Herb-drug interactions: an overview of the clinical evidence.
Herbal medicines are mixtures of more than one active ingredient. The multitude of pharmacologically active compounds obviously increases the likelihood of interactions taking place. Hence, the likelihood of herb-drug interactions is theoretically higher than drug-drug interactions, if only because synthetic drugs usually contain single chemical entities. Case reports and clinical studies have highlighted the existence of a number of clinically important interactions, although cause-and-effect relationships have not always been established. Herbs and drugs may interact either pharmacokinetically or pharmacodynamically. Through induction of cytochrome P450 enzymes and/or P-glycoprotein, some herbal products (e.g. St John's wort) have been shown to lower the plasma concentration (and/or the pharmacological effect) of a number of conventional drugs, including cyclosporine, indinavir, irinotecan, nevirapine, oral contraceptives and digoxin. The majority of such interactions involves medicines that require regular monitoring of blood levels. To date there is less evidence relating to the pharmacodynamic interaction. However, for many of the interactions discussed here, the understanding of the mechanisms involved is incomplete. Taking herbal agents may represent a potential risk to patients under conventional pharmacotherapy.
Izzo
Angelo A
AA
Department of Experimental Pharmacology, University of Naples Federico II, via D. Montesano 49, 80131 Naples, Italy. aaizzo@unina.it
D018926:Anti-Allergic Agents / Q000493:pharmacokinetics / Q000494:pharmacology; D018927:Anti-Asthmatic Agents / Q000493:pharmacokinetics / Q000494:pharmacology; D000890:Anti-Infective Agents / Q000493:pharmacokinetics / Q000494:pharmacology; D002317:Cardiovascular Agents / Q000493:pharmacokinetics / Q000494:pharmacology; D002491:Central Nervous System Agents / Q000493:pharmacokinetics / Q000494:pharmacology; D002986:Clinical Trials as Topic; D003276:Contraceptives, Oral / Q000493:pharmacokinetics / Q000494:pharmacology; D041743:Herb-Drug Interactions; D006801:Humans; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics / Q000494:pharmacology; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000494:pharmacology
D018926:Anti-Allergic Agents; D018927:Anti-Asthmatic Agents; D000890:Anti-Infective Agents; D002317:Cardiovascular Agents; D002491:Central Nervous System Agents; D003276:Contraceptives, Oral; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents