 Lithium Carbonate

o Have reduced catecholamine clearance

o Used to treat bipolar
o Fairly common drug
o Patients put on this may not be stabilized w.r.t. their bipolar affect until 3
weeks later
o Low NaCl diet increase Lithium reabsorption
o Blocks the reabsorption of T3 – so expect to see hypothyroidism
 Lithium interaction
o Plantago reduces absorption of digtalis and digitoxin
o Take fibe more than an hour away from lithium
o Astragalus gummifer
 Another form of fibre
o Ulmus fulva
 Slippery elm
o Caffeine
 4 cups of day reduces the Li effect
 Withdrawal increases tremors
 Get risk of increased Li levels during withdrawal
o Oenothera biennis – can reduce tremor levels (about 2 – 3 g/day)
o Need to stay away from caffeine and sugar
 Sepculation
o Fucus vesiculosis and Laminaria digitans
 Could have beneficial thyroid effects
 Want to be careful not to induce hyperthyroid state
o Diuresis
 Can contriubute to potassium and sodium loss
 Taraxacum officinale – depends on soil
 If have UTI can use these herbs to treat
 Phenothiazine/Fluphenazine/thirodazine
o Used in schizophrenia
o Oneotheria biennis
 In some individuals have tendency to have seizures
 No way to know for sure, patient needs to experience it to be sure
o Areca catechu
 Tropical plant used for stimulation
 Increases the S/E of these two drugs
o Silybum marianum
 Reduces LV toxicity
o Won’t be tested on dosages
o Coffea Arabica
 Reduces absorption
o Camellia sinensin and high tannin
  May lower absorption
 MAOI
o Schizophrenia from vitamin B3 deficiency
o Less used than they used to be, now used in difficulty patients
o Drugs were originally developed to treat TB
o Noticed that there was mood elevation and hypotension
o Went back and tried it as an antidepressant
o People developed liver toxicity
o Well absorbed but many side effects
o Very short half-life and high risk of liver cirrhosis
o Interesting: people from different genetic backgrounds metabolize them
differently (Asians – metabolize slower)
 MAOI: Interactions
o Interact with a lot of things, that’s why seen less in practice
o They interact with reserpine, which is in many things
o OTC amine eg. Allergies and cold medications
o L-tyrosine – goes to adrenals and thyroids
o L-tryptophan – goes on to produce dopamine
o Diet becomes a challenged (especially with fermented food)
o Kaolin – used to absorbed ammonia
o Na bicarbonate increases the ½ life to 21 hours – so taking one particular
substance can be a serious problem for the patient
 Can get from IV therapy for pH control (big problem!!!!)
o Hydrazine sulfate
 Cancer treatment
o Like a person on a blood thinner
 SSRI
o 90% metabolized
o Excretion is slower the older the patient gets
o Have a long ½ life 24 hrs (CPS says up to 65 hrs)
o Enter the breast milk – so not a good idea for breast feeding moms
o Been given to teenagers even though increased suicide rate
o Do not quit cold turkey!!!!
o Interaction
o NSAIDS and ASA
 Increases risk for GI bleed
 More than if you took ASA by itself
o A little less problems than MAOI
o Weight gain – typically 20 to 50 lbs
o Disinhibits eating reflex and crave sweets
o Very hard for them to get it off
o Dermatologic – skin rashes
o Reduces libido and reduces orgasmic effect in both sexes
 SSRI: Interactions
o Hypericum perforatum
 Negative outcome can occr
 SSRI: Speculative Interactions
o Salix alba, s. nigra…. – all have salicylates!!!
o Melilotus officinalis
 Source of coumarins
o Tanacetum
 Fever few
 Antidepressants
o See them occasionally
o CI with MAOI
o Trazodone
 People take to sleep
 Mechanism is not fully understood
 SE
• Priapism – prolonged painful erection
 Interactions
o Gingko, helps to offset sexual dysfunction
o EGb761 – standardized one that’s used in all European studies
 Where the research has been done
o Pausinystalia yohimbe
 Can help with erectile dysfunction
 Have to be careful with it
 Sepeculative Interaction
o Humulus lupulus
 Downer
 Puts you down more
o Valerian
 Downer
o Lactuca viosa
 Downer
 CNS Depressants, Anesthetics
o Very addictive and hard to get off of
o very effective drugs because have benzo receptors in the body
o also used if going into surgery to bring you down and then and antibenzo
to bring you back up
o there are some with 100 hr ½ life
o steady state is received after 5 half lives
 body gets used to it very quickly
 so also difficult to get off of
 Interactions
o Grapefruit juice – increases effect
 o Hypericum perforatum
 May help wean patients off
o Not an easy withdrawal, patient really has to want to do it
o Hypericum can also be used – not always
o GABA – helps with sleep
o Diazepine group is given to patient
 Interactions: Speculations
o Humus lupus – downer
o Morphine – see clinically in a variety of situations for pain
 Corticosteroids
o Very powerful drugs
o ½ life varies depending on the corticosteroid
o Metabolized by LV with excretion in urine and bile
o CI: fungal infections – even though CI
o Immunosuppressant
o Na reabsorption, use K instead!!!!
o Interaction
 Will have problems controlling their blood sugar
 Estrogen
• Interact with women on BCP or HRT
 Glycyrrhiza Glabra
• Might have some anti-inflammatory effect
• Long-term can have anti-stress effect
 Riges nigrum
• With corticosteroid is a positive effect
 Borago officinalis
• With corticosteroid is a positive effect
 Anamas comosus
• Oral bromeline
 Interactions: Speculative
o Contain antiquinones
 Can lead to dependency and K loss
 Can lead to arrhythmia
o Astragalus membranaceious….
