Phytopharmaka

Abstract

There is a great enthusiasm for herbal medications with increasing and widespread use among the population in various countries. A certain scepticism towards the use of pharmaceutical drugs may promote the use of herbal medicines such as echinacea, ginger, garlic, ginkgo, cranberry, valerian or St. John's wort even in western countries. Although considered safe among users, adverse effects such as increased bleeding tendencies, hypertension and hepatotoxicity can occur. Physicians should caution patients on the adverse side effects of herbal medicines and interactions between herbal medicines and pharmaceutical drugs, leading to various and uncontrollable deterioration of vital functions in the perioperative period. Although evidence-based data are lacking, anaesthesiologists and surgeons should be familiar with the effects of herbal medicines and should enquire about the use of these agents in the preoperative assessment. Currently available data suggest that herbal medications should be discontinued up to 2 weeks before elective surgery, although no guidelines of scientific societies have yet been published.

Effects of naturopathic medicines on Multiplate and ROTEM: a prospective experimental pilot study in healthy volunteers

“…Further clinical studies are needed before any firm conclusions can be drawn. In anticipation of more such studies, experts have recommended avoiding herbs for at least 2 weeks prior to surgery [ 3 ]. This is a reasonable recommendation because stopping the naturopathic medications during this limited time is probably not harmful and may decrease the risk of perioperative complications.…”

“…Of patients undergoing surgery, 22 to 57 % have been reported to be using naturopathic medicines [ 1 , 2 ]. Although evidence based data of increased perioperative bleeding are lacking [ 3 ] several naturopathic medicines may increase the risk of bleeding or enhance the effect of other drugs that may increase bleeding, such as non-steroid anti-inflammatory drugs [ 4 ]. The recommendation of the Swedish Medical Products Agency [ 5 ] is to stop the usage of the naturopathic medicines echinacea, fish oil, ginkgo biloba, ginseng, St. John’s wort, valeriana and garlic 2 weeks before elective surgery to avoid unwanted bleeding effects.…”

Herbal and alternative medicine: the impact on anesthesia

“…The effects on the endocrine system are varied and specific to relevant herbs, 16 and include hyper-and hypoglycaemia, 64 oral contraception failure with some preparations, 65 impaired corticosteroid synthesis 66 and hypokalaemia.…”