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2017 HCHB_digital

Herbal Supplements:

Herbal Supplements: Interactions Herbal Supplements – Interactions Herb/herb group Possible interacting drugs Possible interaction(s) References Ginkgo (Ginkgo biloba) cont. Ginseng (Panax ginseng) Metformin Some potentiation of hypoglycaemic action suggested 84, 85 Midazolam Possible enhancement in drug bioavailability 86 Simvastatin Bioavailability of oral simvastatin but not simvastatin acid PK reduced 227 Tamoxifen No pharmacokinetic interactions in women; slight efficacy increase in rats 237, 238 Tolbutamide Slight attenuation of hypoglycaemic effect possible 86 Albendazole Increased excretion from GIT reported following IV ginseng 87 Caffeine Increased stimulant effects possible 88 Digoxin Interference with certain laboratory plasma measurements reported 89, 90 Hypoglycaemic drugs MAOI antidepressants Theoretical potentiation of hypoglycaemic effects, and improved insulin resistance Possible potentiation of MAOI effects, causing headache, mania Globe artichoke Cholesterol-lowering drugs Theoretically additive effects with large doses 68 Goji Warfarin Three case reports of potentiated anticoagulant effects 92, 93, 228 (Lycium barbarum – fruit) Golden Seal Debrisoquine Increased drug levels possible 94 Gotu kola Adriamycin Possible protection against cardiac toxicity 95 Grapefruit juice Terfenadine Increased plasma levels reported 96 Calcium channel blockers Increased plasma concentration and thus cardiovascular effects 97 Chloroquine Increased plasma concentrations 98 Fexofenadine Reduced oral bioavailability reported 99 Immunosuppressants (eg cyclosporin, Increased plasma concentrations 97 tacrolimus, sirolimus) Many other drugs Possible increased plasma concentration and thus effects 100 Statins Increased plasma levels reported 101 Green tea Bortezomib Reduced anticancer effects of bortezomib reported in vitro 102 Guar gum and other Antibiotics Absorption of phenoxymethypenicillin reduced 103 bulking agents Guarana Amiodarone Reduced drug plasma levels reported in rats 229 (Paullinia cupana) Gymnema sylvestre Glimepiride Potentially beneficial antidiabetic effects 252 Hypoglycaemic drugs, including insulin Possible potentiation of hypoglycaemic effects 104 Hawthorn Digoxin and other cardiac glycosides Increased inotropic/cardiovascular activity; consider dosage reduction 105 Hypotensive drugs Increased hypotensive effect possible, with large doses of hawthorn 105 Hemidesmus indicus Gentamicin Protection against nephrotoxicity shown in animal studies 106 Honey Carbamazepine Reduced plasma levels of carbamazepine reported following large doses honey 107 in rabbits Diltiazem Reduced plasma levels diltiazem reported following large doses honey to 108 rabbits Phenytoin Increased plasma levels of phenytoin reported in rabbits 109 Hops Horse chestnut Horseradish Benzodiazepines, hypnotics, opioid analgesics, tricyclic antidepressants Anticoagulants and antiplatelet agents such as warfarin and aspirin 5-fluorouracil Propylthiouracil, methimazole and other antithyroid agents Potentiation of sedative effects 110 Potentiation of anticoagulant effects reported 111 In vitro potentiation of activity against hepatocellular carcinoma reported for 213 aescin, a key constituent Increased thyrotoxic activity possible with large doses 112 Thyroxine Possible antagonism of thyroxine activity, with large doses 112 Jia-Wei-xiao-yao-san 5-fluorouracil Increased bioavailability of IV 5-FU in rats, with large doses of TJ-24 253 (Kami-shoyo-san; TJ-24) Kaempferia parviflora Sildenafil Reduced drug bioavailability in rats, after large doses of KP 254 91 Page 200 HEALTHCARE HANDBOOK 2017-2018 References Charts

