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Herb Contraindications & Drug Interactions, 3rd Edition.

Herb Contraindications & Drug Interactions, 3rd Edition. by Francis Brinker, N.D. 2001. 432 pp., softcover. ISBN 1-888483-11-3. $25.95. ABC Catalog #B282 .

An increasingly common question asked of healthcare providers is, "Will this herbal product interact with the other medication that I am taking?" This book compiles the voluminous amount of scientific information, making it extremely useful when answering questions concerning herbal safety.

The first two editions of Herb Contraindications & Drug Interactions have been widely used for basic information on herb-drug interactions and contraindications. This third edition updates and adds to the information found in the earlier editions, and continues to be an outstanding resource for healthcare providers, especially pharmacists and physicians. In addition, the book will assist consumers who self-administer herbal medicines. Continuing a feature that began in the first edition, the author uses common diagnostic terms, rather than scientific and medical terminology, to foster lay readers' understanding (e.g., high blood pressure instead of hypertension). He also highlights many of these terms to call attention to specific health concerns, such as pregnancy, prolonged use, or children.

Several important changes have been made to this edition. To begin, the main section of the text, which is devoted to herbal contraindications and drug interactions, has expanded to 249 herbals. Second, common herb names have been standardized to the names designated in the second edition of the American Herbal Products Association's Herbs of Commerce. This should reduce confusion when searching for information in the book. Third, drug interactions have been categorized into four categories based on levels of evidence, including: (I) information obtained from human or pharmacological studies, case reports, or clinical experience; (II) data obtained from animal research; (III) speculative data based on in vitro studies or evaluations based on known mechanisms of action; and (IV) dubious information based on flawed or uncertain evidence. In addition, the appendices have been expanded and include 614 herbs and 17 vitamins/minerals as to their affect on organ systems, certain conditions and in combination with specific drugs. Lastly, several new appendices have been added to the book.

The book is divided into six sections: an introductory section, the main section of the book, an appendixes section, a brief addendum (Complementary Interactions of Herbs with Drugs), the cited references, and the easy-to-use index that cross-references the entire text. The introduction includes a forward on the need for information on herb-drug information and contraindication written by Colin Nicholls, editor of the British Journal of Phytotherapy. The preface and introduction provide an overview and introduction on how to use the book.

The main section of the book provides a wealth of authoritative information on herbal contraindications and drug interactions. The entries are presented alphabetically (from Acacia to Yohimbe) by common plant name, followed by the scientific binomial and a listing of common names used in other countries or by Native Americans. Each contraindication and drug interaction is documented as to the category of evidence and the reference sources are cited within the text. Reference sources include primary literature and authoritative secondary resources. In addition, English-language abstracts were used occasionally.

The second half of the book includes four comprehensive referenced appendices: Appendix A, herbs to be used with caution; Appendix B, herb/drug interactions, listed on the basis of physiological effects; Appendix C, herbs contraindicated in mothers and children; and Appendix D, vitamin/mineral/drug interactions. Appendix A is subdivided into herbs that have a potential to produce allergic response, photosensitization, local irritation, acute inflammation of the urinary tract, irritation to the gastrointestinal tract, herbs that can affect the thyroid, and herbs that should only be used under the supervision of a healthcare provider due to their potential to produce serious adverse effects.

Appendix B includes herbs that can modify absorption, affect pharmacological activities, and herbs that interfere with distribution, clearance, and elimination. Appendix C includes herbs that should be avoided during pregnancy, while breast-feeding, and in children. Appendix D includes interactions between drugs and minerals with vitamin supplements.

The number of references has been expanded to a total of 1,099 citations. The author has highlighted significant references in the reference list. Five free web updates to the text will be available at <>. The updates are intended to supplement the third edition so that users will not have to purchase a new printed edition annually, and should be a godsend to those interested in the latest information on herb contraindications and drug interactions.

Several key elements should be considered when evaluating information sources on herbal medicine. For instance, one should consider the reputation of the author, whether the information is unbiased, if the information referenced, and how often the reference is updated. Of particular importance, the author should evaluate the strength and validity of the evidence.

The author, Francis Brinker, N.D. is a well-known and respected authority in herbal medicine. The first two editions of the book have been highly praised. The information in this edition is current, thorough, and detailed enough to be useful when needing quick information. The soft-cover book, albeit a little bulky, will fit in a lab coat pocket. The web updates will be well worth the minimal price of the book.

Healthcare practitioners need to know the strength of the evidence supporting the key clinical recommendations. The United States Pharmacopoeia (USP) has established criteria to evaluate the literature on the efficacy and safety of herbal supplements. The USP has classified four levels of evidence. Level I consists of "high quality" randomized controlled trials, meta-analysis, or epidemiological studies. Level II includes randomized controlled trials, meta-analysis, or epidemiological studies that have methodological flaws. Level III includes non-randomized studies, and Level IV includes case reports. The USP has concluded that only Level II evidence should be used to support an appropriate clinical decision.

The author has developed his own evidence-based system consisting of four categories of supporting research. Accordingly, category I of the book would include all four levels of the USP criteria. Therefore, category I of the book is too broad and should be subdivided. As an example, category I could be divided into category IA ("well conducted" clinical trials, meta-analysis, epidemiological studies), IB (less-well conducted clinical trails, meta-analysis, epidemiological studies), IC (non-randomized studies), and ID (case reports).

The author does not include the plant authority with the scientific binomial name which would help solve identification problems. Occasionally, the appendices are not in alphabetical order. Even though the author includes more than 600 herbs, a few commonly used herbs are not included (e.g., French maritime pine bark, also called Pycnogenol¨, and grape seed extract).

Even with these minor flaws, the book is an invaluable resource for all health professionals, especially pharmacists, who should be on the front line when promoting the responsible use of herbal medicines. This book belongs on the shelf of every pharmacy. The nominal cost should allow healthcare students to purchase the book for their libraries. Additionally, consumers will find the book useful to better evaluate their efficacious and safe use of herbal medicines.