Herb-drug interactions and mechanistic and clinical considerations

Chen, X-W., Sneed, Kevin B., Pan, Si-Yuan, Cao, Chuanhai, Kanwar, Jagat R., Chew, Helen and Zhou, Shu-Feng 2012, Herb-drug interactions and mechanistic and clinical considerations, Current drug metabolism, vol. 13, no. 5, pp. 640-651.

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Title Herb-drug interactions and mechanistic and clinical considerations
Author(s) Chen, X-W.
Sneed, Kevin B.
Pan, Si-Yuan
Cao, Chuanhai
Kanwar, Jagat R.
Chew, Helen
Zhou, Shu-Feng
Journal name Current drug metabolism
Volume number 13
Issue number 5
Start page 640
End page 651
Total pages 12
Publisher Bentham Science Publishers Ltd
Place of publication Hilversum, The Netherlands
Publication date 2012-06
ISSN 1389-2002
Keyword(s) CYP
drug interaction
herb medicine
P-gp
pharmacokinetics
toxicity
Summary Herbal medicines are often used in combination with conventional drugs, and this may give rise to the potential of harmful herb-drug interactions. This paper updates our knowledge on clinical herb-drug interactions with an emphasis of the mechanistic and clinical consideration. In silico, in vitro, animal and human studies are often used to predict and/or identify drug interactions with herbal remedies. To date, a number of clinically important herb-drug interactions have been reported, but many of them are from case reports and limited clinical observations. Common herbal medicines that interact with drugs include St John's wort (Hypericum perforatum), ginkgo (Ginkgo biloba), ginger (Zingiber officinale), ginseng (Panax ginseng), and garlic (Allium sativum). For example, St John's wort significantly reduced the area under the plasma concentration-time curve (AUC) and blood concentrations of cyclosporine, midazolam, tacrolimus, amitriptyline, digoxin, indinavir, warfarin, phenprocoumon and theophylline. The common drugs that interact with herbal medicines include warfarin, midazolam, digoxin, amitriptyline, indinavir, cyclosporine, tacrolimus and irinotecan. Herbal medicines may interact with drugs at the intestine, liver, kidneys, and targets of action. Importantly, many of these drugs have very narrow therapeutic indices. Most of them are substrates for cytochrome P450s (CYPs) and/or P-glycoprotein (P-gp). The underlying mechanisms for most reported herb-drug interactions are not fully understood, and pharmacokinetic and/or pharmacodynamic mechanisms are implicated in many of these interactions. In particular, enzyme induction and inhibition may play an important role in the occurrence of some herbdrug interactions. Because herb-drug interactions can significantly affect circulating levels of drug and, hence, alter the clinical outcome, the identification of herb-drug interactions has important implications.
Language eng
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2012, Bentham Science Publishers
Persistent URL http://hdl.handle.net/10536/DRO/DU:30047034

Document type: Journal Article
Collection: Institute for Technology Research and Innovation
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