Drug Interactions

Many have the mistaken notion that all herbs and foods are safe to combine with medications because they are natural. However, everything you put in your mouth has the potential to interact since it travels the digestive system in similar ways to medications or simply increase symptoms. Some drugs interfere with the body’s ability to absorb nutrients, and certain herbs and foods can speed up or slow down the action of a medication.

Interaction symptoms can include headaches, flu-like symptoms, increased anxiety, insomnia, nausea and some can be life threatening.

The team at Point of Return specialize in this field and know that an interaction can create unnecessary discomfort or pose a danger. Our program outlines herb, foods and others that may interact with Antidepressants, Benzodiazepines and Sleeping Pills.

Whether you are withdrawing from medications or not, it is critical to understand how many items can affect your prescriptions or heavily deplete the body. Below is just a sampling of items to avoid such as Passionflower, St. John’s Wort, 5-HTP, Caffeine, Barley Grass, Ginseng, Chinese Herbs and others.

Some items such as artificial sweeteners should be avoided when possible, whereas specific herbs should be gradually tapered versus an abrupt discontinuation. *Always consult your healthcare practitioner before starting or stopping any herb,vitamin, supplement or medication.

Vitamins & Herbs:

While vitamins are generally safe, they are regularly consumed without appreciating that some have the potential to interact with medications. Herbs are plant-derived drugs, and while many may be beneficial, they can also pose a serious risk when combined with various prescription pills.

5HTP - Combining 5-HTP with Antidepressants may cause an unsafe rise in Serotonin and lead to Serotonin Syndrome, a dangerous condition characterized by mental changes, hot flashes, rapidly fluctuating blood pressure and heart rate, and possibly coma.

Calcium - Benzodiazepines and Sleeping Pills significantly inhibit the transport of calcium into the nerve cells in the brain, heart and throughout the body. The alteration of the calcium balance is what contributes to anxiety, fear, panic and muscle cramping, since Calcium modulates the effects on the GABA receptors. The GABA receptors are excited by Calcium supplements and even low dosage Calcium vitamins (not naturally occurring calcium in food items) can over-stimulate the brain neurons and increase anxiety, insomnia and fear.  

Chinese Herbs - can interact with many medications and either interfere or exaggerate their effects, which can lead to increased sedation and when combined with benzodiazepines, causing an unsafe lowering of blood pressure and suppression of the lungs. Some research indicates that many Chinese Herbs can interact with any medication that utilizes the P450 liver enzymes, which includes antidepressants, sleeping pills and benzodiazepines.

Ginger - used as a common spice but also can significantly alter the blood levels of many benzodiazepines and other medications.  Ginger can interfere with how many benzodiazepines are processed, reducing the blood level of the drug significantly. This can leave the individual feeling withdrawal symptoms although a standard dosage of the drug was ingested.

Ginseng - can increase blood pressure, making it dangerous for anyone trying to control his or her blood pressure. Ginseng may over-stimulate the nervous system, resulting in insomnia. Therefore consuming caffeine with ginseng increases the risk of over-stimulation and gastrointestinal upset. Long-term use of ginseng may cause menstrual abnormalities and breast tenderness in some women. Ginseng is not recommended for pregnant or lactating women.

Inositol - is a naturally occurring element of glucose, though it is considered to be a member of the B vitamin family (B8). Serotonin selective reuptake inhibitors (SSRIs) have a similar therapeutic profile to Inositol – they both inhibit serotonin reuptake in the synaptic cleft. Inositol has an antidepressant effect and may involve the Serotonin receptors by enhancing or speeding up the response to SSRIs. The side effects are similar to SSRIs.

Kava - Investigative studies suggest that Kava has addictive effects when combined with benzodiazepines, since it acts on the same GABA binding sites of the central nervous system. This can cause excess sedation, a lowering of blood pressure, physical depression, suppression of the lungs and cognitive impairment.

Milk Thistle - may interfere with many medications and increase them to dangerous levels because the same liver enzymes break down the herb. Milk thistle should not be combined with allergy medications, drugs for high cholesterol, anti-anxiety agents (alprazolam, diazepam, lorazepam, clonazepam, Temazepam), antiplatelet and anticoagulant drugs (blood thinners), anti-seizure medications, anti-psychotics, antidepressants, hormones and others.

