ArticleLiterature Review

Cardiovascular pharmacotherapy and herbal medicines: The risk of drug interaction

February 2005
International Journal of Cardiology 98(1):1-14

February 2005
98(1):1-14

DOI:10.1016/j.ijcard.2003.06.039

Source
PubMed

Authors:

Angelo Izzo

University of Naples Federico II

Francesca Borrelli

University of Naples Federico II

Edzard Ernst

University of Exeter

Use of herbal medicines among patients under cardiovascular pharmacotherapy is widespread. In this paper, we have reviewed the literature to determine the possible interactions between herbal medicines and cardiovascular drugs. The Medline database was searched for clinical articles published between January 1996 and February 2003. Forty-three case reports and eight clinical trials were identified. Warfarin was the most common cardiovascular drug involved. It was found to interact with boldo, curbicin, fenugreek, garlic, danshen, devil's claw, don quai, ginkgo, papaya, lycium, mango, PC-SPES (resulting in over-anticoagulation) and with ginseng, green tea, soy and St. John's wort (causing decreased anticoagulant effect). Gum guar, St. John's wort, Siberian ginseng and wheat bran were found to decrease plasma digoxin concentration; aspirin interactions include spontaneous hyphema when associated with ginkgo and increased bioavailability if combined with tamarind. Decreased plasma concentration of simvastatin or lovastatin was observed after co-administration with St. John's wort and wheat bran, respectively. Other adverse events include hypertension after co-administration of ginkgo and a diuretic thiazide, hypokalemia after liquorice and antihypertensives and anticoagulation after phenprocoumon and St. John's wort. Interaction between herbal medicine and cardiovascular drugs is a potentially important safety issue. Patients taking anticoagulants are at the highest risk.

Interações medicamentosas entre anticoagulantes e fitoterápicos

Article

Jun 2023

Introdução: Os riscos de interações entre produtos naturais e alopáticos são consideravelmente altos e alarmantes. Por serem de origem natural, são considerados pela maior parte da população como seguras e isentas de toxicidade. É difícil estabelecer a origem de uma interação entre plantas medicinais, fitoterápicos e medicamentos alopáticos, especialmente em pacientes poli medicados, pois muitos compostos químicos presentes nas plantas não possuem seus mecanismos de ação conhecidos. Também deve-se ressaltar que as plantas medicinais possuem mais de um composto ativo, o que aumenta a probabilidade de ocorrência de interações medicamentosas, diante disso, o objetivo deste trabalho foi o de realizar um levantamento de informações existentes na literatura sobre a interação entre alopáticos e fitoterápicos com anticoagulantes. Metodologia: Estudo de revisão bibliográfica, com finalidade integrativa. Resultado: A varfarina e a heparina são medicamentos, e existem várias outras plantas, que apresentam como metabólito secundário as cumarinas, que inibem ou ativam inúmeras enzimas e, quando administradas com anticoagulantes, aumentam o risco de sangramentos. Essa interação ocorre devido à constituição muito complexa das plantas e dos fitoterápicos, ou seja, com muitos compostos químicos que são responsáveis pelas interações com efeito aditivo, antagônico ou sinérgico. Conclusão: Conforme a revisão de literatura, observou se que uso da varfarina e da heparina com interação com tratamentos alopáticos e fitoterápicos tem benefícios e malefícios, se não utilizados corretamente. No entanto, o uso destes fármacos com interação de plantas medicinais (chá verde, boldo, camomila e alho) podem causar sangramentos com potencial hemorrágicos.

Pharmacy practitioners’ practice, awareness and knowledge about herbal products and their potential interactions with cardiovascular drugs

Article

Full-text available

Sep 2022

Background: Herbal medicine use is widespread among patients, as community pharmacies may provide such products. Therefore, pharmacy practitioners should be aware of potential herbal products’ adverse effects and herb-drug interactions, particularly with medications for comorbid diseases, such as cardiovascular drugs, in which pharmacy practitioners need to have good knowledge to provide patients with relevant advice to get optimal and safe therapeutic outcomes. Accordingly, the study is designed to assess the knowledge and awareness of pharmacy practitioners regarding herbal product dispensing and cardiovascular drug interaction in Jordan and view their role in patients’ counselling to set up safe and effective drug use. Methods : A cross-sectional study was conducted in Jordan using an online formatted questionnaire distributed to pharmacy practitioners working in community pharmacies. Descriptive and analytical statistics were performed for the responses using the Statistical Package for the Social Sciences (SPSS) software, version 26. Results: Out of 508 participants, 41.7% had medium knowledge of herbal products pertaining mainly to university education (68.1%); 55.1% of participants dispensed herbal products without prescriptions for obesity and weight reduction (72.8%) and gastrointestinal problems (70.9%); this is because respondents agreed that herbal remedies are safe (28.5%) and effective (38.4%). Whilst the knowledge level of respondents about herbal medicine interaction with cardiovascular medication was medium, with a mean of 1.94, as this interaction may result in potentially serious consequences, 40.7% of respondents strongly agreed to gain more knowledge about the side effects of herbal products and medicine interactions through educational courses. Conclusions: The pharmacy practitioners had medium knowledge of herbal products; however, more attention should be paid to herb-drug interactions in the pharmacy educational curriculum. Additionally, pharmacy practitioners need to refresh their knowledge by attending periodic educational courses and by using reliable resources for information about herbal products in order to provide effective and competent pharmaceutical care.

Pharmacovigilance of Natural Herbal Medicines Research for Efficacy, Safety and Quality Assurance of Phytomedicine Products

Article

Full-text available

Nov 2020

Improved traditional medicine/phytomedicine formulations have gained a global acceptability and popularity as therapeutic agents for many diseases in Sub-Saharan Africa. Herbal products are generally considered as safe, environmentally friendly and increasingly consumed by the community without prescription. There is a lack of systematic data on traditional medicine-associated adverse effects due to complex issues such as products with multiple ingredients, poor standardization, lack of clinical trials, variation in manufacturing processes, contamination, adulteration and misidentification of herbs. The aim of pharmacovigilance is to detect, assess, understand, and prevent the adverse effects or any other possible drug-related problems, related to herbal, traditional and complementary medicines. Pharmacovigilance for herbal medicines is in its infancy, and monitoring the safety of natural products presents unique challenges, and as such, preparations are available from a wide range of sources where limited qualified healthcare professionals are available. The ethico-legal issues and regulatory approval mechanism of herbal medicine vary from country to country. This paper also elucidates the level of challenges associated with herbal pharmacovigilance geared towards improving safety monitoring for herbal medicines in the future.

Patterns of natural health product use at an outpatient heart function clinic

Article

Feb 2023

Background Natural health product (NHP) use is common among Canadians, but the NHPs used by outpatients with cardiovascular conditions such as atrial fibrillation and heart failure have not been identified. Objectives Describe NHP use among outpatient cardiac patients, assess drug interactions and their potential implications and determine NHP documentation by health care providers. Methods Telephone interviews were conducted by the main researcher with patients who attended the Cardiac Clinics at the Royal Columbian Hospital. Medication reconciliation was performed to elicit information regarding NHP use and clinic charts were used to supplement demographic information. Results There were 119 successful interviews. Most patients were approximately 65 years old and male, were diagnosed with atrial fibrillation, had 2 to 3 queried comorbidities and took 2 cardiovascular medications. It was found that 62% of patients use NHPs, and 239 individual NHPs were identified. The most common NHPs used were vitamins and minerals (63%), especially vitamin D (13%), multivitamins (8%) and omega-3s (8%). Interactions between cardiac medications and NHPs occurred in 86% of patients. NHP use was completely documented by health care providers in 24% of patients. Conclusion NHP use is common among patients who attend outpatient cardiac clinics. Interactions between NHPs and cardiovascular medications are prevalent and may carry specific individual patient risks. NHP documentation by health care providers is often incomplete.

Pharmacy practitioners’ attitudes and practice towards herbal products in Jordan: Exploring their knowledge about herbal products potential interactions with cardiovascular medications

Article

Aug 2022

Types of Paeonia and Their Use in Phytotherapy

Article

Full-text available

Jun 2021

Treatment with medicinal herbs dates back to the times before Christ and has been widely used all over the world for years. Today, its importance is increasing day by day and it is widely preferred because it is found more reliable. According to the World Health Organization, 20 thousand plant species are known in modern and traditional medicine. The number of plants used by the cosmetic and botanical industry is not included to the number. It takes many years to recognize a plant and use it in treatment and it is very difficult to protect it. Therefore, it is of great importance to recognize and develop the plants used in phytotherapy in the past. Paeonia L. (Paeoniaceae), known as "peony", is a perennial (geofit) plant with showy and attractive flowers and tubers under the ground. Paeoniaceae family is located in the rich flora of our country and has been used for their many medicinal effects. In this review article, peony species and their use in phytotherapy in Turkey and World were discussed with the studies on the subject.

The use of complementary and alternative medicine among hypertensive and type 2 diabetic patients in Western Jamaica: A mixed methods study

Article

Full-text available

Feb 2021
PLOS ONE

Background: The simultaneous or intermittent use of alternative treatments and prescription medications for hypertension and type 2 diabetes mellitus can have adverse health effects. Objectives: To identify beliefs and practices associated with the use of alternative treatments for hypertension and type 2 diabetes mellitus among patients. Methods: A mixed-methods study including an investigator-administered survey and focus group discussion sessions using convenience sampling was conducted among patients aged ≥18 years during May to August 2018. Descriptive statistics were used to describe and compare demographic characteristics among groups of survey participants using JMP Pro 14.0. Thematic analysis was conducted to analyze the qualitative data using NVivo. Results: Most study participants (87-90%) were on prescription medication for their condition. Of survey participants, 69% reported taking their medication as prescribed and 70% felt that prescription medicine was controlling their condition. Almost all participants (98%) reported using alternative treatments, mainly herbal medications, and 73-80% felt that herbal medicines controlled their conditions. One-third believed that herbal medicines are the most effective form of treatment and should always be used instead of prescription medication. However, most participants (85%) did not believe that prescription and herbal treatments should be used simultaneously. Most (76-90%) did not discuss herbal treatments with their healthcare providers. Four themes emerged from the focus group sessions: 1) Simultaneous use of herbal and prescription medicine was perceived to be harmful, 2) Patients did not divulge their use of herbal medicine to healthcare providers, 3) Alternative medicines were perceived to be highly effective, and 4) Religiosity and family elders played key roles in herbal use. Conclusions: This study provides useful insights into perceptions and use of alternative treatments by patients that can be used by healthcare providers in developing appropriate interventions to encourage proper use of prescription medicines and alternative medicines resulting in improved management of these chronic diseases.

A COMPREHENSIVE REVIEW ON CARDIOPROTECTIVE MEDICINAL PLANTS

Article

Full-text available

Jul 2014

Cardiotoxicity is a condition that occurs during therapy with several cytotoxic drugs and may be the dose limiting factor in the cancer treatment. The use of herbal supplements has become increasingly popular in recent years. Cardiotoxicity appears in several forms, though cardiomyopathy and congestive heart failure are the most important cumulative dose-limiting adverse effects of anthracyclines. Doxorubicin (DOX), an anthracycline antibiotic, is an excellent drug for the treatment of a wide variety of human solid tumors and leukemias. However, its clinical uses are limited by seriously high incidence of cardiotoxicity. DOX causes free radical formation by two major pathways. First, some of flavin-centered, NADPH-dependent reductases are capable to produce a non-electron reduction of anthracyclines to anthracycline semiquinone free radicals that induce apoptosis in cardiomyocytes. Second, anthracycline free radicals may arise via a non-enzymatic mechanism including reactions of anthracyclines and iron. The heart is particularly vulnerable to the free radicals produced by DOX administration, as it contains less free radical detoxifying substances such as superoxide dismutase, glutathione and catalase than do other metabolic organs such as liver or kidney and its highly oxidative metabolism. Additionally, DOX has a very high affinity by cardiolipin, a phospholipid that is present in mitochondrial membranes of heart, resulting in the accumulation of DOX inside cardiac cell. The present review is aimed to elucidate the list of cardioprotective medicinal plants, which are scientifically proved in treating cardiotoxicity.

Changes Induced by Copper Toxicity in the Rat Liver and the Effects of Panax Ginseng on These Changes

Article

Full-text available

Feb 2024

Copper is a trace element that accumulates in the body and forms harmful effects. Panax ginseng is a plant that possesses antioxidant properties. The purpose of this study is to evaluate whether Panax ginseng protects the livers of rats exposed to copper sulfate. The rats were randomly divided into four groups as control, Panax ginseng, copper sulfate and Panax ginseng + copper sulfate. At the end of the trial, blood and liver samples were obtained from the animals. Biochemical analysis was carried out in blood samples. Oxidant and antioxidant parameters were analyzed in liver samples. In addition, liver tissue sections were stained with the hematoxylin-eosin, Masson’s trichrome, periodic acid-Schiff, and rhodanine staining methods for histochemical and histopathological examinations. It was found that serum alanine transaminase (ALT) and aspartate transaminase (AST) levels, also densities of copper and histopathological parameters except for central vein dilatation and malondialdehyde (MDA) value in the liver significantly increased in copper sulfate group compared to control group, but inflammatory cell infiltration and MDA value decreased in Panax ginseng+ copper sulfate group compared to copper sulfate group. In addition, it was determined that glycogen density, glutathione (GSH) level and superoxide dismutase (SOD) activity in the liver significantly decreased in copper sulfate group compared to control group, and they increased in Panax ginseng + copper sulfate group compared to copper sulfate group. As a result, copper sulfate causes structural and oxidative abnormalities in the liver. Additionally, Panax ginseng helps to protect liver tissue by diminishing oxidative damage in copper sulfate toxicity.

