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Interactions Between Herbs and Antiinfective Medications

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Drug Interactions in Infectious Diseases

Part of the book series: Infectious Disease ((ID))

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Abstract

Over 15 million people in the United States report using complementary and alternative medications (CAM). Patients with HIV infection represent an important segment of this population. Because of their ability to modulate a variety of cytochrome P450 (CYP) enzymes and drug transport proteins such as P-glycoprotein (P-gp), a number of herbs have been shown to interact with coadministered medications. Unfortunately, in vitro microsomal studies often fail to predict results obtained in humans. The herb associated with the greatest number of drug interactions in humans is St. John’s wort (Hypericum perforatum). As a potent inducer of CYP and P-gp, St. John’s wort has been shown to reduce the plasma concentrations of certain coadministered medications by >50%. Other herbs have been shown to induce the metabolism of coadministered medications as well. However, the magnitude of these interactions is markedly less than that produced by St. John’s wort. Nonetheless, even mild herb-drug interactions may be clinically relevant for coadministered medications with narrow therapeutic indices. To this end, the need for rigorous studies to identify potentially significant herb-drug interactions continues. Clinicians caring for patients taking CAM therapy should maintain a high degree of suspicion for herb-drug interactions in the face of unexplained toxicity or loss of efficacy, and be familiar with resources that can help manage or avoid herb-drug interactions.

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References

  1. Eisenberg DM, Davis RB, Ettner SL et al. Trends in alternative medicine use in the United States, 1990–1997. JAMA 1998;280:1569–75.

    Article  PubMed  CAS  Google Scholar 

  2. Tachjian A, Maria V, Jahangir A, Use of herbal products and potential interactions in patients with cardiovascular diseases. J Am Coll Cardiol 2010;55:515–25.

    Article  PubMed  Google Scholar 

  3. Jordan SA, Cunningham DG, Marles RJ. Assessment of herbal medicinal products: challenges, and opportunities to increase the knowledge base for safety assessment. Toxicol Appl Pharmacol 2010;243:198–216.

    Article  PubMed  CAS  Google Scholar 

  4. Dietary Supplement Health and Education Act 1994, Pub. L. 103–417, Sec,1(a), 108 Stat. 4325 (Oct. 25, 1994).

    Google Scholar 

  5. http://www.usp.org/USPVerified/dietarySupplements/ (accessed June 10, 2010).

  6. Bent S, Ko R. Commonly used herbal medicines in the United States. Am J Med 2004;116:478–85.

    Article  PubMed  Google Scholar 

  7. Dreikorn K. Complementary and alternative medicine in urology. BJU Int 2005;96:1177–84.

    Article  PubMed  CAS  Google Scholar 

  8. Wu T, Yang X, Zeng X, Poole P. Traditional Chinese medicine in the treatment of acute respiratory tract infections. Respir Med 2008;102:1093–8.

    Article  PubMed  Google Scholar 

  9. Stickel F, Schuppan D. Herbal medicine in the treatment of liver diseases. Dig Liver Dis 2007;39:293–304.

    Article  PubMed  CAS  Google Scholar 

  10. Chichon PG. Herbs and the common cold. Adv Nurse Pract 2000;8:31–2.

    PubMed  CAS  Google Scholar 

  11. Littlewood RA, Vanable PA. Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care. AIDS Care 2008;20:1002–1018.

    Article  PubMed  Google Scholar 

  12. Fairfield KM, Eisenberg DM, Davis RB, Libman H, Phillips RS. Patterns of use, expenditures, and perceived efficacy of complementary and alternative therapies in HIV-infected patients. Arch Intern Med 1998;158:2257–2264.

    Article  PubMed  CAS  Google Scholar 

  13. Hsiao AF, Wong MD, Kanouse DE et al. Complementary and alternative medicine use and substitution for conventional therapy by HIV-infected patients. J Acquir Immune Defic Syndr 2003;33:157–65.

    Article  PubMed  Google Scholar 

  14. Cherniak EP, Senzal RS, Pan CX. Correlates of use of alternative medicine by the elderly in an urban population. J Altern Complement Med 2001;7:277–80.

    Article  Google Scholar 

  15. Tanaka E, Hisawa S. Clinically significant pharmacokinetic drug interactions with psychoactive drugs: antidepressants and antipsychotics and the cytochrome P450 system. J Clin Pharmacy Ther 1999;24:7–16.

    Article  CAS  Google Scholar 

  16. Indiana University School of Medicine. Cytochrome P450 Drug Interaction Table. Available at: http://medicine.iupui.edu/clinpharm/ddis/table.asp (accessed June 10, 2010).

  17. Marchetti S, Mazzanti R, Beijnen JH, Schellens JH. Concise review: Clinical relevance of drug drug and herb drug interactions mediated by the ABC transporter ABCB1 (MDR1, P-glycoprotein). Oncologist 2007;12:927–41.

    Article  PubMed  Google Scholar 

  18. Garrovo C, Rosati A, Bartoli F, Decorti G. St John’s wort modulation and developmental expression of multidrug transporters in the rat. Phytother Res 2006;20:468–73.

    Article  PubMed  Google Scholar 

  19. Harris RZ, Jang GR, Tsunoda S. Dietary effects on drug metabolism and transport. Clin Pharmacokinet 2003;42:1071–88.

    Article  PubMed  CAS  Google Scholar 

  20. Gurley BJ, Gardner SF, Hubbard MA et al. Cytochrome P450 phenotypic ratios for predicting herb-drug interactions in humans. Clin Pharmacol Ther 2002;72:276–87.

    Article  PubMed  CAS  Google Scholar 

  21. Gurley BJ, Swain A, Williams DK, Barone G, Battu SK. Gauging the clinical significance of P-glycoprotein-mediated herb-drug interactions: comparative effects of St. John’s wort, Echinacea, clarithromycin, and rifampin on digoxin pharmacokinetics. Mol Nutr Food Res 2008;52:772–79.

    Article  PubMed  CAS  Google Scholar 

  22. Wang LS, Zhou G, Zhu B. St John’s wort induces both cytochrome P450 3A4-catalyzed sulfoxidation and 2C19-dependent hydroxylation of omeprazole. Clin Pharmacol Ther 2004;75:191–7.

    Article  PubMed  CAS  Google Scholar 

  23. Jiang X, Williams KM, Liauw WS et al. Effect of St. John’s wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol 2004;57:592–599.

    Article  PubMed  CAS  Google Scholar 

  24. Xu H, Liauw KM, Murray M, Day RO, McLachlan AJ. Effects of St. John’s wort and CYP2C9 genotype on the pharmacokinetics and pharmacodynamics of gliclazide. Br J Pharmacol 2008;153:1579–86.

    Article  PubMed  CAS  Google Scholar 

  25. Hafner V, Jäger M, Matthée A-K et al. Effect of simultaneous induction and inhibition of CYP3A by St. John’s wort and ritonavir an CYP3A activity. Clin Pharmacol Ther 2010;87:191–196.

    Article  PubMed  CAS  Google Scholar 

  26. Markowitz JS, Devane CL, Chavin KD, Taylor RM, Ruan Y, Donovan JL. Effects of garlic (Allium sativum L.) supplementation on cytochrome P450 2D6 and 3A4 activity in healthy volunteers. Clin Pharmacol Ther 2003;74:170–7.

    Article  PubMed  CAS  Google Scholar 

  27. Gurley BJ, Gardner SF, Hubbard MA. In vivo assessment of botanical supplementation on human cytochrome P450 phenotypes: Citrus aurantium, Echinacea purpurea, milk thistle, and saw palmetto. Clin Pharmacol Ther 2004;76:428–40.

    Article  PubMed  Google Scholar 

  28. Gurley BJ, Barone GW, Williams DK. Effect of milk thistle (Silybum marianum) and black cohosh (Cimicifuga racemosa) supplementation on digoxin pharmacokinetics in humans. Drug Metab Dispos 2006;34:69–74.

    Article  PubMed  CAS  Google Scholar 

  29. Robertson SM, Davey RT, Voell J, Formentini E, Alfaro RM, Penzak SR. Effect of Ginkgo biloba extract on lopinavir, midazolam, and fexofenadine pharmacokinetics in healthy subjects. Curr Med Res Opin 2008;24:591–99.

    Article  PubMed  CAS  Google Scholar 

  30. Jiang X, Williams KM, Liauw WS et al. Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol 2005;59:425–32.

    Article  PubMed  CAS  Google Scholar 

  31. Mahutsky MA, Anderson GD, Miller JW, Elmer GW. Ginkgo biloba: evaluation of CYP2C9 drug interactions in vitro and in vivo. Am J Ther 2006;13:24–31.

    Article  Google Scholar 

  32. Yin OQP, Tomlinson B, Waye MMY, Chow AHL, Chow MSS. Pharmacogenetics and herb-drug interactions: experience with Ginkgo biloba and omeprazole. Pharmacogenetics 2004;14:841–850.

    Article  PubMed  Google Scholar 

  33. Yasui-Furukori N, Furukori H, Kaneda A, Kaneko S, Tateishi T. The effects of Ginkgo biloba extracts on the pharmacokinetics and pharmacodynamics of donepezil. J Clin Pharmacol 2004;44:538–42.

    Article  PubMed  CAS  Google Scholar 

  34. Penzak SR, Robertson SM, Hunt JD et al. Echinacea Purpurea significantly induces cytochrome P450 3A (CYP3A) but does not alter lopinavir-ritonavir exposure in healthy subjects. Pharmacotherapy (in press).

    Google Scholar 

  35. Gorski JC, Huang SM, Pinto A et al. The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo. Clin Pharmacol Ther 2004;75:89–100.

