HERB-DRUG INTERACTIONS
S.RUPESH KUMAR
T.SRI KRISHNA*
PRESENTED BY
4th YEAR B.PHARM
Under the guidance of
HERB-DRUG INTERACTIONS
INTRODUCTION When Herbal Medicinal Products and Western drugs
administered together may interact each other in body leading to kinetic and dynamic alterations
Herbs are often administered in combination with therapeutic drugs, raising the potential of herb-drug interactions.
An estimated 5-20% of general people consume herbal medicines because
1. Naturally available2. Consideration of safe to use3. Ready available
Adverse Events and Drug-Interaction Caused by Herbal or Traditional Medicines by the study of
– ANIMAL STUDY
– CONTROLLED TRIAL
– SINGLE CASE REPORT
– MULTIPLE CASE REPORTS
EVIDENCE
Facts about drug interactions/herbal medicine/
herb-drug interactions Drug interactions - 4th – 6th Cause of
death At least 100 preoperative fatalities
due to herb -drug/surgery interactions
>70 – 80 Herbs - Increase risk of bleeding
>30 – 40 Herbs possibility of causing hepatic failure
Ephedra – 54 deaths , 1600 Adverse events
Aloe vera injection – 4 Deaths Pennyroyal tea – 2 infants
Multiorgan Dysfunction Aristolochic Acid – Death of 100
Belgian Women
HERB-DRUG INTERACTIONS
PHARMACOKINETIC PHARMACODYNAMIC
Related to action of herb and drug
Interactions can be predicted
Antagonism or Synergism
Modify metabolic pathways in body
Mainly occur in
GIT
Kidney
Liver
EFFECT OF HERBS ON PHARMACOKINETICS
INCREASED DECREASED
ABSORPTION GingerGreen Tea
Black Pepper
FibresMucilage
herbs
METABOLISM
Guggul Grape fruit
ELIMINATION
LaxativeDiuretic
herbs
Liquorice
REASONS FOR HERB-DRUG INTERACTION
oClinicians lack of adequate knowledge of combinations
oNo quality assurance for purity and potency
oNo advancement in research
– May ↑ bleeding times with anticoagulants– ↓ blood levels and toxicity of protease inhibitors like ritonavir, indinavir….etc
May ↑ bleeding with anticoagulants↓ effect of antacids
Ginger might decrease blood sugar
High blood pressure (Calcium channel blockers) interacts with GINGER
Insulin, Chlorpropamide , Glipizide, Tolbutamide
verapamil , felodipine , amlodipin
GINGER:
GARLIC:
BLACKPEPPERBlack and white pepper might decrease how quickly the liver breaks down some medications
lovastatin (Mevacor) ketoconazole (Nizoral) Itraconazole (Sporanox), …etc.
It will decrease the action of antacidsThe black pepper majorly shows interaction and increase the AUC of The drugs are:
Phenytoin (Dilantin)Carbamazepine (Tegretol) tranquilizers
Propranolol (Inderal)
RifampinTheophylline
in healthy volunteers
in patients with pulmonary tuberculosis.
CINNAMON
Taking cinnamon bark along with diabetes medications might cause your blood sugar to go too low.
Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.
Decreased effectiveness of Fluoroquinolones, Increased risk of photo toxicity with tetracycline's
It increase the AUC of anti hypertensive's.
Medications that can harm the liver (Hepatotoxic drugs) interacts with CASSIA CINNAMON these are miodarone, carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), methyldopa ,and others.
CLOVE BUDS
Clove contains eugenol. Eugenol is the part of clove that might slow blood clotting.
It may increase the bleeding with drugs such as anticoagulants (heparin, warfarin ), and NSAIDS like aspirin, diclofenac, ibuprofen, naprox, and others.
In children decrease the effect of anti-epileptic drugs as phenytoin by damaging the liver.
GREEN TEA
High in tannin, do not take with codeine
Large amounts may↑ effects and side effects of theophylline
May ↓ effect of coronary vasodilator drugs
May ↓ effects of warfarin Green tea and aspirin should not be
mixed because they both prevent platelets from clotting
– May ↑ bleeding with anticoagulants– May ↑ effects of antibiotics– ↑ efficacy of 5-fluorouracil and vincristine
May bleeding with anticoagulants (Anticoagulant / Anti platelet drugs) interacts with CAPSICUM
Medications for high blood pressure (ACE inhibitors) interacts with CAPSICUM might increase the side effects of cocaine including heart attack and death.
Cayenne:
Bromelain:
Capsicum increase the theophylline absorption of the body & also increases the side effects of theophylline
PEPPERMINT
The peppermint will decrease the metabolism of cyclosporin (Neoral, Sandimmune)
Some medications that are changed by the liver include amitriptyline (Elavil), haloperidol (Haldol), ondansetron (Zofran), propranolol (Inderal),theophylline verapamil (Calan, Isoptin, others), and others.Medications changed by the liver (Cytochrome P450 2C19 (CYP2C)
TAMARIND:
Tamarind (Tamarindus indica) Aspirin Increased bioavailability of aspirin52
TURMERIC:
Increase the blood-thinning effect with drug like warfarin, aspirin(NSAIDs).
cs the activity of antacids (Lansoprazole …etc).
Actively participate in the ce the blood glucose level, when taken with anti diabetic drugs that cause risk of lower blood sugar (hypoglycaemia).
GRAPE JUICE:
Increase the oral bioavailability (human).
Gastrointestinal absorption and bioavailability of statins like levostatin
Dicreases the total body metabolic rate.
May ↑ bleeding with anticoagulants May ↑ activity and side effects of MAO inhibitors Increases blood pressure when combined with a thiazide diuretic and even caused coma Increases the digoxin plasma levels
GINSENG(PANAX GINSENG):
Increases the AUC of digoxin
Decreased activity of opioids – clear mechanism is unknown
Increased CNS side effects due to additive effect of
MAO inhibitors
Phenelzine
Ginkgo:
Valerian induces the sleep with anti-seizure medications like barbiturates.Ex. phenobarbitone, pentobarbitoneProlongation of aesthesia with anaesthetics
Produce sadation with barbiturates &benzodiazepines– Contraindicated with hepatotoxic drugs and alcohol– ↓ efficacy of Parkinson drugs (L-Dopa)
VALERIAN:
KAVA:
AUC Corticosteroids like prednisalone , methylprednisalone
↓ efficacy, ↑ toxicity of diuretics ↓ efficacy, side effects of digoxin
↓ hepatotoxicity of drugs (haloperidol, phenytoin)
↓ kidney toxicity of anesthetics
Milk Thistle:
Liquorice:
PHARMACIST’S ROLE
Advising
Monitoring
Reporting
Health care professionals and pharmacists have to play an important role in giving advisory knowledge on monitoring concurrent use of herbal and conventional medicines and to collect data for suspected herb-drug interactions.
We need to bring into lime light about the herb – drug interactions
CONCLUSION
Baravkar A A, Sawant S D- “Herb-Drug-Interactions”Wheaton A G, Blanck H M- “Medicinal herb use in population
based survey”Arthur M. Presser- “Herb-Drug Interactions”Dorothea Dayley- “Drug-Herb-Nutrient Interactions”Schuyler W.Lininger- “Drug-Herb-Vitamin InteractionsNatural medicines - Comprehensive database by
editors of Pharmacist’s letter and Prescriber’s letter
REFERENCES
Thank you