Effect of herb-drug interactions of Bacopa monnieri Linn. (Brahmi) formulation on the pharmacokinetics of amitriptyline in rats

Khurshid, Fowad; Jeyabalan, G.; Khalilullah, Habibullah; Nomani, Mohammed Shivli; Shahid, Mudassar; Ain, Ruhal; Alsultan, Mohammed S.

doi:10.1590/s2175-97902017000417072

Cited by 4 publications

(4 citation statements)

References 30 publications

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“…Studies suggest that extracts derived from this plant can contribute to herb–drug interactions, as they have an inhibitory effect on the activity of many cytochrome isoenzymes such as CYP2C9, CYP2C19, CYP1A2, CYP2D6, and CYP3A4 ( Ramasamy et al, 2014 ). Animal studies have shown that Bacopa monnieri extracts increase intestinal absorption and reduce first-pass metabolism of amitriptyline through the inhibition of CYP3A and CYP2C and decrease oral clearance of this drug ( Khurshid et al, 2018 ). To the best of our knowledge, there is only one study presenting adverse events related to the drug interaction with this adaptogen.…”

Section: Discussionmentioning

confidence: 99%

Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs

Siwek,

Woroń,

Wrzosek

et al. 2023

Front. Pharmacol.

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Aim: We aimed to systematically evaluate the prevalence and clinical characteristics of adverse events associated with the adaptogens and antidepressant drug interactions in a retrospective chart review.Methodology: A total of 1,816 reports of adverse events were evaluated. Cases were included in the analysis if the pharmacoepidemiological analysis showed the presence of a high probability of a causal relationship between an adaptogen and antidepressant interaction and the occurrence of adverse events. The following data were extracted from the reports: age, sex, antidepressant, plant products containing adaptogens, other concomitant medications, and clinical consequences of the interactions and their possible mechanisms.Results: Adaptogens were involved in 9% of adverse events associated with the concomitant use of antidepressants and other preparations. We identified 30 reports in which side effects presented a causal relationship with the use of antidepressants and adaptogens. Here, we present the list of adaptogens with the corresponding antidepressants and the side effects caused by their interactions: Withania somnifera: reboxetine (testicle pain and ejaculatory dysfunctions), sertraline (severe diarrhea), escitalopram (myalgia, epigastric pain, nausea, vomiting, restless legs syndrome, and severe cough), and paroxetine (generalized myalgia, ophthalmalgia, and ocular hypertension); Eleutherococcus senticosus: duloxetine (upper gastrointestinal bleeding), paroxetine (epistaxis), sertraline (vaginal hemorrhage), and agomelatine (irritability, agitation, headache, and dizziness); Schisandra chinensis: bupropion (arthralgia and thrombocytopenia), amitriptyline (delirium), and fluoxetine (dysuria); Tribulus terrestris: citalopram (generalized pruritus), escitalopram (galactorrhea), and trazodone (psoriasis relapse); Coptis chinensis: mianserin (arrhythmias), mirtazapine (edema of lower limbs and myalgia), and fluoxetine (gynecomastia); Cimicifuga racemosa: mianserin (restless legs syndrome), paroxetine (gynecomastia and mastalgia), and venlafaxine (hyponatremia); Bacopa monnieri: agomelatine (back pain and hyperhidrosis) and moclobemide (myocardial infarction); Gynostemma pentaphyllum: duloxetine (back pain); Cordyceps sinensis: sertraline (upper gastrointestinal bleeding); Lepidium meyenii: mianserin (restless legs syndrome); and Scutellaria baicalensis: bupropion (seizures).Conclusion: Clinicians should monitor the adverse events associated with the concomitant use of adaptogens and antidepressant drugs in patients with mental disorders. Aggregation of side effects and pharmacokinetic interactions (inhibition of CYP and p-glycoprotein) between those medicines may result in clinically significant adverse events.

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Section: Discussionmentioning

confidence: 99%

Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs

Siwek,

Woroń,

Wrzosek

et al. 2023

Front. Pharmacol.

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“…In a study with male Wistar albino rats, when compared to amitriptyline alone, the pre‐treatment with B. monnieri enhanced the oral bioavailability of amitriptyline as verified by a significant increase in C max , AUC and t 1/2 by 16.8%, 26.5%, and 15.5%, respectively. Furthermore, it was observed a decrease of oral clearance and volume of distribution (Khurshid et al, 2017). The authors suggested a pharmacokinetic interaction mediated by increased intestinal absorption and reduced first‐pass metabolism of amitriptyline, in the intestine and liver, through inhibition of CYP2C and CYP3A.…”

Section: Herb Interactions With Drugs Acting On the Cns And Pnsmentioning

confidence: 99%

“…The authors suggested a pharmacokinetic interaction mediated by increased intestinal absorption and reduced first‐pass metabolism of amitriptyline, in the intestine and liver, through inhibition of CYP2C and CYP3A. The enhanced bioavailability of amitriptyline was also the outcome for the pharmacokinetic interaction with C. asiatica , hypothesized to be mediated by the inhibition of CYP3A4 and CYP2D6 in rat models (Khurshid et al, 2018).…”

Section: Herb Interactions With Drugs Acting On the Cns And Pnsmentioning

confidence: 99%

Herb‐drug interactions: A short review on central and peripheral nervous system drugs

Bernardo,

Valentão

2024

Phytotherapy Research

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Herbal medicines are widely perceived as natural and safe remedies. However, their concomitant use with prescribed drugs is a common practice, often undertaken without full awareness of the potential risks and frequently without medical supervision. This practice introduces a tangible risk of herb‐drug interactions, which can manifest as a spectrum of consequences, ranging from acute, self‐limited reactions to unpredictable and potentially lethal scenarios. This review offers a comprehensive overview of herb‐drug interactions, with a specific focus on medications targeting the Central and Peripheral Nervous Systems. Our work draws upon a broad range of evidence, encompassing preclinical data, animal studies, and clinical case reports. We delve into the intricate pharmacodynamics and pharmacokinetics underpinning each interaction, elucidating the mechanisms through which these interactions occur. One pressing issue that emerges from this analysis is the need for updated guidelines and sustained pharmacovigilance efforts. The topic of herb‐drug interactions often escapes the attention of both consumers and healthcare professionals. To ensure patient safety and informed decision‐making, it is imperative that we address this knowledge gap and establish a framework for continued monitoring and education. In conclusion, the use of herbal remedies alongside conventional medications is a practice replete with potential hazards. This review not only underscores the real and significant risks associated with herb‐drug interactions but also underscores the necessity for greater awareness, research, and vigilant oversight in this often‐overlooked domain of healthcare.

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“…[57] According to a comprehensive article, the medicinal herb Bacopa has the ability to alter the pharmacokinetics of amitriptyline in rats, via inhibition of CYP2C and CYP3A enzymes, Bacopa monnieri mediated increased intestinal absorption and decreased first-pass metabolism of amitriptyline in the intestine and liver, indicating an herb-drug interaction. [378]…”

Section: Bacopa Monnieri Toxicity Spectrum and Herb-drug Interactionsmentioning

confidence: 99%

In Quest of the Mysterious Holistic Vedic Herb Bacopa monnieri (L.) Pennell

Mondal¹,

Bhar²,

Mondal³

et al. 2023

Pharmacogn. Res.

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Throughout history, complementary and alternative therapies have been widely utilised. In recent years, there has been a surge in interest in the usage of herbal treatments all around the world. Various natural chemicals, such as those produced from plants, have been investigated as potential therapies for a myriad of ailments. The essence of this review was to methodically describe everything we know about Bacopa monnieri (L.) Pennell, a mysterious holistic Vedic herb belonging to the Plantaginaceae family, a well-known nootropic and effective memory enhancer, which has recently emerged as one of the most important medical herbs, widely used therapeutically in the Orient and growing in popularity around the world. Literature was gathered from sources such as Scopus, PubMed, Google Scholar, and ScienceDirect, and reviewed using the Prisma quality metacritic paradigm. It is now plainly obvious that current therapies fall short of meeting the demands of the vast majority of individuals with health problems, and traditional medicines are gaining appeal as a result of their reduced toxicity. Bacopa is a traditional herb used in Ayurvedic medicine to treat brain and nerve weariness, as well as in Siddha medicine to treat impaired memory. It's also used to cure brain and nerve exhaustion in Unani medicine. We improved Brahmi micropropagation and secondary metabolite biosynthesis by compiling pharmacobotanical and pharmacognostical descriptions, as well as ethnoarchaeological data and nanotechnology domination. This critique also highlights our contemporary information of pharmacological activity, preclinical and clinical investigations, significant bioactives, reported mechanisms of action, clinical effectiveness, safety, and the potential for herb-drug interactions. At the same time, the current incarnation of research at the plant is reviewed, as well as future research possibilities. Brahmi offers a lot of potential for treating a range of illnesses, including neuro-pharmacological, depression, inflammation, hepatoprotective, antidiabetic, and others. According to the presumptions of this review, further clinical trials and research are needed. While the impact of Brahmi as an anxiolytic and antidepressant has to be explored further, its potential as an anti-epileptic therapy and a treatment for antiepileptic drugs side effects is also being researched. Furthermore, Brahmi's antioxidant ability may explain, at least in part, the antistress, immunomodulatory, cognition-facilitating, anti-inflammatory, and anti-aging benefits documented in experimental animals and clinical circumstances, necessitating further study into its other therapeutic characteristics.

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Effect of herb-drug interactions of Bacopa monnieri Linn. (Brahmi) formulation on the pharmacokinetics of amitriptyline in rats

Cited by 4 publications

References 30 publications

Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs

Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs

Herb‐drug interactions: A short review on central and peripheral nervous system drugs

In Quest of the Mysterious Holistic Vedic Herb Bacopa monnieri (L.) Pennell

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