    Article  PubMed  Google Scholar 

  36. Freeman C, Spelman K. A critical evaluation of drug interactions with Echinacea spp. Mol Nutr Food Res 2008;52:789–98.

    Article  PubMed  CAS  Google Scholar 

  37. Jiang X, Blair EY, McLachlan AJ. Investigation of the effects of herbal medicines on warfarin response in healthy subjects: a population pharmacokinetic-pharmacodynamic modeling approach. J Clin Pharmacol 2006;46:1370–8.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  39. Sandhu RS, Prescilla RP, Simonelli TM, Edwards DJ. Influence of goldenseal root on the pharmacokinetics of indinavir. J Clin Pharmacol 2003;43:1283–8.

    Article  PubMed  CAS  Google Scholar 

  40. Gurley BJ, Swain A, Barone GW et al. Effect of goldenseal (Hydrastis canadensis) and kava kava (Piper methysticum) supplementation on digoxin pharmacokinetics in humans. Drug Metab Dispos 2007;35:240–5.

    Article  PubMed  CAS  Google Scholar 

  41. Donovan JL, DeVane CL, Chavin KD et al. Multiple night-time doses of valerian (Valeriana officinalis) had minimal effects on CYP3A4 activity and no effect on CYP2D6 activity in healthy volunteers. Drug Metab Dispos 2004;32:1333–1336.

    Article  PubMed  CAS  Google Scholar 

  42. Dong SX, Ping ZZ, Xiao WZ et al. Possible enhancement of the first-pass metabolism of phenacetin by ingestion of grape juice in Chinese subjects. Br J Clin Pharmacol 1999;48:638–40.

    Article  CAS  Google Scholar 

  43. Donovan JL, Chavin KD, Devane CL et al. Green tea (Camellia sinensis) extract does not alter cytochrome p450 3A4 or 2D6 activity in healthy volunteers. Drug Metab Dispos 2004;32:906–8.

    Article  PubMed  CAS  Google Scholar 

  44. Tankanow R, Tamer HR, Streetman DS et al. Interaction study between digoxin and a preparation of hawthorn (Crataegus Oxyacantha). J Clin Pharmacol 2003;43:637–42.

    PubMed  CAS  Google Scholar 

  45. Markowitz JS, Donovan JL, Devane CL et al. Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers. Clin Pharmacol Ther 2003;74:536–42.

    Article  PubMed  CAS  Google Scholar 

  46. Wang G, Xiao CQ, Li Z et al. Effect of soy extract administration on losartan pharmacokinetics in healthy female volunteers. Ann Pharmacother 2009;43:1045–9.

    Article  PubMed  CAS  Google Scholar 

  47. Anderson GD, Rosito G, Mohustsy MA, Elmer GW. Drug interaction potential of soy extract and Panax ginseng. J Clin Pharmacol. 2003;43:643–8.

    PubMed  Google Scholar 

  48. Piscitelli SC, Burstein AH, Chaitt D, Alfaro RM, Falloon J. Indinavir concentrations and St. John’s wort. Lancet 2000;355:547–48.

    Article  PubMed  CAS  Google Scholar 

  49. Rengelshausen J, Banfield M, Riedel KD et al. Opposite effects of short-term and long-term St. John’s wort intake on voriconazole pharmacokinetics. Clin Pharmacol Ther 2005;78:25–33.

    Article  PubMed  CAS  Google Scholar 

  50. Piscitelli SC, Burstein AH, Welden N, Gallicano KD, Falloon J. The effect of garlic supplements on the pharmacokinetics of saquinavir. Clin Infect Dis 2002;34:234–8.

    Article  PubMed  Google Scholar 

  51. Gallicano K, Foster B, Choudhri S. Effect of short-term administration of garlic supplements on single-dose ritonavir pharmacokinetics in healthy volunteers. Br J Clin Pharmacol 2003;55:199–202.

    Article  PubMed  CAS  Google Scholar 

  52. Piscitelli SC, Formentini E, Burstein AH, Alfaro R, Jagannatha S, Falloon J. Effect of milk thistle on the pharmacokinetics of indinavir in healthy volunteers. Pharmacotherapy 2002;22:551–6.

    Article  PubMed  CAS  Google Scholar 

  53. DiCenzo R, Shelton M, Jordan K et al. Coadministration of milk thistle and indinavir in healthy subjects. Pharmacotherapy 2003;23:866–70.

    Article  PubMed  CAS  Google Scholar 

  54. Mills E, Wilson K, Clarke M. Milk thistle and indinavir: a randomized controlled pharmacokinetics study and meta-analysis. Eur J Clin Pharmacol 2005;61:1–7.

    Article  PubMed  CAS  Google Scholar 

  55. Rajnarayana K, Reddy MS, Vidyasagar J, Krishna DR. Study on the influence of silymarin pretreatment on metabolism and disposition of metronidazole. Arzneimittelforschung. 2004;54:109–13.

