By Andrea Bickford, RD, CSR, LD

Editors Note: Before beginning any herbal therapy, talk to your doctor and other healthcare professionals. Herbal remedies can pose dangerous problems to dialysis and transplant patients. The long-term safety of herbs is unknown and they may possess safety risks in patients with kidney failure. The information in the table below was reviewed by Drew Silverman PharmD, a Clinical Pharmacy Specialist with Tampa General Hospital. Dr. Silverman has been working with kidney, heart and liver transplant patients for 14 years and has been a kidney transplant recipient for the past 15 years.

Herbal therapies are becoming more popular as alternative treatments for various ailments including colds, nausea, constipation, insomnia, and depression.  While some herbs have shown promise, the lack of long-term studies regarding their overall health benefits leaves a lot to the unknown.  A piece of the unknown includes how these herbs are excreted by the body.  This becomes even more of a concern in the renal patient population since we are unsure of how impaired kidney function, renal therapies and various medications can impact their effectiveness and safety.

In addition, there are no guarantees or minimal federal regulations to ensure that the purity or potency in the products you purchase are consistent, let alone safe. It is a “buyer beware” market.  At a minimum, use with precaution, find out as much as you can regarding their safety and possible drug interactions, and most importantly, always talk with your doctor and dietitian before starting any new products.  Remember if it sounds too good to be true…it probably is.

Herb: ALOE

Health Claim: Laxative in acute constipation. Not for chronic use. Possible effect on the immune system.

Aloe vera gel used externally can assist with healing of burns and wounds.

Notes/Safety/Side Effects: May cause cramps or diarrhea. Over time may cause electrolyte imbalance and alter absorption of some drugs. Do not use if pregnant or have a GI illness. Daily dose 0.05-0.2 g dry extract. Lethal dose is 1 g/day for several days.

Herb: ECHINACEA

Health Claim: May assist in the treatment of upper respiratory tract infections and flu. Best taken at the first signs of cold symptoms to reduce intensity and duration of symptoms. Topically may provide antioxidant protection.

Notes/Safety/Side Effects: Do not take if you have a transplant. Do not take continuously. Allergic reaction possible. Effects of oral capsules and teas inconsistent and questionable.  AIDS patients should not use.

Herb: EPHEDRA (Ma Hung, Ephedrin, Ultimate xhphoria)

Health Claim: May be used as a decongestant and a stimulant of the central nervous system.  Thought to decrease appetite, but not recommended for weight loss.

Notes/Safety/Side Effects: It is not recommended for either transplant or dialysis patients. May increase blood pressure, heart rate, heart palpitations and risk of stroke. Caffeine increases effect. Should not be taken by patients with heart disease, high blood pressure, thyroid disease or diabetes. Avoid if using antihypertensive or antidepressant drugs. No more than 24mg/day. Do not use longer than 7 days. Causes dry mouth.

Herb: GINKGO BILOBA

Health Claim: Antioxidant, may increase blood flow to your brain and legs. May improve concentration, memory, vertigo, depression and headache.

Notes/Safety/Side Effects: Side effects include headache, GI problems and dizziness. Patients with bleeding disorders should not take.  Overdose may cause irritability, restlessness, diarrhea and vomiting. Ginkgo seeds are toxic.  Do not use if taking anticoagulants. Must be taken consistently for 12 weeks to be effective.

Herb: GARLIC

Health Claim: May improve blood lipid levels and reduce blood pressure in those people with mild hypertension.  May increase bleeding or clotting time.

Notes/Safety/Side Effects: Side effects include GI symptoms, possible odor and allergic reactions.  Do not use if taking blood pressure or anticoagulation medications. Dose: 2-4 gm fresh/1-2 cloves or 10mg alliium/4 mg allicium. May have less effect on lipids when used with a modified diet.

Herb: GINSENG

Health Claim: May be used as a stimulant or relaxant.  Regulates glucose in Type II diabetics. May aid in treatment of anemia, depression and as an appetite stimulant. May enhance immunity.

Notes/Safety/Side Effects: Do not use if you have a transplant. Side effects include headaches, insomnia, anxiety, skin rash and morning diarrhea.  Limit/avoid intake of caffeine. Diabetics should monitor for possible hypoglycemia.  Rare severe side effects.  Amount of ginsenosides varies among brands and preparations.

Herb: KAVA KAVA

Health Claim: Primarily used as a relaxant, sedative and for sleep enhancement.

Notes/Safety/Side Effects: Heavy daily use may cause dry, flaky skin, yellowing of the skin and eyes, persistent lethargy. Do not use if you are taking prescription medications for sedation or anxiety. Dose: 45-70 mg kavalactones three times a day for anxiety, 135-210 mg one hour before bedtime for sleep. Dosage in many teas or over the counter preparations may be ineffective.

Herb: LICORICE ROOT

Health Claim: Used in the treatment of peptic ulcers.  May have anti-inflammatory properties. Often found mixed with other herbs.

Notes/Safety/Side Effects: Do not take if you have kidney disease, glaucoma, or take blood pressure, Digitalis, corticoid, or diuretic medications.  May cause sodium and water retention and excessive potassium losses. Not as effective as prescription medications.

Herb: ST. JOHN'S WORT

Health Claim: Used to treat mild to moderate depression, but not severe depression.  May also have antiviral, antibacterial, wound-healing activity.

Notes/Safety/Side Effects: Not recommended for patients experiencing renal failure. Side effects include headache, flu-like symptoms, cough, fatigue, confusion, increased sensitivity to light and GI irritation (may be lessened if taken with food).  Do not take with other antidepressant medications. 300 mg three times daily. Must take consistently for 4 weeks. Inconsistent amounts of active ingredient, hypericin, in most OTC products is a concern.

Andrea Brickford is a renal dietitian in Wheaton, Illinois. The article originally appeared in aakpRENALIFE, Vol. 15, No. 5, May 2000.

This article originally appeared in aakpRENALIFE, Vol. 15, No. 5, May 2000.

Back