Drug-Herb Interactions in the Elderly Patient with IBD: a Growing Concern

Abstract

Inflammatory bowel disease (IBD), which includes conditions such as Crohn's disease and ulcerative colitis, is becoming more prevalent with the elderly being the fastest growing group. Parallel to this, there is an increasing interest in the use of complementary and alternative medicine (CAM). Nearly half of patients with IBD have used CAM at one time. The elderly patients, however, are burdened by comorbid conditions, polypharmacy, and altered functional status. With increasing use of complementary and alternative medicine in our elderly patients with IBD, it is vital for the provider to provide counsel on drug-herb potential interactions. CAM includes herbal products, diet, dietary supplements, acupuncture, and prayer. In this paper, we will review common CAM, specifically herbs, that are used in patients with IBD including the herb background, suggested use, evidence in IBD, and most importantly, potential interactions with IBD medications used in elderly patients. Most important evidence-based adverse events and drug-herb interactions are summarized. The herbs discussed include Triticum aestivum (wheat grass), Andrographis paniculata (chiretta), Boswellia serrata, tormentil, bilberry, curcumin (turmeric), Plantago ovata (blond psyllium), Oenothera biennis (evening primrose oil), germinated barley foodstuff, an herbal preparation of myrrh, chamomile and coffee extract, chios mastic gum, wormwood (absinthe, thujone), Cannabis sativa (marijuana, THC), tripterygium wilfordii (thunder god vine), Ulmus rubra (slippery elm bark), trigonella foenugraecum (fenugreek), Dioscorea mexicana (wild yam), Harpagophytum procumbens (devil's claw), ginger, cinnamon, licorice, and peppermint.

Tormentillae rhizoma – Review for an Underestimated European Herbal Drug

“…The plant is generally well tolerated, apart from a few cases of mild stomachache only. There are no known interactions with IBD drugs [45]. In comparison to a variety of other herbal products, Tormentil extract was assessed as the most promising herbal product for treatment of IBD [46].…”

Herbal medicinal products for inflammatory bowel disease: A focus on those assessed in double‐blind randomised controlled trials

“…Although often considered by patients to be “less harmful” than conventional medications, the safety profiles have not been fully delineated for all herbal products. However, the herbal medicinal products discussed in this review are generally well tolerated, inducing no or only mild unwanted effects (Rahman, Kim, Leung, Green, & Katz, ). Importantly, herbal medications can interact with the metabolism of conventional medications used in IBD, which can increase toxicity (Rahman et al, ).…”

“…However, the herbal medicinal products discussed in this review are generally well tolerated, inducing no or only mild unwanted effects (Rahman, Kim, Leung, Green, & Katz, ). Importantly, herbal medications can interact with the metabolism of conventional medications used in IBD, which can increase toxicity (Rahman et al, ). The interactions of some herbal substances or products with drug metabolising enzymes in the in vitro model of human liver microsomes have been studied.…”

Quantitative Determination of Andrographolide and Related Compounds in Andrographis paniculata Extracts and Biological Evaluation of Their Anti-Inflammatory Activity

“…is widely used as medicinal herb in traditional medicine [1][2][3]. Diterpenoid lactones isolated from these extracts have been the subject of intensive investigations and are reported to exhibit a wide spectrum of biological activities, including antibacterial [4], anti-inflammatory [5][6][7][8], hepatoprotective [9][10][11], neuroprotective [12], cardioprotective [13,14] and anticancer properties [15,16]. Andrographolide 1 (Figure 1) has been reported to be the main active compound in the plant [17,18].…”