Herbal Supplements – Interactions Herb/herb group Possible interacting drugs Possible interaction(s) References Karela (Momordica charantia) Kava Kelp Kyushin (Japanese preparation) Laxative herbs (containing anthraquinone) Insulin, sulphonylureas, biguanides Potentiation of hypoglycaemic effects possible 113 Dopamine antagonists (eg antipsychotics, Increased risk of parkinsonian side effects theoretically possible 114 metoclopramide) Drugs with a risk of hepatotoxicity Possible increased risk of hepatotoxicity 115 Ethanol Additive CNS depressant effects possible, especially with large doses 116 Levo-dopa & other dopaminergic agents Possible reduction of efficacy of Leva-dopa in Parkinson’s disease. 114 Sedatives (eg, hypnotics, benzodiazepines, opiates, some analgesics) Additive CNS depressant effects possible, especially with large doses 117 Antithyroid agents (carbimazole, Possible interference with antithyroid activity 18, 19 propylthiouracil etc) Thyroxine Possible potentiation of thyroid hormone activity 18, 19 Digoxin Possible interference with digoxin plasma assay Antiarrhythmic drugs Possible interference with drug activity if hypokalaemia following long-term 3, 4 laxative abuse Digoxin Possible digoxin toxicity due to hypokalaemia if long-term laxative abuse 3, 4 Lemon Chloroquine Possible reduction in bioavailability and thus antimalarial effects 118 Liquorice (Chinese; Glycyrrhiza uralensis, European; Glycyrrhiza glabra) Alprazolam Potentiation of anxiolytic effect suggested from animal studies 246 Antihypertensives Interference with hypotensive effects, with prolonged use of large doses 119 Azathioprine Lowered risk of hepatotoxicity possible 120 Corticosteroids Theoretical potentiation of steroidal effects Digoxin Hypokalaemia leading to adverse cardiovascular effects, if large doses taken 119 Lignocaine Drug clearance increased after pre-treatment with large doses in rats 121 Ribavarin Reduced drug plasma levels reported with concurrent glycyrrhizin in rats 251 Thiazide and loop diuretics Hypokalaemia with adverse effects especially likely when combined with 122 digoxin as above Milk (St Mary’s) thistle Doxorubicin Protection against myocardial adverse effects shown in rats 123 Glibenclamide, metformin Improved diabetic control possible 124 Metronidazole Reduced antibiotic effects possible – Silymarin shown to increase clearance of 125 metronidazole Raloxifene Silybin A and silybin B may increase raloxifene systemic exposure by inhibiting 255 intestinal raloxifene glucuronidation Ribavarin Reduced drug plasma levels reported with concurrent silymarin in rats 256 Risperidone Increased oral drug bioavailability reported in rats 230 Myrrh Warfarin Case report of reduced anticoagulant effects 126 Ocimum gratissimum (African Basil) Orange juice Paeony (Paeonia lactiflora) Passionflower Pepper Piper nigrum (black) Piper longum (long) Ampicillin Enhanced activity against E. coli & Proteus mirabilis suggested 127 Cotrimoxazole Enhanced activity against E. coli suggested 127 Nystatin Enhanced anti-candidal activity suggested 127 Ketoconazole Enhanced anti-candidal activity suggested 127 Atenolol, celiprolol and possibly other beta-blockers Reduced bioavailability following 200ml orange juice 3 times daily 128, 129 Sodium picosulphate and other stimulant Reduced plasma levels of paeony active metabolite possible 130-132 laxatives; amoxicillin and metronidazole Benzodiazepines, hypnotics, opioid Theoretical potentiation of sedative effects 6 analgesics, tricyclic antidepressants Amoxycillin, cefotaxime and other betalactam Increased plasma levels possible 133 antibiotics Diclofenac and other NSAID drugs Combined pepper and ginger products reduced plasma levels in rabbits 134 Phenytoin, rifampicin Increased bioavailability shown with piperine 134 Page 201

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