Pharmacokinetic Interactions between Carbamazepine and the Traditional Chinese Medicine Paeoniae Radix.

Chen, Lih Chi; Chen, Yu Fang; Chou, Mei Huei; Lin, Muh-Shi; Yang, Ling; Yen, Kun Ying

doi:10.1248/bpb.25.532

Cited by 23 publications

(16 citation statements)

References 14 publications

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“…Second, PGD interactions with risperidone and other antipsychtoic drugs are unclear, although the pharmacokinetic properties of major constituents of PGD and their interactions with carbamazepine have been well investigated. [28][29][30][31][32]43 Thus, whether herb-drug interactions are involved in the effects of PGD observed in the present study could not be excluded. Third, unlike the studies in animals, 21-25 the present study did not observe effects of PGD on estradiol levels.…”

Section: Discussionmentioning

confidence: 92%

A Randomized, Crossover Comparison of Herbal Medicine and Bromocriptine Against Risperidone-Induced Hyperprolactinemia in Patients With Schizophrenia

Yuan

Wang²,

Sze³

et al. 2008

Journal of Clinical Psychopharmacology

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Hyperprolactinemia is a common adverse effect that occurs as a result of antipsychotic therapies, which often results in discontinuation. Empirical evidence has shown that some herbal medicines have suppressive effects on prolactin (PRL) hyperactivities. This study was designed to compare the herbal preparation called Peony-Glycyrrhiza Decoction (PGD) with bromocriptine (BMT), a dopamine agonist widely used for PRL-secreting disorders, in the treatment of risperidone-induced hyperprolactinemia. Twenty schizophrenic women who were under risperidone maintenance treatment, diagnosed with hyperprolactinemia (serum PRL levels >50 mug/L), and currently experiencing oligomenorrhea or amenorrhea were selected for the study. Subjects were randomized to additional treatment with PGD (45 g/d) followed by BMT (5 mg/d) or BMT followed by PGD at the same doses for 4 weeks each, with an interval of 4-week washout period between 2 treatment sessions. The severity of psychotic symptoms, adverse events, serum PRL, estradiol, testosterone, and progesterone levels were examined at baseline and end point. Peony-Glycyrrhiza Decoction treatment produced a significant baseline-end point decrease in serum PRL levels, without exacerbating psychosis and changing other hormones, and the decreased amplitudes were similar to those of BMT (24% vs 21%-38%). Moreover, there was a significantly greater proportion of patients during PGD treatment than BMT treatment showing improvements on adverse effects associated with hyperprolactinemia (56% vs 17%, P = 0.037). These results suggest that the herbal therapy can yield additional benefits while having comparable efficacy in treating antipsychotic-induced hyperprolactinemia in individuals with schizophrenia.

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Section: Discussionmentioning

confidence: 92%

A Randomized, Crossover Comparison of Herbal Medicine and Bromocriptine Against Risperidone-Induced Hyperprolactinemia in Patients With Schizophrenia

Yuan

Wang²,

Sze³

et al. 2008

Journal of Clinical Psychopharmacology

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“…Ginsenoside (an active compound in ginseng ) was also shown to activate CYP3A4 activity in vitro and thereby increased CBZ metabolism [39]. Xiao-qing-long-tang and Xiao-cha-hu-tang delayed the time for CBZ to reach peak plasma concentration through decreasing gastric emptying rate [38, 50], whereas Paeoniae Radix decreased the T max⁡ of CBZ through possibly improving dissolution of CBZ [46]. Acorus calamus Linn., berberine (an active compound in Coptidis rhizome), Cardiospermum halicacabum Linn., Chai-hu-jia-long-gu-mu-li-tang, and Hypericum perforatum Linn.…”

Section: Resultsmentioning

confidence: 99%

Interaction of Carbamazepine with Herbs, Dietary Supplements, and Food: A Systematic Review

