Journal articles: 'Herb-drug interaction'

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Cheng, Tsung O. "Comment: Drug—Herb Interaction." Annals of Pharmacotherapy 35, no. 1 (January 2001): 124. http://dx.doi.org/10.1177/106002800103500101.

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Shakeel, Faisal, Fang Fang, Kelley M. Kidwell, Lauren A. Marcath, and Daniel L. Hertz. "Comparison of eight screening tools to detect interactions between herbal supplements and oncology agents." Journal of Oncology Pharmacy Practice 26, no. 8 (February 19, 2020): 1843–49. http://dx.doi.org/10.1177/1078155220905009.

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Introduction Patients with cancer are increasingly using herbal supplements, unaware that supplements can interact with oncology treatment. Herb–drug interaction management is critical to ensure optimal treatment outcomes. Several screening tools exist to detect drug–drug interactions, but their performance to detect herb–drug interactions is not known. This study compared the performance of eight drug–drug interaction screening tools to detect herb–drug interaction with anti-cancer agents. Methods The herb–drug interaction detection performance of four subscription (Micromedex, Lexicomp, PEPID, Facts & Comparisons) and free (Drugs.com, Medscape, WebMD, RxList) drug–drug interaction tools was assessed. Clinical relevance of each herb–drug interaction was determined using Natural Medicine and each drug–drug interaction tool. Descriptive statistics were used to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Linear regression was used to compare performance between subscription and free tools. Results All tools had poor sensitivity (<0.20) for detecting herb–drug interaction. Lexicomp had the highest positive predictive value (0.98) and best overall performance score (0.54), while Medscape was the best performing free tool (0.52). The worst subscription tools were as good as or better than the best free tools, and as a group subscription tools outperformed free tools on all metrics. Using an average subscription tool would detect one additional herb–drug interaction for every 10 herb–drug interactions screened by a free tool. Conclusion Lexicomp is the best available tool for screening herb–drug interaction, and Medscape is the best free alternative; however, the sensitivity and performance for detecting herb–drug interaction was far lower than for drug–drug interactions, and overall quite poor. Further research is needed to improve herb–drug interaction screening performance.

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Parvez, Mohammad K., and Vikas Rishi. "Herb-Drug Interactions and Hepatotoxicity." Current Drug Metabolism 20, no. 4 (June 11, 2019): 275–82. http://dx.doi.org/10.2174/1389200220666190325141422.

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Background: In recent times, herbals or phytomedicines have become very popular due to their global acceptance as a complementary and alternative remedy. While modern drugs are commercially available only after laboratory validations, clinical trials, as well as approval from drug regulatory authorities, majority of the marketed herbal products lack such scientific evidence of efficacy and safety. This results in herb or herb-drug interaction induced unfavorable clinical outcomes without crucial documentation on their temporal relations and concomitant use. Methods: An online literature search for peer-reviewed articles was conducted on the PubMed, Europe PMC, Medline and Google Scholar portals, using the phrases: complementary & alternative medicine, traditional Chinese medicine, herb-drug interaction, mechanisms of herb-drug interaction, herb-induced toxicity, herbal hepatotoxicity and causality, traditional medicine, viral hepatitis, etc. Results: The retrieved data showed that globally, patients are attracted to herbal remedies with the misconception that these are completely safe and therefore, use them simultaneously with prescription drugs. Notably, there exists a potential risk of herb-drug interactions leading to some adverse side effects, including hepatotoxicity. The toxicological effect of a drug or herb is due to the inhibition of drug metabolizing enzymes (e.g., cytochrome P450), including interactions with certain prescription drugs through various mechanisms. Several cases of hepatotoxicity due to use of herbals in viral hepatitis-related liver diseases have been recently reported. However, limited experimental data and clinical evidence on herbal pharmacokinetics hamper the evaluation and reporting of adverse reactions and the underlying mechanisms. Conclusion: Herb-drug interaction related morbidity is thus an emerging serious public health issue with broad implications for clinicians, pharmaceutical industries and health authorities. Nonetheless, despite increasing recognition of herb-drug interaction, a standard system for interaction prediction and evaluation is still nonexistent. This review article discusses the herb-drug interactions related hepatotoxicity and underlying mechanisms, including drug metabolizing enzymes and their regulation.

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Cui, Zhijie, Hong Kang, Kailin Tang, Qi Liu, Zhiwei Cao, and Ruixin Zhu. "Screening Ingredients from Herbs against Pregnane X Receptor in the Study of Inductive Herb-Drug Interactions: Combining Pharmacophore and Docking-Based Rank Aggregation." BioMed Research International 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/657159.

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The issue of herb-drug interactions has been widely reported. Herbal ingredients can activate nuclear receptors and further induce the gene expression alteration of drug-metabolizing enzyme and/or transporter. Therefore, the herb-drug interaction will happen when the herbs and drugs are coadministered. This kind of interaction is called inductive herb-drug interactions. Pregnane X Receptor (PXR) and drug-metabolizing target genes are involved in most of inductive herb-drug interactions. To predict this kind of herb-drug interaction, the protocol could be simplified to only screen agonists of PXR from herbs because the relations of drugs with their metabolizing enzymes are well studied. Here, a combinational in silico strategy of pharmacophore modelling and docking-based rank aggregation (DRA) was employed to identify PXR’s agonists. Firstly, 305 ingredients were screened out from 820 ingredients as candidate agonists of PXR with our pharmacophore model. Secondly, DRA was used to rerank the result of pharmacophore filtering. To validate our prediction, a curated herb-drug interaction database was built, which recorded 380 herb-drug interactions. Finally, among the top 10 herb ingredients from the ranking list, 6 ingredients were reported to involve in herb-drug interactions. The accuracy of our method is higher than other traditional methods. The strategy could be extended to studies on other inductive herb-drug interactions.

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Babos, Mary Beth, Michelle Heinan, Linda Redmond, Fareeha Moiz, Joao Victor Souza-Peres, Valerie Samuels, Tarun Masimukku, David Hamilton, Myra Khalid, and Paul Herscu. "Herb–Drug Interactions: Worlds Intersect with the Patient at the Center." Medicines 8, no. 8 (August 5, 2021): 44. http://dx.doi.org/10.3390/medicines8080044.

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This review examines three bodies of literature related to herb–drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb–drug combinations. Interacting herb–drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen’s kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb–drug information is needed, including open and respectful discussion with patients.

