine, or if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Less serious side effects are more likely, and you may have none at all. Talk to your doctor about any side effect that seems unusual or is especially bothersome.

Before taking this medicine

Do not use Fish Oil if you are allergic to fish or soybeans.

Ask a doctor or pharmacist about using this medicine if you have:

a pancreas disorder;

if you drink more than 2 alcoholic beverages per day.

FDA pregnancy category C. It is not known whether Fish Oil will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using Fish Oil. It is not known whether omega-3 polyunsaturated fatty acids pass into breast milk or if this could harm a nursing baby. Do not use Fish Oil without telling your doctor if you are breast-feeding a baby. Do not give this medication to anyone under 18 years old.

See also:

How should I take Fish Oil?

Use Fish Oil exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Swallow the Fish Oil capsule whole. Do not puncture or open the capsule. Fish Oil works best if you take it with food.

To be sure this medication is helping your condition, your blood may need to be tested often. Visit your doctor regularly.

Fish Oil is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

Store Fish Oil at room temperature away from moisture and heat. Do not freeze.

See also:

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid?

Avoid eating foods that are high in fat or cholesterol. Fish Oil will not be as effective in lowering your triglycerides if you do not follow the diet plan recommended by your doctor.

Avoid drinking alcohol. It can increase triglycerides and may make your condition worse.

Fish Oil side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Fish Oil: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Fish Oil and call your doctor at once if you have any of these serious side effects:

fever, chills, body aches, flu symptoms;

Less serious Fish Oil side effects may include:

unusual or unpleasant taste in your mouth;

upset stomach, belching; or

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also:

What other drugs will affect Fish Oil?

Tell your doctor about all other medicines you use, especially:

estrogens (birth control pills or hormone replacement);

a blood thinner such as warfarin (Coumadin, Jantoven);

a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Dutoprol, Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others; or

a diuretic (water pill) such as chlorothiazide (Diuril), hydrochlorothiazide (HydroDIURIL, Microzide), chlorthalidone (Hygroton, Thalitone), indapamide (Lozol), metolazone (Mykrox, Zaroxolyn), and others.

This list is not complete and other drugs may interact with Fish Oil. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

See also:

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 6.04.

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A Look Back at Old-Time Medicines

Antique medicines contained everything from arsenic to opium — and promised instant cures.

Pity the poor Victorian-era family whose bottle of Mrs. Winslow’s Soothing Syrup ran dry. It was touted as an indispensable aid to quiet bawling babies and teething tots, and it packed a wallop of an ingredient: morphine.

Today, no one would dream of calming an infant with morphine, but the museum of medicine is littered with such discarded remedies. Some were fanciful potions that quacks concocted to make a buck, while others were legitimate — even revered — treatments that eventually yielded to more enlightened science.

For example, opium suffers a tainted reputation these days. But doctors have favored it throughout history, especially to control coughing and diarrhea .

«It was regarded as an all-purpose drug. One physician called it ‘God’s own medicine,'» says James C. Whorton, PhD, a medical historian and professor at the University of Washington School of Medicine.

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‘Legitimate’ Medicine of an Earlier Era

Doctors used arsenic and mercury to treat syphilis before the introduction of penicillin in the 1940s.

One company sold heroin tablets to relieve asthma symptoms.

Cocaine drops for toothache came on the market after doctors discovered its pain-relieving qualities. One Belgian company even promoted cocaine throat lozenges as «indispensable for singers, teachers and orators.» Dentists and surgeons also used cocaine as an anesthetic.

While doctors of the late 1800s considered these drugs legitimate, a whole range of shady patent medicines, sometimes called «nostrums,» also flourished during that period.

Traveling Medicine Shows

People bought nostrums from traveling medicine shows, and the cures beckoned boldly from billboards and newspaper and magazine ads. «You couldn’t get away from them,» Whorton says. «They were inescapable.»

Many nostrums targeted vague «female complaints.» The delicate dames of yore didn’t mention menstrual cramps and hot flashes in polite company. But they were lining up to buy Lydia E. Pinkham’s Vegetable Compound, one of the most popular women’s remedies of the time.

