Skip to main content
SpringerLink
Log in

Summertime and the Herbals are Hot

Fatal Forty DDI: goldenseal, amitriptyline, CYP2D6, CYP3A4

  • Chapter
A Case Approach to Perioperative Drug-Drug Interactions

  • 83 Accesses

Abstract

This case discusses the pharmacokinetic interaction between amitriptyline and goldenseal, leading to tricyclic antidepressant toxicity. Amitriptyline is a cytochrome P450 3A4 and cytochrome P450 2D6 substrate and goldenseal is a 3A4 and 2D6 inhibitor.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effect of goldenseal, kava kava black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4 phenotypes. Clin Pharmacol Ther. 2005;77(5):415–26.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  2. Gurley BJ, Swain A, Hubbard MA, et al. Clinical assessment of CYP2D6-mediated herb-drug interactions in humans: effects of milk thistle, black cohosh, goldenseal, kava kava, St. John’s wort, and Echinacea. Mol Nutr Food Res. 2008;52(7):755–63.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  3. Venkatakrishnan K, Greenblatt DJ, von Moltke LL, et al. Five distinct human cytochromes mediate amitriptyline N-demethylation in vitro: dominance of CYP 2C19 and 3A4. J Clin Pharmacol. 1998;38(2):112–21.

    Article  PubMed  CAS  Google Scholar 

  4. Herbs at a glance: Goldenseal. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/goldenseal. Accessed 21 Sept 2009.

  5. Toxicity, Tricyclic Antidepressant. MedScape Reference: Drugs, Diseases & Procedures. http://emedicine.medscape.com/article/1010089-overview. Last accessed 24 Sept 2009.

Download references

Author information

Authors and Affiliations

  1. Oregon Anesthesiology Group, Providence St. Vincent’s Hospital, Portland, OR, USA

    Jessica Miller MD, BM

  2. Oregon Anesthesiology Group, Portland, OR, USA

    Leelee Thames MD

Authors
  1. Jessica Miller MD, BM
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leelee Thames MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica Miller MD, BM .

Editor information

Editors and Affiliations

  1. Anesthesia Services Department, Philadelphia Veterans Affairs Med Center, Philadelphia, PA, USA

    Catherine Marcucci MD

  2. Department of Anesthesiology, Oregon Health and Science University, Portland, OR, USA

    Michael P. Hutchens MD

  3. Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA

    Erica D. Wittwer MD, PhD , Toby N. Weingarten MD , Juraj Sprung MD, PhD  & Wayne T. Nicholson MD, PharmD, MSc , ,  & 

  4. Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA

    Kirk Lalwani MD

  5. Department of Anesthesiology, University of Pittsburgh School of Med Liliane S. Kaufmann Building, Pittsburgh, PA, USA

    David G. Metro MD

  6. Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA

    Randal O. Dull MD, PhD

  7. Department of Anesthesiology, Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA

    Christopher E. Swide MD

  8. Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA

    F. Jacob Seagull PhD

  9. Department of Anesthesiology and Perioperative Medicine, Portland, OR, USA

    Jeffrey R. Kirsch MD (Professor and Chair) (Professor and Chair)

  10. Department of Psychiatry, University of Maryland Medical System VA Maryland Health Care System, Baltimore, MD, USA

    Neil B. Sandson MD

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Miller, J., Thames, L. (2015). Summertime and the Herbals are Hot. In: Marcucci, C., et al. A Case Approach to Perioperative Drug-Drug Interactions. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7495-1_214

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-7495-1_214

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7494-4

  • Online ISBN: 978-1-4614-7495-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation