Drug Interactions With Herbal Medicines

Skalli, Souad; Zaîd, Abdelhamid; Soulaymani-Bencheikh, Rachida

doi:10.1097/ftd.0b013e31815c17f6

Cited by 92 publications

(62 citation statements)

References 98 publications

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“…Current estimates place the sales of herbal remedies and nutraceuticals at well over 4 billion dollars in the United States alone (Blumenthal et al, 2006). In addition to the sales of herbal therapies, the number of reports of adverse events related to the use of such products has also risen (Skalli et al, 2007). Not surprisingly, the research community as a whole has placed a greater emphasis on the characterization and safety profiles of widely used herbal therapies both in the United States and around the world (Foti and Wahlstrom, 2008).…”

mentioning

confidence: 99%

In Vitro Inhibition of Multiple Cytochrome P450 Isoforms by Xanthone Derivatives from Mangosteen Extract

Foti¹,

Pearson²,

Rock³

et al. 2009

Drug Metab Dispos

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ABSTRACT:Mangosteen is a xanthone-containing fruit found in Southeast Asia for which health claims include maintaining healthy immune and gastrointestinal systems to slowing the progression of tumor growth and neurodegenerative diseases. Previous studies have identified multiple xanthones in the pericarp of the mangosteen fruit. The aim of the current study was to assess the drug inhibition potential of mangosteen in vitro as well as the cytochrome P450 (P450) enzymes responsible for the metabolism of its individual components. The various xanthone derivatives were found to be both substrates and inhibitors for multiple P450 isoforms. Aqueous extracts of the mangosteen pericarp were analyzed for xanthone content as well as inhibition potency. Finally, in vivo plasma concentrations of ␣-mangostin, the most abundant xanthone derivative found in mangosteen, were predicted using Simcyp and found to be well above their respective in vitro K i values for CYP2C8 and CYP2C9.

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mentioning

confidence: 99%

In Vitro Inhibition of Multiple Cytochrome P450 Isoforms by Xanthone Derivatives from Mangosteen Extract

Foti¹,

Pearson²,

Rock³

et al. 2009

Drug Metab Dispos

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“…This may result in activation or inhibition of the metabolism of concomitantly taken drugs, under-or overexposure to drugs, and consequently, treatment failure or toxicity. At least 30 clinically proven herb-drug interactions mediated through CYP enzymes have been described [19][20][21]. Induction of CYP2C19, for example, by Ginkgo biloba resulted in subtherapeutic levels of anticonvulsant drugs, which precipitated fatal seizures [22].…”

mentioning

confidence: 99%

Effects of Herbal Supplements on Drug Glucuronidation. Review of Clinical, Animal, andIn VitroStudies

Mohamed

Frye

2010

Planta Med

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“…The basis of this usage of herbal products is the concept that being a natural product, the herbal must be safe to use. However, contrary to this perception it has been well documented that significant pharmacokinetic and/or pharmacodynamic effects can occur through herb-drug interaction [1,2] which has led to an increased concern regarding the safety and even toxicity of the coadministration of these products with therapeutic drugs [3][4][5][6][7]. This effect is exacerbated more so for drugs that have a narrow therapeutic index (e.g., warfarin, digoxin, and many chemotherapeutic agents).…”

Section: Editorialmentioning

confidence: 88%

Mechanisms and Implication of Drug-Herbal Interactions

Gorman¹

2012

JBB

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EditorialIt has been well recognized that an increasing percentage of the population is using herbal products for both preventive and therapeutic purposes. Often times the use of herbals is associated with attenuating side-effects produced from therapeutic drugs such as chemotherapeutic regimen. The basis of this usage of herbal products is the concept that being a natural product, the herbal must be safe to use. However, contrary to this perception it has been well documented that significant pharmacokinetic and/or pharmacodynamic effects can occur through herb-drug interaction [1,2] which has led to an increased concern regarding the safety and even toxicity of the coadministration of these products with therapeutic drugs [3][4][5][6][7]. This effect is exacerbated more so for drugs that have a narrow therapeutic index (e.g., warfarin, digoxin, and many chemotherapeutic agents). The mechanisms of herbal-drug interaction are generally pharmacokinetic in nature and result in changes in absorption and metabolism of the therapeutic agent. In addition to the chemical/physical properties of drugs that effect absorption after oral dosing (e.g., lipid/water solubility, molecular size, degree of ionization, etc), the inhibition or induction of drug transporters can have a substantial effect on the amount of drug absorbed. Perhaps the best characterized drug transporter is P-glycoprotein (P-gp) which has been found in the apical membrane of cells in various organs including the gastrointestinal tract, liver, lungs, and kidneys. Active compounds in the herbal product have been shown to function as transporter substrates resulting in either inhibition or induction of P-gp causing either elevated or reduced drug concentrations, respectively [7,8]. These alterations in drug concentration could result in either a sub-therapeutic level of exposure or potentially produce toxic side effects.Herbal products also have components which function as cytochrome P450 (CYP450) substrates which may also result in the inhibition [9] or induction [10] of the metabolizing enzymes. For inhibition of CYP450 enzymes, herbal products do so in a mixed competitive/noncompetitive manner depending on the particular isozyme and active compounds in the product [9,11]. Competitive inhibition is reversible and is usually simple competition between the drug and the active herbal component for the reactive site on the enzyme. Noncompetitive inhibition is typically characterized by reversible binding of the inhibitor at an allosteric site on the enzyme resulting in a change in its conformation where the drug substrate can still bind but the enzyme cannot catalyze the biotransformation of the drug. Additionally, active components of the herbal may bind irreversibly through covalent interactions with the enzyme thereby reducing the concentration of the enzyme. Alternatively, metabolites of the herbal may also bind irreversibly to the enzyme (mechanism based inhibition) again reducing the pool of enzymes available to catalyze biotransformations of the drug....

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Drug Interactions With Herbal Medicines

Cited by 92 publications

References 98 publications

In Vitro Inhibition of Multiple Cytochrome P450 Isoforms by Xanthone Derivatives from Mangosteen Extract

In Vitro Inhibition of Multiple Cytochrome P450 Isoforms by Xanthone Derivatives from Mangosteen Extract

Effects of Herbal Supplements on Drug Glucuronidation. Review of Clinical, Animal, andIn VitroStudies

Mechanisms and Implication of Drug-Herbal Interactions

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