
| Herb | Relevant effects | Surgery concerns | Recommendations |
|---|---|---|---|
| Echinacea | Boost immunity | Allergic reactions, impairs immune suppressive drugs, can cause immune suppression when taken long-term, could impair wound healing | Discontinue as far in advance as possible, especially for transplant patients or those with liver dysfunction |
| Ephedra (ma huang) | Increases heart rate, increases blood pressure | Risk of heart attack, arrhythmia, stroke, interaction with other drugs, kidney stones | Discontinue at least 24 hours before surgery |
| Garlic (ajo) | Prevents clotting | Risk of bleeding, especially when combined with other drugs that inhibit clotting. | Discontinue at least seven days before surgery |
| Ginkgo (duck foot, maidenhair, silver apricot) | Prevents clotting | Risk of bleeding, especially when combined with other drugs that inhibit clotting | Discontinue at least 36 hours before surgery |
| Ginseng | Lowers blood glucose, inhibits clotting | Lowers blood-sugar levels. Increases risk of bleeding Interferes with warfarin (an anti- clotting drug.) | Discontinue at least seven days before surgery. |
| Kava (kawa, awa, intoxicating pepper) | Sedates, decreases anxiety | May increase sedative effects of anesthesia Risks of addiction, tolerance and withdrawal unknown. | Discontinue at least 24 hours before surgery. |
| St. John's wort (amber, goatweed, Hypericum, klamatheweed) | Inhibits re-uptake of neuro-transmitters (similar to Prozac) | Alters metabolisms of other drugs such as cyclosporin (for transplant patients), warfarin, steroids, protease inhibitors (for HIV). May interfere with many other drugs | Discontinue at least five days before surgery. |
| Valerian | Sedates | Could increase effects of sedatives. Long-term use could increase the amount of anesthesia needed. Withdrawal symptoms resemble Valium addiction | If possible, taper dose weeks before surgery. If not, continue use until surgery. Treat withdrawal symptoms with benzodiazepines. |
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