N-Acetyl Cysteine (NAC) - is an altered form of the amino acid cysteine, and assists the body in synthesizing Glutathione. The side effects reported include nausea, vomiting, headache, dry mouth, dizziness, blurred vision and abdominal pain. NAC increases zinc excretion, so supplementing with additional zinc and copper is recommended. Vitamin C must also be taken with NAC to prevent the cysteine from converting to cystine, which can form kidney or bladder stones. NAC is moderately effective at raising Glutathione levels, but dosing is limited due to the toxic side effects.

Passionflower - works by increasing levels of gamma-aminbutric acid (GABA) in the brain. Combining it with benzodiazepines, sleeping pills or antidepressants can cause excess sedation, physical depression including a suppression of respiration, an unsafe lowering of blood pressure, visual disturbances, pulmonary hypertension (high blood pressure in the arteries that supply the lungs), reduced plasma proteins and impaired cognitive function. Passionflower also may increase the amount of time blood needs to clot, so it could make the effects of blood-thinning medications stronger and increase the risk of bleeding. It is essential to gradually taper off passionflower rather than abruptly discontinue the herb, or the levels of other medications can change drastically.

Phenibut - is a derivative of neurotransmitter GABA and chemically breaks down to beta-phenyl-gamma-aminobutyric acid.   Phenibut can be addictive, cause withdrawal symptoms and tolerance in similar ways to a benzodiazepine. Symptoms of Phenibut withdrawal include insomnia, anxiety, sweaty hands and reduced appetite.

In addition, Phenibut interacts with many medications including Benzodiazepines, MAO Inhibitors, Antidepressants, Stimulants and Sleeping Pills.  Many supplements have Phenibut as an ingredient so please review labels carefully.

St. John's Wort - Mixing St. John’s Wort with Antidepressants can cause an overload of Serotonin, since the herb contains active principals that are comparable to medications for depression. But St. John’s Wort also affects other neurotransmitters increasing the amounts of dopamine, norepinephrine, l-glutamate and GABA. This makes it dangerous to combine with sleeping pills, benzodiazepines, amphetamines, asthma inhalants, decongestants, diet pills, narcotics, immunosuppressant drugs, and the amino acids tryptophan and tyrosine. Avoid the following substances when using St.-John's-wort: Amino acids tryptophan and tyrosine; amphetamines; asthma inhalants; beer, coffee, wine; chocolate, fava beans, salami, smoked or pickled foods, and yogurt; cold or hay fever medicines; diet pills; narcotics; nasal decongestants. They all contain chemicals that react adversely to hypericin, causing high blood pressure and nausea. It is essential to gradually taper off St. John’s Wort rather than abruptly discontinue the herb, or the levels of other medications can change drastically.

Tumeric - is a spice made from grinding Curcumin roots and belongs to the ginger family. known to interact with at least 73 medications including many antidepressants, blood pressure medication, and drugs that travel the CYP3A4, CYP1A2, CYP2A6 and intestinal P-Glycoprotein pathways.  Turmeric is contraindicated with most antidepressants due to the risk of Serotonin Syndrome. There is a long list of medications altered significantly by Turmeric and starting or stopping Turmeric should be discussed by a qualified professional. 

Valerian - Because Valerian has the possibility of affecting the GABA receptors in much the same way as benzodiazepines, it is recommended to not combine with Alprazolam, Diazepam, Lorazepam, Clonazepam, Temazepam or Sleeping Pills. Valerian has been reported to cause excitability, headaches, stomach upset, uneasiness, unsteadiness, vertigo, low body temperature, and with chronic use, insomnia. A hangover effect has been reported with high doses and withdrawals may occur if you stop using Valerian suddenly. Symptoms could include cardiac complications, delirium and gastrointestinal discomfort.

Foods & Beverages
The risk of a drug interaction isn't limited to herbal supplements and over-the-counter medications. Certain foods can interact with various prescription pills.

Alcohol - is a drug that interacts with almost every medication, especially central nervous system agents and other drugs that affect the brain and nervous system. Alcohol interacts with most antidepressants, benzodiazepines and sleeping pills. The combination can cause fatigue, dizziness, slow reactions by increasing the concentration of medications. A small amount of beer, wine, or liquor can also increase the risk of stomach bleeding or liver damage when mixed with over-the-counter anti-inflammatory drugs and medications used to treat pain and fever. These include aspirin, ibuprofen and acetaminophen (Tylenol, Excedrin).

Barley Grass - The fiber in barley may decrease the absorption of medications and prevent their full effects. Hordenine, a chemical in the root of developing barley, may stimulate the sympathetic nervous system and increase the heart rate and promote wakefulness.

Broccoli - Cruciferous vegetables (broccoli, kale, brussel sprouts, cabbage, cauliflower) like charbroiled foods can accelerate the processing of some Antidepressants and some sleeping pills and can leave less amounts to enter the bloodstream. This can make an individual feel as if a reduction in medication occurred without ever changing the dose.

Caffeine - increases anxiety and reduces the effectiveness of benzodiazepines. Caffeine is present in coffee, black tea, green tea, chocolate, some soft drinks and many over-the-counter medications. Caffeine is a stimulant and its effects can last up to 20 hours in the body. Some people will have disturbed sleep patterns even when their last cup of coffee was in the morning. So the sensible option is to avoid caffeine completely if taking a benzodiazepine, struggling with anxiety or insomnia.

Charbroiled Foods - Grilled foods can present a concern for anyone taking asthma medications containing theophyllines. The chemical compounds formed when food is grilled prevent the medication from working effectively, increasing the possibility of an unmanageable asthma attack. But charbroiled foods also alter the metabolization of some Antidepressants and can therefore change the amount of medication in the bloodstream.

Chamomile - is a member of the daisy family, and may intensify the effects of central nervous system medications such as benzodiazepines, narcotics, sleeping pills and antidepressants. This can cause excess sedation, a lowering of blood pressure, depression, suppression of the lungs and cognitive impairment. Chamomile can also increase the effects of anticoagulant medications (Warfarin, Coumadin, Aspirin), and its natural tannin content can interfere with iron absorption.

Diet Drinks - Diet Beverages contain artificial sweeteners including Aspartame, Splenda and Saccharin, which are all excitotoxins to the central nervous system. This can increase anxiety, panic, depression, insomnia, headaches and gastrointestinal issues. Ironically, it is well documented that excitotoxins can actually cause weight gain.

Grapefruit - affects more than 50 prescription medications since it inhibits an enzyme in the intestines that normally breaks down certain drugs, allowing more of a medication to enter the blood stream. The interaction symptoms can appear up to 3 days after eating or drinking grapefruit. This means you cannot drink grapefruit juice in the morning and take your medications late in the day. Grapefruit should be avoided with all Antidepressants, Benzodiazepines and Sleeping Pills.

Kiwi - has a naturally high serotonin concentration and can have a synergistic effect when combined with SSRIs (Selective Serotonin Reuptake Inhibitors). This can produce levels of Serotonin that are too high, resulting is agitation, confusion, headache seating and nausea. Kiwi may increase the risk of bleeding when taken with blood thinning medications including aspirin, warfarin, heparin, anti-platelet drugs and non-steroidal drugs such as ibuprofen, Aleve or Naproxen.


Artificial Sweeteners & Flavorings
Many foods are laced with excitotoxins (toxins that affect the central nervous system) in the form of additives that cause brain cells to swell and die. Excitotoxins are included in beverages, artificial sweeteners and sauces. These compounds are often disguised as hydrolyzed vegetable protein, sodium caseinate, calcium caseinate, yeast extract, soy protein isolate, textured protein, and even natural seasoning and spices can be 12 to 40 percent MSG. Eliminating excitotoxins is essential to protect the brain, eyes, hypothalamus and the central nervous system. Even artificial sweeteners, sold as diet items, have actually been associated with weight gain.

