51
|
Liu Y, Santillo MF. Cytochrome P450 2D6 and 3A4 enzyme inhibition by amine stimulants in dietary supplements. Drug Test Anal 2015; 8:307-10. [PMID: 26360628 DOI: 10.1002/dta.1863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 01/25/2023]
Abstract
A number of dietary supplements used for weight loss and athletic performance enhancement have been recently shown to contain a variety of stimulants, for which there is a lack of pharmacological and toxicological information. One concern for these emerging compounds is their potential to inhibit metabolic enzymes in the liver such as cytochromes P450 (CYP), which can lead to unexpected interactions among dietary supplements, drugs, and other xenobiotics. In this study, inhibition of human recombinant CYP2D6 and CYP3A4 by 27 amine stimulants associated with dietary supplements and their analogs was evaluated by luminescence assays. The strongest CYP2D6 inhibitors were coclaurine (IC50 = 0.14 ± 0.01 μM) and N-benzylphenethylamine (IC50 = 0.7 ± 0.2 μM), followed by several other relatively strong inhibitors (IC50 , 2-12 μM) including β-methylphenethylamine, N,β-dimethylphenethylamine (phenpromethamine), 1,3-dimethylamylamine (DMAA), N,α-diethylphenethylamine, higenamine (norcoclaurine) and N,N-diethylphenethylamine. Only nine compounds inhibited CYP3A4 by 20-55% at 100 μM. Results of this study illustrate that several amine stimulants associated with dietary supplements inhibit CYP2D6 and CYP3A4 in vitro, and these compounds may participate in adverse drug-dietary supplement interactions in vivo. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Yitong Liu
- Division of Toxicology, Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, US Food and Drug Administration, 8301 Muirkirk Rd, Laurel, MD, 20708, USA
| | - Michael F Santillo
- Division of Toxicology, Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, US Food and Drug Administration, 8301 Muirkirk Rd, Laurel, MD, 20708, USA
| |
Collapse
|
52
|
Abstract
People mistakenly think that all herbs are safe, because of the fact that they are natural, and the use of herbal medication is growing. Aspects of the efficacy, safety, and quality of herbal or natural products are the subjects of on-going debates. Concurrent administration of herbs may interfere with the effect of drugs. Lack of knowledge of the interaction potential together with an underreporting of herbal use poses a challenge for health care providers and a safety concern for patients. A good understanding of the mechanisms of herb-drug interactions is also essential for assessing and minimizing clinical risks. Examples of herbal medicine-pharmaceutical drug interactions of commonly used herbs are presented. The potential pharmacokinetic and pharmacodynamic basis of such interactions is discussed, as well as the challenges associated with the identification and prediction of herb-drug interactions.
Collapse
|
53
|
Drewe J, Bucher KA, Zahner C. A systematic review of non-hormonal treatments of vasomotor symptoms in climacteric and cancer patients. SPRINGERPLUS 2015; 4:65. [PMID: 25713759 PMCID: PMC4331402 DOI: 10.1186/s40064-015-0808-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/09/2015] [Indexed: 12/03/2022]
Abstract
The cardinal climacteric symptoms of hot flushes and night sweats affect 24-93% of all women during the physiological transition from reproductive to post-reproductive life. Though efficacious, hormonal therapy and partial oestrogenic compounds are linked to a significant increase in breast cancer. Non-hormonal treatments are thus greatly appreciated. This systematic review of published hormonal and non-hormonal treatments for climacteric, and breast and prostate cancer-associated hot flushes, examines clinical efficacy and therapy-related cancer risk modulation. A PubMed search included literature up to June 19, 2014 without limits for initial dates or language, with the search terms, (hot flush* OR hot flash*) AND (clinical trial* OR clinical stud*) AND (randomi* OR observational) NOT review). Retrieved references identified further papers. The focus was on hot flushes; other symptoms (night sweats, irritability, etc.) were not specifically screened. Included were some 610 clinical studies where a measured effect of the intervention, intensity and severity were documented, and where patients received treatment of pharmaceutical quality. Only 147 of these references described studies with alternative non-hormonal treatments in post-menopausal women and in breast and prostate cancer survivors; these results are presented in Additional file 1. The most effective hot flush treatment is oestrogenic hormones, or a combination of oestrogen and progestins, though benefits are partially outweighed by a significantly increased risk for breast cancer development. This review illustrates that certain non-hormonal treatments, including selective serotonin reuptake inhibitors, gabapentin/pregabalin, and Cimicifuga racemosa extracts, show a positive risk-benefit ratio. Key pointsSeveral non-hormonal alternatives to hormonal therapy have been established and registered for the treatment of vasomotor climacteric symptoms in peri- and post-menopausal women. There are indications that non-hormonal treatments are useful alternatives in patients with a history of breast and prostate cancer. However, confirmation by larger clinical trials is required.
Collapse
Affiliation(s)
- Juergen Drewe
- Max Zeller AG, Seeblickstr. 4, 8590 Romanshorn, Switzerland
| | | | | |
Collapse
|
54
|
Gupta PK, Barone G, Gurley BJ, Fifer EK, Hendrickson HP. Hydrastine pharmacokinetics and metabolism after a single oral dose of goldenseal (Hydrastis canadensis) to humans. Drug Metab Dispos 2015; 43:534-52. [PMID: 25609220 DOI: 10.1124/dmd.114.059410] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The disposition and metabolism of hydrastine was investigated in 11 healthy subjects following an oral dose of 2.7 g of goldenseal supplement containing 78 mg of hydrastine. Serial blood samples were collected for 48 hours, and urine was collected for 24 hours. Hydrastine serum and urine concentrations were determined by Liquid Chromatography-tandem mass spectrometry (LC-MS/MS). Pharmacokinetic parameters for hydrastine were calculated using noncompartmental methods. The maximal serum concentration (Cmax) was 225 ± 100 ng/ml, Tmax was 1.5 ± 0.3 hours, and area under the curve was 6.4 ± 4.1 ng ⋅ h/ml ⋅ kg. The elimination half-life was 4.8 ± 1.4 hours. Metabolites of hydrastine were identified in serum and urine by using liquid chromatography coupled to high-resolution mass spectrometry. Hydrastine metabolites were identified by various mass spectrometric techniques, such as accurate mass measurement, neutral loss scanning, and product ion scanning using Quadrupole-Time of Flight (Q-ToF) and triple quadrupole instruments. The identity of phase II metabolites was further confirmed by hydrolysis of glucuronide and sulfate conjugates using bovine β-glucuronidase and a Helix pomatia sulfatase/glucuronidase enzyme preparation. Hydrastine was found to undergo rapid and extensive phase I and phase II metabolism. Reduction, O-demethylation, N-demethylation, hydroxylation, aromatization, lactone hydrolysis, and dehydrogenation of the alcohol group formed by lactone hydrolysis to the ketone group were observed during phase I biotransformation of hydrastine. Phase II metabolites were primarily glucuronide and sulfate conjugates. Hydrastine undergoes extensive biotransformation, and some metabolites may have pharmacological activity. Further study is needed in this area.
Collapse
Affiliation(s)
- Prem K Gupta
- Department of Pharmaceutical Sciences, College of Pharmacy (P.K.G., B.J.G., E.K.F., H.P.H.), and Department of Surgery, College of Medicine (G.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Gary Barone
- Department of Pharmaceutical Sciences, College of Pharmacy (P.K.G., B.J.G., E.K.F., H.P.H.), and Department of Surgery, College of Medicine (G.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Bill J Gurley
- Department of Pharmaceutical Sciences, College of Pharmacy (P.K.G., B.J.G., E.K.F., H.P.H.), and Department of Surgery, College of Medicine (G.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - E Kim Fifer
- Department of Pharmaceutical Sciences, College of Pharmacy (P.K.G., B.J.G., E.K.F., H.P.H.), and Department of Surgery, College of Medicine (G.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Howard P Hendrickson
- Department of Pharmaceutical Sciences, College of Pharmacy (P.K.G., B.J.G., E.K.F., H.P.H.), and Department of Surgery, College of Medicine (G.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
55
|
Interactions between herbs and antidiabetics: an overview of the mechanisms, evidence, importance, and management. Arch Pharm Res 2014; 38:1281-98. [PMID: 25475096 DOI: 10.1007/s12272-014-0517-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 11/10/2014] [Indexed: 02/08/2023]
Abstract
Complementary and alternative therapies are quickly gaining importance because they are perceived to be free of side effects due to their natural origin. However, herbal remedies are complex mixtures of bioactive entities, which may interact with prescription drugs through pharmacokinetic or pharmacodynamic mechanisms and sometimes result in life-threatening consequences. In particular, diabetes patients are often treated with multiple medications due to different comorbidities, and such patients use antidiabetic medications for their entire lives; thus, it is important to make the public aware of herb interactions with antidiabetic drugs. In this paper, we summarize the reports available on the interaction of herbal remedies with oral hypoglycemic agents and describe mechanisms, preclinical or clinical evidence, importance, and management strategies.
