Cyclosporine and Herbal Supplement Interactions

Abstract

Cyclosporine (CyA) is a well-known immunosuppressant with a narrow therapeutic window. Its bioavailability is affected by many other traditional drugs and herbal extracts. Cytochrome P-450 isoenzymes CYP3A4 and CYP3A5 and protein P-glycoprotein (P-gp) are involved in CyA bioavailability. Interactions of CyA with herbal extracts are not well known, but, given their increased concomitant use, it is important to know which extracts, many of which are commonly self-prescribed, can affect CyA blood concentrations. Decreased CyA blood concentration has been shown with St John's wort in case reports and, in vivo animal studies, with ginger, liquorice, scutellariae radix, and quercetin. Increased CyA concentration has been reported in patients with grapefruit juice, chamomile, or berberine, and with cannabidiol or resveratrol in animal studies. Effects of Echinacea and Serenoa repens on CyA levels have not been shown consistently, but concomitant use should be avoided. Although findings from animal studies cannot be directly translated into humans, avoiding concomitant use of herbal extracts is prudent until human clinical studies have ruled out any possible interaction. Clinicians should interview their patients carefully about their use of herbal supplements before CyA administration, and those receiving CyA should be warned about possible interactions between herbal preparations and CyA.

Berberine, a plant alkaloid with lipid- and glucose-lowering properties: From in vitro evidence to clinical studies

“…BBR modulates the expression/activity of some CYP isoenzymes both in vitro and in vivo [10; 11], and this may translate into clinically relevant interactions with some drugs (Table 1): in renal-transplant recipients, BBR markedly increases the blood concentration of cyclosporine A, due to the inhibition of CYP3A4 and P-gp [12]. An interaction between tacrolimus and BBR, M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 both substrates of CYP3A4-A5, has been reported, resulting in a rapid increase of tacrolimus blood concentration [13].…”

Paprastųjų Jonažolių Naudojimas Gydant Sunkią Depresiją

“…Dėl to jonažolių negalima skirti kartu su antidepresantais, priklausančiais MAO inhibitorių ir SSRI grupėms [29]. Be to, prieš skiriant jonažoles reikia įsitikinti, ar pacientas kartu nevartos kitų serotoninerginiu poveikiu pasižyminčių ir citochromo P450 3A4 poveikį keičiančių vaistų, nes iki šiol nėra pakankamai ištir-ta, su kokiais vaistais jonažolės gali turėti kliniškai reikšmin-gų sąveikų [30][31][32][33][34].…”

Cyclosporine use in Hematopoietic Stem Cell Transplantation: Pharmacokinetic Approach

“…It has been reported that St John's wort, ginger, liquorice, scutellariae radix and quercetin decrease CsA levels [126]. Increased CsA levels observed frequently by grapefruit juice consumption [126,127], and also with chamomile, berberine, cannabidiol and resveratrol. Generally, these and some other products suspicious for interactions should be avoided in concomitant use [126].…”