Aspartame (NutraSweet, Equal) - Aspartame is an excitotoxin that was approved in 1981 and is 180 times sweeter than sugar. It can be found today in more than 7,000 commonly consumed foods, beverages and medications.  All of Aspartame’s components are toxic to humans. Aspartame is 50% Phenylalanine, and 10% Methanol. Phenylalanine is an amino acid used by the brain. But anyone suffering from the genetic disorder phenylketonuria (PKU) cannot metabolize phenylalanine, and excess amounts can lead to a decrease of serotonin levels, and could cause emotional disorders and depression. Menthanol is also known as wood alcohol. Methanol breaks down in the body to produce formic acid and the deadly neurotoxin, formaldehyde, a known carcinogen that causes retinal damage and birth defects, interferes with DNA replication, and has been shown to cause a form of skin cancer in animals.  Even low-level formaldehyde exposure can cause symptoms that include headaches, fatigue, chest tightness, dizziness, nausea, poor concentration and seizures. Aspartic acid is a neurotransmitter produced in the body to assist in the transfer of information from neuron to neuron. Consumption of aspartame creates an excess of synthetic aspartic acid that damages neurons by continuous over-stimulation. Another byproduct of metabolized aspartame is diketopiperazine (DKP). DKP has been associated with brain tumors and has been found to form in beverages that contain aspartame when stored above 86 degrees F. The most common side effects of aspartame are headaches/migraines, nausea, abdominal pain, fatigue, sleep problems, vision problems, depression, asthma and anxiety attacks. In the European Union, Aspartame is banned for use in any children’s products.

Saccharin (Sweet-and-Low, Sugar Twin) - Saccharin was the first of the artificial sweeteners and is 300 times sweeter than sugar. It was discovered in 1879 by a chemist researching coal tar derivatives in the laboratory at Johns Hopkins University. He synthesized the reaction of anthranillic acid with nitrous acid, sulfur dioxide, chlorine and ammonia. Saccharin is absorbed rapidly in the digestive tract, cannot be metabolized, and therefore has been linked to concerns of bladder cancer. According to Andrew Laumbach, Ph.D., consumer safety officer in FDA's Office of Premarket Approval, "We know for certain that it (Saccharin) causes cancer in animals."  Canada banned the use of saccharin, but it is allowed in the United States with a warning label stating saccharin may be a carcinogen. The common side effects are nausea, headaches, diarrhea, eczema, hives, itching, wheezing and excessive urination to name a few.

Sucralose (Splenda) - is marketed as the sweetener Splenda and is about 600 times sweeter than sugar. Splenda is chlorinated sugar, or chlorocarbon. Some chlorinated molecules serve as the basis for pesticides (such as DDT), and store in the fatty tissues of the body. Although the manufacturer claims it passes through the body unabsorbed, the FDA’s “Final Rule” report stated the human body absorbs 11-27%. However, the Japanese Food Sanitation Council found that as much as 40% is absorbed.  Sucralose was found to concentrate in the liver, kidney and gastrointestinal tract. Side effects include skin rashes/flushing, agitation, panic attacks, dizziness, numbness, diarrhea, muscle aches, headaches, intestinal cramping, bladder issues, stomach pain, chest pains, acne, bleeding, hair loss, heart palpitations, elevated blood pressure and many others.

MSG (Monosodium Glutamate or Sodium Glutamate) - MSG or Monosodium Glutamate is also known as Protein Hydrolysate, Natural Flavor or Accent, and is used to enhance the taste of foods. MSG is addictive and can cause migraine headaches, anxiety, panic attacks, depression, short-term memory and cognitive impairment. MSG is an excitotoxin that causes more rapid cell death. MSG promotes a dangerous toxic reaction in many people and it is estimated that 30% of people get dizzy and disoriented after ingesting it. Research has also linked MSG to obesity since it damages the body’s ability to control weight. MSG is also known as Hydrolyzed Vegetable Protein, Accent, Aginomoto, Natural Meat Tenderizer, as many others.  The list of side effects is extensive and includes cardiac variations (arrhythmia, atrial fibrillation, tachycardia, rapid heartbeat, palpitations, angina, extreme rise or drop in blood pressure), swelling, diarrhea, nausea/vomiting, stomach cramps, depression, mood swings, rage, migraine headaches, dizziness, mental confusion, anxiety, panic attacks, hyperactivity, behavioral changes, lethargy, insomnia, blurred vision and hives.

