nach oben

Drugs

Erschienen in:

01.12.2001 | Review Article

Interactions Between Herbal Medicines and Prescribed Drugs

A Systematic Review

verfasst von: Angelo A. Izzo, Dr Edzard Ernst

Erschienen in: Drugs | Ausgabe 15/2001

Einloggen, um Zugang zu erhalten

Abstract

Despite the widespread use of herbal medicines, documented herb-drug interactions are sparse. We have reviewed the literature to determine the possible interactions between the seven top-selling herbal medicines (ginkgo, St John’s wort, ginseng, garlic, echinacea, saw palmetto and kava) and prescribed drugs. Literature searches were performed using the following databases: Medline (via Pubmed), Cochrane Library, Embase and phytobase (all from their inception to July 2000). All data relating to herb-drug interactions were included regardless of whether they were based on case reports, case series, clinical trials or other types of investigation in humans. In vitro experiments were excluded. Data were extracted by the first author and validated by the second author. 41 case reports or case series and 17 clinical trials were identified.

The results indicate that St John’s wort (Hypericum perforatum) lowers blood concentrations of cyclosporin, amitriptyline, digoxin, indinavir, warfarin, phenprocoumon and theophylline; furthermore it causes intermenstrual bleeding, delirium or mild serotonin syndrome, respectively, when used concomitantly with oral contraceptives (ethinylestradiol/desogestrel), loperamide or selective serotonin-reuptake inhibitors (sertaline, paroxetine, nefazodone). Ginkgo (Ginkgo biloba) interactions include bleeding when combined with warfarin, raised blood pressure when combined with a thiazide diuretic and coma when combined with trazodone. Ginseng (Panax ginseng) lowers blood concentrations of alcohol and warfarin, and induces mania if used concomitantly with phenelzine. Garlic (Allium sativum) changes pharmacokinetic variables of paracetamol, decreases blood concentrations of warfarin and produces hypoglycaemia when taken with chlorpropamide. Kava (Piper methysticum) increases ‘off periods in Parkinson patients taking levodopa and can cause a semicomatose state when given concomitantly with alprazolam. No interactions were found for echinacea (Echinacea angustifolia, E. purpurea, E. pallida) and saw palmetto (Serenoa repens).

In conclusion, interactions between herbal medicines and synthetic drugs exist and can have serious clinical consequences. Healthcare professionals should ask their patients about the use of herbal products and consider the possibility of herb-drug interactions.

Blumenthal M. Herb market levels after five years of boom. HerbalGram 1999; 47: 64–5

Gruenwald J. The supplement markets in the US and Europe. Neutraceuticals World 2000 Jul/Aug: 36–7

Ernst E. Herbal medicine. Aconcise overview for professionals. Oxford: Butterworth Heinemann, 2000

Ernst E. Herbal medicines: where is the evidence? BMJ 2000; 321: 395–6PubMedCrossRef

Ernst E. Harmless herbs? A review of the recent literature. Am J Med 1998; 104: 170–8PubMedCrossRef

Fugh-Berman A. Herb-drug interactions. Lancet 2000; 355: 134–8PubMedCrossRef

Eisenberg D, David RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990–1997. JAMA 1998; 280: 1569–75PubMedCrossRef

Hobbs WR, Rall TW, Verdoorn TA. Hypnotics and sedatives: ethanol. In: Hardman JG, Goodman Gilman A, Molinoff PB, et al. editors. Goodman & Gilman’s The pharmacological basis of therapeutics. 9th ed. New York (NY): McGraw Hill, 1996: 361–96

Brinker F. Herb contraindications and drug interactions. Sandy (OR): Eclectic Medical Publications, 1998

10.

Lininger SW. A-Z guide to drug-herb-vitamin interactions. Rocklin (CA): Prima Publishing, 1999

11.

Meletis CD, Jacobs T. Interactions between drugs and natural medicines. Sandy (OR): Eclectic Medical Publications, 1999

12.

Cupp MJ. Herbal remedies: adverse effects and drug interactions. Am Fam Physician 1999; 59: 1239–45PubMed

13.

Klepser TB, Klepser ME. Unsafe and potentially safe herbal therapies. Am J Health Syst Pharm 1999; 56: 125–37PubMed

14.

