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Selected herbs
Chapter 9 Herbal Therapy with Nursing Implications
| Common name/botanical name | Class and part used | Actions and Uses | Dosage | Interactions/Precautions | Side/Adverse Effects | uses | precautions |
|---|---|---|---|---|---|---|---|
| Dong QuaiAngelica Sinensis | Class 2b (root)Roots, rhizomes | Phytoestrogen activity; vasodilation, small muscle relaxationDecreased IgE antibody production | Tea: 1–4 c/d (equivalent 1–2 g dried herb)Tincture: ½-4 ml, Max: 6×/d | Herb-Drug Interaction: additive bleeding effect with anticoagulants, aspirin, NSAIDs | Rash and photosen- sitivity; fever, bleeding | PMS, menopausal symptoms, cardiovascular support | AVOID USE OF THIS HERBAvoid use with prescription anticoagulants, history of bleeding disorders, pregnancy, if at risk for breast cancer |
| Echinacea (purple coneflower)E. purpura; E. angustifolia, E. pallida | Class 1 (root/seed)Aerial parts of E. pallida; root of E. pallida and angustifolia | Stimulates immune system; antibacterial, antiviral, antipyretic;Antifungal as topical | Tab: 500 mg-1 g t.i.d.Tea: 1–5 c/dTincture: max: 2 tsp t.i.d. | Short-term use: 2 wk; 8 wk if low dose; may be hepatotoxic if taken continuously | Lozenge/tincture: Temporary numbness or tingling of tongueCross-sensitivity in clients allergic to daisy family, GI upset, diarrhea | Prevention and early treatment of colds and flu; recurrent respiratory, ear, and urinary tract infectionsTopical: Canker sores, fungal infectionsInvestigational use: Stimulate immune system of HIV/AIDS clients | Avoid use with immunosup- pressants such as cortico- steroids (may counteract); persons with chronic systemic disease of immune system (e.g., SLE, HIV, TB, MS)Safety not determined in pregnancy lactation, and in children <2 y |
| Evening primroseOenothera biennis | Class 4Oil of seed | Natural estrogen promoter | Take with meals (increases absorption):Oil: PMS: 3–6 g/d for 6 mo, 14 days before mensesInflammatory conditions: 4–8 g/d for 3–4 moMS: 500 mg/d for 3 wk with exacerbation | Avoid use during pregnancy and lactationMay lower seizure threshold if taken with anticonvul- sants; anticonvulsant dose may need modification or do not use concurrently | GI upset, nausea, headache, rash. Immunosuppression with long- term use | PMS, problems with synthesis of fatty acids, abnormal prostaglandin production, diabetic neuropathies, chronic inflammatory conditions (eczema), overactive immune systems | Avoid use during pregnancy and lactationMay lower seizure threshold if taken with anticonvul- sants; anticonvulsant dose may need modification or do not use concurrently. H/F, H/H: None known |
| FeverfewTanacetum parthenium; chrysanthemum parthenium | Class 2b (whole herb)Leaves, flowering tops | Interferes with platelet aggregation, inhibits release of serotonin from platelets, blocks proin- flammatory mediators, digestive relaxant | Cap/tab (at least 2% parthenolide) 125 mg/d; increase to 1–2 g with acute attack | May be 4–6 wk before effect; continuous use for best outcomeCross sensitivity to plants in daisy familyAvoid with pregnancy, lactation, with prescription anticoagulants, and in children <2 y | Possible gastric distress or mouth sores if using raw leaves; muscle stiffness; may have rebound headache if discontinued abruptlyMay interfere with SSRI antidepressants (e.g., Prozac) | Prevention and long- term management of migraine headaches; rheumatoid arthritis; menstrual problems; allergies | Consult HCP before using herb if taking prescription NSAIDs (decreases effectiveness)May interfere with SSRI antidepressants (e.g., Prozac) |
| GarlicAllium sativum | Class 2cBulb | Detoxifies body and increases immune function; decreases platelet aggregation; increases HDL and decreases cholesterol and triglycerides, broad antimicrobial activity, mild antihypertensive; hypoglycemia | Caps (enteric coated): (ED of 5000 mcg of allicin/d in divided doses)Raw garlic clove is best source; minimum: 1/d | Avoid use during pregnancy and lactation (may stimulate labor or cause infant colic) and hypothyroidismBlood pressure may decrease in 30 min and return to baseline in about 2 hr | Heartburn,flatulence, gastric irritation, decreased RBCs; dizzines,diaphoresis | Hypercholesterolemia, mild HTN, colds and flu | Caution: Use with anticoagulants because of increased fibrinolysis and decreased platelet aggregation; modify antidiabetic doses. H/F: None; H/H: Acidophilus deceases absorption of garlic |
