2017 HCHB_digital
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Herbal Supplements – Interactions<br />
Herb/herb group Possible interacting drugs Possible interaction(s) References<br />
St John’s wort<br />
cont.<br />
Clopidogrel Enhanced antiplatelet effects reported in hyporesponders 247<br />
Clozapine Case report of reduced plasma drug levels and clinical deterioration 220<br />
Cyclosporin, tacrolimus and other<br />
immunosuppressants<br />
Possible reduction in plasma immunosuppressant levels and thus compromised<br />
treatment/ transplant rejection<br />
Daunorubicin Possible reduction in plasma levels and thus failure of cytotoxic effect 158<br />
Digoxin Possible reduction in plasma digoxin levels, and thus therapeutic failure 159<br />
Docetaxel Possible reduced plasma levels and thus failure of cytotoxic effect 153<br />
Fexofenadine Reduction of plasma levels and thus antihistaminic effects 160<br />
Gliclazide Reduced plasma levels possible 161<br />
Imatinib mesylate Possible reduced plasma levels and thus failure of cytotoxic effects 162<br />
Indinavir, saquinavir, ritonavir and other Possible reduction in plasma levels, and thus failure of antiviral effect 135<br />
protease inhibitor antivirals<br />
Irinotecan Reduced plasma levels of active metabolite SN-38 in cancer patients reported 164, 165<br />
Ivabradine Reduced plasma levels possible 166<br />
MAOIs<br />
Theoretical possibility of serious serotonin syndrome, though no cases reported<br />
Methadone Case reports of reduced plasma levels in two methadone patients 167<br />
Midazolam Reduced plasma levels in volunteer study 168<br />
Morphine Potentiated antinociceptive effects reported in mice 169<br />
Nevirapine Reduced plasma levels reported 170<br />
Nifedipine Reduced plasma levels possible 171<br />
Omeprazole Reduced plasma levels reported 172<br />
Oral contraceptives<br />
Increased breakthrough bleeding possible; case reports of unwanted<br />
173, 174, 175<br />
pregnancies though no evidence of reduced efficacy from 3 controlled studies<br />
Oxycodone Possible reduction in plasma levels and thus analgesic effect 211<br />
Phenprocoumon Reduced plasma levels and thus anticoagulant effects 176<br />
Phenytoin Theoretical reduction in plasma levels 177<br />
Phenobarbitone Theoretical reduction in plasma levels 177<br />
Procainamide Single dose of SJW increases procainamide plasma levels in mice 178<br />
Quazepam Reduced plasma levels possible 179<br />
Simvastatin Reduced plasma concentrations and thus hypocholesterolaemic effects 180<br />
SSRI antidepressants (eg, fluoxetine,<br />
sertraline, paroxetine)<br />
Theoretical possibility of serious serotonin syndrome, though few case reports<br />
to date<br />
Talinolol Reduced plasma levels possible 181<br />
Tacrolimus Reduced plasma levels reported in renal transplant patients 182, 183<br />
Tolbutamide Increased incidence of hypoglycaemia 176<br />
Triptans (sumatriptan, naratriptan, Theoretical possibility of serotonin syndrome, though no case reports to date<br />
rizatriptan, zolmitriptan)<br />
Verapamil Reduced bioavailability reported in healthy volunteers 184<br />
Warfarin Possible reduction in anticoagulant effect 185, 186<br />
Zolpidem Reduced plasma drug levels reported 210<br />
St Mary’s thistle – see milk thistle<br />
Sutherlandia frutescens Nevirapine Reduced drug bioavailability in rats 222<br />
Sympathomimetics ACE inhibitors Severe hypertension 187<br />
(eg, ephedrine and<br />
pseudoephedrine from<br />
Anaesthetics Arrhythmia 188<br />
Ephedra spp.)<br />
Antidepressants Hypertensive crises with MAOIs; hypertension, arrhythmias with tricyclics 189, 190<br />
Antihypertensives, antipsychotics, betablockers<br />
Antagonism, hypertension (possibly severe) 191, 187<br />
157<br />
Page 203
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