 b/c of their effect on immune system
o Salix spp….
 b/c contains salicylates
o Melilotus officinalis
 b/c contains coumarins
o drug that has to be tapered off very gradually and carefully
o very adrenal suppressive
 Chemotherapeutic Agents
o No ½ life in exams
 o Cyclophosphamide
 Immunosuppressant
o normal range for WBC : 4 – 11
o various chemotherapeutic agents will lower it to almost 0
o when lower to 2 to 2 ½ will stop chemotherapy
o if immune system down, not a good chance at fighting chemotherapy
o important to keep their count up, so less likely to get infection and able to
fight
o Seen with Withania and Astragalus
o Cisplatin
 Used post IV for a variety of cancers
 Long ½ life 180 days
 Cisplatin disrupts Kreb’s cycle
 10% bile not 105 bile
 Will loose feelings in fingers and memory
 Interact with diabetics
 Will most likely lead to problems
 Interactions
o Particularily associated with NAC (N-acetylcistein)
o Cannabis sativa
o Reduces nausea
o Astragalus membranaceus
 Reduces death risk
o Theoretical
 Diuretics – increase the nephrotoxicity
 Want to be cautious about using these herbs with patients
o Methotrexate
 Increases glycine and homocysteine
 Oral is used for RA and IV used for Cancer
o Interactions real
 Panax quinquefolium – increases treatment effect in Estrogen
positive breast cancer
o Capecitabine
 Typically given orally
 Leads to cell damage
 Used in colorectal cancer where it’s gone to the LIV
 Based on patient size
 Usually what happens is that they’re give IV, then off for 1 – 2
weeks then go back on IV…and continually cycled
 Prognosis – not good
 Interactions
• Coumarin anticoagulants
 Interactions Theoretical
 • Angelica – b/c contains a type of coumarin
 Biological responses
• Interferon – hep C reactive
 Cytotoxic Ab
• Used for treating cancers
 Doxorubicin
• Comes out through bile in 7 days
• Hangs around if have LV impairment
• If have LV cancer, lasts even longer
• Cardiac toxicity is permanent
• Melatonin is protective of a heart receiving Doxorubicin
• Doesn’t reduce the anti-cancer effect
 Aceta racemosa
• Black cohosh
 Hormone antagonists
• Prostate cancer
• Antiestrogen – used for breast and endometrial cancer
• Nonsteroidal – used when need to keep hormones at certain
level
o Tamoxifin
 Max clinical benefit is achieved in 18 to 24 mo
 So after she’s been on it for 2 years she’s achieved max benefit
 Interactions
• Mg – lowers levels
• Zn – concentrates levels
 Hypericum perforatum – theoretically lowers effect of Tamxoifin
 Protein kinase inhibitor
• New relm in chemo
• Suppose to be without side effects
o Velcade, bortezmi, PS-341 not in notes
 Protease inhibitor
 Induces apoptosis via inhibition NF kappa B (proinflammatory
agent, OA RA involvement, involved in cancers spread by
inflammation), stabilization protoapoptopic proteins
 Promotes chemo & radio-sensitization
 Relapsed multiple myeloma
 Interactions Real: in vitro human cancer cell lines w/ antioxidants
 Velcade + vit C
• Not induce apoptosis
• Not induce G(2)-arrest
• Not induce apoptosis w/ induced TNF-ligand
• Suppressed velcade inhibition of proteasome activity
 • Mechanisms: velcade does not generate intracellular
reactive oxygen species
• Don’t use together in these types of patients b/c will reduce
effect of chemotherapy in these patients
• Vit C not protecting cell but interacting with Velcade
 Oral Contraceptives
o Mechanism
 Work by different methods
 ½ life is 7days
o Interactions
 Real CYP345 3A4
• St. John’s work also works CYP450 3A4
• Really effects nutrient levels
• Has effect on CVD
 B6, B12 and folic acid – related to homocystein
 Gastroesophageal Reflux
o Omeprazole seen most commonly
o Theoretical Interactions
 If lower acids not able to absorb minerals
 Immunosuppressants
o CSE – convulsions, GI ulcer, susceptible fungal, viral infections
o Mostly used from soil samples in Norwegian
o Used in patients who’ve had transplants
o Azathioprine
 Used in people with lymphomas and myelomas
 Causes bone cell suppression so can do stem cell transplant
 Inhibits purine synthesis: esp leukocytes, lymphocytes
 Use: KI transplant, RA (some recent research in using for RA)
o Citrus paradise – some increase and some decrease AUC (Area under the
curve)
o Codyceps sinensis – benefits KI transplant patients
o Medicago sativa + Actea racemosa – can get KI rejection if not careful
 Vaccines
o What to do to increase it’s effect, by giving water extract of Uncaria – got
enchanced immunological vaccine response
o Unicaria tomentosa (cat’s claw)
 Nicotiana tabacum
o Renders insulin ineffective
o Increases metabolism of theophylline (green tea – used for Tx of asthma)
 Citrus paradise
o Reduces absorption of clarithromycin (Ab)
 Hypericum Perforatum
o Increases sedation with surgery
 Remember
o Caffeine
o Nicotiana
o Citrus
o Hypericum
o Anticoagulants
 Individualize treatment
o Have to know patient and what they are taking
 Monitor patient
 Stay current w/ medical literature (buy Brinker)