Collapse
|
56
|
Cui HM, Zhang QY, Wang JL, Chen JL, Zhang YL, Tong XL. In vitro studies of berberine metabolism and its effect of enzyme induction on HepG2 cells. JOURNAL OF ETHNOPHARMACOLOGY 2014; 158 Pt A:388-396. [PMID: 25456436 DOI: 10.1016/j.jep.2014.10.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 09/23/2014] [Accepted: 10/13/2014] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Berberine (BER) and BER-original herbal medicines have a variety of pharmacological functions and have been widely used in clinical. However, its effect of enzyme induction on cytochrome P450 (CYP) in human hepatocytes is unknown. MATERIAL AND METHOD Metabolism of berberine and its effect on main metabolic enzymes in HepG2 cell in vitro was investigated. Cocktail probe drugs, mRNA expression and protein expression were used to evaluate the metabolism potency. Meanwhile, an UPLC-MS/MS method was validated for the analysis of BER and four probe drugs in HepG2 cell. RESULT BER significantly increased the metabolism of midazolam, phenacetin and tolbutamide by inducing the CYP1A2 and 3A4 enzyme in a dose-dependent manner, the mRNA and protein expression of CYP1A2 and 3A4 were increased by berberine at 1000ng·mL(-1). The activity of CYP1A2 and 3A4 could be induced by BER more than 500ng·mL(-1) in HepG2 cell, which was confirmed by the increase of its mRNA and protein expression. CONCLUSION BER increases the metabolism of cocktail drugs such as midazolam, phenacetin and tolbutamide by increasing the mRNA and protein expression of CYP1A2 and 3A4.
Collapse
Affiliation(s)
- Han-Ming Cui
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China.
| | - Qiu-Yan Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Jia-Long Wang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Jian-Long Chen
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Yu-Ling Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Xiao-Lin Tong
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China.
| |
Collapse
|
57
|
Naramoto K, Kato M, Ichihara K. Effects of an ethanol extract of Brazilian green propolis on human cytochrome P450 enzyme activities in vitro. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2014; 62:11296-302. [PMID: 25361167 DOI: 10.1021/jf504034u] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Supplement-drug interaction on CYP enzyme activity is occasionally found to cause clinically adverse events, and no report on interactions of propolis is available either in vitro or clinical. In this study, we tried to estimate the risk of an interaction between an ethanol extract of Brazilian green propolis (EEP-B55) and drugs in vitro and in vivo. The activities of CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4 were attenuated by EEP-B55 in a concentration-dependent manner, and artepillin C, kaempferide, dihydrokaempferide, isosakuranetin, and kaempferol were estimated to have potential for CYP inhibition. The IC50 values of artepillin C for each CYP were approximately 33-fold higher than its Cmax in the blood of rats after dosing with 5-fold the recommended daily intake of EEP-B55. These findings suggest that liver CYP enzyme activities are not markedly affected by artepillin C at the recommended daily intake of EEP-B55.
Collapse
Affiliation(s)
- Kyoko Naramoto
- Nagaragawa Research Center, API Co., Ltd., 692-3 Nagara, Gifu 502-0071, Japan
| | | | | |
Collapse
|
58
|
Kawaguchi-Suzuki M, Frye RF, Zhu HJ, Brinda BJ, Chavin KD, Bernstein HJ, Markowitz JS. The effects of milk thistle (Silybum marianum) on human cytochrome P450 activity. Drug Metab Dispos 2014; 42:1611-6. [PMID: 25028567 PMCID: PMC4164972 DOI: 10.1124/dmd.114.057232] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 07/15/2014] [Indexed: 01/08/2023] Open
Abstract
Milk thistle (Silybum marianum) extracts are widely used as a complementary and alternative treatment of various hepatic conditions and a host of other diseases/disorders. The active constituents of milk thistle supplements are believed to be the flavonolignans contained within the extracts. In vitro studies have suggested that some milk thistle components may significantly inhibit specific cytochrome P450 (P450) enzymes. However, determining the potential for clinically significant drug interactions with milk thistle products has been complicated by inconsistencies between in vitro and in vivo study results. The aim of the present study was to determine the effect of a standardized milk thistle supplement on major P450 drug-metabolizing enzymes after a 14-day exposure period. CYP1A2, CYP2C9, CYP2D6, and CYP3A4/5 activities were measured by simultaneously administering the four probe drugs, caffeine, tolbutamide, dextromethorphan, and midazolam, to nine healthy volunteers before and after exposure to a standardized milk thistle extract given thrice daily for 14 days. The three most abundant falvonolignans found in plasma, following exposure to milk thistle extracts, were silybin A, silybin B, and isosilybin B. The concentrations of these three major constituents were individually measured in study subjects as potential perpetrators. The peak concentrations and areas under the time-concentration curves of the four probe drugs were determined with the milk thistle administration. Exposure to milk thistle extract produced no significant influence on CYP1A2, CYP2C9, CYP2D6, or CYP3A4/5 activities.
Collapse
Affiliation(s)
- Marina Kawaguchi-Suzuki
- Department of Pharmacotherapy and Translational Research (M.K.-S., R.F.F., B.J.B., J.S.M.) and Center for Pharmacogenomics (M.K.-S., R.F.F., J.S.M.), University of Florida, Gainesville, Florida; Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan (H.-J.Z.); and Department of Surgery, Division of Transplantation (K.D.C.), and Department of Psychiatry and Behavioral Sciences (H.J.B.), Medical University of South Carolina, Charleston, South Carolina
| | - Reginald F Frye
- Department of Pharmacotherapy and Translational Research (M.K.-S., R.F.F., B.J.B., J.S.M.) and Center for Pharmacogenomics (M.K.-S., R.F.F., J.S.M.), University of Florida, Gainesville, Florida; Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan (H.-J.Z.); and Department of Surgery, Division of Transplantation (K.D.C.), and Department of Psychiatry and Behavioral Sciences (H.J.B.), Medical University of South Carolina, Charleston, South Carolina
| | - Hao-Jie Zhu
- Department of Pharmacotherapy and Translational Research (M.K.-S., R.F.F., B.J.B., J.S.M.) and Center for Pharmacogenomics (M.K.-S., R.F.F., J.S.M.), University of Florida, Gainesville, Florida; Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan (H.-J.Z.); and Department of Surgery, Division of Transplantation (K.D.C.), and Department of Psychiatry and Behavioral Sciences (H.J.B.), Medical University of South Carolina, Charleston, South Carolina
| | - Bryan J Brinda
- Department of Pharmacotherapy and Translational Research (M.K.-S., R.F.F., B.J.B., J.S.M.) and Center for Pharmacogenomics (M.K.-S., R.F.F., J.S.M.), University of Florida, Gainesville, Florida; Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan (H.-J.Z.); and Department of Surgery, Division of Transplantation (K.D.C.), and Department of Psychiatry and Behavioral Sciences (H.J.B.), Medical University of South Carolina, Charleston, South Carolina
| | - Kenneth D Chavin
- Department of Pharmacotherapy and Translational Research (M.K.-S., R.F.F., B.J.B., J.S.M.) and Center for Pharmacogenomics (M.K.-S., R.F.F., J.S.M.), University of Florida, Gainesville, Florida; Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan (H.-J.Z.); and Department of Surgery, Division of Transplantation (K.D.C.), and Department of Psychiatry and Behavioral Sciences (H.J.B.), Medical University of South Carolina, Charleston, South Carolina
| | - Hilary J Bernstein
- Department of Pharmacotherapy and Translational Research (M.K.-S., R.F.F., B.J.B., J.S.M.) and Center for Pharmacogenomics (M.K.-S., R.F.F., J.S.M.), University of Florida, Gainesville, Florida; Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan (H.-J.Z.); and Department of Surgery, Division of Transplantation (K.D.C.), and Department of Psychiatry and Behavioral Sciences (H.J.B.), Medical University of South Carolina, Charleston, South Carolina
| | - John S Markowitz
- Department of Pharmacotherapy and Translational Research (M.K.-S., R.F.F., B.J.B., J.S.M.) and Center for Pharmacogenomics (M.K.-S., R.F.F., J.S.M.), University of Florida, Gainesville, Florida; Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan (H.-J.Z.); and Department of Surgery, Division of Transplantation (K.D.C.), and Department of Psychiatry and Behavioral Sciences (H.J.B.), Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
59
|
Ulbricht C, Windsor RC. An Evidence-Based Systematic Review of Black cohosh (Cimicifuga racemosa, Actaea racemosa) by the Natural Standard Research Collaboration. J Diet Suppl 2014; 12:265-358. [PMID: 25153652 DOI: 10.3109/19390211.2014.946731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
An evidence-based systematic review of black cohosh (Cimicifuga racemosa, Actaea racemosa) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
Collapse
|
60
|
Wanwimolruk S, Phopin K, Prachayasittikul V. Cytochrome P450 enzyme mediated herbal drug interactions (Part 2). EXCLI JOURNAL 2014; 13:869-96. [PMID: 26417310 PMCID: PMC4464477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/28/2014] [Indexed: 10/30/2022]
Abstract
To date, a number of significant herbal drug interactions have their origins in the alteration of cytochrome P450 (CYP) activity by various phytochemicals. Among the most noteworthy are those involving St. John's wort and drugs metabolized by human CYP3A4 enzyme. This review article is the continued work from our previous article (Part 1) published in this journal (Wanwimolruk and Prachayasittikul, 2014[ref:133]). This article extends the scope of the review to six more herbs and updates information on herbal drug interactions. These include black cohosh, ginseng, grape seed extract, green tea, kava, saw palmetto and some important Chinese medicines are also presented. Even though there have been many studies to determine the effects of herbs and herbal medicines on the activity of CYP, most of them were in vitro and in animal studies. Therefore, the studies are limited in predicting the clinical relevance of herbal drug interactions. It appeared that the majority of the herbal medicines have no clear effects on most of the CYPs examined. For example, the existing clinical trial data imply that black cohosh, ginseng and saw palmetto are unlikely to affect the pharmacokinetics of conventional drugs metabolized by human CYPs. For grape seed extract and green tea, adverse herbal drug interactions are unlikely when they are concomitantly taken with prescription drugs that are CYP substrates. Although there were few clinical studies on potential CYP-mediated interactions produced by kava, present data suggest that kava supplements have the ability to inhibit CYP1A2 and CYP2E1 significantly. Therefore, caution should be taken when patients take kava with CYP1A2 or CYP2E1 substrate drugs as it may enhance their therapeutic and adverse effects. Despite the long use of traditional Chinese herbal medicines, little is known about the potential drug interactions with these herbs. Many popularly used Chinese medicines have been shown in vitro to significantly change the activity of human CYP. However, with little confirming evidence from clinical studies, precaution should be exercised when patients are taking Chinese herbal medicines concomitantly with drugs that are CYP substrates. Currently there is sufficient evidence to indicate that herbal drug interactions can occur and may lead to serious clinical consequence. Further clinical trial research should be conducted to verify these herbal drug interactions. Education on herbal drug interactions and communication with patients on their use of herbal products is also important.