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Liu, Mou-Ze, Yue-Li Zhang, Mei-Zi Zeng, Fa-Zhong He, Zhi-Ying Luo, Jian-Quan Luo, Jia-Gen Wen, Xiao-Ping Chen, Hong-Hao Zhou, and Wei Zhang. "Pharmacogenomics and Herb-Drug Interactions: Merge of Future and Tradition." Evidence-Based Complementary and Alternative Medicine 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/321091.

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The worldwide using of herb products and the increasing potential herb-drug interaction issue has raised enthusiasm on discovering the underlying mechanisms. Previous review indicated that the interactions may be mediated by metabolism enzymes and transporters in pharmacokinetic pathways. On the other hand, an increasing number of studies found that genetic variations showed some influence on herb-drug interaction effects whereas these genetic factors did not draw much attention in history. We highlight that pharmacogenomics may involve the pharmacokinetic or pharmacodynamic pathways to affect herb-drug interaction. We are here to make an updated review focused on some common herb-drug interactions in association with genetic variations, with the aim to help safe use of herbal medicines in different individuals in the clinic.

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Barone, Gary W., Bill J. Gurley, Beverley L. Ketel, Meredith L. Lightfoot, and Sameh R. Abul-Ezz. "Comment: drug–herb interaction—AUTHOR'S REPLY." Annals of Pharmacotherapy 35 (January 2001): 124–25. http://dx.doi.org/10.1345/aph.10088b.

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Sarvesh, Sabarathinam, Preethi L, Haripritha Meganathan, M. Arjun Gokulan, Dhivya Dhanasekaran, Nila Ganamurali, and Rahul Radhakrishnan. "HCIP: An Online database for prediction CYP450 Enzyme Inhibition potential of bioactive compounds." Journal of Drug Delivery and Therapeutics 11, no. 2 (April 1, 2021): 253–55. http://dx.doi.org/10.22270/jddt.v11i2.4637.

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Background: Concomitant administration of herbal medicine and conventional may lead to severe metabolism-oriented herb-drug interactions. However, detecting herb-drug interaction is expensive and higher time-consuming. Several computer-aided techniques have been proposed in recent years to predict drug interactions. However, most of the methods cannot predict herb-drug interactions effectively. Methods: Canonical SMILES of bioactive compounds was gathered from the PubChem online database, and its inhibition details were gathered PKCSM from the webserver. Results: By searching the bioactive compound name in the search bar of “The Herb-CYP450 Enzyme Inhibition Predictor online database” (HCIP- http://hcip.in/), it will provide the liver enzyme inhibition profile of the selected bioactive compound. For example; Guggulsterone: CYP3A4 inhibitor. Conclusion: The Herb-CYP450 Enzyme Inhibition Predictor online database is very peculiar and easy to determine the inhibition profile of the targeted bioactive compound. Keywords: CYP450; Enzyme inhibition; Bioactive Compounds; Online database; Herb-Drug Interaction

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Hossain, Md Nazmul, Nishat Akther, Md Alauddin, Robiul Hasan Bhuiyan, Muhammad Mosaraf Hossain, and Md Abdur Rahaman. "In Vitro Interaction Between Oral Hypoglycemic Drug And Herbal Sex Stimulants: Drug Interactions." European Scientific Journal, ESJ 12, no. 9 (March 30, 2016): 238. http://dx.doi.org/10.19044/esj.2016.v12n9p238.

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Sexual dysfunction is a common, underappreciated complication of diabetes. Male sexual dysfunction among diabetic patients can include disorders of libido, ejaculatory problems, and erectile dysfunction (ED). All three forms of male dysfunction can cause significant bother for diabetic patients and can affect their quality of life. Diabetic patients take oral hypoglycemic drug to control their diabetic as well as take herbal sex stimulants to control to increase the libido. The combined use of herbs and drugs has increased the possibility of herb-drug interactions. The study was undertaken to explore the herb-drug interactions. To investigate the herbdrug interactions an in vitro dissolution study in different simulated pH medium were performed. In this study gliclazide containing tablet of 80mg as oral hypoglycemic drug and different herbal sex stimulants available in local market were used. The release mechanism was explored and explained with zero order, first order and Higuchi equations to identify drug interaction. Higher percentage release of gliclazide was found at simulated phosphate buffer of pH 7.4 compared to gastric medium of pH 1.2 and also in presence of herbal sex stimulants. Increased release pattern of gliclazide by concomitant administration of herbal sex stimulants gives slightly higher absorption, which gives the indication of herb-drug interactions.

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Fasinu, Pius S., Heike Gutmann, Hilmar Schiller, Patrick J. Bouic, and Bernd Rosenkranz. "The potential ofHypoxis hemerocallideafor herb–drug interaction." Pharmaceutical Biology 51, no. 12 (July 11, 2013): 1499–507. http://dx.doi.org/10.3109/13880209.2013.796393.

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Amaeze, O. U., O. A. Olugbake, and M. Lawal. "Knowledge of Herbal Medicines and Herb-drug Interaction Among Medical and Pharmacy Students of the University of Lagos, Nigeria." Nigerian Journal of Pharmaceutical Research 16, no. 1 (July 20, 2020): 61–70. http://dx.doi.org/10.4314/njpr.v16i1.7.

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Background: Concurrent use of herbal and orthodox medicines can result in herb-drug interaction, which could remain unidentified due to the limited knowledge of health care providers on herbal medicines effects and safety.Objectives: This study aimed to assess the knowledge of medical and pharmacy students of the University of Lagos on herbal medicines and herb-drug interactions.Method: The study was a cross-sectional survey of final year pharmacy and medical undergraduate students (422) of the University of Lagos. Data was collected using a validated, previously developed, and standardized self-administered questionnaire. Descriptive statistics was used to evaluate the students’ demographics, knowledge of herbal medicines and herb-drug interactions, types and uses of herbal medicines, while inferential statistics was employed to assess the association between the students’ demographics and their knowledge of herb-drug interactions. Statistical significance was set at P<0.05.Results: The response rate was 97%. The students (98.0%) knew that herbs can be used as medicines; common uses of herbal medicines reported by the students include malaria (11.4%), pain (24.6%), and fever (36.2%). There was no association between the students’ demographics and their knowledge about herbal medicine. Age was significantly associated with knowledge of herb-drug interaction (P<0.05). The students (96.8%) knew that herbs can interact with conventional drugs when administered concurrently. The sources of the students’ knowledge about herbal medicine and herb-drug interaction include lectures (52.2%), literature (14%) and personal experience (13.9%).Conclusion: The students had good knowledge of herbal medicines; however, the subject of herbal medicines and their effects should be given more attention in the medical and pharmacy program curriculum, in order to enhance the students’ knowledge base of herbal medicines and interactions, and equip the future physicians and pharmacists adequately for better patient care. Keywords: Herbal medicines, Herb-drug interaction, Pharmacy students, Medical students

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Kansara, Mital B., and Ashutosh J. Jani. "Possible interactions between garlic and conventional drugs: a review." Pharmaceutical and Biological Evaluations 4, no. 2 (April 2, 2017): 73. http://dx.doi.org/10.26510/2394-0859.pbe.2017.12.

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Herbs can affect body function; therefore, when herbs are taken concurrently with drugs, interactions are possible. The interaction between drugs and herbal medicines is a safe concern and these interactions are especially important for drugs with narrow therapeutics index. The probability of herb-drug interaction can be higher than drug interaction, if conventional drug having single chemical entities, whereas most of the herbal medicinal product contain a mixture of pharmacologically active constituents. The herb-drug interaction may involve either an increase or decrease in the amount of drug in blood, either by altering the absorption, distribution, metabolism, and elimination (ADME) of drug and by antagonizing or synergism of the effect of drug or pharmacodynamics interaction may arise. This article we focus on how garlic interacts with conventional drug or it is favourable or not.

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Cott, Jerry M. "Herb-Drug Interactions: Focus on Pharmacokinetics." CNS Spectrums 6, no. 10 (October 2001): 827–32. http://dx.doi.org/10.1017/s1092852900001644.

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ABSTRACTRecent literature regarding drug-drug, herb-drug, and food-drug interactions must not be ignored; nor can they always be taken at face value. Studies have shown that St. John's wort (SJW)(Hypericum perforatum) can reduce plasma levels of indinavir, cyclosporin, digoxin, and possibly other drugs as well. Current knowledge regarding the metabolism of these medications suggests that the cytochrome P450 (CYP) drug metabolizing enzyme systems cannot account for all these effects. It has been reported that the P-glycoprotein (Pgp) transmembrane pump is also induced by SJW. Medications that are substrates of both CYP 3A4 a Pgp are of particular concern and may pose special interaction risks when combined with certain foods or botanical products such as SJW.

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Burhan, Aslam, and Bhavin Vyas. "BIOANALYTICAL METHOD DEVELOPMENT OF ATENOLOL IN RAT PLASMA BY ULTRA PERFORMANCE LIQUID CHROMATOGRAPHY AND TANDEM MASS SPECTROMETRY METHOD: APPLICATION TO PHARMACOKINETIC DRUG-HERB INTERACTION STUDY." International Journal of Pharmacy and Pharmaceutical Sciences 10, no. 7 (July 1, 2018): 117. http://dx.doi.org/10.22159/ijpps.2018v10i7.26462.

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Objective: To develop a rapid, simple and sensitive ultra-performance liquid chromatography and tandem mass spectrometry (UPLC-MS/MS) method for quantitative estimation of atenolol (ATN) in rat plasma and its application to pharmacokinetic drug-herb interaction study.Methods: Simple precipitation method was used for the extraction of plasma samples with an aliquot of 25 μl plasma samples extracted using acetonitrile precipitation technique containing internal standard. Chromatographic separation was performed using Phenomenex, Kinetex, C18, 50 x 2.1 mm, 1.7µ by a gradient mixture of 0.1 % formic acid in acetonitrile and 10 mmol Ammonium formate as a mobile phase at the flow rate of 0.7 ml/min. The analyte was protonated in the positive electrospray ionization (ESI) interface and detected in multiple reactions monitoring (MRM) modes using the transition m/z 145.0-267.2.Results: The developed method had an advantage of fast chromatography run time of 1.8 min with improved sensitivity over existing methods and broader application to use for drug-herb or drug-drug interaction studies in rat pharmacokinetic. Calibration curves have been linear over the wide range of 4.93-5047.00 ng/ml in rat plasma which covers a wide range of plasma concentrations form study samples. ATN is widely used as a biomarker for determination of the drug-herb or drug-drug interactions studies, especially with the drugs that alter the permeability of another administered drug(s) and the developed method can be used to explore drug interaction studies. Especially to evaluate the role of concurrently administered drugs and its impact on permeability enhancer or absorption enhancer drugs following oral dose administration. This method will be significantly useful for the drug-herb pharmacokinetic interaction studies where we cannot quantify the herb because of multiple components in the hydro-alcoholic or aqueous extract of any herb, so choice remained is to quantify ATN and therefore it will be extremely helpful in such scenario.Conclusion: It was concluded that the developed UPLC-MS/MS method was sensitive linear and rapid; can be used for quantification of ATN in rat plasma for pharmacokinetic drug-herb interaction study.

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Joseph, Lovelyn, Rejeesh Edavan Puthillath, and Sudarshanram Narayan Rao. "Drug Interaction analysis-Nigella sativa L.seed (Black Cumin) ethanolicextract on antiseizure activity of Phenobarbitone sodium." Asian Journal of Medical Sciences 11, no. 2 (February 29, 2020): 18–20. http://dx.doi.org/10.3126/ajms.v11i2.27308.

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Background: Multidisciplinary therapy is gaining popularity and drug herb interactions is one of the biggest risk factor contributing to therapeutic failures or toxicities. Apart from analysis of one of such Drug-Herb combinations, this work also aims at emphasizing need for ethnopharmacovigilance practices. Aims and Objectives: Herb-Drug Interaction analysis between Nigella sativa seed ethanolic extract and Phenobarbitone sodium in maximal electroshock seizure in Swiss albino mice with a modified isobolographic analysis. Materials and Methods: Experiment model was Maximal electroshock seizure in Swiss albino mice. Dose ratios of the combination tested were NsEE: Phenobarbitone; 3:1(NsEE75%: Pbt25%), 1:1, 1:3. Analysis was done with modified isobolographic analysis. Results: Nigella sativa seed ethanolic extract exhibit synergistic interaction with Phenobarbitone sodium at 1:1 and 1:3 dose ratios and antagonistic interaction at 3:1 combination. The parameter measured was Hind limb tonic extensor phase in maximal electroshock seizure test in Swiss albino mice. Conclusion: The study showed that interaction profile of Nigella sativa extract-phenobarbitone combination is dose dependent and requires well designed posological studies in epileptic patients to formulate dose adjustment guidelines for multidisciplinary therapy with the herb and Phenobarbitone, also to avoid food drug interactions.

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Cordova, Ezequiel, Laura Morganti, and Claudia Rodriguez. "Possible Drug–Herb Interaction between Herbal Supplement Containing Horsetail (Equisetum arvense) and Antiretroviral Drugs." Journal of the International Association of Providers of AIDS Care (JIAPAC) 16, no. 1 (November 30, 2016): 11–13. http://dx.doi.org/10.1177/2325957416680295.

