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Herbal Medications and Surgery Don't Always Mix
July 10, 2001 -- Whether it's St. John's wort for depression or ginkgo biloba to improve memory, millions of Americans take an herbal medication on a regular basis. But studies show the vast majority of these people don't tell their doctors they're using these medications, often because they don't consider them to be drugs. Now a new study shows failing to disclose this information before a surgery could be dangerous.
Because herbal medications can be sold as "dietary supplements," they are not subject to the same safety and effectiveness tests as prescription drugs, even though some claim to be "natural" versions of popular drugs.
But just because something is natural doesn't mean your doctor doesn't need to know about it, says Chun-Su Yuan, MD. "It's very important for physicians to know what their patients are taking in terms of herbal medicine," says Yuan, associate director of the Tang Center for Herbal Medicine Research at the University of Chicago.
In the July 11 issue of the Journal of the American Medical Association, Yuan and colleagues reviewed data on eight of the most common herbal medications: echinacea, ephedra, garlic, ginkgo, ginseng, kava, St. John's wort and valerian -- which account for about half of all herbal use in the U.S.
They say taking any of these medications just prior to surgery can speed up or slow down your heart rate, increase the risk of bleeding, alter your immune system, and affect how you respond to anesthesia and even pain.
Since the effects of some herbal medications can last two to three weeks after you stop using them, Yuan and colleagues have come up with specific recommendations on when patients should discontinue specific herbal medicines if they are scheduled for surgery.
The recommendations advise discontinuing:
- Ephedra and kava -- at least 24 hours before surgery;
- Ginkgo -- at least 36 hours before surgery;
- St. John's wort -- at least five days before surgery;
- Garlic and ginseng -- at least seven days before surgery;
- Echinacea -- as far in advance as possible;
- Valerian -- taper dose in the weeks before surgery or continue to use until surgery under a doctor's advice only
Yuan says about 22% of people scheduled for surgery report using some form of herbal medication, but that number may be even higher according to colleague Jonathan Moss, MD, PhD, because many people who take such things don't report them even when a doctor specifically asks.
"Even when you do get an answer [from a patient] you don't know how much is in what they're taking because even if you know the total content there are big differences ... in the biological components," says Moss, professor of anesthesia at the University of Chicago.
"It's definitely a problem," says Mary Ann Richardson, DrPH, a researcher at the National Institute of Health's National Center for Complementary/ Alternative Medicine. "One of the main reasons patients don't talk about these things is because physicians never ask them. Or they think they may get some sort of negative response ... or they think the physician won't know anything about it, which is generally true."
She says the topic needs to be brought up more often and doctors need to let patients know it's okay to talk about it.
Moss says the number of patients who have had problems after surgery as a result of taking herbal medications is reported to be in the hundreds, but that figure may be the "tip of the iceberg" since there is no system for reporting such complications.
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