Heart Attacks, Herbs, and Drug Interactions
By Brian Benjamin
Carter, MSci, LAc
with information from Pamela Wyckoff, PharmD.
Brian is an author of international
renown and public speaker. He is currently writing his book
Chinese Medicine: A Practical Guide to Optimal Healing.
Brian practices acupuncture and Chinese herbal medicine
in sunny San Diego, California.
I am a 49 year old licensed acupuncturist and had a light infarction
on Aug.7, 03. Burning in diaphragm and in back, nausea, vomit, and
cold sweat, sent me to ER. Had catheterization and angioplasty involving
3 stents for a 100% blockage half way down in right coronary artery.
No past history of chest pain, labored breathing, numbness, or dizziness.
Was 40lbs.over, consumed quart of coffee/day, and smoked 2 packs/day.
Exercising daily now, 25 lbs. over, quit smoking, and no caffeine.
Feeling great, and don't sweat near as much as used to upon exertion.
Doc has me on Plavix(75mg./day), Lisinopril(40mg./day), Metoprolol(50mg-every
12 hours), Coated Aspirin (325mgs./day), and Simvastatin(40mg./day).
My concern is the STATIN drug. I've read where they can seriously
deplete Co-Enzyme Q10..and actually cause cardiomyopathys later
on...and alas..plus cancer..mainly I've read due to the Co enzyme
My cholesterol has been in the 300-400 range and triglycerides
in the 1200 range in the past, but I had unfortunately ignored
this problem. There is only limited research into reactions involving
pharmaceuticals and Chinese medicine or other herbal medicines.
Due to this I would like to find an acupuncturist who would have
quite a bit more experience in the Tx. of heart patients seeking
to wean off of STATIN medications.
Would you be aware of any of these types of practitioners?
Is there any safe way to use Chinese herbs/formulas to wean off
of STATIN medications, or would this be literally taking a shot
in the dark?
Sorry to hear about your infarct. Glad to hear about your lifestyle
Ya, I've heard some things about statins as well- can't think
they're some new wonder drug- I have some reservations, and think
your caution is prudent.
True, there is limited research on drug-herb interactions, but
I do see some patterns in these interactions- first, check out
my article, "Are My Herbs and Drugs
Dangerous Together? Drug Herb Interactions."
The patterns I see are:
1. Single herbs are more likely to interact with drugs.
2. Formulas are less likely to interact, and may even synergize
for more effect with fewer side effects.
How to Determine If You Can Take
Herbs with Your Drugs
Although we may not catch some of the exceptions (the unknown
drug/formula interactions), there is a process for determining
whether a drug is likely to interact with herbs in general. Use
Information Handbook for this part.
By the way, I owe this process to pharmacist Pamela Wyckoff.
I've begged her to publish it, but she has not... and people are
suffering without the info, so I'm giving it to you, and giving
her credit for it! Hopefully she won't be too mad at me.
The major things you look at in a drug are
- Reference range
- Protein binding
The acronym RAMP-E should help you remember all the steps.
It fits since some drugs require you to ramp down or ramp up your
Reference Range (Therapeutic Margin)
Reference range comes first, though, because it determines whether
you will even use herbs with a specific drug. If the Drug Handbook
has a 'Reference Range' for the drug in question, that means that
drug has a narrow therapeutic margin. That is to say: for the
drug to be effective and not be toxic, the blood levels have to
be a relatively specific amount.
Another way to think of it is that the drug is 'sensitive.' It
doesn't take much interference to throw it off. Warfarin (Coumadin)
is such a drug. For the patient to stay safe from blood clots,
the warfarin levels in the blood must remain rather constant.
If herbs throw off these levels, then they are in danger of stroke,
aneurysm, or whatever their MD is trying to prevent.
The Reference Range Rule:
If the drug has a reference range, don't use herbs.
Absorption is about getting the herb into the bloodstream. There
are three ways that absorption can be affected: pH, binding (not
the same as protein binding), and motility.
- pH: antacids, proton pump inhibitors, and H2 antagonists
alter pH, thus altering the ionization of the drug molecule.
Obviously, if stomach pH is lowered, less of the herb can be
- Binding: Some drugs are sticky, and bind to herbs,
preventing them from crossing the membrane into the blood stream.
These are questran, carafate, and activated charcoal.
- Motility: Changes in GI motility change the usual time
the drug is exposed to membranes, changing the amount of drug
absorption. Those that increase motility are reglan, cholinergics,
and propulsid. Those that decrease are anti-cholinergics, narcotics,
and phenobarbitol. If motility is increased, herb dosage must
be increased, and vice versa.
Drugs and herbs are primarily metabolized in the liver (but also
can be kidney, lung, or GI epithelium). Most are handled by the
liver cytochrome P450 system. Mainly, look for whether the drug
induces, or inhibits liver enzymes. Inducers decrease breakdown
time (increase dosage), and inhibitors increase breakdown time
(If you want to save time, do protein binding second, right after
reference range. This one, like the reference range, can be enough
to tell you that herbs are too dangerous.) Protein binding is
a measure of how much of the drug binds to albumin, the most common
protein in the blood. The amount of the drug bound to albumin
are not active. The rest that's in the blood is active. The danger
is when the amount that's bound to albumin is very high. Then
if some other drug or herb comes in and changes the percentage
bound, blood levels of the drug can increase dramatically. This
can lead to side effects and toxicity.
For most people, drugs that have 98% or greater protein binding
are too dangerous. An exception is phenytoin (dilantin) because
it is highly susceptible to binding changes. it takes less than
most drugs to unbind from the albumin. For patients with mild
liver disease, drugs with 95% or greater protein binding are dangerous
to combine with herbs; their liver can metabolize out high blood
levels of drugs as well as healthier people. For people with cirrhosis
or jaundice (serious liver disease) watch out for 90% or higher.
So, if the protein binding % of any of their drugs is too high,
don't use herbs.
Patient Protein Binding Danger Level
- Healthy liver: Greater than or equal to 98%
- Abnormal liver (High liver function tests, chronic
Hep C, etc.): Greater than or equal to 95%
- Seriously diseased liver (Cirrhosis, jaundice, end
stage alcoholism): Greater than or equal to 90%
The Protein Binding Rule:
If the drug has a high protein binding percentage, don't use herbs.
Some medications that interfere with distribution of drug spread
through the body are coumadin, dilantin, oral contraceptives,
Renal, biliary, fecal, intestinal, saliva, sweat, breast milk,
lungs... altering renal flow rate, urine pH, or damaging kidneys
will affect elimination. Diuretics increase clearance, and aminoglycosides
and aphotericin damage the kidneys.
So, all that said, I wouldn't call it a shot in the dark, but
rather a shot in the twilight? ;-)
Plus, some good new formulas have been translated by Philippe
Sionneau from the Chinese research based partly on classical theory
and partly on the pharmaceutical action of herbs... there are
formulas for high triglycerides, etc. The book hasn't come out
yet in English, but email me (bbcarter at pulsemed dot org) if
you want me to email you some of that information- just specify
Formulas like that may help you substitute for some of the drugs
you've been prescribed- but yes, I would work with a good herbalist
(who is knowledgeable about western medicine) and an open-minded
And don't forget bout niacin- it's shown great cholesterol
lowering abilities with few or no side effects.