Plenty of other patent medicines flooded the American landscape, according to a history posted on the web site of the FDA. They included: Fatoff Obesity Cream, Make-Man Tablets, and Antimorbific Liver and Kidney Medicine. Also touted for «weak hearts, weak blood, weak nerves» was a product called Anglo-American Heart Remedy. And Dr. Bonker’s Celebrated Egyptian Oil was available for » colic , cramps in the stomach and bowels, and cholera.»

Another classic: Mack Mahon the Rattle Snake Oil King’s Liniment for Rheumatism and Catarrh. Catarrh? Not as weird as it sounds. Just an old-fashioned way of saying congestion — the kind that comes with the common cold.

Continued

Good for All That Ails You

Some patent medicines simply took a scattershot approach. In 1862, Mixer’s Cancer and Scrofula Syrup claimed to treat «Cancer, Tumors, Erysipelas, Abscesses, Ulcers , Fever Sores, Goiter, Catarrh, Salt Rheum, Scald Head, Piles, Rheumatism, and ALL BLOOD DISEASES.» [sic]

Others favored open-ended labeling. Cerralgine Food of the Brain boasted of being «a safe cure for Headache, Neuralgia, Nervousness, Insomnia , Etc.»

Hucksters didn’t just limit themselves to elixirs and pills. They also invented a dizzying array of devices, such as electric insoles and magic shoes, to cure sore feet and crippling conditions.

Consider, too, the Health Jolting Chair of the 1880s. It resembled a garden-variety armchair—only rigged with springs and levers. Its advertising promised that the chair would give «efficient exercise to the essentially important nutritive organs of the body.»

According to the manufacturer, all that jiggling and jolting was essential for «millions of human beings who may be living sedentary lives through choice or necessity.» The chair was, «For certain classes of invalids a veritable Treasure-Trove.» [sic]

End of an Era

The golden age of patent medicines ended in the early 1900s, notes the FDA web site, when muckraking journalists wrote exposГѓВ©s and the federal government cracked down with new legislation to prohibit adulteration or misbranding of foods and drugs, as well as false advertising.

Also, as the state of legitimate medicine evolved, new cures replaced the old. When doctors began treating syphilis with penicillin, a grateful generation was spared the toxic effects of arsenic and mercury, including inflammation of the gums, destruction of the teeth and jaws, and organ damage.

Opium and other addictive drugs also fell by the wayside once scientists realized their pitfalls. Novocain replaced its predecessor, cocaine, as an anesthetic.

Looking Ahead

No doubt, more medical advances on the horizon will make some of today’s medicines outdated. So perhaps it’s wise to avoid smugness.

After all, will sophisticated new cancer treatments make today’s harsh chemotherapy agents look like the arsenic and mercury of the past? «I’m sure people will wonder why we put up with it,» Whorton says.

Will future generations be aghast that that we pumped people’s foreheads full of Botox? «I think it’s pretty strange now,» Whorton adds. «I don’t think we have to wait.»

And in the year 2250, will folks be chortling over our antiquated Internet, purveyor of fad diets, bust developers, male enhancers, and overnight baldness cures?

Sources

SOURCES: James C. Whorton, PhD, medical historian; professor, University of Washington School of Medicine. Walsh, James J. Cures: The Story of the Cures That Fail, D. Appleton and Company, 1923. FDA web site: «The Patent Medicine Menace.» State University of New York-Upstate Medical University Health Sciences Library web site: «Marketing Medicines: Help or Harm?» State University of New York-University at Buffalo (Addiction Research Unit) web site: «Before Prohibition.» Washington State University web site: «An Overview of Advertising.»

www.webmd.com

Staxyn

Generic Name: vardenafil (var DEN a fil)
Brand Names: Levitra, Staxyn

Medically reviewed by P. Thornton, DipPharm Last updated on Dec 11, 2018.

What is Staxyn?

Staxyn (vardenafil) relaxes muscles found in the walls of blood vessels and increases blood flow to particular areas of the body.

Staxyn orally disintegrating tablets are used to treat erectile dysfunction (impotence).

Staxyn may also be used for purposes not listed in this medication guide.

Important Information

Taking Staxyn with certain other medicines can cause a sudden and serious decrease in blood pressure. Do not take vardenafil if you also take riociguat (Adempas) or a nitrate drug such as nitroglycerin.

