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Oyanna VO, Clarke JD. Mechanisms of intestinal pharmacokinetic natural product-drug interactions. Drug Metab Rev 2024:1-17. [PMID: 39078118 DOI: 10.1080/03602532.2024.2386597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/25/2024] [Indexed: 07/31/2024]
Abstract
The growing co-consumption of botanical natural products with conventional medications has intensified the need to understand potential effects on drug safety and efficacy. This review delves into the intricacies of intestinal pharmacokinetic interactions between botanical natural products and drugs, such as alterations in drug solubility, permeability, transporter activity, and enzyme-mediated metabolism. It emphasizes the importance of understanding how drug solubility, dissolution, and osmolality interplay with botanical constituents in the gastrointestinal tract, potentially altering drug absorption and systemic exposure. Unlike reviews that focus primarily on enzyme and transporter mechanisms, this article highlights the lesser known but equally important mechanisms of interaction. Applying the Biopharmaceutics Drug Disposition Classification System (BDDCS) can serve as a framework for predicting and understanding these interactions. Through a comprehensive examination of specific botanical natural products such as byakkokaninjinto, green tea catechins, goldenseal, spinach extract, and quercetin, we illustrate the diversity of these interactions and their dependence on the physicochemical properties of the drug and the botanical constituents involved. This understanding is vital for healthcare professionals to effectively anticipate and manage potential natural product-drug interactions, ensuring optimal patient therapeutic outcomes. By exploring these emerging mechanisms, we aim to broaden the scope of natural product-drug interaction research and encourage comprehensive studies to better elucidate complex mechanisms.
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Affiliation(s)
- Victoria O Oyanna
- Department of Pharmaceutical Sciences, WA State University, Spokane, Washington, USA
| | - John D Clarke
- Department of Pharmaceutical Sciences, WA State University, Spokane, Washington, USA
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2
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Nascimento MDL, do Nascimento SB, Lima EDSP, de Oliveira FM, Dos Santos RR, Cesar IDC, de Castro WV. Evaluation of the Effects of Extracts Containing Valeriana officinalis and Piper methysticum on the Activities of Cytochrome P450 3A and P-Glycoprotein. PLANTA MEDICA 2024; 90:792-800. [PMID: 39013429 DOI: 10.1055/a-2360-4808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
This work investigated interactions ascribed to the administration of phytomedicines containing Valeriana officinalis and Piper methysticum with conventional drugs. The phytomedicines were characterized by HPLC and administered per os to male Wistar rats, either concomitantly or not with the CYP3A substrate midazolam. To distinguish between the presystemic or systemic effect, midazolam was given orally and intravenously. The effects on the P-gp substrate fexofenadine uptake by Caco-2 cells were examined. The valerenic acid content was 1.6 ± 0.1 mg per tablet, whereas kavain was 13.7 ± 0.3 mg/capsule. Valerian and kava-kava extracts increased the maximum plasma concentration (Cmax) of midazolam 2- and 4-fold compared to the control, respectively. The area under the plasma concentrations versus time curve (AUC(0-∞)) was enhanced from 994.3 ± 152.3 ng.h/mL (control) to 3041 ± 398 ng.h/mL (valerian) and 4139 ± 373 ng.h/mL (kava-kava). The half-life of midazolam was not affected. These changes were attributed to the inhibition of midazolam metabolism by the enteric CYP3A since the i. v. pharmacokinetic of midazolam remained unchanged. The kava-kava extract augmented the uptake of fexofenadine by 3.5-fold compared to the control. Although Valeriana increased the uptake of fexofenadine, it was not statistically significant to that of the control (12.5 ± 3.7 ng/mg protein vs. 5.4 ± 0.3 ng/mg protein, respectively). Therefore, phytomedicines containing V. officinalis or P. methysticum inhibited the intestinal metabolism of midazolam in rats. Conversely, the P-gp-mediated transport of fexofenadine was preferably affected by kava-kava.
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Affiliation(s)
- Mariana de Lima Nascimento
- Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Chanadour, Divinópolis-MG, Brazil
| | - Sara Batista do Nascimento
- Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Chanadour, Divinópolis-MG, Brazil
| | | | - Flávio Martins de Oliveira
- Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Chanadour, Divinópolis-MG, Brazil
| | | | | | - Whocely Victor de Castro
- Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Chanadour, Divinópolis-MG, Brazil
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Bernardo J, Valentão P. Herb-drug interactions: A short review on central and peripheral nervous system drugs. Phytother Res 2024; 38:1903-1931. [PMID: 38358734 DOI: 10.1002/ptr.8120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/24/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024]
Abstract
Herbal medicines are widely perceived as natural and safe remedies. However, their concomitant use with prescribed drugs is a common practice, often undertaken without full awareness of the potential risks and frequently without medical supervision. This practice introduces a tangible risk of herb-drug interactions, which can manifest as a spectrum of consequences, ranging from acute, self-limited reactions to unpredictable and potentially lethal scenarios. This review offers a comprehensive overview of herb-drug interactions, with a specific focus on medications targeting the Central and Peripheral Nervous Systems. Our work draws upon a broad range of evidence, encompassing preclinical data, animal studies, and clinical case reports. We delve into the intricate pharmacodynamics and pharmacokinetics underpinning each interaction, elucidating the mechanisms through which these interactions occur. One pressing issue that emerges from this analysis is the need for updated guidelines and sustained pharmacovigilance efforts. The topic of herb-drug interactions often escapes the attention of both consumers and healthcare professionals. To ensure patient safety and informed decision-making, it is imperative that we address this knowledge gap and establish a framework for continued monitoring and education. In conclusion, the use of herbal remedies alongside conventional medications is a practice replete with potential hazards. This review not only underscores the real and significant risks associated with herb-drug interactions but also underscores the necessity for greater awareness, research, and vigilant oversight in this often-overlooked domain of healthcare.
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Affiliation(s)
- João Bernardo
- REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Patrícia Valentão
- REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
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Nguyen JT, Tian DD, Tanna RS, Arian CM, Calamia JC, Rettie AE, Thummel KE, Paine MF. An Integrative Approach to Elucidate Mechanisms Underlying the Pharmacokinetic Goldenseal-Midazolam Interaction: Application of In Vitro Assays and Physiologically Based Pharmacokinetic Models to Understand Clinical Observations. J Pharmacol Exp Ther 2023; 387:252-264. [PMID: 37541764 PMCID: PMC10658920 DOI: 10.1124/jpet.123.001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/11/2023] [Accepted: 07/06/2023] [Indexed: 08/06/2023] Open
Abstract
The natural product goldenseal is a clinical inhibitor of CYP3A activity, as evidenced by a 40%-60% increase in midazolam area under the plasma concentration versus time curve (AUC) after coadministration with goldenseal. The predominant goldenseal alkaloids berberine and (-)-β-hydrastine were previously identified as time-dependent CYP3A inhibitors using human liver microsomes. Whether these alkaloids contribute to the clinical interaction, as well as the primary anatomic site (hepatic vs. intestinal) and mode of CYP3A inhibition (reversible vs. time-dependent), remain uncharacterized. The objective of this study was to mechanistically assess the pharmacokinetic goldenseal-midazolam interaction using an integrated in vitro-in vivo-in silico approach. Using human intestinal microsomes, (-)-β-hydrastine was a more potent time-dependent inhibitor of midazolam 1'-hydroxylation than berberine (KI and kinact: 8.48 μM and 0.041 minutes-1, respectively, vs. >250 μM and ∼0.06 minutes-1, respectively). Both the AUC and Cmax of midazolam increased by 40%-60% after acute (single 3-g dose) and chronic (1 g thrice daily × 6 days) goldenseal administration to healthy adults. These increases, coupled with a modest or no increase (≤23%) in half-life, suggested that goldenseal primarily inhibited intestinal CYP3A. A physiologically based pharmacokinetic interaction model incorporating berberine and (-)-β-hydrastine successfully predicted the goldenseal-midazolam interaction to within 20% of that observed after both chronic and acute goldenseal administration. Simulations implicated (-)-β-hydrastine as the major alkaloid precipitating the interaction, primarily via time-dependent inhibition of intestinal CYP3A, after chronic and acute goldenseal exposure. Results highlight the potential interplay between time-dependent and reversible inhibition of intestinal CYP3A as the mechanism underlying natural product-drug interactions, even after acute exposure to the precipitant. SIGNIFICANCE STATEMENT: Natural products can alter the pharmacokinetics of an object drug, potentially resulting in increased off-target effects or decreased efficacy of the drug. The objective of this work was to evaluate fundamental mechanisms underlying the clinically observed goldenseal-midazolam interaction. Results support the use of an integrated approach involving established in vitro assays, clinical evaluation, and physiologically based pharmacokinetic modeling to elucidate the complex interplay between multiple phytoconstituents and various pharmacokinetic processes driving a drug interaction.
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Affiliation(s)
- James T Nguyen
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.T.N., D.-D.T., R.S.T., M.F.P.); Department of Pharmaceutics (C.M.A., J.C.C., K.E.T.) and Department of Medicinal Chemistry (A.E.R.), School of Pharmacy, University of Washington, Seattle, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (A.E.R, K.E.T., M.F.P.)
| | - Dan-Dan Tian
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.T.N., D.-D.T., R.S.T., M.F.P.); Department of Pharmaceutics (C.M.A., J.C.C., K.E.T.) and Department of Medicinal Chemistry (A.E.R.), School of Pharmacy, University of Washington, Seattle, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (A.E.R, K.E.T., M.F.P.)
| | - Rakshit S Tanna
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.T.N., D.-D.T., R.S.T., M.F.P.); Department of Pharmaceutics (C.M.A., J.C.C., K.E.T.) and Department of Medicinal Chemistry (A.E.R.), School of Pharmacy, University of Washington, Seattle, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (A.E.R, K.E.T., M.F.P.)
| | - Christopher M Arian
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.T.N., D.-D.T., R.S.T., M.F.P.); Department of Pharmaceutics (C.M.A., J.C.C., K.E.T.) and Department of Medicinal Chemistry (A.E.R.), School of Pharmacy, University of Washington, Seattle, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (A.E.R, K.E.T., M.F.P.)
| | - Justina C Calamia
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.T.N., D.-D.T., R.S.T., M.F.P.); Department of Pharmaceutics (C.M.A., J.C.C., K.E.T.) and Department of Medicinal Chemistry (A.E.R.), School of Pharmacy, University of Washington, Seattle, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (A.E.R, K.E.T., M.F.P.)
| | - Allan E Rettie
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.T.N., D.-D.T., R.S.T., M.F.P.); Department of Pharmaceutics (C.M.A., J.C.C., K.E.T.) and Department of Medicinal Chemistry (A.E.R.), School of Pharmacy, University of Washington, Seattle, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (A.E.R, K.E.T., M.F.P.)
| | - Kenneth E Thummel
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.T.N., D.-D.T., R.S.T., M.F.P.); Department of Pharmaceutics (C.M.A., J.C.C., K.E.T.) and Department of Medicinal Chemistry (A.E.R.), School of Pharmacy, University of Washington, Seattle, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (A.E.R, K.E.T., M.F.P.)
| | - Mary F Paine
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington (J.T.N., D.-D.T., R.S.T., M.F.P.); Department of Pharmaceutics (C.M.A., J.C.C., K.E.T.) and Department of Medicinal Chemistry (A.E.R.), School of Pharmacy, University of Washington, Seattle, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (A.E.R, K.E.T., M.F.P.)