| GingerZingiber officinale | Class 1 (fresh root)Class 2b/2dDried rootRhizome | Stimulates digestion, increases bile and motility; antispasmodic; decreased platelet aggregation; decreases absorption and increases excretion of cholesterol; antioxidant | Take with foodCap/tab/tea: 2–4 g in 2–3 divided dosesFor motion sickness start 2 d to 2 hr before travelInflammatory joint disease: 4 g in 2–3 divided doses Nausea : 1 g in divided doses for 1–4 dTincture: 1.5-3 ml in 8 oz juice q.i.d., PRN | Avoid long-term use with pregnancy, thrombocytopenia (abortifacient in large amounts)Caution: With prescription anticoagulants (additive effect) | May cause gastric discomfort if not taken with food; anorexia | Nausea, pregnancy morning sickness (short term, low dose ONLY); motion sickness; gastric protection with NSAIDs | Consult with HCP before use if have gallstonesMay increase absorption of all PO medications H/F, H/H: None known |
| Ginkgo bilobaGingko folium | Class 1 (leaf)Leaves;(standardized to at least 24% ginkgo flavone glycosides and 6% Terpene lactones) | Antioxidant;peripheral vasodilation and increased blood flow to CNS, reduces platelet aggregationUse:Allergic rhinitis, Alzheimer's disease,anxiety/stress, dementia, Raynaud's disease, tinnitus, vertigo, impotence, poor circulation; altitude sickness | Cap/tab: 120–240 mg/d in 2–3 divided dosesTincture: 5–10 ml b.i.d., t.i.d.Circulation/memory: 120 mg/d in 2–3 divided dosesAlzheimer's dementia, tinnitus: up to 240 mg/d in 2–3 divided doses | Effects seen in 2–3 wk; 12-wk course recommendedAvoid use in pregnancy, lactation, children, and with MAOIs,Caution: With prescription anticoagulants monitor bleeding and prothrombin times. Extra caution if using ginger, garlic, or feverfew | Initially, mild transient headache that usually stops in 2 d; mild gastric distress;Toxicity: vomiting, diarrhea, dermitis, irritability | Allergic rhinitis, Alzheimer's disease, anxiety/stress, dementia, Raynaud's disease, tinnitus, vertigo, impotence, poor circulation; altitude sickness | May increase BP if used with thiazide diureticsDiscontinue 2 wk before surgeryGinkgo fruit may result in severe rash; seeds are toxic. H/F, H/H: None known |
| Ginseng, eleuthera or SiberianEleutherococcus senticosus, Acanthopanax senticosus | Class 2b/2c/2dRoot | Supports adrenal glands, enhances energy levels by inhibiting alarm phase SNS response, stimulates RBC production, decreases blood sugar levels, protects from cellular mutation from carcinogens | Cap/tab: 2–3 g/d in 3–4 divided dosesTea: 1–4 c/dTincture: 5–20 ml/d in 3–4 divided doses | Take for 6–8 wk; then 1 wk drug holiday, and resume for total of 3 moAvoid with BP >170/90, pregnancy, lactation, children, bipolar or psychic disorders, DM, may increase or decrease anticoagulants (dependent on species), anticoagulants | Hypertension, palpitations, occasional diarrhea, possible insomnia if taken at bedtimeGinseng abuse syndrome: Edema, insomnia, hypertonia; may be life threatening | Cold and flu prevention, adaptation to stress, chronic fatigue syndrome, SLE, HIV, mental fatigue and physical exhaustion, following chemotherapy or radiation treatments, recovery from chronic or long-term illness | May increase effects of caffeine and HRT, falsely elevate digoxin levels, interact with antipsychotic drugs. H/F: Overstimulation may occur with caffeinated coffee, cola, and tea. H/H: None |
| GoldensealHydrastis canadensis | Class 2bRoot, rhizome | Stimulates immune system and bile secretion, antipyretic, broad spectrum antibiotic activity | Cap/tab: 2–4 g/d in divided doses (standardized to 8%-12% alkaloid content) | Avoid with pregnancy, lactation, children, HTNDosing >5-7 d of higher doses may increase liver enzymes or malabsorption of B vitamins | In higher doses may be hepatotoxicToxicity: CNS depression, restlessness, seizures, cardiovascular collapseEndangered plant species | For infection: respiratory, digestive, urinary tract, mucous membranes, cholecystitis, cirrhosis | Avoid with pregnancy, lactation, children, HTNDosing >5-7 d of higher doses may increase liver enzymes or malabsorption of B vitamins |
