Dr. Edmund Pribitkin, Professor of Otolaryngology and Head and Neck Surgery at Jefferson Medical College, reviews the most common herbal medicines patients take and the side effects that physicians need to know about.

Summarizing the “4 G’s ” – Garlic, Gingko, Ginger and Ginseng, as well as the one F, feverfew, he describes how these herbal medicines have pharmacological properties like any other drug and need to be discontinued by patients prior to surgery.

Summary of Learning Objectives 1. Herbal medicines have pharmacological properties, therefore it is vital to ask patients what they have taken prior to surgery.

2. There are four herbal medicines starting with the letter “G” to remember to ask about – Garlic, Ginger, Gingko and Ginseng (Asian); high doses can interfere with bleeding times. Stop these medications 2 weeks before surgery.

3. Feverfew, used to treat migraines, can cause withdrawal symptoms with recurrence of migraine. The dose must be tapered first before stopping.

References and Resources
Spolarich AE, Andrews L. An examination of the bleeding complications associated with herbal supplements, antiplatelet and anticoagulant medications. J Dent Hyg. 2007 Summer;81(3):67. Epub 2007 Jul 1. Review.

Ciocon JO, Ciocon DG, Galindo DJ. Dietary supplements in primary care. Botanicals can affect surgical outcomes and follow-up.Geriatrics. 2004 Sep;59(9):20-4. Review.