Article

Interactions Between Herbal Medicines and Prescribed Drugs

Department of Experimental Pharmacology, University of Naples Federico II, via D Montesano 49, Naples 80131, Italy.
Drugs (Impact Factor: 4.13). 02/2009; 69(13):1777-98. DOI: 10.2165/11317010-000000000-00000
Source: PubMed

ABSTRACT The concomitant use of herbal medicines and pharmacotherapy is wide spread. We have reviewed the literature to determine the possible interactions between seven popular herbal medicines (ginkgo, St John's wort, ginseng, garlic, echinacea, saw palmetto and kava) and conventional drugs. Literature searches were performed using MEDLINE, Cochrane Library and EMBASE and we identified 128 case reports or case series, and 80 clinical trials. Clinical trials indicate that St John's wort (Hypericum perforatum), via cytochrome P450 (CYP) and/or P-glycoprotein induction, reduces the plasma concentrations (and/or increases the clearance) of alprazolam, amitriptyline, atorvastatin, chlorzoxazone, ciclosporin, debrisoquine, digoxin, erythromycin, fexofenadine, gliclazide, imatinib, indinavir, irinotecan, ivabradine, mephenytoin, methadone, midazolam, nifedipine, omeprazole, oral contraceptives, quazepam, simvastatin, tacrolimus, talinolol, verapamil, voriconazole and warfarin. Case reports or case series suggest interactions of St John's wort with adrenergic vasopressors, anaesthetics, bupropion, buspirone, ciclosporin, eletriptan, loperamide, nefazodone, nevirapine, oral contraceptives, paroxetine, phenprocoumon, prednisone, sertraline, tacrolimus, theophylline, tibolone, tryptophan, venlafaxine and warfarin. Ginkgo (Ginkgo biloba) decreases the plasma concentrations of omeprazole, ritonavir and tolbutamide. Clinical cases indicate interactions of ginkgo with antiepileptics, aspirin (acetylsalicylic acid), diuretics, ibuprofen, risperidone, rofecoxib, trazodone and warfarin. Ginseng (Panax ginseng) may interact with phenelzine and warfarin. Kava (Piper methysticum) increases the clearance of chlorzoxazone (a CYP2E1 substrate) and may interact with alprazolam, levodopa and paroxetine. Garlic (Allium sativum) interacts with chlorpropamide, fluindione, ritonavir and warfarin; it also reduces plasma concentrations of chlorzoxazone (a CYP2E1 probe). Echinacea might affect the clearance of caffeine (a CYP1A2 probe) and midazolam (a CYP3A4 probe). No interactions have been reported for saw palmetto (Serenoa repens). Numerous interactions between herbal medicines and conventional drugs have been documented. While the significance of many interactions is uncertain, several interactions, particularly those with St John's wort, may have serious clinical consequences.

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    • "They serve as therapeutic agents as well as important raw materials for the manufacture of traditional and modern medicine. In present decades, there is increasing interest to unlock the secrets of ancient herbal remedies (Izzo and Ernst, 2009).The natural products of plant origin are a rich source of cancer chemotherapy drugs, and exhibited low or almost no toxicity to normal tissues; hence, more attention is being paid to searching for new antitumor agents from natural products (Dai et al., 2011). More than 60% of the anticancer agents used today are derived directly or indirectly from natural sources Cragget al. (1997). "
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    • "They serve as therapeutic agents as well as important raw materials for the manufacture of traditional and modern medicine. In present decades, there is increasing interest to unlock the secrets of ancient herbal remedies (Izzo and Ernst, 2009).The natural products of plant origin are a rich source of cancer chemotherapy drugs, and exhibited low or almost no toxicity to normal tissues; hence, more attention is being paid to searching for new antitumor agents from natural products (Dai et al., 2011). More than 60% of the anticancer agents used today are derived directly or indirectly from natural sources Cragget al. (1997). "
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    • "Besides a mass usage of antibiotics to combat diseases, more than 50% of all drugs have been derived from natural sources around the globe till date [1] [2] [3] [4] [5] [6] [7] . A number of antibiotics have become almost archaic due to the emergence of resistant or even the multi-resistant strains, or have been reported to be associated with adverse side effects [8] [9] [10] . "
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    ABSTRACT: Objective To examine the prevalence of microorganisms and the antibacterial feature within commonly available flowers including Hibiscus rosa-sinensis, Ixora coccinea, Ipomoea digitata, Allamanda cathartica, Nymphaea nouchali and Vinca rosea, samples were randomly collected from different areas in Dhaka city, Bangladesh. Methods Conventional cultural and biochemical methods were applied to isolate and enumerate the flower accessing microorganisms. Flower extracts were prepared using the solvent extraction methods and the subsequent antibacterial activities were demonstrated. Results The total bacterial load and fungal load was estimated to be around 107-108 CFU/g and 105-107 CFU/g, respectively. All samples were found to be shaded with Staphylococcus spp. (˜107 CFU/g) while the prevalence of actinomycetes was also observed except for Ipomoea digitata. The prevalence of Gram negative pathogenic bacteria was also noted within more than 50% samples. The in vitro antibacterial activity of these flowers, especially of Ixora coccinea, Hibiscus rosa-sinensis, Allamanda cathartica and Nymphaea nouchali in alcoholic extracts (methanol and ethanol) was notable against most of the tested microorganisms. Conclusions The contaminating microbial flora identified within the flower samples studied could be a potential environmental hazard if disseminated. Conversely the revealed antibacterial traits of the flower extracts would be useful alternate remedies of the synthetic drugs for disease medication.
    02/2015; 5(2):91–97. DOI:10.1016/S2222-1808(14)60634-4
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