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Herb-drug interactions: a novel algorithm-assisted information system for pharmacokinetic drug interactions with herbal supplements in cancer treatment

  • Pharmacokinetics and Disposition
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To develop a system to estimate the risk of herb-drug interactions that includes the available evidence from clinical and laboratory studies, transparently delineates the algorithm for the risk estimation, could be used in practice settings and allows for adaptation and update.

Methods

We systematically searched Drugbank, Transformer, Drug Information Handbook, European and German Pharmacopoeia and MEDLINE for studies on herb-drug interactions of five common medicinal plants (coneflower, ginseng, milk thistle, mistletoe and St. John’s wort). A diverse set of data were independently extracted by two researchers and subsequently analysed by a newly developed algorithm. Results are displayed in the form of interaction risk categories. The development of the algorithm was guided by an expert panel consensus process.

Results

From 882 publications retrieved by the search, 154 studies were eligible and provided 529 data sets on herbal interactions. The developed algorithm prioritises results from clinical trials over case reports over in vitro investigations and considers type of study, consistency of study results and study outcome for clinical trials as well as identification, permeability, bioavailability, and interaction potency of an identified herbal perpetrator for in vitro investigations. Risk categories were assigned to and dynamically visualised in a colour-coded matrix format.

Conclusions

The novel algorithm allows to transparently generate and dynamically display herb-drug interaction risks based on the available evidence from clinical and laboratory pharmacologic studies. It provides health professionals with readily available and easy updatable information about the risk of pharmacokinetic interactions between herbs and oncologic drugs.

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Abbreviations

CAM:

Complementary and alternative medicine

CYP:

Cytochrome P450

UGT:

Uridine-diphosphate glucuronosyl transferase

Pgp:

Permeability-glycoprotein

MDR:

Multidrug resistance

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Acknowledgements

This work is part of the collaborative research project ‘Competence Network of Complementary Medicine in Oncology’ (Kompetenznetz Komplementärmedizin in der Onkologie - KOKON), which was funded by the Stiftung Deutsche Krebshilfe, Bonn, Germany (Project No. 110150). The authors also thank the following experts for helpful discussions while developing the algorithm and matrix: Joachim Boos, Thomas Efferth, Robert Herrmann, Wolfgang Kämmerer, Ulrich Klotz, Ulrike Lindequist, Klaus Mross, Friedemann Nauck, Friederich Overkamp and Oliver von Richter. In addition, we acknowledge the participation of the following pharmacy students in the independent data extraction and grading process: Kathleen Gewiese, Sophie Müller, Franziska Splettstößer and Anne Stolzenburg. Peter Kößler and Jan Less are acknowledged for their contributions in developing the database and programming the algorithm. Finally, Laura Russell edited the manuscript for English language.

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Author notes

  1. Janine Ziemann and Annette Lendeckel contributed equally to this work.

Authors and Affiliations

  1. Department of Clinical Pharmacy, Institute of Pharmacy, Ernst-Moritz-Arndt-University of Greifswald, Greifswald, Germany

    Janine Ziemann, Annette Lendeckel, Susann Müller & Christoph A. Ritter

  2. Department of Internal Medicine, Division of Oncology/Hematology and Pneumology, Paracelsus Medical University, Klinikum Nuernberg, Nuernberg, Germany

    Markus Horneber

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Contributions

AL and JZ searched the literature, extracted and assessed study data, developed the algorithm and participated in writing the manuscript. SM assessed study data and participated in writing the manuscript. MH participated in designing the research, developing the algorithm and writing the manuscript. CAR designed research, participated in developing the algorithm and wrote the manuscript.

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Correspondence to Christoph A. Ritter.

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Ziemann, J., Lendeckel, A., Müller, S. et al. Herb-drug interactions: a novel algorithm-assisted information system for pharmacokinetic drug interactions with herbal supplements in cancer treatment. Eur J Clin Pharmacol 75, 1237–1248 (2019). https://doi.org/10.1007/s00228-019-02700-6

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