Non-pharmacological Methods in the Management of Postoperative Sore Throat in Patients Undergoing Endotracheal Intubation: A Systematic Review

Article

Full-text available

Feb 2024

Healthcare Professionals and Undergraduate Students' Knowledge Toward Drug-Food Interactions in the Eastern Region of Saudi Arabia

Article

Full-text available

Sep 2023

Introduction Drug and Food Interactions (DFI) arise when particular nutrients in food interact with drugs when consumed concurrently, consequently resulting in alterations in the pharmacokinetics, pharmacodynamics, and therapeutic effectiveness of the drug. This study aimed to evaluate the information and understanding of healthcare providers (HCPs) about common DFI. Methods A cross-sectional study was achieved by a self-administered online-based questionnaire to gather data from HCPs in eastern region of Saudi Arabia between Sep. to Oct. 2022. The questionnaire integrated questions related to HCP demographic features and knowledge of DFI. The DFI section included questions that assessed the general knowledge of DFI and knowledge of specific food and drug interactions. Results A total of 401 participants completed the study questionnaire; 41.4% were undergraduate students, 37.2% were pharmacists, 10.5% were nurses, and 9.5% were doctors. Unfortunately, HCPs are unable to recognize several food types that may interact with medications, which may lead to undesirable consequences associated with an enormous financial burden. For instance, only 27.9% of the HCPs stated that patients on monoamine oxidase inhibitors should avoid cheese. In addition, only approximately 11% of HCPs knew that patients on levothyroxine should avoid cauliflower, those taking digoxin should avoid wheat bran, those taking lithium should avoid cola, and those on heparin should avoid calcium-rich food. Overall knowledge was significantly higher among pharmacists and others HCPs with more than 5 years of experience. Discussion and Conclusion This study demonstrated a low level of knowledge regarding specific food and drug interactions among healthcare providers in the eastern region of Saudi Arabia.

Integrated traditional herbal medicine in the treatment of gastrointestinal disorder: the pattern of use and the knowledge of safety among the Eastern Region Saudi population

Article

Full-text available

Oct 2023

Background Herbal medicine is commonly integrated with conventional medicine in Saudi Arabia, especially for the management of digestive disorders. However, the majority of Saudis use herbal remedies without prior consultation with a physician, which raises concerns about their appropriate and safe use. The aim of this study was to assess the level of awareness among the Saudi population regarding the proper utilization and potential adverse effects of frequently used herbs for the treatment of gastrointestinal (GI) diseases. Methods A cross-sectional survey was conducted in Saudi Arabia from January to March 2021. An electronic self-administered questionnaire was distributed. Results A total of 543 participants from different age groups, educational levels, and cities across Saudi Arabia completed the study questionnaire. The most commonly used herbs at home by the participants were: myrrh, parsley, black seed, chamomile, mint, anise, clove, and green tea. 57.7% of the participants perceived herbs as safer than conventional medicines; 27.3% reported that using herbal remedies over conventional medicine was a family tradition, and 21.4% used herbs because they were cheaper than conventional medicines. Conclusion Herbal remedies, including myrrh, parsley, blackseed, chamomile, mint, and anise, are commonly employed for the treatment of gastrointestinal disorders in Saudi Arabia. However, the knowledge level of participants regarding potential side effects and drug-herb interactions was found to be deficient. As such, there is a pressing need for educational campaigns and community awareness programs to elucidate the proper usage of herbal remedies and to caution against their potential adverse effects.

Effect of St. John’s Wort (Hypericum perforatum L.) on Male Sexual and Reproductive Health: A Narrative Review

Article

Full-text available

Oct 2023

Background: Hypericum species are widely acknowledged for their biological attributes, with notable attention being paid to Hypericum perforatum, commonly known as St. John's wort (SJW) within the Hypericum section of the Hypericaceae family. This species is among the most thoroughly investigated herbal medicines, particularly in terms of its application in the management of mild to moderate depression. SJW is used to treat depression, menopausal symptoms, attention-deficit hyperactivity disorder (ADHD), somatic symptom disorder, obsessive-compulsive disorder, and skin conditions, such as wounds and muscle pain. However, the usefulness and effectiveness of SJW for male sexual and reproductive health (SRH) are not well known. Objective: To assess the current evidence in the literature on the effect of SJW on male SRH. Methods: This narrative review followed a predetermined protocol and used MEDLINE and PubMed to identify articles published in English on the effects of SJW on male SRH. The search used various keywords, such as "Hypericum Perforatum", "St. John's Wort", and terms related to sexual and reproductive health issues. Articles published between the inception of the database and August 2023 were included. Results: We identified 12 articles published from 1999 to 2019, the majority of which were experimental and conducted on animals. These studies demonstrate variability in terms of design, sample size, type of SJW extract used, the dosage administered, and duration of treatment. Studies have indicated potential sexual dysfunction (SD) due to SJW, which includes reduced libido, delayed ejaculation, delayed orgasm, and erectile dysfunction. Additionally, reproductive toxicity has been suggested, as evidenced by spermicidal effects through the inhibition of sperm motility, abnormal spermatozoa, chromosomal aberrations, and DNA denaturation. Furthermore, some studies have reported potential adverse events during maternal exposure, inhibition of fertilization, and disruption of reproductive parameters. Conclusions: Our review suggests that the safety and efficacy of SJW in the treatment of human SRH remain unclear. Further comprehensive, well-designed studies with larger samples, longer exposure periods, and specific dosages are needed to clarify SJW's effects of SJW. Therefore, consultation with healthcare professionals before using herbal remedies or supplements is crucial.

Safety Concerns Related to the Simultaneous Use of Prescription or Over-the-Counter Medications and Herbal Medicinal Products: Survey Results among Latvian Citizens

Article

Full-text available

Aug 2023
Int J Environ Res Publ Health

The use of herbal medicines is increasing worldwide. While the safety profile of many herbal medicines is promising, the data in the literature show important interactions with conventional drugs that can expose individual patients to high risk. The aim of this study was to investigate the experience of the use of herbal medicines and preparations and the risks of interactions between herbal and conventional medicines among Latvian citizens. Data were collected between 2019 and 2021 using a structured questionnaire designed for pharmacy customers in Latvia. Electronic databases such as Drugs.com, Medscape, and European Union herbal monographs were reviewed for the risk of drug interactions and potential side effects when herbal medicines were involved. The survey included 504 respondents. Of all the participants, 77.8% used herbal preparations. Most of the participants interviewed used herbal remedies based on the recommendation of the pharmacist or their own initiative. A total of 38.3% found the use of herbal remedies safe and harmless, while 57.3% of respondents regarded the combination of herbal and regular drugs as unsafe. The identified herbal medicines implicated in the potential risk of serious interactions were grapefruit, St. John’s wort, and valerian. As the risks of herb–drug interactions were identified among the respondents, in the future, both pharmacy customers and healthcare specialists should pay more attention to possible herb–drug interactions of over-the-counter and prescription medications.

A dual-modal graph learning framework for identifying interaction events among chemical and biotech drugs

Article

Jul 2023
BRIEF BIOINFORM

Drug-drug interaction (DDI) identification is essential to clinical medicine and drug discovery. The two categories of drugs (i.e. chemical drugs and biotech drugs) differ remarkably in molecular properties, action mechanisms, etc. Biotech drugs are up-to-comers but highly promising in modern medicine due to higher specificity and fewer side effects. However, existing DDI prediction methods only consider chemical drugs of small molecules, not biotech drugs of large molecules. Here, we build a large-scale dual-modal graph database named CB-DB and customize a graph-based framework named CB-TIP to reason event-aware DDIs for both chemical and biotech drugs. CB-DB comprehensively integrates various interaction events and two heterogeneous kinds of molecular structures. It imports endogenous proteins founded on the fact that most drugs take effects by interacting with endogenous proteins. In the modality of molecular structure, drugs and endogenous proteins are two heterogeneous kinds of graphs, while in the modality of interaction, they are nodes connected by events (i.e. edges of different relationships). CB-TIP employs graph representation learning methods to generate drug representations from either modality and then contrastively mixes them to predict how likely an event occurs when a drug meets another in an end-to-end manner. Experiments demonstrate CB-TIP's great superiority in DDI prediction and the promising potential of uncovering novel DDIs.

Phytotherapy in patients with cardiovascular diseases - A descriptive survey in Vojvodina, Serbia

Article

Jul 2023

Improving the safety of prescribing and using antibiotics in the treatment of exacerbations of COPD in hospitalized patients in tertiary care

Article

Dec 2022

Changes in Pharmacokinetics and Pharmacodynamics of Losartan in Experimental Diseased Rats Treated with Curcuma longa and Lepidium sativum

Article

Full-text available

Dec 2022

The current study investigated “pharmacodynamics and pharmacokinetics interactions” of losartan with Curcuma longa (CUR) and Lepidium sativum (LS) in hypertensive rats. Hypertension was induced by oral administration of L-NAME (40 mg/kg) for two weeks. Oral administration of CUR or LS shows some substantial antihypertensive activity. The systolic blood pressure (SBP) of hypertensive rats was decreased by 7.04% and 8.78% 12 h after treatment with CUR and LS, respectively, as compared to rats treated with L-NAME alone. LS and CUR display the ability to potentiate the blood pressure-lowering effects of losartan in hypertensive rats. A greater decrease in SBP, by 11.66% and 13.74%, was observed in hypertensive rats treated with CUR + losartan and LS + losartan, respectively. Further, both the investigated herbs, CUR and LS, caused an increase in plasma concentrations of losartan in hypertensive rats. The AUC0-t, AUC0-inf and AUMC0-inf of losartan were increased by 1.25-fold, 1.28-fold and 1.09-fold in hypertensive rats treated with CUR + losartan. A significant (p < 0.05) increase in AUC0-t (2.41-fold), AUC0-inf (3.86-fold) and AUMC0-inf (8.35-fold) of losartan was observed in hypertensive rats treated with LS + losartan. The present study affirms that interactions between CUR or LS with losartan alter both “pharmacokinetics and pharmacodynamics” of the drug. Concurrent administration of losartan with either CUR or LS would require dose adjustment and intermittent blood pressure monitoring for clinical use in hypertensive patients. Additional investigation is necessary to determine the importance of these interactions in humans and to elucidate the mechanisms of action behind these interactions.

Concurrent use of Chinese herbal medicine and anticoagulants may reduce major bleeding events

Article

Full-text available

Aug 2022
PLOS ONE

Background This retrospective cohort study investigated the risk of major bleeding events during the concurrent use of Chinese herbal medicine (CHM) and anticoagulants in clinical practice. Methods A total of 4,470 patients receiving anticoagulant drugs were selected from Taiwan’s National Health Insurance Research Database (NHIRD). Half (n = 2,235) were also using CHMs (CHM cohort); the other half were not (non-CHM cohort). Each cohort was matched 1:1 using the propensity score. Chi-square testing and the Student’s t -test were used to examine differences between two cohorts. Cox proportional hazard regression analysis assessed the risks for major bleeding events in each cohort, as well as bleeding risks associated with specific CHM formulas and herbs. Cumulative incidence curves for major bleeding events were calculated using Kaplan-Meier analysis. Results Compared with the non-CHM cohort, the CHM cohort had a lower risk of overall bleeding events (p < 0.001) including hemorrhagic stroke (p = 0.008), gastrointestinal (GI) bleeding (p < 0.001), urogenital bleeding (p ≤ 0.001) and nasal/ear/eye bleeding (p = 0.004). Single herbs, such as Glycyrrhiza uralensis et Rhizoma , Panax notoginseng , Panax ginseng , Platycodon grandiflorum , Eucommia ulmoides Oliver and formulas, such as Shu Jing Huo Xue Tang, Shao Yao Gan Cao Tang and Ji Sheng Shen Qi Wan were associated with a lower risk of major bleeding events. Conclusion Using CHMs with anticoagulants appeared to decrease the risk of major bleeding, especially CHMs products containing Glycyrrhiza uralensis et Rhizoma , Panax notoginseng , Panax ginseng , Platycodon grandiflorum and Eucommia ulmoides Oliver . Further investigations are needed to determine whether CHM can maintain the therapeutic efficacy of anticoagulants while simultaneously reducing potential side effects.

Attitude, Beliefs, and Use of Herbal Remedies by Patients in the Riyadh Region of Saudi Arabia

Article

Full-text available

May 2022

Background: The consumption of herbal medicines (HMs) is increasing worldwide, especially in developing countries. This study attempts to investigate and evaluate the patient's perception with regard to the security of HMs, their attitudes towards the concomitant use of HMs with modern medicines, and counseling about their use. Design: Self-administered questionnaire-based cross-sectional survey study. Setting: A self-administered structured questionnaire was administered to 200 patients who received HMs from four different government and private hospitals in the Riyadh region of Saudi Arabia, over a period of three months. Results: The response rate was 74.5%. Out of these, 76.83% of respondents reported using HMs in some form for a variety of conditions. There was no statistically significant relationship between various demographic characteristics and the use of herbs. The majority of the respondents (76.72%) reported using HMs without any professional supervision. This exposes them to the risk of harmful side effects and drug interactions. Conclusions: Physicians and pharmacists should work to provide evidence-based information about HMs to patients about effectiveness and side effects and be vigilant while writing prescriptions and dispensing drugs to them. Patient counseling and education about medication use are required to augment their awareness about their use.