Collapse
Affiliation(s)
- Sompon Wanwimolruk
- Center for Innovation Development and Technology Transfer, Faculty of Medical Technology, Mahidol University, Thailand
| | - Kamonrat Phopin
- Center for Innovation Development and Technology Transfer, Faculty of Medical Technology, Mahidol University, Thailand
| | - Virapong Prachayasittikul
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Thailand
| |
Collapse
|
61
|
Baek JH, Nierenberg AA, Kinrys G. Clinical applications of herbal medicines for anxiety and insomnia; targeting patients with bipolar disorder. Aust N Z J Psychiatry 2014; 48:705-15. [PMID: 24947278 DOI: 10.1177/0004867414539198] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients with bipolar disorder frequently continue to experience residual anxiety and insomnia between mood episodes. In real-world practice, patients increasingly self-prescribe alternative medicines. METHODS We reviewed case reports, open-label, and placebo-controlled trials investigating the use of herbal medicines to treat anxiety and insomnia, and discussed their potential applications for bipolar disorder. RESULTS Eleven herbal medicines that have been studied in human subjects are included in this review. Mechanisms of action, efficacy, side effects, and drug-drug interactions are discussed. Based on currently available evidence, valerian seems to be the most promising candidate for insomnia and anxiety in bipolar disorder. CONCLUSIONS Adjunctive herbal medicines may have the potential to alleviate these symptoms and improve the outcomes of standard treatment, despite limited evidence. Physicians need to have a more in-depth understanding of the evidence of benefits, risks, and drug interactions of alternative treatments.
Collapse
Affiliation(s)
- Ji Hyun Baek
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, USA School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Andrew A Nierenberg
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, USA Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Gustavo Kinrys
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, USA Department of Psychiatry, Harvard Medical School, Boston, USA
| |
Collapse
|
62
|
Koe XF, Tengku Muhammad TS, Chong ASC, Wahab HA, Tan ML. Cytochrome P450 induction properties of food and herbal-derived compounds using a novel multiplex RT-qPCR in vitro assay, a drug-food interaction prediction tool. Food Sci Nutr 2014; 2:500-20. [PMID: 25473508 PMCID: PMC4237480 DOI: 10.1002/fsn3.122] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 12/22/2022] Open
Abstract
A multiplex RT-qPCR was developed to examine CYP1A2, CYP2D6, and CYP3A4 induction properties of compounds from food and herbal sources. The induction of drug metabolizing enzymes is an important pharmacokinetic interaction with unique features in comparison with inhibition of metabolizing enzymes. Cytochrome induction can lead to serious drug-drug or drug-food interactions, especially if the coadministered drug plasma level is critical as it can reduce therapeutic effects and cause complications. Using this optimized multiplex RT-qPCR, cytochrome induction properties of andrographolide, curcumin, lycopene, bergamottin, and resveratrol were determined. Andrographolide, curcumin, and lycopene produced no significant induction effects on CYP1A2, CYP2D6, and CYP3A4. However, bergamottin appeared to be a significant in vitro CYP1A2 inducer starting from 5 to 50 μmol/L with induction ranging from 60 to 100-fold changes. On the other hand, resveratrol is a weak in vitro CYP1A2 inducer. Examining the cytochrome induction properties of food and herbal compounds help complement CYP inhibition studies and provide labeling and safety caution for such products.
Collapse
Affiliation(s)
- Xue Fen Koe
- Malaysian Institute of Pharmaceuticals & Nutraceuticals, Ministry of Science, Technology & Innovation (MOSTI) Halaman Bukit Gambir, 11700, Georgetown, Pulau Pinang, Malaysia
| | | | - Alexander Shu-Chien Chong
- Malaysian Institute of Pharmaceuticals & Nutraceuticals, Ministry of Science, Technology & Innovation (MOSTI) Halaman Bukit Gambir, 11700, Georgetown, Pulau Pinang, Malaysia ; The Centre for Chemical Biology, Universiti Sains Malaysia Georgetown, Pulau Pinang, Malaysia
| | - Habibah Abdul Wahab
- Malaysian Institute of Pharmaceuticals & Nutraceuticals, Ministry of Science, Technology & Innovation (MOSTI) Halaman Bukit Gambir, 11700, Georgetown, Pulau Pinang, Malaysia ; School of Pharmaceutical Sciences, Universiti Sains Malaysia Georgetown, Pulau Pinang, Malaysia
| | - Mei Lan Tan
- Malaysian Institute of Pharmaceuticals & Nutraceuticals, Ministry of Science, Technology & Innovation (MOSTI) Halaman Bukit Gambir, 11700, Georgetown, Pulau Pinang, Malaysia ; Advanced Medical & Dental Institute, Universiti Sains Malaysia Georgetown, Pulau Pinang, Malaysia
| |
Collapse
|
63
|
Wanwimolruk S, Prachayasittikul V. Cytochrome P450 enzyme mediated herbal drug interactions (Part 1). EXCLI JOURNAL 2014; 13:347-91. [PMID: 26417265 PMCID: PMC4463967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 03/20/2014] [Indexed: 10/29/2022]
Abstract
It is well recognized that herbal supplements or herbal medicines are now commonly used. As many patients taking prescription medications are concomitantly using herbal supplements, there is considerable risk for adverse herbal drug interactions. Such interactions can enhance the risk for an individual patient, especially with regard to drugs with a narrow therapeutic index such as warfarin, cyclosporine A and digoxin. Herbal drug interactions can alter pharmacokinetic or/and pharmacodynamic properties of administered drugs. The most common pharmacokinetic interactions usually involve either the inhibition or induction of the metabolism of drugs catalyzed by the important enzymes, cytochrome P450 (CYP). The aim of the present article is to provide an updated review of clinically relevant metabolic CYP-mediated drug interactions between selected herbal supplements and prescription drugs. The commonly used herbal supplements selected include Echinacea, Ginkgo biloba, garlic, St. John's wort, goldenseal, and milk thistle. To date, several significant herbal drug interactions have their origins in the alteration of CYP enzyme activity by various phytochemicals. Numerous herbal drug interactions have been reported. Although the significance of many interactions is uncertain but several interactions, especially those with St. John's wort, may have critical clinical consequences. St. John's wort is a source of hyperforin, an active ingredient that has a strong affinity for the pregnane xenobiotic receptor (PXR). As a PXR ligand, hyperforin promotes expression of CYP3A4 enzymes in the small intestine and liver. This in turn causes induction of CYP3A4 and can reduce the oral bioavailability of many drugs making them less effective. The available evidence indicates that, at commonly recommended doses, other selected herbs including Echinacea, Ginkgo biloba, garlic, goldenseal and milk thistle do not act as potent or moderate inhibitors or inducers of CYP enzymes. A good knowledge of the mechanisms of herbal drug interactions is necessary for assessing and minimizing clinical risks. These processes help prediction of interactions between herbal supplements and prescription drugs. Healthcare professionals should remain vigilant for potential interactions between herbal supplements/medicines and prescription drugs, especially for drugs with a narrow therapeutic index are used.
