Boswellia (Boswellia serrata)

Analgesic

Anti-inflammatory

Anticancer

Inhibits 5-lipoxygenase and cyclo-oxygenase-1

Inhibits nuclear transcription factor kappa B (NF-kappa B) signaling, thereby decreasing production of tumor necrosis factor alpha (TNF-alpha)

Cytotoxic

Radioenhancing

Improves cognitive function

Lowers insulin resistance

Typically well tolerated; occasional GI upset

Unknown clinical significance regarding anion transporter OATP1B3, multidrug resistant protein MRP2, and P-glycoprotein

May inhibit platelet aggregation and thereby increase risk of bleeding

Turmeric (Curcuma longa)

Analgesic

Anti-inflammatory

Anticancer

Antiemetic

Decreases TNF-alpha concentration

Antiproliferative

Inhibits matrix metalloproteinase

Radioenhancing, chemosensitizing

Diarrhea, flatulence, and/or bloating with high doses

May lead to headache and nausea

May increase risk of bleeding when combined with NSAIDs

Unknown clinical significance of interactions with chemotherapeutic drugs

Ginger (Zingiber officinale)

Analgesic

Anti-inflammatory

Anticancer

Hypoglycemic

Antiemetic

Regulates GI motility

Anti-infective for GI tract

Stimulates flow of saliva, bile, and gastric secretions

Competitive antagonist of serotonin 5-HT3 receptors

Inhibits thromboxane formation and platelet aggregation

Stimulates mucosal cells to secrete interferon-beta to combat viral infection

Reduces tumor growth by damaging microtubules and inducing mitotic arrest

Inhibits angiogenic cytokines, vascular endothelial growth factor, and interleukin-beta in cell cultures

Increases levels of circulating antioxidant and phase II enzymes

Reduces lipid peroxidation levels

Abdominal discomfort, diarrhea, gastric irritation, and mucosal irritation of the oropharynx are possible.

May increase risk of bleeding when combined with NSAIDs

Can cause additive reductions in blood glucose when co-administered with other glucose-lowering substances.

May lead to decreased blood concentrations of cyclosporine

Devil's claw (Harpagophytum procumbens)

Analgesic

Anti-inflammatory

Antiosteoporotic

Antioxidant

Appetite suppressing

Decreases inflammatory cytokine production such as TNF-alpha

Inhibits pro-inflammatory gene expression

GI bleeding, acute pancreatitis, gastric discomfort or ulcers

May affect blood levels of substances metabolized by cytochrome P450 enzymes due to its inhibition of several families of these enzymes.

May impact drug transport mediated by P-glycoprotein.

Cayenne or capsaicin (Capsicum frutescens)

Analgesic

Circulatory support

Depletes substance P from C-fiber polymodal nociceptors.

Activates transient receptor potential vanilloid subfamily member 1 (TRPV1).

Releases calcitonin gene-related peptide (CGRP) to cause coronary vasodilation.

GI irritation with oral administration

Interacts with cytochrome P450 (CYP) 3A and P-glycoprotein (P-gp) substrates, leading to altered absorption and metabolism of co-administered medications. Drugs affected by capsaicin include ACE inhibitors, antihypertensive agents, antiplatelet drugs, immunosuppressants such as cyclosporine, and theophylline.

Peppermint (Mentha piperita L.)

Analgesic for aches

Alleviates digestive discomfort / antispasmodic

Anti-inflammatory

Anticancer

Hypoglycemic/antidiabetic

Antifungal

Antibacterial

Antifibrotic

Antioxidant

Anti-infective for GI tract

Diminishes calcium influx, thereby regulating calcium channel–dependent activities in GI tract smooth muscle

Menthol reduces lipid peroxidation, oxidative stress, and inflammation in colitis animal model

Mild GI upset, nausea, vomiting with oral administration

Dermatitis with topical administration

May increase risk of bleeding

Unknown clinical significance of interactions with chemotherapeutic drugs

Lavender (Lavandula angustifolia)