BİR ÜNİVERSİTE HASTANESİNİN KALP VE DAMAR CERRAHİSİ KLİNİĞİNE YATIŞ YAPAN HASTALARDA BESİN TAKVİYELERİNİN KULLANIMI VE ALGILAMALARI

Conference Paper

Full-text available

Sep 2019

GİRİŞ VE AMAÇ: Son yıllarda tüm dünyada bitki kökenli takviyeler de dahil olmak üzere tamamlayıcı ve alternatif tıp uygulamalarının kullanımı oldukça yaygındır. Amerika Birleşik Devletleri’nde (ABD), bu ürünlerin kullanımı geçtiğimiz otuz yılda giderek artmıştır; besin takviyeleri için pazar 590,9 milyon ABD dolarına ulaşmıştır. Besin takviyesi, bir veya daha fazla beslenme gıdaları (vitaminler, mineraller, bitkiler veya diğer botanik ürünler, amino asitler ve bazı başka maddeler) veya bunların bileşenlerinin ağız yoluyla alınmasıdır. Besin takviyelerinin kullanımı kalp cerrahisi geçirecek hastalarda, ameliyat sırası ve sonrasında kanama, sedasyon, hipoglisemi, hepatotoksisite, nefrotoksisite, anestezinin etkinsiz ya da fazla etkin olması, miyokard infarktüsü ve allogreft rejeksiyonuna neden olabilir. Özellikle kalp cerrahisi geçirecek hastalarda ameliyat öncesi kullanılan besin takviyeleri, ameliyat sırası ve sonrası birçok zararlı etkilere sebep olabildiğinden bu hastalardaki kullanım oranları daha dikkatli biçimde izlenmelidir. Bu araştırmanın amacı, Ege Üniversitesi Kalp ve Damar Cerrahisi kliniğine yatış yapan açık kalp cerrahisi geçirecek yetişkin hastalarda besin takviyelerinin kullanım sıklığını, besin takviyelerine yönelik algılarını tanımlamaktır. GEREÇ VE YÖNTEM: Araştırma, tanımlayıcı niteliktedir. Araştırmaya, Ege Üniversitesi Kalp ve Damar Cerrahisi kliniğine açık kalp cerrahi geçirmek üzere yatış yapan araştırmaya katılmayı kabul eden 200 yetişkin hasta alınmış, veriler Ağustos 2018- 2019 tarihleri arasında toplanmıştır. Veri toplamada; literatür doğrultusunda hazırlanan anket formu kullanılmıştır. Verilerin analizleri, IBM SPSS Statistics 25.0 programında yapılmıştır. Verilerin analizinde katılımcıların sosyodemografik özellikleri, besin takviyesi kullanma durumu, besin takviyelerine yönelik etkililik ve güvenlik algısının belirlenmesine ilişkin bilgilerinin elde edilmesinde tanımlayıcı istatistiklerden yararlanılmıştır. BULGULAR: Araştırmaya katılan hastaların %64’ünün besin takviyesi kullandığı, %42’sinin kullandıkları besin takviyelerinin etki/yan etkilerini bilmediği, %97,5’unun herhangi bir yan etkiyle karşılaşmadığı, %18,5’unun kullandıkları ürünleri hekim/hemşireye bildirdiği, en fazla kullanılan besin takviyesinin adaçayı/ıhlamur olduğu saptanmıştır. Hastaların %75’i besin takviyelerini güvenli bulmadığını ifade etmiş, besin takviyelerinin hastalık belirtilerini tedavi etmeyeceği (%62), hastalıkları önlemeyeceği ve iyileştiremeyeceğine (sırasıyla %55, %67) inandıklarını belirtmişlerdir. TARTIŞMA VE SONUÇ: Cerrahi işlem geçirecek hastaların, ameliyat öncesi dönemde besin takviyesi kullandıkları, ve hekim/hemşireye bildirmedikleri, besin takviyesi kullanan ve kullanmayan bireyler arasında güvenlik ve etkinlik konulararında fikir ayrılıklarının olduğu saptanmıştır. Kalp cerrahisi geçirecek hastalarda ameliyat öncesi kullanılan besin takviyeleri, ameliyat sırası ve sonrası birçok zararlı etkilere yol açabildiğinden bu hastalardaki kullanım oranları daha dikkatli biçimde izlenmesi, bu konuda hastanelerde uygulama protokollerin oluşturulması önerilmektedir. Anahtar Kelimeler: Besin takviyesi; hemşirelik; cerrahi CARDIOVASCULAR SURGERY OF A UNIVERSITY HOSPITAL NUTRITIONAL SUPPLEMENT IN PATIENTS ADMITTED TO CLINIC USE AND PERCEPTIONS ABSTRACT INTRODUCTION: In recent years, the use of complementary and alternative medicine, including plant-based supplements, is quite common all over the world. In the United States (USA), the use of these products over the past thirty years; the market for nutritional supplements has reached US $ 590.9 million. Nutritional supplement is the ingestion of one or more nutritional foods (vitamins, minerals, plants or other botanical products, amino acids, and some other substances) or components thereof. The use of nutritional supplements may cause bleeding risk, sedation, hypoglycemia, hepatotoxicity, nephrotoxicity, ineffective or overactive anesthesia, myocardial infarction and allograft rejection in patients undergoing cardiac surgery. Preoperative nutritional supplements, especially in patients who will undergo cardiac surgery, can cause many harmful effects during and after surgery, and their usage rates should be monitored more carefully. The aim of this study is to define the frequency of nutritional supplements and their perceptions about nutritional supplements in adult patients who will undergo open heart surgery in Ege University Cardiovascular Surgery Department. MATERIALS AND METHODS: The research is descriptive study. 200 adult patients who were admitted to Ege University Cardiovascular Surgery Department for open heart surgery were included in this study and the data were collected between August 2018-2019. In data collection; a questionnaire prepared in line with the literature was used. Data were analyzed using IBM SPSS Statistics 25.0. In the analysis of the data, descriptive statistics were used to obtain information about the participants' sociodemographic characteristics, nutritional supplement use, effectiveness and safety perception of nutritional supplements. RESULTS: It was found that 64% of the individuals who participated in the study used nutritional supplements, 42% did not know the effect / side effects of the nutritional supplements, 97.5% did not encounter any side effects, and 18.5% reported the products they used to the physician / nurse. The most commonly used dietary supplement was sage / linden tea. 75% of the patients stated that they did not find nutritional supplements safe and they believed that nutritional supplements would not treat disease symptoms (62%), prevent and cure diseases (55%, 67% respectively). DISCUSSION AND CONCLUSION: It was concluded that the patients who will undergo surgical procedures use nutritional supplements in the preoperative period, and that they do not inform the physician / nurse, that there are differences of opinion about safety and efficacy issues between individuals using and not using dietary supplements. Since preoperative nutritional supplements in patients undergoing cardiac surgery can cause many harmful effects during and after surgery, it is recommended that the usage rates in these patients should be monitored more carefully and application protocols should be established in hospitals. Keywords: Nutritional supplement; nursing; surgery

Toxicology of Herbal Medicines

Chapter

Nov 2021

Bioactive Foods and Medicinal Plants for Cardiovascular Complications of Type II Diabetes: Current Clinical Evidence and Future Perspectives

Article

Full-text available

Sep 2021
EVID-BASED COMPL ALT

Cardiovascular diseases (CVDs) are the main cause of mortality in type 2 diabetes mellitus (T2DM); however, not all patients are fully satisfied with the current available treatments. Medicinal plants have been globally investigated regarding their effect in CVD, yet the field is far from getting exhausted. The current paper aims to provide an evidence-based review on the clinically evaluated medicinal plants and their main therapeutic targets for the management of CVD in T2DM. Electronic databases including PubMed, Cochrane, Embase, Scopus, and Web of Science were searched from 2000 until November 2019, and related clinical studies were included. Lipid metabolism, glycemic status, systemic inflammation, blood pressure, endothelial function, oxidative stress, and anthropometric parameters are the key points regulated by medicinal plants in T2DM. Anti-inflammatory and antioxidant properties are the two most important mechanisms since inflammation and oxidative stress are the first steps triggering a domino of molecular pathological pathways leading to T2DM and, subsequently, CVD. Polyphenols with potent antioxidant and anti-inflammatory effects, essential oil-derived compounds with vasorelaxant properties, and fibers with demonstrated effects on obesity are the main categories of phytochemicals beneficial for CVD of T2DM. Some medicinal plants such as garlic (Allium sativum) and milk thistle (Silybum marianum) have strong evidences regarding their beneficial effects; however, others have low level of evidence which reveals the need for further clinical studies with larger sample sizes and longer follow-up periods to confirm the safety and efficacy of medicinal plants for the management of CVD in T2DM.

Berberine Attenuates MPP+-Induced Neuronal Injury by Regulating LINC00943/miR-142-5p/KPNA4/NF-κB Pathway in SK-N-SH Cells

Article

Full-text available

Aug 2021
NEUROCHEM RES

Berberine plays a neuro-protective role in neurodegenerative diseases, including Parkinson’s disease (PD). Long non-coding RNAs (lncRNAs) play critical roles in PD pathogenesis. The purpose of this study was to investigate whether LINC00943 was involved in the role of berberine in PD. 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) or 1-methyl-4-phenyl pyridine (MPP+) were used to construct PD mouse and cell models, respectively. Cell proliferation was evaluated by Cell Counting Kit-8 (CCK-8) and 5-Ethynyl-2’-deoxyuridine (Edu) assays. Inflammation and cell apoptosis were assessed by enzyme-linked immunosorbent assay (ELISA) and flow cytometry, respectively. Quantitative real-time PCR (qRT-PCR) was employed to test the expression of LINC00943, microRNA (miR)-142-5p, and karyopherin subunit alpha 4 (KPNA4) mRNA. The protein levels of NF-κB pathway-related markers and KPNA4 were measured by western blot. Oxidative stress level was assessed by corresponding kits. The interaction between miR-142-5p and LINC00943 or KPNA4 was determined via dual-luciferase reporter and RNA immunoprecipitation (RIP) assays. Berberine inhibited MPP+-induced injury in SK-N-SH cells by promoting cell proliferation and suppressing inflammation, apoptosis, and oxidative injury. LINC00943 and KPNA4 were upregulated and miR-142-5p was downregulated in PD mouse and cell models. LINC00943 (or KPNA4) overexpression or miR-142-5p inhibition abated the neuro-protective role of berberine in PD cell model. Moreover, miR-142-5p was a target of LINC00943, and KPNA4 could specially bind to miR-142-5p. Additionally, berberine inhibited NF-κB pathway by regulating LINC00943/miR-142-5p/KPNA4 axis. Berberine protected SK-N-SH cell from MPP+-induced neuronal damage via regulating LINC00943/miR-142-5p/KPNA4/NF-κB pathway, highlighting novel evidence for the neuro-protective role of berberine in PD.

Community burden of hypertension and treatment patterns: An in-depth age predictor analysis: (The Rural Community Risk of Non- Communicable Disease Study -Nyive Phase I)

Article

Full-text available

Aug 2021
PLOS ONE

Background This study aimed to describe the burden, treatment patterns and, age threshold for predicting hypertension among rural adults in Nyive in the Ho Municipality of the Volta Region, Ghana. Methods A population-based cross-sectional study design was employed. A total of 417 adults aged 20 years and above were randomly selected from households within the Nyive community. The WHO STEPwise approach for non-communicable diseases risk factor surveillance (STEPS) instrument was used to obtain socio-demographic and clinical information including age, gender, educational background, marital status, and occupation as well as hypertension treatment information. Blood pressure was measured using standard methods. The risk of hypertension and the critical age at risk of hypertension was determined using binary logistic regression model and the receiver-operator characteristics (ROC) analysis. Results The direct and indirect age-standardized hypertension prevalence was higher in males (562.58/487.34 per 1000 residents) compared to the females (489.42/402.36 per 1000 residents). The risk of hypertension among the study population increased by 4.4% (2.9%-5.9% at 95% CI) for one year increase in age while the critical age at risk of hypertension was >39 years among females and >35 years among males. About 64(46.72%) of the hypertensive participants were not on treatment whereas only 42(30.66%) had their blood pressure controlled. Conclusion Rural hypertension is high among adults in Nyive. The critical age at risk of hypertension was lower among males. The estimated annual increase of risk of hypertension was 4.7% for females and 3.1% for males. High levels of undiagnosed and non-treatment of hypertension and low levels of blood pressure control exist among the rural folks.

From Bush Medicine to Modern Phytopharmaceutical: A Bibliographic Review of Devil's Claw (Harpagophytum spp.)

Article

Full-text available

Jul 2021

Thomas Brendler

Devil’s claw (Harpagophytum spp., Pedaliaceae) is one of the best-documented phytomedicines. Its mode of action is largely elucidated, and its efficacy and excellent safety profile have been demonstrated in a long list of clinical investigations. The author conducted a bibliographic review which not only included peer-reviewed papers published in scientific journals but also a vast amount of grey literature, such as theses and reports initiated by governmental as well as non-governmental organizations, thus allowing for a more holistic presentation of the available evidence. Close to 700 sources published over the course of two centuries were identified, confirmed, and cataloged. The purpose of the review is three-fold: to trace the historical milestones in devil’s claw becoming a modern herbal medicine, to point out gaps in the seemingly all-encompassing body of research, and to provide the reader with a reliable and comprehensive bibliography. The review covers aspects of ethnobotany, taxonomy, history of product development and commercialization, chemistry, pharmacology, toxicology, as well as clinical efficacy and safety. It is concluded that three areas stand out in need of further investigation. The taxonomical assessment of the genus is outdated and lacking. A revision is needed to account for intra- and inter-specific, geographical, and chemo-taxonomical variation, including variation in composition. Further research is needed to conclusively elucidate the active compound(s). Confounded by early substitution, intermixture, and blending, it has yet to be demonstrated beyond a reasonable doubt that both (or all) Harpagophytum spp. are equally (and interchangeably) safe and efficacious in clinical practice.

Effect of Licorice and Green Tea Gargle on Post-Extubation Sore Throat, Cough, and Hoarseness: A Triple-blind Clinical Trial

Preprint

Full-text available

Jun 2021

Background Endotracheal extubation is associated with a high prevalence of complications such as sore throat, cough, and hoarseness. This study aimed to compare the effect of green tea and licorice gargle on sore throat, cough, and hoarseness after endotracheal extubation. Method The study was designed as a randomized, triple-blind, controlled clinical trial. 102 patients who were candidates for elective surgery in two specialized hospitals in Tehran, Iran in 2020–2021, were randomly divided into licorice, green tea, and control (placebo) groups. The scores of sore throat, cough, and hoarseness of patients were assessed one hour after endotracheal extubation. After the gag reflex returned, patients were given 100 cc of the prepared solutions to gargle for 30 seconds. The intervention was repeated two hours later. The scores of sore throat, cough, and hoarseness were assessed in the three groups, immediately after the first intervention and two hours after the second intervention. Result There was a significant difference between three groups, in posttest1 and posttest 2 in terms of three variables (P < 0.0001). In addition, both licorice and green tea interventions had a high effect size on the decrease of the studied variables and there was no significant difference between these solutions (P < 0.0167). Conclusion Both green tea and licorice solutions greatly reduced post-extubation complications. These results can be clinical evidence for the use of these two plants to prevent complications of endotracheal extubation. Trial registration This study was registered in the Iranian Registry of Clinical Trials (IRCT) with the code “IRCT20190729044373N1” on 2019-12-27.

Green Tea: Production, Chemical Composition and its Health Benefits

Conference Paper

Full-text available

Nov 2019

Tea is the most consumed beverage in the world -after water- due to its pleasant sensory characteristics, cultural characteristics and health benefits. Tea plant (Camellia sinensis L) belongs to the genus Camellia in the family Theaceae which is a perennial and an evergreen suburb. It is worth to mention that the different types of tea are obtained according to the processing method of the fresh leaves and buds of tea plant. The chemical composition of green tea- which is manufactured by preventing oxidation of phenolic compounds- is very complex. Green tea and its extracts contain a wide variety of bioactive compounds including polyphenols, flavones, phenolic acids, amino acids, alkaloids, carbohydrates, minerals, vitamins and enzymes. Tea is a rich source of phenolic compounds compared to other foods. Green tea contains various polyphenolic compounds which have antioxidant activities. However, the most abundant polyphenols in green tea are catechins, which make up 25-35% of the dry weight of green tea leaves. Among these, epigalocatechin-3-gallate is the most examined due to its bioactive properties and functional value. Numerous researches focused on the health effects of green tea due to its content of biologically active compounds compared to the other tea types. Many studies in the resent years have reported that green tea and its extracts have antiproliferative, antimutagenic, antioxidant, antibacterial, antiviral, antiaging and cholesterol lowering effects. In addition it may actually help in the prevention of cardiovascular, cancer, diabetes, parkinson, alzheimer and other chronic diseases. In this review, production methods, chemical composition and health benefit of green tea have been summarized.

Warfarin: Looking beyond Vitamin K in diet

Article

Full-text available

Dec 2020

Navneet Attri

MECHANISMS OF THE HYPOTENSIVE ACTION OF (HYPERICACEAE) STEM BARK AQUEOUS EXTRACT IN RATS

Article

Full-text available

Mar 2018

Possible Herbal-Drug Interactions An Evidenced Base Review

Article

Oct 2020
Alternative Ther Health Med

Background • The use of herbal/ herbal products has increased from more than a decade. Other than increasing the safety and efficacy of these products, the public needs to be aware of the possible interactions that could occur when combined with conventional drug therapy. Despite the lack of sufficient information on the safety of herbal products, their use as an alternative and complementary medicine is globally widespread. Herbal medicines are now mainly used in active pharmaceutical ingredients. Concurrent usage of natural and prescription medicines is of significant concern. The most significant therapeutic consequence of this approach is the herbal-drug interface (HDI). The proof of HDI is of various degrees of clinical significance utilizing a formal assessment method. Pharmacodynamics HDIs are also recognized for the inherent pharmacological effects of phytochemicals. Objective • The main concern is to mainly highlight the most common Herb-Drug interaction concerning most common herbal-drug interaction. Method • The current review mainly focused on the literature available for the drug-drug interaction in case of most commonly used herbal drugs. Some of the evidence has been compiled through extensive literature survey on different database platforms like Pubmed, Embase and google scholar supporting our review in every aspect of drug-drug interactions reported in these ten years, our team has also tried of including some previous studies by researchers. Result • The data reliability of such data can be questionable in terms of authenticity, but due to availability of some documented case reports, the risk for HDI will be evaluated in a not-clinical health evaluation step of the product development cycle for the increasing number of plant-based pharmacological activities. The primary concern which was seen to be worried was the self- medication of many herbal drugs which are readily available OTC for the consumers. Available evidence on HDIs is inadequate for therapeutic uses; thus, it may need further clinical studies. This is valid from in vitro trials, and clinical research tested for herbal-drugs interactions. Conclusion • The purpose of this article was to gather data to cater an evidence-based discussion and information for providing complete knowledge to existing patients and consumers regarding herbal drug-drug interactions, would also help them a brief knowledge that what can go wrong in case of herbal-drug interaction, in conclusion, we also found that there is still no basic guideline defining the drug-drug interactions.

Guanxinshutong capsule ameliorates cardiac function and architecture following myocardial injury by modulating ventricular remodeling in rats

Article

Full-text available

Oct 2020
BIOMED PHARMACOTHER

Guanxinshutong capsule (GXST), which consists of five traditional Chinese medicines, has been used for a long time in China for the treatment of cardiovascular diseases, such as coronary artery disease and myocardial infarction. However, the effects on GXST on myocardial injury (MI) have not been studied in detail. In these experiments, we found that GXST administration decreased MI-associated ventricular remodeling (VR) with a reduction in interventricular septal thickness in diastole (IVSd), left ventricular posterior wall diameter in systole (LVPWs), and left ventricular posterior wall diameter in diastole (LVPWd) to ameliorate cardiac function and architecture, as measured by echocardiography. Furthermore, histological analysis showed that GXST could ameliorate pathological alterations in the myocardium. And Sirius red staining, wheat germ agglutinin staining and inflammation-related immunohistochemistry results showed that GXST ameliorated the fibrosis areas, cardiac hypertrophy and inflammation (IL-6 and TNF-α). In addition, GXST upregulated intercellular junction proteins (N-cad and Cx-43) and downregulated the angiogenesis-related proteins (PDGF and VEGFA), myocardial fibrosis-related proteins (TGF-β1), and matrix metalloproteinase (MMP-2 and MMP-9). We also found that GXST medium-dose group (1 g/kg/d) dosage was the most efficacious. In conclusion, GXST protected cardiac tissues against MI by reducing VR, thus indicating the potential application of GXST in the treatment of MI.

Toxicity of Signal Grass (Brachiaria Decumbens) :a Review Article Article Info

Article

Full-text available

Jan 2012

Potential herb–drug interactions in community-dwelling older adults in China: the Shanghai Aging Study

Article

Full-text available

Dec 2020
AGING CLIN EXP RES

Background Potential herb–drug interactions (pHDIs) often go unrecognized, and little is known about the prevalence of pHDIs in older adults.AimsThis study aimed to investigate the prevalence of pHDIs in community-dwelling older adults in Shanghai and identify patterns and factors associated with pHDIs.Methods Baseline data from the Shanghai Aging Study, which was designed to establish a prospective community-based cohort of older adults in Shanghai, were analyzed regarding pHDIs with Lexi-Interact Online software.ResultsAmong 1227 participants who used any combination of drug–herb or herb–herb, 43.3% were exposed to at least one pHDI. A total of 1641 different pHDIs were identified among the study samples. Only seven (0.4%) pHDIs were rated as risk category X, indicating that the combinations were contraindicated and should be avoided. Worryingly, 876 (53.4%) pHDIs were rated as risk category D, indicating that significant interactions may occur and therapeutic modification should be considered. Of particular concern is that 99.8% of pHDIs in risk category D involve herbs with anticoagulant/antiplatelet properties. Individuals with stroke (odds ratio [OR] 2.02), hyperlipidemia (OR 1.51) or heart diseases (OR 1.42) and the number of herbs (2.66), number of drugs (OR 1.21), and age (OR 1.02) were significantly associated with the risk of pHDIs.Conclusion43.3% of community-dwelling older adults who used any combination of drug–herb or herb–herb was exposed to pHDIs, and more than half of pHDIs were related to herbs with anticoagulant/antiplatelet properties. Awareness of the patterns and high-risk groups of these pHDIs may contribute to increased patient safety.

Potential Drug–Nutrient Interactions of 45 Vitamins, Minerals, Trace Elements, and Associated Dietary Compounds with Acetylsalicylic Acid and Warfarin—A Review of the Literature

Article

Full-text available

Mar 2024

In cardiology, acetylsalicylic acid (ASA) and warfarin are among the most commonly used prophylactic therapies against thromboembolic events. Drug–drug interactions are generally well-known. Less known are the drug–nutrient interactions (DNIs), impeding drug absorption and altering micronutritional status. ASA and warfarin might influence the micronutritional status of patients through different mechanisms such as binding or modification of binding properties of ligands, absorption, transport, cellular use or concentration, or excretion. Our article reviews the drug–nutrient interactions that alter micronutritional status. Some of these mechanisms could be investigated with the aim to potentiate the drug effects. DNIs are seen occasionally in ASA and warfarin and could be managed through simple strategies such as risk stratification of DNIs on an individual patient basis; micronutritional status assessment as part of the medical history; extensive use of the drug–interaction probability scale to reference little-known interactions, and application of a personal, predictive, and preventive medical model using omics.

Phytotherapeutic approach for conquering menopausal syndrome and osteoporosis

Article

Mar 2024

Women face a significant change in their reproductive health as menopause sets in. It is marred with numerous physiological changes that negatively impact their quality of life. This universal, transition phase is associated with menopausal and postmenopausal syndrome, which may spread over 2–10 years. This creates a depletion of female hormones causing physical, mental, sexual and social problems and may, later on, manifest as postmenopausal osteoporosis leading to weak bones, causing fractures and ultimately morbidity and mortality. Menopausal hormone therapy generally encompasses the correction of hormone balance through various pharmacological agents, but the associated side effects often lead to cessation of therapy with poor clinical outcomes. However, it has been noticed that phytotherapeutics is trusted by women for the amelioration of symptoms related to menopause and for improving bone health. This could primarily be due to their reduced side effects and lesser costs. This review attempts to bring forth the suitability of phytotherapeutics/herbals for the management of menopausal, postmenopausal syndrome, and menopausal osteoporosis through several published research. It tries to enlist the available botanicals with their key constituents and mechanism of action for mitigating symptoms associated with menopause as well as osteoporosis. It also includes a list of a few herbal commercial products available for these complications. The article also intends to collate the findings of various clinical trials and patents available in this field and provide a window for newer research avenues in this highly important yet ignored health segment.

Clinically Relevant Herb-Drug Interactions: A 30-Year Historical Assessment

Article

Mar 2024

Bill J. Gurley

Plant Poisons, Hallucinogens, and Traditional Medicines

Chapter

Jan 2024

Jeffrey K. Aronson

Trigonelline: An Emerging Paradigm for Effective Therapy in Diabetes Mellitus

Article

Full-text available

May 2023

Diabetes Mellitus (DM) is recognized as a critical priority because of its epidemic nature. Successful diabetes treatment is not yet established and nowadays, diabetes is considered a global problem. Recent medications have not proved to be complete treating agents because, until now no one had completely cured diabetes. Current antidiabetic drugs have many undesirable side effects. So, an alternative therapy is required. Nowadays, various plant species are used worldwide as hypoglycemic, antihyperglycemic, antidiabetic and antihyperlipidemic agents. A number of plants contain active metabolites such as alkaloids, flavonoids, glycosides, carotenoids, terpenoids, etc., which are extensively used in antidiabetic drugs. About 400 plant species have been reported as having hypoglycemic activity. From these medicinal plants and their active components, various herbal drugs are being formed. This review aims to understand different plant species used to date for treating diabetes, the therapeutic potential of fenugreek, the active compounds isolated from fenugreek, the chemical structure of trigonelline, therapeutic uses of trigonelline as an antidiabetic agent. Research papers, manuscripts and review papers were searched and relevant contents were studied. One hundred sixty-three papers were included in this review. The review resulted in a better understanding of the use of trigonelline in diabetes treatment.