Collapse
Affiliation(s)
- Sompon Wanwimolruk
- Center for Innovation Development and Technology Transfer, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand,*To whom correspondence should be addressed: Sompon Wanwimolruk, Center for Innovation Development and Technology Transfer, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand, Tel.: +66 2 441 4370, Fax: +66 2 441 4380, E-mail:
| | - Virapong Prachayasittikul
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand
| |
Collapse
|
64
|
Updates on the clinical evidenced herb-warfarin interactions. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:957362. [PMID: 24790635 PMCID: PMC3976951 DOI: 10.1155/2014/957362] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/17/2014] [Accepted: 02/13/2014] [Indexed: 12/11/2022]
Abstract
Increasing and inadvertent use of herbs makes herb-drug interactions a focus of research. Concomitant use of warfarin, a highly efficacious oral anticoagulant, and herbs causes major safety concerns due to the narrow therapeutic window of warfarin. This paper presents an update overview of clinical findings regarding herb-warfarin interaction, highlighting clinical outcomes, severity of documented interactions, and quality of clinical evidence. Among thirty-eight herbs, Cannabis, Chamomile, Cranberry, Garlic, Ginkgo, Grapefruit, Lycium, Red clover, and St. John's wort were evaluated to have major severity interaction with warfarin. Herbs were also classified on account of the likelihood of their supporting evidences for interaction. Four herbs were considered as highly probable to interact with warfarin (level I), three were estimated as probable (level II), and ten and twenty-one were possible (level III) and doubtful (level IV), respectively. The general mechanism of herb-warfarin interaction almost remains unknown, yet several pharmacokinetic and pharmacodynamic factors were estimated to influence the effectiveness of warfarin. Based on limited literature and information reported, we identified corresponding mechanisms of interactions for a small amount of “interacting herbs.” In summary, herb-warfarin interaction, especially the clinical effects of herbs on warfarin therapy should be further investigated through multicenter studies with larger sample sizes.
Collapse
|
65
|
Brantley SJ, Argikar AA, Lin YS, Nagar S, Paine MF. Herb-drug interactions: challenges and opportunities for improved predictions. Drug Metab Dispos 2014; 42:301-17. [PMID: 24335390 PMCID: PMC3935140 DOI: 10.1124/dmd.113.055236] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/11/2013] [Indexed: 01/23/2023] Open
Abstract
Supported by a usage history that predates written records and the perception that "natural" ensures safety, herbal products have increasingly been incorporated into Western health care. Consumers often self-administer these products concomitantly with conventional medications without informing their health care provider(s). Such herb-drug combinations can produce untoward effects when the herbal product perturbs the activity of drug metabolizing enzymes and/or transporters. Despite increasing recognition of these types of herb-drug interactions, a standard system for interaction prediction and evaluation is nonexistent. Consequently, the mechanisms underlying herb-drug interactions remain an understudied area of pharmacotherapy. Evaluation of herbal product interaction liability is challenging due to variability in herbal product composition, uncertainty of the causative constituents, and often scant knowledge of causative constituent pharmacokinetics. These limitations are confounded further by the varying perspectives concerning herbal product regulation. Systematic evaluation of herbal product drug interaction liability, as is routine for new drugs under development, necessitates identifying individual constituents from herbal products and characterizing the interaction potential of such constituents. Integration of this information into in silico models that estimate the pharmacokinetics of individual constituents should facilitate prospective identification of herb-drug interactions. These concepts are highlighted with the exemplar herbal products milk thistle and resveratrol. Implementation of this methodology should help provide definitive information to both consumers and clinicians about the risk of adding herbal products to conventional pharmacotherapeutic regimens.
Collapse
Affiliation(s)
- Scott J Brantley
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina (S.J.B.); Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, Pennsylvania (A.A.A., S.N.); Department of Pharmaceutics, University of Washington, Seattle, Washington (Y.S.L.); and College of Pharmacy, Washington State University, Spokane, Washington (M.F.P.)
| | | | | | | | | |
Collapse
|
66
|
Hook ILI. Danggui to Angelica sinensis root: are potential benefits to European women lost in translation? A review. JOURNAL OF ETHNOPHARMACOLOGY 2014; 152:1-13. [PMID: 24365638 DOI: 10.1016/j.jep.2013.12.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/25/2013] [Accepted: 12/15/2013] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Danggui (Chinese Angelica root; Dong quai; Angelica sinensis (Oliv.) Diels.) is a traditional Chinese herbal remedy with a long history of use in China, Korea and Japan. Even today it is still one of the herbs most commonly used by Traditional Chinese Medicine (TCM) practitioners in China, as well as Europe. It is mainly used for the treatment of women's reproductive problems, such as dysmenorrhea, amenorrhoea, menopause, among others. Using Angelica sinensis (Oliv.) Diels. root as the example, this Review examines the ease with which the use of a Traditional Chinese Herbal Remedy can be transposed from one culture to another. By examining the more recent literature, a number of aspects are considered by the author to be potentially lost in translation: (i) identity and quality (phytochemistry); (ii) tradition of use and processing (smoke-drying, stir-frying, with and without wine); (iii) method of use and traditional types of Chinese herbal medicines; (iv) ethnic differences (Caucasian vs. Asian); (v) efficacy, safety and potential for western drug-herb interactions. MATERIALS AND METHODS This review is based on evaluation of the literature available in scientific journals, textbooks, electronic sources such as ScienceDirect, PubMed, Scopus, etc., as well as other web-sites. RESULTS A vast amount of information concerning the use of Angelica sinensis exists in the public domain. Many aspects associated with the use of the root are deemed problematical, such as identity, processing, amount and types of constituents, tradition of use in combination with other Chinese herbs, ethnicity of users, etc. Numerous constituents have been isolated with phthalides, ferulic acid and polysaccharides showing biological activities. CONCLUSION In spite of the potential activities associated with the traditional use of danggui, and the many trials using the Chinese system of 'Zheng differentiation', well-designed western-style clinical trials carried out using the authenticated, chemically standardized crude drug material to confirm clinical efficacy are in short supply. However increasing research into Angelica sinensis extracts and constituents shows that many of the traditional uses are not without scientific basis.
Collapse
Affiliation(s)
- Ingrid L I Hook
- School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland.
| |
Collapse
|
67
|
Haefeli WE, Carls A. Drug interactions with phytotherapeutics in oncology. Expert Opin Drug Metab Toxicol 2014; 10:359-77. [DOI: 10.1517/17425255.2014.873786] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
68
|
Han SY, Zhao HY, Zhou N, Zhou F, Li PP. Marsdenia tenacissima extract inhibits gefitinib metabolism in vitro by interfering with human hepatic CYP3A4 and CYP2D6 enzymes. JOURNAL OF ETHNOPHARMACOLOGY 2013; 151:210-217. [PMID: 24157377 DOI: 10.1016/j.jep.2013.10.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 10/07/2013] [Accepted: 10/07/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The stem of Marsdenia tenacissima (Roxb.) Wight et Arn. is mainly produced in Yunnan China and has long been used as a medicine to treat cancer in China. Xiao-Ai-Ping injection, the water-soluble part of the stem of Marsdenia tenacissima, is administrated as an anti-cancer agent in clinics for decades. Our previous study showed that Marsdenia tenacissima extract (MTE) restored gefitinib sensitivity in gefitinib-resistant non-small cell lung cancer (NSCLC) cells, but the mechanism involved is unknown. Gefitinib undergoes hepatic metabolism predominantly through human cytochrome P450 (CYP) 3A4 and CYP2D6 enzymes. This study aims to evaluate whether MTE interferes with gefitinib metabolism via human hepatic P450 enzymes. MATERIAL AND METHODS A cocktail-substrate assay was used to test the effect of MTE on major CYP enzyme activities by incubation of pooled human liver microsomes with specific substrate probes of CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4 in the absence and presence of MTE. Recombinant human CYP450 enzymes were used to predict in vitro gefitinib metabolic clearance in the absence and presence of MTE. The metabolites of the substrate probes and gefitinib were detected by high-performance liquid chromatographic tandem mass spectrometry (HPLC-MS/MS). Human hepatoma HepG2 cells were used to investigate the effect of gefitinib alone or in combination with MTE on CYP3A4 and CYP2D6 mRNA and protein expression. RESULTS The cocktail-substrate assay showed that MTE inhibited CYP450 activities in human liver microsomes with the inhibition rate of 3A4>2C9>2C19>1A2>2D6. The co-administration of MTE with gefitinib significantly decreased the in vitro intrinsic clearance (Clint) of gefitinib by 2.6 and 4.0-fold for CYP2D6 and CYP3A4, respectively, but did not affect other CYP450s. CYP2D6 and CYP3A4 mRNA and protein expression in human hepatoma HepG2 cells were greatly reduced in the combined gefitinib and MTE treatment. CONCLUSION We demonstrate that MTE inhibits gefitinib metabolism by interfering with CYP3A4 and CYP2D6. Meanwhile, MTE combined with gefitinib down-regulates the mRNA and protein expression of CYP3A4 and CYP2D6 in the HepG2 cells. Thus, these data suggest that MTE is a promising herbal medicine to enhance gefitinib efficacy through improving its metabolic stability.
Collapse
Affiliation(s)
- Shu-Yan Han
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration of Chinese and Western Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, PR China
| | - Hai-Yu Zhao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 10070, PR China
| | - Ning Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration of Chinese and Western Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, PR China
| | - Fei Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration of Chinese and Western Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, PR China
| | - Ping-Ping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integration of Chinese and Western Medicine, Peking University Cancer Hospital & Institute, Beijing 100142, PR China.
| |
Collapse
|
69
|
|
70
|
Sweet ES, Standish LJ, Goff BA, Andersen MR. Adverse events associated with complementary and alternative medicine use in ovarian cancer patients. Integr Cancer Ther 2013; 12:508-16. [PMID: 23625025 DOI: 10.1177/1534735413485815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Many women with ovarian cancer are choosing to include complementary and alternative medicine (CAM) substances in conjunction with their conventional treatment for ovarian cancer. Many oncologists express concern that the adjunct use of CAM substances may be detrimental to the achievement of therapeutic levels of chemotherapy leading to increases in drug toxicity, under-treatment of disease or other adverse events. In an effort to ascertain the extent of the potential problem with simultaneous use of CAM with conventional treatment we undertook comprehensive systematic review of published case reports describing CAM-related adverse events among ovarian cancer patients. STUDY DESIGN This article describes a systematic literature review. METHODS The Natural Medicines Comprehensive Database (NMCD). PubMed, EMBASE® and the Cochrane Central Register of Controlled Trials (CCTR) were systematically reviewed for research articles pertaining to case reports describing adverse events in patients, and clinical trials which examined the effects of herbs and supplements used during cancer treatment. RESULTS Only one case report and one clinical trial were identified which met our inclusion criteria and were relevant to the current investigation. CONCLUSION Although there are concerns about the potential for adverse events related to concurrent use of CAM substances during conventional treatment we found few case reports and clinical trials in the literature which support this.
