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Postsurgical Risks of
Herbal Supplements

E-Newsletter No. 8

Once used by only a small segment of the population, the use of so-called "natural" herbal supplements has in recent years become widespread. Herbal supplements have become increasingly popular, and, since the passage of the Dietary Supplement Health and Education Act of 1994, also largely unregulated with respect to purity, potency, and claims made for particular products. Of particular concern is the question of poorly understood and often even more poorly publicized effects of herbal preparations. Consumers may find themselves lulled into a false sense of security by buzzwords such as "organic" and "all natural".

In the present study taken from the Journal of the American Medical Association, July 11, 2001, Dr. Michael Ang-Lee and his colleagues investigate one limited set of unintended consequences arising from the use of eight selected herbal supplements. The investigators examined a group of the more widely used herbal preparations: Echinacea, ephedra, garlic, ginkgo, ginseng, kava, St. Johnís wort, and valerian. Their principle concern was whether and how any of these substances might contribute to perioperative complications. Other points are addressed that have bearing on non-surgical practice as well.

The researchers investigated the effects of these herbal medications beginning with searches of Medicine and Cochrane Collaboration databases. They gathered information for each substance concerning usage patterns, drug effects, pharmcokinetics, and drug interactions both proved and suspected. The results are collected and published in a series of brief digests as well as in tabular form.

Highlights for Particular Herbal Preparations Include:

Cutting Out Herbs

New research suggests that patients facing surgery stop taking herbal supplements days, or sometimes weeks, before an operation.

Herb Discontinue Before Surgery

as far in advance as possible, especially for transplant patients or those with liver problems.


at least 24 hours before surgery.
Garlic at least seven days before surgery.
Ginkgo at least 36 hours before surgery


at least seven days before surgery.
Kava at least 24 hours before surgery.

St. Johnís wort

at least five days before surgery.


taper off during several weeks before surgery. Suddenly stopping can cause withdrawal problems.

The authors also note that patients who make extensive use of herbal preparations are unreliable self-reporters of their use of these substances. They physician requires accurate knowledge of the patientís complete medical history, including an accurate knowledge of the patientís use of herbal preparations. This is important not only because of the effects of these drugs, but because patients who use them may be self-mediating undiagnosed and potentially serious health problems.

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