The use of herbal supplements in the United States is steadily growing and raises concern about safety, efficacy and how they affect patient care. The direct risks of using herbal supplements include hypertension, prolonged bleeding and the potential for drug-herb interactions. These potential drug interactions are of particular concern in patients undergoing anesthesia (145). Interaction between a drug and herbal supplement may even cause death (81). Moreover, interactions between fruit juices and drugs also have important clinical significance. Such interactions may also lead to unusually low or high concentration of a therapeutic drug in a patient who demonstrated stable therapeutic level of the same drug before. Clinical laboratory professionals need to be aware of such interactions. In many cases, patients consider herbal supplements as natural and thus safe and do not inform their clinicians about their self-medication with such herbal supplements. Therefore, if a laboratory professional is suspicious of an unusual concentration of a therapeutic drug as a result of a potential drug-herb interaction, the individual should alert the ordering physician.

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