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Pregnant women may use HMs as complementary or alternative medicine to reduce their blood pressure. Many women taking HMs see them as a less-toxic natural alternative to prescription drugs. Therefore, they may consider taking Rauwolfia [Rauvolfia serpentina (L.) Benth. ex Kurz], buchu [Agathosma betulina (P.J.Bergius) Pillans], garlic (A. sativum L.), black or green tea [C. sinensis (L.) Kuntze], or Roselle (Hibiscus sabdariffa L.), hypertensive HMs (Tabassum and Ahmad, 2011; Lobay, 2015). For many of HMs, antihypertensive properties were established in animal models (Tabassum and Ahmad, 2011). Rauwolfia is a well-known HM used for the treatment of hypertension (Lobay, 2015). Reserpine isolated from this herb was approved and use as a conventional drug for hypertension treatment. Currently, rauwolfia extracts may be used as adjunct therapy to the prescription medication (Lobay, 2015). Below we discuss potential interactions of HMs with prescription drugs used for the treatment of hypertension in pregnant women ( Table 3 ).
The information on safety and efficacy of medicinal herbs generally comes from the experience of past generations. Preclinical and clinical studies completed in the last two to three decades have provided scientific evidence of the efficacy and safety of some medicinal herbs and herbal formulations.
Root extracts prepared from V. officinalis L. are used for the treatment of insomnia (Ziegler et al., 2002) and anxiety (Kohnen and Oswald, 1988). Although valerian has been implicated in the inhibition of CYP3A4 and P-glycoprotein (Hellum and Nilsen, 2008), no clinically relevant interactions with medications metabolized by these enzymes have been observed (Donovan et al., 2004).
Potential HM interactions with conventional antihypertensive drugs taken by pregnant women.
The indications for the use of HMs during pregnancy may vary and can be either mother- or child-related. HMs may be used sometimes as a part of maternal care to treat pregnancy-related problems, and often to improve the well-being of the mother or unborn child. The most commonly reported indications were nausea and vomiting, urinary tract infections (UTIs), preparation for and/or facilitation of labor, cold or flu, gastrointestinal issues, pain conditions, improvement of fetal outcomes, prevention of miscarriage, anxiety, health maintenance, and edema (Hall et al., 2011; Kennedy et al., 2013; John and Shantakumari, 2015; Teni et al., 2017). The most common herbal products consumed during pregnancy and their indications are described in Table 1 .
Gingko, an extract from the leaves and seeds of the plant G. biloba L. has been used in the treatment of Alzheimer’s (Kanowski et al., 1996; Oken et al., 1998) and premenstrual syndrome (Tamborini and Taurelle, 1993). It is reported to be pro-convulsive in animal models (Pilija et al., 2004) and initiates seizures in children (Fessenden et al., 2001). Gingko has been considered relatively safe (Hashiguchi et al., 2015), however caution should be used during lactation, as it partitions into breast-milk (Romaszko et al., 2014).
In summary, hypertension occurring during pregnancy is a serious condition that may result in life-threatening complications. There is not enough evidence to conclude that medicinal herbs that women can consume during pregnancy will have a clinically meaningful effect on the pharmacokinetics and pharmacodynamics of anti-hypertensive medications. Based on the currently available data, we believe that concurrent use of labetalol and nifedipine with HMs in recommended doses would not alter metabolism of conventional drugs. However, many consumers consider HMs as a safe alternative to the conventional drugs and may exceed recommended HM doses. In this situation, the concurrent use of HM may complicate treatment of hypertension in pregnancy. The most alarming is the clinically proven interaction of nifedipine with St. John’s Wort. Therefore, healthcare professionals should discuss with their patients potential risks of the concomitant use of anti-hypertensive drugs and herbal supplements.
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