Do not use Staxyn if you are also using a nitrate drug for chest pain or heart problems, including nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, and some recreational drugs such as «poppers». Taking vardenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Stop using Staxyn and get emergency medical help if you have sudden vision loss.

During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect.

Before taking this medicine

You should not use Staxyn if you are allergic to vardenafil, or if you take other medicines to treat pulmonary arterial hypertension, such as riociguat (Adempas).

Staxyn is not approved for men younger than 18 years old.

Do not take vardenafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite («poppers»). Taking vardenafil with a nitrate medicine can cause a sudden and serious decrease in blood pressure.

Tell your doctor if you have ever had:

heart disease, heart rhythm problems;

long QT syndrome (in you or a family member);

liver disease, kidney disease (or if you are on dialysis);

hearing or vision problems, vision loss;

an eye disorder such as retinitis pigmentosa (an inherited condition of the eye);

a physical deformity of the penis (such as Peyronie’s disease); or

if you have been told you should not have sexual intercourse for health reasons.

Vardenafil can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoked or were over 50 years old. It is not clear whether vardenafil is the actual cause of vision loss.

Staxyn is not for use in women, and the effects of this medicine during pregnancy or in breastfeeding women are unknown.

Staxyn may contain phenylalanine. Talk to your doctor before using this form of vardenafil if you have phenylketonuria (PKU).

How should I use Staxyn?

Staxyn orally disintegrating tablets should not be used in place of Levitra (vardenafil regular tablets). Avoid medication errors by using only the form and strength your doctor prescribes.

Use Staxyn orally disintegrating tablets exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Remove an orally disintegrating tablet from the package only when you are ready to take the medicine. Place the tablet in your mouth and allow it to dissolve without chewing. Swallow several times as the tablet dissolves. Do not take Staxyn with liquid.

Staxyn is taken only when needed, about 60 minutes before sexual activity. The medicine can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill.

Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Store at room temperature away from moisture and heat.

If you receive medical care for heart problems, tell your caregivers when you last took vardenafil.

Staxyn dosing information

Usual Adult Dose for Erectile Dysfunction:

-Initial dose: 10 mg orally once a day, as needed, approximately 60 minutes before sexual activity. Increase to 20 mg or decrease to 5 mg based on efficacy and tolerability.
-Maximum dose: 20 mg once a day

Patients on stable alpha blocker therapy:
-Initial dose: 5 mg orally once a day

Comments:
-Sexual stimulation is required for a response to treatment.
-A time interval between dosing should be considered when administering this drug concomitantly with alpha-blockers.
-Patients taking alpha-blockers should not initiate therapy with Staxyn orally disintegrating tablet.

Use: Erectile dysfunction

Usual Geriatric Dose for Erectile Dysfunction:

65 years or older:
-Initial dose: 5 mg orally once a day, as needed, approximately 60 minutes before sexual activity

Comments: Sexual stimulation is required for a response to treatment.

Use: Erectile dysfunction

See also:

What happens if I miss a dose?

Since Staxyn is used as needed, you are not likely to be on a dosing schedule.

Do not use Staxyn more than once a day. Allow 24 hours to pass between doses.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Staxyn?

Grapefruit may interact with vardenafil and lead to unwanted side effects. Avoid the use of grapefruit products.

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Drinking alcohol can increase certain side effects of vardenafil.

Do not use any other drug to treat impotence unless your doctor tells you to.

Staxyn side effects

Get emergency medical help if you have signs of an allergic reaction to Staxyn: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking this medicine and get emergency medical help if you have:

heart attack symptoms — chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;

vision changes or sudden vision loss; or

erection is painful or lasts longer than 4 hours (prolonged erection can damage the penis).

Stop using Staxyn and call your doctor at once if you have:

ringing in your ears, or sudden hearing loss;

swelling in your hands, ankles, or feet;

shortness of breath;

a light-headed feeling, like you might pass out;

penis erection that is painful or lasts 4 hours or longer; or

Common Staxyn side effects may include:

flushing (warmth, redness, or tingly feeling);

stuffy nose, sinus pain;

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also:

What other drugs will affect Staxyn?

Do not use Staxyn with similar medications such as avanafil (Stendra), sildenafil (Viagra), or tadalafil (Cialis). Tell your doctor about all other medications you use for erectile dysfunction.

