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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