| | Common name | Pharmacological effects | Side effects | Recommeded cessation time |
| Garlic
(Allium sativum) | Natural antibiotic, antiplatelet, antithrombolytic, lower lipid and cholesterol, reduced pulmonary and systemic resistance, potentiation of warfarin, risk of interaction with cardiovascular medications, MAO-I, hypoglycaemics [1, 3, 4, 6, 7, 9, 11, 13] | Epidural hematoma, postoperative bleeding, concerns for neuraxial blockage [4, 6, 7, 9, 11, 13], nausea, hypotension, allergy [3, 9] | Discontinued at least 7 days before surgery [3, 7, 9, 13] |
| | Echinacea | Immunostimulatory effects, with long use may be immunosuppressive [1, 4, 6, 7, 9, 11, 13] | Hepatotoxic, with long use (8 weeks) it acts as immunosuppressant, reduced effectiveness of immunosuppressants, cause allergic and anaphylactic reactions [4, 6, 7, 9, 11, 13] | No data available, discontinue 2 weeks before surgery [9, 13] |
| Ephedra
Ma huang | Sympathomimetic effects [1, 3, 4, 6, 7, 11, 13] weight loss, asthma treatment [9] | Autonomic side effects (tachycardia, hypertension, arrhythmia), myocardial infarction, stroke, seizure, renal stones, interacts with MAO-I, ergot alkaloids, halotan [1, 3, 4, 6, 7, 9, 11, 13] | Discontinued 24 hours preoperatively [3, 9] |
| | Ginkgo biloba | Stabilise cognitive functions, vasoregulation, inhibition of thrombocyte activation factors, antagonize the activation of vitamin B6 [1, 3, 4, 6, 7, 9, 11, 13] | Spontaneous intracranial bleeding, hyphema, sedation, postoperative bleeding, decrease efficiency of anticonvulsants, may potentiate other platelet inhibitors [1, 3, 4, 6, 7, 9, 11, 13] | Discontinue 36 hours before surgery [7, 9, 13] |
| Ginseng
Panax ginseng | Adaptogenic, lower blood glucose, inhibit platelet aggregation [1, 3, 4, 6, 7, 9, 13] | Hypoglycaemic effects (diabetics, posted surgery), interaction cardiovascular medications, digitalis and MAO-I [1, 3, 4, 6, 7, 9, 13] | Discontinue 24 hours before surgery [7, 13], discontinue 7 days before surgery [7, 9] |
| Kava
Piper methysticum | Anxiolytic, sedative, antiepileptic, neuroprotective [3, 4, 6, 7, 9, 13] | Potentiate sedative effects of anaesthetic agents, hepatotoxic, GABA-R inhibition [3, 4, 6, 7, 9, 11, 13] cava dermopathy [3, 9] | Discontinue 24 hours before surgery [7, 9, 13] |
| St. John’s wort
Hypericum perforatum | Inhibited reuptake of serotonin, norepinenephrine, and dopamine by the neurons, induction of cytochrome P4503A4, P450 2C29 [1, 3, 4, 6, 7, 9, 11, 13] | Serotoninism, drug interaction with cyclosporine, digitalis, MAO-I, warfarin, oral contraceptives, throphylline, midazolam, lignocaine, sedative effect [1, 3, 4, 6, 7, 9, 11, 13]risk of organ rejection, increases uterine tone [3, 9] | Stopped 5 days before the surgery [3, 7, 9, 13] |
| Valerian
Valeriana officinalis | Sedative, inhibited reuptake of GABA [3, 4, 6, 7, 9, 11] | High risk of potentiating of anesthetic and adjuvant drug actions, withdrawal-type syndrome with sudden abstinence [3, 4, 6, 7, 9, 11, 13] | No data available, discontinue 2 weeks before surgery [9] |
| Ginger
Zingiber officinale | Useful in parturients who are suffering from hyperemesis, motion sickness, anti-inflamatuar, inhibited thromboxane synthetases activity [1, 4, 6, 7, 9, 13] | Possible mutagenesis, bleeding complications with warfarin, antiplatelet, risk of hyperglycaemia, abrupt discontinuation produce benzodiazepine withdrawal like symptoms [1, 4, 6, 7, 9, 13] | No data available, discontinue 2 weeks before surgery [9] |
| | Green tea | Neurogenerative disease, anticancer, hypolipidemic [3] | Caffeine and tannins cause stimulation of CNS, source of vit. K, antioxidant. It may antagonise actions of warfarin, may cause arrhythmias, caution in renal and thyroid disease, insomnia [3] | No data available, discontinue 2 weeks before surgery |
| | Grapefruit juice | Decreased atherosclerotic plaque formation and inhibit cancer cell proliferation [3, 4] | Inhibit CYP3A4 and alter the metabolism of various medications [3, 4] | No data available, discontinue 2 weeks before surgery |
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