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2017 HCHB_digital

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Herbal Supplements – Interactions<br />

Herb/herb group Possible interacting drugs Possible interaction(s) References<br />

Karela<br />

(Momordica charantia)<br />

Kava<br />

Kelp<br />

Kyushin<br />

(Japanese preparation)<br />

Laxative herbs<br />

(containing anthraquinone)<br />

Insulin, sulphonylureas, biguanides Potentiation of hypoglycaemic effects possible 113<br />

Dopamine antagonists (eg antipsychotics, Increased risk of parkinsonian side effects theoretically possible 114<br />

metoclopramide)<br />

Drugs with a risk of hepatotoxicity Possible increased risk of hepatotoxicity 115<br />

Ethanol Additive CNS depressant effects possible, especially with large doses 116<br />

Levo-dopa & other dopaminergic agents Possible reduction of efficacy of Leva-dopa in Parkinson’s disease. 114<br />

Sedatives (eg, hypnotics,<br />

benzodiazepines, opiates, some<br />

analgesics)<br />

Additive CNS depressant effects possible, especially with large doses 117<br />

Antithyroid agents (carbimazole, Possible interference with antithyroid activity 18, 19<br />

propylthiouracil etc)<br />

Thyroxine Possible potentiation of thyroid hormone activity 18, 19<br />

Digoxin<br />

Possible interference with digoxin plasma assay<br />

Antiarrhythmic drugs<br />

Possible interference with drug activity if hypokalaemia following long-term 3, 4<br />

laxative abuse<br />

Digoxin Possible digoxin toxicity due to hypokalaemia if long-term laxative abuse 3, 4<br />

Lemon Chloroquine Possible reduction in bioavailability and thus antimalarial effects 118<br />

Liquorice<br />

(Chinese; Glycyrrhiza<br />

uralensis, European;<br />

Glycyrrhiza glabra)<br />

Alprazolam Potentiation of anxiolytic effect suggested from animal studies 246<br />

Antihypertensives Interference with hypotensive effects, with prolonged use of large doses 119<br />

Azathioprine Lowered risk of hepatotoxicity possible 120<br />

Corticosteroids<br />

Theoretical potentiation of steroidal effects<br />

Digoxin Hypokalaemia leading to adverse cardiovascular effects, if large doses taken 119<br />

Lignocaine Drug clearance increased after pre-treatment with large doses in rats 121<br />

Ribavarin Reduced drug plasma levels reported with concurrent glycyrrhizin in rats 251<br />

Thiazide and loop diuretics<br />

Hypokalaemia with adverse effects especially likely when combined with 122<br />

digoxin as above<br />

Milk (St Mary’s) thistle Doxorubicin Protection against myocardial adverse effects shown in rats 123<br />

Glibenclamide, metformin Improved diabetic control possible 124<br />

Metronidazole<br />

Reduced antibiotic effects possible – Silymarin shown to increase clearance of 125<br />

metronidazole<br />

Raloxifene<br />

Silybin A and silybin B may increase raloxifene systemic exposure by inhibiting 255<br />

intestinal raloxifene glucuronidation<br />

Ribavarin Reduced drug plasma levels reported with concurrent silymarin in rats 256<br />

Risperidone Increased oral drug bioavailability reported in rats 230<br />

Myrrh Warfarin Case report of reduced anticoagulant effects 126<br />

Ocimum gratissimum<br />

(African Basil)<br />

Orange juice<br />

Paeony (Paeonia lactiflora)<br />

Passionflower<br />

Pepper<br />

Piper nigrum (black)<br />

Piper longum (long)<br />

Ampicillin Enhanced activity against E. coli & Proteus mirabilis suggested 127<br />

Cotrimoxazole Enhanced activity against E. coli suggested 127<br />

Nystatin Enhanced anti-candidal activity suggested 127<br />

Ketoconazole Enhanced anti-candidal activity suggested 127<br />

Atenolol, celiprolol and possibly other<br />

beta-blockers<br />

Reduced bioavailability following 200ml orange juice 3 times daily 128, 129<br />

Sodium picosulphate and other stimulant Reduced plasma levels of paeony active metabolite possible 130-132<br />

laxatives; amoxicillin and metronidazole<br />

Benzodiazepines, hypnotics, opioid Theoretical potentiation of sedative effects 6<br />

analgesics, tricyclic antidepressants<br />

Amoxycillin, cefotaxime and other betalactam<br />

Increased plasma levels possible 133<br />

antibiotics<br />

Diclofenac and other NSAID drugs Combined pepper and ginger products reduced plasma levels in rabbits 134<br />

Phenytoin, rifampicin Increased bioavailability shown with piperine 134<br />

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