IN VITRO ANTIOXIDANT AND TOXICOLOGICAL EVALUATION OF HERBAL HEALTH SUPPLEMENTS, CLAIMED AS ANTIOXIDANT BOOSTERS, FROM LOCAL MARKETS OF LAHORE, PAKISTAN

Article

Full-text available

Dec 2022

S. Islam

Our present work was aimed to evaluate in vitro ant-ioxidant potential and cytotoxicity of few locally synthesised herbal health supplements, claimed as antioxidant boosters. Six different samples were collected from famous traditional herbal medicine shops of Lahore, Pakistan. Antioxidant activities of all these synthesized Health supplements were determined by 2,2--diphenyl-1- picrylhydrazyl method (DPPH), TAC antioxidant assay, Hydrogen peroxide (H2O2) assay, and Anti- lipid peroxidation, LPO method. Toxicity study of the Health supplements was also evaluated by Brine Shrimps Toxicity Bioassay (BSLT). Although all the samples are claimed as “Antioxidant boosters” but percentage antioxidant index (%AI) of all the samples was not the same. Supplement Hs5 showed maximum antioxidant activity. The decreasing order of activity of the supplements was: Hs5 (72%) > Hs4 (63%) > Hs2 (42%) > Hs6 (33%) > Hs3 (25%) > Hs1 (21%). Further these supplements showed remarkable variations in their antioxidant potential when samples were analyzed by different assays. All these health supplements did not show significant toxicity at test concentration. Our results reveals that local health supplements are potential source of natural antioxidants and are safe to use at test concentration. This may also justify the use of these supplements for the cure of oxidative stress.

Transmembrane passage of Sulfamethoxazole/Trimethoprim in combination with leaves extracts of Pseudocedrela kotschyi and Crossopteryx febrifuga

Article

Jan 2022

An ultra‐high performance liquid chromatography‐tandem mass spectrometry method for the simultaneous quantitation of 10 alkaloids of Corydalis Decumbentis Rhizoma preparation in dog plasma and its application to a pharmacokinetic study

Article

Oct 2022

Objective: A sensitive and rapid ultra high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method was successfully applied to the determination of ten alkaloids in beagle dog plasma following a single oral dose of Xiatianwu capsules and enteric-coated capsules, with theophylline serving as the internal standard (IS). Methods: Plasma samples were preprocessed using liquid-liquid extraction (LLE) with ethyl acetate ahead to separation using a gradient elution procedure on a Waters ACQUITY UPLC HSS T3 column (1.8 μm, 100×2.1 mm). The mobile phase was composed of 0.1% formic acid solution and acetonitrile at the flow rate of 0.3 mL/min. Multiple reaction monitoring (MRM) was used to determine the analytes in the positive ion mode. Results: The calibration curves for 10 analytes demonstrated a high degree of linearity (r ≥ 0.9920). The lower limit of quantification (LLOQ) values for ten alkaloids were all more than 1.074 ng/mL, and matrix effects varied from 94.25% to 106.15%. The mean extraction recovery of quality control samples at low (LQC), medium (MQC), and high (HQC) concentrations, as well as IS, was all more than 76.60%. The intra-day and inter-day precision (RSD) also satisfied the requirement. Simultaneously, the variation of assay accuracies (RE) was between 13.05% and 9.38%. Conclusion: The test was validated in accordance with regulatory bioanalytical guidelines and was found to be suitable for use in a pharmacokinetic investigation of these compounds in beagle dogs after oral administration of Xiatianwu general capsules and enteric-coated capsules. The Cmax of ten alkaloids ranged from 52.61 ng/mL to 192.46 ng/mL after oral administration of Xiatianwu capsules, and from 67.50 mg/mL to 247.36 ng/mL. The Tmax was between 0.59 h and 1.33 h of Xiatianwu capsules, and between 1.08 h and 2.00 h of enteric-coated capsules. The t1/2 ranged from 3.18 h to 7.47 h of general capsules, and from 6.01 h to 11.36 h. AUC0-t ranged from 181.06 ng·h/mL to 722.74 ng·h/mL of Xiatianwu capsules, and from 275.03 ng·h/mL to 884.17 ng·h/mL of enteric-coated capsules. The Cmax of enteric-coated capsules were significantly increased except for tetrahydropalmatine and berberine. Tmax of general capsules were less than 1 h, and of enteric-coated capsules were less than 2 h. The t1/2 of dehydrocorydaline, palmatine, tetrahydrojatrorrhizine, jatrorrhizine, and coptisine in enteric-coated capsules was longer than that in ordinary capsule. The AUC0-t and AUC0-∞ of bicuculline, dehydrocorydaline, protopine, magnoflorine, tetrahydrojatrorrhizine, jatrorrhizine, berberine, and coptisine were all significantly higher in enteric-coated capsules.

Effect of Licorice and Green Tea Gargle on Post- Extubation Sore Throat, Cough and Hoarseness in Patients Undergoing Elective Surgery: A Randomized Controlled Trial

Article

Full-text available

Aug 2022

Background: Endotracheal extubation is associated with high complications such as sore throat, cough, and hoarseness. Aim: This study was performed aimed to compare the effect of green tea and licorice gargle on sore throat, cough, and hoarseness after endotracheal extubation. Method: This randomized controlled clinical trial was performed in the operating rooms and surgical wards of two hospitals in Tehran during 2020-2021. A total of 102 candidates for elective surgery were allocated to licorice, green tea, and control groups by simple random allocation. The scores of sore throat, cough, and hoarseness were assessed one hour after endotracheal extubation. After the gag reflex returned, 30 cc of the prepared solutions was given to the patients to gargle for 30 seconds. The intervention was repeated two hours later. The scores were assessed in the three groups immediately after the first stage of the intervention (post test1), and two hours after the second stage of the intervention (Post-test 2). Data were analyzed by SPSS software (version 16) and One-way Analysis of Variance-ANOVA, Repeated Measure ANOVA and post hoc test. P<0.05 was considered statistically significant. Results: There was significant difference between the three groups regarding sore throat, cough, and hoarseness variables in the post-test 1 and post-test 2 stages (P<0.05). The intervention groups had significantly reduced scores in three main variables compared to the control group (P< 0.05), but the difference between the two intervention groups was not significant (P> 0.05). Implications for Practice: Gargle of licorice solutions or green tea is recommended as a non-pharmacological and low-cost intervention to reduce post-extubation complications.

Bruk av kosttilskudd og legemidler hos en gruppe personer over 50 år

Article

Mar 2017

Erik Arnesen

Prehospital Use of Herbal Medicine in the Southwestern Ethiopia: Prevalence, Associated Factors and Safety Concern

Preprint

Full-text available

Nov 2021

Background In Ethiopia, despite the frequent reports that demonstrate the use of herbal medicine for treatment of many ailments, there is no finding that describes the prevalence and associated factors with prehospital use of herbal medicine. Therefore, the present study was aimed to assess the prevalence of the prehospital use of herbal medicine and associated factors as well as safety concern in the South western Ethiopia. Methodology A Hospital based cross-sectional study design was employed among patients admitted to Medical wards in Jimma Medical Center (JMC) (n=217) from June to September, 2021. The pre-tested questionnaire was used for data collection. Moreover, literatures were reviewed to identity the potential toxicity and/or drug interactions (if any,) associated with the herbal medicine used before admission by patients. The Statistical Package for Social Science (SPSS) version 21.0 (Chicago, SPSS Inc.) was used for data analysis. The results were summarized using descriptive statistics. The bivariate logistic regression was used to check the association between the outcomes and independent variables. Then, multivariate logistic regression was employed for independent variables possessing p-value of less than 0.05 to identify the strength of association between variables at 5% level of significance. Results The current study revealed that about 34% of respondents revealed the prehospital use of herbal medicine. The majority respondents (78.7%) did not discuss with their health care providers about prehospital use of herbal medicine. The factors like age (AOR: 0.281, 95% CI: 0.115, 0.683), educational level (AOR: 2.672, 95% CI: 1.101, 6.485) and insurance coverage (AOR: 2.082, 95% CI: 1.083, 4.004) were significantly associated with prehospital use of herbal medicine. Moreover, ‘Dammakese’ (Ocimum gratissimum L), ‘Tenadam’ (Ruta chalepensis L), ‘Makkanisa’ (Croton macrostachyus), ‘Jinjibli’ (Zingiber officinale), ‘Barzaafi Adii’ (Eucalyptus globulus Labill), ‘Qabarichoo’ (Echinops kebericho, Mesfin) and ‘Papaya’ (Carica papaya L) were the most commonly used herbs before admission to hospital. From published literatures review we revealed that the Zingiber officinale, Carica papaya L, Eucalyptus globulus Labill and Ruta chalepensis L possess the potential interaction with many conventional medicines as well as toxic effects. Conclusions The present study revealed that the prehospital use of herbal medicine was relatively high in which majority of patients did not disclose to the health care providers. Its use was significantly associated with age, educational level and insurance coverage. In addition, some of herbs used are associated with safety issues. Therefore, health care providers should thoroughly discuss with their patients regarding the prehospital use of herbal medicine.

Concurrent Use of Chinese Herbal Medicine and Anticoagulants May Reduce Major Bleeding Events

Preprint

Full-text available

Jul 2021

Background: This retrospective cohort study investigated the risk of major bleeding events during the concurrent use of Chinese herbal medicine (CHM) and anticoagulants in clinical practice. Methods: A total of 4,470 patients receiving anticoagulant drugs were selected from Taiwan’s National Health Insurance Research Database (NHIRD). Half (n=2,235) were also using CHMs (CHM cohort); the other half were not (non-CHM cohort). Each cohort was matched 1:1 using the propensity score. Chi-square testing and the Student’s t-test were used to examine differences between two cohorts. Cox proportional hazard regression analysis assessed the risks for major bleeding events in each cohort, as well as bleeding risks associated with specific CHM formulas and herbs. Cumulative incidence curves for major bleeding events were calculated using Kaplan-Meier analysis. Results: Compared with the non-CHM cohort, the CHM cohort had a lower risk of overall bleeding events (p < 0.001) including hemorrhagic stroke (p = 0.008), gastrointestinal (GI) bleeding (p < 0.001), urogenital bleeding (p ≤ 0.001) and nasal/ear/eye bleeding (p = 0.004). Single herbs, such as Glycyrrhiza uralensis et Rhizoma, Panax notoginseng, Panax ginseng, Platycodon grandiflorum, Eucommia ulmoides Oliver and formulas, such as Shu Jing Huo Xue Tang, Shao Yao Gan Cao Tang and Ji Sheng Shen Qi Wan were associated with a lower risk of major bleeding events. Conclusions: Using CHMs with anticoagulants appeared to decrease the risk of major bleeding. Further investigations are needed to determine whether CHM can maintain the therapeutic efficacy of anticoagulants while simultaneously reducing potential side effects. Trial registration: Not applicable.

Quantitative and qualitative analyses of herbal medication use among Ghanaian stroke survivors

Article

Jun 2021
J NEUROL SCI

Background Herbal medicines are not regulated by regulatory authorities and are often not of proven safety and efficacy. Anecdotal reports suggest widespread use of traditional herbal medicine (THM) for treatment of stroke in Africa, but verifiable data are limited in published literature. Objective To assess the frequency and reasons for THM use among Ghanaian stroke survivors. Methods We conducted a cross-sectional survey of 106 consecutive stroke survivors presenting for care at a tertiary medical center in Kumasi, Ghana between June and October 2020. Information on demographic, clinical, vascular risk factors and use of THM were collected in a non-judgmental manner and analyzed. Results Among the cohort, 46 (43.4%) reported use of any THM for their stroke management. There was a trend towards fewer women who reported use of THM 34.8% vs 53.3%, p = 0.06. Of those reporting use of THM, 78% had blood pressure > 140/90 mmHg vs. 56% among those not exposed to THM (p = 0.02). Top reasons proffered for use of THM were: expecting them to aid faster recovery from stroke (n = 30), expecting them to cure stroke (n = 18), and expecting them to be of superior effectiveness compared to approved conventional medications of proven efficacy/safety (n = 1). Conclusion Almost half the individuals in this contemporary sample of Ghanaian stroke survivors reported use of THM with expectations for improved outcomes. More counseling is required to inform patients about potential safety issues with THM use, and more research is needed to explore risk/benefit of promising THMs to improve stroke outcomes.

