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Table 1 Original Chart in APEC

From: Evaluation and implications of natural product use in preoperative patients: a retrospective review

Herb

Pharmacological Effect

Perioperative Concerns

Preoperative Discontinuation

Echinacea

Activation of cell-mediated immunity

Allergic reactions, decreased effectiveness of immunosuppressants; potential for immunosuppression with long-term use

No data

Ephedra (ma huang)

Increased HR and BP through direct and indirect sympathomimetic effects

Risk of MI and stroke from tachycardia and htn; ventricular arrhythmias with halothane; long-term uses depletes endogenous catecholamines and may cause intraoperative hemodynamic instability; life-threatening interaction with MAOI's

At least 24 hours before surgery

Garlic

Inhibition of platelet aggregation, increased fibrinolysis, equivocal antihypertensive activity

Potential to increase risk of bleeding, especially when combined with other medications that inhibit platelet aggregation

At least 7 days before surgery

Ginkgo

Inhibition of platelet-activating factor

Potential to increase risk of bleeding, especially when combined with other medications that inhibit platelet aggregation

At least 36 hours before surgery

Ginseng

Lowers blood glucose; inhibition of platelet aggregation; increased PT-PTT in animals; varied others

Hypoglycemia; potential to increase risk of bleeding; potential to decrease anticoagulation effects of warfarin

At least 7 days before surgery

Kava

Sedation, anxiolysis

Potential to increase sedative effect of anesthetics; potential for addiction, tolerance, and withdrawal after abstinence unstudied

At least 24 hours before surgery

St. John's Wort

Inhibition of neurotransmitter reuptake, MAO inhibition unlikely

Induction of P450 enzymes (CYP 3A4) affecting cyclosporine, warfarin, steroids, protease inhibitors, and possibly benzo's, calcium channel blockers, and many other drugs; decreased serum digoxin levels

At least 5 days before surgery

Valerian

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