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White Willow Bark - Possible Herb - Drug Interactions

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Updated September 14, 2013

Bismuth Subsalicylates:

Bismuth subsalicylates (e.g. Pepto-Bismol, Bismatrol, Maalox Total Stomach Relief) are used to treat symptoms of diarrhea, heartburn, nausea, acid indigestion, prevent traveler's diarrhea, and treat ulcers. They should not be taken with white willow bark due to an increased risk of salicylate toxicity.

Carbonic Anhydrase Inhibitors:

e.g. Acetazolamide (e.g. Diamox), Dichlorphenamide, Methazolamide
Carbonic anhydrase inhibitors are used to treat glaucoma, epileptic seizures, fluid retention, and altitude sickness. These drugs should not be used with white willow, which contains salicylates, due to an increased risk of salicylate toxicity.

Cox-2 Selective Nonsteroidal Anti-Inflammatory Drugs (NSAIDS):

e.g. Celecoxib (Celebrex), Valdecoxib (Bextra)
Cox-2 Inhibitors are used to treat rheumatoid arthritis symptoms, pain, fever, and inflammation, dysmenorrhea, and colorectal polyps. No interactions with white willow bark have been reported at the time of writing. However, until we have further research on the safety of white willow bark, they should not be combined because Cox-2 inhibitors are not recommended with aspirin due to an increased risk of stomach ulcers.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS):

e.g. Aspirin, Ibuprofen (e.g. Motrin, Advil) Naproxen (Naprosyn, Aleve), Diclofenac (Voltaren), Indomethacin (Indocin), Etodolac (Lodine), Ketorolac (Toradol), Piroxicam (Feldene), Sulindac (Clinoril), Nabumetone (Relafen), Salsalate (e.g. Amigesic)
Nonsteroidal anti-inflammatory drugs combined with white willow bark may increase the risk of stomach ulcers.

Metoclopramide:

Metoclopramide (e.g. Reglan) is used to reduce nausea and vomiting and reduce symptoms of esophagitis and stomach swelling in people with diabetes. Because it can increase the absorption of aspirin, it might also increase the absorption of white willow bark.

Methotrexate:

Methotrexate (e.g. Rheumatrex) is used to treat some types of cancer, to treat severe psoriasis, and to treat severe rheumatoid arthritis. Because it is not recommended that people combine methotrexate and aspirin (which also contains salicylates), the drug should not be taken with white willow.

Platelet Inhibitors:

e.g. Ticlopidine (Ticlid), Clopidogrel (Plavix)
Platelet inhibitors are used to reduce the risk of heart attack or stroke and for patients who have had a coronary stent implant. Like aspirin, white willow contains salicylates which may thin blood, so it can increase the risk of bleeding.

Anticoagulants:

e.g. Warfarin (Coumadin)
White willow bark contains salicylates and should not be combined with anticoagulants. They may increase the risk of bleeding or cause spontaneous bleeding.

Source:

Griffith, H. Winter. Complete Guide to Prescription and Nonprescription Drugs 2006 Edition. New York: Perigree, 2005.
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