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5
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Husain I, Dale OR, Idrisi M, Gurley BJ, Avula B, Katragunta K, Ali Z, Chittiboyina A, Noonan G, Khan IA, Khan SI. Evaluation of the Herb-Drug Interaction (HDI) Potential of Zingiber officinale and Its Major Phytoconstituents. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:7521-7534. [PMID: 37134183 DOI: 10.1021/acs.jafc.2c07912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Ginger is currently one of the most popular herbs commonly added to diverse foods, beverages, and dietary supplements. We evaluated the ability of a well-characterized ginger extract, and several of its phytoconstituents, to activate select nuclear receptors as well as modulate the activity of various cytochrome P450s and ATP-binding cassette (ABC) transporters because phytochemical-mediated modulation of these proteins underlies many clinically relevant herb-drug interactions (HDI). Our results revealed ginger extract activated the aryl hydrocarbon receptor (AhR) in AhR-reporter cells and pregnane X receptor (PXR) in intestinal and hepatic cells. Among the phytochemicals investigated, (S)-6-gingerol, dehydro-6-gingerdione, and (6S,8S)-6-gingerdiol activated AhR, while 6-shogaol, 6-paradol, and dehydro-6-gingerdione activated PXR. Enzyme assays showed that ginger extract and its phytochemicals dramatically inhibited the catalytic activity of CYP3A4, 2C9, 1A2, and 2B6, and efflux transport capabilities of P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP). Dissolution studies with ginger extract conducted in biorelevant simulated intestinal fluid yielded (S)-6-gingerol and 6-shogaol concentrations that could conceivably exceed cytochrome P450 (CYP) IC50 values when consumed in recommended doses. In summary, overconsumption of ginger may disturb the normal homeostasis of CYPs and ABC transporters, which in turn, may elevate the risk for HDIs when consumed concomitantly with conventional medications.
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Affiliation(s)
- Islam Husain
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Olivia R Dale
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Mantasha Idrisi
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Bill J Gurley
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Bharathi Avula
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Kumar Katragunta
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Zulfiqar Ali
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Amar Chittiboyina
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Gregory Noonan
- Center for Food Safety and Applied Nutrition, United States Food and Drug Administration, College Park, Maryland 20740, United States
| | - Ikhlas A Khan
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
- Department of Bio-Molecular Sciences, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
| | - Shabana I Khan
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
- Department of Bio-Molecular Sciences, School of Pharmacy, The University of Mississippi, University, Mississippi 38677, United States
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6
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Chan WJJ, Adiwidjaja J, McLachlan AJ, Boddy AV, Harnett JE. Interactions between natural products and cancer treatments: underlying mechanisms and clinical importance. Cancer Chemother Pharmacol 2023; 91:103-119. [PMID: 36707434 PMCID: PMC9905199 DOI: 10.1007/s00280-023-04504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023]
Abstract
Natural products, also referred to as dietary supplements, complementary and alternative medicines, and health or food supplements are widely used by people living with cancer. These products are predominantly self-selected and taken concurrently with cancer treatments with the intention of improving quality of life, immune function and reducing cancer symptoms and treatment side effects. Concerns have been raised that concurrent use may lead to interactions resulting in adverse effects and unintended treatment outcomes. This review provides an overview of the mechanisms by which these interactions can occur and the current evidence about specific clinically important natural product-drug interactions. Clinical studies investigating pharmacokinetic interactions provide evidence that negative treatment outcomes may occur when Hypericum perforatum, Grapefruit, Schisandra sphenanthera, Curcuma longa or Hydrastis canadensis are taken concurrently with common cancer treatments. Conversely, pharmacodynamic interactions between Hangeshashinto (TJ-14) and some cancer treatments have been shown to reduce the side effects of diarrhoea and oral mucositis. In summary, research in this area is limited and requires further investigation.
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Affiliation(s)
- Wai-Jo Jocelin Chan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Jeffry Adiwidjaja
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Alan V Boddy
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Joanna E Harnett
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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7
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Haron MH, Dale O, Martin K, Avula B, Chittiboyina AG, Khan IA, Gurley BJ, Khan SI. Evaluation of the Herb-Drug Interaction Potential of Commonly Used Botanicals on the US Market with Regard to PXR- and AhR-Mediated Influences on CYP3A4 and CYP1A2. J Diet Suppl 2022:1-14. [PMID: 36017806 DOI: 10.1080/19390211.2022.2110351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
In this study, hydroethanolic extracts of 30 top-selling botanicals (herbs) commonly used as ingredients of herbal dietary supplements in the US were screened for their potential to activate the human pregnane X receptor (hPXR) and human aryl hydrocarbon receptor (hAhR) and to increase the activities of hPXR- and hAhR-regulated drug metabolizing cytochrome P450 enzymes (i.e., CYP3A4 and CYP1A2, respectively). Of the 30 botanicals tested, 21 induced PXR and 29 induced AhR transcriptional activities. Out of the 21 botanicals that induced hPXR transcriptional activity, 14 yielded >50% induction in CYP3A4 activity at concentrations ranging from 6 to 60 µg/mL and 16 out of the 29 botanicals that activated hAhR yielded >50% induction in CYP1A2 activity at concentrations ranging from 3 to 30 µg/mL. Moreover, eight botanicals (G. gummi-gutta [garcinia], Hemp [low and high CBD content], H. perforatum [St. John's wort], M. vulgare [horehound], M. oleifera [moringa], O. vulgare [oregano], P. johimbe [yohimbe] and W. somnifera [ashwagandha]) yielded >50% induction in both CYP3A4 and CYP1A2 activity. Herbal products are mixtures of phytoconstituents, any of which could modulate drug metabolism. Our data reveals that several top-selling botanicals may pose herb-drug interaction (HDI) risks via CYP450 induction. While in vitro experiments can provide useful guidance in assessing a botanical's HDI potential, their clinical relevance needs to be investigated in vivo. Botanicals whose effects on hPXR/CYP3A4, and hAhR/CYP1A2 activity were most pronounced will be slated for further clinical investigation.
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Affiliation(s)
- Mona H Haron
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Olivia Dale
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Katherine Martin
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Bharathi Avula
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Amar G Chittiboyina
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Ikhlas A Khan
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS, USA.,Department of BioMolecular Sciences, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Bill J Gurley
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS, USA
| | - Shabana I Khan
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, MS, USA.,Department of BioMolecular Sciences, School of Pharmacy, The University of Mississippi, University, MS, USA
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8
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Gómez-Garduño J, León-Rodríguez R, Alemón-Medina R, Pérez-Guillé BE, Soriano-Rosales RE, González-Ortiz A, Chávez-Pacheco JL, Solorio-López E, Fernandez-Pérez P, Rivera-Espinosa L. Phytochemicals That Interfere With Drug Metabolism and Transport, Modifying Plasma Concentration in Humans and Animals. Dose Response 2022; 20:15593258221120485. [PMID: 36158743 PMCID: PMC9500303 DOI: 10.1177/15593258221120485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/16/2022] Open
Abstract
Phytochemicals (Pch) present in fruits, vegetables and other foods, are known to inhibit or induce drug metabolism and transport. An exhaustive search was performed in five databases covering from 2000 to 2021. Twenty-one compounds from plants were found to modulate CYP3A and/or P-gp activities and modified the pharmacokinetics and the therapeutic effect of 27 different drugs. Flavonols, flavanones, flavones, stilbenes, diferuloylmethanes, tannins, protoalkaloids, flavans, hyperforin and terpenes, reduce plasma concentration of cyclosporine, simvastatin, celiprolol, midazolam, saquinavir, buspirone, everolimus, nadolol, tamoxifen, alprazolam, verapamil, quazepam, digoxin, fexofenadine, theophylline, indinavir, clopidogrel. Anthocyanins, flavonols, flavones, flavanones, flavonoid glycosides, stilbenes, diferuloylmethanes, catechin, hyperforin, alkaloids, terpenes, tannins and protoalkaloids increase of plasma concentration of buspirone, losartan, diltiazem, felodipine, midazolam, cyclosporine, triazolam, verapamil, carbamazepine, diltiazem, aripiprazole, tamoxifen, doxorubicin, paclitaxel, nicardipine. Interactions between Pchs and drugs affect the gene expression and enzymatic activity of CYP3A and P-gp transporter, which has an impact on their bioavailability; such that co-administration of drugs with food, beverages and food supplements can cause a subtherapeutic effect or overdose. Therefore, it is important for the clinician to consider these interactions to obtain a better therapeutic effect.
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Affiliation(s)
| | - Renato León-Rodríguez
- Laboratorio de Contención Biológica BSL-3, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
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9
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Melchert PW, Qian Y, Zhang Q, Klee BO, Xing C, Markowitz JS. In vitro inhibition of carboxylesterase 1 by Kava (Piper methysticum) Kavalactones. Chem Biol Interact 2022; 357:109883. [DOI: 10.1016/j.cbi.2022.109883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
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10
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Physiologically based pharmacokinetic model predictions of natural product-drug interactions between goldenseal, berberine, imatinib and bosutinib. Eur J Clin Pharmacol 2022; 78:597-611. [DOI: 10.1007/s00228-021-03266-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
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11
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Liu Y. Use In Silico and In Vitro Methods to Screen Hepatotoxic Chemicals and CYP450 Enzyme Inhibitors. Methods Mol Biol 2022; 2474:189-198. [PMID: 35294766 DOI: 10.1007/978-1-0716-2213-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In silico and in vitro methods have emerged as valuable tools to rapidly screen and prioritize large numbers of chemicals including new drug entities, food ingredients, and environmental compounds for further in vivo analysis. These methods have been frequently used to conduct screening for a wide range of endpoints including physicochemical properties (e.g., logD), human biokinetic parameters (e.g., metabolism), and human organ toxicities (e.g., hepatotoxicity). This chapter describes a tiered approach of incorporating multiple in silico (quantitative structure-activity relationship, QSAR) and in vitro (e.g., human liver cell models, human liver microsomes) methods into the screening of hepatotoxic chemicals and cytochromes P450 enzyme (CYP) inhibitors. Chemicals are prioritized for further studies (e.g., in vivo animal study) based on the in silico and in vitro results, as well as a literature search for their in vivo exposures (e.g., plasma concentration).