Collapse
|
71
|
Fritz H, Seely D, McGowan J, Skidmore B, Fernandes R, Kennedy DA, Cooley K, Wong R, Sagar S, Balneaves LG, Fergusson D. Black Cohosh and Breast Cancer. Integr Cancer Ther 2013; 13:12-29. [DOI: 10.1177/1534735413477191] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background. Many women use black cohosh as a natural treatment for menopausal symptoms. However, controversy exists around safety in breast cancer, because of its purported estrogenic activity. We conducted a systematic review of black cohosh use in women with or at risk of breast cancer. Methods. We searched MEDLINE, Embase, the Cochrane Library, and AMED from inception to July 2012 and October 2012 for human interventional or observational data pertaining to the safety and efficacy of black cohosh in patients with or at risk of breast cancer, including an assessment of the effect of black cohosh on estrogen responsive tissues. Results. Of 450 records, we included 26 articles: 14 randomized controlled trials, 7 uncontrolled trials, and 5 observational studies.The evidence on efficacy for ho t flashes is divided, with some benefits seen when compared with baseline, but not when compared with placebo. Two observational studies found no association between black cohosh and risk of breast cancer, whereas 2 studies reported significant reductions in risk of primary breast cancer among postmenopausal women (adjusted odds ratio = 0.47, 95% confidence interval = 0.27-0.82), and risk of recurrence (adjusted hazard ratio = 0.75, 95% confidence interval = 0.63-0.89). Seventeen trials showed no significant impact on circulating hormone levels or proliferation in estrogen responsive tissues. Conclusions. Current evidence does not support an association between black cohosh and increased risk of breast cancer. There is a lack of evidence supporting the efficacy of black cohosh for reduction of hot flashes in breast cancer patients. Given conflicting but promising results, and apparent safety, further research is warranted.
Collapse
Affiliation(s)
- Heidi Fritz
- The Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Dugald Seely
- The Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Integrative Cancer Center, Ottawa, Ontario, Canada
| | - Jessie McGowan
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- The Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | | | - Deborah A. Kennedy
- The Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
- The University of Toronto, Toronto, Ontario, Canada
| | - Kieran Cooley
- The Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
- The University of Toronto, Toronto, Ontario, Canada
| | - Raimond Wong
- Juravinski Cancer Center, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | - Stephen Sagar
- Juravinski Cancer Center, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | | | - Dean Fergusson
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
72
|
Lee KS, Chae SW, Park JH, Park JH, Choi JM, Rhie SJY, Lee HJ. Effects of single or repeated silymarin administration on pharmacokinetics of risperidone and its major metabolite, 9-hydroxyrisperidone in rats. Xenobiotica 2012. [PMID: 23205514 DOI: 10.3109/00498254.2012.731092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
1. The interactions between herbal dietary supplements and therapeutic drugs have emerged as an important issue and P-glycoprotein (P-gp) has been reported as one of the significant factors of these interactions. 2. The objective of this article is to examine the effects of single and repeated administrations of silymarin on pharmacokinetics of a P-gp substrate, risperidone, and its major metabolite, 9-hydroxyrisperidone, in rats. 3. To determine the plasma levels of risperidone and 9-hydroxyrisperidone in rats, a HPLC method was developed using a liquid-liquid acid back extraction. When risperidone (6 mg/kg) was co-administered with silymarin (40 mg/kg) to rats orally, the C(max) of 9-hydroxyrisperidone was significantly increased to1.3-fold (p < 0.05), while the other pharmacokinetic parameters did not show any significant differences. Expanding the experiment where rats were repeatedly administered with silymarin for 5 days prior to giving risperidone, the C(max) of risperidone and 9-hydroxyrisperidone were significantly increased to 2.4-fold (p < 0.001) and 1.7-fold (p < 0.001), respectively, and the AUC(0-t), as well to 1.7-fold (p < 0.05) and 2.1-fold (p < 0.01), respectively. 4. The repeated exposures of silymarin, compared to single administration of silymarin, increased oral bioavailability and affected the pharmacokinetics of risperidone and 9-hydroxyrisperidone, by inhibiting P-gp.
Collapse
Affiliation(s)
- Kyoung Sin Lee
- Center for Cell Signaling & Drug Discovery Research, Division of Life and Pharmaceutical Sciences and College of Pharmacy, Ewha Womans University, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
73
|
Lee KS, Park JH, Lee HJ, Rhie S. Preclinical study of a potent P-glycoprotein and cytochrome P450 enzyme inducer rifampicin changing pharmacokinetic parameters of risperidone and its metabolite, 9-hydroxyrisperidone, using a rat model. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2012. [DOI: 10.1007/s40005-012-0045-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
74
|
Tsai HH, Lin HW, Simon Pickard A, Tsai HY, Mahady GB. Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review. Int J Clin Pract 2012; 66:1056-78. [PMID: 23067030 DOI: 10.1111/j.1742-1241.2012.03008.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND AIMS The use of herbs and dietary supplements (HDS) alone or concomitantly with medications can potentially increase the risk of adverse events experienced by the patients. This review aims to evaluate the documented HDS-drug interactions and contraindications. METHODS A structured literature review was conducted on PubMed, EMBASE, Cochrane Library, tertiary literature and Internet. RESULTS While 85 primary literatures, six books and two web sites were reviewed for a total of 1,491 unique pairs of HDS-drug interactions, 213 HDS entities and 509 medications were involved. HDS products containing St. John's Wort, magnesium, calcium, iron, ginkgo had the greatest number of documented interactions with medications. Warfarin, insulin, aspirin, digoxin, and ticlopidine had the greatest number of reported interactions with HDS. Medications affecting the central nervous system or cardiovascular system had more documented interactions with HDS. Of the 882 HDS-drug interactions being described its mechanism and severity, 42.3% were due to altered pharmacokinetics and 240 were described as major interactions. Of the 152 identified HDS contraindications, the most frequent involved gastrointestinal (16.4%), neurological (14.5%), and renal/genitourinary diseases (12.5%). Flaxseed, echinacea, and yohimbe had the largest number of documented contraindications. CONCLUSIONS Although HDS-drug interactions and contraindications primarily concerned a relatively small subset of commonly used medications and HDS entities, this review provides the summary to identify patients, HDS products, and medications that are more susceptible to HDS-drug interactions and contraindications. The findings would facilitate the health-care professionals to communicate these documented interactions and contraindications to their patients and/or caregivers thereby preventing serious adverse events and improving desired therapeutic outcomes.
Collapse
Affiliation(s)
- H-H Tsai
- School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan
| | | | | | | | | |
Collapse
|
75
|
Yamaura K, Shimada M, Nakayama N, Ueno K. Protective effects of goldenseal (Hydrastis canadensis L.) on acetaminophen-induced hepatotoxicity through inhibition of CYP2E1 in rats. Pharmacognosy Res 2012; 3:250-5. [PMID: 22224048 PMCID: PMC3249784 DOI: 10.4103/0974-8490.89745] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 07/29/2011] [Accepted: 11/15/2011] [Indexed: 01/18/2023] Open
Abstract
Background: Goldenseal (Hydrastis canadensis L.) inhibits various cytochrome P450 (CYP) isoforms such as CYP2C9, CYP2C19, CYP2D6, CYP2E1, and CYP3A in vitro. High doses of acetaminophen (APAP) generate the highly reactive intermediate, N-acetyl-p-benzoquinone imine (NAPQI), catalyzed mainly by CYP2E1. The aim of this study was to investigate the hepatoprotective effects of orally administrated goldenseal against APAP-induced acute liver failure (ALF) via inhibition of CYP2E1. Materials and Methods: Male Wistar rats were treated orally with goldenseal (300 and 1000 mg/kg) 2, 18, and 26 h before and 6 h after oral APAP (400 mg/kg) administration. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities as well as serum APAP concentration were evaluated. Results: Goldenseal extract inhibited CYP1A2, CYP2D6, CYP2E1, and CYP3A activity, and the inhibitory effect on CYP2E1 was the strongest (IC50 4.32 μg/mL). Treatment with goldenseal (300 mg/kg) significantly attenuated the APAP-induced increase in serum AST and ALT, and the hepatoprotective effect of goldenseal was stronger than that of silymarin (200 mg/kg). Moreover, serum APAP concentration was increased by goldenseal treatment, presumably as a result of the inhibitory effect of goldenseal on the metabolism of APAP to NAPQI. Conclusion: These results suggest that goldenseal ameliorates APAP-induced ALF and that this protection can likely be attributed to the inhibition of CYP2E1 activity, which generates the highly reactive intermediate of APAP.
