Flor-Essence
Essiac/Drug Interactions:
GeneralGeneral: In general, there is a lack of safety and efficacy data for Essiac?. Drug interactions are primarily based on theoretical or empirical knowledge of the individual constituents. In theory, precipitation of some drugs may occur when taken concomitantly with sorrel. Therefore, separate administration is recommended.Alkaloid agentsAlkaloid agents: Herbal textbooks suggest that herbs with high tannin content should not be ingested in combination with medications of high alkaloid content due to possibility of precipitate formation, although this is largely theoretical (44).Angiotensin converting enzyme (ACE) inhibitorsAngiotensin converting enzyme (ACE) inhibitors: Tannins may possess inhibitory activity against the ACE, and may in theory potentiate ACE inhibitors (45). In a clinical trial, rhubarb synergistically interacted with ACE inhibitors to decrease serum creatinine levels (32). AntacidsAntacids: If taken within one hour, antacids may decrease the effectiveness of rhubarb.Anti-arrhythmic agentsAnti-arrhythmic agents: Due to theoretical potassium depletion, avoid concomitant use of Essiac? and anti-arrhythmic agents (6; 12). AntibioticsAntibiotics: Concurrent use of doxycycline with Quanterra? Sinus Defense or Sinupret? is reported in a human trial to synergistically improve outcomes in patients with acute bacterial sinusitis (46). Additional supporting evidence in this area is limited.Antiplatelet agentsAntiplatelet agents: Theoretically, an additive effect may occur with antiplatelet agents, due to inhibition of platelet activating factor (PAF) in an animal study (47). In addition, oxalate constituents may theoretically alter calcium concentrations and decrease coagulation time (12). Anti-psychotic drugsAnti-psychotic drugs: In a clinical trial, rhubarb and low doses of anti-psychotic drugs reduced the need for higher doses of anti-psychotic drugs in schizophrenic patients (48). AtropineAtropine: Herbal textbooks suggest that herbs with high tannin content should not be ingested in combination with medications of high alkaloid content due to the possibility of precipitate formation, although this is largely theoretical (44).CaptoprilCaptopril: In clinical trials, rhubarb has shown a synergistic effect with captopril to reduce serum creatinine levels (32; 49; 34; 50). Cardiac glycosidesCardiac glycosides: Due to theoretical potassium depletion, avoid concomitant use of Essiac? and cardiac glycosides (12). Overuse of rhubarb may increase the risk of adverse effects of cardiac glycosides, e.g., digoxin (51; 52). Chemotherapy drugsChemotherapy drugs: Anecdotally, concomitant Essiac? with chemotherapy and radiotherapy may render the compound ineffective.ChlorhexidineChlorhexidine: In a clinical trial, rhubarb reduced gingivitis when used with chlorhexidine (53). CisplatinCisplatin: Based on animal study, concomitant therapy with rhubarb may have a significant protective effect and reduce renal and lethal toxic side effects of cis-diamminedichloroplatinum (54). CorticosteroidsCorticosteroids: In theory, potassium depletion may occur with concomitant use of Essiac? and corticosteroids (12). Rhubarb along with dexamethasone reduced the lung edema in rats due to endotoxin-induced lung injury (55). Cytochrome 450 enzymesCytochrome 450 enzymes: Based on a case report, one patient taking the experimental drug DX-8951f (metabolized by CYP3A4 and CYP1A2) experienced toxic side effects and drug clearance that was four to five times slower than in other patients (56).. This patient was also taking "essiac tea," although further details are not available, and it is not clear if the patient was taking Essiac? or an essiac formulations.DigoxinDigoxin: Overuse of rhubarb may cause potassium depletion, increasing the risk of digoxin toxicity (51; 52). DisulframDisulfram: Some tinctures contain high concentrations of ethanol, and may lead to vomiting if used concomitantly with disulfiram (Antabuse?) or metronidazole (Flagyl?).DiureticsDiuretics: Animal models and human study have reported diuretic effects of burdock (26) and rhubarb. Based on animal study, rhubarb's diuretic activity may be due to sodium-potassium ATPase blockade in the renal medulla (57). EstrogensEstrogens: Oral burdock use has been associated with estrogenic effects in HIV patients (26), and in theory, may act additively with estrogens. Hepatotoxic drugsHepatotoxic drugs: The high tannin level of rhubarb root may increase the chance of hepatic necrosis (58). In large amounts, ingestion of sorrel may lead to liver damage, and should be avoided with agents that are hepatotoxic. Insulin and oral hypoglycemic agentsInsulin and oral hypoglycemic agents: Burdock extracts have demonstrated conflicting hypoglycemic activity in rats (28; 27), but may lower blood glucose levels in humans (59; 60; 61). Concomitant use with insulin or oral hypoglycemic agents may additively reduce blood glucose levels, and doses may require adjustment. LaxativesLaxatives: Concomitant use of rhubarb and laxatives may in theory increase risk of electrolyte and fluid loss (16). MetronidazoleMetronidazole: Some tinctures contain high concentrations of ethanol, and may lead to vomiting if used concomitantly with disulfiram (Antabuse?) or metronidazole (Flagyl?).Nephrotoxic drugsNephrotoxic drugs: In an animal study, orally administrated anthraquinones from rhubarb induced nephrotoxicity in rats (62). In large amounts, ingestion of sorrel may lead to kidney stones or kidney damage, and should be avoided with agents that are renotoxic. NifedipineNifedipine: In a clinical trial, rhubarb enhanced nifedipine's anti-pre-eclampsia effects (63). Oral contraceptivesOral contraceptives: Based on limited human evidence that is not entirely clear (26), burdock may have estrogen-like properties, and may act to increase the effects of estrogenic agents including hormone replacement therapies such as Premarin? or birth control pills. Oral drugsOral drugs: Rhubarb's laxative effects with may reduce the absorption of other oral drugs, due to a reduction in gastrointestinal transit time. Slippery elm could theoretically slow down or decrease absorption of other oral medications due to hydrocolloidal fibers, although supportive evidence is lacking. Slippery elm contains tannins, which could theoretically decrease absorption of nitrogen containing substances such as alkaloids, although no actual interactions have been reported.Potassium-depleting diureticsPotassium-depleting diuretics: Overuse of rhubarb may compound diuretic-induced potassium loss (50). Essiac/Herb/Supplement Interactions:
GeneralGeneral: In general, there is a lack of safety and efficacy data for Essiac? and essiac formulations. Herb and supplement interactions are primarily based on theoretical or empirical knowledge of the individual constituents. In theory, precipitation of some herbs or supplements may occur when taken concomitantly with sorrel. Therefore, separate administration is recommended.Alismatics orientalisAlismatics orientalis: In a clinical trial, rhubarb has shown hypolipidemic properties when used with Alismatics orientalis (64). Alkaloid agentsAlkaloid agents: In theory, herbs with high tannin content such as sorrel should not be used in combination with alkaloid agents such as atropine, belladonna, galantamine, or scopolamine, due to the possibility of precipitate formation (44).AloeAloe: Essiac? contains the anthraquinone derivative aloe-emodin. Aloe vera also contains these derivatives, and in theory, concomitant use may have additive effects.AntibioticsAntibiotics: Concurrent use of doxycycline with Quanterra? Sinus Defense or Sinupret? is reported in a human trial to synergistically improve outcomes in patients with acute bacterial sinusitis (46). Additional supporting evidence in this area is limited.Antiplatelet agentsAntiplatelet agents: Theoretically, an additive effect may occur with antiplatelet herbs or supplements, due to inhibition of platelet activating factor (PAF) in animal study (47). In addition, oxalate constituents may theoretically alter calcium concentrations and decrease coagulation time (12). Anti-psychotic herbs and supplementsAnti-psychotic herbs and supplements: In a clinical trial, rhubarb and low doses of anti-psychotic drugs reduced the need for higher doses of anti-psychotic drugs in schizophrenic patients (48). BelladonnaBelladonna: Herbal textbooks suggest that herbs with high tannin content should not be ingested in combination with medications of high alkaloid content due to possibility of precipitate formation, although this is largely theoretical (44).Blessed thistleBlessed thistle: Some essiac formulations such as Flor-Essence? contain additional ingredients, such as blessed thistle. In theory, concomitant use may cause additive effects, or potentiate the effects of the original Essiac? compound.CalciumCalcium: In theory, concurrent use of rhubarb and sorrel may decrease mineral absorption, although an animal study of rhubarb stalk fiber did not find altered bioavailability of calcium (65). The oxalate content may bind multivalent metal ions and decrease their absorption (12). Cardiac glycosidesCardiac glycosides: In theory, concomitant use of rhubarb can increase toxicity of cardiac glycoside-active herbs, due to its potential to deplete potassium (12; 51; 52). Cardioactive herbsCardioactive herbs: In theory, concomitant use of rhubarb can increase toxicity of cardiac-active herbs, due its potential to deplete potassium. These herbs include calamus, cereus, cola, coltsfoot, devils' claw, European mistletoe, fenugreek, fumitory, ginger, Panax ginseng, hawthorn, white horehound, mate, parsley, quassia, scotch broom flower, shepherd's