Use of nontraditional therapies—implications for older adults

AORN Journal,  May, 2003  by Linda C. Haynes,  Jan Hoot Martin,  Dianne Endres

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Table 1
PERIOPERATIVE IMPLICATIONS OF BOTANICAL, HERBAL,
AND NUTRITIONAL SUPPLEMENTS USED BY OLDER ADULTS (1)

Clinical condition   Supplement                Major use

Memory loss          * Gingko biloba
                       Vitamin E (high dose)
                       Phosphatidylserine

                     * L carnitine

Osteoarthritis       * Glucosamine sulfate
                       Chondroitin
                       Methylsulfonylmethane

                     * SAM-e

Hypercholesteremia   * Shark cartilage

                     * Fish oil
                       Garlic
                       Flax seed oil

                     * Red yeast rice

Cardiovascular       * Hawthorn                * Treat conges-
                                                 tive heart
                                                 failure (CHF),
                                                 angina

                     * L carnitine             * Treat CHF,
                                                 angina

                     * Coenzyme Q10            * Treat CHF

Respiratory--        * Ma huang
allergy/asthma
                     * Licorice

                     * Grape seed extract

                     * Quercetin
                       Nettles
                       Methylsulfonylmethane

Depression,          * St John's wort
anxiety,
or insomnia          * Kava
                       Hops
                       Valerian
                       Passion flower

Immunity             * Echinacea
                       Colloidial silver
                       Olive leaf extract
                       Vitamin C

Miscellaneous        * Ginseng                 * Improve mental
                                                 and physical
                                                 performance

                     * Bilberry                * Improve vision

                     * Saw palmetto            * Treat benign prostatic
                                                 hyperplasia

                     * Gotu kola               * Treat varicose
                                                 veins

Clinical condition   Supplement                Perioperative
                                               implications

Memory loss          * Gingko biloba           * Increases potential
                       Vitamin E (high dose)     for bleeding due to
                       Phosphatidylserine        effects on clotting

                     * L carnitine              * None known

Osteoarthritis       * Glucosamine sulfate      * None known
                       Chondroitin
                       Methylsulfonylmethane

                     * SAM-e                    * Patients who are
                                                  bipolar may develop
                                                  mania; monitor for
                                                  serotonin syndrome
                                                  when taken in
                                                  conjunction with
                                                  selective serotonin
                                                  reuptake inhibitors

Hypercholesteremia   * Shark cartilage           * May require
                                                   magnesium or
                                                   potassium
                                                   supplements

                     * Fish oil                  * Increases potential
                       Garlic                      for bleeding due to
                       Flax seed oil               effect on clotting
                                                   factors

                     * Red yeast rice            * Potentially
                                                   dangerous interac-
                                                   tion when combined
                                                   with erythromycin,
                                                   high dose statins,
                                                   fibrates, and
                                                   grapefruit juice in
                                                   large quantities

Cardiovascular       * Hawthorn                  * Can increase effects
                                                   of digitalis

                     * L carnitine               * None known

                     * Coenzyme Q10              * None known

Respiratory--        * Ma huang                  * May cause elevated
allergy/asthma                                     blood pressure or
                                                   result in
                                                   tachycardia,
                                                   myocardial
                                                   infarction, or
                                                   stroke; should not
                                                   be used with other
                                                   sympathetic
                                                   stimulants

                     * Licorice                  * May cause
                                                   pseudoaldosteronism
                                                   with sodium and
                                                   water retention and
                                                   potassium loss;
                                                   can lead to
                                                   increased blood
                                                   pressure and cardiac
                                                   arrest; increases
                                                   potassium loss when
                                                   given with thiazide
                                                   diuretics

                     * Grape seed extract        * Increases potential
                                                   for bleeding

                     * Quercetin                 * None known
                       Nettles
                       Methylsulfonylmethane

Depression,          * St John's wort            * Increases activity
anxiety,                                           of cytochrome P450
or insomnia                                        pathway, thus
                                                   decreasing plasma
                                                   levels of
                                                   medications, such as
                                                   warfarin, digoxin,
                                                   protease inhibitors,
                                                   aminophylline,
                                                   macrolide
                                                   antibiotics, calcium
                                                   channel blockers,
                                                   nonsedating
                                                   antihistamines, and
                                                   select antifungals

                     * Kava                      * Possible
                       Hops                        potentiation of
                       Valerian                    central nervous
                       Passion flower              system depressants,
                                                   such as barbiturates
                                                   and benzodiazepines

Immunity             * Echinacea                 * None known
                       Colloidial silver
                       Olive leaf extract
                       Vitamin C

Miscellaneous        * Ginseng                   * Decreases blood
                                                   glucose; increases
                                                   clotting; may
                                                   increase the effects
                                                   of caffeine and
                                                   other stimulants;
                                                   may cause
                                                   fluctuations in
                                                   blood pressure; may
                                                   increase the effects
                                                   of antipsychotics,
                                                   antihypertensives,
                                                   antidiabetics, and
                                                   glucocorticoids

                     * Bilberry                  * Increases potential
                                                   for bleeding

                     * Saw palmetto              * None known

                     * Gotu kola                 * None known

NOTE

(1.) M Blumenthal, "Interactions between herbs and conventional drugs:
Introductory considerations," HerbalGram 49 (Summer 2000) 52-63;
Integrative Medicine Access: Professional Reference to Conditions,
Herbs, and Supplements, first ed (Newton, Mass: Integrative Medicine
Communications, 2000); M Blumenthal, ed, The Complete German Commission
E Monographs: Therapeutic Guide to Herbal Medicines (Boston:
Integrative Medicine Communications, 1998).