Collapse
Affiliation(s)
- Katsunori Yamaura
- Department of Geriatric Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Chiba University, Japan
| | | | | | | |
Collapse
|
76
|
Moltó J, Valle M, Miranda C, Cedeño S, Negredo E, Clotet B. Effect of milk thistle on the pharmacokinetics of darunavir-ritonavir in HIV-infected patients. Antimicrob Agents Chemother 2012; 56:2837-41. [PMID: 22430963 PMCID: PMC3370734 DOI: 10.1128/aac.00025-12] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/11/2012] [Indexed: 11/20/2022] Open
Abstract
The aim of this open-label, fixed-sequence study was to investigate the potential of the botanical supplement milk thistle (silymarin) to interact with the boosted protease inhibitor combination darunavir-ritonavir. Fifteen HIV-infected patients receiving antiretroviral therapy with darunavir-ritonavir (600/100 mg twice daily) for at least 4 weeks were included. Silymarin (150 mg every 8 h) was added to the antiretroviral treatment from days 1 to 14. Darunavir concentrations in plasma were determined by high-performance liquid chromatography immediately before and 1, 2, 4, 6, 8, 10, and 12 h after a morning dose of darunavir-ritonavir on day 0 and darunavir-ritonavir plus silymarin on day 14. Individual darunavir pharmacokinetic parameters were calculated by noncompartmental analysis and compared between days 0 and 14 by means of the geometric mean ratio (GMR) and its 90% confidence interval (CI). The median age was 48 years (interquartile range, 44 to 50 years), and the median body weight was 70 kg (interquartile range, 65 to 84 kg). Silymarin was well tolerated, and all participants completed the study. The GMRs for darunavir coadministered with silymarin relative to darunavir alone were 0.86 (90% CI, 0.70 to 1.05) for the area under the concentration-time curve from 0 to 12 h, 0.83 (90% CI, 0.80 to 0.98) for the maximum concentration, and 0.94 (90% CI, 0.73 to 1.19) for the concentration at the end of the dosing interval. In summary, coadministration of silymarin with darunavir-ritonavir seems to be safe in HIV-infected patients; no dose adjustment for darunavir-ritonavir seems to be necessary.
Collapse
Affiliation(s)
- José Moltó
- Lluita contra la Sida Foundation, HIV Clinic, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
| | | | | | | | | | | |
Collapse
|
77
|
Wu AHB, Lorizio W, Tchu S, Lynch K, Gerona R, Ji W, Ruan W, Ruddy KJ, Desantis SD, Burstein HJ, Ziv E. Estimation of tamoxifen metabolite concentrations in the blood of breast cancer patients through CYP2D6 genotype activity score. Breast Cancer Res Treat 2012; 133:677-83. [PMID: 22294487 PMCID: PMC5739025 DOI: 10.1007/s10549-012-1963-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 01/16/2012] [Indexed: 10/14/2022]
Abstract
Tamoxifen, a prodrug used for adjuvant breast cancer therapy, requires conversion to the active metabolite endoxifen through CYP 2D6. We aimed to construct an algorithm to predict endoxifen concentrations based on a patient’s CYP 2D6 genotype, demographic factors, and co-medication use. Eighty-eight women enrolled in the UCSF TamGen II study and 81 women enrolled in a prospective study at Dana-Farber Cancer Institute were included in this analysis. All the women had been on tamoxifen for at least 3 months before blood collection. Demographic information included the patient’s age, race/ethnicity, body mass index (where available), and self-reported and measured medications and herbals that affect 2D6 activity. DNA was extracted and genotyped for 2D6 (Amplichip, Roche Diagnostics). An activity score was calculated based on genotypes and adjusted for use of medications known to inhibit 2D6. Serum was tested for tamoxifen and metabolite concentrations and for the presence of drugs by liquid chromatography/mass spectrometry. Univariate and multivariate regression analysis were computed for age, body mass index, ethnicity, and adjusted activity score to predict tamoxifen metabolite concentrations in the training data-set of UCSF patients, and the resulting algorithm was validated in the Dana-Farber patients. For the training set, the correlation coefficient (r2) for log endoxifen and N-desmethyltamoxifen:endoxifen ratio to activity score, age, and race, were 0.520 and 0.659, respectively; 0.324 and 0.567 for the validation; and 0.396 and 0.615 for both the datasets combined. An algorithm that incorporates genotype and demographic variables can be used to predict endoxifen concentrations for women on tamoxifen therapy. If endoxifen levels are confirmed to be predictive of tamoxifen benefit, then this algorithm may be helpful to determine which women warrant endoxifen testing.
Collapse
Affiliation(s)
- Alan H B Wu
- Department of Laboratory Medicine, San Francisco General Hospital, San Francisco, CA 94110, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
78
|
|
79
|
Izzo AA. Interactions between herbs and conventional drugs: overview of the clinical data. Med Princ Pract 2012; 21:404-28. [PMID: 22236736 DOI: 10.1159/000334488] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 10/05/2011] [Indexed: 12/25/2022] Open
Abstract
This article provides an overview of the clinical evidence of interactions between herbal and conventional medicines. Herbs involved in drug interactions--or that have been evaluated in pharmacokinetic trials--are discussed in this review. While many of the interactions reported are of limited clinical significance and many herbal products (e.g. black cohosh, saw palmetto, echinacea, hawthorn and valerian) seem to expose patients to minor risk under conventional pharmacotherapy, a few herbs, notably St. John's wort, may provoke adverse events sufficiently serious to endanger the patients' health. Healthcare professionals should remain vigilant for potential interactions between herbal medicines and prescribed drugs, especially when drugs with a narrow therapeutic index are used.
Collapse
Affiliation(s)
- Angelo A Izzo
- Department of Experimental Pharmacology, Federico II University of Naples, Naples, Italy.
| |
Collapse
|
80
|
Chin AC, Baskin LB. Effect of Herbal Supplement–Drug Interactions on Therapeutic Drug Monitoring. Ther Drug Monit 2012. [DOI: 10.1016/b978-0-12-385467-4.00019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
81
|
Coleus forskohlii extract induces hepatic cytochrome P450 enzymes in mice. Food Chem Toxicol 2011; 50:750-5. [PMID: 22178802 DOI: 10.1016/j.fct.2011.11.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/14/2011] [Accepted: 11/29/2011] [Indexed: 01/20/2023]
Abstract
Coleus forskohlii root extract (CFE) is popular for use as a weight loss dietary supplement. In this study, the influence of standardized CFE containing 10% active component forskolin on the hepatic drug metabolizing system was investigated to evaluate the safety through its drug interaction potential. Male ICR mice were fed AIN93G-based diets containing 0-5% CFE or 0.05% pure forskolin for 2-3 weeks. Intake of two different sources of 0.5% CFE significantly increased the relative liver weight, total content of hepatic cytochrome P450 (CYP) and induced CYPs (especially 2B, 2C, 3A types) and glutathione S-transferase (GST) activities. CFE significantly increased mRNA expression of CYPs and GST with dose related responses. However, unlike the CFE, intake of 0.05% pure forskolin was found to be associated with only weak induction in CYP3A and GST activities with no significant increases in relative liver weight, total hepatic content or other CYPs activities. The inductions of CYPs and GST by CFE were observed at 1 week of feeding and rapidly recovered by discontinuation of CFE. These results indicated the induction potential of CFE on CYPs, and that this effect was predominantly due to other, as yet unidentified constituents, and not forskolin contained in CFE.
Collapse
|
82
|
|
83
|
Dostalek M, Pistovcakova J, Jurica J, Sulcova A, Tomandl J. THE EFFECT OF ST JOHN'S WORT (HYPERICUM PERFORATUM) ON CYTOCHROME P450 1A2 ACTIVITY IN PERFUSED RAT LIVER. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2011; 155:253-7. [DOI: 10.5507/bp.2011.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
84
|
Li J, Gödecke T, Chen SN, Imai A, Lankin D, Farnsworth NR, Pauli GF, van Breemen RB, Nikolić D. In vitro metabolic interactions between black cohosh (Cimicifuga racemosa) and tamoxifen via inhibition of cytochromes P450 2D6 and 3A4. Xenobiotica 2011; 41:10.3109/00498254.2011.603385. [PMID: 21827327 PMCID: PMC3565011 DOI: 10.3109/00498254.2011.603385] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Women who experience hot flashes as a side effect of tamoxifen (TAM) therapy often try botanical remedies such as black cohosh to alleviate these symptoms. Since pharmacological activity of TAM is dependent on the metabolic conversion into active metabolites by the action of cytochromes P450 2D6 (CYP2D6) and 3A4, the objective of this study was to evaluate whether black cohosh extracts can inhibit formation of active TAM metabolites and possibly reduce its clinical efficacy. At 50 μg/mL, a 75% ethanolic extract of black cohosh inhibited formation of 4-hydroxy- TAM by 66.3%, N-desmethyl TAM by 74.6% and α-hydroxy TAM by 80.3%. In addition, using midazolam and dextromethorphan as probe substrates, this extract inhibited CYP3A4 and CYP2D6 with IC(50) values of 16.5 and 50.1 μg/mL, respectively. Eight triterpene glycosides were identified as competitive CYP3A4 inhibitors with IC(50) values ranging from 2.3-5.1 µM, while the alkaloids protopine and allocryptopine were identified as competitive CYP2D6 inhibitors with K(i) values of 78 and 122 nM, respectively. The results of this study suggests that co-administration of black cohosh with TAM might interfere with the clinical efficacy of this drug. However, additional clinical studies are needed to determine the clinical significance of these in vitro results.