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Affiliation(s)
- Yitong Liu
- Division of Toxicology, Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Laurel, MD, USA.
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12
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Surana AR, Agrawal SP, Kumbhare MR, Gaikwad SB. Current perspectives in herbal and conventional drug interactions based on clinical manifestations. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00256-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
Background
Herbs are an important source of pharmaceuticals. Herbs are traditionally used by millions of peoples for medicine, food and drink in developed and developing nations considering that they are safe. But, interaction of herbs with other medicines may cause serious adverse effects or reduces their efficacy. The demand for “alternative” medicines has been increased significantly, which include medicine derived from plant or herbal origin. The objective of this review article mainly focuses on drug interactions of commonly used herbs along with possible mechanisms. The method adopted for this review is searching of herb-drug interactions in online database.
Main text
Herb-drug interaction leads to pharmacological modification. The drug use along with herbs may show pharmacodynamic and pharmacokinetic interactions. Pharmacokinetic interaction causes alteration in absorption, distribution, metabolism and elimination. Similarly, pharmacodynamic interaction causes additive or synergistic or antagonist effect on the drugs or vice versa. Researchers had demonstrated that herbs show the toxicities and drug interactions like other pharmacologically active compounds. There is lack of knowledge amongst physician, pharmacist and consumers related to pharmacological action and mechanism of herb-drug interaction. This review article focuses on the herb-drug interaction of danshen (Salvia miltiorrhiza), Echinacea (Echinacea purpurea), garlic (Allium sativum), ginkgo (Ginkgo biloba), goldenseal (Hydrastis canadensis), green tea (Camellia sinensis), kava (Piper methysticum), liquorice (Glycyrrhiza glabra), milk thistle (Silybum marianum) and St. John’s wort (Hypericum perforatum) along with probable mechanisms and clinical manifestation based on case studies reported in literature.
Conclusion
Herb-drug interactions may lead to serious side effects. Physician, pharmacist and patients must be more cautious while prescribing and or consuming these herbs.
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Wendl T, Frechen S, Gerisch M, Heinig R, Eissing T. Physiologically-based pharmacokinetic modeling to predict CYP3A4-mediated drug-drug interactions of finerenone. CPT Pharmacometrics Syst Pharmacol 2021; 11:199-211. [PMID: 34783193 PMCID: PMC8846632 DOI: 10.1002/psp4.12746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/29/2021] [Accepted: 10/31/2021] [Indexed: 12/17/2022] Open
Abstract
Finerenone is a nonsteroidal, selective mineralocorticoid receptor antagonist that recently demonstrated its efficacy to delay chronic kidney disease (CKD) progression and reduce cardiovascular events in patients with CKD and type 2 diabetes. Here, we report the development of a physiologically‐based pharmacokinetic (PBPK) model for finerenone and its application as a victim drug of cytochrome P450 3A4 (CYP3A4)‐mediated drug‐drug interactions (DDIs) using the open‐source PBPK platform PK‐Sim, which has recently been qualified for this application purpose. First, the PBPK model for finerenone was developed using physicochemical, in vitro, and clinical (including mass balance) data. Subsequently, the finerenone model was validated regarding the contribution of CYP3A4 metabolism to total clearance by comparing to observed data from dedicated clinical interaction studies with erythromycin (simulated geometric mean ratios of the area under the plasma concentration‐time curve [AUCR] of 3.46 and geometric mean peak plasma concentration ratios [CmaxRs] of 2.00 vs. observed of 3.48 and 1.88, respectively) and verapamil (simulated AUCR of 2.91 and CmaxR of 1.86 vs. observed of 2.70 and 2.22, respectively). Finally, the finerenone model was applied to predict clinically untested DDI studies with various CYP3A4 modulators. An AUCR of 6.31 and a CmaxR of 2.37 was predicted with itraconazole, of 5.28 and 2.25 with clarithromycin, 1.59 and 1.40 with cimetidine, 1.57 and 1.38 with fluvoxamine, 0.19 and 0.32 with efavirenz, and 0.07 and 0.14 with rifampicin. This PBPK analysis provides a quantitative basis to guide the label and clinical use of finerenone with concomitant CYP3A4 modulators.
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Affiliation(s)
- Thomas Wendl
- Pharmaceuticals R&D, Pharmacometrics, Bayer AG, Leverkusen, Germany
| | | | - Michael Gerisch
- Pharmaceuticals R&D, Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany.,Pharmaceuticals R&D, Clinical Pharmacology, Bayer AG, Wuppertal, Germany
| | - Roland Heinig
- Pharmaceuticals R&D, Clinical Pharmacology, Bayer AG, Wuppertal, Germany
| | - Thomas Eissing
- Pharmaceuticals R&D, Pharmacometrics, Bayer AG, Leverkusen, Germany
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14
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Babos MB, Heinan M, Redmond L, Moiz F, Souza-Peres JV, Samuels V, Masimukku T, Hamilton D, Khalid M, Herscu P. Herb-Drug Interactions: Worlds Intersect with the Patient at the Center. MEDICINES (BASEL, SWITZERLAND) 2021; 8:44. [PMID: 34436223 PMCID: PMC8401017 DOI: 10.3390/medicines8080044] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023]
Abstract
This review examines three bodies of literature related to herb-drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb-drug combinations. Interacting herb-drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen's kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb-drug information is needed, including open and respectful discussion with patients.
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Affiliation(s)
- Mary Beth Babos
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA; (F.M.); (J.V.S.-P.); (V.S.); (T.M.); (M.K.)
| | - Michelle Heinan
- School of Medical Sciences, Lincoln Memoria University, Harrogate, TN 37752, USA;
| | - Linda Redmond
- Medical Center Long Term Care, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Fareeha Moiz
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA; (F.M.); (J.V.S.-P.); (V.S.); (T.M.); (M.K.)
| | - Joao Victor Souza-Peres
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA; (F.M.); (J.V.S.-P.); (V.S.); (T.M.); (M.K.)
| | - Valerie Samuels
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA; (F.M.); (J.V.S.-P.); (V.S.); (T.M.); (M.K.)
| | - Tarun Masimukku
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA; (F.M.); (J.V.S.-P.); (V.S.); (T.M.); (M.K.)
| | | | - Myra Khalid
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA; (F.M.); (J.V.S.-P.); (V.S.); (T.M.); (M.K.)
| | - Paul Herscu
- Research Division, Herscu Laboratory, Amherst, MA 01002, USA;
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15
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Tseng E, Eng H, Lin J, Cerny MA, Tess DA, Goosen TC, Obach RS. Static and Dynamic Projections of Drug-Drug Interactions Caused by Cytochrome P450 3A Time-Dependent Inhibitors Measured in Human Liver Microsomes and Hepatocytes. Drug Metab Dispos 2021; 49:947-960. [PMID: 34326140 DOI: 10.1124/dmd.121.000497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/01/2021] [Indexed: 11/22/2022] Open
Abstract
Cytochrome P450 3A (CYP3A) is a frequent target for time-dependent inhibition (TDI) that can give rise to drug-drug interactions (DDI). Yet many drugs that exhibit in vitro TDI for CYP3A, do not result in DDI. Twenty-three drugs with published clinical DDI were evaluated for CYP3A TDI in human liver microsomes (HLM) and hepatocytes (HHEP), and these data were utilized in static and dynamic models for projecting DDI caused by inactivation of CYP3A in both liver and intestine. TDI parameters measured in HHEP, particularly kinact, were generally lower than those measured in HLM. In static models, the use of average unbound organ exit concentrations offered the most accurate projections of DDI with geometric mean fold errors of 2.2 and 1.7 for HLM and HHEP, respectively. Use of maximum organ entry concentrations yielded marked overestimates of DDI. When evaluated in a binary fashion (i.e. projection of DDI of 1.25-fold or greater), data from HLM offered the greatest sensitivity (100%) and specificity (42%) and yielded no missed DDI when average unbound organ exit concentrations were used. In dynamic physiologically-based pharmacokinetic modeling, accurate projections of DDI were obtained with geometric mean fold errors of 1.7 and 1.6 for HLM and HHEP, respectively. Sensitivity and specificity were 100% and 67% when using TDI data generated in HLM and Simcyp modeling. Overall, DDI caused by CYP3A-mediated TDI can be reliably projected using dynamic or static models. For static models, average organ unbound exit concentrations must be used as input values otherwise DDI will be markedly overestimated. Significance Statement CYP3A time-dependent inhibitors are important in design and development of new drugs. The prevalence of CYP3A TDI is high among newly synthesized drug candidates and understanding the potential need for running clinical DDI studies is essential during drug development. Ability to reliably predict DDI caused by CYP3A TDI has been difficult to achieve. We report a thorough evaluation of CYP3A TDI and demonstrate that DDI can be predicted when using appropriate models and input parameters generated in HLM or HHEP.
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Affiliation(s)
- Elaine Tseng
- Pharmacokinetics, Dynamics, and Metabolism, Pfizer Global Research and Development, United States
| | - Heather Eng
- Pharmacokinetics, Dynamics, and Metabolism, Pfizer Global Research and Development, United States
| | | | | | | | - Theunis C Goosen
- Pharmacokinetics, Dynamics & Metabolism, Pfizer, Inc, United States
| | - R Scott Obach
- Groton Laboratories, Pfizer Global Research and Development, United States
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16
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Dimmito MP, Stefanucci A, Della Valle A, Scioli G, Cichelli A, Mollica A. An overview on plants cannabinoids endorsed with cardiovascular effects. Biomed Pharmacother 2021; 142:111963. [PMID: 34332376 DOI: 10.1016/j.biopha.2021.111963] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/14/2021] [Accepted: 07/22/2021] [Indexed: 12/01/2022] Open
Abstract
Nowadays cardiovascular diseases (CVDs) are the major causes for the reduction of the quality of life. The endocannabinoid system is an attractive therapeutic target for the treatment of cardiovascular disorders due to its involvement in vasomotor control, cardiac contractility, blood pressure and vascular inflammation. Alteration in cannabinoid signalling can be often related to cardiotoxicity, circulatory shock, hypertension, and atherosclerosis. Plants have been the major sources of medicines until modern eras in which researchers are experiencing a rediscovery of natural compounds as novel therapeutics. One of the most versatile plant is Cannabis sativa L., containing phytocannabinoids that may play a role in the treatment of CVDs. The aim of this review is to collect and investigate several less studied plants rich in cannabinoid-like active compounds able to interact with cannabinoid system; these plants may play a pivotal role in the treatment of disorders related to the cardiovascular system.