    PubMed  CAS  Google Scholar 

  56. Mogatle S, Skinner M, Mills E, Kanfer I. Effect of African potato (Hypoxis hemerocallidea) on the pharmacokinetics of efavirenz. S Afr Med J 2008;98:945–9.

    PubMed  CAS  Google Scholar 

  57. Jellin JM. Natural Medicines Comprehensive Database. Therapeutic Research Faculty, Stockton, CA. Available at www.naturaldatabase.com (accessed June 11, 2010).

  58. Dürr D, Stieger B, Kullak-Ublick GA et al. St. John’s wort induces intestinal P-glycoprotein/MDR1 and intestinal and hepatic CYP3A4. Clin Pharmacol Ther 2000;68:598–604.

    Article  PubMed  Google Scholar 

  59. Staudinger JL, Ding X, Lichti K. Pregnane X receptor and natural products: beyond drug-drug interactions. Expert Opin Drug Metab Toxicol 2006;2:847–57.

    Article  PubMed  CAS  Google Scholar 

  60. de Maat MM, Hoetelmans RM, Math t RA et al. Drug interaction between St John’s wort and nevirapine. AIDS 2001;15:420–21.

    Article  PubMed  Google Scholar 

  61. Hyland R, Jones BC, Smith DA. Identification of the cytochrome P450 enzymes involved in the N-oxidation of voriconazole. Drug Metab Dispos 2003;31:540–47.

    Article  PubMed  CAS  Google Scholar 

  62. Moore LB, Goodwin B, Jones SA et al. St. John’s wort induces hepatic drug metabolism through activation of the pregnane X receptor. Proc Natl Acad Sci USA 2009;97:7500–02.

    Article  Google Scholar 

  63. Zhou SF, Xue CC, Yu XQ, Wang G. Metabolic activation of herbal and dietary constituents and its clinical and toxicological implications: an update. Curr Drug Metab. 2007;8:526–53.

    Article  PubMed  CAS  Google Scholar 

  64. Brady JF, Isizaki H, Fukuto JM et al. Inhibition of cytochrome P-450 2E1 by diallyl sulfide and its metabolites. Chem Res Toxicol 1991;4:642–7.

    Article  PubMed  CAS  Google Scholar 

  65. Foster BC, Foster MS, Vandenhoek S. An in vitro evaluation of human cytochrome P450 3A4 and P-glycoprotein inhibition by garlic. J Pharm Pharm Sci 2001;4:176–84.

    PubMed  CAS  Google Scholar 

  66. Arnault I, Haffner T, Siess MH, Vollmar A, Kahane R, Auger J. Analytical method for appreciation of garlic therapeutic potential and for validation of a new formulation. J Pharm Biomed Anal 2005;37:963–70.

    Article  PubMed  CAS  Google Scholar 

  67. Zou L, Harkey GL, Henderson GL. Effects of herbal components on cDNA-expressed cytochrome P450 enzyme catalytic activity. Life Sci 2002;71:1579–89.

    Article  PubMed  CAS  Google Scholar 

  68. Laroche M, Choudhri S, Gallicano K, Foster B. Severe gastrointestinal toxicity with concomitant ingestion of ritonavir and garlic. Can J Infect Dis 1998;9(Suppl A):471P.

    Google Scholar 

  69. Budzinski JW, Trudeau VL, Drouin CE, Panahi M, Arnason JT, Foster BC. Modulation of human cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp) in Caco-2 cell monolayers by selected commercial-source milk thistle and goldenseal products. Can J Physiol Pharmacol 2007;85:966–78.

    Article  PubMed  CAS  Google Scholar 

  70. Sridar C, Goosen TC, Kent UM, Williams JA, Hollenberg PF. Silybin inactivates cytochromes P450 3A4 and 2C9 and inhibits major hepatic glucuronosyltransferases. Drug Metab Dispos 2004;32:587–94.

    Article  PubMed  CAS  Google Scholar 

  71. van Erp NP, Baker SD, Zhao M et al. Effect of milk thistle (Silybum marianum) on the ­pharmacokinetics of irinotecan. Clin Cancer Res 2005;11:7800–6.

    Article  PubMed  CAS  Google Scholar 

  72. Sidelmann UG, Cornett C, Tjørnelund J, Hansen SH. A comparative study of precision cut liver slices, hepatocytes, and liver microsomes from the wistar rats using metronidazole as a model substrate. Xenobiotica 1996;26:709–22.

    Article  PubMed  CAS  Google Scholar 

  73. Beckmann-Knopp S, Rietbrock S, Weyhenmeyer R, et al. Inhibitory effects of silibinin on cytochrome P-450 enzymes in human liver microsomes. Pharmacol Toxicol 2000;86:250–6.

    Article  PubMed  CAS  Google Scholar 

  74. Kim DH, Jin YH, Park JB, Kobashi K. Silymarin and its components are inhibitors of beta-glucuronidase. Biol Pharm Bull 1994;17:443–5.