Barrett B, Kiefer D, Rabago D. Assessing the risks and benefits of herbal medicine: an overview of scientific evidence. Altern Ther 1999; 5: 40–9

15.

Smolinske, SC. Dietary supplement-drug interactions. J Am Med Womens Assoc 1999; 4: 191–2

16.

Miller LG. Herbal medicinals. Selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998; 158: 2200–11PubMedCrossRef

17.

Ernst E. Possible interactions between synthetic and herbal medicinal products. Part 1: a systematic review of the indirect evidence. Perfusion 2000; 13: 4–15

18.

Leak JA. Perioperative considerations in the management of the patient taking herbal medicines. Curr Opin Anaesthesiol 2000; 13: 321–5PubMedCrossRef

19.

WHO monographs on selected medicinal plants. Vol. 1. Geneva: World Health Organisation, 1999

20.

Boon H, Smith M. The botanical pharmacy. Kingston (ON): Quarry Press Kingston, 1999

21.

Ross IA. Medicinal plants of the World. Totowa (NJ): Human Press, 1999

22.

Cupp MJ. Toxicology and clinical pharmacology of herbal products. Totowa (NJ): Human Press, 2000CrossRef

23.

Foster S, Tyler VE. Tyler’s honest herbal. New York (NY): The Haworth Herbal Press, 1999

24.

Jepson RG, Kleijnen J, Leng GC. Garlic for peripheral arterial occlusive disease. Update software, CD 000095. Oxford: The Cochrane Library, 2000

25.

Diamond BJ, Shifflett SC, Feiwel N, et al. Ginkgo biloba extract: mechanisms and clinical indications. Arch Phys Med Rehabil 2000; 81: 668–78PubMed

26.

Bahrke MS, Morgan WP. Evaluation of the erogogenic properties of ginseng. Sports Med 2000; 29: 113–33PubMedCrossRef

27.

Pittler MH, Ernst E. Efficacy of kava extract for treating anxiety: systematic review and meta-analysis. J Clin Psychopharmacol 2000; 20: 84–9PubMedCrossRef

28.

McIntyre M. A review of the benefits, adverse events, drug interactions, and safety of St John’s wort (Hypericum perforatum): the implications with regard to the regulation of herbal medicines. J Altern Med 2000; 6: 115–24CrossRef

29.

Percival SS. Use of echinacea in medicine. Biochem Pharmacol 2000; 60: 155–8PubMedCrossRef

30.

Wilt T, Ishani A, Stark G, et al. Serenoa repens for benign prostatic hyperplasia. Update software, CD001423 Issue 2. Oxford: The Cochrane Library, 2000

31.

Aslam M, Stockley I. Interaction between curry ingredient (karela) and drug (chlorpropamide). Lancet 1979; I: 607CrossRef

32.

Sunter WH. Warfarin and garlic. Pharm J 1991; 246: 772

33.

Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997; 336: 1108PubMedCrossRef

34.

Shaw D, Leon D, Kolev S, et al. Traditional remedies and food supplements: a 5-year toxicological study (1991–1995). Drug Saf 1997; 17: 342–56PubMedCrossRef

35.

Galluzzi S, Zanetti O, Binetti G, et al. Coma in a patient with Alzheimer’s disease taking low dose trazodone and ginkgo biloba. J Neurol Neurosurg Psychiatry 2000; 68: 679–83PubMedCrossRef

36.

Matthews MK. Association of Ginkgo biloba with intracerebral haemorrhage. Neurology 1998; 5: 1933CrossRef

37.

Shader RI, Greenblatt DJ. Phenelzine and the dream machine — ramblings and reflections. J Clin Psychopharmacol 1985; 5: 65PubMedCrossRef

38.

Jones BD, Runikis AM. Interaction of ginseng with phenelzine. J Clin Psychopharmacol 1987; 7: 201–2PubMedCrossRef

39.

Janetzky K, Morreale AP. Probable interactions between warfarin and ginseng. Am J Health Syst Pharm 1997; 54: 692–3PubMed

40.

Almeida JC, Grimsley EW Coma from the health food store: interaction between kava and alprazolam. Ann Intern Med 1996; 125: 940–1PubMed

41.

