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CHAPTER 64 Dietary Supplements & Herbal Medications 1145

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C ASE STUD Y ANSWER

Garlic has shown significant benefits in lowering total choles- flashes are preliminary but show promise. Good data support
terol, LDL, and systolic and diastolic blood pressure, but the use of the herb to alleviate symptoms of mild to moderate
effects are moderate and unlikely to be large enough to lower depression when used for up to 1 year. However, this patient is
this patient’s values into the normal range. While this patient’s not a good candidate for St. John’s wort (a cytochrome P450
diabetes is under control, her hypertension places her at risk 1A2, 2C9, 3A4 inducer) because of her prescription drug use
for microvascular complications of diabetes, thus making it and the potential for herb-drug interactions. Several dietary
necessary to reevaluate her current medication adherence, supplements reviewed in this chapter (garlic, ginkgo, and gin-
doses of benazepril for hypertension and simvastatin for hyper- seng) may have antiplatelet effects that could be additive with
lipidemia, and duration of therapy. She would benefit from ibuprofen. If this patient were also taking warfarin, additional
meeting with a nutritionist because packaged frozen dinners interactions could occur with coenzyme Q10 (vitamin K-like
can be high in sodium, and this may be elevating her blood structure), St. John’s wort, and melatonin (in vitro decreased
pressure. Adding exercise to her weekly routine could also help prothrombin time), leading to a decreased warfarin effect, or
with weight control and overall cardiovascular health. The with glucosamine (increased international normalized ratio),
data supporting benefits of St. John’s wort in patients with hot leading to an increased warfarin effect.