    Article  PubMed  CAS  Google Scholar 

  75. Venkataramanan R, Ramachandran V, Komoroski BJ, et al. Milk thistle, a herbal supplement, decreases the activity of CYP3A4 and uridine diphosphoglucuronosyl transferase in human hepatocyte cultures. Drug Metab Dispos 2000;28:1270–3.

    PubMed  CAS  Google Scholar 

  76. Deng JW, Shon JH, Shin HJ, et al. Effect of silymarin supplement on the pharmacokinetics of rosuvastatin. Pharm Res 2008;25:1807–14.

    Article  PubMed  CAS  Google Scholar 

  77. Blumenthal M. The Complete German Commission E Monographs, Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council, 1998.

    Google Scholar 

  78. Kubota Y, Kobayashi K, Tanaka N et al. Interaction of Ginkgo biloba extract (GBE) with hypotensive agent, nicardipine, in rats. In vivo 2003;17:409–412.

    PubMed  CAS  Google Scholar 

  79. Shinozuka K, Umegaki K, Kubota Y et al. Feeding of Ginkgo biloba extract (GBE) enhances gene expression of hepatic cytochrome P-450 and attenuates the hypotensive effect of nicardipine in rats. Life Sci 2002;70:2783–2792.

    Article  PubMed  CAS  Google Scholar 

  80. Umegaki K, Saito K, Kubota Y, Sanada H, Yamada K, Shinozuka K. Ginkgo biloba extract markedly induces pentoxyresorufin O-dealkylase activity in rats. Jpn J Pharmacol 2002;90:345–351.

    Article  PubMed  CAS  Google Scholar 

  81. Sugiyama T, Kubota Y, Shinozuka K, Yamada S, Yamada K, Umegaki K. Induction and recovery of hepatic drug metabolizing enzymes in rats treated with Ginkgo biloba extract. Food Chem Toxicol 2004;42:953–957.

    Article  PubMed  CAS  Google Scholar 

  82. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273–282.

    PubMed  CAS  Google Scholar 

  83. He N, Edeki TI. Effects of ginseng and Ginkgo biloba components on CYP3A4 mediated testosterone 6beta-hydroxylation in human liver microsomes [abstract]. Clin Pharmacol Ther 2003;73:50. Abstract PII-81.

    Google Scholar 

  84. Yoshioka M, Ohnishi N, Koishi T, et al. Studies on interactions between functional foods or dietary supplements and medicines. IV. Effects of ginkgo biloba leaf extract on the pharmacokinetics and pharmacodynamics of nifedipine in healthy volunteers. Biol Pharm Bull 2004 Dec;27(12):2006–9.

    Article  PubMed  CAS  Google Scholar 

  85. Morse GD, Rosenkranz S, Para MF et al. Amprenavir and Efavirenz Pharmacokinetics before and after the Addition of Nelfinavir, Indinavir, Ritonavir, or Saquinavir in Seronegative Individuals. Antimicrob Agents Chemother 2005;49:3373–81.

    Article  PubMed  CAS  Google Scholar 

  86. Gallicano K, Khaliq Y, Carignan G, Tseng A, Walmsley S, Cameron DW. A pharmacokinetic study of intermittent rifabutin dosing with a combination of ritonavir and saquinavir in patients infected with human immunodeficiency virus. Clin Pharmacol Ther 2001;70:149–58.

    Article  PubMed  CAS  Google Scholar 

  87. Wiegman DJ, Brinkman K, Franssen EJ. Interaction of Ginkgo biloba with efavirenz. AIDS 2009;23:1184–5.

    Article  PubMed  Google Scholar 

  88. Modarai M, Gertsch J, Suter A, Heinrich M, Kortenkamp A. Cytochrome P450 inhibitory action of Echinacea preparations differs widely and co-varies with alkylamide content. J Pharm Pharmacol 2007;59:567–73.

    Article  PubMed  CAS  Google Scholar 

  89. The New Mexico AIDS Education and Training Center at the University of New Mexico Health Sciences Center. Echinacea. Fact Sheet Number 726. Available at: www.aidsinfonet.org (accessed June 11, 2010).

  90. Sullivan Al, Laba JG, Moore JA, Lee TDG. Echinacea-induced macrophage activation. Immunopharmacol Immunotoxicol 2008;30:553–74.

    Article  PubMed  CAS  Google Scholar 

  91. Morlat P, Pereira E, Clayette P et al. Early evolution of plasma soluble TNF-alpha p75 receptor as a marker of progression in treated HIV-infected patients. AIDS Res Hum Retroviruses 2008;24:1383–9.

    Article  PubMed  CAS  Google Scholar 

  92. van den Bout-van den Beukel CJ, Koopmans PP, van der Ven AJ, De Smet PA, Burger DM. Possible drug-metabolism interactions of medicinal herbs with antiretroviral agents. Drug Metab Rev 2006;38:477–514.

    Article  CAS  Google Scholar 

  93. Streetman DS, Bertino JS Jr, Nafziger AN. Phenotyping of drug-metabolizing enzymes in adults: a review of in-vivo cytochrome P450 phenotyping probes. Pharmacogenetics 2000 Apr;10(3):187–216.

