Complementary and Alternative Therapies

Saw palmetto (Serenoa repens)

Treats and prevents benign prostatic hypertrophy (BPH)

Side Effects: Saw palmetto

• headache

• altered platelet function

Herb/Medication Interactions: Saw palmetto

additive effect with anticoagulants

Studies: Saw palmetto

several well-conducted studies support the use for reducing symptoms of BPH

Nursing Considerations: Saw palmetto

1. allow 4 to 6 weeks to see effects

2. discontinue use prior use to surgery

Valerian root

insomnia, migraines, and menstrual cramps

Side Effects: Valerian root

• drowsiness

• headache

• nervousness with prolonged use

Herb/Medication Interactions: Valerian root

additive effect with barbiturates and benzodiazepines

Studies: Valerian root

several studies support the use for mild to moderate sleep disorders and mild anxiety

Nursing Considerations: Valerian root

1. advise client against driving or operating machinery

2. advise client against long-term use

3. discontinue valerian at least 1 week prior to surgery

St John’s wort (Hypericum perforatum)

depression, seasonal affective disorder, anxiety

Side Effects: St John’s wort

• headache

• sleep disturbances

• phototoxicity (long-term use)

• constipation

Herb/Medication Interactions: St John’s wort

• oral contraceptives

• cyclosporine

• warfarin

• reduced antiretroviral effects

• digoxin

• calcium channel blockers

• antidepressants

Studies: St John’s wort

several well-conducted studies support the use for mild to moderate depression

Nursing Considerations: St John’s wort

• should not be used to treat severe depression (only mild to moderate)

• should only be used with medical guidance

Echinacea (Echinacea purpurea)

prevents and treats the common cold, stimulates the immune system, promotes wound healing

Side Effects: Echinacea

• fever and nausea (rare)

• anaphylaxis in susceptible individuals

Herb/Medication Interactions: Echinacea

• may reduce the effects of immunosuppressants

• may increase serum levels of alprazolam, calcium channel blockers, and protease inhibitors

Studies: Echinacea

well-conducted studies have conflicted as to the effectiveness in the treatment of the common cold

Nursing Considerations: Echinacea

long-term use may cause immunosuppression

Garlic

blocks LDL cholesterol and raises HDL cholesterol lowers triglycerides

suppresses platelet aggregation and disrupts coagulation

acts as a vasodilator (can lower bp)

Herb/Medication Interactions: Garlic

• an increase risk of bleeding in clients taking NSAIDs, warfarin, and heparin

• decreases levels of saquinavir (a medication for HIV treatment) and cyclosporine

Nursing Considerations: Garlic

1. question clients about concurrent use of NSAIDs, heparin, and warfarin

2. Have clients who are taking antiplatelet or anticoagulant medication, cyclosporin, or saquinavir contact their provider prior taking garlic as a supplement

Ginger root

• relieves vertigo and nausea

• increase intestinal motility

• increases gastric mucus production

• decreases GI spasms

• produces an anti-inflammatory effect

• suppresses platelet aggregation

• used to treat morning sickness, motion sickness, nausea from surgery

• can decrease pain and stiffness of RA

Herb/Medication Interactions: Ginger root

1. use cautiously in clients who are pregnant because high doses can cause uterine contractions

2. interacts with medications that interfere with coagulation (NSAIDs, warfarin, heparin)

3. can increase hypoglycemia effects of diabetes

Nursing Considerations: Ginger root

1. question clients about concurrent use with NSAIDs, heparin, or warfarin

2. monitor for hypoglycemia if the client takes insulin or other medication for diabetes

Ginkgo (Ginkgo bioloba)

improves cerebral circulation to treat dementia and memory loss

decreases pain with walking in clients who have PAD

Side Effects: Ginkgo

• dizziness

• stomach upset

• vertigo

Herb/Medication Interactions: Ginkgo

1. may increase the effects of MAOIs, anticoagulants, and antiplatelet aggregates

2. may reduce the effectiveness of insulin

Studies: Ginkgo

studies conflict as to the effectiveness in all purported uses

Nursing Considerations: Ginkgo

1. discontinue 2 weeks prior to surgery

2. may cause seizures with overdose

3. keep out of the reach of children

Glucosamine (2-Amino-2-deoxglucose)

relieves osteoarthritis

promotes joint health

Side Effects: Glucosamine (2-Amino-2-deoxglucose)

• nausea

• heartburn

Herb/Medication Interactions: Glucosamine (2-Amino-2-deoxglucose)

1. may increase resistance to anti-diabetic agents and insulin

2. may increase risk of bleeding. use cautiously with clients on anticoagulants

Studies: Glucosamine (2-Amino-2-deoxglucose)

several studies support the use in reducing the symptoms of osteoarthritis in the knees

Nursing Considerations: Glucosamine (2-Amino-2-deoxglucose)

1. use glucosamine with caution in clients who have shellfish allergy

2. monitor glucose frequently in clients who have diabetes mellitus

3. allow extended time to see the effects of glucosamine

4. used often in combination with chondroitin

Omega-3 fatty acids

improves hypertriglyceridemia

helps maintain cardiac health

Side Effects: Omega-3 fatty acids

• nausea

• diarrhea

Studies: Omega-3 fatty acids

1. several well-conducted studies support the use in reducing blood triglyceride levels, preventing cardiovascular disease in clients who have a history of a heart attack, and slightly reducing blood pressure

2. studies support improvement in symptoms of bipolar disorder

Herb/Medication Interactions: Omega-3 fatty acids

may increase the risk of vitamin A or D overdose

Nursing Considerations: Omega-3 fatty acids

1. found in fish oils, nuts, and vegetable oils

2. some fish contain methylmercury and polychlorinated biphenyls (PCBs) that can be harmful in large amounts, especially in women who are pregnant or nursing

Melatonin

treats insomnia and jet lag

Side Effects: Melatonin

• morning grogginess

• lower body temperature

• vivid dreams

Herb/Medication Interactions: Melatonin

• beta blockers

• warfarin

• steroids

Studies: Melatonin

several studies support antioxidant effects

Nursing Considerations: Melatonin

pregnant or nursing women should not take melatonin

Nursing Assessments for Herbal Medication

1. ask the client specifically about herbal medications, vitamins, or other supplements during the client interview

2. OTC medications are often not considered medication by the client

Nursing Interventions: Herbal Medications

1. instruct the client that herbal medications and supplements are not regulated by the FDA, often interact with other medications, and may cause serious adverse effects

2. instruct the client that it is important to use herbal medications and supplements cautiously and with medical supervision

3. discourage use in pregnant and nursing mothers, infants, young children, and other older adults who have cardiovascular or liver disease