Herb-drug interactions: a growing concern in dental practice
Reprinted from Dental Editor’s Digest
Over-the-counter natural herb products constitute a rapidly growing market
in the United States, as consumers increasingly embrace alternative or
complementary health care modalities.
As with conventional medications, dental professionals need to be aware
of these products’ effects, side effects, advantageous synergies,
and adverse drug reactions, say Richard P. Cohan, DDS, and Peter L. Jacobsen,
PhD, DDS, in the August, 2000, Journal of the California Dental Association.
The most popular herbal supplements are promoted and used to minimize
fatigue and/or depression, boost the immune system, improve circulation
and memory, modify blood pressure, control cholesterol levels, and decrease
pain, the authors observe. Many herbal supplements offer vague, nonspecific
health claims, they add.
Their article examines 20 of the most frequently used herbs in the country
and focuses on appropriate precautions and herb-drug interactions of possible
concern in clinical dental practice. Dentists should recognize that distinguishing
the true cause of drug interactions is often difficult because of a variety
of factors that may be patient-related or drug-related, Drs. Cohen and
Jacobsen state.
The authors conclude that there are a few significant herb-drug adverse
drug reactions secondary to dental therapy and these problems are uncommon.
But they stress that dentists must be vigilant regarding the potential
for adverse drug reactions. Patients taking anticoagulants, some cardiac
medications, antidepressants, and some diabetic drugs are at risk, they
point out.
Providing examples, the authors explain how St. John’s wort, a supplement
widely used for depression and anxiety, was recently reported to interact
with the immunosuppressant drug cyclosporine and the antiretroviral drug
indinavir. Also, some patients may experience increased photosensitivity
when St. John’s wort and tetracycline are combined, they write.
Patients taking Kava-Kava and alprazolam may go into comas, they add.
The first step in preventing any adverse drug reactions is to identify
which conventional and/or natural therapies the patient is using, according
to Drs. Cohan and Jacobsen. Many patients don’t inform their dentist
or physician that they take alternative products. So the practitioner
should create a nonjudgmental office environment and a health history
form to ensure that vital information about the patient’s use of
complementary drugs and other treatment modalities is elicited, the authors
continue.
They point out that patients are more likely to cooperate if the dentist
is able to discuss why that information is relevant to being able to deliver
safe and efficacious dental care.
When appropriate, the authors recommend that precautions be taken, such
as medical consultations and blood coagulation studies.
Finally, they say it is imperative to advise patients regarding discontinuation
of herbal supplements, especially if any moderate to major adverse drug
reactions with any drugs the dentist plans to prescribe are established,
probable, or suspected.
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All rights reserved. Revised February 14, 2001
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