Case: herbal treatment and liver toxicity

We should take a history of over-the-counter medical and herbal medication use. Even if a patient does not mention taking herbal medicines, it is important to ask. Many herbal medicines can interact with prescription drugs and cause serious side effects, even death.

Haydn Owen Jones, a retired electrician, was a fighter. He had beaten multiple myeloma once, but the cancer had returned. He was determined to beat it again.

This time, however, Mr. Jones faced a new challenge. He was also taking a herbal remedy containing mistletoe, yarrow, and lily of the valley. He was not aware that this herbal remedy could interact with his chemotherapy drugs and damage his liver.

The combination of the herbal remedy and the chemotherapy drugs proved to be too much for Mr. Jones's body. He died from liver failure.

Mr. Jones's death was a tragic reminder that even seemingly harmless herbal remedies can interact with prescription drugs and cause serious side effects. It is important for patients to talk to their doctor about all of the medications they are taking, including over-the-counter and herbal medications. The coroner called for clearer leaflets for chemotherapy patients about the risks of herbal medicines.

Examples of interactions 

• Antidepressants: St. John's wort, ginseng, and kava can interact with antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These interactions can cause serious side effects, such as serotonin syndrome, which is a potentially life-threatening condition.

• Anticoagulants: Garlic, ginger, and turmeric can interact with anticoagulants, such as warfarin. These interactions can increase the risk of bleeding.

• Blood pressure medications: Grapefruit juice, hawthorn, and licorice can interact with blood pressure medications. These interactions can cause blood pressure to drop too low or rise too high.

• Diabetes medications: Fenugreek, ginseng, and milk thistle can interact with diabetes medications. These interactions can cause blood sugar levels to drop too low.

• Statins: Milk thistle, turmeric, and grapefruit juice can interact with statins. These interactions can increase the risk of side effects from statins, such as muscle pain and liver damage.