Heart Attacks, Herbs, and Drug Interactions By Brian Benjamin Carter, MSci, LAc with information from Pamela Wyckoff, PharmD. Brian is an author of international renown and public speaker. He is currently writing his book Chinese Medicine: A Practical Guide to Optimal Healing. Brian practices acupuncture and Chinese herbal medicine in sunny San Diego, California.

Doc has me on Plavix(75mg./day), Lisinopril(40mg./day), Metoprolol(50mg-every 12 hours), Coated Aspirin (325mgs./day), and Simvastatin(40mg./day). My concern is the STATIN drug. I've read where they can seriously deplete Co-Enzyme Q10..and actually cause cardiomyopathys later on...and alas..plus cancer..mainly I've read due to the Co enzyme Q10 depletion.

My cholesterol has been in the 300-400 range and triglycerides in the 1200 range in the past, but I had unfortunately ignored this problem. There is only limited research into reactions involving pharmaceuticals and Chinese medicine or other herbal medicines. Due to this I would like to find an acupuncturist who would have quite a bit more experience in the Tx. of heart patients seeking to wean off of STATIN medications.

Would you be aware of any of these types of practitioners? Is there any safe way to use Chinese herbs/formulas to wean off of STATIN medications, or would this be literally taking a shot in the dark?

Thanks! Mike

Hi Mike,

Sorry to hear about your infarct. Glad to hear about your lifestyle changes!

Ya, I've heard some things about statins as well- can't think they're some new wonder drug- I have some reservations, and think your caution is prudent.

True, there is limited research on drug-herb interactions, but I do see some patterns in these interactions- first, check out my article, "Are My Herbs and Drugs Dangerous Together? Drug Herb Interactions."

The patterns I see are:

1. Single herbs are more likely to interact with drugs.
2. Formulas are less likely to interact, and may even synergize with drugs
for more effect with fewer side effects.

How to Determine If You Can Take Herbs with Your Drugs

Although we may not catch some of the exceptions (the unknown drug/formula interactions), there is a process for determining whether a drug is likely to interact with herbs in general. Use the Drug Information Handbook for this part.

By the way, I owe this process to pharmacist Pamela Wyckoff. I've begged her to publish it, but she has not... and people are suffering without the info, so I'm giving it to you, and giving her credit for it! Hopefully she won't be too mad at me.

The major things you look at in a drug are

• Reference range
• Absorption
• Metabolism
• Protein binding
• Elimination

The acronym RAMP-E should help you remember all the steps. It fits since some drugs require you to ramp down or ramp up your herbal dosages.

Reference Range (Therapeutic Margin)

Reference range comes first, though, because it determines whether you will even use herbs with a specific drug. If the Drug Handbook has a 'Reference Range' for the drug in question, that means that drug has a narrow therapeutic margin. That is to say: for the drug to be effective and not be toxic, the blood levels have to be a relatively specific amount.

Another way to think of it is that the drug is 'sensitive.' It doesn't take much interference to throw it off. Warfarin (Coumadin) is such a drug. For the patient to stay safe from blood clots, the warfarin levels in the blood must remain rather constant. If herbs throw off these levels, then they are in danger of stroke, aneurysm, or whatever their MD is trying to prevent.

The Reference Range Rule:
If the drug has a reference range, don't use herbs.

Absorption

Absorption is about getting the herb into the bloodstream. There are three ways that absorption can be affected: pH, binding (not the same as protein binding), and motility.

• pH: antacids, proton pump inhibitors, and H2 antagonists alter pH, thus altering the ionization of the drug molecule. Obviously, if stomach pH is lowered, less of the herb can be assimilated.
• Binding: Some drugs are sticky, and bind to herbs, preventing them from crossing the membrane into the blood stream. These are questran, carafate, and activated charcoal.
  
• Motility: Changes in GI motility change the usual time the drug is exposed to membranes, changing the amount of drug absorption. Those that increase motility are reglan, cholinergics, and propulsid. Those that decrease are anti-cholinergics, narcotics, and phenobarbitol. If motility is increased, herb dosage must be increased, and vice versa.

Metabolism

Drugs and herbs are primarily metabolized in the liver (but also can be kidney, lung, or GI epithelium). Most are handled by the liver cytochrome P450 system. Mainly, look for whether the drug induces, or inhibits liver enzymes. Inducers decrease breakdown time (increase dosage), and inhibitors increase breakdown time (decrease dosage).

Protein Binding

(If you want to save time, do protein binding second, right after reference range. This one, like the reference range, can be enough to tell you that herbs are too dangerous.) Protein binding is a measure of how much of the drug binds to albumin, the most common protein in the blood. The amount of the drug bound to albumin are not active. The rest that's in the blood is active. The danger is when the amount that's bound to albumin is very high. Then if some other drug or herb comes in and changes the percentage bound, blood levels of the drug can increase dramatically. This can lead to side effects and toxicity.

For most people, drugs that have 98% or greater protein binding are too dangerous. An exception is phenytoin (dilantin) because it is highly susceptible to binding changes. it takes less than most drugs to unbind from the albumin. For patients with mild liver disease, drugs with 95% or greater protein binding are dangerous to combine with herbs; their liver can metabolize out high blood levels of drugs as well as healthier people. For people with cirrhosis or jaundice (serious liver disease) watch out for 90% or higher. So, if the protein binding % of any of their drugs is too high, don't use herbs.

Patient Protein Binding Danger Level

• Healthy liver: Greater than or equal to 98%
  
• Abnormal liver (High liver function tests, chronic Hep C, etc.): Greater than or equal to 95%
  
• Seriously diseased liver (Cirrhosis, jaundice, end stage alcoholism): Greater than or equal to 90%

The Protein Binding Rule:
If the drug has a high protein binding percentage, don't use herbs.

Some medications that interfere with distribution of drug spread through the body are coumadin, dilantin, oral contraceptives, and NSAIDs.

Elimination

Renal, biliary, fecal, intestinal, saliva, sweat, breast milk, lungs... altering renal flow rate, urine pH, or damaging kidneys will affect elimination. Diuretics increase clearance, and aminoglycosides and aphotericin damage the kidneys.

Conclusion

So, all that said, I wouldn't call it a shot in the dark, but rather a shot in the twilight? ;-)

Plus, some good new formulas have been translated by Philippe Sionneau from the Chinese research based partly on classical theory and partly on the pharmaceutical action of herbs... there are formulas for high triglycerides, etc. The book hasn't come out yet in English, but email me (bbcarter at pulsemed dot org) if you want me to email you some of that information- just specify which diseases.

Formulas like that may help you substitute for some of the drugs you've been prescribed- but yes, I would work with a good herbalist (who is knowledgeable about western medicine) and an open-minded western doc.

And don't forget bout niacin- it's shown great cholesterol lowering abilities with few or no side effects.

B