Tell your doctor about all your other medicines, especially:

This list is not complete and many other drugs may interact with vardenafil. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

See also:

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Staxyn only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 11.02.

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9 most common street drugs

The crippling damage drugs cause to the brain has remained unseen — until recently. For the first time scans have shown exactly how these substances mutilate our minds — while psychiatrists deal with the fall-out.

It doesn’t matter which drug you try, even if it’s only once — you have to know you’re playing with fire. The stuff you’re smoking, sniffing or shooting up is going to hit your brain with the force of a lightning bolt.

  • Midwives are holding babies born with their intestines outside their bodies.
  • Policemen are dealing with the victims of merciless crimes.
  • Neurologists, with the help of the latest technology, are assessing the extent of the brain damage caused by these drugs.

Effects on the body:

Increased heart rate, increased blood pressure, numbness and weakness.

LSD affects a large number of chemicals in the brain, including the neurotransmitters dopamine and serotonin. The drug may also increase the levels of a substance called glutamate in very specific parts of the brain, over-stimulating the brain cells and causing an «electric storm». Each electric storm causes hallucinations, and can lead to permanent changes.

With a brain Spect doctors can look at the damage done by impaired blood flow caused by various drugs, explains Dr Pieter Botha of the department of radiology at Tygerberg Hospital in Cape Town. Drugs such as alcohol, cocaine or marijuana impair the effectiveness of blood vessels in the brain, constricting blood flow to certain areas. On scans these affected areas show up as «holes» in the brain.

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18 Herbal Supplements with Risky Drug Interactions

Medically reviewed by L. Anderson, PharmD Last updated on Jul 8, 2019.

What is a Herbal Supplement?

The use of herbal supplements has a long history — dating back thousands of years. Examples of important medicines extracted from botanicals include reserpine, morphine, penicillin, and vinca alkaloid anti-cancer drugs.

Today, herbal supplements and nutraceuticals can be purchased over-the-counter (OTC) and may be labeled «all-natural». But that does not always mean they are safe?

Not always. While these products are intended to boost health, and may make claims to that effect, robust clinical studies may be lacking.

Herbal supplements are sold in many different forms — dried leaves for teas, powdered, as capsules or tablets, or in solution.

Does the FDA Regulate Herbal Products?

The FDA does not apply the same effectiveness and safety studies used for prescription drugs to herbals, dietary supplements, and their manufacturers. The FDA can and does seize and remove from the market tainted, contaminated or unsafe dietary supplements when they are aware of problems; kratom is one example that has been involved in many seizures.

Learn More: What is Kratom?

Herbal supplements are not subject to review by the FDA and their use can often be risky. Consumers need to understand that even though the label may say «natural», these products are not always safe, as demonstrated by «all natural» alternatives for erectile dysfunction that the FDA found contained actual prescription medications.

Aren’t Herbs Are ‘All Natural’ and Safe?

Even though herbal supplements may be from plant or herb sources, the active ingredients can still be potent chemicals. Because of this, herbal supplements can have drug interactions, even with each other or with food or alcohol. Unfortunately, these products are not labeled with safety warnings, and it is difficult for a consumer to know if an interaction may occur.

Herbal interactions with prescription medications or other chemicals can:

  • interfere with how the drug may be broken down in the body
  • enhance side effects of prescription medications
  • block the intended therapeutic effect of a drug.

You can search for herbal supplement-drug interactions here, and always check with your doctor or pharmacist for clarification.

Black Cohosh

Black cohosh is a shrub-like plant found in North America. Black cohosh is often used for menopausal disorders («hot flashes»), painful menstruation, uterine spasms, and vaginitis. However, prescription drugs broken down by certain liver enzymes may accumulate in the body and lead to toxicity if used with black cohosh. There is concern that black cohosh might also be toxic to the liver and may enhance liver toxicity with certain medications, such as:

Let’s face it, drug interactions are complicated and numerous, so have your medications — even herbals and OTCs — screened by your pharmacist to review for black cohosh drug interactions, or other herb-drug interactions.

Coenzyme Q10

CoenzymeQ10, also known as ubiquinone or CoQ10, is found naturally in the heart, kidney, liver and pancrease, but aging and smoking can deplete these natural stores.

