At last, a magazine article that tells the truth about herbal medicine! It’s about time that people realised that herbal medicines are not some sort of harmless "plan B" to opt for when conventional drugs look unappealing. Herbal medicines are still drugs! They still have side effects, drug interactions, and may not work at all, just like any other drug. Why do people get so romantic about them?

What is a drug?

The definition of a drug is "Any chemical substance which is taken into the body to change the way it normally works". So by that definition, herbal medicines are drugs too. So let’s not kid ourselves – coffee, tea, wine, herbs, vitamins, even some cosmetics are drugs. But that doesn’t mean they are bad. Drugs are like tools in a tool box – they are there to help us do a job – use them properly when we need them and put them down when we don’t need them.

Just as there are no good or bad tools – there are no good drugs or bad drugs. They’re all just drugs. The important thing is to use them wisely. Learn about them, so that you are armed to maximise the benefits and minimise the risks. For example, you might think that cocaine is a bad drug; it’s addictive and often abused. But it is a very good local anaesthetic for Eye, Ear, Nose or Throat Surgery, and helps many patients remain pain free during surgery. Not such a bad drug after all!

Some herbal medicines may increase the risk of seizures. The two well-known examples of this are St John’s Wort and Evening Primrose Oil.

SJW works as an antidepressant because it increases serotonin levels in the brain. There are many other drugs that can increase serotonin in the brain, such as pethidine, sumatriptan (Imigran ®), and prescription antidepressants e.g. Prozac. The danger is that when two or more of these medicines are used together, excessive serotonin levels result causing "serotonin syndrome", which can result in seizures.

The other danger of SJW is that it interacts with many, many other drugs, (which also makes it a very inconvenient drug to use). In the presence of SJW, drugs which are metabolised in the liver by an enzyme called CYP3A4, last less time in the body and blood concentrations fall. Anti-convulsant medications such as diazepam and carbamazepine can be affected in this way (lower levels) but so can important medicines such as the Pill, cyclosporin (for transplants and eczema), indinavir (for HIV) and some blood pressure medicines.

Just a year or two ago, there was very little information on the seizure risk of EPOil. It was thought that EPOil was only likely to increase seizures if used in combination with antipsychotic medication, such as Melleril ® or Stelazine ®. However, it has come to light through spontaneous reporting to Adverse Drug Reactions hotlines, that there are at least fifteen recorded episodes of people experiencing a return of seizures after commencing taking EPOil. Unfortunately, it is currently unknown why EPOil would cause seizures. In order to learn more about the causes, everybody who has experienced seizures after taking herbal remedies should report it to a reporting authority as well as your doctor.

In Queensland, you can report an adverse event you suspect might have been caused by herbal remedy (you don’t have to be sure, just suspicious), by calling the ADVERSE DRUG REACTION HOTLINE on Ph: 130 134 237. Monday to Friday, 9am to 5pm.

Our experienced clinical pharmacists can help you work out whether the herbal remedy would have contributed, what other explanations there might be, and report it to the appropriate authorities if need be.