The effect of Guanxin Shutong capsule on alleviating the myocardial fibrosis in heart failure rats

Article

Apr 2021
J ETHNOPHARMACOL

Ethnopharmacological relevance Guanxin Shutong (GXST) capsule is a renowned traditional Chinese medicine widely used for the treatment of cardiovascular diseases in the clinic. However, no pharmacological experimental studies of GXST has been reported on the treatment of pressure overload-induced heart failure. This study aimed to investigate the effects of GXST capsule on ameliorating myocardial fibrosis conditions in pressure overload-induced heart failure rats. Material and Methods Rats were randomly divided into 6 groups: Normal group, Model group, GXST-treated group at a dose of 0.5 g/kg, 1 g/kg, 2 g/kg, respectively, and digoxin positive control group at a dose of 1 mg/kg. After 4 weeks of administration, cardiac function was evaluated by echocardiography. Cardiac injury and fibrotic conditions were evaluated by H&E staining, Masson staining, and Sirius Red staining. Myocardial fibrosis was evaluated by immunohistochemistry staining and western blot. Results GXST significantly inhibited cardiac fibrosis, reduced the excessive deposition of collagen, and finally improved cardiac function. GXST reversed ventricular remodeling might be through the TGF-β/Smad3 pathway. Conclusion GXST capsule demonstrated a strong anti-fibrosis effect in heart failure rats by inhibiting the TGF-β/Smad3 signaling pathway.

PHARMACOVIGILANCE OF AYURVEDIC MEDICINES IN INDIA: AN OVERVIEW

Article

Jun 2020

Chapter 8: Pharmacognosy and Dietary Supplements

Chapter

Jul 2020

Trends in Alternative Medicine Use in the United States, 1990-1997: Results of a Follow-up National Survey

Article

Full-text available

Nov 1998

A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. To document trends in alternative medicine use in the United States between 1990 and 1997. Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively. A total of 1539 adults in 1991 and 2055 in 1997. Prevalence, estimated costs, and disclosure of alternative therapies to physicians. Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.

Probable interaction between warfarin and Ginseng

Article

Full-text available

Apr 1997

Panax ginseng pharmacology: A nitric oxide link?* 1

Article

Full-text available

Aug 1997
BIOCHEM PHARMACOL

C N Gillis

Panax ginseng is used in traditional Chinese medicine to enhance stamina and capacity to cope with fatigue and physical stress. Major active components are the ginsenosides, which are mainly triterpenoid dammarane derivatives. The mechanisms of ginseng actions remain unclear, although there is an extensive literature that deals with effects on the CNS (memory, learning, and behavior), neuroendocrine function, carbohydrate and lipid metabolism, immune function, and the cardiovascular system. Reports are often contradictory, perhaps because the ginsenoside content of ginseng root or root extracts can differ, depending on the method of extraction, subsequent treatment, or even the season of its collection. Therefore, use of standardized, authentic ginseng root both in research and by the public is to be advocated. Several recent studies have suggested that the antioxidant and organ-protective actions of ginseng are linked to enhanced nitric oxide (NO) synthesis in endothelium of lung, heart, and kidney and in the corpus cavernosum. Enhanced NO synthesis thus could contribute to ginseng-associated vasodilatation and perhaps also to an aphrodisiac action of the root. Ginseng is sold in the U.S. as a food additive and thus need not meet specific safety and efficacy requirements of the Food and Drug Administration. Currently, such sales amount to over $300 million annually. As public use of ginseng continues to grow, it is important for this industry and Federal regulatory authorities to encourage efforts to study the efficacy of ginseng in humans by means of appropriately designed double-blind clinical studies.

Herb and Drug Interaction

Chapter

Feb 2018

Herbal medicines have been widely used since ancient times for the treatment of various ailments, and are now gaining popularity worldwide as complementary or alternative treatments for a variety of diseases. Since herbal medicines are regarded as safe, they are often coadministered with many prescribed drugs, and thereby arises the potential of herb-drug interactions (HDIs). Herbal drugs contain more than one pharmacologically active ingredient, which also contributes to HDIs. Simultaneous use of herbs may increase or decrease the effect of prescribed drugs, which can have very serious consequences. The possibility of HDIs had been largely ignored, but the finding that grapefruit juice could impair drug metabolism forced the scientific fraternity to look at the problem more closely. These interactions could be ascribed to both pharmacokinetic and/or pharmacodynamic mechanisms. A significant proportion of reported HDIs are of pharmacokinetic origin, arising from the effects of herbal medicines on metabolic enzymes and/or transporters. Pharmacokinetic alterations may result in changes in absorption, distribution, metabolism, and excretion of the concomitantly prescribed drugs. These changes are clinically very significant as pharmacokinetic parameters such as the area under the plasma concentration-time curve, the maximum plasma concentration, or the elimination half-life of the concomitant drug alter. Induction or inhibition of metabolic enzymes such as cytochrome P450 (CYP3A4, CYP2C9, CYP1A2) and modulation of efflux transporters (P-glycoproteins) are usually the common mechanisms involved in pharmacokinetic interactions. St. John's wort (SJW; Hypericum perforatum) was a widely used herbal medicine for the treatment of affective disorders such as depression and anxiety, until its propensity to cause drug interactions was known. Its active constituents such as hyperforin and amentoflavone induced intestinal P-glycoprotein and hepatic CYP3A4 enzyme, which markedly increased the metabolism of their cosubstrates. SJW is a potent uptake inhibitor of neurotransmitters such as serotonin, norepinephrine, and dopamine. In combination with other drugs that may elevate serotonin levels (serotonin reuptake inhibitors), SJW may contribute to serotonin syndrome, a potentially life-threatening adverse drug reaction. Thus to increase the safety of herbal drug usage the potential for HDI should always be assessed in the preclinical safety assessment phase of the drug development process. More clinically relevant research is also necessary in this domain as the present information on HDI is insufficient for clinical applications.

A guide for health-care for health-care professionals

Article

Jan 1996

Interaction between warfarin and danshen (Salvia miltiorrhiza)

Article

Apr 2001

TYK Chan

OBJECTIVE: TO discuss the potential for an adverse interaction between the Chinese herb danshen, the dry root and rhizome of Salvia miltiorrhiza Bge, and warfarin. DATA SOURCES: A MEDLINE search was performed (from January 1966 through October 2000) using the key words danshen and Salvia miltiorrhiza. Ail articles written in English or with an English extract were considered for review. STUDY SELECTION AND DATA EXTRACTION: Ail studies of antithrombotic effects of danshen or interaction between danshen and warfarin were evaluated. Previous case reports of an adverse interaction between danshen and warfarin were reviewed. DATA SYNTHESIS: Danshen is commonly used in mainland China for the treatment of atherosclerosis-related disorders such as cardiovascular and cerebrovascular diseases. Danshen can affect hemostasis in several ways, including inhibition of platelet aggregation, interference with the extrinsic blood coagulation, antithrombin III-like activity, and promotion of fibrinolytic activity. Single-dose and steady-state studies in rats indicated that danshen increased the absorption rate constants, AUCs, maximum concentrations, and elimination half-lives, but decreased the clearances and apparent volume of distribution of both R- and S-warfarin. Consequently, the anticoagulant response to warfarin was exaggerated. Three cases have previously been published reporting gross overanticoagulation and bleeding complications when patients receiving chronic warfarin therapy also took danshen. CONCLUSIONS: Because of both pharmacokinetic and pharmacodynamic interactions, danshen should be avoided in patients taking warfarin.

Different effects of St. John's Wort on the pharmacokinetics of simvastatin and pravastatin.

Article

Feb 2002

St. John's Wort induces intestinal P-glycoprotein and intestinal and hepatic CYP3A4

Article

Feb 2001

St. John's Wort (SJW, hypericum perforatum) is a frequently used herbal medicine for therapy of mild depression and was reported to substantially decrease blood/plasma concentrations of cyclosporine A and digoxin. We investigated potential mechanisms of these SJW induced drug interactions. In a pre-clinical study, administration of SJW (1000mg/kg/d) extract to rats during 14 days resulted in a 3.8 fold increase of intestinal P-glycoprotein expression and in a 2.5 fold increase in hepatic CYP3A2 expression (western blot analyses). In a clinical study, the oral administration of SJW (3×300mg/d) extract to 8 healthy male volunteers during 14 days resulted in an 18% decrease of the oral AUC(0-7h) of a single digoxin dose (0.5 mg), in 1.4 and 1.5 fold increased expressions of duodenal P-glycoprotein and CYP3A4 (western blot analyses), respectively, and in a 1.4 fold increase in the functional activity of hepatic CYP3A4 (14C-erythromycin breath test). These results indicate direct inducing effects of SJW on intestinal P-glycoprotein (rat, man), on hepatic CYP3A2 (rat) and intestinal and hepatic CYP3A4 (man). They provide a mechanistic explanation for the previously observed drug interactions in patients and support the importance of P-glycoprotein for drug absorption and disposition.

Johanniskraut: Ein Enzyminduktor?

Article

Jan 1999

Cardiovascular benefits and adverse effects of common herbal therapies

Article

Jun 2004

The use of herbal medicine in the United States is increasing even among patients taking prescription medications. Because few data are available regarding the adverse effects of using these therapies alone or in combination with other drugs or supplements, physicians often know little about these remedies. It is especially important for cardiologists to become familiar with the available information because herbal products often affect the cardiovascular system. We provide an overview of the efficacy, adverse effects, and interactions of these therapies on the cardiovascular system.

Interaction of St. John's wort extract with phenprocoumon

Article

Jan 1999

Interaction between fibre and Iovastatin

Article

Sep 1991

WernerO. Richter

Traditional Remedies and Food Supplements

Article

Nov 1997

Since 1991, the Medical Toxicology Unit (MTU) at Guys’ Hospital, London, has been assessing the toxicological problems associated with the use of traditional and herbal remedies and dietary supplements. This assessment was carried out by evaluating reports to the National Poisons Information Service (London) [NPIS(L)] which provides emergency information to medical professionals. Relevant telephone enquiries to NPIS(L) were identified. Further case details were obtained by follow-up questionnaire, clinical consultation, toxicological analysis of samples from patients and/or products and botanical identification of plant material. Of 1297 symptomatic enquiries evaluated there was a possible/confirmed association in 785 cases. Case series have been identified which substantiate previous reports, including liver problems following the use of Chinese herbal medicine for skin disorders, allergic reactions to royal jelly and propolis and heavy metal poisoning caused by remedies from the Indian subcontinent. Although the overall risk to public health appears to be low, certain groups of traditional remedies have been associated with a number of potentially serious adverse effects. Considering the extent of use of herbal remedies and food supplements a comprehensive surveillance system for monitoring the adverse health effects of these products is essential. Surveillance of a large population is needed for the complex task of identifying the uncommon and unpredictable adverse effects which are potentially serious. In the UK, the Medicines Control Agency responded to the MTU report by recognising the need for vigilance and by incorporating adverse reactions reporting on unlicensed herbal remedies into their drug reaction monitoring function. As a further step to safeguard the patients/consumers an effective single regulatory system is required which would ensure the safety and quality of all herbal remedies and food supplements available in the UK.

Interaction between Warfarin and Mango Fruit

Article

May 2002

Different effects of St John's Wort on the pharmacokinetics of simvastatin and pravastatin

Article

Dec 2001

K Sugimoto

Coagulopathy Associated With Vitamin E Ingestion

Article

Dec 1974

James J. Corrigan

Although hypervitaminosis E causes a prolonged prothrombin time and a hemorrhagic state in animals, excessive vitamin E has not previously been found to cause bleeding in normal humans. We have seen a prolonged prothrombin time and ecchymoses develop in a patient who was taking warfarin sodium and clofibrate concomitant with self-administration of vitamin E. The prothrombin time returned to base line after vitamin E ingestion was stopped while warfarin and clofibrate treatment was continued. Coagulation studies demonstrated enhanced reduction of the levels of vitamin K-dependent coagulation factors during the period of vitamin E ingestion, which returned to base-line levels after the patient stopped taking the vitamin. Plasma warfarin levels did not change and platelet function remained normal. The data suggest that patients with vitamin K deficiency may risk hemorrhage if they take vitamin E. (JAMA 230:1300-1301, 1974)

Herbal Drug Curbicin and Anticoagulation Effect with and without Warfarin: Possibly Related to the Vitamin E Component

Article

Jun 2001

Herbal medicines: A guide for health-care professionals

Article

Sep 1996
PHYTOCHEMISTRY

Jeffrey B. Harborne

Trends in alternative medicine use in the United States

Article

Nov 1997

Rational Phytotherapy (A Physicians’ Guide to Herbal Medicine)

Article

Sep 2001
J ETHNOPHARMACOL

Adolfo Andrade Cetto

Adverse Effects of Herbal Treatment of Cardiovascular Disease

Article

May 2001
Heart Dis

Selected Clinical Considerations Focusing on Known or Potential Drug-Herb Interactions

Article

Lucinda G. Miller

Different effects of St John's Wort on the pharmacokinetics of simvastatin and pravastatin

