1
|
HDI Highlighter, The First Intelligent Tool to Screen the Literature on Herb-Drug Interactions. Clin Pharmacokinet 2022; 61:761-788. [PMID: 35637377 DOI: 10.1007/s40262-022-01131-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/03/2022]
Abstract
Herbal food supplements are commonly used and can be an important part of patient self-care. Like all other bio-active and therapeutic products, they have a benefit/risk balance. These products are not without adverse effects and potentially interact with other therapies. Educating patients and providing information for health professionals about the risk of herb-drug interactions is key. One of the purposes of the biomedical literature is to inform prescribers. Scientific literature accessible on databases such as PubMed is dense and careful reading is time consuming. We propose a reading aid tool named "HDI highlighter" to help readers to find key information in clinical studies and case reports describing herb-drug interactions. It uses natural language processing algorithms (artificial intelligence) with a pharmaceutical focus. Semantic relation extraction for herb-drug interactions from the biomedical literature are overexpressed using keywords. We have tested it to review 120 published articles over the last 10 years. In these articles, we have shown that case reports often involved long-term or semi-long-term treatments such as cancer or human immunodeficiency virus therapies, antiepileptic drugs, or central nervous system drugs. Similarly, these classes of drugs are more extensively targeted by clinical studies. Herb-drug interactions described in case reports are identified in medicinal, recreational, and alimentary uses. They also usually lack a rigorous description of the herb(s) involved. Typically, clinical studies provide a complete description of protocols and dosages, with a few exceptions explained by patients' needs. Clinical studies on herbs are nevertheless conducted on a limited number of patients. All these limitations make the interpretation of herb-drug interactions complicated, but the HDI highlighter provides a quick overview of the herb-drug interaction literature.
Collapse
|
2
|
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.
Collapse
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;
| |
Collapse
|
3
|
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).
Collapse
|
4
|
Chrubasik-Hausmann S, Vlachojannis J, McLachlan AJ. Understanding drug interactions with St John's wort (Hypericum perforatum L.): impact of hyperforin content. J Pharm Pharmacol 2018; 71:129-138. [DOI: 10.1111/jphp.12858] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 10/24/2017] [Indexed: 02/03/2023]
Abstract
Abstract
Objective
The aim of this study was to review herb–drug interaction studies with St John's wort (Hypericum perforatum L.) with a focus on the hyperforin content of the extracts used in these studies.
Methods
PUBMED was systematically searched to identify studies describing pharmacokinetic interactions involving St John's wort. Data on study design and the St John's wort extract or product were gathered to extract hyperforin content and daily dose used in interaction studies.
Key findings
This analysis demonstrates that significant herb–drug interactions (resulting in a substantial change in systemic exposure) with St John's wort products were associated with hyperforin daily dosage. Products that had a daily dose of <1 mg hyperforin were less likely to be associated with major interaction for drugs that were CYP3A4 or p-glycoprotein substrates. Although a risk of interactions cannot be excluded even for low-dose hyperforin St. John's wort extracts, the use of products that result in a dose of not more than 1 mg hyperforin per day is recommended to minimise the risk of interactions.
Conclusions
This review highlights that the significance of herb–drug interactions with St John's wort is influenced by the nature of the herbal medicines product, particularly the hyperforin content.
Collapse
Affiliation(s)
| | - Julia Vlachojannis
- Institute of Forensic Medicine, University of Freiburg, Freiburg, Germany
| | - Andrew J McLachlan
- Centre for Education and Research on Ageing, Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| |
Collapse
|
5
|
Gupta RC, Chang D, Nammi S, Bensoussan A, Bilinski K, Roufogalis BD. Interactions between antidiabetic drugs and herbs: an overview of mechanisms of action and clinical implications. Diabetol Metab Syndr 2017; 9:59. [PMID: 28770011 PMCID: PMC5527439 DOI: 10.1186/s13098-017-0254-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/12/2017] [Indexed: 12/26/2022] Open
Abstract
Diabetes is a complex condition with a variety of causes and pathophysiologies. The current single target approach has not provided ideal clinical outcomes for the treatment of the disease and its complications. Herbal medicine has been used for the management of various diseases such as diabetes over centuries. Many diabetic patients are known to use herbal medicines with antidiabetic properties in addition to their mainstream treatments, which may present both a benefit as well as potential risk to effective management of their disease. In this review we evaluate the clinical and experimental literature on herb-drug interactions in the treatment of diabetes. Pharmacokinetic and pharmacodynamic interactions between drugs and herbs are discussed, and some commonly used herbs which can interact with antidiabetic drugs summarised. Herb-drug interactions can be a double-edged sword presenting both risks (adverse drug events) and benefits (through enhancement). There is a general lack of data on herb-drug interactions. As such, more rigorous scientific research is urgently needed to guide clinical practice as well as to safeguard the wellbeing of diabetes patients.
Collapse
Affiliation(s)
- Ramesh C. Gupta
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
- Department of Agricultural Chemistry and Soil Science, School of Agricultural Sciences and Rural Development, Nagaland University, Medziphema, 797 106 India
| | - Dennis Chang
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
| | - Srinivas Nammi
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
| | - Alan Bensoussan
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
| | - Kellie Bilinski
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
| | - Basil D. Roufogalis
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
- Discipline of Pharmacology, School of Medical Sciences, Sydney Medical School, The University of Sydney, Sydney, NSW 2006 Australia
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Backman JT, Filppula AM, Niemi M, Neuvonen PJ. Role of Cytochrome P450 2C8 in Drug Metabolism and Interactions. Pharmacol Rev 2016; 68:168-241. [PMID: 26721703 DOI: 10.1124/pr.115.011411] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
During the last 10-15 years, cytochrome P450 (CYP) 2C8 has emerged as an important drug-metabolizing enzyme. CYP2C8 is highly expressed in human liver and is known to metabolize more than 100 drugs. CYP2C8 substrate drugs include amodiaquine, cerivastatin, dasabuvir, enzalutamide, imatinib, loperamide, montelukast, paclitaxel, pioglitazone, repaglinide, and rosiglitazone, and the number is increasing. Similarly, many drugs have been identified as CYP2C8 inhibitors or inducers. In vivo, already a small dose of gemfibrozil, i.e., 10% of its therapeutic dose, is a strong, irreversible inhibitor of CYP2C8. Interestingly, recent findings indicate that the acyl-β-glucuronides of gemfibrozil and clopidogrel cause metabolism-dependent inactivation of CYP2C8, leading to a strong potential for drug interactions. Also several other glucuronide metabolites interact with CYP2C8 as substrates or inhibitors, suggesting that an interplay between CYP2C8 and glucuronides is common. Lack of fully selective and safe probe substrates, inhibitors, and inducers challenges execution and interpretation of drug-drug interaction studies in humans. Apart from drug-drug interactions, some CYP2C8 genetic variants are associated with altered CYP2C8 activity and exhibit significant interethnic frequency differences. Herein, we review the current knowledge on substrates, inhibitors, inducers, and pharmacogenetics of CYP2C8, as well as its role in clinically relevant drug interactions. In addition, implications for selection of CYP2C8 marker and perpetrator drugs to investigate CYP2C8-mediated drug metabolism and interactions in preclinical and clinical studies are discussed.
Collapse
Affiliation(s)
- Janne T Backman
- Department of Clinical Pharmacology, University of Helsinki (J.T.B., A.M.F., M.N., P.J.N.), and Helsinki University Hospital, Helsinki, Finland (J.T.B., M.N., P.J.N.)
| | - Anne M Filppula
- Department of Clinical Pharmacology, University of Helsinki (J.T.B., A.M.F., M.N., P.J.N.), and Helsinki University Hospital, Helsinki, Finland (J.T.B., M.N., P.J.N.)
| | - Mikko Niemi
- Department of Clinical Pharmacology, University of Helsinki (J.T.B., A.M.F., M.N., P.J.N.), and Helsinki University Hospital, Helsinki, Finland (J.T.B., M.N., P.J.N.)
| | - Pertti J Neuvonen
- Department of Clinical Pharmacology, University of Helsinki (J.T.B., A.M.F., M.N., P.J.N.), and Helsinki University Hospital, Helsinki, Finland (J.T.B., M.N., P.J.N.)
| |
Collapse
|
8
|
Choi JG, Eom SM, Kim J, Kim SH, Huh E, Kim H, Lee Y, Lee H, Oh MS. A Comprehensive Review of Recent Studies on Herb-Drug Interaction: A Focus on Pharmacodynamic Interaction. J Altern Complement Med 2016; 22:262-79. [PMID: 27003511 DOI: 10.1089/acm.2015.0235] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The concomitant use of herbal and conventional drugs accelerates the possibility of clinically significant herb-drug interactions (HDIs). This paper aims to analyze the current status of HDI studies worldwide and to review studies on HDI-induced pharmacodynamic (PD) interactions. METHODS HDI studies published from 2000 to 2014 and indexed in PubMed were categorized according to publication year, area/country, study methods and objectives, and disease categories. The reviewed studies focused on HDI-induced PD; each PD interaction with concurrent use of approximately 100 herbal drugs and 70 conventional drugs was summarized. All PD-related articles were categorized according to four characteristics: herbal drugs, conventional drugs, types of PD interaction, and type of study. Among them, 17 well-designed clinical studies were evaluated by using the Jadad Quality Assessment Scale. RESULTS The number of HDI reports has gradually increased since 2000, with a primary focus on neoplasms and diseases of the circulatory system. Most of these investigated pharmacokinetic reactions, such as cytochrome P450 enzyme metabolism, with fewer reports investigating PD. Most PD interaction studies investigated warfarin, ginkgo leaves, and St. John's wort. An evaluation of 17 studies revealed a generally positive view of PD effects involving synergism or reduced toxicity and a high average quality score (>3 points on a 0-5 scale). CONCLUSIONS These results demonstrate that most HDI studies so far have examined PK interactions and have been limited to very few conventional drugs and herbal drugs. This suggests that more studies focusing on PD are necessary to understand interactions between commonly used herbal and conventional drugs.
Collapse
Affiliation(s)
- Jin Gyu Choi
- 1 Department of Life and Nanopharmaceutical Sciences, Graduate School, Kyung Hee University , Seoul, Korea
| | - Sang Min Eom
- 2 Department of Pharmacy, College of Pharmacy, Kyung Hee University , Seoul, Korea
| | - Jaeyoung Kim
- 2 Department of Pharmacy, College of Pharmacy, Kyung Hee University , Seoul, Korea
| | - Soon Han Kim
- 2 Department of Pharmacy, College of Pharmacy, Kyung Hee University , Seoul, Korea
| | - Eugene Huh
- 3 Department of Herbal Pharmacology, College of Korean Medicine, Kyung Hee University , Seoul, Korea
| | - Hocheol Kim
- 3 Department of Herbal Pharmacology, College of Korean Medicine, Kyung Hee University , Seoul, Korea
| | - Yunwoo Lee
- 4 College of Medicine, Hallym University , Chuncheon, Korea
| | - Hyangsook Lee
- 5 Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University , Seoul, Korea
| | - Myung Sook Oh
- 1 Department of Life and Nanopharmaceutical Sciences, Graduate School, Kyung Hee University , Seoul, Korea.,6 Department of Oriental Pharmaceutical Science, College of Pharmacy and Kyung Hee East-West Pharmaceutical Research Institute, Kyung Hee University , Seoul, Korea
| |
Collapse
|
9
|
Pharmacogenomics and herb-drug interactions: merge of future and tradition. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:321091. [PMID: 25821484 PMCID: PMC4363646 DOI: 10.1155/2015/321091] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 12/16/2022]
Abstract
The worldwide using of herb products and the increasing potential herb-drug interaction issue has raised enthusiasm on discovering the underlying mechanisms. Previous review indicated that the interactions may be mediated by metabolism enzymes and transporters in pharmacokinetic pathways. On the other hand, an increasing number of studies found that genetic variations showed some influence on herb-drug interaction effects whereas these genetic factors did not draw much attention in history. We highlight that pharmacogenomics may involve the pharmacokinetic or pharmacodynamic pathways to affect herb-drug interaction. We are here to make an updated review focused on some common herb-drug interactions in association with genetic variations, with the aim to help safe use of herbal medicines in different individuals in the clinic.
Collapse
|
10
|
Interactions between herbs and antidiabetics: an overview of the mechanisms, evidence, importance, and management. Arch Pharm Res 2014; 38:1281-98. [PMID: 25475096 DOI: 10.1007/s12272-014-0517-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 11/10/2014] [Indexed: 02/08/2023]
Abstract
Complementary and alternative therapies are quickly gaining importance because they are perceived to be free of side effects due to their natural origin. However, herbal remedies are complex mixtures of bioactive entities, which may interact with prescription drugs through pharmacokinetic or pharmacodynamic mechanisms and sometimes result in life-threatening consequences. In particular, diabetes patients are often treated with multiple medications due to different comorbidities, and such patients use antidiabetic medications for their entire lives; thus, it is important to make the public aware of herb interactions with antidiabetic drugs. In this paper, we summarize the reports available on the interaction of herbal remedies with oral hypoglycemic agents and describe mechanisms, preclinical or clinical evidence, importance, and management strategies.
Collapse
|
11
|
Hu M, Fan L, Zhou HH, Tomlinson B. Theranostics meets traditional Chinese medicine: rational prediction of drug–herb interactions. Expert Rev Mol Diagn 2014; 12:815-30. [DOI: 10.1586/erm.12.126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|