CoQ10 is promoted to help heart damage caused by certain cancer medicines and for breast cancer, gum disease, or muscular dystrophy, although robust studies confirming these uses are lacking.

However, use of CoQ10 with anticoagulant drugs like warfarin may decrease the blood thinning effects of the anticoagulant and increase the risk for a clot.

If you are considering the use of any supplement, always check with your doctor first. And if you take a blood thinner, check with your doctor before starting CoQ-10. You may need to have your blood clotting tests checked more frequently and may need a change in your anticoagulant dose.

Cranberry

Even the simple, delicious cranberry can have drug interactions.

Cranberries are a fruit chock full of vitamin C, and some people drink cranberry juice to help prevent urinary tract infections (UTI). Although data is conflicting, some studies have shown cranberry can reduce recurrent UTIs in pregnant women, the elderly and hospitalized patients; but it is not helpful to cure a UTI.

Cranberry may exert an increased effect on blood thinners (anticoagulants) like warfarin and lead to bruising or bleeding. If you take an oral blood thinner, check with your doctor before consuming unusual amounts of cranberry or cranberry juice. You may need to have your International Normalized Ratio (INR) or other blood clotting lab test checked more frequently.

Echinacea

Echinacea is also known as the American Cone Flower, Black Susan, or Purple Coneflower. Echinacea has been used to stimulate the immune system, and is most commonly used in the treatment of the common cold.

Most echinacea drug interactions are minor. Echinacea might slow the breakdown (metabolism) of caffeine in your body, and could lead to side effects like jitteriness, headache, or insomnia.

Echinacea may also change how the body metabolizes many drugs that go through the liver. These are somewhat complicated interactions that can lead to side effects or reduced effectiveness of your medicine, so always check with your pharmacist.

Evening Primrose Oil

Evening primrose is a flowering plant known by other names such as Oenothera biennis, scabish, or king’s cureall.

Evening primrose oil provides fatty acids used by the body for growth. Evening primrose oil contains gammalinoleic acid that may slow blood clotting and increase the likelihood of brusing or bleeding. If you take drugs or herbs that may have blood thinner effects, check with your health care provider before using evening primrose oil

Use of evening primrose oil may increase the risk for seizures if you take anti-seizure medications or phenothiazine drugs. You can check for other evening primrose oil drug interactions here.

Valerian

Valerian has been used to treat insomnia and anxiety, although evidence is conflicting. Germany’s Commission E, the authorities that evaluate the use of herbal products in Germany, has approved valerian as an effective mild sedative. There are over 500 possible drug interactions with valerian, so a drug interaction screen is important when using valerian.

Speak with your doctor before combining valerian with:

or other medicines that cause drowsiness. These drugs may increase drowsiness and dizziness while you are taking valerian.

St. John’s Wort

St. John’s Wort is a popular herbal supplement widely used to help with symptoms of depression. Drug interactions with St. John’s Wort can be numerous and dangerous. Due to the seriousness of many drug interactions, you should consult with your health care provider before using St. John’s Wort. Do not combine St. John’s Wort with these medications:

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and many other drugs. Check with your doctor or pharmacist for a drug interaction screen with St. John’s Wort if you also take prescription, OTC, vitamin or other herbal medications.

Saw Palmetto

Use of saw palmetto is popular for benign prostatic hypertrophy (BPH), a noncancerous prostate gland enlargement. Evidence suggests that saw palmetto may be effective for mild-to-moderate BPH, but always ask your doctor for advice about this product. Saw palmetto should be avoided with other agents used to treat BPH, such as finasteride (Proscar), unless directed by your doctor.

Saw palmetto may also slow blood clotting and may increase the risk for bruising or bleeding if used with certain blood thinners like warfarin. If saw palmetto is combined with estrogens or oral contraceptives, the effectiveness of the hormonal therapies could be reduced.

Check with your doctor or pharmacist for a drug interaction screen.

Melatonin

Melatonin is a natural hormone that helps to regulate the sleep-wake cycle. For some people, melatonin tablets may be helpful for insomnia, jet lag and shift work sleep disorders.

