Common name: artichoke

Part used: leaf

Dose: 5 - 10mg daily

Indications:

functional dyspepsia, hyperlipoproteinaemia, alcohol-induced hangover symptoms

Interactions:

None reported

Common name: astragalus

Part used: root

Dose: 9 - 30g of dried root daily

Indications: leucopenia, improving immunicty, prophylaxis of common cold, ischaemic heart disease, angina pectoris

Counselling: Discuss use for individuals with cancer with medical professionals

Interactions:

Suspected to reduce efficacy of immunosuppressants

Common name: bilberry

Part used: fruit

Dose: 320 - 480mg daily

Indications: visual and circulatory problems

Side effects: mild, mostly gastrointestinal and cutaneous

Interactions:

Anticoagulants: avoid concommitent use

Common name: cascara sagrada

Part used: aged bark

Dose: 1.5 - 2g daily

Indications: laxative

Side effects: cramping, diarrhoea, long term abuse, fluid and electrolyte imbalances

Interactions:

digoxin and other antiarrthmics

 thiazide diuretics

Cimicifuga racemosa

Common name: black cohosh

Part used: root and rhizome

Dose: 40 - 140mg daily

Indications: PMS, dysmennorrhoea, menopausal symptoms

Side effects

hypotension, nausea, vomitting, dizziness, headache, tremors, mastalgia, weight gain.  A few reports of liver failure

Counselling: discuss use with health professional if receiving anti-oestrogenic or chemotherapeutic treatments.    Avoid in pregnant patients

Interactions: tamoxifen, hemotherapeutic agents, hormonal preparations, reduces CYP2D6 enzymes

Common name: cayenne

Part used: fruit

Dose: topically applied

Indications: counter irritants and external analgesia

Side effects: extreme burning pain in nose, sneezing and serous discharge, GI discomfort, transient bronchoconstriction and skin irritation

Counselling:

Apply as a thin film 3 to 4 times daily and massage in to affected area.  Initial application may cause burning, but pain relief will occur gradually over 14  28 days.  Wash hands after application to avoid contact with mucous membranes and eyes 

Interactions:

ACEI and theophylline

Common name: celery

Part used: fruit

Dose: 1.5 - 3g daily

Indications: arthritis, rheumatism, gout, urinary tract inflammation, nervousness

Side effects: CNS depression, dermatitis, hypersensitivity reactions, phototoxicity

Interactions:

anticoagulants, thyroxine

Common name: Chamomile, german

Part used: flower heads

Dose: 3g daily

Indications: mild sedative, irritable/spasmodic conditinos of GIT, dysmenorrhoea, used topically for inflammatory skin conditions

Common name: chaste tree

Part used: berry

Dose: 30 - 40mg

Indications: menstrual cycle irregularities, premenstrual symptoms and menopause

Side effects

headache, GI disturbances, skin conditions such as acne, pruritus and rashes

Interactions:

dopamine receptor antagonists

oral contraceptives

Dose: 100 - 150mg daily

Indications: ischaemic heart disease, heart failure, hypertension, reduce reperfusion injury and improve physical endurance, reduction of side effects of anthracyclines, parkinson's disease

Side effects

anorexia, mild nausea, diarrhoea, epigastric discomfort, ischaemic tissue damage

Interactions:

warfarin

Common name: Cranberry

Part used: fruit

Dose: 400 - 800 mg daily

Indications: prevention of UTI, treatment of mild UTI

Side effects:

None known at recommended doses

Interactions:

Warfarin

omeprazole (potentially favorable interaction)

Common name: Devil's claw

Part used: root

Dose: 2 - 9g daily

Indications: arthritis, gout, myalgia, fibrositis, lumbago, pleurodynia, rheumatic pain

Side effects: diarrhoea

Interactions:

warfarin

Angelica polymorpha

Common name: dong quai

Part used: root

Dose: 4.5 - 9g daily

Indications: gynacological disorders

Side effects: hypersensitivity may cause bleeding, diarrhoea and fever.  photosensitivity.

Interactions:

warfarin

Common name: echinacea

Part used: root

Dose: 1g tds

Indications: wound healing, prevention and treatment of colds and upper respiratory tract infections

Side effects: allergic reactions (rash, bronchospasm)

Interactions:

immunosuppressants, midazolam

Oenothera biennis

Common name: evening primrose

Part used: seed oil

Dose: 250 - 2000mg daily

Indications: dermatitis, PMS, psoriasis, eczema, mastalgia, ADD, schizophrenia

Side effects well tolerated.  Occasional mild GI effects, indigestion, nausea, headache and softening of stools

Interactions:

anticoagulants and antiplatelets

antipsychotics (risk of seizures)

tamoxifen (increased response to tamoxifen)

Common name: feverfew

Part used: leaf

Dose: 50 - 120mg

Indications: migraine prophylaxis, fever, menstual disorders, arthritic conditions

Side effects

Usually mild and transient.  Occassional mouth ulcers.  Dry and sore tongue, swollen lips and mouth with loss of taste, gastric disturbances

Interactions:

warfarin

Common name: garlic

Part used: bulb

Dose:4g daily

Indications: lowering serum lipids and blood pressure, nausea, mild hypoglycaemic agent, antibacterial and antifungal agent

Side effects

Rarely burning sensation in mouth and GIT, nausea, diarrhoea and vomitting

Counselling:

Stop taking one week prior to surgery

Interactions:

significant inhibitor of CYP2E1 (therefore affects caffeine, paracetamol and theophylline)

ritonavir

saquinavir

warfarin

Common name: ginger

Part used:rhizome

Dose: 0.25 - 1g tds (caution in pregnancy)

Indications: Antiemetic, arthritic conditions

Side effects

dyspepsia

Counselling:

Stop taking 1 week prior to surgery

Interactions:

antacids

warfarin

Ginkgo biloba

Common name: Ginkgo

Part used: leaf

Dose: 120 - 240mg daily

Indications: dementia, tinnitus, intermittent claudication

Side effects

GI upset, headache

Counselling:

Stop at least 1 week prior to surgery

Interactions:

anaesthetic drugs, anti-diabetic drugs, aspirin, ibuprofen, digozin, haloperidol, nifedipine, omeprazole, warfarin

No effect on:

donepezil, CYP enzymes 

Common name: ginseng

Part used: root

Dose: 1-2 g per day

Indications: enhanced physical performance, psychomotor performance/cognitive function, immunomodulation, T2DM, herpes simplex type II

Side effects: uncommon, headache, sleep, GI disorders.  Usually mild and transient

Interactions:

Hypoglycaemic agents, phenelzine, warfarin

Dose: 500mg tds

Indications: osteoarthritis of the knee

Side effects: constipation, diarrhoea, drowsiness, epigastric pain and discomfort, headache, heartburn, nausea, rash

Interactions: warfarin

Common name:

Part used:

Dose: 1.5 - 3g daily

Indications: catarrh of upper respiratory tract, mucosal inflammatino, bacterial infections. 

Lack of evidence of efficacy 

Precautions/Contraindications:

Do not use in pregnancy  

Avoid in hypertensive patients 

Side effects:

toxicity including delirium, hyperreflexia, convulsions, paralysis

Interactions:

Inhibitor of CYP3A4 and CYP2D6

Indinavir

Warfarin

Common name: gotu kola

Part used: whole plant

Dose: 1.8g daily

Indications: wound healing, variscose veins, chronic hepatic disorders, rheumatism, anxiety states

Side effects: burning sensation, contact dermatitis, hypercholesterolaemia, hyperglycaemia, pruritis, sedation

Interactions: none reported

Common name: Grape seed

Part used: seed

Dose: 12g taken 2 - 3 times daily

Indications: antioxidant, inflammatory conditions, varicose veins

Side effects

Increased blood pressure by 5 mm Hg in people also taking vitamin C.