Scheloscky L, Raffauf C, Kendroska K, et al. Kava and dopamine antagonism. J Neurol Neurosurg Psychiatry 1995; 58: 639–40CrossRef

42.

Bon S, Hartmann K, Kubn M. Johanniskraut: Ein Enzyminduktor? Schweitzer Apothekerzeitung 1999; 16: 535–6

43.

Breidenbach Th, Kliem V, Burg M, et al. Profound drop of cyclosporin. A whole blood trough levels caused by St John’s Wort (Hypericum perforatum). Transplantation 2000; 69: 2229–32PubMedCrossRef

44.

Breidenbach Y, Hoffmann MW, Becher T, et al. Drug interaction of St John’s wort with cyclosporin. Lancet 2000; 355: 1912PubMedCrossRef

45.

Roots I, Johne A, Maurer A, et al. Arzneimittel interaktionen von hypericum-extract. Proc Germ Soc Pharmacol 2000 Jun 16–17; Berlin

46.

Rey JM, Walter G. Hypericum perforatum (St John’s wort) in depression: pest or blessing? Med J Aust 1998; 169: 583–6PubMed

47.

Ruschitzka F, Meier PJ, Turina M, et al. Acute heart transplant refection due to Saint John’s wort. Lancet 2000; 355: 548–9PubMedCrossRef

48.

Khawaja IS, Marotta RF, Lippmann S. Herbal medicines as a factor in delirium. Psychiatric services 1999; 50: 969–70PubMed

49.

Yue Q-Y, Bergquist C, Gerden B. Safety of St John’s wort (Hypericum perforatum). Lancet 2000; 355: 576–7PubMedCrossRef

50.

Lantz MS, Buchalter E, Giambanco V. St. John’s wort and antidepressant drug interactions in the elderly. J Geriatr Psychiatry Neurol 1999; 12: 7–10PubMedCrossRef

51.

Barbenel DM, Yusufi B, O’Shea D, et al. Mania in a patient receiving testosterone replacement post-orchidectomy taking St John’s wort and sertraline. J Psychopharmacol 2000; 14: 84–6PubMedCrossRef

52.

Gordon JB. SSRIs and St. John’s wort: possible toxicity? Am Fam Phys 1998; 57: 950

53.

Nebel A, Schneider BJ, Baker RK, et al. Potential metabolic interaction between St. John’s wort and theophylline. Ann Pharmacother 1999; 33: 502PubMedCrossRef

54.

Gwilt PR, Lear CL, Tempero MA, et al. The effect of garlic extract on hyman metabolism of acetaminophen. Cancer Epidemiol, Biomarkers Prev 1994; 3: 155–60

55.

Duche JC, Barre J, Guinot P, et al. Effect of ginkgo biloba extract on microsomal enzyme induction. Int J Clin Pharmacol Res 1998; 9: 165–8

56.

Felber JP. Effet de l’extrait de ginkgo biloba sur le parametres biologiques endocriniens. Presse Med 1986; 15: 1573–4PubMed

57.

Lee FC, Ko JH, Park JK, et al. Effects of panax ginseng on blood alcohol clearance in man. Clin Exp Pharmacol Physiol 1987; 14: 543–6PubMedCrossRef

58.

Scaglione F, Cattaneo G, Alessandria M, et al. Efficacy and safety of the standardised ginseng extract G115 for potentiating vaccination against the influenza syndrome and protection against the common cold. Drugs Exp Clin Res 1996; 22: 65–72PubMed

59.

Herberg WK. Zum Einfluss von Kava-spezialextrakt WS1490 in kombination mit ethylalkohol auf sicherheitsrelevante leistungsparameter. Blutalkohol 1993; 30: 96–105PubMed

60.

Schmidt U, Harrer G, Kuhn U, et al. Wechselwirkungen von hypericum-xtrakt mit alkohol. Neuenheilkunde 1995; 12: 314–9

61.

Herberg KW. Alternative zu synthetischen Psychopharmaka? Therapiewoche 1994; 44: 704–13

62.

Roots I, Johne A, Schmider I, et al. Interaction of a herbal extract from St John’s wort with amitriptyline and its metabolites. Clin Pharmacol Ther 2000; 67: 159

63.