OVER-THE-COUNTER (OTC) MEDICATIONS
Whenever an over-the-counter item is taken with a prescription medication, there is a chance that there will be an interaction between them. The interaction may increase or decrease the effectiveness and/or the side effects and might also result in a new side effect that is not generally seen with the medications individually. The likelihood of drug interactions increases as the number of combinations increases. Most drug interactions are due to altered absorption in the intestine and can change the blood flow to the intestines, metabolism of the drug by the intestine, increased movement in the intestines resulting in diarrhea or constipation, alterations in the acidity of the stomach and a change in the bacteria of the gut region. The liver and kidney are where most drugs are eliminated and therefore are important sites of drug interactions. Drug interactions can be complex and unpredictable, so minimizing the risk is essential.

Antihistamines - antihistamines are drugs that temporarily relieve a runny nose, or reduce sneezing, itching of the nose or throat, and itchy watery eyes. However, antihistamines increase the effect of benzodiazepines and sleeping pills and can cause cognitive deficits, dangerous drops in blood pressure, suppression of the lungs and extreme sedation. Antihistamines also alter the metabolism of many SSRIs, increasing blood levels of the Antidepressant and increasing their side effects.  Combining antihistamines with hypertension medication may cause an increase in heart rate and blood pressure.

Nasal Decongestants - Most nasal decongestant sprays will cause increased adrenaline and norepinephrine, which can worsen anxiety and depression. Use of decongestants for longer than 3-5 days can damage the nasal tissue and lead to chronic congestion. Nasal decongestants may decrease the effectiveness of some blood pressure medications, and the most common side effects are stomach upset, trouble sleeping, dizziness, lightheadedness, headache, nervousness, fast heartbeat, loss of appetite and shaking.

Pain Relievers - Painkillers such as Acetaminophen and Ibuprofen are called analgesics, which numb pain. Both can have a profound effect on other medications, the absorption of nutrients and therefore to our general health.

Acetaminophen, also known as Paracetamol, is widely used in over-the-counter pain reliever and fever reducer derived from coal tar and has been shown to reduce glutathione production (the body’s master antioxidant). Acetaminophen is metabolized primarily in the kidneys with a lesser amount traveling through the liver, where a toxic by-product called N-acetyl-p-benzoquioneimine (NAPQI) is produced in response to the acetaminophen, and is extremely harmful to the liver. The side effects of acetaminophen include nausea, vomiting, loss of appetite, diarrhea, sweating, irritability, abdominal pain (particularly near the liver), yellow eyes or skin, liver or kidney failure, heart problems and seizures.

Ibuprofen reduces melatonin levels and may affect sleep if taken at bedtime. Other drugs that interfere with melatonin production are Valium, Xanax, diuretics, beta-blockers, calcium channel blockers, alcohol and caffeine. Ibuprofen may also exacerbate anxiety and depression by causing a disruption in the hormone system that participates in the contraction and relaxation of the muscles, blood vessels and modulates inflammation. Side effects include rash, riming of the ears, headaches, dizziness, abdominal pain, nausea, diarrhea, constipation, heartburn, bruising, tingling, numbness, nervousness, depression and insomnia.

Stomach Relievers - Some Over-the-Counter medications that reduce the production of stomach acid can upset the natural balance of healthy bacteria required for good health, and allow unhealthy bacteria to proliferate.

Proton-pump inhibitors block stomach acid production AND increase the risk of a common infectious form of diarrhea. Taking a heartburn medication (Nexium, Losec) significantly increase the risk of diarrhea from the Clostridium difficile bacteria. Frequently prescribed anti-heartburn drugs called H2 antagonists (Zantac, Prevacid) double the risk of the bacterial diarrhea. PPIs and H2 antagonists reduce gastric acid, allowing for bacteria to multiply in the digestive system. While antibiotics formerly blamed for outbreaks of the illness have declined in use, the acid-blocking drugs have become steadily more popular to treat ulcers and conditions such as gastric reflux disease.

Additionally, stomach medications can slow the absorption of benzodiazepines and sleeping pills and lead to increased anxiety and insomnia. Antacids taken with antibiotics, heart and blood pressure or thyroid medications can decrease their absorption up to 90 percent, and may pose a concern with certain antidepressants. Antacids also bind to nutrients and prevent proper absorption.