Herb drug interaction ppt by rupesh kumar


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Herb drug interaction ppt by rupesh kumar

  2. 2. HERB-DRUG INTERACTIONS INTRODUCTION  When Herbal Medicinal Products and Western drugs administered together may interact each other in body leading to kinetic and dynamic alterations  Herbs are often administered in combination with therapeutic drugs, raising the potential of herb-drug interactions.  1. 2. 3. An estimated 5-20% of general people consume herbal medicines because Naturally available Consideration of safe to use Ready available
  3. 3. Adverse Events and Drug-Interaction Caused by Herbal or Traditional Medicines by the study of – ANIMAL STUDY – CONTROLLED TRIAL – SINGLE CASE REPORT – MULTIPLE CASE REPORTS
  4. 4. Facts about drug interactions/herbal medicine/ herb-drug interactions  Drug interactions - 4th – 6th Cause of death  At least 100 preoperative fatalities due to herb -drug/surgery interactions  >70 – 80 Herbs - Increase risk of bleeding  >30 – 40 Herbs possibility of causing hepatic failure  Ephedra – 54 deaths , 1600 Adverse events  Aloe vera injection – 4 Deaths  Pennyroyal tea – 2 infants Multiorgan Dysfunction  Aristolochic Acid – Death of 100 Belgian Women
  5. 5. HERB-DRUG INTERACTIONS PHARMACOKINETIC Modify metabolic pathways in body Mainly occur in GIT Kidney Liver PHARMACODYNAMIC Related to action of herb and drug Interactions can be predicted Antagonism or Synergism
  6. 6. INCREASED DECREASED ABSORPTION Ginger Green Tea Black Pepper Fibres Mucilage herbs METABOLISM Guggul Grape fruit ELIMINATION Laxative Diuretic herbs Liquorice
  7. 7. oClinicians lack of adequate knowledge combinations oNo quality assurance for purity and potency oNo advancement in research
  8. 8. GARLIC: – May ↑ bleeding times with anticoagulants – ↓ blood levels and toxicity of protease inhibitors like ritonavir, indinavir….etc GINGER:  May ↑ bleeding with anticoagulants ↓ effect of antacids Ginger might decrease blood sugar Insulin, Chlorpropamide , Glipizide, Tolbutamide High blood pressure (Calcium channel blockers) interacts with GINGER verapamil , felodipine , amlodipin
  9. 9. Black and white pepper might decrease how quickly the liver breaks down some medications  lovastatin (Mevacor)  ketoconazole (Nizoral)  Itraconazole (Sporanox), …etc. It will decrease the action of antacids The black pepper majorly shows interaction and increase the AUC of The drugs are: Phenytoin (Dilantin) Carbamazepine (Tegretol) tranquilizers in healthy volunteers Propranolol (Inderal) Rifampin Theophylline in patients with pulmonary tuberculosis.
  10. 10. Taking cinnamon bark along with diabetes medications might cause your blood sugar to go too low. Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others. Decreased effectiveness of Fluoroquinolones, Increased risk of photo toxicity with tetracycline's It increase the AUC of anti hypertensive's. Medications that can harm the liver (Hepatotoxic drugs) interacts with CASSIA CINNAMON  these are miodarone, carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), methyldopa ,and others.
  11. 11. Clove contains eugenol. Eugenol is the part of clove that might slow blood clotting. It may increase the bleeding with drugs such as anticoagulants (heparin, warfarin ), and NSAIDS like aspirin, diclofenac, ibuprofen, naprox, and others. In children decrease the effect of anti-epileptic drugs as phenytoin by damaging the liver.
  12. 12. GREEN TEA High in tannin, do not take with codeine Large amounts may↑ effects and side effects of theophylline May ↓ effect of coronary vasodilator drugs May ↓ effects of warfarin Green tea and aspirin should not be mixed because they both prevent platelets from clotting
  13. 13. – May ↑ bleeding with anticoagulants – May ↑ effects of antibiotics – ↑ efficacy of 5-fluorouracil and vincristine  May bleeding with anticoagulants (Anticoagulant / Anti platelet drugs) interacts with CAPSICUM Capsicum increase the theophylline absorption of the body & also increases the side effects of theophylline Medications for high blood pressure (ACE inhibitors) interacts with CAPSICUM  might increase the side effects of cocaine including heart attack and death.
  14. 14. PEPPERMINT The peppermint will decrease the metabolism of cyclosporin (Neoral, Sandimmune) Some medications that are changed by the liver include amitriptyline (Elavil), haloperidol (Haldol), ondansetron (Zofran), propranolol (Inderal),theophylline verapamil (Calan, Isoptin, others), and others. Medications changed by the liver (Cytochrome P450 2C19 (CYP2C) TAMARIND: Tamarind (Tamarindus indica) Aspirin Increased bioavailability of aspirin52
  15. 15. TURMERIC:  cs the activity of antacids (Lansoprazole …etc).  Increase the blood-thinning effect with drug like warfarin, aspirin(NSAIDs).  Actively participate in the ce the blood glucose level, when taken with anti diabetic drugs that cause risk of lower blood sugar (hypoglycaemia). GRAPE JUICE: Increase the oral bioavailability (human). Gastrointestinal absorption and bioavailability of statins like levostatin Dicreases the total body metabolic rate.
  16. 16. Ginkgo: May ↑ bleeding with anticoagulants  May ↑ activity and side effects of MAO inhibitors  Increases blood pressure when combined with a thiazide diuretic and even caused coma  Increases the digoxin plasma levels GINSENG (PANAX GINSENG): Increases the AUC of digoxin Decreased activity of opioids – clear mechanism is unknown Increased CNS side effects due to additive effect of MAO inhibitors Phenelzine
  17. 17. VALERIAN:  Valerian induces the sleep with antiseizure medications like barbiturates. Ex. phenobarbitone, pentobarbitone Prolongation of aesthesia with anaesthetics Produce sadation with barbiturates &benzodiazepines – Contraindicated with hepatotoxic drugs and alcohol – ↓ efficacy of Parkinson drugs (L-Dopa)
  18. 18. Liquorice: ↓ efficacy, ↑ toxicity of diuretics  ↓ efficacy, side effects of digoxin  AUC Corticosteroids like prednisalone , methylprednisalone Milk Thistle: ↓ hepatotoxicity of drugs (haloperidol, phenytoin) ↓ kidney toxicity of anesthetics
  19. 19. PHARMACIST’S ROLE Advising Monitoring Reporting
  20. 20.  Health care professionals and pharmacists have to play an important role in giving advisory knowledge on monitoring concurrent use of herbal and conventional medicines and to collect data for suspected herb-drug interactions. We need to bring into lime light about the herb – drug interactions
  21. 21. REFERENCES  Baravkar A A, Sawant S D- “Herb-Drug-Interactions”  Wheaton A G, Blanck H M- “Medicinal herb use in population     based survey” Arthur M. Presser- “Herb-Drug Interactions” Dorothea Dayley- “Drug-Herb-Nutrient Interactions” Schuyler W.Lininger- “Drug-Herb-Vitamin Interactions Natural medicines - Comprehensive database by editors of Pharmacist’s letter and Prescriber’s letter