Summary
Herbal therapeutics are increasingly associated with herb drug interactions. The vast majority of the purported cases is unsubstantiated and misinterpreted. Pharmacological and clinical studies should only be demanded in cases of reliable evidence. First steps to be taken by manufacturers of herbal drugs should be in vitro studies with metabolizing systems like CYP and P-gp. Manufacturers of drugs that are metabolized by modulated systems should be requested to conduct drug specific interaction studies as necessary.
Zusammenfassung
Phytopharmaka werden in den letzten Jahren vermehrt mit Arzneimittelwechselwirkungen in Verbindung gebracht. Die Mehrzahl der Verdachtsmomente ist jedoch unbegründet und führt zu oft nicht nachvollziehbaren Schlussfolgerungen. Pharmakologische oder klinische Studien sollten nur dann gefordert werden, wenn tatsächlich belastbare Hinweise existieren. Die Hersteller von Phytopharmaka sollten in solchen Fällen Studien zur Beeinflussung metabolisierender Systeme wie CYP bzw. P-gp durchführen. Weiterführende Interaktionsstudien sind von den Herstellern der Arzneistoffe zu fordern, die über die beeinflussten Systeme verstoffwechselt werden.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Literatur
EMEA (2006) Guideline on non-clinical documentation for herbal medicinal products in applications for marketing authorisation (bibliographical and mixed applications) and in applications for simplified registration. URL: http://www.emea.europa.eu/pdfs/human/hmpc/3211605en.pdf (abgerufen: 12. Februar 2007)
Unger M, Frank A (2004) Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom 18: 2273–2281
Barone GW, Gurley BJ, Ketel BL, Lightfoot ML, Abul-Ezz SR (2000) Drug interaction between St. John's wort and cyclosporine. Ann Pharmacother 34: 1013–1016
Mai I, Kruger H, Budde K, Johne A, Brockmoller J, Neumayer HH, Roots I (2000) Hazardous pharmacokinetic interaction of Saint John's wort (Hypericum perforatum) with the immunosuppressant cyclosporin. Int J Clin Pharmacol Ther 38: 500–502
Butterweck V, Derendorf H, Gaus W, Nahrstedt A, Schulz V, Unger M (2004) Pharmacokinetic herb-drug interactions: are preventive screenings necessary and appropriate? Planta Med 70: 784–791
Hu Z, Yang X, Ho PC, Chan SY, Heng PW, Chan E, Duan W, Koh HL, Zhou S (2005) Herb-drug interactions: a literature review. Drugs 65: 1239–1282
Rajah SM, Penny AF, Crow MJ, Pepper MD, Watson DA (1979) The interaction of varying doses of dipyridamole and acetyl salicylic acid on the inhibition of platelet functions and their effect on bleeding time. Br J Clin Pharmacol 8: 483–489
Dannawi M (2002) Possible serotonin syndrome after combination of buspirone and St John's Wort. J Psychopharmacol 16: 401–401
Lantz MS, Buchalter E, Giambanco V (1999) St. John's Wort and Antidepressant Drug Interactions in the Elderly. J Geriatr Psychiatry Neurol 12: 7–10
Nieuwstraten C, Labiris NR, Holbrook A (2006) Systematic overview of drug interactions with antidepressant medications. Can J Psychiatry 51: 300–316
Indiana University School of Medicine (2006) Drug Interactions, Cytochrome P450 System. URL: http://medicine.iupui.edu/flockhart/table.htm (Stand: 17.10.2006) (abgerufen: 12. Februar 2007)
Greiner B, Eichelbaum M, Fritz P, Kreichgauer HP, von Richter O, Zundler J, Kroemer HK (1999) The role of intestinal P-glycoprotein in the interaction of digoxin and rifampin. J Clin Invest 104: 147–153
Endres CJ, Hsiao P, Chung FS, Unadkat JD (2006) The role of transporters in drug interactions. Eur J Pharm Sci 27: 501–517
Venkatakrishnan K, Von Moltke LL, Greenblatt DJ (2001) Human drug metabolism and the cytochromes P450: application and relevance of in vitro models. J Clin Pharmacol 41: 1149–1179
Kuhlmann J (2004) Clinical-pharmacological aspects to accelerate the development process from the preclinical to the clinical phase/2nd communication: promising strategies. Arzneimittelforschung 54: 307–313
EMEA (2001) Note for guidance on the investigation of bioavailability and bioequivalence. URL: http://www.emea.europa.eu/pdfs/human/ewp/140198en.pdf(abgerufen: 12. Februar 2007)
Strandell J, Neil A, Carlin G (2004) An approach to the in vitro evaluation of potential for cytochrome P450 enzyme inhibition from herbals and other natural remedies. Phytomedicine 11: 98–104
BfArM (2005) Bekanntmachung über die Registrierung, Zulassung und Nachzulassung von Arzneimitteln, Abwehr von Gefahren durch Arzneimittel, Stufe II, hier: Johanniskraut (Hypericum)-haltige Humanarzneimittel zur innerlichen Anwendung vom 10. Oktober 2005. BAnz Nr. 208: 15729–15731
Yang XX, Hu ZP, Duan W, Zhu YZ, Zhou SF (2006) Drug-herb interactions: eliminating toxicity with hard drug design. Curr Pharm Des 12: 4649–4664
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Freudenstein, J., Nißlein, T. Wechselwirkungen mit Phytopharmaka. Wien Med Wochenschr 157, 352–355 (2007). https://doi.org/10.1007/s10354-007-0438-2
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10354-007-0438-2