Working with Medications
Some clients want to stay on prescriptions for many reasons but also want to be able to work with herbs alongside their meds safely. A well educated clinical herbalist can help you get the best of both worlds. I respect your autonomy and encourage you to collaborate with your prescribers and leave my consults with well-informed herbal recommendations that you can bring to your prescribers for more follow-up if desired. My job is to support your goals, protect safety, and help your plan feel doable. Herbs can sit beside conventional care when we use a clear process and watch the right markers.
The safety screen I run on every case
I look at the medication list, doses, timing, and the reason each drug was prescribed. Then I screen candidate herbs through these questions.
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Will this herb work against the medication’s purpose?
Example: strong stimulants with a sedating herb can tug the nervous system in two directions and create whiplash effects. -
Will it exacerbate the condition we are treating? e.g., licorice can raise blood pressure in some people.
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Will it change drug metabolism or transport?
- Speed up breakdown and lower drug levels. Example: CYP3A4 inducers like St. John’s wort can lower levels of many meds in your system, meaning you are not getting your intended dose.
- Slow down breakdown and raise drug levels – AKA concentrate certain drugs.
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Will it thin the blood or shift clotting risk?
“Blood thinning” covers different mechanisms. Some herbs reduce platelet stickiness. Others may affect coagulation pathways or vasodilation. I look for additive effects with anticoagulants, antiplatelets, high-dose omega-3s, or salicylate-rich plants. -
Will it push glucose, blood pressure, heart rhythm, or mood in the wrong direction?
Additive effects can be helpful or risky. We plan and monitor. -
What is the medication’s therapeutic window?
Narrow windows require tighter caution and closer communication with your prescriber. -
What does the person’s context add?
Liver or kidney impairment, pregnancy or lactation, bleeding history, arrhythmia, serotonin sensitivity, seizure threshold, and allergy history change the equation.
Work with the meds, not against them
Once safety is established, we use herbs to support the same therapeutic direction or to ease side effects.
Align with the medication’s job
Often when people have been on medications for a long time their drugs stop having the same effects in the degree they used to perform at. Often this can be exhaustion of the system that drug is working, depletion of required nutrients, or shifts in how the health condition is expressing itself.
This is where drugs shine. Many herbs approach health conditions in totally different ways than pharmaceuticals. This gives us a wider net we are casting at your health problem. If one way isn’t working, we are also trying another approach, giving us a much higher chance of achieving relief than a single-pronged approach.
Now this needs to be done with care so that we aren’t just stacking up effects and possibly tipping things into the danger zone (examples of this are bringing in serotonergic herbs on top of SSRIs or sedatives on top of sedative drugs), but if we are conscious of compounding effects and take alternative approaches or space doses we can keep pharmaceutical doses modest while getting more work done on resistant conditions.
Mitigate common side effects
Another reason to work with herbs may be because you really need the effects of pharmaceuticals but you’re dealing with some unwanted side effects. The easiest example of this is NSAIDs like ibuprofen. It’s such a relief for pain, but it can irritate the GI tract lining. Working with gentle GI-repairing herbs can allow you to get the relief of the anti-inflammatory drug when you need it and mitigate some of the damage it can cause.
Working with your prescriber
When working with herbs and meds we are a team: you, me, and your prescriber working together with all the information we have to get effective results and maintain safety. Most MDs and even many NDs don’t know much about herbs. They won’t have the herb end of things and can be wary of using any at all. I think not understanding something isn’t a great reason to write off an incredible tool, so I encourage my clients to bring well-informed plans and herbal information that I can provide to their prescribers if they are feeling nervous about discussing using herbs in tandem with pharmaceuticals.
More often than not I find my clients reporting back that their doctor was more receptive than they expected when they brought in a well-informed herb/drug plan that we made together in a visit.
Monitoring is important
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We will agree on simple metrics: a symptom scale, sleep diary, home BP or glucose, bowel habits, and energy ratings to track both effectiveness and early signs that something starts to seem off.
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Set clear “call your prescriber” thresholds. For example, consistent BP under 100/60 with symptoms; signs of easy bruising; resting heart rate changes that feel wrong. We will identify risks based on the plan we are working on that you can be aware of and watch for.
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Revisit monthly at first. Adjust one variable at a time.
When I typically recommend avoiding an herb
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Narrow therapeutic window on a critical medication and a plausible interaction path
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History of abnormal bleeding, arrhythmia, or severe serotonin sensitivity
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Pregnancy or lactation when the mechanism suggests risk
There are usually alternative herbs we can work with and still get effective results.
