Sample, Safety & Ethics: Herb-Drug Interactions, Part 2
Value: Approved for 4 continuing education units for 4 California acupuncture CEUs (category 1), 4 NCCAOM national Diplomate points (most states), 4 Florida Board of Acupuncture 'medical errors' category CEs, 4 Texas CAEs (1 ethics, 2 herbs, 1 biomedicine) and 4 CTCMA CEs. For nurses, this course is valid for 4 California Board of Registered Nursing contact hours.
This course has been approved by the NCCAOM to fulfil the 4 hour acupuncturist safety and ethics requirement. This course is approved for acupuncture continuing education credit for acupuncturists in the USA and Canada. Download the course, complete the online quiz, and receive immediate acupuncture CEU license credit!
Excerpt of Acupuncture CEU course material
Raise blood pressure & increase heart beat drugs
Medications may be used to intentionally raise blood pressure, heart beat rate, and strengthen contractility or these very same effects may be the adverse effects of medications and are undesirable consequences. Herbal medicine may serve to assist the functions of the medications in a synergistic or additive function or they may serve to quell the unwanted side effects of medications. Additionally, herbal medicine may have antagonistic effects thereby reducing the functional power of the medications.
Herbs that warm the interior and strengthen Kidney Yang and Qi must be used with caution when patients take drugs that raise the blood pressure or increase heart contractility (force of contraction). The herbs and the drugs have similar functions and therefore may have a synergistic or additive effect when combined. Care must be taken with the tonic herbs as not to induce tachycardia or excessively high blood pressure
Alternately, herbs are helpful to assist the functions of the medications. If medications fail to bring blood pressure up to a normal range and are unable to strengthen the contractility of the heart, these herbs will help to restore balance, lift the blood pressure and strengthen contractility.
Herbs that anchor the Yang may lower blood pressure. When patients take medications that induce tachycardia and high blood pressure as adverse side effects, they are effective in helping to control these side effects.
Patients taking drugs that raise blood pressure and heart contractility should use caution if taking alpha-agonists such as pseudoephedrine (Sudafed). It is an agonist at alpha and beta adrenergic receptors which causes the release of endogenous norepinephrine (noradrenaline). It is known for causing vasoconstriction.
Pseudoephedrine also occurs in its natural form, ephedrine, in Ma Huang (ephedra). Caution is indicated when using Ma Huang with patients taking pseudoephedrine due to synergistic and additive effects.
Patients taking drugs that raise blood pressure and heart contractility should use caution if taking phenylephrine. Phenylephrine (Neo-Synephrine) is an alpha adrenergic receptor agonist that is used as a decongestant. It is also used to dilate the pupil and increase blood pressure. It is marketed as a substitute for pseudoephedrine (Sudafed). It may cause hypertension as a side effect and is contraindicated in patients with epilepsy or for those taking anticonvulsant medications. The drug interaction may cause seizures.
Caution should be used if a patient is using digoxin to increase heart contractility. Digoxin (Digitalis) increases myocardial contrac￼tility, decreases heart rate, and increases blood pressure due to increased stroke volume. It is extracted from the digitalis lanata plant (Woolly Foxglove). Digitalis lanata is highly toxic and may be fatal if ingested, particularly for children. Shu Di Huang (Chinese Foxglove, Radix Rehmanniae Glutinosae Conquitae) is not related to digitalis lanata and does not share its toxic properties.
Midodrine (Amatine, ProAmatine, Gutron) is a vasopressor/antihypotensive agent. Approved in 1996 for the treatment of orthostatic hypotension, the FDA proposed withdrawing this approval in 2010 because the manufacturer did not complete the post-market required studies. Orthostatic hypotension is also known as a “head rush” or “dizzy spell” and is when a person’s blood pressure suddenly drops upon standing. Midodrine is metabolised into an active metabolite which is an alpha-receptor agonist and activates alpha-adrenergic receptors of both venous and arteriolar vasculature. This increases vascular tone and elevates blood pressure.
Fludrocortisone (Florinef) is a synthetic corticosteroid which is used to replace aldosterone for patients with adrenal insufficiency as in the case of Addison’s disease. It is also used for orthostatic intolerance (OI). OI is a disorder of the autonomic nervous system which occurs upon standing. Upon standing, the blood pressure drops suddenly, cerebral blood flow is inhibited and there may be loss of consciousness. It can also be relieved by sitting or reclining.
Fludrocortisone may cause water retention, sodium retention, high blood pressure, headaches, low blood potassium levels, increased risk of infection, impaired wound healing, thinning of skin, dyspepsia, peptic ulcer, depression, weight gain, menstrual cycle changes, partial vision loss due to cataracts, glaucoma, and increased intracranial pressure.
Fu Zi (RadLateralis Aconiti Carmichaeli) strengthens the devastated Yang and benefits the Qi and Yang. It is toxic and is contraindicated during pregnancy. Use extreme caution with patients who have a history of cardiovascular disorders or are taking antiarrhythmic drugs. Overdose of Fu Zi may be treated with Rou Gui if taken within the first several hours. The Rou Gui tea induces vomiting within approximately 15 minutes and the toxin is expelled. Overdose symptoms include tremors, numbness of the lips, mouth, and tongue; irregularities of the heat rate and rhythm, excess salivation, nausea, dizziness, vomiting, diarrhea, difficulty breathing, and decreased blood pressure. Overdose may be fatal.
