Herbal supplements

This posting on KevinMD.com could not have come at a better time for me as I struggle with a difficult patient scenario. This article discusses a manuscript published in the Journal of the American College of Cardiology.

The upshot seems to be that many herbs may interact in negative ways with cardiovascular medications and therefore increase mortality. Now, of course many prescription medications also interact with cardiovascular medications, but at least we know what are in the preparations and the relative benefit of each. Therefore, one may decide, in the case of a bad interaction, if benefits outweigh risks.

This is relevant to me because I recently had a patient have terrible side effects from a new herbal regimen, which made it impossible for me to continue to give her chemotherapy. Just as the article says, the patient in this case did not immediately tell me about the herbs, I presume because of an assumption of safety (they are natural right? So they must be safe). I feel terrible that the patient did not tell me (or the herbalist, for that matter!).

Additionally, the article points out that one of the most common medication interactions with herbs causing excessive bleeding can be especially tricky in cancer patients on chemotherapy who have fluctuating platelet counts. I have many patients who take herbal therapies with my permission. Perhaps I should be more firm in my opposition? I worry about driving a therapeutic wedge between the patient and I if I am too strongly opposed to herbs, but maybe that priority is off, and I should be more heavy handed about my recommendation not to take herbal treatments, particularly while on chemotherapy.