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Affiliation(s)
- Marilisa Pia Dimmito
- Department of Pharmacy, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Azzurra Stefanucci
- Department of Pharmacy, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Alice Della Valle
- Department of Pharmacy, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Giuseppe Scioli
- Department of Pharmacy, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Angelo Cichelli
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Adriano Mollica
- Department of Pharmacy, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
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17
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Gougis P, Hilmi M, Geraud A, Mir O, Funck-Brentano C. Potential Cytochrome P450-mediated pharmacokinetic interactions between herbs, food, and dietary supplements and cancer treatments. Crit Rev Oncol Hematol 2021; 166:103342. [PMID: 33930533 DOI: 10.1016/j.critrevonc.2021.103342] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022] Open
Abstract
Herbs, food and dietary supplements (HFDS), can interact significantly with anticancer drug treatments via cytochrome p450 isoforms (CYP) CYP3A4, CYP2D6, CYP1A2, and CYP2C8. The objective of this review was to assess the influence of HFDS compounds on these cytochromes. Interactions with CYP activities were searched for 189 herbs and food products, 72 dietary supplements in Web of Knowledge® databases. Analyses were made from 140 of 3,125 clinical trials and 236 of 3,374 in vitro, animal model studies or case reports. 18 trials were found to report direct interactions between 9 HFDS with 8 anticancer drugs. 21 HFDS were found to interact with CYP3A4, a major metabolic pathway for many anticancer drugs. All 261 HFDS were classified for their interaction with the main cytochromes P450 involved in the metabolism of anticancer drugs. We provided an easy-to-use colour-coded table to easily match potential interactions between 261 HFDS and 117 anticancer drugs.
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Affiliation(s)
- Paul Gougis
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013, Paris, France; CLIP² Galilée, Department of Medical Oncology Pitié-Salpêtrière Hospital, F-75013, Paris, France.
| | - Marc Hilmi
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013, Paris, France
| | - Arthur Geraud
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013, Paris, France; Early Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | - Olivier Mir
- Department of Ambulatory Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Christian Funck-Brentano
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013, Paris, France
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18
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Cox EJ, Tian DD, Clarke JD, Rettie AE, Unadkat JD, Thummel KE, McCune JS, Paine MF. Modeling Pharmacokinetic Natural Product-Drug Interactions for Decision-Making: A NaPDI Center Recommended Approach. Pharmacol Rev 2021; 73:847-859. [PMID: 33712517 PMCID: PMC7956993 DOI: 10.1124/pharmrev.120.000106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The popularity of botanical and other purported medicinal natural products (NPs) continues to grow, especially among patients with chronic illnesses and patients managed on complex prescription drug regimens. With few exceptions, the risk of a given NP to precipitate a clinically significant pharmacokinetic NP-drug interaction (NPDI) remains understudied or unknown. Application of static or dynamic mathematical models to predict and/or simulate NPDIs can provide critical information about the potential clinical significance of these complex interactions. However, methods used to conduct such predictions or simulations are highly variable. Additionally, published reports using mathematical models to interrogate NPDIs are not always sufficiently detailed to ensure reproducibility. Consequently, guidelines are needed to inform the conduct and reporting of these modeling efforts. This recommended approach from the Center of Excellence for Natural Product Drug Interaction Research describes a systematic method for using mathematical models to interpret the interaction risk of NPs as precipitants of potential clinically significant pharmacokinetic NPDIs. A framework for developing and applying pharmacokinetic NPDI models is presented with the aim of promoting accuracy, reproducibility, and generalizability in the literature. SIGNIFICANCE STATEMENT: Many natural products (NPs) contain phytoconstituents that can increase or decrease systemic or tissue exposure to, and potentially the efficacy of, a pharmaceutical drug; however, no regulatory agency guidelines exist to assist in predicting the risk of these complex interactions. This recommended approach from a multi-institutional consortium designated by National Institutes of Health as the Center of Excellence for Natural Product Drug Interaction Research provides a framework for modeling pharmacokinetic NP-drug interactions.
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Affiliation(s)
- Emily J Cox
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (J.D.C., A.E.R., J.D.U., K.E.T., J.S.M., M.F.P.); Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (E.J.C., D.-D.T., J.D.C., M.F.P.); Departments of Medicinal Chemistry (A.E.R.) and Pharmaceutics (J.D.U., K.E.T.), University of Washington, Seattle, Washington; and Department of Population Sciences, City of Hope, Duarte, California (J.S.M.)
| | - Dan-Dan Tian
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (J.D.C., A.E.R., J.D.U., K.E.T., J.S.M., M.F.P.); Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (E.J.C., D.-D.T., J.D.C., M.F.P.); Departments of Medicinal Chemistry (A.E.R.) and Pharmaceutics (J.D.U., K.E.T.), University of Washington, Seattle, Washington; and Department of Population Sciences, City of Hope, Duarte, California (J.S.M.)
| | - John D Clarke
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (J.D.C., A.E.R., J.D.U., K.E.T., J.S.M., M.F.P.); Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (E.J.C., D.-D.T., J.D.C., M.F.P.); Departments of Medicinal Chemistry (A.E.R.) and Pharmaceutics (J.D.U., K.E.T.), University of Washington, Seattle, Washington; and Department of Population Sciences, City of Hope, Duarte, California (J.S.M.)
| | - Allan E Rettie
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (J.D.C., A.E.R., J.D.U., K.E.T., J.S.M., M.F.P.); Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (E.J.C., D.-D.T., J.D.C., M.F.P.); Departments of Medicinal Chemistry (A.E.R.) and Pharmaceutics (J.D.U., K.E.T.), University of Washington, Seattle, Washington; and Department of Population Sciences, City of Hope, Duarte, California (J.S.M.)
| | - Jashvant D Unadkat
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (J.D.C., A.E.R., J.D.U., K.E.T., J.S.M., M.F.P.); Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (E.J.C., D.-D.T., J.D.C., M.F.P.); Departments of Medicinal Chemistry (A.E.R.) and Pharmaceutics (J.D.U., K.E.T.), University of Washington, Seattle, Washington; and Department of Population Sciences, City of Hope, Duarte, California (J.S.M.)
| | - Kenneth E Thummel
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (J.D.C., A.E.R., J.D.U., K.E.T., J.S.M., M.F.P.); Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (E.J.C., D.-D.T., J.D.C., M.F.P.); Departments of Medicinal Chemistry (A.E.R.) and Pharmaceutics (J.D.U., K.E.T.), University of Washington, Seattle, Washington; and Department of Population Sciences, City of Hope, Duarte, California (J.S.M.)
| | - Jeannine S McCune
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (J.D.C., A.E.R., J.D.U., K.E.T., J.S.M., M.F.P.); Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (E.J.C., D.-D.T., J.D.C., M.F.P.); Departments of Medicinal Chemistry (A.E.R.) and Pharmaceutics (J.D.U., K.E.T.), University of Washington, Seattle, Washington; and Department of Population Sciences, City of Hope, Duarte, California (J.S.M.)
| | - Mary F Paine
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (J.D.C., A.E.R., J.D.U., K.E.T., J.S.M., M.F.P.); Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington (E.J.C., D.-D.T., J.D.C., M.F.P.); Departments of Medicinal Chemistry (A.E.R.) and Pharmaceutics (J.D.U., K.E.T.), University of Washington, Seattle, Washington; and Department of Population Sciences, City of Hope, Duarte, California (J.S.M.)
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19
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Liu Y, Mapa MST, Sprando RL. Anthraquinones inhibit cytochromes P450 enzyme activity in silico and in vitro. J Appl Toxicol 2021; 41:1438-1445. [PMID: 33438235 DOI: 10.1002/jat.4134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/29/2020] [Accepted: 12/14/2020] [Indexed: 01/11/2023]
Abstract
Anthraquinones exhibit various pharmacological activities (e.g., antioxidant and laxative) and are commonly found in consumer products including foods, dietary supplements, drugs, and traditional medicines. Despite their widespread use, there are limited data available on their toxicokinetic properties. Cytochrome P450 enzymes (CYPs) in the liver play major roles in metabolizing exogenous chemicals (e.g., pharmaceuticals, food ingredients, and environmental pollutants) and endogenous biomolecules (e.g., steroid hormones and cholesterol). Inhibition of CYP activities may lead to serious interactions among these compounds. Here, in silico (quantitative structure-activity relationship modeling) and in vitro (human recombinant enzymes and liver microsomes) methods were used to identify inhibitors of five major CYP isoforms (CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4) among 22 anthraquinones. First, in silico prediction and in vitro human recombinant enzyme assays were conducted for all compounds, and results showed that most of the anthraquinones were potent CYP1A2 inhibitors. Second, five selected anthraquinones (emodin, aloe-emodin, rhein, purpurin, and rubiadin) were further evaluated in human liver microsomes. Finally, plasma concentrations of the five anthraquinones in animal and humans were identified in the literature and compared to their in vitro inhibition potency (IC50 values) towards CYP activities. Emodin, rhein, and aloe-emodin inhibited activities of multiple CYPs in human liver microsomes and potential in vivo inhibition may occur due to their high plasma concentrations. These in silico and in vitro results enabled rapid identification of potential CYP inhibitors and prioritized future in-depth studies.
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Affiliation(s)
- Yitong Liu
- Division of Toxicology, Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Laurel, Maryland, USA
| | - Mapa S T Mapa
- Division of Toxicology, Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Laurel, Maryland, USA
| | - Robert L Sprando
- Division of Toxicology, Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Laurel, Maryland, USA
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20
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Nguyen JT, Tian DD, Tanna RS, Hadi DL, Bansal S, Calamia JC, Arian CM, Shireman LM, Molnár B, Horváth M, Kellogg JJ, Layton ME, White JR, Cech NB, Boyce RD, Unadkat JD, Thummel KE, Paine MF. Assessing Transporter-Mediated Natural Product-Drug Interactions Via In vitro-In Vivo Extrapolation: Clinical Evaluation With a Probe Cocktail. Clin Pharmacol Ther 2020; 109:1342-1352. [PMID: 33174626 DOI: 10.1002/cpt.2107] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022]
Abstract
The botanical natural product goldenseal can precipitate clinical drug interactions by inhibiting cytochrome P450 (CYP) 3A and CYP2D6. Besides P-glycoprotein, effects of goldenseal on other clinically relevant transporters remain unknown. Established transporter-expressing cell systems were used to determine the inhibitory effects of a goldenseal extract, standardized to the major alkaloid berberine, on transporter activity. Using recommended basic models, the extract was predicted to inhibit the efflux transporter BCRP and uptake transporters OATP1B1/3. Using a cocktail approach, effects of the goldenseal product on BCRP, OATP1B1/3, OATs, OCTs, MATEs, and CYP3A were next evaluated in 16 healthy volunteers. As expected, goldenseal increased the area under the plasma concentration-time curve (AUC0-inf ) of midazolam (CYP3A; positive control), with a geometric mean ratio (GMR) (90% confidence interval (CI)) of 1.43 (1.35-1.53). However, goldenseal had no effects on the pharmacokinetics of rosuvastatin (BCRP and OATP1B1/3) and furosemide (OAT1/3); decreased metformin (OCT1/2, MATE1/2-K) AUC0-inf (GMR, 0.77 (0.71-0.83)); and had no effect on metformin half-life and renal clearance. Results indicated that goldenseal altered intestinal permeability, transport, and/or other processes involved in metformin absorption, which may have unfavorable effects on glucose control. Inconsistencies between model predictions and pharmacokinetic outcomes prompt further refinement of current basic models to include differential transporter expression in relevant organs and intestinal degradation/metabolism of the precipitant(s). Such refinement should improve in vitro-in vivo prediction accuracy, contributing to a standard approach for studying transporter-mediated natural product-drug interactions.
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Affiliation(s)
- James T Nguyen
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Dan-Dan Tian
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Rakshit S Tanna
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Deena L Hadi
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA.,Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA
| | - Sumit Bansal
- Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Justina C Calamia
- Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Christopher M Arian
- Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Laura M Shireman
- Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Bálint Molnár
- SOLVO Biotechnology, SZTE Biológiai Epület, University of Szeged, Szeged, Hungary
| | - Miklós Horváth
- SOLVO Biotechnology, SZTE Biológiai Epület, University of Szeged, Szeged, Hungary
| | - Joshua J Kellogg
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Matthew E Layton
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - John R White
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Nadja B Cech
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA.,Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Richard D Boyce
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jashvant D Unadkat
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA.,Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Kenneth E Thummel
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA.,Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Mary F Paine
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA.,Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA
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21
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Mandal SK, Maji AK, Mishra SK, Ishfaq PM, Devkota HP, Silva AS, Das N. Goldenseal (Hydrastis canadensis L.) and its active constituents: A critical review of their efficacy and toxicological issues. Pharmacol Res 2020; 160:105085. [PMID: 32683037 DOI: 10.1016/j.phrs.2020.105085] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/19/2022]
Abstract
Goldenseal (Hydrastis canadensis L.) is a medicinal plant widely used in various traditional systems of medicine and as a food supplement. It has been traditionally used by Native Americans as a coloring agent and as medicinal remedy for common diseases and conditions like wounds, digestive disorders, ulcers, skin and eye ailments, and cancer. Over the years, goldenseal has become a popular food supplement in the USA and other regions. The rhizome of this plant has been used for the treatment of a variety of diseases including, gastrointestinal disorders, ulcers, muscular debility, nervous prostration, constipation, skin and eye infections, cancer, among others. Berberine is one of the most bioactive alkaloid that has been identified in different parts of goldenseal. The goldenseal extract containing berberine showed numerous therapeutic effects such as antimicrobial, anti-inflammatory, hypolipidemic, hypoglycemic, antioxidant, neuroprotective (anti-Alzheimer's disease), cardioprotective, and gastrointestinal protective. Various research finding suggest the health promoting effects of goldenseal components and their extracts. However, few studies have also suggested the possible neurotoxic, hepatotoxic and phototoxic activities of goldenseal extract and its alkaloids. Thus, large randomized, double-blind clinical studies need to be conducted on goldenseal supplements and their main alkaloids to provide more evidence on the mechanisms responsible for the pharmaceutical activity, clinical efficacy and safety of these products. Thus, it is very important to review the scientific information about goldenseal to understand about the current scenario.
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Affiliation(s)
- Sudip Kumar Mandal
- Dr. B. C. Roy College of Pharmacy and AHS, Durgapur, 713206, West Bengal, India
| | | | - Siddhartha Kumar Mishra
- Cancer Biology Laboratory, Department of Zoology, School of Biological Sciences, Dr. Harisingh Gour Central University, Sagar, 470003, Madhya Pradesh, India
| | - Pir Mohammad Ishfaq
- Cancer Biology Laboratory, Department of Zoology, School of Biological Sciences, Dr. Harisingh Gour Central University, Sagar, 470003, Madhya Pradesh, India
| | - Hari Prasad Devkota
- Department of Instrumental Analysis, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Kumamoto, 862-0973, Japan; Program for Leading Graduate Schools, Health Life Sciences: Interdisciplinary and Glocal Oriented (HIGO) Program, Kumamoto University, 5-1 Oe-honmachi, Kumamoto, 862-0973, Japan
| | - Ana Sanches Silva
- National Institute for Agricultural and Veterinary Research (INIAV), I.P., Rua dos Lagidos, Lugar da Madalena, Vairão, Vila do Conde, 4485-655, Portugal; Center for Study in Animal Science (CECA), ICETA, University of Oporto, Oporto, 4051-401, Portugal
| | - Niranjan Das
- Department of Chemistry, Iswar Chandra Vidyasagar College, Belonia, 799155, Tripura, India.
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22
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Pharmacokinetic Interactions between Herbal Medicines and Drugs: Their Mechanisms and Clinical Relevance. Life (Basel) 2020; 10:life10070106. [PMID: 32635538 PMCID: PMC7400069 DOI: 10.3390/life10070106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 01/20/2023] Open
Abstract
The therapeutic efficacy of a drug or its unexpected unwanted side effects may depend on the concurrent use of a medicinal plant. In particular, constituents in the medicinal plant extracts may influence drug bioavailability, metabolism and half-life, leading to drug toxicity or failure to obtain a therapeutic response. This narrative review focuses on clinical studies improving knowledge on the ability of selected herbal medicines to influence the pharmacokinetics of co-administered drugs. Moreover, in vitro studies are useful to anticipate potential herbal medicine-drug interactions. In particular, they help to elucidate the cellular target (metabolic or transporter protein) and the mechanism (induction or inhibition) by which a single constituent of the herbal medicine acts. The authors highlight the difficulties in predicting herbal–drug interactions from in vitro data where high concentrations of extracts or their constituents are used and pharmacokinetics are missed. Moreover, the difficulty to compare results from human studies where different kinds of herbal extracts are used is discussed. The herbal medicines discussed are among the best sellers and they are reported in the “Herbal Medicines for Human Use” section of the European Medicinal Agency (EMA).
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23
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McDonald MG, Tian DD, Thummel KE, Paine MF, Rettie AE. Modulation of Major Human Liver Microsomal Cytochromes P450 by Component Alkaloids of Goldenseal: Time-Dependent Inhibition and Allosteric Effects. Drug Metab Dispos 2020; 48:1018-1027. [PMID: 32591416 DOI: 10.1124/dmd.120.091041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
Botanical and other natural products (NPs) are often coconsumed with prescription medications, presenting a risk for cytochrome P450 (P450)-mediated NP-drug interactions. The NP goldenseal (Hydrastis canadensis) has exhibited antimicrobial activities in vitro attributed to isoquinoline alkaloids contained in the plant, primarily berberine, (-)-β-hydrastine, and to a lesser extent, hydrastinine. These alkaloids contain methylenedioxyphenyl rings, structural alerts with potential to inactivate P450s through formation of metabolic intermediate complexes. Time-dependent inhibition experiments were conducted to evaluate their ability to inhibit major P450 activities in human liver microsomes by using a cocktail of isozyme-specific substrate probes. Berberine inhibited CYP2D6 (dextromethorphan O-demethylation; K I = 2.7 μM, kinact = 0.065 minute-1) and CYP3A4/5 (midazolam 1'-hydroxylation; K I = 14.8 μM, kinact = 0.019 minute-1); (-)-β-hydrastine inhibited CYP2C9 (diclofenac 4'-hydroxylation; K I = 49 μM, kinact = 0.036 minute-1), CYP2D6 (K I > 250 μM, kinact > 0.06 minute-1), and CYP3A4/5 (K I = 28 μM, kinact = 0.056 minute-1); and hydrastinine inhibited CYP2D6 (K I = 37 μM, kinact = 0.049 minute-1) activity. Berberine additionally exhibited allosteric effects on midazolam hydroxylation, showing both positive and negative heterotropic cooperativity. Experiments with recombinant isozymes showed that berberine activated midazolam 1'-hydroxylation by CYP3A5, lowering K m(app), but showed mixed inhibition and negative cooperativity toward this reaction when catalyzed by CYP3A4. Berberine inactivated CYP3A4 at a much faster rate than CYP3A5 and was a noncompetitive inhibitor of midazolam 4-hydroxylation by CYP3A4 but a strong mixed inhibitor of the CYP3A5 catalyzed reaction. These complex kinetics should be considered when extrapolating the risk for NP-drug interactions involving goldenseal. SIGNIFICANCE STATEMENT: Robust kinetic parameters were determined for the reversible and time-dependent inhibition of CYP2C9, CYP2D6, and CYP3A4/5 activities in human liver microsomes by major component isoquinoline alkaloids contained in the botanical natural product goldenseal. The alkaloid berberine also exhibited opposing, isozyme-specific allosteric effects on midazolam hydroxylation mediated by recombinant CYP3A4 (inhibition) and CYP3A5 (activation). These data will inform the development of a physiologically based pharmacokinetic model that can be used to predict potential clinically relevant goldenseal-drug interactions.
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Affiliation(s)
- Matthew G McDonald
- Departments of Medicinal Chemistry (M.G.M., A.E.R.) and Pharmaceutics (K.E.T.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Pharmaceutical Sciences (D.-D.T., M.F.P.), College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (K.E.T., M.F.P., A.E.R.)
| | - Dan-Dan Tian
- Departments of Medicinal Chemistry (M.G.M., A.E.R.) and Pharmaceutics (K.E.T.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Pharmaceutical Sciences (D.-D.T., M.F.P.), College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (K.E.T., M.F.P., A.E.R.)
| | - Kenneth E Thummel
- Departments of Medicinal Chemistry (M.G.M., A.E.R.) and Pharmaceutics (K.E.T.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Pharmaceutical Sciences (D.-D.T., M.F.P.), College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (K.E.T., M.F.P., A.E.R.)
| | - Mary F Paine
- Departments of Medicinal Chemistry (M.G.M., A.E.R.) and Pharmaceutics (K.E.T.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Pharmaceutical Sciences (D.-D.T., M.F.P.), College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (K.E.T., M.F.P., A.E.R.)
| | - Allan E Rettie
- Departments of Medicinal Chemistry (M.G.M., A.E.R.) and Pharmaceutics (K.E.T.), School of Pharmacy, University of Washington, Seattle, Washington; Department of Pharmaceutical Sciences (D.-D.T., M.F.P.), College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington; and Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington (K.E.T., M.F.P., A.E.R.)
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24
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Bordes C, Leguelinel-Blache G, Lavigne JP, Mauboussin JM, Laureillard D, Faure H, Rouanet I, Sotto A, Loubet P. Interactions between antiretroviral therapy and complementary and alternative medicine: a narrative review. Clin Microbiol Infect 2020; 26:1161-1170. [PMID: 32360208 DOI: 10.1016/j.cmi.2020.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The use of complementary and alternative medicine including herbal medicine (phytotherapy), vitamins, minerals and food supplements is frequent among people living with HIV/AIDS (PLWHAs) who take antiretroviral (ARV) drugs, but is often not known by their prescribing physicians. Some drug-supplement combinations may result in clinically meaningful interactions. AIMS In this literature review, we aimed to investigate the evidence for complementary and alternative medicine interactions with ARVs. SOURCES A bibliographic search of all in vitro, human studies and case reports of the PubMed database was performed to assess the risk of interactions between complementary and alternative self-medication products and ARVs. The 'HIV drug interaction' (https://www.hiv-druginteractions.org) and 'Natural medicines comprehensive database' (https://naturalmedicines.therapeuticresearch.com) interaction checkers were also analysed. CONTENT St John's wort, some forms of garlic, grapefruit and red rice yeast are known to have significant interaction and thus should not be co-administered, or should be used with caution with certain ARV classes. Data on other plant-based supplements come from in vitro studies or very small size in vivo studies and are thus insufficient to conclude the real in vivo impact in case of concomitant administration with ARVs. Some polyvalent minerals such as calcium, magnesium, and iron salts can reduce the absorption of integrase inhibitors by chelation. Potential interactions with vitamin C and quercetin with some ARVs should be noted and efficacy and tolerance of the treatment should be monitored. IMPLICATIONS This review shows the importance of screening all PLWHAs for complementary and alternative medicine use to prevent treatment failure or adverse effects related to an interaction with ARVs. Further human studies are warranted to describe the clinical significance of in vitro interactions between numerous complementary and alternative medicine and ARVs.
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Affiliation(s)
- C Bordes
- Pharmacy Department, University of Montpellier, CHU Nimes, France
| | - G Leguelinel-Blache
- Pharmacy Department, University of Montpellier, CHU Nimes, France; UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier, Montpellier, France
| | - J-P Lavigne
- VBMI, INSERM U1047, University of Montpellier, Department of Microbiology and Hospital Hygiene, CHU Nîmes, Nîmes, France
| | - J-M Mauboussin
- Department of Infectious and Tropical Diseases, CHU Nîmes, Nîmes, France
| | - D Laureillard
- Department of Infectious and Tropical Diseases, CHU Nîmes, Nîmes, France; Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français Du Sang, University of Montpellier, Montpellier, France
| | - H Faure
- Pharmacy Department, CH de Royan, Royan, France
| | - I Rouanet
- Department of Infectious and Tropical Diseases, CHU Nîmes, Nîmes, France
| | - A Sotto
- VBMI, INSERM U1047, University of Montpellier, Department of Infectious and Tropical Diseases, CHU Nîmes, Nîmes, France
| | - P Loubet
- VBMI, INSERM U1047, University of Montpellier, Department of Infectious and Tropical Diseases, CHU Nîmes, Nîmes, France.
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25
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Prommer E. Midazolam: an essential palliative care drug. Palliat Care Soc Pract 2020; 14:2632352419895527. [PMID: 32215374 PMCID: PMC7065504 DOI: 10.1177/2632352419895527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/13/2019] [Indexed: 12/16/2022] Open
Abstract
Midazolam is a commonly used benzodiazepine in palliative care and is considered one of the four essential drugs needed for the promotion of quality care in dying patients. Acting on the benzodiazepine receptor, it promotes the action of gamma-aminobutyric acid. Gamma-aminobutyric acid action promotes sedative, anxiolytic, and anticonvulsant properties. Midazolam has a faster onset and shorter duration of action than other benzodiazepines such as diazepam and lorazepam lending itself to greater flexibility in dosing than other benzodiazepines. The kidneys excrete midazolam and its active metabolite. Metabolism occurs in the liver by the P450 system. This article examines the pharmacology, pharmacodynamics, and clinical uses of midazolam in palliative care.
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Affiliation(s)
- Eric Prommer
- UCLA/VA Hospice and Palliative Medicine Program, UCLA School of Medicine, 11301 Wilshire Blvd., Bldg. 500, Room 2064A, Los Angeles, CA 90073, USA
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26
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In vivo evaluation of enhanced drug carrier efficiency and cardiac anti-hypertrophy therapeutic potential of nano-curcumin encapsulated photo-plasmonic nanoparticles combined polymerized nano-vesicles: A novel strategy. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2019; 199:111619. [DOI: 10.1016/j.jphotobiol.2019.111619] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/17/2019] [Accepted: 08/26/2019] [Indexed: 12/19/2022]
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27
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Wen B, Gorycki P. Bioactivation of herbal constituents: mechanisms and toxicological relevance. Drug Metab Rev 2019; 51:453-497. [DOI: 10.1080/03602532.2019.1655570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Bo Wen
- Department of Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Collegeville, PA, USA
| | - Peter Gorycki
- Department of Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Collegeville, PA, USA
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28
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Gougis P, Palmieri LJ, Funck-Brentano C, Paci A, Flippot R, Mir O, Coriat R. Major pitfalls of protein kinase inhibitors prescription: A review of their clinical pharmacology for daily use. Crit Rev Oncol Hematol 2019; 141:112-124. [PMID: 31276964 DOI: 10.1016/j.critrevonc.2019.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
Protein kinase inhibitors (PKI) are a growing class of anticancer agents. They are prescribed with flat doses, and their oral administration is associated with interindividual variability in exposure. Patients can be over- or underexposed, due to numerous factors. We reviewed key pharmacokinetic concepts and mechanisms by which PKIs prescription could be altered. Challenging situations that could lead to increased toxicity or to therapeutic failure are described and recommendation for clinicians are proposed. Finally, the interest of therapeutic drug monitoring and indications for its use in daily practice is discussed.
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Affiliation(s)
- Paul Gougis
- Sorbonne Université, Faculty of Medicine, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Center, F-75013, Paris, France; CLIP² Galilée, Pitié-Salpêtrière Hospital, F-75013, Paris, France.
| | - Lola-Jade Palmieri
- AP-HP, Cochin Hospital, Department of gastroenterology and gastrointestinal oncology, Université Paris Descartes, Paris, France
| | - Christian Funck-Brentano
- Sorbonne Université, Faculty of Medicine, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Center, F-75013, Paris, France; INSERM, CIC-1421 and UMR ICAN 1166, Institute of Cardiometabolism and Nutrition (ICAN), F-75013, Paris, France
| | - Angelo Paci
- Service de Pharmacologie, Département de Biologie et Pathologie Médicales, Gustave Roussy et Université Paris Saclay, Villejuif, France
| | - Ronan Flippot
- Department of Medical Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - Olivier Mir
- Department of Medical Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France; Department of Ambulatory Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Romain Coriat
- AP-HP, Cochin Hospital, Department of gastroenterology and gastrointestinal oncology, Université Paris Descartes, Paris, France
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29
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Hanke N, Frechen S, Moj D, Britz H, Eissing T, Wendl T, Lehr T. PBPK Models for CYP3A4 and P-gp DDI Prediction: A Modeling Network of Rifampicin, Itraconazole, Clarithromycin, Midazolam, Alfentanil, and Digoxin. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2018; 7:647-659. [PMID: 30091221 PMCID: PMC6202474 DOI: 10.1002/psp4.12343] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 07/16/2018] [Indexed: 01/03/2023]
Abstract
According to current US Food and Drug Administration (FDA) and European Medicines Agency (EMA) guidance documents, physiologically based pharmacokinetic (PBPK) modeling is a powerful tool to explore and quantitatively predict drug‐drug interactions (DDIs) and may offer an alternative to dedicated clinical trials. This study provides whole‐body PBPK models of rifampicin, itraconazole, clarithromycin, midazolam, alfentanil, and digoxin within the Open Systems Pharmacology (OSP) Suite. All models were built independently, coupled using reported interaction parameters, and mutually evaluated to verify their predictive performance by simulating published clinical DDI studies. In total, 112 studies were used for model development and 57 studies for DDI prediction. 93% of the predicted area under the plasma concentration‐time curve (AUC) ratios and 94% of the peak plasma concentration (Cmax) ratios are within twofold of the observed values. This study lays a cornerstone for the qualification of the OSP platform with regard to reliable PBPK predictions of enzyme‐mediated and transporter‐mediated DDIs during model‐informed drug development. All presented models are provided open‐source and transparently documented.
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Affiliation(s)
- Nina Hanke
- Clinical Pharmacy, Saarland University, Saarbrücken, Germany
| | | | - Daniel Moj
- Clinical Pharmacy, Saarland University, Saarbrücken, Germany
| | - Hannah Britz
- Clinical Pharmacy, Saarland University, Saarbrücken, Germany
| | | | - Thomas Wendl
- Clinical Pharmacometrics, Bayer AG, Leverkusen, Germany
| | - Thorsten Lehr
- Clinical Pharmacy, Saarland University, Saarbrücken, Germany
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30
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The role of hepatic cytochrome P450s in the cytotoxicity of dronedarone. Arch Toxicol 2018; 92:1969-1981. [PMID: 29616291 DOI: 10.1007/s00204-018-2196-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/21/2018] [Indexed: 02/06/2023]
Abstract
Dronedarone is used to treat patients with cardiac arrhythmias and has been reported to be associated with liver injury. Our previous mechanistic work demonstrated that DNA damage-induced apoptosis contributes to the cytotoxicity of dronedarone. In this study, we examined further the underlying mechanisms and found that after a 24-h treatment of HepG2 cells, dronedarone caused cytotoxicity, G1-phase cell cycle arrest, suppression of topoisomerase II, and DNA damage in a concentration-dependent manner. We also investigated the role of cytochrome P450s (CYPs)-mediated metabolism in the dronedarone-induced toxicity using our previously established HepG2 cell lines expressing individually 14 human CYPs (1A1, 1A2, 1B1, 2A6, 2B6, 2C8, 2C9, 2C18, 2C19, 2D6, 2E1, 3A4, 3A5, and 3A7). We demonstrated that CYP3A4, 3A5, and 2D6 were the major enzymes that metabolize dronedarone, and that CYP3A7, 2E1, 2C19, 2C18, 1A1, and 2B6 also metabolize dronedarone, but to a lesser extent. Our data showed that the cytotoxicity of dronedarone was decreased in CYP3A4-, 3A5-, or 2D6-overexpressing cells compared to the control HepG2 cells, indicating that the parent dronedarone has higher potency than the metabolites to induce cytotoxicity in these cells. In contrast, cytotoxicity was increased in CYP1A1-overexpressing cells, demonstrating that CYP1A1 exerts an opposite effect in dronedarone's toxicity, comparing to CYP3A4, 3A5, or 2D6. We also studied the involvement of topoisomerase II in dronedarone-induced toxicity, and demonstrated that the overexpression of topoisomerase II caused an increase in cell viability and a decrease in γ-H2A.X induction, suggesting that suppression of topoisomerase II may be one of the mechanisms involved in dronedarone-induced liver toxicity.
