Herbal Medicines Called Surgery Risk
Some popular herbal medicines can be dangerous and even life-threatening for people undergoing surgery and should not be taken before an operation, according to a review of research released Tuesday.
Echinacea, ephedra, garlic, ginkgo, ginseng, kava, St. John’s wort and valerian, which account for nearly 50% of all herbal medicines on the market, “potentially pose the greatest impact to the care of patients undergoing surgery,” according to the researchers from the University of Chicago who conducted the study.
The researchers analyzed a host of existing studies, case reports and reviews about the safety of the eight common herbal medicines and concluded the substances could directly affect the patient or interfere with other drugs given during surgery. Their findings are published in the current issue of the Journal of the American Medical Assn.
Patients often do not tell their doctors about their herbal usage, fearing doctors will not approve of self-medication or because they do not think of herbal products as being real medicines, said one of the study’s authors, Dr. Chun-Su Yuan, assistant professor of anesthesia and associate director of the Tang Center for Herbal Medicine Research at the University of Chicago. As a result, he said, if complications arise during surgery, the doctor does not know how to react.
“There is no real recognition of herbal medicines,” Yuan said. “The Food and Drug Administration classifies these products as dietary supplements, so patients think of them more as a food than as medicine.”
The FDA is only responsible for ensuring that dietary supplements are safe and cannot order a labeling change if a manufacturer wants to call its product a dietary supplement as opposed to an herbal medicine, said Christine Lewis, director of the FDA’s Office of Nutritional Products, Labeling and Dietary Supplements.
The length of time to avoid an herbal medicine before surgery varies. Ginkgo, for example, should be discontinued at least 36 hours before surgery. It can interfere with blood’s clotting ability and put surgical patients at greater risk for bleeding. Ginseng should be discontinued at least seven days before surgery. It inhibits warfarin, a blood-thinning drug used during surgery and the interference can result in death, said Yuan.
The study cautions, however, that in some cases, stopping an herb suddenly can be dangerous. For example, suddenly stopping valerian, an herb often used as a sleeping aid, can cause acute withdrawal. Researchers suggested that people taking valerian taper off their use of the drug over a several-week period before surgery.
Currently, the American Society of Anesthesiologists recommends patients stop taking herbal medicines at least two weeks before surgery. That, however, poses a problem for patients requiring emergency surgery.
To come up with their shorter recommendations, the researchers looked at studies of how long it takes to excrete a specific herb--a sign that it had been metabolized and eliminated from the body.
Philip Weintraub, a spokesman for the anesthesiologists, called the study “excellent” but said that more patient studies need to be done before the organization could issue new guidelines.
Dr. James Adams, associate professor of molecular pharmacology and toxicology at USC said the findings are only a start.
“This study is very good,” Adams said, “but there are hundreds of other herbal medicines out there that ought to be tested.”
Adams said physicians should also consult pharmacists because they know a lot about herbal products.
Yuan said the review article wasn’t meant to scare patients.
“Herbal medicines do a lot of good,” he said. “But patients and physicians must be aware of the risks as well.”
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Cutting Out Herbs
New research suggests that patients facing surgery stop taking popular herbal supplements days, or in some cases weeks, before an operation.
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Herb: Echinacea
Discontinue before surgery: As far in advance as possible, especially for transplant patients or those with liver problems.
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Herb: Ephedra
Discontinue before surgery: At least 24 hours before surgery.
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Herb: Garlic
Discontinue before surgery: At least seven days before surgery.
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Herb: Ginkgo
Discontinue before surgery: At least 36 hours before surgery.
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Herb: Ginseng
Discontinue before surgery: At least seven days before surgery.
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Herb: Kava
Discontinue before surgery: At least 24 hours before surgery.
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Herb: St. John’s wort
Discontinue before surgery: At least five days before surgery.
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Herb: Valerian
Discontinue before surgery: Taper off weeks before surgery. Suddenly stopping can cause withdrawal problems.
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Source: Journal of the American Medical Assn.
