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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 Broom (Cytisus scoparius) Buckthorn (Rhamnus frangula) Bugleweed (Lycopus virginicus; Lycopus europaeus) Antihypertensive drugs Possible interference with hypotensive activity 20 Cardiac glycosides + antiarrhythmic agents Use of large doses may product hypokalaemia, which potentiates drug toxicity 3, 4 Antithyroid agents (carbimazole, Possible potentiation of anti-thyroid effects 21, 22 propylthiouracil, etc) Thyroxine Possible antagonism of thyroxine activity 21, 22 Bupleurum spp. Corticosteroids (eg, prednisone) Theoretical potentiation of anti-inflammatory action of corticosteroids 23 Butterbur Corticosteroids Enhanced anti-inflammatory effects in asthma 24 (Petasites hybridus) Carica papaya Amiodarone Increased bioavailability reported in rats 244 Cascara (and other anthraquinone laxatives) Digoxin, quinidine and other antiarrhythmic drugs Possible hypokalaemia with long-term laxative use, possibly potentiating cardiac glycoside and antiarrhythmic toxicity Cassia auriculata Carbamazepine Increased bioavailability likely 25 Capsicum / cayenne pepper Theophylline Increased bioavailability likely 26 Antacids Possible antagonism of gastroprotective action Aspirin Reduced salicylic acid bioavailability in rats following large doses of chilli 27 Theophylline Increased bioavailability possible 28 Chamomile Antihistamines Potentiation of antipruritic effects 29 Chaste tree (Vitex agnus castus) Cinchona bark (contains quinine) Haloperidol, chlorpromazine, metoclopramide and other dopamine receptor antagonists Progesterone drugs, oral contraceptives, HRT, clomiphene Possible antagonism of antipsychotic or anti-emetic effects, due to possible dopaminergic action of Chaste Tree Possible interference with activity of hormonal drugs, by as yet unknown mechanisms Antiarrhythmics Plasma concentration of flecainide increased 32 Antihistamines Ventricular arrhythmias with astemizole and terfenadine 33 Cardioactive glycosides Plasma concentration of digoxin increased 34 Cimetidine Increased plasma levels quinine due to inhibition of metabolism by cimetidine 35 Cinnamon Insulin Possible potentiation of hypoglycaemic effect 36 Oral hypoglycaemic drugs Possible potentiation of hypoglycaemic effect Cochinchina momordica Foot and mouth disease vaccine Enhancement of immune response to vaccine shown in pigs 37 Influenza vaccination (H5N1) Enhancement of immune responses shown in chickens 38 Coleus Anticoagulants and antiplatelet agents Potentiation of anticoagulant or antiplatelet effect theoretically possible 39 (Coleus forskohlii) Cola Caffeine Enhanced stimulant effects possible with large doses 40 Phenytoin Increased bioavailability of phenytoin reported in rabbits 41 Cordyceps sinensis Gentamicin and other aminoglycosides Protection against nephrotoxicity in rats 42 Cranberry Warfarin Several case reports of increased anticoagulant effects; similar effects in one out of three studies on healthy volunteers; avoid ingestion of large amounts Cumin (Cuminum cyminum) Rifampicin Enhancement of plasma levels by aqueous extract reported 55 Curcumin (from turmeric) Ethanol Possible protection against alcohol-induced neurological disorders 57 Gliclazide Multiple doses of curcumin enhanced the hypoglycaemic effects of gliclazide in 262 rats and rabbits Vinblastine and other cytotoxics Possible enhanced cytotoxic effects due to reversal of multidrug resistance 56 Dandelion leaf Diuretics Theoretical potentiation of diuretic effects with large doses Da-Cheng-Qi (Rheum tanguticum, Citrus aurantium) Dan shen (Salvia miltiorrhiza) Ranitidine Increased drug bioavailability reported in rats 58 Anticoagulants Potentiation of anticoagulant effects likely 59 Cyclosporin Protection against nephrotoxicity from parenteral Salvia in rats 60 3, 4 30 31 43, 44, 45, 46, 47–54 Page 198 HEALTHCARE HANDBOOK 2017-2018 References Charts