    Article  PubMed  CAS  Google Scholar 

  94. Smith M, Lin KM, Zheng YP. An open trial of nifedipine-herb interactions: nifedipine with St. John’s wort, ginseng, or ginkgo biloba [abstract]. Clin Pharmacol Ther 2001;69:86. Abstract PIII-89.

    Google Scholar 

  95. Henderson GL, Harkey MR, Gershwin ME, Hackman RM, Stern JS, Stresser DM. Effects of ginseng components on c-DNA-expressed cytochrome P450 enzyme catalytic activity. Life Sci 1999;65:209–214.

    Article  Google Scholar 

  96. Furutsu M, Koyama Y, Kusakabe M, Takahashi S. Preventative effect of the extract of Du-zhong (Tochu) leaf and ginseng root on acute toxicity of chlorpyrifos. Jpn J Toxicol Environ Health 1997;43:92–100.

    CAS  Google Scholar 

  97. Malati CY, Robertson SM, Hunt JD et al. Influence of Panax ginseng on Cytochrome P450(CYP)3A and P-glycoprotein (P-gp) Activity in Healthy Participants. J Clin Pharmacol. 2011 Jun 6. [Epub ahead of print].

    Article  PubMed  Google Scholar 

  98. Mills E, Cooper C, Seely D, Kanfer. African herbal medicines in the treatment of HIV: Hypoxis and Sutherlandia. An overview of evidence and pharmacology. Nutr J 2005;4:19.

    Article  PubMed  Google Scholar 

  99. Albrecht CF, Kruger PB, Smit BJ et al. The pharmacokinetic behaviour of hypoxoside taken orally by patients with lung cancer in a phase I trial. S Afr Med J 1995;85::861–5.

    PubMed  CAS  Google Scholar 

  100. Mills E, Foster BC, van Heeswijk R et al. Impact of African herbal medicines on antiretroviral metabolism. AIDS 2005;19:95–97.

    Article  PubMed  Google Scholar 

  101. Nair VD, Foster BC, Thor Arnason J, Mills EJ, Kanfer I. In vitro evaluation of human cytochrome P450 and P-glycoprotein-mediated metabolism of some phytochemicals in extracts and formulations of African potato. Phytomedicine 2007;14:498–507.

    Article  PubMed  CAS  Google Scholar 

  102. Brown L, Heyneke O, Brown D, van Wyk JP, Hamman JH. Impact of traditional medicinal plant extracts on antiretroviral drug absorption. J Ethnopharmacol 2008;119:588–92.

    Article  PubMed  CAS  Google Scholar 

  103. Tsukamoto S, Aburatani M, Ohta T. Isolation of CYP3A4 Inhibitors from the Black Cohosh (Cimicifuga racemosa). Evid Based Complement Alternat Med 2005;2:223–226.

    Article  PubMed  Google Scholar 

  104. 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;52:755–63.

    Article  PubMed  CAS  Google Scholar 

  105. Abourashed EA, Khan IA. High-performance liquid chromatography determination of hydrastine and berberine in dietary supplements containing goldenseal. J Pharm Sci. J Pharm Sci 2001;90:817–22.

    CAS  Google Scholar 

  106. Etheridge AS, Black SR, Patel PR, So J, Mathews JM. An in vitro evaluation of cytochrome P450 inhibition and P-glycoprotein interaction with goldenseal, Ginkgo biloba, grape seed, milk thistle, and ginseng extracts and their constituents. Planta Med 2007;73:731–41.

    Article  PubMed  CAS  Google Scholar 

  107. Qiu W, Jiang XH, Liu CX, Ju Y, Jin JX. Effect of berberine on the pharmacokinetics of substrates of CYP3A and P-gp. Phytother Res 2009;23:1553–8.

    Article  PubMed  CAS  Google Scholar 

  108. Lin HL, Liu TY, Lui WY, Chi CW. Up-regulation of multidrug resistance transporter expression by berberine in human and murine hepatoma cells. Cancer 1999;85(9):1937–42.

    PubMed  CAS  Google Scholar 

  109. Mathews JM, Etheridge AS, Black SR. Inhibition of human cytochrome P450 activities by kava extract and kavalactones. Drug Metab Dispos 2002;30:1153–7.

    Article  PubMed  CAS  Google Scholar 

  110. Zou L, Henderson GL, Harkey MR, Sakai Y, Li A. Effects of kava (Kava-kava, ‘Awa, Yaqona, Piper methysticum) on c-DNA-expressed cytochrome P450 enzymes and human cryopreserved hepatocytes. Phytomedicine 2004;11:285–94.

    Article  PubMed  CAS  Google Scholar 

  111. Unger M, Frank A. 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 2004;18:2273–81.

    Article  PubMed  CAS  Google Scholar 

  112. Weiss J, Sauer A, Frank A, Unger M. Extracts and kavalactones of Piper methysticum G. Forst (kava-kava) inhibit P-glycoprotein in vitro. Drug Metab Dispos 2005;33:1580–3.

