INTERACTIONS BETWEEN HERBS AND DRUGS AT THE LEVEL OF TRAN
Journal Title: Българско списание за обществено здраве (Bulgarian Journal of Public Health) - Year 2019, Vol 0, Issue 1
Abstract
A literature review of undesirable potential clinical interactions at the pharmacokinetics ((P-GP) transport), between herbal products (HPs)2 and drugs3 , when administered concomitantly. Permeability glycoprotein (P-gp) transport system is considered to be a major efflux system, expressed predominantly in the intestinal epithelial cells. Substrates of (P-gp) are: certain anticancer drugs; several calcium channel blockers (amlodipine); immunosuppressants (tacrolimus); calcineurin inhibitors 4 (cyclosporine); digoxin; macrolide antibiotics (clarithromycin, erythromycin); ftorhinolones; HIV-1 protease inhibitors (ritonavir, indinavir and saquinavir); statins (lovastatin); medicines to treat diarrhea (loperamide); ftorhinolones, etc. HPs-inhibitors of P-GP are: grapefruit juice; dried mature fruit of Schisandra chinensis (Turcz); valerian (Valeriana officinalis L); rosemary (Rosmarinus Officinalis L); sage tea (Salvia officinalis), ginkgo biloba (Ginkgo biloba L), horse chestnut (Aesculus hippocastanum L), which may prolong the action of the important substrates of this system and increase the risk of intoxication. In a number of cases, the P-gp enzyme induction from PPs: St. John‘s wort (Hypericum perforatum L); red clover (Trifolium pretense L); milk thistle (Silybum marianim L), reduces the pharmacological effects of drug-substrates of this system. Conclusion: HPs, inhibitors and inducers of the P-gp transport system, modulate the effectiveness of drugs substrates of this system at the pharmacokinetics level in their concomitant use. To avoid such situations, it is necessary to raise awareness among physicians, pharmacists and patients about the potential interactions between HPs and drugs that lead to the occurrence of adverse reactions.
Authors and Affiliations
Iliyana Yaneva, Valentin Balabanski, Tatyana Karanesheva
Keywords
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