Top 20 Herbal Products
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| Glucosamine/Chondroitin | Osteoarthritis | Chondrointin can increase bleeding risk with antiplatelet agents/antigcoagulants. Caution in DM, HTN, Hyperlipidemia, and shellfish allergy
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| Echinacea | Common cold and URI | Avoid in autoimmune disorder; ADR: allergic reactions, rash
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| Ginkgo | Alzheimer dementia, memory loss, vertigo, tinnitus, intermittent claudication, motion sickness | Increase bleeding risk with anticoagulants, antiplatelet agents; ADR: mild GI upset, constipation, dizziness, HA
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| Ginseng | Improve energy, increse resistant to stress, improve immune function | Possible antipletelet effects; may reduce warfarin absorption; reduce immunosuppressants' effects; increase antidiabetic drugs' effects; ADR: insomnia, edema, HTN, tachycardia
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| Saw Palmetto | BPH | Do not affect prostate size or PSA; pts must continue to be evaluated for prostate CA; ADR: dizziness, nausea, vomiting, diarrhea, sexual dysfuntion
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| Fish Oil | Heart disease; Hypertriglyceridemia | Increase bleeding rish with very high doses; do not increase INR; ADR: fishy aftertaste, GI intolerance, loose stools, belching (dose-related)
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| St. Jonh's Wort | Mild-Moderate Depression | Reduce levels of cyclosporine, HIV agents, OCs, CBZ, warfarin. Reduce effects of antidepressants, triptans. Caution in bipolar, schizoprenia, Alzheimer. ADR: GI, dry mouth, restlessness/insomnia, vivid dreams, agitation, mania, dizziness, rash, photosensi
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| Garlic | Hyperlipidemia, HTN, prevention of atherosclerosis | Increase bleeding risk w/ warfarin, ASA. Reduce effects of cyclosporine, saquinavir, OCs. ADR: heartburn, N/V, bad breath, body odor
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| Melatonin | Insomnia, jet lag | Increase antiplatelet effects. Increase BP & impair blood sugar control. ADR: fatigue, drowsiness, anxiety, dizziness
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| Coenzyme Q10 | Congestive heart failure, angina, HTN | Reduce effect of warfarin. Synergistic effects with antihypertensive agents
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| Cranberry | UTI | Action not due to acidic pH
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| Feverfew | Migraines, colds, PMS, fever | CI: pregnancy due to increase bleeding risk; Caution: allergies to ragweed, daisies, mums
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| Ginger | Motion sickness, nausea, stomach disorders | Monitor patients on anticoagulants
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| Hawthorn | Cardiotonic (lowers BP) | Avoid: pregnancy
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| Milk thistle | Hepatoprotectant | ADR: loose stools
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| Valerian | Mild tranquilizer & sedative for insomnia | ADR: sleep disorders
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| Soy isoflavones | Hot flashes | Avoid: Hx of breast cancer
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| Black cohosh | Hot flashes | Conflicting evidences
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| SAM-e | Depression, Osteoporosis | Well tolerated
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| MSM | Osteoporosis | Limited data
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