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31
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Grimstein M, Huang SM. A regulatory science viewpoint on botanical-drug interactions. J Food Drug Anal 2018; 26:S12-S25. [PMID: 29703380 PMCID: PMC9326881 DOI: 10.1016/j.jfda.2018.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/20/2018] [Accepted: 01/23/2018] [Indexed: 11/28/2022] Open
Abstract
There is a continued predisposition of concurrent use of drugs and botanical products. Consumers often self-administer botanical products without informing their health care providers. The perceived safety of botanical products with lack of knowledge of the interaction potential poses a challenge for providers and both efficacy and safety concerns for patients. Botanical–drug combinations can produce untoward effects when botanical constituents modulate drug metabolizing enzymes and/or transporters impacting the systemic or tissue exposure of concomitant drugs. Examples of pertinent scientific literature evaluating the interaction potential of commonly used botanicals in the US are discussed. Current methodologies that can be applied to advance our efforts in predicting drug interaction liability is presented. This review also highlights the regulatory science viewpoint on botanical–drug interactions and labeling implications.
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Affiliation(s)
- Manuela Grimstein
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
| | - Shiew-Mei Huang
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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32
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Abstract
Over 70% of Americans take some form of dietary supplement every day, and the supplement industry is currently big business, with a gross of over $28 billion. However, unlike either foods or drugs, supplements do not need to be registered or approved by the US Food and Drug Administration (FDA) prior to production or sales. Under the Dietary Supplement Health and Education Act of 1994, the FDA is restricted to adverse report monitoring postmarketing. Despite widespread consumption, there is limited evidence of health benefits related to nutraceutical or supplement use in well-nourished adults. In contrast, a small number of these products have the potential to produce significant toxicity. In addition, patients often do not disclose supplement use to their physicians. Therefore, the risk of adverse drug-supplement interactions is significant. An overview of the major supplement and nutraceutical classes is presented here, together with known toxic effects and the potential for drug interactions.
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Affiliation(s)
- Martin J J Ronis
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA; , ,
| | - Kim B Pedersen
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA; , ,
| | - James Watt
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA; , ,
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33
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Liperoti R, Vetrano DL, Bernabei R, Onder G. Herbal Medications in Cardiovascular Medicine. J Am Coll Cardiol 2017; 69:1188-1199. [PMID: 28254182 DOI: 10.1016/j.jacc.2016.11.078] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/11/2016] [Accepted: 11/07/2016] [Indexed: 01/01/2023]
Abstract
Herbal medications are commonly used for clinical purposes, including the treatment of cardiovascular conditions. Compared with conventional medications, herbal medications do not require clinical studies before their marketing or formal approval from regulatory agencies, and for this reason their efficacy and safety are rarely proven. In this review, we summarize available evidence on herbal medications mostly used in cardiovascular medicine. We show that the use of these medications for the treatment of cardiovascular diseases is often not supported by scientific evidence. Despite most of these herbs showing an effect on biological mechanisms related to the cardiovascular system, data on their clinical effects are lacking. Potential relevant side effects, including increased risk of drug interactions, are described, and the possibility of contamination or substitution with other medications represents a concern. Physicians should always assess the use of herbal medications with patients and discuss the possible benefits and side effects with them.
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Affiliation(s)
- Rosa Liperoti
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide L Vetrano
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
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Therapeutic Risk and Benefits of Concomitantly Using Herbal Medicines and Conventional Medicines: From the Perspectives of Evidence Based on Randomized Controlled Trials and Clinical Risk Management. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:9296404. [PMID: 28491115 PMCID: PMC5405391 DOI: 10.1155/2017/9296404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/22/2017] [Accepted: 04/02/2017] [Indexed: 12/30/2022]
Abstract
Despite increased awareness of the potential of herb-drug interactions (HDIs), the lack of rigorous clinical evidence regarding the significance provides a challenge for clinicians and consumers to make rational decisions about the safe combination of herbal and conventional medicines. This review addressed HDIs based on evidence from randomized controlled trials (RCTs). Literature was identified by performing a PubMed search till January 2017. Risk description and clinical risk management were described. Among 74 finally included RCTs, 17 RCTs (22.97%) simply addressed pharmacodynamic HDIs. Fifty-seven RCTs (77.03%) investigated pharmacokinetic HDIs and twenty-eight of them showed potential or actual clinical relevance. The extent of an HDI may be associated with the factors such as pharmacogenomics, dose of active ingredients in herbs, time course of interaction, characteristics of the object drugs (e.g., administration routes and pharmacokinetic profiles), modification of herbal prescription compositions, and coexistence of inducers and inhibitors. Clinical professionals should enhance risk management on HDIs such as increasing awareness of potential changes in therapeutic risk and benefits, inquiring patients about all currently used conventional medicines and herbal medicines and supplements, automatically detecting highly substantial significant HDI by computerized reminder system, selecting the alternatives, adjusting dose, reviewing the appropriateness of physician orders, educating patients to monitor for drug-interaction symptoms, and paying attention to follow-up visit and consultation.
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Practical considerations when designing and conducting clinical pharmacokinetic herb–drug interaction studies. ACTA ACUST UNITED AC 2017. [DOI: 10.4155/ipk-2016-0009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Pharmacokinetic herb–drug interaction (HDI) research has been ongoing for almost two decades and a significant body of information has been published on the subject, yet much of it is contradictory. Some of this disparity stems from the botanical dosage form itself, as product quality and dosage form performance can vary significantly among brands. Unless products are adequately characterized, HDI study results can be misleading. The purpose of this report is to identify several common weaknesses inherent in many prospective clinical HDI studies and to provide guidance in addressing these shortcomings. Topics such as study design, pharmacokinetic end points, product quality, dosage form performance, gauging clinical relevance, and efforts to minimize dietary influences while improving compliance are discussed.
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Brooks KM, George JM, Kumar P. Drug interactions in HIV treatment: complementary & alternative medicines and over-the-counter products. Expert Rev Clin Pharmacol 2016; 10:59-79. [PMID: 27715369 DOI: 10.1080/17512433.2017.1246180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Use of complementary and alternative medicines (CAMs) and over-the-counter (OTC) medications are very common among HIV-infected patients. These products can cause clinically significant drug-drug interactions (DDIs) with antiretroviral (ARV) medications, thereby increasing risk for negative outcomes such as toxicity or loss of virologic control. Areas covered: This article provides an updated review of the different mechanisms by which CAM and OTC products are implicated in DDIs with ARV medications. Expert commentary: Much of the literature published to date involves studies of CAMs interacting with older ARV agents via the cytochrome P450 (CYP450) system. However, the HIV treatment and prevention arsenal is continually evolving. Furthermore, our elucidation of the role of non-CYP450 mediated DDIs with ARV medications is greatly increasing. Therefore, clinicians are well served to understand the various mechanisms and extent by which new ARV therapies may be involved in drug interactions with CAMs and OTC medications.
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Affiliation(s)
- Kristina M Brooks
- a Clinical Pharmacokinetics Research Unit, Clinical Center Pharmacy Department , National Institutes of Health , Bethesda , MD , USA
| | - Jomy M George
- a Clinical Pharmacokinetics Research Unit, Clinical Center Pharmacy Department , National Institutes of Health , Bethesda , MD , USA
| | - Parag Kumar
- a Clinical Pharmacokinetics Research Unit, Clinical Center Pharmacy Department , National Institutes of Health , Bethesda , MD , USA
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Almond LM, Mukadam S, Gardner I, Okialda K, Wong S, Hatley O, Tay S, Rowland-Yeo K, Jamei M, Rostami-Hodjegan A, Kenny JR. Prediction of Drug-Drug Interactions Arising from CYP3A induction Using a Physiologically Based Dynamic Model. ACTA ACUST UNITED AC 2016; 44:821-32. [PMID: 27026679 PMCID: PMC4885489 DOI: 10.1124/dmd.115.066845] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/28/2016] [Indexed: 12/11/2022]
Abstract
Using physiologically based pharmacokinetic modeling, we predicted the magnitude of drug-drug interactions (DDIs) for studies with rifampicin and seven CYP3A4 probe substrates administered i.v. (10 studies) or orally (19 studies). The results showed a tendency to underpredict the DDI magnitude when the victim drug was administered orally. Possible sources of inaccuracy were investigated systematically to determine the most appropriate model refinement. When the maximal fold induction (Indmax) for rifampicin was increased (from 8 to 16) in both the liver and the gut, or when the Indmax was increased in the gut but not in liver, there was a decrease in bias and increased precision compared with the base model (Indmax = 8) [geometric mean fold error (GMFE) 2.12 vs. 1.48 and 1.77, respectively]. Induction parameters (mRNA and activity), determined for rifampicin, carbamazepine, phenytoin, and phenobarbital in hepatocytes from four donors, were then used to evaluate use of the refined rifampicin model for calibration. Calibration of mRNA and activity data for other inducers using the refined rifampicin model led to more accurate DDI predictions compared with the initial model (activity GMFE 1.49 vs. 1.68; mRNA GMFE 1.35 vs. 1.46), suggesting that robust in vivo reference values can be used to overcome interdonor and laboratory-to-laboratory variability. Use of uncalibrated data also performed well (GMFE 1.39 and 1.44 for activity and mRNA). As a result of experimental variability (i.e., in donors and protocols), it is prudent to fully characterize in vitro induction with prototypical inducers to give an understanding of how that particular system extrapolates to the in vivo situation when using an uncalibrated approach.
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Affiliation(s)
- Lisa M Almond
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
| | - Sophie Mukadam
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
| | - Iain Gardner
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
| | - Krystle Okialda
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
| | - Susan Wong
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
| | - Oliver Hatley
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
| | - Suzanne Tay
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
| | - Karen Rowland-Yeo
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
| | - Masoud Jamei
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
| | - Amin Rostami-Hodjegan
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
| | - Jane R Kenny
- Simcyp (a Certara Company), Sheffield, United Kingdom (L.M.A., I.G., O.H., K.R.-Y., M.J., A.R.-H.); DMPK, Genentech Inc., South San Francisco, California (S.M., K.O., S.W., S.T., J.R.K.); and Manchester Pharmacy School, University of Manchester, United Kingdom (A.R.-H.)
