Table 6: Herbal-Drug Interactions of Clinical Concern
Interaction Rating by Lexicomp and the Natural Medicines Comprehensive Database
Herbal-Drug Interaction*
Implications for Dentistry
Black cohosh – CYP2D6 substrates (codeine and hydrocodone)
Risk rating = B Level of evidence = B Severity = Moderate Occurrence = Probable Risk rating = B Level of evidence = B Severity = Moderate Occurrence = Possible Risk Rating = D Level of evidence = B Severity = High Occurrence = Possible Risk rating = B Level of evidence = B Severity = High Occurrence = Possible Risk rating = B Level of evidence = B Severity = Moderate Occurrence = Probable Risk rating = C Level of evidence = D Severity = High Occurrence = Possible Risk rating = D Level of evidence = B Severity = High Occurrence = Possible Risk rating = B Level of evidence = B Severity = Mild Occurrence = Probable Risk rating = A Level of evidence = A Severity = High Occurrence = Possible Risk rating = B Level of evidence = B Severity = Moderate Occurrence = Possible Risk rating = C Level of evidence = D Severity = High Occurrence = Unlikely Risk rating = B Level of evidence = B Severity = Moderate Occurrence = Possible Risk rating = C Level of evidence = D Severity = High Occurrence = Possible Risk rating = C Level of evidence = B Severity = Moderate Occurrence = Possible
Black cohosh can modestly inhibit CYP2D6 and increase levels of drugs metabolized by this enzyme. Echinacea can increase levels of drugs metabolized by CYP1A2, such as acetaminophen and diazepam. Echinacea might interfere with immunosuppressant therapy because of its immunostimulating activity. Elderberry might interfere with immunosuppressant therapy because of its immunostimulating activity.
Echinacea – CYP1A2 substrates (acetaminophen and diazepam)
Echinacea – Glucocorticoids (dexamethasone, prednisone, and methylprednisolone) Elderberry – Glucocorticoids (dexamethasone, prednisone, and methylprednisolone)
Fenugreek – Glucose
Fenugreek may lower blood glucose levels; be aware of use in patients with diabetes.
Fenugreek – Antiplatelet or anticoagulant agents (aspirin and ibuprofen)
Fenugreek can increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.
Ginger – Antiplatelet or anticoagulant agents (aspirin and ibuprofen)
Ginger can increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.
Gingko – alprazolam
Ginkgo might decrease the levels and clinical effects of alprazolam.
Gingko – Antiplatelet or anticoagulant agents (ASA, ibuprofen and warfarin)
Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin. Theoretically, ginkgo might increase the risk of bleeding if used with other anticoagulant or antiplatelet drugs. Ginkgo can increase levels of drugs metabolized by CYP1A2 such as local anesthetics. Green Tea can increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.
Gingko – CYP1A2 substrates (local anesthetics except articaine)
Green Tea – Antiplatelet or anticoagulant agents (aspirin and ibuprofen)
Horehound – Glucose
Horehound might lower blood glucose. Be aware of use in patients with diabetes.
Turmeric – Antiplatelet or anticoagulant agents (aspirin and ibuprofen)
Turmeric can increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.
Turmeric – Glucose
Turmeric may lower blood glucose levels; be aware of use in patients with diabetes.
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