| HawthornCrataegus laevigata, C. oxycantha, C. monogyna | Class 1Ripe fruit, leaves, flowers | Peripheral dilation and increased coronary circulation, improves cardiac oxygenation, antioxidants, mild diuretic, decreases proinflammatory substances | Cap/tab: 100–900 mg/d in divided doses (standardized to 20% procyanidins)Average/dose: 100- 250 mg t.i.d.Tea: 2.5-5 ml t.i.d.Tea: 1 c t.i.d. (4-5 g dried/day) | May need to modify doses of beta blockers, digitalis, and ACE inhibitorsIncreased effects of digitalis, beta blockage, ACE inhibitors, CNS depressants | Hypotension, fatigueSedation, nausea, vomiting, anorexia | Mild HTN, early HF, stable angina | High doses contraindicated with chronic atrial fibrillation and hypotension from dysfunction of valve: IH/F None known; H/H increases action of Lily of the Valley |
| KavaPiper methysticum | Class 2b/2c/2dDried rhizome, roots | CNS sedation without loss of mental acuity or memory | Cap/tab: Anxiety: 50–100 mg up to t.i.d.Insomnia: 180–210 mg at bedtime (standardized to 70% kavalactones)Max: 300 g/wk | Avoid with pregnancy, lactation, parkinsonism, and if taking levodopa; not for young childrenAvoid alcohol use and if need to be alert or operate machinery | Leaf: Long-term higher doses (in animals) anemia, icterus, excitation, death;High doses may cause loss of balance, pulmonary hypertension;May cause liver toxicity;Use >3 mo may turn skin yellow: discontinue drug HTN, headache, weakness | Anxiety, insomnia, skeletal muscle spasmGood with psychotic disorders, no risk of tolerance | Increases CNS sedating drugs, especially benzodiazepinesFat soluble, so may have delayed effects. H/F increased absorption when taken with food; H/H: None knownUnstable gait, numb tongue, mild GI upset |
| LicoriceGlycyrrhiza glabra | Class 2b/2c/2d (root)Root, leaf | Antiinflammatory, antibacterial, antiviral, hepato and gastric protective, antidepressant, estrogenic, laxative | Cap/tab: 200–600 mg glycyrrhizin in 3 divided doses; max: 4–6 wk;Tea: 3 c/d;Tincture: 2.5-5 ml t.i.d;DGL: 300–380 mg; max: 1200 mg/d in chewable form 20 min before meals for 8–16 wk | Avoid with pregnancy, lactation, children, HTN, kidney or liver disorders, or if at risk for hypokalemiaCaution with DMIncreased aldosterone effect with increasing dose and duration | Doses >5000 mg/d results in aldosterone-like syndrome that reverses when herb discontinued | Viral infection, upper respiratory infection, inflammation, Addison's disease, depression, ulcersTopically: Herpes, psoriasis, eczemaDCL: IBS, mouth ulcers | Antagonizes antihypertensive meds and spirolactonePotentiates corticosteroids and digitalis. H/F none known; H/H may cause hypokalemia with aloe |
| Milk thistle (Mary thistle wild artichoke)Silybum marianum | Class 1Seeds of dried flowers | Increased regeneration of liver cells; increases antioxidant activity | Cap/tab: Initially: 500 mg/d in 3 divided doses for 6–8 wk;With improvement: 120–240 mg/d in divided doses; may take 7–10 d for effect; 4–8 wk if liver diseased with alcohol;Tincture: 1 ml t.i.d. (avoid ETOHbased tinctures) | Avoid use in pregnancy, lactation, in children, with drugs metabolized by P-450 enzyme | Diarrhea first days of therapy, nausea, vomiting, menstrual changes | Liver disease (hepatitis), cholecystitis, psoriasis | Herb does not reverse cirrhotic liver changes but disease may be slowed with increased quality of life. H/F, H/H: None known |
| PeppermintMentha piperita, var. officinalis or vulgaris | Class 4Aerial parts | Antispasmodic, increase bile flow, carminative, external analgesic | Cap/tab: enteric coated: 1–2 t.i.d. between mealsTea: 2–3 c/d (equivalent 3–6 g dried herb)Tincture/oil: 6–12 gtts/d diluted in divided doses | Consult HCP before taking if have cholecystitis or obstructed bile ductNo known drug interactions; may interfere with iron absorption | None known | BS, indigestion, cholecystitis, infant colic, nasal decongestantTopically: Musculoskeletal pain, itching, colds | Consult HCP before taking if have cholecystitis or obstructed bile ductNo known drug interactions; may interfere with iron absorption |
