MEDICAL AND DENTAL IMPLICATIONS FOR DRUG INTERACTIONS WITH SPECIFIC HERBAL MEDICATIONS
Of the top 20 most common herbal medications that OHCPs are likely to encounter (shown in Table 1) and the list of drugs commonly used in dentistry (shown in Table 2), the medications that are not known to be involved in any significant herbal-drug interactions include: • Azithromycin. • Cephalexin.
A similar list of the herbal supplements not known to be involved in any significant herbal-drug interactions includes: ● Aloe vera. ● Beta-sitosterol. ● Cannabidiol (CBD). ● Cranberry. ● Garlic. ● Ivy leaf.
• Benzocaine (topical). • Dyclonine (topical). • Lidocaine (topical). • Tetracaine (topical). • Albuterol. • Epinephrine.
• Chlorhexidine (topical). • Clotrimazole (topical). • Fluconazole. • Metronidazole.
● Red rice yeast. ● Saw palmetto. ● Wheat grass / Barley grass.
• Nystatin. • Penicillin. • Articaine. • Epinephrine
• Flumazenil. • Naloxone. • Nitroglycerine. • Oxygen.
In other words, these drugs and herbal medications may be considered the safest supplements from the lists in Tables 1 and 2.
Elderberry Orally, elderberry is used for influenza (the flu) and H1N1 “swine” flu. It is also used as a laxative; as a means to stimulate immune function (for example, in patients with HIV/AIDS); as a means to control pain, such as that seen with chronic fatigue syndrome, allergic rhinitis, sinusitis, sciatica, neuralgia, and cancer; and as a diuretic and diaphoretic. Although there is insufficient evidence in the medical literature to support its effectiveness in most of these situations, there is medical evidence in support of this herbal supplement’s possible effectiveness in treating influenza. Clinical research shows that some elderberry extracts might reduce flu-like symptoms. Fifteen milliliters (1 tablespoon) of a specific syrup formulation of elderberry fruit extract administered orally four times daily seems to reduce the symptoms and duration of influenza infection when given within 48 hours of initial symptoms (Kinoshita, Hayashi, Katayama, Hayashi, & Obata, 2012; Zakay-Rones et al., 1995; Zakay-Rones, Thom, Wollan, & Wadstein, 2004). Significant symptom relief seems to occur within 2 to 4 days of treatment for most patients. On average, this elderberry extract reduces the duration of symptoms by about 56% (Zakay-Rones et al., 2004). In another preliminary clinical study, an elderberry extract lozenge taken four times daily for 2 days, starting within 24 hours of initial symptoms, significantly improved flu-like symptoms compared with placebo. Substantial symptom relief occurred within 48 hours for most treated patients (Kong, 2009). Horehound In manufacturing, the extracts of white horehound are used as flavoring in foods and beverages and as an expectorant in cough syrups and lozenges. Patients may be unaware that they are consuming this herbal medication as the primary ingredient in many throat lozenges, and this lack of awareness may be problematic specifically in the diabetic population (adding to the problem that many of these dosage forms also contain a significant amount of sugar; Donaldson, Goodchild, & Epstein, 2015). Evidence from animal research suggests that horehound might lower blood glucose (Roman, Alarcon-Aguilar, Lara-Lemus, & Flores-Saenz, 1992; Novaes et al., 2001 – although preliminary clinical research suggests that horehound only slightly lowers blood glucose when taken in combination with antidiabetic agents, suggesting that the effect may not be clinically significant (Boudjelal, Henchiri, Siracusa, Sari, & Ruberto, Turmeric Turmeric is possibly effective when given orally to treat allergic rhinitis (hay fever), depression, hyperlipidemia, nonalcoholic fatty liver disease, osteoarthritis, and pruritis. Topically, turmeric is used for analgesia, ringworm, sprains and swellings, bruising, leech bites, eye infections, acne, inflammatory skin conditions, skin lesions, psoriasis, inflammation of the oral mucosa,
Theoretically, elderberry might interfere with immunosuppressant therapy because of its immunostimulating activity. Elderberry stimulates production of cytokines, including interleukin and tumor necrosis factor (Barak, Halperin, & Kalickman, 2001). Immunosuppressant drugs include glucocorticoids, which may be administered or prescribed 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, and if they do consume elderberry 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 elderberry supplementation. 2012; Herrera-Arellano, Aguilar-Santamaria, García-Hernández, Nicasio-Torres, & Tortoriello, 2004; Rodriguez Villanueva & Martin Esteban, 2016). Theoretically, horehound may have additive effects when used by patients taking antidiabetic drugs and the dose of diabetes medications might need to be adjusted if patients routinely consume these supplements. From a dental perspective, be aware of diabetic patients who may consume horehound-containing supplements, and request that they do not take these supplements at least 24 hours before the dental procedure. 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 avoided. periodontitis, infected wounds, and gingivitis. As an enema, turmeric is used for ulcerative colitis. Clinical research has also suggested that the turmeric constituent, curcumin, may lower blood glucose levels and glycosylated hemoglobin (HbA1C) in patients with diabetes (Azhdari, M., Karandish, M., & Mansoori, A. 2019; Kato, M, et
Page 92
EliteLearning.com/Dental
Powered by FlippingBook