Use of herbal medication in the perioperative period: Potential adverse drug interactions

• Published in: Journal of clinical anesthesia 2024-08, Vol.95, p.111473, Article 111473
• Main Authors: Elvir Lazo, Ofelia Loani, White, Paul F., Lee, Carol, Cruz Eng, Hillenn, Matin, Jenna M., Lin, Cory, Del Cid, Franklin, Yumul, Roya
• Format: Article
• Language: English
• Subjects: Alternative medicine; Anesthesia; Anesthetics - administration & dosage; Anesthetics - adverse effects; Anticoagulants; Antihypertensives; Cardiac arrhythmia; Dietary supplements; Dietary Supplements - adverse effects; Drug dosages; Drug Interactions; Heart attacks; Herb-Drug Interactions; Herbal medicine; Herbs; Humans; Hypertension; Hypotension; Ingredients; Marijuana; Medical personnel; Perioperative Care - methods; Perioperative Period; Phytotherapy - adverse effects; Plant Preparations - administration & dosage; Plant Preparations - adverse effects; Surgery; Tea; United States
• ISSN: 0952-8180; 1873-4529; 1873-4529
• DOI: 10.1016/j.jclinane.2024.111473

Use of herbal medications and supplements has experienced immense growth over the last two decades, with retail sales in the USA exceeding $13 billion in 2021. Since the Dietary Supplement Health and Education Act (DSHEA) of 1994 reduced FDA oversight, these products have become less regulated. Data from 2012 shows 18% of U.S. adults used non-vitamin, non-mineral natural products. Prevalence varies regionally, with higher use in Western states. Among preoperative patients, the most commonly used herbal medications included garlic, ginseng, ginkgo, St. John's wort, and echinacea. However, 50–70% of surgical patients fail to disclose their use of herbal medications to their physicians, and most fail to discontinue them preoperatively. Since herbal medications can interact with anesthetic medications administered during surgery, the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications 1–2 weeks before elective surgical procedures. Potential adverse drug effects related to preoperative use of herbal medications involve the coagulation system (e.g., increasing the risk of perioperative bleeding), the cardiovascular system (e.g., arrhythmias, hypotension, hypertension), the central nervous system (e.g., sedation, confusion, seizures), pulmonary (e.g., coughing, bronchospasm), renal (e.g., diuresis) and endocrine-metabolic (e.g., hepatic dysfunction, altered metabolism of anesthetic drugs). During the preoperative evaluation, anesthesiologists should inquire about the use of herbal medications to anticipate potential adverse drug interactions during the perioperative period. •This review article summarizes the pharmacologic effects and side effects of the most commonly used herbal medications.•Adverse side effects and potential drug interactions between herbal medications used by patients in the preoperative period.•This review provides anesthesia providers with a concise summary of the available pharmacologic data on herbal medications.•Limited scientific evidence in medical literature on herbal medication effects and dosages concerns anesthesia practitioners.•A lack of standardization in the manufacturing/marketing of herbal products also remains a concern for anesthesia providers.