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Garlic has shown significant benefits in lowering total choles-terol, LDL, and systolic and diastolic blood pressure, but the effects are moderate and unlikely to be large enough to lower this patient’s values into the normal range. While this patient’s diabetes is under control, her hypertension places her at risk for microvascular complications of diabetes, thus making it necessary to reevaluate her current medication adherence, doses of benazepril for hypertension and simvastatin for hyper-lipidemia, and duration of therapy. She would benefit from meeting with a nutritionist because packaged frozen dinners can be high in sodium, and this may be elevating her blood pressure. Adding exercise to her weekly routine could also help with weight control and overall cardiovascular health. The data supporting benefits of St. John’s wort in patients with hot flashes are preliminary but show promise. Good data support use of the herb to alleviate symptoms of mild to moderate depression when used for up to 1 year. However, this patient is not a good candidate for St. John’s wort (a cytochrome P450 1A2, 2C9, 3A4 inducer) because of her prescription drug use and the potential for herb-drug interactions. Several dietary supplements reviewed in this chapter (garlic, ginkgo, and gin-seng) may have antiplatelet effects that could be additive with ibuprofen. If this patient were also taking warfarin, additional interactions could occur with coenzyme Q10 (vitamin K-like structure), St. John’s wort, and melatonin (in vitro decreased prothrombin time), leading to a decreased warfarin effect, or with glucosamine (increased international normalized ratio), leading to an increased warfarin effect.
Paul W. Lofholm, PharmD, & Bertram G. Katzung, MD, PhD