Wednesday, April 13, 2005

Blood Sugar Interactions

Here's a recent headline that caught my eye: "Diabetics Warned About Taking St. John's Wort" Uh oh, I thought, that doesn't look good. But the details of the article don't quite support the scare headline. Turns out, this is not a warning for all diabetics, only type 2 diabetics, and only those who are taking Avandia, a medication that helps control blood sugar. The article details a study from the University of Florida in which 27 subjects were given eight mg of Avandia daily. In addition, about half the group received either placebo or 900 mg daily of St. John's Wort, the popular herbal treatment for mild depression. Blood and urine samples showed that St. John's Wort accelerated the elimination of Avandia, reducing its effectiveness. In previous alerts I've noted that St. John's Wort may interfere with some prescription drugs. So even though the Florida trial was small, it adds to our understanding of St. John's Wort, which is one of the most widely used herbals in alternative medicine. What the article didn't mention is that Avandia has interaction problems of its own. According to information posted on the FDA web site, when Avandia is taken with other oral diabetes medicines, there's a risk of "blood sugar becoming dangerously low." So it's a no-brainer: If you take Avandia, don't take St. John's Wort or other oral drugs for diabetes. Ah, but there's more. The FDA also cautions that in the few years since Avandia was approved by the agency "there have been reports of inflammation of the liver (hepatitis) and elevated liver enzymes." It's not known if these events are directly related to Avandia use, but the class of drugs that Avandia is in has been associated with "rare but serious liver injury, including liver failure leading to transplant or death."
OUCH.
No wonder then that the FDA advises doctors to evaluate liver health before starting patients on Avandia. In addition, the FDA says blood tests should be taken once every two months for the first year of Avandia use to monitor liver enzymes, followed by less frequent but regular blood checks from then on. Why? Because according to the agency that approved the drug for sale: "Avandia's liver safety profile is not fully determined yet." When I read that, I couldn't help but think: If St. John's Wort caused hepatitis in some users, prompted rare but serious liver injury, required several blood tests each year, and made blood sugar drop to dangerously low levels when combined with certain drugs, do you suppose the medical mainstream would be satisfied to hear that its safety profile is not fully determined yet?

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