However, because melatonin causes drowsiness, its use should be avoided with alcohol and other sedating medicines, such as:

Other herbs that can also lead to drowsiness include 5-HTP, kava, and St. John’s Wort. Melatonin may also increase blood sugar and interfere with diabetes medications. As with many herbal products, blood clotting may be affected with use of melatonin with anticoagulants.

Kava, native to the South Pacific, is a member of the pepper family. Kava has been used to improve sleep, decrease anxiety, and tame nervousness, stress, and restlessness.

There are hundreds of drug interactions with kava. Kava should not be used with alcohol or other drugs or herbs that can also cause liver toxicity. The use of buprenorphine (Buprenex, Butrans, Probuphine) with kava can lead to serious side effects such as respiratory distress or coma.

Call your doctor immediately if you have fever, joint pain, bleeding, skin rash/itch, appetite loss, fatigue, nausea/vomiting, stomach pain, dark colored urine, light colored stools, and/or yellowing of the skin/eyes; these may be signs of liver toxicity.

Ginseng

Ginseng has been used in Asian countries for its therapeutic effects for centuries. Today, ginseng use is reported to improve the body’s resistance to stress and increase vitality, among other uses.

There are many different origins of ginseng, and many types of drug interactions. Long-term use of American ginseng may decrease the effectiveness of warfarin, a blood thinner, and increase the risk for a clot. In general, ginseng should not be used with anticoagulants.

Ironically, ginseng also has blood thinner effects itself, and may lead to bleeding. Ginseng may also affect blood pressure treatments and diabetic medications like insulin or oral hypoglycemics. Be sure to check with your pharmacist or doctor if you use ginseng as an herbal supplement. Serious drug interactions can occur.

Yohimbe

Yohimbe is the name of an evergreen tree that is found in some African countries. The bark of yohimbe contains a chemical called yohimbine, which can dilate blood vessels and is often promoted for erectile dysfunction (ED) or sexual problems caused by selective serotonin reuptake inhibitors (SSRIs).

Also, at least 14 days should elapse between discontinuation of MAOI therapy, infrequently used for depression, and initiation of treatment with yohimbine.

Therapy with yohimbine is generally not recommended in patients with hypertension, angina pectoris, or heart disease because it has a stimulatory effect and can lead to high blood pressure and a rapid heart rate. You can check other yohimbine interactions here.

Feverfew

Feverfew is a member of the daisy family. Feverfew is often used as an herbal remedy to prevent migraine headaches and associated nausea and vomiting; however, the evidence is not conclusive.

Alarmingly, feverfew may increase the risk of bleeding, especially in people with blood-clotting disorders or using blood thinners to help prevent clots, for example:

Check with your health care provider before using feverfew; you can check for other drug interactions with feverfew here.

Ginkgo Biloba

The use of ginkgo extract dates back centuries in traditional Chinese medicine.

Ginkgo has been used for symptoms of Alzheimer’s dementia, Parkinson’s disease, and to aid in general memory suppport, among other uses. Ginkgo may decrease antiviral effects of drugs used in HIV, such as efavirenz or indinavir.

Ginkgo can also alter the actions of medicines metabolized through the liver; the list is extensive but includes agents such as omeprazole (Prilosec OTC), fluvastatin (Lescol), and donepezil (Aricept). Avoid ginkgo in patients who take seizure medications, blood thinners or diabetes drugs.

Ginkgo interacts with over 250 drugs; have a pharmacist check for interactions before use.

Goldenseal

Goldenseal is a flowering herb that grows in the northeast United States. Common uses for goldenseal include skin infections, for cold and flu symptoms, and to treat diarrhea, but evidence is weak for these uses. There are over 60 possible drug interactions with goldenseal.

Two of the more serious interactions occur with certain antipsychotic drugs — using pimozide or thioridazine with goldenseal is not recommended, as antipsychotic blood levels may rise leading to an irregular heart rhythm.

Goldenseal may affect liver enzymes that can alter blood levels of certain drugs; always have your pharmacist run a drug interaction screen on all of your medicines, OTC drugs, or herbs.

Garlic

Garlic is a commonly used flavoring agent, food product and herbal supplement. There are many conditions garlic has been used for — to reduce cholesterol and triglycerides, to prevent cancer, to lower blood sugar levels, and to reduce menstrual pain, among other uses.

