1. KNOWLEDGE IS POWER

Knowledge is your best defense against drug-herb and herb-herb interactions. Know what you are taking and why. Your alternative and conventional medical providers should provide you with the name of all the drugs and herbs, the reason for taking them, the expected benefit and potential side effects. Avoid anything that has a "secret formula". If it works, there should be evidence that it does. Unfortunately, lack of knowledge about how medicinal plants and pharmaceutical drugs affect each other, and large variations between individuals make identifying adverse drug-herb interactions difficult. One of the key things you can do is to be proactive, and work closely with your doctor, pharmacists and complementary care practitioners to make sure each of them are aware of all the substances you are taking and to ensure you get the information you need to make informed treatment decisions.

2. YOUR PHARMACIST IS YOUR FRIEND

Make all of your providers aware of everything you are taking. Project Inform suggests the "Brown Bag Medicine Check Up". Put all of your medications, including over-the-counter, prescription and complimentary products like herbs and vitamins, in a bag and take them to your various health care providers so that they can conduct a personalized review. Typing a list of all the supplements and herbs you take and providing that to your health care providers for your file can be helpful. New information on benefits, adverse effects and drug interactions with herbal remedies is being published in the medical and pharmaceutical literature all the time- your pharmacist or physician may be able to tell you of recent developments (or you may be able to tell them). Whichever way, you'll all be better off.

3.BUYER BEWARE

Buy your herbal products from a reputable manufacturer, or a store that has been in business for some time. Ask your alternative medical provider to recommend a good source of high quality herbs. Products from less reputable manufacturers may be mislabeled, have variable (or incorrect) herb content or quality, or be contaminated with other ingredients. You can't predict or evaluate a drug interaction if you don't know what's in the product.

4. ONE THING AT A TIME

Start one product at a time, and don't use in larger than recommended doses. Avoid combination products with a long list of ingredients. In general, don't start a new herbal regimen at the same time as you start a new antiretroviral regimen - wait until you are stabilized on your new HIV medications. There may be times when you will choose to take herbs to alleviate some of the short-term side effects of a new regimen, such as ginger for nausea, or raspberry tea for diarrhea.

5. WATCH THE KIDS!

Use herbal products in children or infants only under the care of a trained practitioner. Children are more likely to have adverse effects due to altered metabolism. Avoid herbal treatments if you are pregnant, or planning a pregnancy. Some herbs like feverfew and goldenseal can cause premature labour, others such as hawthorn and kava kava decrease the tone of the uterus.

6. WRITE IT DOWN

Keep a diary of your response to each treatment you try, and don't continue use for more than a few weeks if you are not achieving the desired benefit. There are very few long-term studies on most herbal remedies. Minimizing the number of herbs taken decreases the chance of interaction.

7. TIMING IS IMPORTANT

Because we have limited information of drug-herb interactions due to altered absorption, try to separate your doses of antiretrovirals and herbs/supplements by at least an hour. This is especially important for drugs with food restrictions such as didanosine (DDI) and indinavir (Crixivan) or those sensitive to changes in stomach pH, such as itraconazole and ketoconazole.

8. HAVE A HEALTHY RESPECT FOR NATURE

Just because it's natural doesn't mean it’s harmless. Many people assume that because they are taking a "natural" product that there are no potential adverse effects, and that dosing recommendations are to be ignored. There are a wide variety of toxic effects of herbs. Avoid taking herbs that have known toxic effects, such as pennyroyal, comfrey, germander and liferoot. HIV infected persons should avoid the long-term use of echinacea, as it may increase the rate of replication of the HIV virus.

9. AN OUNCE OF PREVENTION

Be especially careful when adding herbal treatments if you are on medication for the treatment of other chronic medical conditions such as: high blood pressure, high cholesterol or triglycerides, diabetes, heart failure or rhythm disturbances, seizure disorders, Parkinson's disease, rheumatoid arthritis or gout, or cancer chemotherapy. Be really, really careful if you are taking blood thinners such as warfarin (Coumadin). Some herbs can increase the toxicity of drugs used to treat these conditions, or counterract their effectiveness. Examples include: Ayurvedic Shankapushpi can decrease the effectiveness of phenytoin in the treatment of seizures, wormwood can lower seizure threshold, black cohosh can antagonize the effects of some high blood pressure medications, figwort can increase possiblity of side effects to digoxin, red clover, chamomile and many others can affect anticoagulants.

10. USE COMMON SENSE