    Article  PubMed  CAS  Google Scholar 

  113. Escher M, Desmeules J, Giostra E, Mentha G. Drug Points: hepatitis associated with kava, a herbal remedy for anxiety. BMJ 2001;322:139.

    Article  PubMed  CAS  Google Scholar 

  114. Russmann S, Lauterberg BH, Hebling A. Kava hepatotoxicity [letter]. Ann Intern Med 2001;135:68.

    PubMed  CAS  Google Scholar 

  115. Liver Toxicity with kava. Pharmacist’s Letter/Prescriber’s Letter 2001;18(1):180115.

    Google Scholar 

  116. Consultation letter MLX 286: Proposals to prohibit the herbal ingredient Kava-Kava (Piper methysticum) in unlicensed medicines. Medicines Control Agency, United Kingdom, July 19, 2002.

    Google Scholar 

  117. Li XZ, Ramzan I. Role of ethanol in kava hepatotoxicity. Phytother Res 2010;24:475–80.

    Article  PubMed  CAS  Google Scholar 

  118. Lefebvre T, Foster BC, Drouin CE, et al. In vitro activity of commercial valerian root extracts against human cytochrome P450 3A4. J Pharm Pharmaceut Sci 2004;7:265–73.

    Google Scholar 

  119. Hellum BH, Nilsen OG. In vitro inhibition of CYP3A4 metabolism and P-glycoprotein-mediated transport by trade herbal products. Basic Clin Pharmacol Toxicol 2008;102:466–75.

    Article  PubMed  CAS  Google Scholar 

  120. Sustiva Prescribing Information. Bristol Myers Squibb Pharma. Princeton, NJ, USA. March, 2010.

    Google Scholar 

  121. Chantre P, Cappelaere A, Leblan D, et al. Efficacy and tolerance or Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Phytomedicine 2000;7:177–84.

    PubMed  CAS  Google Scholar 

  122. Chisholm A, Mann J, Skeaff M, et al. A diet rich in walnuts favourably influences plasma fatty acid profile in moderately hyperlipidaemic subjects. Eur J Clin Nutr 1998;52:12–6.

    Article  PubMed  CAS  Google Scholar 

  123. Freedman JE, Parker C, Li L, et al. Select flavonoids and whole juice from purple grapes inhibit platelet function and enhance nitric oxide release. Circulation 2001;103:2792–8.

    PubMed  CAS  Google Scholar 

  124. Nuttall SL, Kendall MJ, Bombardelli E, Morazzoni P. An evaluation of the antioxidant activity of a standardized grape seed extract, Leucoselect. J Clin Pharm Ther 1998;23:385–89.

    Article  PubMed  CAS  Google Scholar 

  125. Nishikawa M, Ariyoshi N, Kotani A et al. Effects of continuous ingestion of green tea or grape seed extracts on the pharmacokinetics of midazolam. Drug Metab Pharmacokinet 2004;19:280–9.

    Article  PubMed  CAS  Google Scholar 

  126. Raucy JL. Regulation of CYP3A4 expression in human hepatocytes by pharmaceuticals and natural products. Drug Metab Dispos 2003;31:533–9.

    Article  PubMed  CAS  Google Scholar 

  127. Sohn OS, Surace A, Fiala ES et al. Effects of green and black tea on hepatic xenobiotic metabolizing systems in the male F344 rat. Xenobiotica 1994;24:119–27.

    Article  PubMed  CAS  Google Scholar 

  128. Bonkovsky HL. Hepatotoxicity associated with supplements containing Chinese green tea (Camellia sinensis). Ann Intern Med 2006;144:68–71.

    PubMed  Google Scholar 

  129. Jimenez-Saenz M, Martinez-Sanchez, MDC. Acute hepatitis associated with the use of green tea infusions. J Hepatol 2006;44:616–9.

    Article  PubMed  CAS  Google Scholar 

  130. Suekawa M, Ishige A, Yuasa K, et al. Pharmacological studies on ginger. I. Pharmacological actions of pungent constituents, (6)-gingerol and (6)-shogaol. J Pharmacobiodyn 1984;7:836–48.

    PubMed  CAS  Google Scholar 

  131. Pongrojpaw D, Somprasit C, Chanthasenanont A. A randomized comparison of ginger and dimenhydrinate in the treatment of nausea and vomiting in pregnancy. J Med Assoc Thai 2007;90:1703–9.

    PubMed  Google Scholar 

  132. Langner E, Greifenberg S, Gruenwald J. Ginger: history and use. Adv Ther 1998;15:25–44.

    PubMed  CAS  Google Scholar 

  133. Castro AF, Altenberg GA. Inhibition of drug transport by genistein in multidrug-resistant cells expressing P-glycoprotein. Biochem Pharmacol 1997;53:89–93.

