by Dr. Greg Sperber

“Dear Dr. Sperber,

I'd love your opinion on using Chinese herbs with the drug Tegretol (Carbamazepine). I had called a few months ago and we had a discussion about lithium. I now have a patient on Carbamazepine for seizures, 1 tab - 200mg/day only. I know this is also a Central Nervous System drug and I have read about it in your book, Integrated Pharmacology. This patient is on it for seizures and has been her whole life although she recently pushed her MD to lower the dose from 3 tabs to 2 to 1. She is 63 years old.

...

I think this drug may be in a similar category as Lithium, although I know the therapeutic range is not so small as Lithium. My question is how safe is it to use herbs with a patient on this med? In your book there is a short list of possible herbs it might interact with, Zhi shi, Zhi Ke, Qing Pi and Chen Pi. If I avoid these 4 herbs is it generally safe to use herbal formula with this medication? Is that generally the "rule" of thumb?

The herbal part of my practice is really starting to grow and I'm quite excited about it. I'm still getting used to figuring these things out and building a confidence level. I'd appreciate your thoughts on this. I also assume that she would take any meds a couple of hours away from the herbal formula.

Thanks!
Practitioner X”

Greg’s Response:

There are as many as 3 million patients in the US alone affected by seizures or epilepsy. Pharmaceutical drugs are the most common treatment for control of epilepsy with 75-80% of epileptics achieving long-term control with medication. The big issue with all of the anti-epileptics is that you may inadvertently induce a seizure by combining them with herbs. While the chances of this are extremely rare, the consequences are usually severe: in most states, one may not drive until they are 2 years seizure free. Obviously, this can be really life altering in most cases (can’t drive to work, etc…). I am usually very wary of combining herbs with anti-seizure meds unless I have a very serious discussion with the patient about the consequences. And chart the discussion including the patient’s responses.

Having said that, most of the anti-epileptics, with the exception of phenytoin (Dilantin®), are usually pretty safe and don’t have major drug-herb interactions. I would, however, steer practitioners away from the thought process of separating taking herbs from drugs. I know there was a lot of talk about taking herbs and drugs at different times, but, with a few exceptions like antacids, this is probably false, IMO. Drugs usually will take anywhere from an hour or two to days to fully assimilate in the body so separating taking herbs and drugs actually makes the potential for interactions worse, not better. A much better game plan is the one found in my book: start at small doses and ramp up slowly. This way, if an interaction does happen, it can be caught early and without major consequences.

I hope this helps with people’s questions about these drugs and helps everyone interested to see my thought process a little when approaching potential interactions. Congratulations to all of you who are being successful with Chinese herbal medicine; it is quite a feather in your cap with all the hype against herbs today if you are doing well with them and your patients are happy.

Dr. Greg Sperber, BMBS, DAOM, MBA, L.Ac.
Director of Clinical Services and Clinical Chair
Pacific College of Oriental Medicine, San Diego