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Wang X, Zhu HJ, Munoz J, Gurley BJ, Markowitz JS. An ex vivo approach to botanical-drug interactions: a proof of concept study. JOURNAL OF ETHNOPHARMACOLOGY 2015; 163:149-56. [PMID: 25623616 PMCID: PMC4355093 DOI: 10.1016/j.jep.2015.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/12/2015] [Accepted: 01/15/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Botanical medicines are frequently used in combination with therapeutic drugs, imposing a risk for harmful botanical-drug interactions (BDIs). Among the existing BDI evaluation methods, clinical studies are the most desirable, but due to their expense and protracted time-line for completion, conventional in vitro methodologies remain the most frequently used BDI assessment tools. However, many predictions generated from in vitro studies are inconsistent with clinical findings. Accordingly, the present study aimed to develop a novel ex vivo approach for BDI assessment and expand the safety evaluation methodology in applied ethnopharmacological research. MATERIALS AND METHODS This approach differs from conventional in vitro methods in that rather than botanical extracts or individual phytochemicals being prepared in artificial buffers, human plasma/serum collected from a limited number of subjects administered botanical supplements was utilized to assess BDIs. To validate the methodology, human plasma/serum samples collected from healthy subjects administered either milk thistle or goldenseal extracts were utilized in incubation studies to determine their potential inhibitory effects on CYP2C9 and CYP3A4/5, respectively. Silybin A and B, two principal milk thistle phytochemicals, and hydrastine and berberine, the purported active constituents in goldenseal, were evaluated in both phosphate buffer and human plasma based in vitro incubation systems. RESULTS Ex vivo study results were consistent with formal clinical study findings for the effect of milk thistle on the disposition of tolbutamide, a CYP2C9 substrate, and for goldenseal׳s influence on the pharmacokinetics of midazolam, a widely accepted CYP3A4/5 substrate. Compared to conventional in vitro BDI methodologies of assessment, the introduction of human plasma into the in vitro study model changed the observed inhibitory effect of silybin A, silybin B and hydrastine and berberine on CYP2C9 and CYP3A4/5, respectively, results which more closely mirrored those generated in clinical study. CONCLUSIONS Data from conventional buffer-based in vitro studies were less predictive than the ex vivo assessments. Thus, this novel ex vivo approach may be more effective at predicting clinically relevant BDIs than conventional in vitro methods.
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Affiliation(s)
- Xinwen Wang
- Department of Clinical, Social and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Hao-Jie Zhu
- Department of Clinical, Social and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Juliana Munoz
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, Florida, USA; Center for Pharmacogenomics, University of Florida, Gainesville, Florida, USA
| | - Bill J Gurley
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John S Markowitz
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, Florida, USA; Center for Pharmacogenomics, University of Florida, Gainesville, Florida, USA.
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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.
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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
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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.
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Affiliation(s)
- Kyoko Naramoto
- Nagaragawa Research Center, API Co., Ltd., 692-3 Nagara, Gifu 502-0071, Japan
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Abstract
The increasing use of herbal remedies by the general public presents several challenges to healthcare professionals who may be asked to give advice on the use of such products in conjunction with other medicines. In particular, the pharmacological properties and potential interactions of herbal products are often less well understood than those of conventional medicines, increasing the risk of adverse effects and drug interactions. In addition, good quality data on herbal medicines are often lacking. Here we highlight the problem of drug-herb interactions and consider the nature of the evidence supporting drug interactions with herbal products.
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Patil D, Gautam M, Gairola S, Jadhav S, Patwardhan B. Effect of Botanical Immunomodulators on Human CYP3A4 Inhibition. Integr Cancer Ther 2013; 13:167-75. [DOI: 10.1177/1534735413503551] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose. Many botanical immunomodulators are used as adjuvants along with cancer chemotherapy. However, information on the impact of concurrent administration of such botanicals on pharmacokinetics of chemotherapy agents is inadequate. This study investigates inhibitory activities of 3 popular botanical adjuvants: Asparagus racemosus (root aqueous extract; ARE), Withania somnifera (root aqueous extract; WSE), and Tinospora cordifolia (stem aqueous extract, TCE) on human CYP3A4 isoenzyme, responsible for metabolism of several chemotherapy agents. Experimental design. Testosterone 6-β hydroxylation was monitored using high-performance liquid chromatography as an indicator of CYP3A4 catalytic activities. Ketoconazole (positive control) and extracts were studied at their in vivo–relevant concentrations. Results. TCE showed mild inhibition while no significant inhibitory activities were observed in WSE and ARE. TCE was further fractionated to obtain polar and nonpolar fractions. The nonpolar fraction showed significant CYP3A4 inhibition with IC50 13.06 ± 1.38 µg/mL. Major constituents of nonpolar fraction were identified using HPLC-DAD-MS profiling as berberine, jatrorrhizine, and palmatine, which showed IC50 values as 6.25 ± 0.30, 15.18 ± 1.59, and 15.53 ± 1.89 µg/mL, respectively. Conclusion. Our findings suggest that constituents of TCE extract especially protoberberine alkaloids have the potential to interact with cancer chemotherapy agents that are metabolized by CYP3A4 in vivo.
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Affiliation(s)
- Dada Patil
- Serum Institute of India Research Foundation, Hadapsar, Pune, India
| | - Manish Gautam
- Serum Institute of India Research Foundation, Hadapsar, Pune, India
| | - Sunil Gairola
- Serum Institute of India Limited, Hadapsar, Pune, India
| | - Suresh Jadhav
- Serum Institute of India Limited, Hadapsar, Pune, India
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Einolf HJ, Chen L, Fahmi OA, Gibson CR, Obach RS, Shebley M, Silva J, Sinz MW, Unadkat JD, Zhang L, Zhao P. Evaluation of Various Static and Dynamic Modeling Methods to Predict Clinical CYP3A Induction Using In Vitro CYP3A4 mRNA Induction Data. Clin Pharmacol Ther 2013; 95:179-88. [DOI: 10.1038/clpt.2013.170] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/20/2013] [Indexed: 01/06/2023]
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Morisaki T, Hou XL, Takahashi K, Takahashi K. Baicalin pharmacokinetic profile of absorption process using novel in-vitro model: cytochrome P450 3A4-induced Caco-2 cell monolayers combined with rat intestinal rinse fluids. J Pharm Pharmacol 2013; 65:1526-35. [DOI: 10.1111/jphp.12127] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/04/2013] [Indexed: 12/23/2022]
Abstract
Abstract
Objectives
This study was designed to investigate baicalin (BG) pharmacokinetic profile in absorption process using a new model and evaluate the potentiality as a new model.
Methods
The effects of BG on intestinal cytochrome P450 3A4 (CYP3A) protein/mRNA expression, activity and permeability glycoprotein (P-gp) were evaluated in CYP3A4-induced Caco-2 cell monolayers or rats. Intestinal rinse fluids (IF) were obtained from rat were added to modified Caco-2 monolayers.
Key findings
Orally administered BG (7 days pretreatment) inhibited intestinal CYP3A activity and protein expression. Baicalein (B) converted from BG by IF was detected in the upper jejunum in a portion-dependent manner. Subsequently, most BG were converted to B in the caecum. In modified Caco-2 monolayers, BG exhibited no effect on CYP3A4 activity or mRNA, whereas B and BG treated with IF inhibited CYP3A4 transcription and activity.
Conclusions
Intestinal CYP3A was inhibited following oral administration of BG to rat. Correspondingly, BG-mediated CYP3A inhibition was shown in vitro using modified Caco-2 monolayers treated with IF. Hence, in-vivo intestinal absorption pharmacokinetic was reproduced in vitro. IF is a key determinant of intestinal absorption, and it facilitated inhibition of CYP3A by B, not BG.
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Affiliation(s)
- Tomoko Morisaki
- Department of Applied Pharmacognosy, Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan
| | - Xiao-Long Hou
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Mukogawa Women's University, Hyogo, Japan
| | - Kyoko Takahashi
- Basic Research Group for the Assembly and Preservation of Primary Materials, The Museum of Osaka University, Osaka, Japan
| | - Koichi Takahashi
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Mukogawa Women's University, Hyogo, Japan
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Model-based drug development: a rational approach to efficiently accelerate drug development. Clin Pharmacol Ther 2013; 93:502-14. [PMID: 23588322 DOI: 10.1038/clpt.2013.54] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The pharmaceutical industry continues to face significant challenges. Very few compounds that enter development reach the marketplace, and the investment required for each success can surpass $1.8 billion. Despite attempts to improve efficiency and increase productivity, total investment continues to rise whereas the output of new medicines declines. With costs increasing exponentially through each development phase, it is failure in phase II and phase III that is most wasteful. In today's development paradigm, late-stage failure is principally a result of insufficient efficacy. This is manifested as either a failure to differentiate sufficiently from placebo (shown for both novel and precedented mechanisms) or a failure to demonstrate sufficient differentiation from existing compounds. Set in this context, this article will discuss the role model-based drug development (MBDD) approaches can and do play in accelerating and optimizing compound development strategies through a series of illustrative examples.
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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.
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Affiliation(s)
- H-H Tsai
- School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan
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Chatuphonprasert W, Nemoto N, Sakuma T, Jarukamjorn K. Modulations of cytochrome P450 expression in diabetic mice by berberine. Chem Biol Interact 2012; 196:23-9. [PMID: 22342832 DOI: 10.1016/j.cbi.2012.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/19/2012] [Accepted: 01/22/2012] [Indexed: 02/06/2023]
Abstract
Berberine, an isoquinoline alkaloid isolated from medicinal plants such as Berberis aristata, Coptis chinesis, Coptis japonica, Coscinium fenestatun, and Hydrastis Canadensis, is widely used in Asian countries for the treatment of diabetes, hypertension, and hypercholesterolemia. Interaction between berberine and the cytochrome P450 enzymes (CYPs) has been extensively reported, but there are only a few reports of this interaction in the diabetic state. In this study, the effect of berberine on the mRNA of the CYPs in primary mouse hepatocytes and in streptozotocin (STZ)-induced diabetic mice was investigated. In primary mouse hepatocytes, berberine suppressed the induction of Cyp1a1, Cyp1a2, Cyp2e1, Cyp3a11, Cyp4a10, and Cyp4a14 mRNA expression by their prototypical inducers in a concentration-dependent fashion. However, berberine treatment alone increased the expression of Cyp2b9 and Cyp2b10 mRNA. In vivo, berberine showed the same hypoglycemic activity as metformin, an established hypoglycemic drug. The hepatic mRNA levels of Cyp1a1, Cyp2b9, Cyp2b10, Cyp3a11, Cyp4a10, and Cyp4a14 were increased in STZ-induced diabetic mice. Interestingly, berberine itself suppressed the expression of Cyp2e1, an adverse hepatic event-associated enzyme, while the expression of Cyp3a11, Cyp4a10, and Cyp4a14 were restored to normal levels by berberine. In conclusion, berberine has the potential to modify the expression of CYPs by either suppression or enhancement of CYPs' levels. Consumption of berberine as an anti-hyperglycemic compound by diabetic patients might provide an extra benefit due to its potential to restore the expression of Cyp2e1, Cyp3a, and Cyp4a to normal levels. However, an herb-drug interaction might be of concern since any berberine-containing product would definitely cause pronounced interactions based on CYP3A4 inhibition.
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Affiliation(s)
- Waranya Chatuphonprasert
- Research Group for Pharmaceutical Activities of Natural Products using Pharmaceutical Biotechnology (PANPB), Faculty of Pharmaceutical Sciences, National Research University - Khon Kaen University, Khon Kaen 40002, Thailand
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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.
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Affiliation(s)
- Angelo A Izzo
- Department of Experimental Pharmacology, Federico II University of Naples, Naples, Italy.
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