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The use of alternative medicines, including herbs, is common among HIV-positive patients, even in those on antiretroviral treatment. Equisetum arvense, known as “horsetail,” is mainly used for its diuretic properties. There are limited data about the pharmacological properties of this compound and the potential drug–herb interactions. The authors report 2 cases in which a possible drug–herb interaction may have led to virological breakthrough in patients who were maintained on the same regimen for many years, including lamivudine (3TC)/zidovudine (ZDV)/efavirenz (EFV) and emtricitabine (FTC)/tenofovir (TDF)/EFV, respectively. Therefore, a drug–herb interaction may be expected when these agents are taken concurrently. Until additional data are available, the authors advise clinicians to avoid this combination when possible.

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Kurtaran, Melek, Neriman Sila Koc, Melek Seren Aksun, Tolga Yildirim, Şeref Rahmi Yilmaz, and Yunus Erdem. "Petroselinum crispum, a commonly consumed food, affects sirolimus level in a renal transplant recipient: a case report." Therapeutic Advances in Drug Safety 12 (January 2021): 204209862110093. http://dx.doi.org/10.1177/20420986211009358.

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Sirolimus is an immunosuppressive drug used to prevent graft rejection. Therapeutic drug monitoring is required as with other immunosuppressive drugs. Previous studies have shown the interactions between sirolimus and drugs that affect the activity of cytochrome P450 3A4 and P-glycoprotein. There is an increasing tendency for the use of herbal remedies in many countries. Medicinal herbs are rich sources of natural bioactive compounds that could interact with drugs. Parsley, Petroselinum crispum, is a food, spice, and also a medicinal herb. We report a case of a renal transplant recipient who had a supratherapeutic blood level of sirolimus due to consuming excessive parsley to highlight a possible herb–drug interaction. This is the first case report describing sirolimus–parsley interaction. Herb–drug interactions are especially important for drugs with a narrow therapeutic window. For this reason, healthcare professionals should question all patients, especially transplant patients, about the use of herbs or herbal products and report interactions. Plain Language Summary Parsley, a commonly consumed food, affects the level of an important drug in a renal transplant recipient: A case report Sirolimus is a drug that suppresses the immune response used to prevent organ rejection in people who have had kidney transplants. In order to reach the optimum balance between therapeutic efficacy and adverse effects, sirolimus blood levels should be closely monitored. Previous studies have shown the interactions between sirolimus and drugs that affect the activities of metabolizing enzymes and transporter proteins. Parsley is a food, spice, and also a medicinal herb. Medicinal herbs are rich sources of natural bioactive compounds that could interact with a prescription drug. We report a case of a renal transplant recipient who had a rise in the blood level of sirolimus due to the ingestion of an excessive amount of parsley to highlight possible herb–drug interaction.

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Mills, E., V. Montori, P. Wu, K. Gallicano, G. Guyatt, and M. Clarke. "Herb-drug interaction clinical trials: a systematic review." Focus on Alternative and Complementary Therapies 8, no. 4 (June 14, 2010): 522–23. http://dx.doi.org/10.1111/j.2042-7166.2003.tb04044.x.

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Revol, Bruno, Elodie Gautier‐Veyret, Capucine Arrivé, Nathalie Fouilhé Sam‐Laï, Anne McLeer‐Florin, Hélène Pluchart, Julian Pinsolle, and Anne‐Claire Toffart. "Pharmacokinetic herb‐drug interaction between ginger and crizotinib." British Journal of Clinical Pharmacology 86, no. 9 (January 30, 2019): 1892–93. http://dx.doi.org/10.1111/bcp.13862.

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Hogle, Brett C., Xiudong Guan, M. Maggie Folan, and Wen Xie. "PXR as a mediator of herb–drug interaction." Journal of Food and Drug Analysis 26, no. 2 (April 2018): S26—S31. http://dx.doi.org/10.1016/j.jfda.2017.11.007.

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Saw, Jun Tze, Mohd Baidi Bahari, Hooi Hoon Ang, and Yu Hoe Lim. "Potential drug–herb interaction with antiplatelet/anticoagulant drugs." Complementary Therapies in Clinical Practice 12, no. 4 (November 2006): 236–41. http://dx.doi.org/10.1016/j.ctcp.2006.06.002.

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Ge, Beikang, Zhen Zhang, and Zhong Zuo. "Updates on the Clinical Evidenced Herb-Warfarin Interactions." Evidence-Based Complementary and Alternative Medicine 2014 (2014): 1–18. http://dx.doi.org/10.1155/2014/957362.

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Increasing and inadvertent use of herbs makes herb-drug interactions a focus of research. Concomitant use of warfarin, a highly efficacious oral anticoagulant, and herbs causes major safety concerns due to the narrow therapeutic window of warfarin. This paper presents an update overview of clinical findings regarding herb-warfarin interaction, highlighting clinical outcomes, severity of documented interactions, and quality of clinical evidence. Among thirty-eight herbs, Cannabis, Chamomile, Cranberry, Garlic, Ginkgo, Grapefruit, Lycium, Red clover, and St. John’s wort were evaluated to have major severity interaction with warfarin. Herbs were also classified on account of the likelihood of their supporting evidences for interaction. Four herbs were considered ashighly probableto interact with warfarin (level I), three were estimated asprobable(level II), and ten and twenty-one werepossible(level III) anddoubtful(level IV), respectively. The general mechanism of herb-warfarin interaction almost remains unknown, yet several pharmacokinetic and pharmacodynamic factors were estimated to influence the effectiveness of warfarin. Based on limited literature and information reported, we identified corresponding mechanisms of interactions for a small amount of “interacting herbs.” In summary, herb-warfarin interaction, especially the clinical effects of herbs on warfarin therapy should be further investigated through multicenter studies with larger sample sizes.

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Jeon, Ji-Hyeon, Sowon Lee, Wonpyo Lee, Sojeong Jin, Mihwa Kwon, Chul Hwi Shin, Min-Koo Choi, and Im-Sook Song. "Herb–Drug Interaction of Red Ginseng Extract and Ginsenoside Rc with Valsartan in Rats." Molecules 25, no. 3 (January 31, 2020): 622. http://dx.doi.org/10.3390/molecules25030622.