| PsylliumPlantago psyllium | Class 4 | ½ t soaked in water for 15–60 min at bedtime with at least 8 oz waterPO extract: 1–4 ml t.i.d. | Major ingredient in MetamucilMay decrease lithium absorptionAvoid use during pregnancy, lactation, in children | None known | Laxative, treatment of hemorrhoids, colitis, Crohn's disease, IBSHerb of longevity, poultice: wound healing effects | Major ingredient in MetamucilMay decrease lithium absorptionAvoid use during pregnancy, lactation, in children | |
| SageSalvia officinalis | Class 2b/2d (leaf)Whole plant | Gargle tea for sore throat, dries up mother's milk, decreases hot flashesAntidepressant and antiviral activity | Take with food Cap/tab: (standardized to at least 0.1% hypericin) 300 mg t.i.d. | Limit use to 2 wk to avoid toxic effects of tanninsCaution clients with DM and seizure disorders | Nausea, vomiting, anorexia, oral irritation | Gargle tea for sore throat, dries up mother's milk, decreases hot flashesAntidepressant and antiviral activity | Limit use to 2 wk to avoid toxic effects of tanninsCaution clients with DM and seizure disorders |
| St. John's wortHypericum perforatum | Class 2dFlowers | Mood swings, mild to moderate depression, anxiety, sleep disordersTopically: Burns/wounds | Tea: 1–2 c/d for 4–6 wkTincture: 1–2 ml t.i.d. | Long-term use recommended; effects seen in 4–8 wkAvoid with pregnancy, lactation, prescription antidepressants, MAOIs, indinavir, children <2 yMay decrease effect of digoxin related to bioavailability | Skin photosensitivity, headache, occasional GI upset, dry mouth, dizziness, confusion | Mood swings, mild to moderate depression, anxiety, sleep disordersTopically: Burns/wounds | Monitor serum digoxin levelsUse with amphetamines, trazodone, tricyclics may cause serotonin syndromeInterferes with absorption of iron and other minerals; high doses may increase liver enzymes |
| Saw palmettoSerenoa repens, Sabal serrulata | Class 4Berries | Decreases size of prostate; increases breakdown of estrogen, progesterone, and prolactin: antiandrogenicDiuretic | Cap/tab: 230 mg/d in 1–2 doses (standardized to 85%- 95% fatty acids)Tea: 1 c t.i.d. (equivalent dose 1–2 g/d)Liquid extract: 5–6 ml daily | Recommend 45–90 d of treatment; effects seen after 30 d. If effective, may take long termAvoid in pregnancy, lactation, in children, in clients with breast cancerEffectiveness of prophylactic treatment not shown | Headache, dysuria, back painGastric disturbance (rare) | BPH, chronic cystitis; sexual potency | May interfere with PSA test; discontinue herb 1–2 wk before testMay increase or decrease effects of antiinflammatories and immunostimulants; may antagonize hormone therapy |
| ValerianValeriana officinalis | Class 1Root | Sedative/hypnotic, antispasmodic, increases deep sleep | Cap/tab: (standardized to 0.5% essential oils, equivalent to 2–3 g up to b.i.d.)Tea: 1–3 c/d or at bedtimeTincture: 1–3 ml; may repeat 2–3 × over 6 h | Effects may take several dosesFor long-term use; monitor liver function if elevated, discontinue herbAvoid in pregnancy, lactation, children, with prescription sedative/hypnotics, MAOIs, anticoagulants | Anxiety, headache, occasional GI upset and hang-over effect with high doses, CNS depression | Insomnia, stress headaches, mild anxiety, muscle cramps and spasms | Increased sedative effect with barbiturates; negates effects of phenytoinFoul smell; no dependence or tolerance |
| Class 1Herbs that can be safely consumed when used appropriately | 2a: For external use only 2b: Not to be used during pregnancy 2c: Not to be used while nursing 2d: Other specific use restrictions as noted | Class 3-“To be used only under the supervision of an expert qualified in the appropriate use of this substance.Dosage, contraindications, potential adverse effects and drug interactions, and any other relevant information related to safe use | Class 4Herbs for which insufficient data are available for classification | ||||
