Herbal Remedies: Indications and Contraindications

Herbal Remedies

Key Considerations

• Focus on indications (who might take them and for what) and contraindications (who shouldn't take them) for specific herbal remedies.

Feverfew

• Contraindication: Patients taking blood thinners or anticoagulants like warfarin should avoid feverfew.
  • Feverfew combined with anticoagulants can cause an adverse effect.

St. John's Wort

• Contraindication: Patients taking St. John's wort should not combine it with any other antidepressant due to the risk of serotonin syndrome.
  • St. John's wort increases serotonin levels.

Interactions

• Feverfew and Depression: Feverfew itself does not increase serotonin to an extent that would interact with SSRIs or other antidepressants; its primary contraindication is with anticoagulants.
• St. John's Wort and Antidepressants: The interaction of concern is specifically between St. John's wort and other antidepressants because St. John's Wort increases serotonin.

St. John's Wort and Serotonin

• The instructor will cover in week 5 the antidepressant that doesn't affect serotonin, but, the easiest approach is to instruct patients not to combine St. John's wort with antidepressants.