Fong

Gao

Zuo

2013

Evidence-Based Complementary and Alternative Medicine

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Background. Carbamazepine (CBZ) is a first-line antiepileptic drug which may be prone to drug interactions. Systematic review of herb- and food-drug interactions on CBZ is warranted to provide guidance for medical professionals when prescribing CBZ. Method. A systematic review was conducted on six English databases and four Chinese databases. Results. 196 out of 3179 articles fulfilled inclusion criteria, of which 74 articles were reviewed and 33 herbal products/dietary supplement/food interacting with CBZ were identified. No fatal or severe interactions were documented. The majority of the interactions were pharmacokinetic-based (80%). Traditional Chinese medicine accounted for most of the interactions (n = 17), followed by food (n = 10), dietary supplements (n = 3), and other herbs/botanicals (n = 3). Coadministration of 11 and 12 of the studied herbal products/dietary supplement/food significantly decreased or increased the plasma concentrations of CBZ. Regarding pharmacodynamic interaction, Xiao-yao-san, melatonin, and alcohol increased the side effects of CBZ while caffeine lowered the antiepileptic efficacy of CBZ. Conclusion. This review provides a comprehensive summary of the documented interactions between CBZ and herbal products/food/dietary supplements which assists healthcare professionals to identify potential herb-drug and food-drug interactions, thereby preventing potential adverse events and improving patients' therapeutic outcomes when prescribing CBZ.

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“…CYPs also play a critical role in the kinetic interaction between liquorice and peony and conventional drugs (Chen et al, 2002;Wang et al, 2013c;Wu et al, 2012;Zhou et al, 2003). Flavin-containing monooxygenases (FMOs) are hepatic microsomal enzymes with importance in catalyzing massive xenobiotics (Krueger et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Peony-Glycyrrhiza Decoction, an Herbal Preparation, Inhibits Clozapine Metabolism via Cytochrome P450s, but Not Flavin-Containing Monooxygenase in In Vitro Models

et al. 2015

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Our previous studies have shown the therapeutic efficacy and underlying mechanisms of Peony-Glycyrrhiza Decoction (PGD), an herbal preparation, in treating antipsychotic-induced hyperprolactinemia in cultured cells, animal models, and human subjects. In the present study, we further evaluated pharmacokinetic interactions of PGD with clozapine (CLZ) in human liver microsomes (HLM), recombinantly expressed cytochrome P450s (P450s), and flavin-containing monooxygenases (FMOs). CLZ metabolites, N-demethyl-clozapine and clozapine-N-oxide, were measured. PGD, individual peony and glycyrrhiza preparations, and the two individual preparations in combination reduced production of CLZ metabolites to different extents in HLM. While the known bioactive constituents of PGD play a relatively minor role in the kinetic effects of PGD on P450 activity, PGD as a whole had a weak-to-moderate inhibitory potency toward P450s, in particular CYP1A2 and CYP3A4. FMOs are less actively involved in mediating CLZ metabolism and the PGD inhibition of CLZ. These results suggest that PGD has the capacity to suppress CLZ metabolism in the human liver microsomal system. This suppression is principally associated with the inhibition of related P450 activity but not FMOs. The present study provides in vitro evidence of herb-antipsychotic interactions.

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Pharmacokinetic Interactions between Carbamazepine and the Traditional Chinese Medicine Paeoniae Radix.

Cited by 23 publications

References 14 publications

A Randomized, Crossover Comparison of Herbal Medicine and Bromocriptine Against Risperidone-Induced Hyperprolactinemia in Patients With Schizophrenia

A Randomized, Crossover Comparison of Herbal Medicine and Bromocriptine Against Risperidone-Induced Hyperprolactinemia in Patients With Schizophrenia

Interaction of Carbamazepine with Herbs, Dietary Supplements, and Food: A Systematic Review

Peony-Glycyrrhiza Decoction, an Herbal Preparation, Inhibits Clozapine Metabolism via Cytochrome P450s, but Not Flavin-Containing Monooxygenase in In Vitro Models

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