Complementary medicines

There is currently insufficient information on the pharmacokinetics of complementary medicines to enable a judgement on whether they are likely to interact with conventional medicines and whether dosage reduction is necessary in renal impairment. Due to a lack of regulation, adverse effects such as nephrotoxicity may be attributable to impurities rather than the active principle.

Below is an extremely limited list of information on complementary medicines - for specific queries the Welsh Drug Information Centre specialist file and Micromedex may be consulted via pharmacy. There is also a very useful databases at: http://www.nlm.nih.gov/medlineplus/druginformation.html

	Complementary medicine	Issue
	St John's Wort	Decreased CyA levels reported due to CYP450 3A4 induction. May therefore decrease tacrolimus levels also.
	Garlic Papaya Danshen Dong quai Ginger	Increases INR therefore avoid peri-operatively
	Xaiochai hutang	Increases Prednisolone levels
	Chinese herb (Aristolochia) Juniper Pennyroyal	Cause renal damage
	Ginko	Cyclo-oxygenase inhibitor and PAF antagonist
	Echinaecea	Acts as an 'immunostimulant' - stimulates TNF secretion in vitro

Transplant protocols developed on the Edinburgh Transplant Unit. This page first published March 2002 by Amit Adlakha, reviewed December 2006 and last modified Tuesday, August 11, 2009.

NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.