Herb-drug Interaction Precaution List

Drug type Drug name Precautions/Contraindications

Cardiac glycoside Digitoxin No herbs (unless with doctors approval)
Digoxin - Diuretic herbs (eg. Ze Xie, Zhu Ling, Tong Cao)
Foxglove - Herbs that cause hypokalaemia (eg. Lu Hui, Gan Cao, Fan Xie Ye)
- Herbs that can lower blood pressure (eg. Xuan Shen, Shan Zha)
- Nephrotoxic herbs (eg. Fang Ji, Mu Tong, Shui Chang Pu)

Blood thinners Warfarin Generally no herbs unless with clinicians/doctors approval

- Dang Gui, Yin Xing (Ginko), Garlic, Ginger, Jiang Huang (tumeric), Ren Shen (Ginseng),
Dan Shen
- Other IBC herbs
* advise to stop herbs if notice more bruising/excess bleeding (gums)

NSAIDs (particularly aspirin)
- Dang Gui, Yin Xing (Ginko), Garlic, Ginger, Jiang Huang (tumeric), Ren Shen (Ginseng),
Dan Shen
- Other IBC herbs
* advise to stop herbs if notice more bruising/excess bleeding (gums)
- Herbs that may irritate GIT (eg. Ai Ye, Ru Xiang, Da Huang)
- Diuretic herbs

Paracetamol Paracetamol - Potentially hepatotoxic herbs (eg. Bai Xian Pi, Kuan Dong Hua, Chuan Lian Zi)
- Herb that inhibit CYP3A4 (eg. Ju Hua, Dan Shen, Ci Wu Jia)

Opioids Codeine - Herbs that may increase sedation (eg. Bai Jiang Cao, Chan Tui, Long Dan Cao
Fentanyl Fu Shen, He Huan Pi)
Merperidine - Herbs that may worsen hypotension (eg. Diuretic herbs)
Methadone
Morphine
Oxycodone
Panadeine
Tramadol
Antihypertensives Loop diuretics (eg. Furosemide)
(Diuretics) Thiazide/Thiazide-like diuretics (eg.
Chlorothiazide)
Potassium-sparing diuretics (eg. Amiloride)
ACE-inhibitors (eg. Captopril, enalapril)
Calcium channel blockers (eg. Verapamil,
nifedipine)
- Diuretic herbs (eg. Ze Xie, Zhu Ling, Tong Cao)
- Herbs that cause hypokalaemia (eg. Lu Hui, Gan Cao, Fan Xie Ye)
*Except potassium-sparing diuretics
- Herbs that can lower blood pressure (eg. Xuan Shen, Shan Zha)
- Nephrotoxic herbs (eg. Fang Ji, Mu Tong, Shui Chang Pu)

Statins Atorvastatin - Herbs that may decrease drug levels (eg. Huang Bai)
Fluvastatin - Herbs that may increase drug levels /increase risk of side effects (eg. Lu Cha (Green
Pravastatin Tea))

Benzodiazepines Diazepam (Valium) - Herbs that may alter drug level (eg. Ginko, Dang Gui)
Lorazepam - Shen Calming herbs (eg. Yuan Zhi, Suan Zao Ren)
Temazepam

Antidepressants SSRIs (eg. Fluoxetine/Prozac, paroxetine, - Herbs that may interact (eg. Ren Shen, Ma Huang, Gan Cao, Yin Xing, Rou Cong Rong)
sertaline) - Shen Calming herbs (eg. Yuan Zhi, Suan Zao Ren)
SNRI (eg. Venlefaxine)
MAOIs (eg. phenelzine)
TCAs (eg. Amitryptiline, clomipramine,
doxepin)

Corticosteroids Cortisone - Herbs that increase anticoagulant/thrombolytic/anti-platelet effects (eg. Hong Hua,
(systemic and/or Dexamethasone Tao Ren)
topical, particularly Hydrocortisone - Herbs that affect blood glucose (eg. Shan Zha)
for long-term Prednisone - Herbs that affect immunomodulation (eg. Gan Cao, Huang Qi, Ren Shen)
users) Prednisolone - Herbs that irritate the GIT (eg. Ai Ye, Ru Xiang, Da Huang)
Fludcortisone - Diuretic herbs/ Herbs that cause hypokalaemia (eg. Lu Hui, Gan Cao, Fan Xie Ye, Ze
Xie, Tong Cao)
*NOTE* Gan Cao may cause hypokalaemia, water retention and pseudoaldosteronism
Hormone Therapy Oestrogen (eg. Oestradiol)
(particularly for Antioestrogen (eg. Tamoxifen)
oncology patients) Progestogen (eg. Progesterone)
Androgen (eg. Testosterone)
Antiandrogen (eg. Flutamide, nilutamide,
ketaconazole)
- Herbs that may interact (eg. Fan Xie Ye, Gan Cao, Ren Shen, Dan Shen, Lu Cha, Man
Jing Zi, Bai Zhi)
- Herbs with phytoestrogens (eg. Sheng Ma, Dan Dou Chi, Dang Gui, Ge Gen)
- Herbs with anti-oestrogenic actions (eg. Xia Ku Cao)
- Herbs with androgen properties (eg. Yin Yang Huo, Gui Ban)

Other drugs which Tetracycline *For oncology patients, approval from the doctor is necessary
should be taken Thyroxine
with herbs with Diabetes medication (eg. Metformin,
precaution Sulphonylureas, Insulin, Gliptins,
Thiazolidinediones)
Antifungal medications (eg. Imidazole,
triazole)
Anticancer drugs (eg. Cyclophosphamide,
methotrexate)

Generally, overly acidic/basic herbs or herbs that have diuretics, purgatives, emetics may alter the pharmacodynamics/pharmacokinetics of drugs and
should be taken at least 2 hours apart. Patients characteristics (eg. age, condition, KI/LR function) and other general safety precautions (eg. Dosage of
herbs and not taking herbs longer than 3 months subsequently) should be taken into consideration.

**Do NOT ask patients to take herbs 2 hours apart if they are on asthma relievers or if they need adrenaline (eg.Epipen for anaphylactic shock) **