Interactions:

none reported

Common name: green tea

Part used: leaf

Dose: 8 - 10 cups of tea

Indications: prevention of cancer, dental caries, hypercholesterolaemia, atherosclerosis

Side effects: none listed

Interactions:

no effects of CYP3A4 and CYP2D6

warfarin

Common name: guarana

Part used: seed

Dose: 2.5 - 4 g daily

Indications: CNS stimulant

Side effects: diuresis, insomnia

Interactions:

antihypertensives, CNS depression, diuretics, theophylline, caffeine

Crataegus laevigata

Common name: hawthorn

Part used: flower, berry or leaf

Dose: 160 - 900mg

Indications: atherosclerosis, angina, rheumatism, liver problems and congestive heart failure, hyperlipidaemia, hypertension and orthostatic hypotension

Side effects

hypotension, arrhythmia, sedatio.  Nausea, dizziness, GI complaints

Interactions:

antihypertensives, nitrates, digoxin

Aesculus hippocastanum

Common name: horse chestnut

Part used: seed

Dose: 250 - 312.5mg bd

Indications:  chronic venus insufficiency, diarrhoea, fever, phlebitis, haemarrhoids, protate gland enlargement, varicose veins

Side effects

uncommon, infrequent and mild GI irritation may occur

Interactions:

warfarin

Common name: kava

Part used: rhizome and root

Dose: 60 - 120mg daily

Indications: insomnia, tension headaches, anxiety, menopausal symptoms

Side effects: *hepatotoxicity*, mild GI disturbances, allergic skin reactions, disturbances in visual accomodation

Interactions:

levopdopa,

anxiolytics

alcohol

inhibits CYP2E1 enzymes

Common name: kelp

Dose: 4.5 - 8,5mL

Indications: underactive thyroid, antihypertensive, anticoagulant, abortifacient, antirheumatic agent

Side effects

abnormal erythropoiesis, acneiform eruptions, autoimmune thrombocytopenia, bleeding, hyperthyroidism 

Interactions:

thyroxine

C/I and precautions:

pregnancy, thyroid disorders (due to high concentration of iodine)

Common name: licorice

Part used: root and rhizome

Dose: 5 - 15g of root of 1.5 - 5g rhizome

Indications: bronchial catarrh, bronchitis, chronic gastritis, peptic ulcer, constipation, colic and primary adrenocorticoid insufficiency

Side effects: mineralcorticoid effects: headache, lethargy, sodium and water retentino, hypokalaemia, hypokalaemic paralysis, muscle pain and weakness, pseudoaldosteronism, limb ischaemia.  Asthma, heart failure, cardiac arrest, ventricular tachycardia

Interactions:

antihypertensives, digoxin, diuretics, oral contraceptives, prednisolone

Common name: milk thistle (St Mary's thistle)

Part used: seed

Dose: 12 - 15g

Indications: acute and chronic hepatitis, liver tonic, hepatoprotective agent

Side effects

mild GI symptoms including mild laxative effects, sweating, nausea, colicky abdominal pain, fluid diarrhoea, vomitting, weakness 

Interactions:

Indinavir

Metronidazole

Common name: pau d'arco

Part used: bark

Dose: 3 - 6 cups daily

Indications: anitmicrobial, antifungal, antiparasitic, antiviral, immune enhancing

Side effects: potentially toxic.  Nausea, vomitting, pink-coloured urine, reversible anticoagulation

Interactions:

warfarin

Common name: peppermint

Part used: oil, leaves and flowering tops

Dose: 0.2 - 0.4mL oil.  1.5 - 3g dried herb

Indications: dyspepsia, flatulence, colic, diarrhoea, irritable bowel syndrome, nausea, inflammation of gums

Side effects:

Allergic reactions and sensitisation.  Laryngeal or bronchial spasms.  Relaxation of lower oesophageal sphincter and GI smooth muscle which may cause heartburn

Interactions

felodipine (increases bioavailability and possible inhibition of drug metabolism)

phosphatidylserine

Common name: PS

Indications: dementia, improving cognitive function, mood disorders and stress (no evidence)

Side effects: Safe, limited to mild GI distress

Avoid in severe liver or renal disease and in young children

Common name: bee glue

Dose: oral and topical.

