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【medical-news】Herbal Remedies: Adverse Effects and Drug I
美国家庭医生杂志告诫：草药能干扰西药的疗效 [原创 2006-09-03 22:03:44 ] 发表者: albert7835
美国报道：草药能干扰西药的疗效
王澄 美国康复科医生 纽约2006年9月
《美国家庭医生》杂志1999年3月1日发表一篇题为“草药治疗：它的副作用和对西药的干扰。”（概述）在美国，草药不被当作“药”来对待，所以美国食品和药物管理局（FDA, the U.S. Food and Drug Administration）并不对草药进行严格的科学实验。因此，草药也不准作为诊断，治疗和疾病预防的药物上市或出售。因为草药不像美国西药那样被足够纯化和效力剂量化，所以草药的一部分不良作用可能来自不纯，不是草药本身。如混杂入过敏源，植物花粉，或霉菌芽孢；也可能来自草药原料（植物株群）的不同。
部分草药的副作用：
双叶银杏（ginkgo biloba）：自发性出血
金丝桃（St. John’s wort），又名土连翘，五心花，金丝海棠，照明莲，小狗木，水面油，金丝莲（注1）：胃肠不适，过敏反应，疲劳，头晕，胡涂，口干，羞光。
麻黄（Ephedra）：升高血压，失眠，心律失常，神经过敏，震颤，头痛，抽搐，脑血管意外（中凤），心肌梗死，肾结石。
胡椒（Kava），又名味履支，浮椒，玉椒（注1，注2）：脑力迟缓，口舌运动困难，（抽搐）颈偏斜，眼动危象，帕金森病恶化，躯干疼痛性抽搐，皮疹。
部分草药对西药药效的干扰：
双叶银杏（ginkgo biloba）干扰阿司匹林，华法林（warfarin, coumadin 美国常用抗凝药），和ticlopidine(Ticlid), clopidogrel(plavix), dipyridamole(persantine)美国常用的三个针对血小板功能的抗血液粘稠药的药效。
金丝桃（St. John’s wort）干扰抗抑郁药Antidepressants的药效。
麻黄（Ephedra）干扰咖啡因caffeine, 治鼻塞药decongestants, 兴奋剂/刺激药stimulants的药效。
人参（Ginseng）干扰华法林Warfarin的药效。
胡椒（Kava）干扰镇静剂sedative, 安眠药sleeping pills, 抗精神病药antipsychotics, 和酒精alcohol的药效。
此外，文章中还提到双叶银杏有可能影响到大蒜，维生素E和其它抗血小板和抗凝药的药效。（影响药效的意思并不是指“阻断”，是指有加重或减少的可能。）
美国医生建议，有以下病情者不要用含有麻黄的草药：心血管疾病，甲状腺亢进，糖尿病，前列腺肥大，青光眼。
孕妇和哺乳妇女对各种草药都要慎用。
注1：现代中药学大辞典，宋立人，洪恂，丁绪亮，臧载阳主编，人民卫生出版社，北京，2001年5月，第1309页和1436页
注2：Kava (Family: Piperaceae, Genus: Piper, Species: methysticum)
附英文原文：
Herbal Remedies: Adverse Effects and Drug Interactions
MELANIE JOHNS CUPP, PHARM.D.
West Virginia University School of Pharmacy
Morgantown, West Virginia
A growing number of Americans are using herbal products for preventive and therapeutic purposes. The manufacturers of these products are not required to submit proof of safety and efficacy to the U.S. Food and Drug Administration before marketing. For this reason, the adverse effects and drug interactions associated with herbal remedies are largely unknown. Ginkgo biloba extract, advertised as improving cognitive functioning, has been reported to cause spontaneous bleeding, and it may interact with anticoagulants and antiplatelet agents. St. John's wort, promoted as a treatment for depression, may have monoamine oxidaseinhibiting effects or may cause increased levels of serotonin, dopamine and norepinephrine. Although St. John's wort probably does not interact with foods that contain tyramine, it should not be used with prescription antidepressants. Ephedrine-containing herbal products have been associated with adverse cardiovascular events, seizures and even death. Ginseng, widely used for its purported physical and mental effects, is generally well tolerated, but it has been implicated as a cause of decreased response to warfarin. Physicians must be alert for adverse effects and drug interactions associated with herbal remedies, and they should ask all patients about the use of these products.
Increasingly, alternative therapies such as herbal products are being used in the United States. Approximately 25 percent of Americans who consult their physician about a serious health problem are employing unconventional therapy, but only 70 percent of these patients inform their physician of such use.1
Herbal products are not tested with the scientific rigor required of conventional drugs, and they are not subject to the approval process of the U.S. Food and Drug Administration (FDA). Herbal products therefore cannot be marketed for the diagnosis, treatment, cure or prevention of disease. Nonetheless, the Dietary Supplement Health and Education Act of 1994 allows these products to be labeled with statements explaining their purported effect on the structure or function of the human body (e.g., alleviation of fatigue) or their role in promoting general well-being (e.g., enhancement of mood or mentation).2 Analysis of some of the putative effects of herbal products shows that they sometimes closely resemble claims of clinical efficacy for various diseases or conditions.
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作者:admin@医学,生命科学 2011-01-14 05:14
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