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The purpose of this study was to investigate the herb–drug interactions involving red ginseng extract (RGE) or ginsenoside Rc with valsartan, a substrate for organic anion transporting polypeptide (OATP/Oatp) transporters. In HEK293 cells overexpressing drug transporters, the protopanaxadiol (PPD)-type ginsenosides- Rb1, Rb2, Rc, Rd, Rg3, compound K, and Rh2-inhibited human OATP1B1 and OATP1B3 transporters (IC50 values of 7.99–68.2 µM for OATP1B1; 1.36–30.8 µM for OATP1B3), suggesting the herb–drug interaction of PPD-type ginsenosides involving OATPs. Protopanaxatriol (PPT)-type ginsenosides-Re, Rg1, and Rh1-did not inhibit OATP1B1 and OATP1B3 and all ginsenosides tested didn’t inhibit OCT and OAT transporters. However, in rats, neither RGE nor Rc, a potent OATP inhibitor among PPD-type ginsenoside, changed in vivo pharmacokinetics of valsartan following repeated oral administration of RGE (1.5 g/kg/day for 7 days) or repeated intravenous injection of Rc (3 mg/kg for 5 days). The lack of in vivo herb–drug interaction between orally administered RGE and valsartan could be attributed to the low plasma concentration of PPD-type ginsenosides (5.3–48.4 nM). Even high plasma concentration of Rc did not effectively alter the pharmacokinetics of valsartan because of high protein binding and the limited liver distribution of Rc. The results, in conclusion, would provide useful information for herb–drug interaction between RGE or PPD-type ginsenosides and Oatp substrate drugs.

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Fong, Sophia Yui Kau, Qiong Gao, and Zhong Zuo. "Interaction of Carbamazepine with Herbs, Dietary Supplements, and Food: A Systematic Review." Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1–15. http://dx.doi.org/10.1155/2013/898261.

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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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Kamath, M., and K. Brijesh. "Critical analysis of Herb-drug interaction and lifestyle disorders." Journal of Ayurvedic and Herbal Medicine 6, no. 3 (October 9, 2020): 202–5. http://dx.doi.org/10.31254/jahm.2020.6318.

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Life stable disease or lifestyle disorder exists in the world since the last century. Socioeconomic advancements, globalization and blurring geographies for trade are the most common causes. Although advances in medicine have eradicated most of the diseases were based on Germ theory that was prevalent in the last century, Present generation has coped with a fresh set of diseases, creatively called “lifestyle diseases” or “Lifestyle disorder” as the name itself suggests, the change in diet and lifestyle are the major causes of these diseases. A study conducted by The Harvard School of Public Health has described that India will lose around $6.2 trillion during the period 2012-30 by lifestyle maladies. And the size of the world Herbal drug market is 83 billion dollars in 2008 and grown to three trillion US dollars in 2050. In spite of such wide acceptability, Herb-drug interactions are the most common lifestyle diseases.

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Fasinu, Pius S., Heike Gutmann, Hilmar Schiller, Alexander-David James, Patrick J. Bouic, and Bernd Rosenkranz. "The Potential of Sutherlandia frutescens for Herb-Drug Interaction." Drug Metabolism and Disposition 41, no. 2 (December 3, 2012): 488–97. http://dx.doi.org/10.1124/dmd.112.049593.

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Xu, Hao, and Ke-ji Chen. "Herb-drug interaction: An emerging issue of integrative medicine." Chinese Journal of Integrative Medicine 16, no. 3 (June 2010): 195–96. http://dx.doi.org/10.1007/s11655-010-0195-z.

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Zhang, Xi-Shan, Zhi-Qiang Zhao, Zhen-Sheng Qin, Kun Wu, Tian-Fang Xia, and Li-Qun Pang. "Herb-drug interaction between irinotecan and psoralidin-containing herbs." European Journal of Drug Metabolism and Pharmacokinetics 40, no. 4 (September 13, 2014): 481–84. http://dx.doi.org/10.1007/s13318-014-0223-8.

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Yang, Changsop, Youngeun Kim, Icktae Kim, Chul Kim, Sangjun Yea, and Miyoung Song. "Developing a Database of Herb-Drug Interaction on Hypertension." Integrative Medicine Research 4, no. 1 (May 2015): 142. http://dx.doi.org/10.1016/j.imr.2015.04.275.

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Puranik, Amrutesh S., Ganesh Halade, Sandeep Kumar, Ranjan Mogre, Kishori Apte, Ashok D. B. Vaidya, and Bhushan Patwardhan. "Cassia auriculata: Aspects of Safety Pharmacology and Drug Interaction." Evidence-Based Complementary and Alternative Medicine 2011 (2011): 1–8. http://dx.doi.org/10.1093/ecam/nep237.

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Safety pharmacology studies help in identifying preclinical adverse drug reactions. We carried out routine safety pharmacology with focus on cardiovascular variables and pharmacokinetic herb-drug interaction studies on rats fed with standardized traditional hydro-alcoholic extract and technology-based supercritical extract ofCassia auriculatafor 12 weeks. Our studies indicate that both these extracts are pharmacologically safe and did not show any significant adverse reactions at the tested doses. The traditional hydro-alcoholic extract did not show any significant effect on pharmacokinetics; however, the technology-based supercritical extract caused a significant reduction in absorption of metformin. Our results indicate the need to include pharmacokinetic herb-drug interaction studies as evidence for safety especially for technology-based extracts.

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Lin, Ge. "Beneficial herb–drug interaction in combinational therapy of herbal medicine with drug." European Journal of Integrative Medicine 6, no. 6 (December 2014): 697. http://dx.doi.org/10.1016/j.eujim.2014.09.028.

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Glynn, John, and Rashid Bhikha. "Herbal Products and Conventional Drugs – an Uneasy Alliance." International Journal of Human and Health Sciences (IJHHS) 2, no. 4 (August 29, 2018): 193. http://dx.doi.org/10.31344/ijhhs.v2i4.55.

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This review examines the interaction between herbal remedies and conventional (orthodox) drugs. There has been a substantial increase in the consumption of herbal remedies in recent times for various reasons. They are often combined with one another, and are often used simultaneously with conventional drugs that are taken for a wide range of disorders, both acute and chronic. The probability of a real and substantial interaction between the therapeutic agents originating from different medical paradigms is likewise expanding. Whilst most of the herb-drug interactions are undoubtedly minor, benign, and harmless, there are reports of more serious interactions. Possible reasons for specific herb-drug interactions are examined, particularly from the pharmacokinetic and pharmacodynamics perspectives. International Journal of Human and Health Sciences Vol. 02 No. 04 October’18. Page : 193-198

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Akowuah, Gabriel Akyirem, Jin Han Chin, Siew Wei Yeong, Suk Yen Quah, and Mariam Ahmad. "In-Vitro CYP3A4, CYP2E1 and UGT Activity in Human Liver Microsomes by Strobilanthes crispus Leaf Extracts." Natural Products Journal 10, no. 2 (March 24, 2020): 104–12. http://dx.doi.org/10.2174/2210315509666190304124328.

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Background: Strobilanthes crispus (L.) Bremek (Acanthaceae) leaves are used traditionally in Malaysia, Thailand, and Indonesia for anti-diabetic, anti-lytic, diuretic, and laxative purposes. Herb-drug interactions may potentiate or antagonize the absorption and metabolism of drugs which may result in potential toxicity. The aim of the present study was to investigate the effect of juice, hot aqueous, cold aqueous and methanol extracts of S. crispus leaves on phase I cytochrome 3A4 (CYP3A4) and Cytochrome 2E1 (CYP2E1) and phase II human liver enzyme UDP-Glucuronosyl Transferase (UGT). Methods: The herb-drug interactions of the leaf extracts and juice were determined by specific enzyme activity of CYP isoforms with specific probe substrate using spectrophotometry. CYP3A4 activity was measured for aminopyrine specific metabolite (formaldehyde) at 415 nm. CYP2E1 activity was determined using p-nitrophenol specific metabolite (p-nitrocatechol) at 535 nm. UGT activity was quantified through the consumption of p-nitrophenol by UGT at 405 nm. Results: All the S. crispus preparations showed significant inhibition of CYP3A4 activity. Only the methanolic extract showed a significant inhibition in CYP2E1. All the S. crispus extracts showed a significant effect on UGT activation at the higher concentration (1000 ng/ml). Only the cold aqueous extract and the juice showed UGT inhibition at lower concentration (1 ng/ml). Conclusion: S. crispus preparations showed in-vitro drug-herb interaction effects on human liver microsomes. Therefore, there is a possibility of drug-herb interaction could occur with S. crispus leaves through its effect on CYP3A4. Inhibition of the herb extracts on CYP2E1 could show anticarcinogenesis effects. The potency of drugs that metabolized via UGT pathway may be affected when co-administered with S. crispus leaf preparations.

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Cheng, Chung-Wah, Wing Fan, Seong-Gyu Ko, Lisa Song, and Zhao-Xiang Bian. "Evidence-Based Management of Herb-Drug Interaction in Cancer Chemotherapy." EXPLORE 6, no. 5 (September 2010): 324–29. http://dx.doi.org/10.1016/j.explore.2010.06.004.

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Zhong, Qingxiang, Ziqi Shi, Li Zhang, Rongling Zhong, Zhi Xia, Jing Wang, Hao Wu, et al. "The potential of Epimedium koreanum Nakai for herb-drug interaction." Journal of Pharmacy and Pharmacology 69, no. 10 (June 27, 2017): 1398–408. http://dx.doi.org/10.1111/jphp.12773.

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Lee, Sang Yoon, Ji-Yoon Lee, Wonku Kang, Kwang-il Kwon, Song-Kyu Park, Soo Jin Oh, Jin Yeul Ma, and Sang Kyum Kim. "Cytochrome P450-mediated herb–drug interaction potential of Galgeun-tang." Food and Chemical Toxicology 51 (January 2013): 343–49. http://dx.doi.org/10.1016/j.fct.2012.10.012.

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Ni, Hao, Takashi Matsumoto, Junko Watanabe, and Toshiaki Makino. "Inhibitory Effect of Japanese Traditional Kampo Formula Frequently Prescribed in Gynecological Clinics on CYP3A4." Evidence-Based Complementary and Alternative Medicine 2018 (October 1, 2018): 1–7. http://dx.doi.org/10.1155/2018/4259603.

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Recently, the use of herbal medicines has become popular, and information on drug interactions between herbal medicines and chemical drugs is needed in clinics. In Japan, the number of patients taking Japanese traditional Kampo medicines has been increasing, and the proper drug information about herb-drug interaction is highly demanded. The most established herb-drug interaction is the case of grapefruit juice (GFJ) via the inhibition on CYP3A4 expressed in the small intestine. In the present study, we compared the inhibitory titer on CYP3A4 between the target Kampo products and GFJ used as positive control. We evaluated the inhibitory effects of GFJ and three extracts of Kampo formulas frequently used in gynecological clinics on CYP3A4 in vitro and calculated the related titer of one-time dosage of Kampo formulas to GFJ in order to predict its effect on clinics. Although the extracts of these three Kampo formulas and the most of crude drug components in the formulas exhibited the inhibitory effects on CYP3A4 in some levels, the possibilities of tokishakuyakusan and keishibukuryogan to cause drug interaction can be quite low; however, it is possible that the excessive dosage of kamishoyosan may cause drug interaction with the substrate of CYP3A4 in clinics.

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Awortwe, Charles, P. S. Fasinu, and B. Rosenkranz. "Application of Caco-2 Cell Line in Herb-Drug Interaction Studies: Current Approaches and Challenges." Journal of Pharmacy & Pharmaceutical Sciences 17, no. 1 (January 13, 2014): 1. http://dx.doi.org/10.18433/j30k63.

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The Caco-2 model is employed in pre-clinical investigations to predict the likely gastrointestinal permeability of drugs because it expresses cytochrome P450 enzymes, transporters, microvilli and enterocytes of identical characteristics to the human small intestine. The FDA recommends this model as integral component of the Biopharmaceutics Classification System (BCS). Most dedicated laboratories use the Caco-2 cell line to screen new chemical entities through prediction of its solubility, bioavailability and the possibility of drug-drug or herb-drug interactions in the gut lumen. However, challenges in the inherent characteristics of Caco-2 cell and inter-laboratory protocol variations have resulted to generation of irreproducible data. These limitations affect the extrapolation of data from pre-clinical research to clinical studies involving drug-drug and herb-drug interactions. This review addresses some of these caveats and enumerates the plausible current and future approaches to reduce the anomalies associated with Caco-2 cell line investigations focusing on its application in herb-drug interactions. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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Patel, Nima M., and Ramona M. Derkits. "Possible Increase in Liver Enzymes Secondary to Atorvastatin and Black Cohosh Administration." Journal of Pharmacy Practice 20, no. 4 (August 2007): 341–46. http://dx.doi.org/10.1177/0897190007303051.

