title: Botanical-drug interactions: a scientific perspective.
abstract: There is a continued predisposition of concurrent use of drugs and botanical products. A general lack of knowledge of the interaction potential together with an under-reporting of botanical use poses a challenge for the health care providers and a safety concern for patients. Botanical-drug interactions increase the patient risk, especially with regard to drugs with a narrow therapeutic index (e.g., warfarin, cyclosporine, and digoxin). Examples of case reports and clinical studies evaluating botanical-drug interactions of commonly used botanicals in the US are presented. The potential pharmacokinetic and pharmacodynamic bases of such interactions are discussed, as well as the challenges associated with the interpretation of the available data and prediction of botanical-drug interactions. Recent FDA experiences with botanical products and interactions including labeling implications as a risk management strategy are highlighted.
authors.affiliation: Food and Drug Administration Office of Clinical Pharmacology 10903 New Hampshire Avenue Silver Spring, MD 20993, USA. mtoccafondo@yahoo.com
authors.forename: Manuela
authors.initials: M
authors.lastname: de Lima Toccafondo Vieira
authors.forename: Shiew-Mei
authors.initials: SM
authors.lastname: Huang
mesh_terms: D004348:Drug Labeling / Q000331:legislation & jurisprudence; D004357:Drug Synergism; D004791:Enzyme Inhibitors / Q000494:pharmacology*; D041743:Herb-Drug Interactions; D006801:Humans; D027361:Organic Anion Transporters / Q000187:drug effects*; D010599:Pharmacokinetics; D028321:Plant Preparations / Q000494:pharmacology*; D014481:United States; D014486:United States Food and Drug Administration / Q000331:legislation & jurisprudence
chemical_list: D004791:Enzyme Inhibitors; D027361:Organic Anion Transporters; D028321:Plant Preparations