Herbs and Surgery Don't Mix

About 60 million Americans say they use dietary supplements or herbal remedies. Some of that number are also taking prescription medicines.

Yet certain herbs and supplements can interact with medications in a negative manner.  Worse, as the number of supplements grows, so do the possible interactions. 

Surgery typically involves medications such as anesthesia, as well as an incision. So the use of natural supplements and remedies can affect the surgery and its outcome by affecting the anesthesia and clotting of the incision.

For this reason, it is critically important that you tell your doctor about any herbal medications, supplements, or megavitamins you may be taking. If you need emergency surgery, it’s important that a relative or friend be able to give the emergency surgeon the same information.

Widespread problem

Interactions of herbs and supplements with medications used during surgery—including anesthetics, epinephrine, muscle relaxants, and anti-arrhythmics—have become commonplace. For the last 20 years, an average of five people per year have died as a result of complications caused by herbal medications adversely affecting surgery, the FDA says. A far larger number have had severe complications. As a defense against complications, your doctor, the anesthesiologist, and the nursing staff may ask you about any supplements and herbs you take. 

You may be asked to stop taking dietary supplements and herbs two to three weeks before surgery. This is the safest course of action, says the American Society of Anesthesiologists. For emergency surgery, however, you won't have the opportunity to stop the supplements ahead of time. 

Here is a short explanation of complications associated with some of the more common herbal remedies and supplements. 

Ephedra

Possible complications: heart attack and stroke

Ephedra has been banned from supplements in this country since 2004 because of safety concerns. It is currently available in limited dosage. Ephedra raises blood pressure and increases heart rate. It can cause headache, nausea, heart attacks, and stroke. Its beneficial effects include increasing blood flow to the heart, brain, and muscles. It also can open constricted bronchial tubes during an asthma attack. 

Garlic              

Possible complications: bleeding during and immediately following surgery

In large doses, garlic can interfere with blood clotting. This increases the risk for serious bleeding during and after surgery. Garlic can also increase the effect of warfarin, a drug used to prevent blood clotting, and it may lower blood pressure by a small amount.

Ginkgo            

Possible complications: bleeding during and immediately following surgery

Ginkgo interferes with blood clotting and also dilates blood vessels. This may lead to increased bleeding during and just after surgery. Ginkgo may also lead to abnormal bleeding when used in conjunction with blood thinners such as the prescription drug warfarin or with aspirin. 

Ginseng

Possible complications: bleeding during and immediately following surgery

Ginseng can interfere with normal blood clotting and lead to bleeding. In addition, it can stimulate the central nervous system. It can cause headaches, nervousness, and sleep abnormalities or insomnia. Ginseng can cause hypoglycemia. Ginseng interferes with some prescription drugs. It enhances the effect of warfarin and may result in unwanted and dangerous bleeding. When taken with phenelzine, it can cause insomnia and psychological effects, particularly mania from hyperstimulation. 

Kava

Possible complications: may increase the sedative effect of anesthesia

In the South Pacific islands, Kava is used socially for relaxation. It can increase the effect of alcohol, sedatives, or anesthesia. Kava has also been associated with causing liver damage, with some fatalities. The exact mechanism of action is still being studied. Because kava interferes with liver metabolism, it has the potential to interact with a fairly large number of drugs.

St. John's wort

Possible complications: may cause acute rejection of a transplanted organ by interfering with anti-rejection medications; rejection may begin within 24 hours of taking St. John’s wort

St. John’s wort interacts with many drugs. It rapidly decreases the plasma levels of cyclosporine, a medication commonly used to prevent rejection of a transplanted organ. It can decrease the plasma levels of the asthma medication theophylline; HIV medications (indinavir); heart medications (digoxin); and antidepressants (amitriptyline). It decreases the blood-thinning properties of warfarin, acenocoumarol, and phenprocoumon. When used with selective serotonin reuptake inhibitors (SSRIs), such as sertraline, paroxetine, or nefazodone, it can cause a condition known as serotonin syndrome.

Valerian

Possible complications: may increase the sedative effect of anesthesia

Valerian is typically used to induce sleep. This property may dangerously enhance the effects of anesthesia. When taken with opiate medications, it may increase the risk for excessive central nervous system (CNS) depression. Valerian may also cause excessive CNS depression when taken with benzodiazepines.

Vitamin E

Possible complications: bleeding during and immediately following surgery

Taking vitamin E in excess of recommended dosing can interfere with the blood's ability to coagulate. Large doses of vitamin E decrease the ability of platelets in the blood to stick to one another, which is necessary for plugging holes in tiny blood vessels and triggering the clotting process.

Stay safe

Herb/drug and herb/surgery interactions are not trivial. They can result in unwanted complications, increased length of hospital stay, and even death. Here's what you can do to protect yourself:

• Tell your doctor about any herbal medications or supplements that you are taking or have taken within the last two weeks.

• Stop all herbal medications, supplements, and megadoses of vitamins at lease two weeks before scheduled surgery. (A multiple vitamin pill once a day is OK.)

• In case of an emergency, make sure someone is available who can tell the doctors what medications you take or keep a list of medications (prescription, OTC, herbal, and supplemental) in your wallet.