Article

Dec 2001

Objective St John's Wort, a widely used herbal product, is an inducer of CYP3A4 and it decreases blood concentrations of CYP3A4 substrates. The effects of St John's Wort on the pharmacokinetics of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors simvastatin (an inactive lactone pro-drug) and pravastatin were determined in this study.Methods Sixteen healthy male subjects (n = 8 in group 1 and n = 8 in group 2) took a St John's Wort caplet (300 mg) or matching placebo three times a day for 14 days in a double-blind, crossover study. On day 14, a single oral dose of 10 mg simvastatin and 20 mg pravastatin was given to subjects in group 1 and group 2, respectively. Blood samples were obtained during a 24-hour period after the administration of each drug.ResultsRepeated St John's Wort treatment tended to lower plasma simvastatin concentration and significantly (P < .05) lowered concentrations of simvastatin hydroxy acid, its active metabolite. The peak concentration in plasma (ratio, 0.72 of placebo) of simvastatin hydroxy acid tended to be decreased and its area under the plasma concentration-time curve between time zero and 24 hours after administration (ratio, 0.48 of placebo) was significantly decreased (P < .05) by St John's Wort. On the other hand, St John's Wort did not influence plasma pravastatin concentration. No significant differences were observed in the elimination half-life of simvastatin or pravastatin between the placebo and St John's Wort trials.Conclusions This study showed that St John's Wort decreases plasma concentrations of simvastatin but not of pravastatin. Because simvastatin is extensively metabolized by CYP3A4 in the intestinal wall and liver, which are induced by St John's Wort, it is likely that this interaction is partly caused by the enhancement of the CYP3A4-mediated first-pass metabolism of simvastatin in the small intestine and liver.Clinical Pharmacology & Therapeutics (2001) 70, 518-524; doi: 10.1016/S0009-9236(01)64092-X

Complementary/Alternative Medicine: an Evidence‐based Approach

Article

Jun 2010
Focus Alternative Compl Ther

Edzard Ernst

A drug used in traditional medicine, Harpagophytum procumbens: No evidence for NSAID-like effect on whole blood eicosanoid production in human

Article

Sep 1992
PROSTAG LEUKOTR ESS

Devil's Claw (Harpagophytum procumbens), an herbal product being marketed in Canada and in Europe as a home remedy for the relief of arthritic disease, was investigated in healthy humans on eicosanoid production during spontaneously blood clotting. Volunteers took H. procumbens (daily 4 capsules of 500 mg powder containing 3% of total glucoiridoids) for a period of 21 days. The following are the results (mean (SEM)): before H. procumbens intake, prostaglandin (PG)E2 (ng/ml serum): 2.1 (0.4) (n = 25), thromboxane (TX)B2: 147 (27) (n = 25), 6-keto-PGF1 alpha: 4.4 (0.7) (n = 13), leukotriene (LT)B4: 3.4 (0.4) (n = 25); after intake: PGE2: 3.2 (0.6), TXB2: 143 (24), 6-keto-PGF1 alpha: 4.2 (0.9), LTB4: 3.8 (0.6). Each subject serving as her own control, no statistically significant differences were observed between before and after H. procumbens intake. These results indicate that Devil's Claw lacks, at least in healthy humans and under the selected conditions, the biochemical effects on arachidonic acid metabolism of antiarthritic drugs of the non-steroidal antiinflammatory type.

Interaction between fibre and lovastatin

Article

Oct 1991

Ethnopharmacology and the development of natural PAF antagonists as therapeutic agents

Article

May 1991
J ETHNOPHARMACOL

Ginkgolides are unique twenty-carbon terpenes, occurring naturally only in the roots and leaves of Ginkgo biloba. The molecules incorporate a tert-butyl group and six 5-membered rings, and are specific and potent antagonists of platelet-activating factor (PAF), a potent inflammatory autacoid. Studies in animal models with the most potent ginkgolide, BN 52021, and other specific PAF antagonists have demonstrated that PAF plays an important role in pathologies such as asthma, shock, ischemia, anaphylaxis, graft rejection, renal disease, CNS disorders and numerous inflammatory conditions. Ginkgolides are now being developed as therapeutic agents and very promising results have been obtained in clinical trials on shock, organ preservation and thermal injury. In addition to ginkgolides, several other types of natural PAF antagonists have been identified from various medicinal plants. These compounds have not only helped to explain the pharmacological basis of several traditional medicines, but have also provided man with a valuable new class of therapeutic agents.

The effect of wheat bran on the pharmacokinetics of phenprocoumon in normal volunteers

Article

Jul 1985
Klin Wochenschr

Observations of a variable anticoagulatory response in patients being treated by phenprocoumon and wheat bran resulted in a study of seven healthy volunteers. Up to 168 h after the administration of phenprocoumon, both in the fasting state and following the ingestion of 35 g wheat bran in a crossover design, blood samples were taken and urine was collected. The usual pharmacokinetic parameters were calculated from the concentrations measured. Following the ingestion of wheat bran, a decreased absorption rate for phenprocoumon but no decrease in overall bioavailability was observed. In addition, a decrease in total body clearance of phenprocoumon and an increase in the free plasma fraction of phenprocoumon, resulting in decreased free drug clearance, was seen after wheat bran administration. No differences were observed in the urinary excretion of either phenprocoumon or its metabolite. These findings cannot be completely explained by our present knowledge and need further investigation.

Influence of wheat bran and of a bulk-forming ispaghula cathartic on the bioavailability of digoxin in geriatric in-patients

Article

Feb 1987

The present randomized study compared the influence of a gel-forming wheat bran with a nongel-forming bulk cathartic (an ispaghula formulation, Vi-Siblin S) on the steady state concentrations of digoxin in plasma in 30 geriatric in-patients treated with either combination (16 with wheat bran + digoxin, 14 with ispaghula + digoxin) for 4 weeks. After 2 but not after 4 weeks, wheat bran reduced the digoxin levels, although the levels were still within the therapeutic range. Ispaghula had no influence at any time. It is concluded that neither wheat bran nor the ispaghula formulation has any clinically relevant influence on therapeutic digoxin levels in geriatric patients.

Dong quai

Article

Feb 1987

David P.Q. Zhu

The Chinese people discovered Dong Quai and used it as a tonic and spice. Women especially have used Dong Quai to protect their health, generation after generation. This paper reviews the pharmacological effect, toxicity and dosage formula of Dong Quai, based on the modern concept.

The Effect of a Medicinal Chinese Herb on Platelet Function

Article

Jan 1983

We investigated the effect of the Chinese herb Injectio Salvia Miltiorrhizae (ISM) on human platelet function in vitro. ISM inhibited platelet aggregation and serotonin release induced by either ADP or epinephrine in a dose dependent manner. This effect of ISM was observed with both gel-filtered platelets (ID50 = 8-30 micrograms ISM/ml gel-filtered platelets) and platelets in plasma (ID50 = 400-900 micrograms ISM/ml of platelet-rich plasma). The active molecule(s) in ISM was heat stable, resistant to acid, base and proteolysis and fractionated on Sephadex 6-25 at MW approximately 280. ISM did not interact with the platelet alpha-adrenergic receptor, but increased cAMP in intact platelets. The results are consistent with the concept that ISM inhibition of platelet aggregation and release is mediated by an increase in platelet cAMP. The exact mechanism whereby ISM increases platelet cAMP appears to be that of inhibition of cyclic AMP phosphodiesterase. The effect of ISM on platelet function is one mechanism which might explain the therapeutic effect of ISM in experimental and clinical coronary artery disease.

Effect of guar gum, a fibre preparation, on digoxin and penicillin absorption in man

Article

Feb 1984

The effect of guar gum on the absorption of digoxin and phenoxymethyl penicillin was studied in a double blind study in 10 healthy volunteers. Guar gum reduced serum digoxin concentration during the early absorption period, but a similar amount of digoxin was found in 24 h urine whether given with or without guar gum. Both the peak penicillin concentration and the area under the serum curve were significantly reduced by the gum.

Severe hypokalaemia with paralysis induced by small doses of liquorice

Article

Aug 1980

A patient, who presented with a flaccid quadriplegia due to profound hypokalaemia, is described. Hypokalaemia and myoglobinuria were caused by the ingestion of small amounts of liquorice contained in a laxative preparation. Subsequent controlled administration of small amounts of this preparation induced marked hypokalaemia. This was associated with sodium retention and potassium loss confirming a mineralocorticoid-like action. The sodium retention was associated with suppression of plasma levels of renin and aldosterone.

Warfarin interactions with Chinese traditional medicines: Danshen and methyl salicylate medicated oil [2]

Article

Jul 1995
Aust New Zeal J Med

The Effects of Danshen (Salvia miltiorrhiza) on Warfarin Pharmacodynamics and Pharmacokinetics of Warfarin Enantiomers in Rats

Article

Jun 1995

The effects of Danshen (Salvia miltiorrhiza), a popular traditional Chinese medicinal herb on the pharmacokinetics and pharmacodynamics of R- and S-warfarin stereoisomers were studied in rats. After a single oral dose of racemic warfarin (2 mg kg−1), treatment with oral Danshen extract (5 g kg−1, twice daily) for 3 days significantly altered the overall pharmacokinetics of both R- and S-warfarin and increased the plasma concentrations of both enantiomers over a period of 24 h and the prothrombin time over 2 days. At steady-state levels of racemic warfarin (0·2 mg kg−1 day−1 for 5 days) the 3-day treatment of Danshen extract (5 g kg−1, twice daily) not only prolonged the prothrombin time but also increased the steady-state plasma concentrations of R- and S-warfarin. The results indicate that Danshen extracts can increase the absorption rate constant, area under plasma concentration-time curves, maximum concentrations and elimination half-lives, but decreases the clearances and apparent volume of distribution of both R- and S-warfarin. The pharmacokinetic and pharmacodynamic interactions of warfarin during co-treatment with Danshen extract observed in this study indicate an explanation for the clinically observed incidents of exaggerated warfarin adverse effects when traditional Chinese medicinal herbs or herbal products such as Danshen and Danggui (observed in a previous study) were co-administered.

Garlic and the risk of TURF bleeding

Article

Nov 1995
Br J Urol

Spontaneous bilateral subdural hematoma associated with chronic Gingko biloba ingestion

Article

Jul 1996

Elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng

Article

Sep 1996

S McRae

A 74-year-old man taking a constant dose of digoxin for many years was found to have an elevated serum digoxin level with no signs of toxic effects. Common causes of elevated serum digoxin were ruled out, and the patient's digoxin level remained high after digoxin therapy was stopped. The patient then revealed that he was taking Siberian ginseng, a popular herbal remedy. The patient stopped taking ginseng, and the serum digoxin level soon returned to an acceptable level. The digoxin therapy was resumed. The patient resumed taking ginseng several months later, and the serum digoxin level again rose. Digoxin therapy was maintained at a constant daily dose, the ginseng was stopped once more, and the serum digoxin levels again returned to within the therapeutic range. It is unclear whether some component of the ginseng was converted to digoxin in vivo, interfered with digoxin elimination or caused a false serum assay result. The author cautions physicians to be alert to the potential for herbal remedies to interact with prescribed medications and to affect biochemical analyses.

Effect of Tamarindus indica L. on the bioavailability of aspirin in healthy human volunteers

Article

Sep 1996

The influence of Tamarindus indica L. fruit extract incorporated in a traditional meal on the bioavailability of aspirin tablets 600 mg dose was studied in 6 healthy volunteers. There was a statistically significant increase in the plasma levels of aspirin and salicylic acid, respectively, when the meal containing Tamarindus indica fruit extract was administered with the aspirin tablets than when taken under fasting state or with the meal without the fruit extract. The Cmax, AUC0-6h and t1/2 for aspirin increased from 10.04 +/- 0.1 mg/ml to 28.62 +/- 0.21 mg/ml (P < 0.05); 14.03 +/- 0.11 mg/ml.h to 86.51 +/- 0.21 mg/ml.h (P < 0.085) and 1.04 +/- 0.12 h to 1.50 +/- 0.44 h (P < 0.05) respectively. There was no change in the tmax (0.50 +/- 0.17 h) but there was a decrease in the kel from 0.633 +/- 0.22 to 0.463 +/- 0.29 (P < 0.05). Similarly, the Cmax, AUC0-6h and kel for salicylic acid rose from 43.84 +/- 0.21 mg/ml to 68.19 +/- 0.71 mg/ml (P < 0.05); 171.59 +/- 0.07 mg/ml.h to 266.22 +/- 0.21 mg/ml/.h (P < 0.05) and 7.37 +/- 0.29 to 19.30 +/- 0.21 (P < 0.05), respectively. The tmax decreased from 2.0 +/- 0.18 h to 1.0 +/- 0.08 h (P < 0.05) and t1/2 from 0.25 +/- 0.21 h to 0.184 +/- 0.11 h (P < 0.05). The study has indicated that Tamarindus indica L. fruit extract significantly increased the bioavailability of aspirin.

Spontaneous Hyphema Associated with Ingestion of Ginkgo biloba Extract

Article

May 1997

To the Editor: Spontaneous bleeding from the iris into the anterior chamber of the eye is a rare problem.1 We report a case associated with the ingestion of Ginkgo biloba extract, an over-the-counter herbal medication that has recently also been linked to a spontaneous subdural hemorrhage.2,3 A 70-year-old man presented after two days of recurrent blurred vision in the right eye, with each episode lasting 15 minutes, during which he could perceive a red discoloration through his cornea. One week earlier he had begun twice-daily ingestion of a Ginkoba tablet from his health-food store. Each tablet contained 40 mg . . .