Collapse
Affiliation(s)
| | - Tanja Gödecke
- Department of Medicinal Chemistry and Pharmacognosy, UIC/NIH Center for Botanical Dietary Supplements Research, University of Illinois College of Pharmacy, 833 S. Wood Street, Chicago, IL 60612-7231, USA
| | - Shao-Nong Chen
- Department of Medicinal Chemistry and Pharmacognosy, UIC/NIH Center for Botanical Dietary Supplements Research, University of Illinois College of Pharmacy, 833 S. Wood Street, Chicago, IL 60612-7231, USA
| | - Ayano Imai
- Department of Medicinal Chemistry and Pharmacognosy, UIC/NIH Center for Botanical Dietary Supplements Research, University of Illinois College of Pharmacy, 833 S. Wood Street, Chicago, IL 60612-7231, USA
| | - David Lankin
- Department of Medicinal Chemistry and Pharmacognosy, UIC/NIH Center for Botanical Dietary Supplements Research, University of Illinois College of Pharmacy, 833 S. Wood Street, Chicago, IL 60612-7231, USA
| | - Norman R. Farnsworth
- Department of Medicinal Chemistry and Pharmacognosy, UIC/NIH Center for Botanical Dietary Supplements Research, University of Illinois College of Pharmacy, 833 S. Wood Street, Chicago, IL 60612-7231, USA
| | - Guido F. Pauli
- Department of Medicinal Chemistry and Pharmacognosy, UIC/NIH Center for Botanical Dietary Supplements Research, University of Illinois College of Pharmacy, 833 S. Wood Street, Chicago, IL 60612-7231, USA
| | - Richard B. van Breemen
- Department of Medicinal Chemistry and Pharmacognosy, UIC/NIH Center for Botanical Dietary Supplements Research, University of Illinois College of Pharmacy, 833 S. Wood Street, Chicago, IL 60612-7231, USA
| | - Dejan Nikolić
- Department of Medicinal Chemistry and Pharmacognosy, UIC/NIH Center for Botanical Dietary Supplements Research, University of Illinois College of Pharmacy, 833 S. Wood Street, Chicago, IL 60612-7231, USA
| |
Collapse
|
85
|
|
86
|
|
87
|
Ho SHY, Singh M, Holloway AC, Crankshaw DJ. The Effects of Commercial Preparations of Herbal Supplements Commonly Used by Women on the Biotransformation of Fluorogenic Substrates by Human Cytochromes P450. Phytother Res 2011; 25:983-9. [DOI: 10.1002/ptr.3371] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shirley H. Y. Ho
- Honours Biology and Pharmacology Program; McMaster University; Hamilton ON Canada L8N 3Z5
| | - Mohini Singh
- Department of Chemistry; McMaster University; Hamilton ON Canada L8N 3Z5
| | - Alison C. Holloway
- Reproductive Biology Division; Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada L8N 3Z5
| | - Denis J. Crankshaw
- Honours Biology and Pharmacology Program; McMaster University; Hamilton ON Canada L8N 3Z5
- Reproductive Biology Division; Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada L8N 3Z5
| |
Collapse
|
88
|
Unger M. Pharmakokinetische Arzneimittelinteraktionen zwischen Tumortherapeutika und Arzneimitteln der Komplementären Medizin: Mechanismen und klinische Relevanz. ACTA ACUST UNITED AC 2011; 18:213-8. [DOI: 10.1159/000330937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
89
|
Effects of Flos carthami on CYP2D6 and on the Pharmacokinetics of Metoprolol in Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2010; 2011:207076. [PMID: 21127727 PMCID: PMC2994065 DOI: 10.1155/2011/207076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 10/10/2010] [Indexed: 01/22/2023]
Abstract
Flos carthami is a traditional Chinese herbal medicine. Clinically, the Flos carthami Injection has been used concomitantly with other Western drugs and may be used concomitantly with β-blockers, such as metoprolol, to treat cerebrovascular and coronary heart diseases, in China. Metoprolol is a CYP2D6 substrate and is predominantly metabolized by this isozyme. However, we do not know whether there is an effect of Flos carthami on CYP2D6 and the consequences of such an effect. Concern is raised regarding the possible herb-drug interaction. In this report, the effects of Flos carthami on the activity of CYP2D6 in vivo and in vitro and on the pharmacokinetics of metoprolol, in rats, are investigated. To assess the inhibitory potency of Flos carthami, the concentration associated with 50% inhibition (IC50) of dextromethorphan metabolism was determined based on the concentration-inhibition curves. The inhibitory effect of Flos carthami on CYP2D6 was also compared with cimetidine in vitro. Flos carthami could significantly inhibit CYP2D6 in rats both in vitro and in vivo (P < .05) and could slow down the metabolic rate of metoprolol as suggested by prolonged t1/2 (67.45%), by increased Cmax (74.51%) and AUC0−∞ (76.89%). These results suggest that CYP2D6 is a risk factor when Flos carthami is administered concomitantly with metoprolol or other CYP2D6 substrates.
Collapse
|
90
|
Tarirai C, Viljoen AM, Hamman JH. Herb-drug pharmacokinetic interactions reviewed. Expert Opin Drug Metab Toxicol 2010; 6:1515-38. [PMID: 21067427 DOI: 10.1517/17425255.2010.529129] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE OF THE FIELD the global increase in the popularity of alternative medicines has raised renewed concerns regarding herb-drug interactions. These interactions are especially important for drugs with narrow therapeutic indices and may either be pharmacodynamic or pharmacokinetic in nature. AREAS COVERED IN THIS REVIEW pharmacokinetic interactions which may exist between herbs and drugs, and the mechanisms of these interactions with appropriate examples based on primary and secondary data in publications are discussed. The mechanisms covered include those that affect oral drug absorption (e.g., modulation of efflux and uptake transporters, complex formation, gastrointestinal motility and pH) and drug biotransformation (e.g., inhibition or induction of enzymes). WHAT THE READER WILL GAIN knowledge on the mechanisms of herb-drug pharmacokinetic interactions supported by an extended list of these types of interactions for quick reference. A critical evaluation of certain herb-drug pharmacokinetic interactions reported in the scientific literature. TAKE HOME MESSAGE as the incidence and severity of herb-drug pharmacokinetic interactions increase due to a worldwide rise in the use of herbal preparations, more clinical data regarding herb-drug pharmacokinetic interactions are needed to make informed decisions regarding patient safety.
Collapse
Affiliation(s)
- Clemence Tarirai
- Tshwane University of Technology, Department of Pharmaceutical Sciences, Pretoria, South Africa
| | | | | |
Collapse
|
91
|
Battu SK, Repka MA, Maddineni S, Chittiboyina AG, Avery MA, Majumdar S. Physicochemical characterization of berberine chloride: a perspective in the development of a solution dosage form for oral delivery. AAPS PharmSciTech 2010; 11:1466-75. [PMID: 20842541 DOI: 10.1208/s12249-010-9520-y] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 08/25/2010] [Indexed: 11/30/2022] Open
Abstract
The objective of the present research was to evaluate the physicochemical characteristics of berberine chloride and to assess the complexation of drug with 2-hydroxypropyl-β-cyclodextrin (HPβCD), a first step towards solution dosage form development. The parameters such as log P value were determined experimentally and compared with predicted values. The pH-dependent aqueous solubility and stability were investigated following standard protocols at 25°C and 37°C. Drug solubility enhancement was attempted utilizing both surfactants and cyclodextrins (CDs), and the drug/CD complexation was studied employing various techniques such as differential scanning calorimetry, Fourier transform infrared, nuclear magnetic resonance, and scanning electron microscopy. The experimental log P value suggested that the compound is fairly hydrophilic. Berberine chloride was found to be very stable up to 6 months at all pH and temperature conditions tested. Aqueous solubility of the drug was temperature dependent and exhibited highest solubility of 4.05 ± 0.09 mM in phosphate buffer (pH 7.0) at 25°C, demonstrating the effect of buffer salts on drug solubility. Decreased drug solubility was observed with increasing concentrations of ionic surfactants such as sodium lauryl sulfate and cetyl trimethyl ammonium bromide. Phase solubility studies demonstrated the formation of berberine chloride-HPβCD inclusion complex with 1:1 stoichiometry, and the aqueous solubility of the drug improved almost 4.5-fold in the presence of 20% HPβCD. The complexation efficiency values indicated that the drug has at least threefold greater affinity for hydroxypropyl-β-CD compared to randomly methylated-β-CD. The characterization techniques confirmed inclusion complex formation between berberine chloride and HPβCD and demonstrated the feasibility of developing an oral solution dosage form of the drug.
