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近年来,草药的使用在美国显著增加。这些产品未能像常规药那样经过详细审察而被FDA(美国食品药品管理局)管理。使用草药的患者经常是将草药与常规药物一起应用。本文讨论一些常用的草药与止痛药之间潜在的不良反应。非甾体抗炎药(NSAIDs),尤其是阿司匹林,已知该药与草药(银杏、大蒜、姜、越桔、当归、菊、人参、姜黄、旋果蚊子草和柳木)同用,具有抗血小板活性的相互作用;与含有香豆素(甘菊、益母草、欧洲七叶树、胡芦巴、红三叶草)和罗晃子素的草药同用增加出血的风险。对乙酰氨基酚与银杏以及上述的某些草药作用也增加出血的风险。而且当对乙酰氨基酚与肝毒性草药紫薇花、卡瓦胡椒,以及含有水杨酸盐的草药(柳树、锈线菊)伍用时肝毒性和肾毒性发生率可分别增加。阿片类止痛药与有镇静作用的草药缬草、卡瓦胡椒、甘菊同用,可致中枢神经系统抑郁症状增强。阿片的止痛作用还可被人参抑制。以上这些均提示医药专业人员,进一步认识草药与止痛药之间可能存在的相互作用,并应采取适当的措施以避免发生。但是由于大多数的相互作用资料均来源于个体病例报告、动物实验或体外实验数据,这就需要进一步的研究,以确认和评估这些潜在相互作用的临床意义。
In recent years, the use of herbs has increased significantly in the United States. These products failed to be scrutinized by the FDA (the U.S. Food and Drug Administration) as the conventional drugs do. Patients who use herbs often use herbs with conventional medicines. This article discusses the potential adverse reactions between some commonly used herbs and painkillers. Non-steroidal anti-inflammatory drugs (NSAIDs), especially aspirin, are known to be used in combination with herbal medicines (Ginkgo, Garlic, Ginger, Bilberry, Angelica, Chrysanthemum, Ginseng, Turmeric, Interactions of platelet activity; use of herbs with coumarins (chamomile, motherwort, horse chestnut, fenugreek, red clover) and rhodanin increases the risk of bleeding. Acetaminophen and ginkgo, as well as some of the above herbs, also increase the risk of bleeding. Moreover, the incidence of hepatotoxicity and nephrotoxicity may increase when paracetamol is used in combination with hepatotoxic herbs such as crape myrtle, kava and salicylate-containing herbs (willow, rust wire). Opioid analgesics and sedative effects of valerian, kava, chamomile, can cause depressive symptoms of the central nervous system increased. The analgesic effect of opium can also be inhibited by ginseng. All of these prompt medical professionals to further understand the possible interactions between herbal medicines and painkillers and take appropriate measures to avoid them. However, since most of the interaction data come from individual case reports, animal experiments or in vitro experimental data, further studies are needed to confirm and evaluate the clinical significance of these potential interactions.