Mixing herbs and drugs: a dangerous recipe.

EDINBURGH, SCOTLAND — Patients with rheumatologic conditions are


increasingly using herbal and over-the-counter agents for symptom

relief, at times placing themselves at risk of harmful drug


In a survey of 238 outpatients seen at three centers in the United

Kingdom, 44% reported that they had used at least one herbal or OTC

remedy during the past 6 months, Dr. Wendy A. Holden said at the annual

meeting of the British Society for Rheumatology.

“This is a much higher percentage than in the general

population,” said Dr. Holden of the Nuffield Orthopaedic Centre,

Oxford, England.

The most commonly used remedies were cod liver oil cod liver oil

an oil pressed from the fresh liver of the cod and purified. It is one of the best-known natural sources of vitamin D, and a rich source of vitamin A. Because cod liver oil is more easily absorbed than other oils, it was formerly widely used as a nutrient and tonic, , by 35%;

glucosamine, and/or chondroitin, by 21%; and evening primrose oil evening primrose oil

one of the few plant oils containing ?-linolenic acid. Obtained from seeds of Oenothera biennis, it is used for its anti-inflammatory effects in the treatment of skin diseases. , by


Overall, 26 (11%) of the patients were using products that could

have potentially hazardous interactions with their conventional

medications. Among 120 patients taking disease-modifying agents, 5 were

also using echinacea, which is potentially hepatotoxic if used long

term. Of the 238 patients, 24 were taking ginkgo, garlic, devil’s

claw, and starflower oil–all of which can have antiplatelet or other

anticoagulant effects–in combination with nonsteroidal

anti-inflammatory drugs or corticosteroids. Reports also suggest that

devil’s claw can cause gastrointestinal disturbances.

Health care workers should always inquire specifically about herbal

remedies when taking a drug history, and both patients and clinicians

need more education on the risks and potential interactions of these

remedies, Dr. Holden advised.

Other possible hazards have also been reported among patients

taking analgesic drugs. Hepatotoxicity and nephrotoxicity neph·ro·tox·ic·i·ty
The quality or state of being toxic to kidney cells.