| Aloe/aloe Vera/ Aloe barbadensis | Class 1Leaf gelClass 2b/2dDried, juiceClass 2dTopicalBladelike leaf | Internal for constipation; externally to relieve pain and promote healing of burns, wounds, sunburn, psoriasis | Internal: Tincture/extract: 50–300 mgExternal: t.i.d. or PRN | Internal use contraindicated if pregnant, lactating, children <12 yConsult with HCP before taking if have ulcerative colitis or Crohn's disease, taking cardiac glycosides, antiarrhythmics, thiazide diuretics, licorice, or corticosteroids | Internal: Overdose/long-term may cause arrhythmias, neuropathies, edemas, albuminuria, hematuria (side effects are rare) | Internal for constipation; externally to relieve pain and promote healing of burns, wounds, sunburn, psoriasis | Internal use contraindicated if pregnant, lactating, children <12 yConsult with HCP before taking if have ulcerative colitis or Crohn's disease, taking cardiac glycosides, antiarrhythmics, thiazide diuretics, licorice, or corticosteroids |
| BilberryVaccinium myrtillus L. | Class 4Extract of dried fruit and leaf | Fruit may promote healthy vision, increase visual pigment regeneration; decrease diarrhea in childrenLeaf used for diabetes, arthritis, dermatitis, gout | Fruit extract: 80–160 mg t.i.d. (St: 25% anthocyanosides) | Avoid with pregnancy, lactation, childrenNo reported significant interaction with fruitLeaf: May decrease blood sugar and triglyceride levels; may increase action of anticoagulants and NSAIDs; monitor for dose adjustments | Leaf: Long-term higher doses (in animals) anemia, icterus, excitation, death | Fruit may promote healthy vision, increase visual pigment regeneration; decrease diarrhea in childrenLeaf used for diabetes, arthritis, dermatitis, gout | Avoid with pregnancy, lactation, childrenNo reported significant interaction with fruitLeaf: May decrease blood sugar and triglyceride levels; may increase action of anticoagulants and NSAIDs; monitor for dose adjustments |
| Black cohosh (bugwort, snakeroot, squaw root)Cimicifuga | Class 2b/2cRootUses: Antispasmodic, astringent, diuretic, vasodilator, PMS, dysmenorrhea, infertility, menopausal symptoms | Suppresses luteinizing hormone, optimizes estrogen levels | Cap/tab: 20 mg b.i.d.Tincture: 2–5 mg b.i.d. | Avoid with pregnancy, lactation, childrenLimit use to 6 mo; no data on long-term useUnder supervision of qualified herbalist, increases action of antihypertensives; may alter effects of HRTMay decrease iron absorption | Higher doses: dizziness, headache, nausea, change in heart rate | Antispasmodic, astringent, diuretic, vasodilator, PMS, dysmenorrhea, infertility, menopausal symptoms | Avoid with pregnancy, lactation, childrenLimit use to 6 mo; no data on long-term useUnder supervision of qualified herbalist, increases action of antihypertensives; may alter effects of HRTMay decrease iron absorption |
| Chamomile (green chamomile)Matricaria recutita | Class 2bDried flower tops | Stimulates normal digestion, antiinflammatory, antispasmodic, mild sedative, mild diuretic, mild antibacterial with topical use | Between meals:Cap/tab: 2–3 g t.i.d., Tea: 1–4 c/dTincture: max: 1 tsp t.i.d. | Avoid if allergic to daisy family (e.g., ragweed, asters, chrysanthemums)May increase effects of sedatives and interfere with action of anticoagulants. | None known | Anxiety, insomnia, indigestion, inflammatory skin conditions | Avoid if allergic to daisy family (e.g., ragweed, asters, chrysanthemums)May increase effects of sedatives and interfere with action of anticoagulants. H/F, H/H: None known. |
| CranberryVaccinium macrocarpon Ait. | Class 4Berries | Prophylaxis (not treatment) of urinary tract infections; to treat kidney stones | Extract: 300–400 mg concentrated juice b.i.d.Cocktail: 300 ml/d commercial cranberry juice | Caution: avoid use with oliguria and anuria. Clients with DM should use sugarfree cranberry juice; lactating clients, children <12 y, and clients with history of oxalate kidney stones limit to 1 L/day. | Doses of >3 L/day may produce diarrhea | Prophylaxis (not treatment) of urinary tract infections; to treat kidney stones | Caution: avoid use with oliguria and anuria. Clients with DM should use sugarfree cranberry juice; lactating clients, children <12 y, and clients with history of oxalate kidney stones limit to 1 L/day. H/D, H/F, H/H: None known |
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