Drug-herb interactions: eliminating toxicity with hard drug design.

Yang, Xiao-Xia, Hu, Ze-Ping, Duan, Wei, Zhu, Yi-Zhun and Zhou, Shu-Feng 2006, Drug-herb interactions: eliminating toxicity with hard drug design., Current pharmaceutical design, vol. 12, no. 35, pp. 4649-4664.

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Title Drug-herb interactions: eliminating toxicity with hard drug design.
Author(s) Yang, Xiao-Xia
Hu, Ze-Ping
Duan, Wei
Zhu, Yi-Zhun
Zhou, Shu-Feng
Journal name Current pharmaceutical design
Volume number 12
Issue number 35
Start page 4649
End page 4664
Publisher Bentham Science Publishers Ltd
Place of publication Hilversum, The Netherlands
Publication date 2006-12
ISSN 1381-6128
1873-4286
Keyword(s) drug-herb interaction
drug design
herbs
cytochrome P450
p-glycoprotein
Summary By searching the literatures, it was found that a total of 32 drugs interacting with herbal medicines in humans. These drugs mainly include anticoagulants (warfarin, aspirin and phenprocoumon), sedatives and antidepressants (midazolam, alprazolam and amitriptyline), oral contraceptives, anti-HIV agents (indinavir, ritonavir and saquinavir), cardiovascular drug (digoxin), immunosuppressants (cyclosporine and tacrolimus) and anticancer drugs (imatinib and irinotecan). Most of them are substrates for cytochrome P450s (CYPs) and/or P-glycoprotein (PgP) and many of which have narrow therapeutic indices. However, several drugs including acetaminophen, carbamazepine, mycophenolic acid, and pravastatin did not interact with herbs. Both pharmacokinetic (e.g. induction of hepatic CYPs and intestinal PgP) and/or pharmacodynamic mechanisms (e.g. synergistic or antagonistic interaction on the same drug target) may be involved in drug-herb interactions, leading of altered drug clearance, response and toxicity. Toxicity arising from drug-herb interactions may be minor, moderate, or even fatal, depending on a number of factors associated with the patients, herbs and drugs. Predicting drug-herb interactions, timely identification of drugs that interact with herbs, and therapeutic drug monitoring may minimize toxic drug-herb interactions. It is likely to predict pharmacokinetic herb-drug interactions by following the pharmacokinetic principles and using proper models that are used for predicting drug-drug interactions. Identification of drugs that interact with herbs can be incorporated into the early stages of drug development. A fourth approach for circumventing toxicity arising from drug-herb interactions is proper design of drugs with minimal potential for herbal interaction. So-called ”hard drugs” that are not metabolized by CYPs and not transported by PgP are believed not to interact with herbs due to their unique pharmacokinetic properties. More studies are needed and new approached are required to minimize toxicity arising from drug-herb interactions.
Language eng
Field of Research 111502 Clinical Pharmacology and Therapeutics
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2006, Bentham Science Publishers Ltd.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30009144

Document type: Journal Article
Collection: School of Medicine
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