Variations in Product Choices of Frequently Purchased Herbs

Garrard, Judith; Harms, Susan; Eberly, Lynn E.; Matiak, Amy

doi:10.1001/archinte.163.19.2290

Cited by 66 publications

(35 citation statements)

References 16 publications

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“…Second, etravirine is a CYP3A4 inducer itself, and it could have masked potential induction of CYP3A by echinacea. Third, discrepancies between the labeled and the actual content of active constituents have been reported for many botanical preparations, to the extent that commercial products have not contained the labeled herb at all in some cases (7,9). To avoid an effect of this potential limitation within our study, we purchased a single lot of E. purpurea from Arkopharma, which is a leader in the botanical supplement market in Europe.…”

Section: Discussionmentioning

confidence: 99%

Herb-Drug Interaction between Echinacea purpurea and Etravirine in HIV-Infected Patients

Moltó

Valle

Miranda

et al. 2012

Antimicrob Agents Chemother

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The aim of this open-label, fixed-sequence study was to investigate the potential of the botanical supplement Echinacea purpurea to interact with etravirine, a nonnucleoside reverse transcriptase inhibitor of HIV. Fifteen HIV-infected patients receiving antiretroviral therapy with etravirine (400 mg once daily) for at least 4 weeks were included. E. purpurea root/extract-containing capsules were added to the antiretroviral treatment (500 mg every 8 h) for 14 days. Etravirine concentrations in plasma were determined by high-performance liquid chromatography immediately before and 1, 2, 4, 6, 8, 10, 12, and 24 h after a morning dose of etravirine on day 0 and etravirine plus E. purpurea on day 14. Individual etravirine pharmacokinetic parameters were calculated by noncompartmental analysis and compared between days 0 and 14 by means of the geometric mean ratio (GMR) and its 90% confidence interval (CI). The median age was 46 years (interquartile range, 41 to 50), and the median body weight was 76 kg (interquartile range, 68 to 92). Echinacea was well tolerated, and all participants completed the study. The GMR for etravirine coadministered with E. purpurea relative to etravirine alone was 1.07 (90% CI, 0.81 to 1.42) for the maximum concentration, 1.04 (90% CI, 0.79 to 1.38) for the area under the concentration-time curve from 0 to 24 h, and 1.04 (90% CI, 0.74 to 1.44) for the concentration at the end of the dosing interval. In conclusion, the coadministration of E. purpurea with etravirine was safe and well tolerated in HIV-infected patients; our data suggest that no dose adjustment for etravirine is necessary.

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Section: Discussionmentioning

confidence: 99%

Herb-Drug Interaction between Echinacea purpurea and Etravirine in HIV-Infected Patients

Moltó

Valle

Miranda

et al. 2012

Antimicrob Agents Chemother

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“…First, there may be great variability in silymarin content among different milk thistle brands available on the market. Furthermore, discrepancies between the labeled and the actual content of active constituents have been reported for many botanical preparations (13). For our study, we purchased a single lot of silymarin from a sole vendor that used an external laboratory to certify that pills contained 100% of the labeled content of the drug.…”

Section: Discussionmentioning

confidence: 99%

Effect of Milk Thistle on the Pharmacokinetics of Darunavir-Ritonavir in HIV-Infected Patients

Moltó

Valle

Miranda

et al. 2012

Antimicrob Agents Chemother

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The aim of this open-label, fixed-sequence study was to investigate the potential of the botanical supplement milk thistle (silymarin) to interact with the boosted protease inhibitor combination darunavir-ritonavir. Fifteen HIV-infected patients receiving antiretroviral therapy with darunavir-ritonavir (600/100 mg twice daily) for at least 4 weeks were included. Silymarin (150 mg every 8 h) was added to the antiretroviral treatment from days 1 to 14. Darunavir concentrations in plasma were determined by high-performance liquid chromatography immediately before and 1, 2, 4, 6, 8, 10, and 12 h after a morning dose of darunavirritonavir on day 0 and darunavir-ritonavir plus silymarin on day 14. Individual darunavir pharmacokinetic parameters were calculated by noncompartmental analysis and compared between days 0 and 14 by means of the geometric mean ratio (GMR) and its 90% confidence interval (CI). The median age was 48 years (interquartile range, 44 to 50 years), and the median body weight was 70 kg (interquartile range, 65 to 84 kg). Silymarin was well tolerated, and all participants completed the study. The GMRs for darunavir coadministered with silymarin relative to darunavir alone were 0.86 (90% CI, 0.70 to 1.05) for the area under the concentration-time curve from 0 to 12 h, 0.83 (90% CI, 0.80 to 0.98) for the maximum concentration, and 0.94 (90% CI, 0.73 to 1.19) for the concentration at the end of the dosing interval. In summary, coadministration of silymarin with darunavirritonavir seems to be safe in HIV-infected patients; no dose adjustment for darunavir-ritonavir seems to be necessary.

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“…Secondly, herbal products may change over time in terms of their concentration, purity, or potency either owing to change in formulation or change in the botanical products themselves due to variability in harvest conditions. [61][62][63][64][65] Since herbal products have been shown to lead to chronic, selfperpetuating injury, improvement on withdrawal of the product cannot be easily demonstrated for establishing causality. 61 On the other hand, in contrast to the situation with prescription medicines, which does not readily lend itself to rechallenge, incidental reexposure is not uncommon with herbal medicines, leading to recrudescence of liver injury, which helps to establish a causal relationship.…”

Section: Challenges Of Herbal Products In Causationmentioning

confidence: 99%

Drug-Induced Liver Injury

Fisher¹,

Vuppalanchi²,

Saxena

2015

Archives of Pathology &Amp; Laboratory Medicine

161

123

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Context Drug-induced liver injury (DILI) represents a diverse set of responses following exposure to any manufactured or naturally occurring chemical compound. Drug-induced liver injury is of major concern owing to the ever increasing number of compounds introduced into the market for treatment of various diseases as well as the increasing popularity of herbals, which lend themselves to self-medication but are not rigorously regulated. Objective To provide an overview of the prevalence, classification, and diagnosis of DILI with emphasis on pathogenesis and the role of a liver biopsy. To focus on the most common, emerging, and herbal agents that cause DILI with emphasis on the histologic pattern of injury observed. Data Sources A review of the literature was drawn from the PubMed (US National Library of Medicine) repository, textbooks, and online databases. All figures were taken from cases seen at our tertiary referral center, which is 1 of 12 participating sites in the National Institutes of Health–funded Drug-Induced Liver Injury Network. Conclusions Drug-induced liver injury due to prescription, over-the-counter, and herbal products is a major cause of liver disease in the United States and around the world. Diagnosis of DILI is challenging because there is no single clinical, laboratory, or histologic feature specific to DILI. Accurate diagnosis requires establishing a causal relationship with the suspected agent and excluding competing causes of liver injury. The liver biopsy is an essential component in the management of DILI by offering clues to the underlying pathogenesis, providing prognostic information, and guiding therapy.

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Variations in Product Choices of Frequently Purchased Herbs

Cited by 66 publications

References 16 publications

Herb-Drug Interaction between Echinacea purpurea and Etravirine in HIV-Infected Patients

Herb-Drug Interaction between Echinacea purpurea and Etravirine in HIV-Infected Patients

Effect of Milk Thistle on the Pharmacokinetics of Darunavir-Ritonavir in HIV-Infected Patients

Drug-Induced Liver Injury

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