The actor Leary Walker played Ronald Walker in "Nobody Listens"

The actor Leary Walker played Ronald Walker in “Nobody Listens”

Keeping multiple medications from having negative interactions is a difficult enough task when a physician keeps track of everything an elderly person may need to take. A real complex set of problems can arise when a patient adds their own choices based on alternative sources and does not keep their care provider informed.

Bressler (2005) discusses two colliding situations. First, elderly patients often have multiple health issues that require multiple medications. Second, the use of alternative/herbal medicines has increased. He says that often patients add herbal medicines to their regimen that create negative interactions with the traditional prescription medications and they don’t tell their physician about it.

A review by Fugh-Berman (2000) discusses many ways in which herbs can interfere with the effects of prescription drugs. Several examples cited by Fugh-Berman are “mild serotonin syndrome in patients who mix the [ever popular] St John’s wort (Hypericum perforatum) with serotonin-reuptake inhibitors.” And “induction of mania in depressed patients who mix antidepressants and Panax ginseng.”

The elderly may be more susceptible to negative drug interactions because there are age-related changes in the body’s drug metabolism. For example, Bressler (2005) mentions that changes in body chemistry can cause “Inhibition of drug-metabolizing enzymes [which] causes increased levels of the parent drug, prolonged drug effects, and increased drug toxicity. Competition for the active site of drug-metabolizing enzymes or by two or more drugs can result in decreased inactivation of one of the drugs and an increase and prolongation of drug effect, i.e., toxicity.”

So, providers need a conscious program to insure patient awareness of the need to keep care providers fully informed of all medication use, including herbs and foods that may not immediately appear to be relevant to the wellness issues at hand.

A useful film to sensitize providers to these issues is “Nobody Listens.” Produced by me and filmed in Florida and Jamaica, it is the story of a cancer patient who comes to the US for treatment and does not tell his providers about his “little herbs and such.” It raises issues of herb/drug interactions and the need for open communication between patients and providers, and offers some insights into cultural differences.


  1. Bressler, R. Herb-drug interactions – Interactions between Ginkgo biloba and prescription medications. April 2005, 60, 4, 30-33.
  2. Fugh-Berman, A. Herb-drug interactions. Lancet, 2000, 355, 134-138.
  3. Nobody Listens (2009). IMdB entry is at and film may be viewed at