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An updated review on herbal medicine and their effects on procedures

      With an increasing popularity for patients’ use of herbal supplements, there is a greater need to understand the interactions that these herbal medications may have on the body. Some of these postprocedural complications include prolonged bleeding, inflammation, and hypertension. Since many patients do not disclose their use of such herbs, physicians are unaware of the potential for increased adverse effects postprocedurally. The MEDLINE and Cochrane Collaboration databases were searched for articles published between January 2000 and June 2012 using the search term herbal medicine and the names of 10 commonly used herbal medications. We selected studies, case reports, and reviews addressing the safety and pharmacology of the 10 commonly used herbal medications for which safety information pertinent to perioperative adverse effects was available. We extracted safety, pharmacodynamic, and pharmacokinetic information from such selected literature and reached consensus about any discrepancies. Feverfew, garlic, ginger, vitamin E, and echinachea are all known to prolong bleeding and should be discontinued 1 week prior to procedures. Ginkgo biloba is also known to prolong bleeding and should be discontinued for at least 36 hours. Ephedra is known to cause hypertension and should be discontinued at least 24 hours. Ginseng is known to prolong bleeding and worsen hypertension and should be discontinued for at least 1 week. Licorice is known to worsen hypertension and inflammation and should be discontinued for at least 24 hours. Finally, goldenseal is known to worsen inflammation and hypertension and should be discontinued 1 week preprocedure. Physicians need to be become more aware of the potential effects of such commonly used herbal medications to prevent, recognize, and treat potentially serious problems associated with their use and discontinuation. Overall, the understanding of the complications that herbal medications may have could assist to decrease postprocedural adverse effects and improve patient outcomes.