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Introduction: Since the publication of the Women's Health Initiative (WHI) trials, there has been a decline in the use of hormonal replacement therapy (HRT). The risks outweighed the benefits in the WHI trials, and therefore women are seeking alternative treatments including herbal remedies to HRT for mitigation of postmenopausal conditions. The authors report a case of drug-herb interaction between black cohosh (Cimicifuga racemosa ) and atorvastatin leading to elevation in liver enzymes. Case summary: A 53-year-old woman with a past medical history significant for atypical chest pain, family history of coronary artery disease, and menopause discontinued oral HRT and started black cohosh for treatment of her menopausal symptoms. The patient also reported taking atorvastatin, aspirin, glucosamine/chondroitin, and vaginal estradiol (Vagifem® ). Routine lab results revealed an acute elevation of her liver enzymes. At this time, additional blood tests were performed to rule out other plausible causes of acute elevation in liver enzymes, which did not reveal other etiologies. It was recommended that she discontinue the black cohosh immediately due to a potential drug-herb interaction. Following the patient's discontinuation of black cohosh, her liver enzymes decreased within 1 week and completely returned to normal within 1 month. Discussion: Several case reports have associated black cohosh with hepatotoxicity. It was reported that a commercially available formulation of black cohosh may potently inhibit human cytochrome (CYP) 3A4. Inhibition of CYP3A4 by black cohosh could possibly elevate levels of atorvastatin, causing an elevation of liver enzymes. To the authors' knowledge, they report the first case report of drug-herb interaction with use of the black cohosh and atorvastatin. Conclusion: The use of black cohosh concomitantly with atorvastatin may potentially lead to a drug-herb interaction resulting in an elevation of liver enzymes. According to the Naranjo probability scale, there was a possible drug-induced adverse event. Black cohosh should not be routinely recommended for treatment of menopausal symptoms. However, if a patient chooses to use black cohosh against medical advice, particular attention should be given to the potential CYP3A4 drug interactions.

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Auxtero, Maria D., Susana Chalante, Mário R. Abade, Rui Jorge, and Ana I. Fernandes. "Potential Herb–Drug Interactions in the Management of Age-Related Cognitive Dysfunction." Pharmaceutics 13, no. 1 (January 19, 2021): 124. http://dx.doi.org/10.3390/pharmaceutics13010124.

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Late-life mild cognitive impairment and dementia represent a significant burden on healthcare systems and a unique challenge to medicine due to the currently limited treatment options. Plant phytochemicals have been considered in alternative, or complementary, prevention and treatment strategies. Herbals are consumed as such, or as food supplements, whose consumption has recently increased. However, these products are not exempt from adverse effects and pharmacological interactions, presenting a special risk in aged, polymedicated individuals. Understanding pharmacokinetic and pharmacodynamic interactions is warranted to avoid undesirable adverse drug reactions, which may result in unwanted side-effects or therapeutic failure. The present study reviews the potential interactions between selected bioactive compounds (170) used by seniors for cognitive enhancement and representative drugs of 10 pharmacotherapeutic classes commonly prescribed to the middle-aged adults, often multimorbid and polymedicated, to anticipate and prevent risks arising from their co-administration. A literature review was conducted to identify mutual targets affected (inhibition/induction/substrate), the frequency of which was taken as a measure of potential interaction. Although a limited number of drugs were studied, from this work, interaction with other drugs affecting the same targets may be anticipated and prevented, constituting a valuable tool for healthcare professionals in clinical practice.

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Pramesthi, Asri Dwi Endah Dewi, Mirhansyah Ardana, and Niken Indriyanti. "Drug-Herb Interaction between Metformin and Momordica charantia in Diabetic Mice." Molecular and Cellular Biomedical Sciences 3, no. 2 (September 1, 2019): 81. http://dx.doi.org/10.21705/mcbs.v3i2.47.

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Background: Bitter gourd has various metabolites, such as momordicosides, polypeptide-P, v-insulin, charantin, and vicine that have antidiabetic effect. It has synergistically effect while combined with oral diabetic drugs, such as metformin as glucose lowering agent. The aim of this study is to investigate the interaction of bitter gourd fruit juice and metformin as glucose lowering agent in mice.Materials and Methods: Alloxan-induced diabetic mice were treated with bitter gourd fruit juice, metformin, and the combination of those two for 21 days. Glucose level was checked on first and last day of treatment.Results: Furthermore, blood glucose levels measurement showed no significant difference between groups compared with negative control, which was p>0.05. The stomach of groups that treated with metformin and bitter gourd fruit juice histopathologically showed no significant differences.Conclusion: The use of bitter gourd once daily together with metformin is a better choice, while twice daily might induce hypoglycemia and mice death. There is no interaction between them on lowering blood glucose.Keywords: metformin, Momordica charantia, diabetes mellitus

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Bhadra, Rajarshi, Keyvan Ravakhah, and Raktim Ghosh. "Herb-drug interaction: The importance of communicating with primary care physicians." Australasian Medical Journal 8, no. 10 (October 31, 2015): 315–19. http://dx.doi.org/10.4066/amj.2015.2479.

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Yuan, Yue-mei, Jing-wen Gao, Zhan Shi, Ping Huang, Ya-song Lu, Mei-cun Yao, and Min Huang. "Herb–drug pharmacokinetic interaction between radix astragali and pioglitazone in rats." Journal of Ethnopharmacology 144, no. 2 (November 2012): 300–304. http://dx.doi.org/10.1016/j.jep.2012.09.012.

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Zhang, Feng, Jian Huang, Rong-Jing He, Lu Wang, Peng-Chao Huo, Xiao-Qing Guan, Sheng-Quan Fang, Yan-Wei Xiang, Shou-Ning Jia, and Guang-Bo Ge. "Herb-drug interaction between Styrax and warfarin: Molecular basis and mechanism." Phytomedicine 77 (October 2020): 153287. http://dx.doi.org/10.1016/j.phymed.2020.153287.

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Harish Chandra, Rodda, and Ciddi Veeresham. "Herb — drug interaction of noni juice and Ginkgo biloba with phenytoin." Pharmacognosy Journal 2, no. 18 (January 2011): 33–41. http://dx.doi.org/10.1016/s0975-3575(11)80023-4.

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Takahashi, Kyoko, Xiao-Long Hou, and Koichi Takahashi. "Practical application of Kampo formulations: implications for pharmacokinetic herb-drug interaction." Folia Pharmacologica Japonica 132, no. 5 (2008): 270–75. http://dx.doi.org/10.1254/fpj.132.270.

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Moltó, José, Marta Valle, Cristina Miranda, Samandhy Cedeño, Eugenia Negredo, Manuel José Barbanoj, and Bonaventura Clotet. "Herb-Drug Interaction betweenEchinacea purpureaand Darunavir-Ritonavir in HIV-Infected Patients." Antimicrobial Agents and Chemotherapy 55, no. 1 (November 15, 2010): 326–30. http://dx.doi.org/10.1128/aac.01082-10.