purse, and wild carrot.Cat's clawCat's claw: Some essiac formulations contain additional ingredients, such as South American cat's claw bark. In theory, concomitant use may cause additive effects, or potentiate the effects of the original Essiac? compound.Cytochrome 450 enzymesCytochrome 450 enzymes: Based on a case report, one patient taking the experimental drug DX-8951f (metabolized by CYP3A4 and CYP1A2) experienced toxic side effects and drug clearance that was four to five times slower than in other patients (56). This patient was also taking "essiac tea," although further details are not available, and it is not clear if the patient was taking Essiac? or another essiac formulation.DiureticsDiuretics: In theory, electrolyte disturbance, such as potassium depletion may occur with concomitant use of Essiac? and diuretic-type agents (12). Animal models and human study have reported diuretic effects of burdock (26) and rhubarb. Based on animal study, rhubarb's diuretic activity may be due to sodium-potassium ATPase blockade in the renal medulla (57). Polyuria has been reported anecdotally with the use of sorrel, and may add to the effects of diuretics. EphedraEphedra: Herbal textbooks suggest that herbs with high tannin content, such as ephedra, should not be recommended in combination with herbs of high alkaloid content due to the possibility of precipitate formation, although this is largely theoretical (44).EstrogensEstrogens: Oral burdock use has been associated with estrogenic effects in HIV patients (26), and may act additively with estrogens. Evidence is limited. FoxgloveFoxglove: Due to theoretical potassium depletion, avoid concomitant use of essiac formulations and cardiac glycosides (12). Overuse of rhubarb may increase the risk of adverse effects of cardiac glycosides (51; 52). Glauber's salt (mirabilite)Glauber's salt (mirabilite): In a clinical trial, rhubarb enhanced Glauber's salt's laxative effects (66).GoldensealGoldenseal: Herbal textbooks suggest that herbs with high tannin content, such as goldenseal, should not be recommended in combination with herbs of high alkaloid content due to the possibility of precipitate formation, although this is largely theoretical (44).Hepatotoxic herbsHepatotoxic herbs: The high tannin level of rhubarb root may increase the chance of hepatic necrosis (58). HorsetailHorsetail: In theory, concomitant use of rhubarb and horsetail can increase risk of potassium depletion (12). HyoscyamineHyoscyamine: Herbal textbooks suggest that herbs with high tannin content should not be recommended in combination with herbs of high alkaloid content due to the possibility of precipitate formation, although this is largely theoretical (44).Hypoglycemic agentsHypoglycemic agents: Burdock extracts have demonstrated conflicting hypoglycemic activity in rats (28; 27), but may lower blood glucose levels in humans (59; 60; 61). Concomitant use with other hypoglycemic agents may additively reduce blood glucose levels, and doses may require adjustment. IronIron: Based on herbal textbooks, use of rhubarb and sheep sorrel may decrease the absorption of iron (44). Anecdotal reports suggest impaired absorption of iron due to oxalate content (67). However, based on laboratory study, rhubarb (Rheum rhaponticum) may have a moderately enhancing effect on iron absorption (68). JimsonweedJimsonweed: The action of jimsonweed may be increased in chronic use or abuse of rhubarb.KelpKelp: Some essiac products such as Flor-Essence?, contain additional ingredients, such as kelp. In theory, concomitant use may cause additive effects or potentiate the effects of the original Essiac? compound.LeechesLeeches: In a clinical trial, rhubarb and leeches reduced the need for anti-psychotic drugs in schizophrenic patients (48). LicoriceLicorice: Theoretically, there is an increased risk of potassium depletion with concomitant use with rhubarb or sorrel and licorice (12). MineralsMinerals: Anecdotal reports suggest impaired absorption of calcium, iron, and zinc due to oxalate content (67). Nephrotoxic herbsNephrotoxic herbs: In an animal study, total rhubarb anthraquinones administrated orally for 13 weeks induced nephrotoxicity in rats (62). In large amounts, ingestion of sorrel may lead to kidney stones or kidney damage, and should be avoided with agents that are renotoxic. Oral herbsOral herbs: Concomitant use of rhubarb with other oral herbs may reduce their absorption, due to reduction in gastrointestinal transit time. Slippery elm could theoretically slow down or decrease absorption of other oral medications due to hydrocolloidal fibers, although supportive evidence is lacking.Potassium depleting herbsPotassium depleting herbs: Overuse of rhubarb may compound diuretic-induced potassium loss (50). PhytoestrogensPhytoestrogens: Oral burdock use has been associated with estrogenic effects in