Johne A, Brockmoller J, Bauer S, et al. Pharmacokinetic interaction of digoxin with an herbal extract from St John’s wort (Hypericum perforatum). Clin Pharmacol Ther 1999; 66: 338–45PubMedCrossRef

64.

Piscitelli SC, Burstein AH, Chaitt D, et al. Indinavir concentrations and St John’s wort. Lancet 2000; 355: 547–8PubMedCrossRef

65.

Donath F, Roots I, Langheinrich M, et al. Interaction of St John’s wort extract with phenprocoumon. Eur J Clin Pharmacol 1999; 55: A22

66.

Kerb R, Bauser J, Brockmoller J, et al. Urinary 6 β-hydroxycortisol extretion rate is affected by treatment with hypericum extract [abstract]. Eur J Clin Pharmacol 1997; 52: A186

67.

Roby CA, Anderson GD, Kantor E, et al. St John’s wort: effect on CYP3A4 activity. Clin Pharmacol Ther 2000; 67: 451–7PubMedCrossRef

68.

Markowitz JS, DeVane CL, Boulton DW, et al. Effect of St John’s wort (Hypericum perforatum) on cytochrome P-450 2D6 and 3A4 activity in healthy volunteers. Life Sci 2000; 66: PL133–9PubMedCrossRef

69.

Ereshefsky B, Gewertz N, Francis Lam YW, et al. Determination of SJW differential metabolism at CYP2D6 and CYP3A4, using dextromethorphan probe methodology. Proceedings of the 39th Meeting of the NCDEU; 2000 Jul 20–21; Boca Raton (FL): P130

70.

Gewertz N, Ereshefsky B, Francis Lam YW, et al. Determination of the differential effects of St John’s wort on the CYP1A2 and NAT2 metabolic pathways using caffeine probe methodology. Proceedings of the 39th Meeting of the NCDEU; 2000 Jul 20–21; Boca Raton (FL): P131

71.

Burnham BE. Garlic as a possible risk for postoperative bleeding. Plast Reconstruc Surg 1995; 95: 213CrossRef

72.

German K, Kumar U, Blackford HN. Garlic and the risk of TURP bleeding. Br J Urol 1996; 76: 518CrossRef

73.

Zacharias NT, Sebastian KL, Philip B, et al. Hypoglycemic and hypolipidaemic effects of garlic in sucrose fed rabbits. Indian J Physiol Pharmacol 1980; 24: 151–4PubMed

74.

Sitprija S, Plengvidhya C, Kangkaya V, et al. Garlic and diabetes mellitus phase II clinical trials. J Med Assoc Thai 1987; 70 Suppl. 2: 223–7PubMed

75.

Rowin J, Lewis SL. Spontaneous bilateral subdural hematomas associated with chronic ginkgo biloba ingestion. Neurology 1996; 46: 1775–6PubMedCrossRef

76.

Medina JH, Viola H, Wolfman C, et al. Overview-flavonoids: a new family of benzodiazepine receptor ligands. Neurochem Res 1997; 22: 419–25PubMedCrossRef

77.

Koley AP, Buters JTM, Robinson RC, et al. Differential mechanisms of cytochrome P45O inhibition and activation by α-naphthoflavone. J Biol Chem 1997; 272: 3149–52PubMedCrossRef

78.

Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A systematic review of randomised clinical trials. Eur J Clin Pharmacol 1999; 55: 567–75PubMedCrossRef

79.

Shader RI, Greenblatt D. Bees, ginseng and MAOs revisited. J Clin Psychoparmacol 1988; 8: 235

80.

Stancheva SL, Alova LG. Ginsenoside Rg1 inhibits the brain cAMP phosphodiesterase activity in young and aged rats. Gen Pharmacol 1993; 24: 1459–62PubMedCrossRef

81.

Lee YJ, Pantuck CB, Pantuck EJ. Effect of ginseng on plasma levels of ethanol in the rat. Planta Medica 1993; 59: 17–9PubMedCrossRef

82.

Koo MW. Effects of ginseng on ethanol induced sedation in mice. Life Sci 1999; 64: 153–60PubMedCrossRef

83.

Jussofie A, Schmiz A, Hiemke C. Kavapyrone enriched extract from Piper methysticum as a modulator of GABA binding sites in different regions of rat brain. Psychopharmacology Berl 1994; 116: 469–74PubMedCrossRef

84.

