Dong quai is a Chinese herb that contains many naturally occurring coumarins that could lead to potentiation of Warfarin as well as inhibition of platelet aggregation. These potential effects may lead to increased bleeding.

Echinacea is thought to bolster the immune system, and is used as prophylaxis and treatment of upper respiratory infection and other bacterial, viral, protozoan, and fungal infections. It is also used as a wound healer and as an anti-inflammatory.  However, it may lead to ineffective immunosuppression in patients awaiting transplants.  This patient population should be counseled against taking Echinacea as organ transplants can occur at any time.  It may also lead to liver inflammation if taken with anabolic steroids or methotrexate.   Although it has a relatively safe profile, its use should be avoided in AIDS patients, as it may speed the course of their disease.  For more information, please visit http://meded.ucsd.edu/isp/2003/thomas/herb_echinacea.html or click on "Echinacea."

Feverfew is used primarily for the treatment of migraines, but can also be used for treatment of menstrual irregularities, and cessation of threatened spontaneous abortion presumably because it inhibits prostaglandin production. It may also decrease the release of polymorphonuclear leukocytes in joints that are arthritic and inflamed - owing to its use in the treatment of arthritis and rheumatic disease.  In addition, feverfew has been used traditionally for psoriasis, toothache, insect bites, asthma, and stomachache.  Like Nonsteroidal Anti-inflammatory drugs (NSAIDS), it may inhibit platelet aggregation, leading to intraoperative and postoperative bleeding.  There are also reports of a 'post feverfew syndrome' in long-term users who abruptly discontinue use of feverfew - a rebound of migraine symptoms, anxiety, insomnia, myalgias, and arthralgias. 

Garlic is a commonly used preparation.  It is used for lowering cholesterol, triglycerides and blood pressure.  Also, it may be used to fight bacterial infections, asthma, and inflammation.  It may cause a dose-dependant inhibition of platelet aggregation, leading to intraoperative and postoperative bleeding. This is a particular concern in patients taking other platelet inhibitors. Garlic can potentiate the effects of warfarin resulting in increased PT-INRs. Patients should discontinue use at least seven days prior to surgery. 

GBL (gamma-butyrolactone), BD (1,4 butanediol) and GHB (gamma hydroxybutyrate) are illegally distributed, unapproved drugs used for bodybuilding, sleep aids, and for weight loss, they can cause unconsciousness, seizures, bradycardia, decreased respirations and death.

Ginger may be used more frequently by the surgical population due to the claims that it may be a treatment for postoperative nausea and as an analgesic. It has also been used to treat morning sickness and motion sickness.  Its gingerol constituent is a potent thromboxane synthetase inhibitor that may lead to decreased platelet aggregation and subsequent bleeding. It can cause bleeding when combined with warfarin. In high doses, it has been reported to increase nausea and vomiting and to act as an abortifacient.

Ginseng is taken for physical stamina, improved concentration, treatment of diabetes, and cancer prevention.  It may lead to irreversible platelet inhibition, leading to bleeding, and may decrease serum blood sugar, leading to hypoglycemia.  Also, it may result in tachycardia and hypertension. It may have some pro-estrogenic effects, and so breast cancer patients should actually be warned against the drug.  Because of its hypoglycemic action, it may lead to dangerous hypoglycemic episodes in diabetic patients in combination with insulin or other oral hypoglycemics.  Concurrent use of MAOIs with ginseng may result in a manic-like syndrome. In addition, overstimulation may occur when used in conjunction with caffeinated beverages or ephedra. Due to potential surgical complications, it is recommended that Ginseng be discontinued at least a week prior to surgery.

Goldenseal is used as a laxative, an anti-microbial, and an anti-inflammatory aid.  It may lead to high blood pressure as well as increased swelling. Overdose may lead to paralysis however the dosage is not known. It can also act as an aquaretic leading the kidney to only excrete water but not sodium. It can function as an oxytocic, and therefore pregnant patients should be advised against the its use, as it may lead to uterine contractions and miscarriage, as well as neonatal jaundice because of bilirubin displacement properties.

Gotu Kola is used to treat depression and anxiety and to enhance fertility.  Gotu Kola has been found to bind to CCK and GABA receptors.  It has been found to lead to hyperglycemia and hypercholesterolemia and sedation. 

Saw palmetto is used for prostate health, as a diuretic, and for urinary inflammation.  It may cause adverse effects with other hormone therapies and oral contraceptives.  Overall, its use is very well tolerated and causes mild, reversible effects at high doses. 

Valerian is an herb reported to have sedative-hypnotic properties due to its constituents valepotriate and valerenic acid and therefore is used as a sleep aid and muscle relaxant.  It has also been used as an anxiolytic, to reduce gastric hyperactivity, and as an anti-epileptic.  Valerian may negate the therapeutic affect of MAOIs and result in hepatotoxicity with overdose.  This drug may potentiate drugs with similar effects such as benzodiazepines and barbiturates, commonly used anesthetic drugs. A several week preoperative taper is recommended because of the risk of a benzodiazepine-like withdrawal syndrome.

Vitamin E is a dietary supplement utilized to prevent strokes and pulmonary embolism, as well as to prevent aging and for protection against environmental pollution.  Complications include increased risk of bleeding in patients taking anticoagulants, thyroid complications, and a increased risk of high blood pressure in hypertensive patients taking over 400 IU per day.

This list is by no means comprehensive.  Because herbal remedies have not undergone the extensive research that conventional medications have, no herb can be considered "safe" in the surgical patient.  Please talk to your physician about any herbs or supplements that you are taking.