HIV patients (26), and in theory, may act additively with estrogenic herbs or supplements. Red cloverRed clover: Some essiac products such as Flor-Essence?, contain additional ingredients, such as red clover. In theory, concomitant use may cause additive effects, or potentiate the effects of the original Essiac? compound.RhubarbRhubarb: Rhubarb is a source of oxalate, and may add to the toxic effects of oxalate in sorrel.SageSage: In a clinical trial, rhubarb and sage cream reduced the symptoms of herpes labialis (69). Sanchi powderSanchi powder: In a clinical trial, rhubarb and sanchi powder were used together for hemorrhagic fever from nephritic syndrome (70). SennaSenna: Essiac formulas contain rhubarb, which contains sennosides (71). In theory, combination with senna may alter the effects of the essiac formulation or have additive effects. ShamrockShamrock: Shamrock is a source of oxalate, and may add to the toxic effects of oxalate in sorrel.Steroidal herbsSteroidal herbs: In theory, rhubarb or sorrel may increase potassium loss when used concomitantly with steroidal herbs (12). Stimulant laxative herbsStimulant laxative herbs: Theoretically, concomitant use with stimulant-laxative herbs may cause potassium depletion (12; 16). Examples of stimulant laxatives include aloe dried leaf sap, blue flag rhizome, alder buckthorn, European buckthorn, butternut bark, cascara bark, castor oil, colocynth, fruit pulp, gamboges bark exudates, jalap root, black root, manna bark exudates, podophyllum root, senna leaves and pods, wild cucumber fruit and yellow dock root. ValerianValerian: Herbal textbooks suggest that herbs with high tannin content should not be recommended in combination with herbs of high alkaloid content due to the possibility of precipitate formation, although this is largely theoretical (44).WatercressWatercress: Some essiac products such as Flor-Essence?, contain additional ingredients, such as watercress. In theory, concomitant use may cause additive effects, or potentiate the effects of the original Essiac? compound.ZincZinc: In theory, use of rhubarb and sheep sorrel may decrease the absorption of zinc (67). Essiac/Food Interactions:
GeneralGeneral: In general, there is a lack of safety and efficacy data for Essiac? and the various essiac formulations. Food interactions are primarily based on theoretical or empirical knowledge of the individual constituents. Calcium-containing foodCalcium-containing food: Anecdotal reports suggest impaired absorption of calcium due to oxalate content (67; 65). Iron-containing foodIron-containing food: Anecdotal reports suggest impaired absorption of iron due to oxalate content (67; 65). MilkMilk: The effectiveness of rhubarb may be decreased when taken concurrently with milk.PhytoestrogensPhytoestrogens: Oral burdock use has been associated with estrogenic effects in HIV patients (26), and in theory, may act additively with phytoestrogenic foods. Zinc-containing foodZinc-containing food: Anecdotal reports suggest impaired absorption of zinc due to oxalate content (67; 65). Essiac/Lab Interactions:
GeneralGeneral: In general, there is a lack of safety and efficacy data for Essiac? and the various essiac formulations. Lab interactions are primarily based on theoretical or empirical knowledge of the individual constituents. Calcium levelsCalcium levels: Anecdotal reports suggest impaired absorption of calcium due to oxalate content (67). Coagulation panelCoagulation panel: Theoretically, an additive effect may occur with antiplatelet herbs or supplements, due to inhibition of platelet activating factor (PAF) in animal study (47). In addition, oxalate constituents may theoretically alter calcium concentrations and decrease coagulation time (12). ElectrolytesElectrolytes: Concomitant use of rhubarb and laxatives may in theory increase risk of electrolyte and fluid loss (6; 16). Iron levelsIron levels: Anecdotal reports suggest impaired absorption of iron due to oxalate content (67). However, based on laboratory study, rhubarb (Rheum rhaponticum) may have a moderately enhancing effect on iron absorption (68). Potassium levelsPotassium levels: The laxative and diuretic properties of herbs in essiac formulations may lead to low potassium blood levels that are potentially dangerous in people taking digoxin or digitoxin (12; 51; 52). Renal testsRenal tests: Rhubarb tannins have been shown to improve BUN, creatinine, glomerular filtration rate, renal plasma flow, and renal blood flow (72). Serum glucoseSerum glucose: Burdock extracts have demonstrated conflicting hypoglycemic activity in rats (28; 27), but may lower blood glucose levels in humans (59; 60; 61). However, streptozotocin-induced diabetic mice administered burdock paradoxically experienced hyperglycemia (27). Urine testsUrine tests: Rhubarb may discolor urine (orange) and interfere with diagnostic tests.