Ren Shen (Radix Ginseng) and Dang Shen (Radix Codonopsitis Pilosulae) strengthen the Qi. Ren Shen is stronger and Dang Shen is milder and for chronic conditions.
Huang Qi (Radix Astragali Membranaceus) raises and strengthens the Qi up to surface and from interior to exterior.
Lu Rong (Cornu Cervi Parvum ) strengthens, warms and raises the Qi and Yang and nourishes Kidney Jing.
Ge Jie (Gecko) warms and encourages the Kidney Yang.
Suo Yang (Herba Cynomorii Songarici) and Yin Yang Huo (Herba Epimedii) warms the Kidney Yang and moistens the intestines. Suo Yang is stronger to warm the Yang and benefits Kidney Jing to treat impotence, amenorrhea, and infertility. Suo Yang also benefits Liver Yin. Yin Yang Huo is stronger to benefit the flow of Yang and increases libido.
Bai Ji Tian (Rhizoma Bletillae Striatae) warms the Kidney Yang and expels wind damp Bi pain.
Bu Gu Zhi (Fructus Psoraleae Corylifoliae) warms the Kidney and Spleen Yang and stops early morning diarrhea.
Xian Mao (Rhizoma Curculiginis Orchiodis) strongly warms the Kidney Yang and powerfully treats impotence, incontinence, infertility, and spermatorrhea. It is toxic and may cause palpitations and numbness and swelling of the tongue. Long term use is discouraged due to its toxicity.
Gou Ji (Rhizoma Cibotii Barometz) warms the Kidney and Heart Yang and expels wind damp cold Bi pain.
Xu Duan (radix Dipsaci Asperi) warms the Kidney Yang and promotes blood circulation.
Gu Sui Bu (Rhizoma Drynariae) warms the Kidney yang and heals bone fractures. Gu Sui Bu treats tinnitus and numbness caused by streptomycin.
Long Gu (Os Draconis) stabilizes and astringes Heart and Kidney Yang.
Mu Li (Concha Ostrae) and Shi Jue Ming (Concha Haliotidis) stabilizes Liver Yang. Mu Li dissolves nodules. Shi Jue Ming brightens the eyes.
Zhen Zhu Mu (Concha Margaritaferae) stabilizes the Liver Yang and benefits the eyes.
An 83 year old female is taking midodrine to raise her blood pressure due to her heart condition. Recently she had a car accident with the neck, shoulder and lower back adversely affected. Her tongue is dark red with purple dots on the side. Pulse is small and rapid.
Diagnosis: Heart and Kidney Qi and Yin deficiency, Qi and blood stagnation
She was prescribed Gou Ji (Rhizoma Cibotii Barometz) and Xu Duan (Radix Dipsaci Asperi) for her injury but complains that her heart beat is faster with palpitations. After lowering the dosage of Gou Ji (Rhizoma Cibotii Barometz) and Xu Duan (Radix Dipsaci Asperi), there were no further reports of side effects and the patient’s condition significantly improved.
A 76 year old female is taking fludrocortisone to raise her blood pressure due to congenital low blood pressure. Even with the medicine, her blood pressure remains very low. Her tongue is teeth marked and the pulse is weak and deep.
Diagnosis: Spleen and Kidney Qi and Yang deficiency.
She took Huang Qi (Radix Astragali Membranaceus) and Xu Duan (radix Dipsaci Asperi) which raised her blood pressure to the normal range. She is now feeling strong and energized. Huang Qi (Radix Astragali Membranaceus) and Xu Duan (Radix Dipsaci Asperi) strengthen Qi and Yang and also promote blood circulation.
This sample is from the acupuncture continuing education course. Learn more in the Acupuncture CEU course material....
Authors Prof. RIchard Liao, L.Ac. and Kevin Walker, L.Ac., R.Ph. (Registered Pharmacist) cover a variety of herb-drug interaction topics:
Participants review herb-drug interactions including contraindications, cautions, and benefits of using herbal medicine when patients are taking prescription drugs. Participants are familiarized with pharmacodynamics, pharmacokinetics, and also the additive, synergistic, and antagonistic interactions of herbs with drugs. This is presented with simple and clear definitions, straightforward descriptions, individual herb and drug analyses, and case histories.
The interactions of beta-blockers, sedative/hypnotics, and antidepressants with calm spirit and phlegm dissolving herbs.
The interactions of anti-estrogenic (used in the treatment of cancer) drugs with herbs that tonify Qi, Blood, Jing, and Kidney Yang.
The interactions of raise blood pressure & increase heart beat drugs with warm the interior, Kidney Qi and Yang tonics, and anchor the Yang herbs.
The interactions of Lower blood pressure drugs (antihypertensives) with raising the Qi and Yang herbs.
The interactions of stop diarrhea drugs with laxative, purgative, Spleen Qi tonic, and lubricate Yin herbs.
About Prof. Liao:
Professor Liao, L.Ac., Dipl.Ac., has served as professor of herbology and acupuncture theory at the Academy of Chinese Culture & Health Sciences in Oakland, CA. Prof. Liao has also served as faculty at Five Branches University in Santa Cruz, CA. His many years of teaching experience bring the highest quality of interesting and useful courses to HealthCMI continuing education online.