Chinese herbs and warfarin potentiation by 'Danshen

Article

May 1997

Yu CM, Chan JCN, Sanderson JE (Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong). Chinese herbs and warfarin potentiation by 'Danshen'. J Int Med 1997: 241: 337-9. Drug interactions with warfarin can be dangerous and although common drug interactions are now well recognized those with Chinese herbs are not widely appreciated. 'Danshen' is a herbal medicine often used for various complaints, particularly cardiovascular, in the Chinese community. We report a case of danshen-induced overcoagulation with severe and dangerous abnormalities of clotting in a patient with rheumatic heart disease.

Effect of Viscous Fiber (Guar) on Postprandial Motor Activity in Human Small Bowel

Article

Aug 1997

Both caloric value and chemical composition ofa meal have been shown to regulate postprandial smallbowel motility in dog. In the same species, duration ofand contractile activity within the postprandial period also depends on mean viscosity. It isunknown, however, whether meal viscosity and fibercontent also regulate small bowel motor activity in man.In human volunteers, we therefore studied the effect of guar gum on small bowel motor response toliquid and solid meals. Twenty-six prolonged ambulatorysmall bowel manometry studies were performed in 12volunteers. A total of 620 hr of recording were analyzed visually for phase III of the MMC and avalidated computer program calculated the incidence andamplitude of contractions after ingestion of water (300ml), a pure glucose drink (300 ml/330 kcal) or a solid meal (530 kcal) with and without 5 g of guargum. Addition of 5 g of guar gum did not significantlydelay reappearance of phase III after ingestion of water(59 ± 11 vs 106 ± 21 min; P = 0.09).However, guar gum significantly prolonged duration ofpostprandial motility pattern both after the glucosedrink (123 ± 19 vs 199 ± 24 min; P -1), after the glucose drink (1.6 ±0.4 vs 1.7 ± 0.3 min-1) and after the solid meal (2.4 ± 0.4 vs 2.6 ±0.4 min-1). Likewise, mean amplitude ofcontractions was not affected by guar gum after water(22.8 ± 1.4 vs 20.9 ± 1.9 mm Hg), afterthe glucose drink (20.5 ± 1.4 vs 21.3 ±1.2), and after the solid meal (20.3 ± 1.5 vs 21.5± 1.6 mm Hg). Thus a guar gum-induced increase inchyme viscosity markedly prolonged duration ofpostprandial motor activity in the human small bowel.Contractile activity within the postprandial period, however, wasnot affected. We suggest that the postprandial motilitypattern persisted longer after the more viscous meals,because gastric emptying and intestinal transit were delayed by guar gum. We conclude that itis essential to define meal viscosity and fiber contentwhen studying postprandial small bowelmotility.

Traditional Remedies and Food Supplements: A 5Year Toxicological Study (1991-1995)

Article

Dec 1997

Since 1991, the Medical Toxicology Unit (MTU) at Guys' Hospital, London, has been assessing the toxicological problems associated with the use of traditional and herbal remedies and dietary supplements. This assessment was carried out by evaluating reports to the National Poisons Information Service (London) [NPIS(L)] which provides emergency information to medical professionals. Relevant telephone enquiries to NPIS(L) were identified. Further case details were obtained by follow-up questionnaire, clinical consultation, toxicological analysis of samples from patients and/or products and botanical identification of plant material. Of 1297 symptomatic enquiries evaluated there was a possible/confirmed association in 785 cases. Case series have been identified which substantiate previous reports, including liver problems following the use of Chinese herbal medicine for skin disorders, allergic reactions to royal jelly and propolis and heavy metal poisoning caused by remedies from the Indian subcontinent. Although the overall risk to public health appears to be low, certain groups of traditional remedies have been associated with a number of potentially serious adverse effects. Considering the extent of use of herbal remedies and food supplements a comprehensive surveillance system for monitoring the adverse health effects of these products is essential. Surveillance of a large population is needed for the complex task of identifying the uncommon and unpredictable adverse effects which are potentially serious. In the UK, the Medicines Control Agency responded to the MTU report by recognising the need for vigilance and by incorporating adverse reactions reporting on unlicensed herbal remedies into their drug reaction monitoring function. As a further step to safeguard the patients/consumers an effective single regulatory system is required which would ensure the safety and quality of all herbal remedies and food supplements available in the UK.

Association of Gingko Biloba with intracerebral hemorrhage

Article

Jul 1998

Michael K. Matthews

A taste of Chinese medicine!

Article

Oct 1998
ANN THORAC SURG

We report a case of profound anticoagulation caused by interaction between warfarin and danshen, a widely used Chinese herbal medicine, in a patient who had undergone mitral valve replacement. Patients taking warfarin should be warned not to take this herb. In addition, physicians should be alert to the possibility of an interaction with herbal medicine when anticoagulation control becomes difficult and no other causes are apparent. (Ann Thorac Surg 1998;66:941-2) (C) 1998 by The Society of Thoracic Surgeons.

Herbal medicinals: Selected clinical considerations focusing on known or potential drug-herb interactions

Article

Dec 1998
ARCH INTERN MED

L G Miller

Herbal medicinals are being used by an increasing number of patients who typically do not advise their clinicians of concomitant use. Known or potential drug-herb interactions exist and should be screened for. If used beyond 8 weeks, Echinacea could cause hepatotoxicity and therefore should not be used with other known hepatoxic drugs, such as anabolic steroids, amiodarone, methotrexate, and ketoconazole. However, Echinacea lacks the 1,2 saturated necrine ring associated with hepatoxicity of pyrrolizidine alkaloids. Nonsteroidal anti-inflammatory drugs may negate the usefulness of feverfew in the treatment of migraine headaches. Feverfew, garlic, Ginkgo, ginger, and ginseng may alter bleeding time and should not be used concomitantly with warfarin sodium. Additionally, ginseng may cause headache, tremulousness, and manic episodes in patients treated with phenelzine sulfate. Ginseng should also not be used with estrogens or corticosteroids because of possible additive effects. Since the mechanism of action of St John wort is uncertain, concomitant use with monoamine oxidase inhibitors and selective serotonin reuptake inhibitors is ill advised. Valerian should not be used concomitantly with barbiturates because excessive sedation may occur. Kyushin, licorice, plantain, uzara root, hawthorn, and ginseng may interfere with either digoxin pharmacodynamically or with digoxin monitoring. Evening primrose oil and borage should not be used with anticonvulsants because they may lower the seizure threshold. Shankapulshpi, an Ayurvedic preparation, may decrease phenytoin levels as well as diminish drug efficacy. Kava when used with alprazolam has resulted in coma. Immunostimulants (eg, Echinacea and zinc) should not be given with immunosuppressants (eg, corticosteroids and cyclosporine). Tannic acids present in some herbs (eg, St John wort and saw palmetto) may inhibit the absorption of iron. Kelp as a source of iodine may interfere with thyroid replacement therapies. Licorice can offset the pharmacological effect of spironolactone. Numerous herbs (eg, karela and ginseng) may affect blood glucose levels and should not be used in patients with diabetes mellitus.

Unsafe and potentially safe herbal therapies

Article

Feb 1999

Unsafe and potentially safe herbal therapies are discussed. The use of herbal therapies is on the rise in the United States, but most pharmacists are not adequately prepared educationally to meet patients' requests for information on herbal products. Pharmacists must also cope with an environment in which there is relatively little regulation of herbal therapies by FDA. Many herbs have been identified as unsafe, including borage, calamus, coltsfoot, comfrey, life root, sassafras, chaparral, germander, licorice, and ma huang. Potentially safe herbs include feverfew, garlic, ginkgo, Asian ginseng, saw palmetto, St. John's wort, and valerian. Clinical trials have been used to evaluate feverfew for migraine prevention and rheumatoid arthritis; garlic for hypertension, hyperlipidemia, and infections; ginkgo for circulatory disturbances and dementia; ginseng for fatigue and cancer prevention; and saw palmetto for benign prostatic hyperplasia. Also studied in formal trials have been St. John's wort for depression and valerian for insomnia. The clinical trial results are suggestive of efficacy of some herbal therapies for some conditions. German Commission E, a regulatory body that evaluates the safety and efficacy of herbs on the basis of clinical trials, cases, and other scientific literature, has established indications and dosage recommendations for many herbal therapies. Pharmacists have a responsibility to educate themselves about herbal therapies in order to help patients discern the facts from the fiction, avoid harm, and gain what benefits may be available.

Herbal Remedies: Adverse Effects and Drug Interactions

Article

Apr 1999
AM FAM PHYSICIAN

Melanie Johns Cupp

A growing number of Americans are using herbal products for preventive and therapeutic purposes. The manufacturers of these products are not required to submit proof of safety and efficacy to the U.S. Food and Drug Administration before marketing. For this reason, the adverse effects and drug interactions associated with herbal remedies are largely unknown. Ginkgo biloba extract, advertised as improving cognitive functioning, has been reported to cause spontaneous bleeding, and it may interact with anticoagulants and antiplatelet agents. St. John's wort, promoted as a treatment for depression, may have monoamine oxidase-inhibiting effects or may cause increased levels of serotonin, dopamine and norepinephrine. Although St. John's wort probably does not interact with foods that contain tyramine, it should not be used with prescription antidepressants. Ephedrine-containing herbal products have been associated with adverse cardiovascular events, seizures and even death. Ginseng, widely used for its purported physical and mental effects, is generally well tolerated, but it has been implicated as a cause of decreased response to warfarin. Physicians must be alert for adverse effects and drug interactions associated with herbal remedies, and they should ask all patients about the use of these products.

Possible Influences of Ginseng on the Pharmacokinetics and Pharmacodynamics of Warfarin in Rats

Article

Feb 1999

We evaluated the significance of a reported clinical case of drug-drug interaction between ginseng and warfarin using a robust pharmacokinetic/pharmacodynamic approach in a rat model. The influence of ginseng on the pharmacokinetics and pharmacodynamics of oral warfarin after a single dose (2 mg kg−1) and at steady state (0.2 mg kg−1 daily × 6 days) was studied in male Sprague-Dawley rats. Prothrombin time was employed as a pharmacodynamic index. Warfarin plasma concentration and vitamin K content in the ginseng extract were assessed by validated HPLC assays. The pharmacokinetics of warfarin after a single dose were not altered in the presence of ginseng; peak plasma concentration (control 7.8 ± 0.5; ginseng 7.3 ± 2.5 μg mL−1), time to peak (control 2.6 ± 1.0; ginseng 3.1 ± 1.1h), elimination half-life (control 14.3 ± 5.8; ginseng 10.6 ± 3.1h), and oral clearance (control 17.5 ± 3.3; ginseng 20.2 ± 5.5 mL h−1) were not significantly different (P > 0–05). Similarly, alterations in the pharmacokinetics of warfarin were not detected under the multiple dosing paradigm. Under both dosing conditions, ginseng also showed no significant impact on the pharmacodynamics of warfarin as assessed by the area under the prothrombin time vs time curve (multiple dosing; control 3776 ± 619, ginseng 3830 ± 362 s h) and maximum prothrombin time (control 57.2 ± 11.8, ginseng 63.3 ± 9.1 s). Furthermore, the content of vitamin K was undetectable in the ginseng decoction. In conclusion, current data obtained in the rat showed no significant impact of ginseng on the pharmacokinetics/pharmacodynamics of warfarin when they are concomitantly administered.

Effects of arachidonic acid, prostaglandins, retinol, retinoic acid and cholecalciferol on xenobiotic oxidations catalysed by human cytochrome P450 enzymes

Article

Apr 1999

1. Effects of arachidonic acid, prostaglandins, retinol, retinoic acid and cholecalciferol on xenobiotic oxidations catalysed by 12 recombinant human cytochrome P450 (P450 or CYP) enzymes and by human liver microsomes have been investigated. 2. Arachidonic acid (50 microM) significantly inhibited CYP1A1- and 1A2-dependent 7-ethoxycoumarin O-deethylations, CYP2C8-dependent taxol 6alpha-hydroxylation and CYP2C19-dependent R-warfarin 7-hydroxylation. This chemical also inhibited slightly the xenobiotic oxidations catalysed by CYP1B1, 2B6, 2C9, 2D6, 2E1 and 3A4 in recombinant enzyme systems. 3. Retinol, retinoic acid and cholecalciferol were strong inhibitors for xenobiotic oxidations catalysed by recombinant CYP1A1, 2C8 and 2C19. 4. Dixon plots of inhibitions of CYP1A1-, 1A2-, 2C8- and 2C19-dependent xenobiotic oxidations by arachidonic acid, of CYP1A1-, 2B6- and 2C19-dependent activities by retinol, and of CYP1A1- and 2C19-dependent activities by cholecalciferol indicated that these chemicals inhibit P450 activities mainly through a competitive mechanism. 5. In human liver microsomes, arachidonic acid inhibited CYP1A2-dependent theophylline hydroxylation, CYP2C8-dependent taxol 6alpha-hydroxylation and CYP2C19-dependent omeprazole 5-hydroxylation. Taxol 6alpha-hydroxylation was also inhibited by retinol and retinoic acid, and omeprazole 5-hydroxylation was inhibited by retinol in human liver microsomes. 6. These results suggest that xenobiotic oxidations by P450 enzymes are affected by endobiotic chemicals and that the endobiotic-xenobiotic interactions as well as drug-drug interactions may be of great importance when understanding the basis for pharmacological and toxicological actions of a number of xenobiotic chemicals.

Cardiovascular pharmacotherapy and herbal medicines: The risk of drug interaction

Abstract

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