Is it all right to take herbal medicine and prescription drugs together

"Is it all right to take herbal medicine together with my blood pressure medication?"

There is a common answer to this question: "Take them two or three hours apart."

I think this answer is not enough. In some cases a time gap helps, but in other cases it does nothing at all.

Let me explain why, in a little detail.

What a time gap protects

When you swallow two medicines together, they can stick to each other inside the stomach and intestines and interfere with absorption. Spacing them out reduces this problem.

Up to this point a time gap is effective. That is because it is a problem that occurs at the entrance where medicine enters the body.

What a time gap cannot protect

The problem comes after that.

Once a medicine is absorbed and enters the body, it is processed in the liver. The liver has enzymes that break down medicines. These enzymes are of set kinds, and their processing capacity is also set.

Consider the case where two medicines use the same enzyme.

If an herbal ingredient is holding on to that enzyme, the prescription drug cannot be processed and builds up in the body. It becomes the same as if you had taken more of the drug, even though you took only the prescribed amount.

Here is the important point. Holding on to an enzyme is not released by two or three hours. It takes far longer for the enzyme to work again. Even if you leave a time gap, this problem remains as it is.

A similar thing happens with the proteins that act as gatekeepers moving in and out across the cell membrane. These gatekeepers do the work of pumping medicines out of the cell. When an herbal ingredient blocks this gatekeeper, more of the drug remains in the body than expected.

It is not a problem of time, but a problem of meeting at the same crossroads.

So the truly dangerous combinations

There are specific things I must mention.

First, licorice and diuretics or blood pressure medication.

Licorice can act in the direction of sending potassium out of the body. Diuretics also send out potassium. When the two overlap, potassium can drop to a dangerous level.

When potassium drops, the heartbeat becomes irregular. Licorice is in more than half of herbal prescriptions. That is why I always ask someone taking blood pressure medication exactly which medicine it is.

Second, when you are taking heart medication.

I am especially careful with someone taking medicine that affects the heartbeat. Because even a small shift in potassium increases the risk.

Third, blood-thinning medication.

For someone taking medicine that prevents blood clots, I avoid ingredients that could increase the risk of bleeding. This combination can lead to gum bleeding, bruising, and, rarely, serious bleeding.

Fourth, when the liver or kidneys are already weak.

When the organs that do the processing have weakened, whatever you put in becomes a burden. In this case, the decision not to add matters more than the kind of medicine.

What I ask before writing a prescription

Before I make up herbal medicine I ask a few things. It may be a nuisance, but the answers change what I write.

What you're taking these days.
What the hospital gave you comes first, but not only that. If there's something else you keep up with, it helps to mention it too. Usually there's nothing to it; now and then something overlaps, and seen in advance it is easy to steer around.

A packet or a photo is easiest for the names.
"Blood pressure medicine" on its own leaves a bit open. There are several classes of them, and which one it is changes what I look at.

A recent blood test, if you have one.
Liver values, kidney function, electrolytes — those three alone make the judgment much more accurate.

I'm not asking so I can stop you using something. I'm asking so it can be used well. Most of the time it ends with "carry on as you are."

On the other hand, what you need not worry about

Having read this far, you may be frightened. Let me balance it.

Most combinations actually cause no problem. The things listed above are things you can avoid if you know them. You just need to receive your medicine from a doctor who knows.

What matters is that someone is watching. Knowing what went in and how much, and for how long it runs — that is what makes any of this steerable. Taken without that, for months, with nobody looking, is where things get away from us.

There are also cases where using them together is better

Finally, there is something I really want to say.

I do not tell you to stop your prescription drugs and take only herbal medicine.

If your blood pressure is high, you need blood pressure medication. The same goes for diabetes medication, thyroid medication, and anticoagulants. These medicines are preventing dangerous things. Herbal medicine cannot take their place.

What I am trying to do is different. It is to help the body regain the part it can do on its own, without interfering with the work those medicines do.

There are people who, even while taking blood pressure medication, cannot sleep, cannot digest, and are always tense. That part is not the place blood pressure medication touches. That place is the place I take on.

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"Is it all right to take herbal medicine and prescription drugs together?"

"Tell me what that prescription drug is, and I will answer you."

To answer that way I have to know both sides. That is my part.

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Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)