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Reports estimate that 25% of patients who seek medical attention for a serious condition are using herbal treatments, and up to 70% of such patients do not tell their doctor.1,2 It is imperative that you discuss any herbal product you use with your doctor to avoid untoward interactions with your medications. Established herbal remedies that can interfere with your medications include:

*Echinacea

*Garlic

*Gink go Biloba

*St. John's Wort

*Valerian

*Chamomile

*Ginger

*Ginseng

Echinacea is used to enhance the immune system. It can cause an unpleasant taste and allergic reactions. Persistent use can be toxic to the liver and you should not use it with liver-toxic medications like anabolic steroids, amiodarone, methotrexate, or ketoconazole.3

Garlic is used to prevent heart disease. It can cause malodorous breath and body odour. Uncontrolled bleeding and bruising can arise if you use it with anti-platelet medications like clopidogrel, dypyridamol, ticlodipine, cilostazol or aspirin.4 You should use garlic with caution if on the anti-coagluant medication warfarin.5

Ginkgo Biloba is used to enhance memory. It can cause mild stomach discomfort and headache. Similar to garlic, it affects platelets and blood clotting. You should avoid taking it with anti-coagulant or anti-platelet medications.

St. John's Wort is used to treat depression. It can reduce the effectiveness of oral contraceptives6,7, digoxin8,9, indinavir8,10,11 and cyclosporine12,13. You should not take it with serotonin reuptake inhibitor (SSRI) medications like citalopram, fluoxetine, fluvoxamine, paraxetine, or sertraline. This combination can cause the serotonin syndrome of headache, sweating, dizziness and agitation.8,13-15

Valerian is used for calming effects. Persistent use can cause restlessness and palpitations. You should not use it with depressant medications like diazepam or anti-histamine medications like chlorpheniramine.

Chamomile is also used to calm. You should use caution if combining it with other sedating medications.

Ginger is used to reduce nausea and vomiting.16-20 It can cause stomach upset, heartburn, diarrhea and mouth irritation.16 It can prolong bleeding and you should be cautious if combining it with anticoagulant medication as this can result in abnormal bruising and prolonged bleeding.21

Ginseng is used to boost energy.22 Overuse can cause diarrhea, insomnia, nervousness and high blood pressure. You should avoid it if you have heart problems and are taking stimulant medication. You should use

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