Indications: antimicrobial, antioxidate, antiinflammatory, antihyperglycaemic

Side effects

 allergic contact dermatitis, laryngeal oedema, anaphylactic shock

Interactions

none reported

Common name: red clover

Part used: flower head

Dose: 40 - 80mg daily

Indications: menopausal symptoms, hot flushes, bone density loss, CV risks, prostate cancer, benign prostatic hypertrophy, aczema, psoriasis, prostate cancer

Do not use in pregancy or lactation. 

Potential of enhanced anticoagulant effect 

Side effects:

oestrogen-like effects: breast tenderness and enlargement, change in menses, weight gain and redistribution, infertility and growth disorders.  May promote growth of oestrogen erceptor-positive neoplasia

Interactions: tamoxifen

Counselling:

Requires careful medical supervision if hx of oestrogen-receptor-positive neoplasm

Common name: saw palmetto

Part used: berry

Dose: 1 - 2 g daily

Indications: inflammation of genitourinary tract, testicular atrophy, sex hormone disorders, urinary tract symptoms associated with BPH

Side effects: well tolerated. Gi symptoms, headache, diarrhoea reported.

Interactions:

5-alpha-reductase inhibitors

oral contraceptives

warfarin

Indications: analgesic and antiinflammatory, antiangiogenic, antineoplastic, immunostimulant, antibiotic, antioxidant

Slight evidence for psoriasis 

Side effects: GI, rash, acne, taste disturbances, hypercalaemia, asthma

Counselling:

Discuss if cancer patient

Common name: Skullcap

Part used: leaf and root

Dose: 3 - 6 g daily

Indications: mild CNS sedative and relaxant, insomnia and anxiety

Side effects: overdose has caused arrythmia, confusion, giddiness, seizures, stupor, twitching

Interactions: none reported

Common name: slippery elm

Part used: bark

Dose: 1 teaspoon of powder in 500mL fluid

Interactions: numerous (delays absorption - seperate by 2 -3 hours where possible)

Side effects: topically can cause dermatitis

Indications:skin emollient, antitussive, smoothes GI ailments such as dyspepsia, gastritis, reflux, irritable bowel syndrome and crohn's disease

Common name: soy 

Dose: 34 - 160mg daily

Indications: HRT alternative, relief of menopausal symptoms, improving blood cholesterol levels, osteoporosis, prostate cancer

Side effects: well tolerated.  GI symptoms including nausea, bloating, vomiting

Interactions:

tamoxifen, theophylline and thyroid disease

Caution in oestrogen-receptor-positive neoplasm or hx of. 

Common name: St John's Wort

Part used: herb

Dose: 2 - 4g daily

Indications: antidepressant, antiviral, topical antimicrobial in atopic dermatitis, relief of psychological menopausal symptoms

Side effects

GI symptoms, anxiety, hypomania, allergic hypersensitivity, dizziness, dry mouth, restlessness and sleep disturbances.  Photosensitivity

Interactions:

lots

Common name: tea trea

Part used: oil

Dose: concentration depends on ailment

Indications: topical antibacterial and antifungal agent

Side effects CNS depression (ataxia, drowsiness), dermatitis, diarrhoea, oral and GI irritation with vomitting when used orally.

Interactions: none reported

Common name: tribulus

Part used: leaf

Dose: 750 - 1500mg daily

Indications: infertility, impotence, improving libido

Side effects: possible GI irritation.  One case report of gynacomastia

Interactions: theoretically with anabolic steroids

Common name: willow

Part used: bark

Dose: 120 - 240mg daily

Indications: osteoarthritis, rheumatoid arthritis, lower back pain, inflammatory musculoskeletal conditions, analgesic, fever, headache

Side effects: nausea, GI discomfort, dizziness, fatigue, allergic reactions

Interactions: warfarin, aspirin

Common name: valerian

Part used: root and rhizome

Dose: 2 - 3 g, once or several times daily

Indications: sedative, anxiety, insomnia

Side effects: mild, transient and rare.  Include stomach upset, headaches, palpitation and insomnia

Interactions

BZD