Herb-drug interactions
Herb-drug interactions are drug interactions that occur between herbal medicines and conventional drugs.[1] These types of interactions may be more common than drug-drug interactions because herbal medicines often contain multiple pharmacologically active ingredients, while conventional drugs typically contain only one.[1] Some such interactions are clinically significant,[2] although most herbal remedies are not associated with drug interactions causing serious consequences.[3] Most herb-drug interactions are moderate in severity.[4] The most commonly implicated conventional drugs in herb-drug interactions are warfarin, insulin, aspirin, digoxin, and ticlopidine, due to their narrow therapeutic indices.[4][5] The most commonly implicated herbs involved in such interactions are those containing St. John’s Wort, magnesium, calcium, iron, or ginkgo.[4]
Examples
Examples of herb-drug interactions include, but are not limited to:
- St. John's wort affects the clearance of numerous drugs, including cyclosporin, SSRI antidepressants, digoxin, indinavir, and phenprocoumon.[1] It may also interact with the anti-cancer drugs irinotecan and imatinib.[6]
- Salvia miltiorrhiza may enhance anticoagulation and bleeding among people taking warfarin.[2]
- Allium sativum has been found to decrease the plasma concentration of saquinavir, and may cause hypoglycemia when taken with chlorpropamide.[2]
- Ginkgo biloba can cause bleeding when combined with warfarin or aspirin.[2]
- Concomitant ephedra and caffeine use has been reported to, in rare cases, cause fatalities.[7]
Mechanisms
The mechanisms underlying most herb-drug interactions are not fully understood.[8] Interactions between herbal medicines and anticancer drugs typically involve enzymes that metabolize cytochrome P450.[6] For example, St. John's Wort has been shown to induce CYP3A4 and P-glycoprotein in vitro and in vivo.[6]
References
- 1 2 3 Fugh-Berman, Adriane; Ernst, E. (20 December 2001). "Herb-drug interactions: Review and assessment of report reliability". British Journal of Clinical Pharmacology. 52 (5): 587–595. doi:10.1046/j.0306-5251.2001.01469.x. PMID 11736868.
- 1 2 3 4 Hu, Z; Yang, X; Ho, PC; Chan, SY; Heng, PW; Chan, E; Duan, W; Koh, HL; Zhou, S (2005). "Herb-drug interactions: a literature review.". Drugs. 65 (9): 1239–82. doi:10.2165/00003495-200565090-00005. PMID 15916450.
- ↑ Posadzki, Paul; Watson, Leala; Ernst, Edzard (May 2012). "Herb-drug interactions: an overview of systematic reviews". British Journal of Clinical Pharmacology: no–no. doi:10.1111/j.1365-2125.2012.04350.x. PMID 22670731.
- 1 2 3 Tsai, HH; Lin, HW; Simon Pickard, A; Tsai, HY; Mahady, GB (November 2012). "Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review.". International journal of clinical practice. 66 (11): 1056–78. doi:10.1111/j.1742-1241.2012.03008.x. PMID 23067030.
- ↑ Na, Dong Hee; Ji, Hye Young; Park, Eun Ji; Kim, Myung Sun; Liu, Kwang-Hyeon; Lee, Hye Suk (3 December 2011). "Evaluation of metabolism-mediated herb-drug interactions". Archives of Pharmacal Research. 34 (11): 1829–1842. doi:10.1007/s12272-011-1105-0. PMID 22139684.
- 1 2 3 Meijerman, I.; Beijnen, J. H.; Schellens, J. H.M. (1 July 2006). "Herb-Drug Interactions in Oncology: Focus on Mechanisms of Induction". The Oncologist. 11 (7): 742–752. doi:10.1634/theoncologist.11-7-742. PMID 16880233.
- ↑ Ulbricht, C.; Chao, W.; Costa, D.; Rusie-Seamon, E.; Weissner, W.; Woods, J. (1 December 2008). "Clinical Evidence of Herb-Drug Interactions: A Systematic Review by the Natural Standard Research Collaboration". Current Drug Metabolism. 9 (10): 1063–1120. doi:10.2174/138920008786927785. PMID 19075623.
- ↑ Chen, XW; Sneed, KB; Pan, SY; Cao, C; Kanwar, JR; Chew, H; Zhou, SF (1 June 2012). "Herb-drug interactions and mechanistic and clinical considerations.". Current drug metabolism. 13 (5): 640–51. doi:10.2174/1389200211209050640. PMID 22292789.