    Article  PubMed  Google Scholar 

  134. Jäger W, Zembsch B, Wolschann P et al. Metabolism of the anticancer drug flavopiridol, a new inhibitor of cyclin dependent kinases, in rat liver. Life Sci 1998;62:1861–73.

    Article  PubMed  Google Scholar 

  135. South African Development Committee. Ministerial consultative meeting on nutrition and HIV/AIDS, Johannesburg, South Africa, January 20, 2002.

    Google Scholar 

  136. Morito K, Hirose T, Kinjo J, et al. Interaction of phytoestrogens with estrogen receptors alpha and beta. Biol Pharm Bull 2001;24:351–6.

    Article  PubMed  CAS  Google Scholar 

  137. Halm BM, Franke AA, Ashburn LA, Hebshi SM, Wilkens LR. Oral antibiotics decrease urinary isoflavonoid excretion in children after soy consumption. Nutr Cancer 2008;60:14–22.

    Article  PubMed  CAS  Google Scholar 

  138. Kleijnen J. Evening primrose oil. BMJ 1994;309:824–825.

    PubMed  CAS  Google Scholar 

  139. Belch J, Hill A. Evening primrose oil and borage oil in rheumatologic conditions. Am J Clin Nutr 2000;71:352S–6S.

    PubMed  CAS  Google Scholar 

  140. Gurley BJ, Gardner SF, Hubbard MA. Content versus label claims in ephedra-containing dietary supplements. Am J Health-Syst Pharm 2000;57:963–69.

    PubMed  CAS  Google Scholar 

  141. Parasrampuria J, Schwartz K. Quality control of dehydroepiandrosterone dietary supplement products. JAMA 1998;280:1565. [Letter].

    Article  PubMed  CAS  Google Scholar 

  142. Liberti LE, Der Marderosian A. Evaluation of commercial ginseng products. J Pharm Sci 1978;67:1487–89.

    Article  PubMed  CAS  Google Scholar 

  143. Cui J, Garle M, Eneroth P, Björkhem I. What do commercial ginseng preparations contain? Lancet. 1994;344:134. [Letter].

    Article  PubMed  CAS  Google Scholar 

  144. Heptinstall S, Awang DV, Dawson BA, Kindack D, Knight DW, May J. Parthenolide content and bioactivity of feverfew (Tanacetum parthenium (L.) Schulkz-Bip). Estimation of commercial and authenticated feverfew products. J Pharm Pharmacol 1992;44:391–95.

    Article  PubMed  CAS  Google Scholar 

  145. Webb G. “fX” chemically adulterated product does not contain kava. Herbalgram 1997;39:9.

    Google Scholar 

  146. Saper RB, Phillips RS, Sehgal A et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA 2008;300:915–23.

    Article  PubMed  CAS  Google Scholar 

  147. Corns CM. Herbal remedies and clinical biochemistry. Ann Clin Biochem 2003;40 (Pt 5):489–507.

    Article  PubMed  CAS  Google Scholar 

  148. Obach RS. Inhibition of human cytochrome P450 enzymes by constituents of St. John’s Wort, an herbal preparation used in the treatment of depression. J Pharmacol Exp Ther 2000;294:88–95.

    PubMed  CAS  Google Scholar 

  149. Kashuba, A.D.M., Bertino Jr., J.S. (2005). Mechanisms of Drug interactions I: Absorption, Metabolism and Excretion. In: S.C. Piscitelli, K.A. Rodvold (Eds.), Drug Interactions in Infectious Diseases (2nd Ed., pp. 13–39). Totowa, NJ: Human Press.

    Chapter  Google Scholar 

  150. Weber K, Schneider M, Sacks H et al. Trends in complementary/alternative medicine (CAM) use in a large cohort of HIV-infected women in the US from 1994–2001. XIV International AIDS Conference, Barcelona Spain. July 7–12, 2002: Abstract WePeB6004.

    Google Scholar 

  151. Behm Dillon DM, Penzak SR, Bailey Klepser T. The use of herbals by patients with HIV. Adv Pharm 2004;2:41–60.

    Google Scholar 

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  1. Clinical Pharmacokinetics Research Laboratory, Clinical Research Center, Pharmacy Department, National Institutes of Health, Bethesda, MD, 20879, USA

    Scott R. Penzak

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    Stephen C. Piscitelli

  2. College of Pharmacy, Dept. Pharmacy Practice, University of Illinois, Chicago, Chicago, 60612-7230, Illinois, USA

    Keith A. Rodvold

  3. , Pharmaceutical Sciences, Albany College of Pharmacy, Albany, 12208, New York, USA

    Manjunath P. Pai

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Penzak, S.R. (2011). Interactions Between Herbs and Antiinfective Medications. In: Piscitelli, S., Rodvold, K., Pai, M. (eds) Drug Interactions in Infectious Diseases. Infectious Disease. Humana Press. https://doi.org/10.1007/978-1-61779-213-7_5

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