Table 1.

Original Chart in APEC

Herb	Pharmacological Effect	Perioperative Concerns	Preoperative Discontinuation
Echinacea	Activation of cell-mediated immunity	Allergic reactions, decreased effectiveness of immunosuppressants; potential for immunosuppression with long-term use	No data
Ephedra (ma huang)	Increased HR and BP through direct and indirect sympathomimetic effects	Risk of MI and stroke from tachycardia and htn; ventricular arrhythmias with halothane; long-term uses depletes endogenous catecholamines and may cause intraoperative hemodynamic instability; life-threatening interaction with MAOI's	At least 24 hours before surgery
Garlic	Inhibition of platelet aggregation, increased fibrinolysis, equivocal antihypertensive activity	Potential to increase risk of bleeding, especially when combined with other medications that inhibit platelet aggregation	At least 7 days before surgery
Ginkgo	Inhibition of platelet-activating factor	Potential to increase risk of bleeding, especially when combined with other medications that inhibit platelet aggregation	At least 36 hours before surgery
Ginseng	Lowers blood glucose; inhibition of platelet aggregation; increased PT-PTT in animals; varied others	Hypoglycemia; potential to increase risk of bleeding; potential to decrease anticoagulation effects of warfarin	At least 7 days before surgery
Kava	Sedation, anxiolysis	Potential to increase sedative effect of anesthetics; potential for addiction, tolerance, and withdrawal after abstinence unstudied	At least 24 hours before surgery
St. John's Wort	Inhibition of neurotransmitter reuptake, MAO inhibition unlikely	Induction of P450 enzymes (CYP 3A4) affecting cyclosporine, warfarin, steroids, protease inhibitors, and possibly benzo's, calcium channel blockers, and many other drugs; decreased serum digoxin levels	At least 5 days before surgery
Valerian