by OHCPs to help reduce pain, swelling, and trismus related to a dental procedure. Although this herbal-drug interaction may be only theoretical, it is based on a high level of medical evidence (“B”). From a dental perspective, then, when treating immunosuppressed patients (e.g., patients with inflammatory arthropathies such as rheumatoid arthritis or systemic lupus erythematosus, drug- or radiation- induced immunosuppression, malignancy, malnourishment, hemophilia, HIV infection, or insulin-dependent diabetes), if a glucocorticoid is intended to be used, patients should not suddenly start taking this herbal medication before the dental procedure. If they do consume echinacea routinely, they should stop the supplement for 24 hours before the dental procedure and for at least 24 hours after the last dose of the glucocorticoid. However, OHCPs may choose to avoid glucocorticoids altogether in these high-risk immunosuppressed patients, regardless of whether they take echinacea supplementation. concomitant use might increase the risk of bleeding due to decreased platelet aggregation. Some of these drugs include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others. Concomitant use of herbs that have constituents that might affect platelet aggregation could theoretically increase the risk of bleeding in some people who take fenugreek also. These herbs include angelica, clove, danshen, garlic, ginger, ginkgo, red clover, turmeric, and others. Fenugreek may reduce blood glucose levels and could theoretically have additive effects on glucose levels when used with antidiabetes drugs. From a dental perspective, be aware of patients with diabetes who may routinely consume fenugreek and request that they do not suddenly start or stop taking this supplement before the dental procedure; OHCPs will want patients to be as stable as possible when they are seen in the office. As with all patients with diabetes, routine blood glucose monitoring is paramount, dental appointments should be kept relatively short, and patients should maintain their normal nutritional routine. In patients with controlled diabetes, this potential herbal-drug interaction can be easily managed. Gargling with green tea is used for the prevention of colds and flu. Green tea extract is used in a mouthwash for postoperative pain associated with tooth extraction. Topically, green tea bags are used as a wash to soothe sunburn, as a poultice for bags under the eyes, as a compress for headache or tired eyes, and to stop the bleeding of tooth sockets. Green tea in chewable candy is used for gingivitis. Green tea is also used topically to prevent skin damage and cancer related to ultraviolet (UV) radiation (e.g., sunburn) and other environmental causes. A green tea footbath is used for athlete’s foot. The caffeine in green tea might increase the risk of additive central nervous system effects in patients taking amphetamines and amphetamine- like medications such as dextroamphetamine and methylphenidate. These medications are typically used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. The severity of this interaction is high and gets an interaction rating of, “major,” since the risk of occurrence is probable. Catechins in green tea and caffeine are reported to have antiplatelet activity. Theoretically, green tea might increase the risk of bleeding when used with antiplatelet or
the dental appointment if diazepam use is anticipated for sedation. If acetaminophen is to be used for postoperative pain management, concurrent use of echinacea and acetaminophen should be avoided. If patients do not want to discontinue echinacea use in order to avoid this potential herbal-drug interaction, then the dose of acetaminophen should be empirically reduced. Unfortunately, there are no published recommendations to suggest the appropriate dose reduction, but the prudent practitioner may want to consider at least a 50% reduction in the total daily acetaminophen dose. immunostimulating activity (Barrett, 2003; Chavez & Chavez, 1998; Fonseca et al., 2014; Luettig, Steinmuller, Gifford, Wagner, & Lohmann-Matthes, 1989; Schapowal, Klein, & Johnston, 2015; Stimpel, Proksch, Wagner, & Lohmann- Matthes, 1984). Immunosuppressant drugs include glucocorticoids, which may be administered or prescribed Fenugreek Orally, fenugreek is possibly effective when used for diabetes, dysmenorrhea, sexual dysfunction and sexual drive in both men and women. Other indications for use such as treating loss of appetite, dyspepsia, gastroesophageal Theoretically, echinacea may also interfere with immunosuppressant therapy because of its reflux disease (GERD), gastritis, constipation, polycystic ovary syndrome, obesity, atherosclerosis, hyperlipidemia, and for stimulating lactation, lack sufficiently reliable evidence. Topically, fenugreek is used as a poultice for local inflammation, myalgia, lymphadenitis, gout, wounds, leg ulcers, and eczema. In foods, fenugreek is included as an ingredient in spice blends. It is also used as a flavoring agent in imitation maple syrup, foods, beverages, and tobacco. In manufacturing, fenugreek extracts are used in soaps and cosmetics. There is some concern that fenugreek might have additive effects when used with anticoagulant or antiplatelet drugs, resulting in increased risk of bruising and bleeding. Some of the constituents in fenugreek have antiplatelet effects, although these might not be present in concentrations that are clinically significant (Lambert, J., & Cormier, J., 2001; Bordia, A., Verma, S. K., & Srivastava, K. C..1997). Until more is known, fenugreek should be used cautiously in combination with anticoagulant and antiplatelet drugs as Green tea Green tea is used to improve cognitive performance and mental alertness. It is likely effective in treating genital warts and there is a specific green tea extract ointment (Veregen, Bradley Pharmaceuticals; Polyphenon E ointment 15%, MediGene AG) providing 150 mg of sinecatechins per gram of ointment which completely clears external genital and perianal warts in 24% to 60% of patients after 10-16 weeks of treatment (Bradley Pharmaceuticals, 2006). This green tea extract is an FDA-approved prescription product. Green tea taken orally seems to lower cholesterol and triglycerides. Epidemiological research has found that higher consumption of green tea, especially 10 cups daily or more, is associated with improved serum lipids in men but not women (Imai, K., & Nakachi, K., 1995; Pang, J., et al., 2016). There is also preliminary evidence that taking a green tea extract containing catechins 676 mg daily for 12 weeks reduces oxidation of LDL cholesterol, which might lead to reduced damage to the vascular endothelium and reduced arteriosclerosis (Miyawaki, M., et al., 2018). Green tea is possibly effective in treating cervical dysplasia, coronary artery disease, endometrial cancer, hypertension, hypotension, oral leukoplakia, ovarian cancer, and Parkinson’s disease, but clinical studies are conflicting.
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