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ABSTRACTThe aim of this open-label, fixed-sequence study was to investigate the potential ofEchinacea purpurea, a commonly used botanical supplement, to interact with the boosted protease inhibitor darunavir-ritonavir. Fifteen HIV-infected patients receiving antiretroviral therapy including darunavir-ritonavir (600/100 mg twice daily) for at least 4 weeks were included.E. purpurearoot extract capsules were added to the antiretroviral treatment (500 mg every 6 h) 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 darunavir-ritonavir on days 0 (darunavir-ritonavir) and 14 (darunavir-ritonavir plus echinacea). Individual darunavir pharmacokinetic parameters were calculated by noncompartmental analysis and compared between days 0 and 14 with the geometric mean ratio (GMR) and its 90% confidence interval (CI). The median age was 49 (range, 43 to 67) years, and the body mass index was 24.2 (range, 18.7 to 27.5) kg/m2. Echinacea was well tolerated, and all participants completed the study. The GMR for darunavir coadministered with echinacea relative to that for darunavir alone was 0.84 (90% CI, 0.63-1.12) for the concentration at the end of the dosing interval, 0.90 (90% CI, 0.74-1.10) for the area under the concentration-time curve from 0 to 12 h, and 0.98 (90% CI, 0.82-1.16) for the maximum concentration. In summary, coadministration ofE. purpureawith darunavir-ritonavir was safe and well tolerated. Individual patients did show a decrease in darunavir concentrations, although this did not affect the overall darunavir or ritonavir pharmacokinetics. Although no dose adjustment is required, monitoring darunavir concentrations on an individual basis may give reassurance in this setting.

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Li, Jiajia, Qing Liang, and GuangChun Sun. "Interaction between Traditional Chinese Medicine and Anticoagulant/Antiplatelet Drugs." Current Drug Metabolism 20, no. 9 (October 4, 2019): 701–13. http://dx.doi.org/10.2174/1389200220666190827160212.

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Background: Traditional Chinese medicine (TCM) has been used for medical purposes since the ancient time and has gradually gained recognition worldwide. Nowadays, patients with thrombus presiding to anticoagulant/ antiplatelet drugs prefer taking TCM. However, an increasing number of studies on herb–drug interactions have been shown. Nevertheless, findings are frequently conflicting and vague. In this review, we discuss the herb–drug interactions between TCM and anticoagulant/antiplatelet drugs to provide guidance on concomitant ingestion with anticoagulant/antiplatelet drugs. Methods: We undertook a structured search of medicine and drug databases for peer-reviewed literature using focused review questions. Results: Danshen, Ginkgo, Ginger, H. Perforatum, SMY and Puerarin injection had directional regulation effects on the efficacy of anticoagulant drugs by altering the CYPs, pharmacokinetic indexs and hemorheological parameters. H. Perforatum inhibited the efficacy of Clopidogrel by enhancing the CYP3A4 activity and Ginkgo increased the efficacy of Ticlopidine. Additionally, Renshen, the formulae except SMY and injections except Puerarin injection could increase or decrease the efficacy of anticoagulant/antiplatelet drugs via regulating the CYPs, platelet aggregation, hemorheological parameters and others. Conclusion: Some cases have reported that TCMs may increase the bleeding risk or has no effect on coagulation when anticoagulant/antiplatelet drugs are concurrently used. However, pharmacokinetic studies have presented either consistent or slightly varying results. So it is difficult to ascertain whether the concurrent use of TCM may increase or reduce the pharmacologic effects of anticoagulant/antiplatelet drugs with adverse reactions. Therefore, herb–drug interactions of TCM and anticoagulant/antiplatelet drugs should be further explored and defined.

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Sun, Shi, Yifang Wang, Ailing Wu, Zhen Ding, and Xinguang Liu. "Influence Factors of the Pharmacokinetics of Herbal Resourced Compounds in Clinical Practice." Evidence-Based Complementary and Alternative Medicine 2019 (March 5, 2019): 1–16. http://dx.doi.org/10.1155/2019/1983780.

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Herbal medicines have been used to prevent and cure diseases in eastern countries for thousands of years. In recent decades, these phytotherapies are becoming more and more popular in the West. As being nature-derived is the essential attribute of herbal medicines, people believe that taking them for diseases treatment is safe enough and has no side-effects. However, the efficacy of herbal resourced compounds (HRC) depends on the multiple constituents absorbed in the body and their pharmacokinetics. Thus, many factors will influence the clinical practice of HRC, i.e., their absorption, distribution, metabolism, and excretion (ADME). Among these factors, herb-drug interaction has been widely discussed, as these compounds may share the same drug-metabolizing enzymes and drug transporters. Meanwhile there are many other potential factors that can also change the ADME of HRC, including herb pretreatment, herb-herb interactions, pathological status, gender, age of patient, and chemical and physical modification of certain ingredients. With the aim of ensuring the efficacy of HRC and minimizing their clinical risks, this review provides and discusses the influence factors and artificial improvement of the pharmacokinetics of HRC.

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Chen, Feng, Li Li, and Dan-Dan Tian. "Salvia miltiorrhizaRoots against Cardiovascular Disease: Consideration of Herb-Drug Interactions." BioMed Research International 2017 (2017): 1–12. http://dx.doi.org/10.1155/2017/9868694.

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Salvia miltiorrhizaroot (Danshen) is widely used in Asia for its cardiovascular benefits and contains both hydrophilic phenolic acids and lipophilic tanshinones, which are believed to be responsible for its therapeutic efficacy. This review summarized the effects of these bioactive components fromS. miltiorrhizaroots on pharmacokinetics of comedicated drugs with mechanic insights regarding alterations of protein binding, enzyme activity, and transporter activity based on the published data stemming from bothin vitroandin vivohuman studies.In vitrostudies indicated that cytochrome P450 (CYP450), carboxylesterase enzyme, catechol-O-methyltransferase, organic anion transporter 1 (OAT1) and OAT3, and P-glycoprotein were the major targets involved inS. miltiorrhiza-drug interactions. Lipophilic tanshinones had much more potent inhibitory effects towards CYPs activities compared to hydrophilic phenolic acids, evidenced by much lowerKivalues of the former. ClinicalS. miltiorrhiza-drug interaction studies were mainly conducted using CYP1A2 and CYP3A4 probe substrates. In addition, the effects of coexisting components on the pharmacokinetic behaviors of those noted bioactive compounds were also included herein.

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Journal articles on the topic 'Herb-drug interaction'

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