Anxiolytic

Analgesic

Anti-inflammatory

Antioxidant

Antimicrobial

Anticonvulsant

Neuroprotective

Anti-infective for GI tract

Anti-inflammatory and analgesic effects are attributed to the terpene 1,8-cineole; linalool and linalyl acetate relax vasculature and counter anxiety

Nausea, confusion, eructation from oral administration

Possible dermatitis and photosensitivity with topical administration

Additive effects with sedating medications are possible

Kava (Piper methysticum)

Anticonvulsant

Local anesthetic

Skeletal muscle relaxant

Kavapyrones act on CNS to induce skeletal muscle relaxation

Hepatotoxicity

Headache

Urticaria

Skin irritation

Ataxia

Altered mental status

Additive effects when co-administered with CNS depressants

St John's wort (Hypericum perforatum)

Antidepressant

Neuroprotective

Analgesic for neuropathic pain

Hyperforin and hypericin may alleviate neuropathic pain and offer neuroprotective effects

Inhibit neuronal uptake of serotonin, norepinephrine, and dopamine

Photosensitivity

Increased prothrombin time

GI upset

Dry mouth

Headache

Nausea

Neuropathy

Commonly causes herb-drug interactions

Can lead to serotonin syndrome when combined with selective serotonin reuptake inhibitor(s)

Reishi mushroom (Ganoderma lucidum)

Immunomodulatory

Renoprotective

Anti-inflammatory

Hepatoprotective

Anticancer

Beta glucans, polysaccharides provide antitumor and immunostimulatory activities

Triterpene compounds may inhibit invasiveness of tumors by reducing expression of matrix metalloproteinases

Additional anticancer possible

Nausea

Insomnia

May increase risk of bleeding when given with anticoagulants and antiplatelet substances

Can counter immunosuppressant drug activity by enhancing immune responses

May counteract chemotherapeutic agents that rely on free radical formation by increasing plasma antioxidant activity.

Inhibits cytochrome P450 enzyme activity so may affect intracellular concentrations of drugs metabolized by same CYP enzyme families.

Milk thistle (Silybum marianum)

Treat various liver diseases

Antioxidant

Anticancer

Reduce chemotherapy-induced hepatotoxicity and other adverse effects, including the severity of radiodermatitis (silymarin gel)

Silymarin may confer hepatoprotection by downregulating extracellular matrix proteins such as collagen

May reduce liver carcinogenesis by inhibiting mast cells and matrix metalloprotein production

Silibinin (a milk thistle flavonoid) demonstrates antioxidant and anti-inflammatory activity by inhibiting release of hydrogen peroxide and production of TNF-alpha

Various anticancer effects such as arresting G1 and S phases of the cell cycle.

High doses of silibinin may increase bilirubin levels and liver enzymes

Effects on CYP 450 enzymes have unclear clinical significance

Yunnan Baiyao (or Yunnan Paiyao)

Hemostatic

Anti-inflammatory

Antimicrobial

Notoginseng, a major component, demonstrates the following activities when administered as a solo agent:

Anticoagulant

Antiplatelet

Fibrinolytic

Although preparations vary across manufacturers and the ingredients are unknown (proprietary), it appears that some of the nanofiber components in Yunnan Baiyao may help activate blood clotting

Notoginseng also reduces fibrinogen levels in the blood and protects endothelial function, among many other effects on platelets and immune cells

Estrogenic activity in notoginseng and ginsenosides may stimulate the growth of hormone-sensitive mammary cancer

May increase risk of bleeding when given with anticoagulant or antiplatelet medications

May inhibit or induce cytochrome P450 enzymes and thereby alter the metabolism of substrate drugs of those enzymes

Cannabidiol (Cannabis sativa)

Anti-inflammatory

Anticonvulsant

Analgesic

Neuroprotective

Antioxidant

Endocannabinoid modulator

Inhibits pro-inflammatory pathways

Interacts with multiple receptors and neurotransmitter pathways

Nausea

Oversedation

Inappetence

Liver enzyme changes

Possible reproductive system changes

Changes have been reported in co-administered anti-epileptic medications. Concern is growing about additional potential herb-drug interactions.