Jamieson DD, Duffield PH, Cheng D, et al. Comparison of the central nervous system activity of the aqueous and lipid extract of kava (Piper methysticum). Arch Int Pharmacodyn Ther 1989; 301: 66–80PubMed

85.

Jamieson DD, Duffield PH. Positive interaction of ethanol and kava resin in mice. Clin Exp Pharmacol Physiol 1990; 17: 509–14PubMedCrossRef

86.

Linde K, Ramirez G, Mulrow CD, et al. St John’s wort for depression — an overview and meta-analysis of randomised clinical trials. BMJ 1996; 313: 253–8PubMedCrossRef

87.

Linde K, Mulrow CD. St John’s wort for depression (Cochrane Review). Update software. Issue 3. Oxford: The Cochrane Library, 2000

88.

Gaster B, Holroyd J. St John’s wort for depression: a systematic review. Arch Intern Med 2000; 160: 152–6PubMedCrossRef

89.

Stevinson C, Ernst E. Safety of Hypericum in patients with depression: a comparison with conventional antidepressants. CNS Drugs 1999; 11(2): 125–32CrossRef

90.

Obach RS. Inhibition of huyman cytochrome P450 enzymes by constituents of St John’s wort, an herbal preparation used in the treatment of depression. J Pharmacol Exp Ther 2000; 294: 88–95PubMed

91.

Conseil G, Baubichon-Cortay H, Dayan G, et al. Flavonoids: a class of modulators with bifunctional interactions at vicinal ATP- and steroid-binding sites on mouse P-glycoprotein. Proc Natl Acad Sci USA 1998; 95: 9831–6PubMedCrossRef

92.

Lacarelle B, Rahmani R, de Sousa G, et al. Metabolism of digoxin, digixigenin digitoxosides and digoxigenin in human hepatocytes and liver microsomes. Fundam Clin Pharmacol 1991; 5: 567–82PubMedCrossRef

93.

Müller WE, Rolli M, Schafer C, et al. Effects of hypericum extract (LI160) in biochemical models of antidepressant activity. Pharmacopsychiatry 1997; 30 Suppl. 2: 102–7PubMedCrossRef

94.

Müller WE, Singer A, Wonnemann M, et al. Hyperforin represents the neurotransmitter reuptake inhibiting constituent of hypericum extract. Pharmacopsychiatry 1998; 31 Suppl. 1: 16–21PubMedCrossRef

95.

Brown TM, Skop BP, Mareth TR. Pathophysiology and management of the serotonin syndrome. Ann Pharmacother 1996; 30: 527–33PubMed

96.

Schwartz RH, Rodrigues WJ. Toxic delirium possibly caused by loperamide. J Pediatrics 1991; 118: 656–7CrossRef

97.

Ernst E. Second thoughts about the safety of St John’s wort. Lancet 1999; 354: 2014–6PubMedCrossRef

98.

Melchart D, Linde K, Fisher P, et al. Echinacea for the prevention and treatment of the common cold (Cochrane Review). Update software. Issue 1. Oxford: The Cochrane Library, 1999

99.

Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia. JAMA 1998; 280: 1604–9PubMedCrossRef

100.

Tyler VE. Product definition deficiencies in clinical studies of herbal medicines. Scientific Rev Alt Med 2000; 4: 17–21

101.

Ernst E, Eisenberg D, Pittler MH, et al. The desktop guide to complementary and alternative medicine. Edinburgh: Mosby, 2001

Titel: Interactions Between Herbal Medicines and Prescribed Drugs
A Systematic Review
verfasst von: Angelo A. Izzo
Dr Edzard Ernst
Publikationsdatum: 01.12.2001
Verlag: Springer International Publishing
Erschienen in: Drugs / Ausgabe 15/2001
Print ISSN: 0012-6667
Elektronische ISSN: 1179-1950
DOI: https://doi.org/10.2165/00003495-200161150-00002

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 15/2001

Estradiol-Intranasal

Once-Weekly Fluoxetine

Renal Toxicity with Sevoflurane

Pharmacological Options for the Treatment of Tourette’s Disorder

Capecitabine

Transdermal Fentanyl