There are a few simple guidelines for safe use of these formulas and herbs in general:

1. When using an herb or formula for the first time, it is wise to take only 1/4 the recommended dosage to make sure you will not have an adverse reaction to it. If such a reaction occurs, immediately discontinue using the herb or herbal product. Slowly increase the dosage over 2 weeks until you are at the recommended dose level.

2. Always pay careful attention to recommended use or dosage. “If a little is good more must be better” does not apply here. Many herbs, particularly the stronger medicines used to treat chronic problems, are best used in small doses taken over an extended period of time.

3. There are few herbs that are truly safe during pregnancy. If you have a history of miscarriage or problem pregnancy consult a midwife or competent physician before trying herbs.

4. Know yourself! Always use common sense and careful discretion when choosing appropriate remedies for yourself. If you try something and it doesn’t work for you, you may have misinterpreted your symptoms and should consult a health care practitioner. But be patient, the actions of many herbs are subtle and only manifest when used over time.

5. If you are taking prescription drugs, interactions between some herbs and pharmaceuticals are possible. Discussing these possibilities with a clinical herbalist, professional member of the American Herbalists Guild, knowledgeable pharmacist or physician is advised.

Energetics - It is important to keep in mind the energetic properties of herbs in relationship to the condition being treated. For example, when treating a hot condition—red, inflamed, hot to the touch—a cool, soothing herb like marshmallow will be most helpful. Using a hot herb like Ginger could irritate the tissue even more.

Pregnancy - During pregnancy and nursing one must consider the dose of any medicine that the baby may receive through the placenta or milk. Any very bitter tonic or laxative can cause contractions of the uterus as a reaction from stimulating other organs. For simple home remedies a pregnant or nursing mother would be wise to limit her choices to food or superior herbs taken in teas. Teas are assimilated more slowly than extracts and would therefore have a milder impact on the baby.

6. Antagonistic or incompatible activities (laxatives & astringents, CNS stimulants & sedatives).

4. Does reaction cease on stopping herb?

1. Follow traditional knowledge of herb activity to predict and prevent possible synergies or antagonisms with prescription drugs. - Hawthorn may potentiate Digitaloids (Digoxin, Lanoxin and Beta-blockers). - Diuretics such as Buchu, Uva-Ursi, Juniper, etc. are contra-indicated while taking Lithium. - Herbs with Vitamin K such as Shepherd’s Purse & Nettles should not be added to the diet in large amounts if taking blood thinners. - Garlic, Ginkgo and Horse Chestnut should be used cautiously taken with prescription blood thinners (Dicoumarin). - MAO inhibitors such as Licorice and Passionflower should not be used with benzodiazepine medications. Valerian, Hops and Kava may potentiate the effects of benzodiazepines, barbituates or moderate alcohol consumption. - Mucilagenous herbs like Slippery Elm and Marshmallow may reduce absorption of other medications. - Laxative and diuretic herbs may increase potassium loss, therefore increasing the toxicity of cardiac glycosides present in Digoxin, Digitoxin or Lanoxin. - Cola nut is contra-indicated with MAO inhibitors and with ephedrine containing drugs.

2. Use formulas and lower dosages of herbs with potential problems - a recent study of St. John’s wort showed that its ability to provoke a herb/drug interaction was dose dependent. In traditional herbal medicine herbs are usually used in formulas, thus reducing the amount of any one herb ingested.

3. Take herbs & drugs separately (by 2-3 hours).

4. When adding herbs to already established drug regimens, start at low dose and gradually increase the dose. Monitor patients carefully.

5. Avoid starting or stopping medications and herbs suddenly. Subtle changes may not create a problem but substantial changes may trigger a major response.

6. Avoid red flags - Warfarin - interacts with over 200 foods, drugs, etc. Other problematic drugs include protease inhibitors, Cyclosporin, & Digoxin. Use care combining herbs, drugs, or supplements with medications that have a narrow therapeutic index.

7. Avoid using Kava with hepatotoxic medications (tetracycline, statin drugs, excessive alcohol, acetominophin).

8. Studies indicate St. John’s wort has the ability to stimulate Phase I liver detoxification (cyclic P-450 activity-CYP3A4, CYP2D6 and CYP2E1) and P-Glycoprotein activity in the gut. Medications known to be metabolised via these pathways may have reduced blood levels if taken with St. John’s wort. Avoid using St. John’s wort with protease inhibitors, Cyclosporin, Irinotecan, Digoxin and Warfarin.

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