Herbal Supplements – Interactions Herb/herb group Possible interacting drugs Possible interaction(s) References Diuretics (eg, Apium graveolens) Dong quai (Angelica sinensis) Echinacea Corticosteroids Increased risk adverse effects due to increased potassium loss (theoretical only) 61 Anticoagulants Theoretical risk of enhanced anticoagulant effects 62 Immunosuppressive drugs (eg, Theoretical reduction in immunosuppressive effects, though no cases reported 63 cyclosporin, tacrolimus) Marijuana Increased sensitivity to pharyngeal irritant effects of alkamide-rich liquids 64 Ephedra sinica Antihypertensive agents Possible antagonism of antihypertensive effect CNS stimulants Digoxin and cardioactive glycosides Ergotamine and oxytocin Halothane Monoamine oxidase inhibitors (MAOIs) SSRI antidepressants Sympathomimetic effects; hypertension Arrhythmias possible Hypertension possible Arrhythmias possible Life-threatening acute hypertensive response + hyperpyrexia and coma possible Potentiation of serotonergic effects possible Eugenol Gemcitabine Enhanced cytotoxicity reported in vitro 235 Eurycoma longifolia Propranolol Decreased drug bioavailability reported in healthy volunteers 215 (Tongkat ali; Pasak bumi) Evodia rutaecarpa Theophylline Reduction in drug effects possible 65, 66 Fenugreek Antidiabetic agents Possible potentiation of hypoglycaemic activity (large doses) 67 Hypolipidaemic agents Possible potentiation of lipid-lowering effects (large doses) 68 Theophylline Reduced oral drug bioavailability reported in dogs following large doses 245 Feverfew Anticoagulants Theoretical potentiation of anticoagulant effects 69 Flaxseed Many drugs Theoretical delay in absorption of drugs taken simultaneously 70 (Linum usitatissimum) Garlic Adriamycin Protection against cardiotoxicity from large doses 71 Gentian (and other bitters) Ginger Anticoagulants (warfarin, Possible mild potentiation of anticoagulant effect 72, 73 phenprocoumon) Gentamycin Protection against nephrotoxicity 74 Glibenclamide Large garlic doses increased hypoglycaemic activity in rats 236 Platelet inhibitors (dipyridamole, aspirin, Theoretical potentiation of platelet inhibitory effects, with large doses garlic 75 indomethacin, etc) Saquinavir Reduced plasma levels reported, with large doses garlic 76 Anti peptic-ulcer agents Anticoagulants (warfarin, phenprocoumon) Antiplatelet agents (eg, aspirin, dipyridamole) Possible antagonism of anti-ulcer effects Theoretical potentiation of anticoagulant effect, when high doses ginger taken, though little clinical evidence Theoretical potentiation of antiplatelet effect, when high doses ginger taken, though little clinical evidence and no effect in healthy volunteers Cyclosporin Large doses ginger may reduce bioavailability of oral cyclosporin 78 Diclofenac Reduced plasma levels seen in rabbits from a combined ginger and pepper 79 preparation Ginkgo (Ginkgo biloba) Amlodipine Increased oral drug bioavailability reported in rats 250 Anticoagulants and antiplatelet agents Theoretical potentiation of anticoagulant or antiplatelet effects, though no 74, 77, 80 effect in healthy volunteers Cilostazol Enhanced antiatherogenic effect suggested in mice 226 Clopidogrel Pretreatment decreased Cmax and AUC of clopidogrel, but high dose ginko 26 increased Cmax and AUC of the clopidogrel active metabolite Doxorubicin Reduction in cardiotoxicity in animal studies 81, 82 Efavirenz Two cases of virological breakthrough reported 219 Gentamycin Protection against ototoxicity reported in guinea pigs and rats 214 Haloperidol Improves efficacy of haloperidol and reduces adverse effects 83 77 77 Page 199

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