Collapse
|
92
|
Shord SS, Shah K, Lukose A. Drug-botanical interactions: a review of the laboratory, animal, and human data for 8 common botanicals. Integr Cancer Ther 2010; 8:208-27. [PMID: 19815591 DOI: 10.1177/1534735409340900] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Many Americans use complementary and alternative medicine (CAM) to prevent or alleviate common illnesses, and these medicines are commonly used by individuals with cancer.These medicines or botanicals share the same metabolic and transport proteins, including cytochrome P450 enzymes (CYP), glucuronosyltransferases (UGTs), and P-glycoprotein (Pgp), with over-the-counter and prescription medicines increasing the likelihood of drug-botanical interactions.This review provides a brief description of the different proteins, such as CYPs, UGTs, and Pgp.The potential effects of drug-botanical interactions on the pharmacokinetics and pharmacodynamics of the drug or botanical and a summary of the more common models used to study drug metabolism are described.The remaining portion of this review summarizes the data extracted from several laboratory, animal, and clinical studies that describe the metabolism, transport, and potential interactions of 8 selected botanicals. The 8 botanicals include black cohosh, Echinacea, garlic, Gingko biloba, green tea, kava, milk thistle, and St John's wort; these botanicals are among some of the more common botanicals taken by individuals with cancer.These examples are included to demonstrate how to interpret the different studies and how to use these data to predict the likelihood of a clinically significant drug-botanical interaction.
Collapse
Affiliation(s)
- Stacy S Shord
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | | | | |
Collapse
|
93
|
Kennedy DA, Seely D. Clinically based evidence of drug-herb interactions: a systematic review. Expert Opin Drug Saf 2010; 9:79-124. [PMID: 20021292 DOI: 10.1517/14740330903405593] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Healthcare practitioners are deeply concerned about drug-herb interactions and how concurrent administration may affect both the safety and effectiveness of prescribed drugs. Interactions between botanical medicines and synthetic drugs can be clinically relevant and it is important to understand what kinds of interactions are possible. Better knowledge in this area will help avoid negative interactions and may also help enable synergistic interactions. AREAS COVERED IN THIS REVIEW Includes articles related to the investigation of Western botanicals or whole herbal extracts in human subjects, investigating either the impact on Cytochrome P450 isoenzymes or an assessment of specific drug-herb interactions within a clinical trial. Searches were conducted in both Pubmed and EMBASE from inception to March 2009. WHAT THE READER WILL GAIN Knowledge regarding specific interactions to consider in clinical practice. The reader will also gain an appreciation of the complexities associated with the area of drug-herb interactions. Summary tables of relevant drug-herb interactions are presented both for the individual herbs included and at the level of the CYP450 enzymes. TAKE HOME MESSAGE Knowledge of drug-herb interactions is limited and much more research needs to be done to further document clinically relevant interactions. Even though preclinical data are often poorly generalizable to the human situation, caution must be taken in the absence of clinical evidence especially where drugs with narrow therapeutic windows are concerned.
Collapse
Affiliation(s)
- Deborah A Kennedy
- Department of Research & Clinical Epidemiology, The Canadian College of Naturopathic Medicine, 1255 Sheppard Avenue East, Toronto, ON M2K 1E2, Canada
| | | |
Collapse
|
94
|
Brantley SJ, Oberlies NH, Kroll DJ, Paine MF. Two flavonolignans from milk thistle (Silybum marianum) inhibit CYP2C9-mediated warfarin metabolism at clinically achievable concentrations. J Pharmacol Exp Ther 2010; 332:1081-7. [PMID: 19934397 PMCID: PMC2835426 DOI: 10.1124/jpet.109.161927] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 11/23/2009] [Indexed: 12/20/2022] Open
Abstract
Milk thistle (Silybum marianum) is a popular herbal product used for hepatoprotection and chemoprevention. Two commercially available formulations are the crude extract, silymarin, and the semipurified product, silibinin. Silymarin consists of at least seven flavonolignans, of which the most prevalent are the diastereoisomers silybin A and silybin B; silibinin consists only of silybin A and silybin B. Based on a recent clinical study showing an interaction between a silymarin product and the CYP2C9 substrate losartan, the CYP2C9 inhibition properties of silybin A and silybin B and corresponding regioisomers, isosilybin A and isosilybin B, were evaluated using human liver microsomes (HLMs), recombinant CYP2C9 (rCYP2C9) enzymes, and the clinically relevant probe, (S)-warfarin. Silybin B was the most potent inhibitor in HLMs, followed by silybin A, isosilybin B, and isosilybin A (IC(50) of 8.2, 18, 74, and >100 microM, respectively). Next, silybin A and silybin B were selected for further characterization. As with HLMs, silybin B was more potent than silybin A toward rCYP2C9 1 (6.7 versus 12 microM), rCYP2C9 2 (9.3 versus 19 microM), and rCYP2C9 3 (2.4 versus 9.3 microM). Using a matrix of five substrate (1-15 microM) and six inhibitor (1-80 microM) concentrations and HLMs, both diastereoisomers inhibited (S)-warfarin 7-hydroxylation in a manner described best by a mixed-type inhibition model (K(i) values of 4.8 and 10 microM for silybin B and silybin A, respectively). These observations, combined with the high systemic silibinin concentrations (>5-75 microM) achieved in a phase I study involving prostate cancer patients, prompt clinical evaluation of a potential warfarin-milk thistle interaction.
Collapse
Affiliation(s)
- Scott J Brantley
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7569, USA
| | | | | | | |
Collapse
|
95
|
Genetic polymorphism of metabolic enzymes P450 (CYP) as a susceptibility factor for drug response, toxicity, and cancer risk. Arh Hig Rada Toksikol 2009; 60:217-42. [PMID: 19581216 DOI: 10.2478/10004-1254-60-2009-1885] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The polymorphic P450 (CYP) enzyme superfamily is the most important system involved in the biotransformation of many endogenous and exogenous substances including drugs, toxins, and carcinogens. Genotyping for CYP polymorphisms provides important genetic information that help to understand the effects of xenobiotics on human body. For drug metabolism, the most important polymorphisms are those of the genes coding for CYP2C9, CYP2C19, CYP2D6, and CYP3A4/5, which can result in therapeutic failure or severe adverse reactions. Genes coding for CYP1A1, CYP1A2, CYP1B1, and CYP2E1 are among the most responsible for the biotransformation of chemicals, especially for the metabolic activation of pre-carcinogens. There is evidence of association between gene polymorphism and cancer susceptibility. Pathways of carcinogen metabolism are complex, and are mediated by activities of multiple genes, while single genes have a limited impact on cancer risk. Multigenic approach in addition to environmental determinants in large sample studies is crucial for a reliable evaluation of any moderate gene effect. This article brings a review of current knowledge on the relations between the polymorphisms of some CYPs and drug activity/toxicity and cancer risk.
Collapse
|
96
|
Borrelli F, Izzo AA. Herb-drug interactions with St John's wort (Hypericum perforatum): an update on clinical observations. AAPS JOURNAL 2009; 11:710-27. [PMID: 19859815 DOI: 10.1208/s12248-009-9146-8] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 09/21/2009] [Indexed: 12/15/2022]
Abstract
St John's wort (SJW) extracts, prepared from the aerial parts of Hypericum perforatum, contain numerous pharmacologically active ingredients, including naphthodianthrones (e.g., hypericin and its derivatives), phloroglucinols derivatives (e.g., hyperforin, which inhibits the reuptake of a number of neurotransmitters, including serotonin), and flavonoids. Such extracts are widely used for the treatment of mild-to-moderate depression. As a monotherapy, SJW has an encouraging safety profile. However, relevant and, in some case, life-threatening interactions have been reported, particularly with drugs which are substrate of cytochrome P450 and/or P-glycoprotein. Well-documented SJW interactions include (1) reduced blood cyclosporin concentration, as suggested by multiple case reports as well as by clinical trials, (2) serotonin syndrome or lethargy when SJW was given with serotonin reuptake inhibitors, (3) unwanted pregnancies in women while using oral contraceptives and SJW, and (4) reduced plasma drug concentration of antiretroviral (e.g., indinavir, nevirapine) and anticancer (i.e., irinotecan, imatinib) drugs. Hyperforin, which is believed to contribute to the antidepressant action of St John's wort, is also strongly suspected to be responsible of most of the described interactions.
Collapse
Affiliation(s)
- Francesca Borrelli
- Department of Experimental Pharmacology, University of Naples Federico II, Via D. Montesano 49, 80131, Naples, Italy.
| | | |
Collapse
|
97
|
Yi S, Cho JY, Lim KS, Kim KP, Kim J, Kim BH, Hong JH, Jang IJ, Shin SG, Yu KS. Effects ofAngelicae tenuissima radix, Angelicae dahuricae radixandScutellariae radixExtracts on CytochromeP450Activities in Healthy Volunteers. Basic Clin Pharmacol Toxicol 2009; 105:249-56. [DOI: 10.1111/j.1742-7843.2009.00423.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
98
|
Krämer S, Testa B. The Biochemistry of Drug Metabolism - An Introduction. Chem Biodivers 2009; 6:1477-660, table of contents. [DOI: 10.1002/cbdv.200900233] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
99
|
|
100
|
Toselli F, Matthias A, Gillam EM. Echinacea metabolism and drug interactions: The case for standardization of a complementary medicine. Life Sci 2009; 85:97-106. [DOI: 10.1016/j.lfs.2009.04.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 04/06/2009] [Accepted: 04/30/2009] [Indexed: 12/11/2022]
|