What herbal supplements should I avoid taking after a liver transplant?

The list below summarizes some of the herbal products that are known to interact with liver transplant medications, including:

• Neoral / Sandimmune (cyclosporine)
• Prograf (tacrolimus)
• Rapamune (sirolimus)

Please note that this is not an all-inclusive list of herbal products that should be avoided; please check with a transplant healthcare provider before taking any herbal and/or over-the-counter medications.

• Echinacea -- may stimulate the immune system and increases the risk of transplant rejection; decreases effectiveness of immunosuppressant medications
• Ephedra -- increases blood pressure, heart rate, heart palpitations, and risk of stroke
• Garlic -- can affect blood sugar control; increases the effects of blood thinners (aspirin and warfarin), which may increase the risk of bleeding
• Ginkgo -- slows the body's ability to metabolize drugs appropriately; has blood thinning properties which may increase risk of bleeding
• Ginseng -- slows the body's ability to metabolize drugs appropriately; may increase the risk of bleeding; can cause low blood sugar; can lead to trouble sleeping, nervousness, and agitation
• Kava -- interacts with prescription drug products such as sedatives and analgesics;
• interferes with perception and movement
• Melatonin -- may stimulate the immune system to increase the risk of transplant rejection; associated with excessive sleepiness, confusion, and headache
• Red Yeast Rice -- interacts with many prescription drug products; can cause severe muscle pain
• St. John's Wort -- many drug interactions which may increase the risk of transplant rejection; increases sensitivity to sunlight
• Valerian -- many drug interactions which may increase the risk of transplant rejection; contraindicated in individuals taking sedatives or anxiolytics