Garlic has been reported to moderately affect blood clotting and blood sugar levels and may affect people who take blood thinning agents like aspirin, warfarin, or clopidogrel (Plavix). Use of garlic supplements with HIV protease inhibitors (PI) may decrease the PI blood levels.

There are other possible garlic interactions, so be sure to review all possible drug interactions with garlic and speak with your healthcare provider.

Green Tea

Green tea is a popular drink that originated in China and has been promoted for stomach disorders, to lower cholesterol, as an anti-cancer antioxidant, as a stimulant, and to lessen belly fat, among other uses.

In the U.S., it has gained recent popularity due to claims it can boost metabolism and aid in weight loss. Dried green tea leaves contain vitamin K, which can increase blood clotting. Large amounts of vitamin K may interfere with the activity of some blood thinners.

A substantial decrease in the INR (a measure of blood clotting) has been reported in a patient treated with warfarin after he began consuming large quantities (1/2 to 1 gallon daily) of green tea. Patients treated with warfarin should probably avoid large amounts of green tea as it can interfere with the blood-thinning capabilities of warfarin.

Ginger

Ginger is a commonly used flavoring agent, food product, and herbal supplement. Ginger has been used in the treatment and prevention of motion sickness, vertigo, to increase appetite, and to reduce stomach acidity. Ginger has also been used by some women under medical supervision to reduce severe nausea and vomiting in pregnancy.

Drug interactions with ginger are not well documented; however, it is known to inhibit thromboxane synthetase, which can prolong bleeding time and may cause interactions with anticoagulants like warfarin, aspirin, or other blood thinners.

Check other possible ginger-drug interactions here.

How Should I Handle Possible Herbal-Drug Interactions?

It is important to remember that the best way to handle any possible drug interaction is to predict it and prevent it.

In order to do that, you need to be proactive in checking for possible drug interactions yourself in addition to asking your health care provider to screen for interactions.

Tell your doctor or pharmacist about all the medications you take, including:

Be sure a drug interaction screen is conducted by a healthcare provider each time you start or stop a medication. Consult your doctor about any symptoms you are experiencing and discuss all herbal products prior to use.

How to Handle an Herbal Drug Interaction?

Advice from your health care provider is your best option in preventing serious health effects from any drug interaction.

Remember that herbal supplements are not subject to FDA oversight and have not usually been tested in clinical studies to prove their effectiveness or safety.

Contact your health care provider if you discover that a possible drug interaction may occur between medications and herbal products that you use.

Do not stop taking your medication unless directed to do so by your doctor. The interaction may be insignificant and no change may be needed; on the other hand, the interaction could be serious and the herbal supplement may need to be discontinued.

More questions? Visit our Top 9 Ways to Prevent a Deadly Drug Interaction slideshow and join the Drugs.com Herbal Support Group to ask questions about drug interactions, check on the latest medical news, and provide your feedback, too.

Finished: 18 Herbal Supplements with Risky Drug Interactions

OTC Medication Use In Pregnancy: Wise or Worrisome?

Memos on Menopause — What Every Woman Needs to Know

Sources

  • National Institute of Health. Office of Dietary Supplements. Dietary Supplement Fact Sheets. Accessed July 8, 2019 at https://ods.od.nih.gov/
  • «All Natural» Alternatives for Erectile Dysfunction: A Risky Proposition. FDA Consumer Articles. Drugs.com. Accessed July 8, 2019 at https://www.drugs.com/fda-consumer/all-natural-alternatives-for-erectile-dysfunction-a-risky-proposition-349.html
  • Kratom (mitragyna speciosa) powder products by Gaia Ethnobotanical: Recall — Due to Potential Salmonella Contamination. Accessed July 8, 2019 at https://www.drugs.com/fda/kratom-mitragyna-speciosa-powder-products-gaia-ethnobotanical-recall-due-potential-salmonella-14176.html
  • Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998:158;2200-11.
  • Richards JS. Overview of Herbal Supplements. Elite Continuing Education CE 2013. p.46-62.
  • MedFacts Natural Products. Drugs.com. Accessed July 8, 2019. at https://www.drugs.com/npp/

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some mixtures of medications can lead to serious and even fatal consequences.

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