Chapter 8

Herbal and natural remedies

I. Herbal–drug interactions

Q. Do herbal products have any harmful effects?

A. One of the major skepticisms is whether these products are safe and effective. One of the most worrisome adverse effects of herbal products is anticoagulation. Most herbal medicines are unapproved drugs being sold as dietary ­supplements. In 1990, the Food and Drug Administration (FDA) classified herbal medicines as food supplements. The Dietary Supplement and Health Education Act (DSHEA) of 1994 classifies vitamins, minerals, amino acids, and herbs as dietary supplements, which allows the marketing of these “food supplements” without the approval of any government agency for testing for safety, efficacy, or standards of manufacturing. The FDA is only required to prove that these ­products are unsafe. Dietary supplements do not have to be tested prior to marketing, and the effectiveness of the ­product does not have to be demonstrated by the manufacturer. The product label must include a disclaimer that the product is not FDA evaluated or approved and it is not intended to diagnose, treat, or prevent any disease (Cupp, 1999). The DSHEA does not regulate the accuracy of the label; the product may or may not contain the product listed in the amounts claimed. Herbal products therefore cannot be marketed for the diagnosis, treatment, cure, or prevention of disease. However, these products can be labeled explaining their proposed effect on the human body (e.g., alleviation of fatigue) or their role in promoting general well-being (e.g., enhancement of mood). Dietary supplement labeling requires the wording “dietary supplement” as part of the product name, and it must include a “supplement facts” panel on the ingredients. Also, products derived from plants must designate the plant part and the Latin binomial.

Q. What are herbal medications made from?

A. Herbal medications are made from natural ingredients extracted from a plant and are produced either in the original form or refined, where the essential extract is removed from the plant, concentrated, and then added back into the original form to make it more concentrated. The active ingredients in an herbal product may be present in only one specific part of the plant or in all parts. For example, the active ingredient in ginger is composed of roots found below ground, whereas in St. John’s wort it comes from leaves and stems that are above the ground. Every herb contains many active chemicals. Most of these chemicals have not been isolated and identified so that the strength of the product varies considerably, which makes standardization difficult. Additionally, the chemical composition of herbal supplements is unpredictable. Some standardizations are printed on the product label and may differ from one manufacturer to another.

Q. What are some adverse effects of herbal medications that are of concern especially for dental surgery?

A. Most reactions are due to filler substances added to the herbal product but not on the label. More commonly encountered adverse effects include sedation and bleeding, which manifests either via direct effects on capillaries, by ­interfering with platelet adhesion, or by increasing fibrinolytic activity. Caution should be used when nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended to patients taking herbs that could increase bleeding, including ginger, garlic, and ginkg/>

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