Here are four dietary supplements mentioned in the document: 1. Garlic - Contains allicin and other organosulfur compounds. Used to support heart and immune health. 2. Ginseng - Contains ginsenosides. Used as an adaptogen to improve resistance to stress. 3. Ginkgo biloba - Contains flavonoids and terpenoids. Used to support brain and cognitive function. 4. Pepper - Contains piperine. Used as a spice and for its carminative effects.

1. STUDY OF HERBS AND THEIR
INTERACTIONS
Dr.U,Srinivasa, Professor and Head
Srinivas college of pharmacy,
Valachil, Mangalore - 574143

2. Drug Interactions
• Types of drug interactions –
• 1. Drug – Drug interactions
• 2. Drug –Food interactions
• 3. Drug – Disease interactions

3. Mechanism of drug interaction
• 1.Pharmacodynamic
• Due pharmacological effects of drugs
• 2. Pharmacokinetic
• Absorption
• Distribution
• Metabolism
• Excretion

4. Herb - food interactions
• Heart tonics herbs such as digitalis, cactus ,should
be avoided when taking heart medications
• Caffeine containing herbs like green tea ,kola nuts,
coffee and herbal stimulants like ephedra should
be avoided when taking heart medications or mood
altering drugs or antidepressants.

5. • Avoid herbs or formulations containing Liquorice
when using diuretics like furosemide because ,
Liquorice can cause potassium depletion from the
body
• Grape fruit juice interacts with calcium channel
blockers (Antihypertensive) , lipid lowering drugs ,
oral contraceptives and antiallergic medications.
Grape juice modifies the metabolism pattern of
these drugs in liver.

6. • Spicy substances such as ginger , capsicum, etc
can enhance the absorption rate of some drugs ,
hence they need to be taken one hour after drug
administration

7. GARLIC
• Biological source :
• It consists of the fresh compound bulb of Allium sativum
• Family : Liliaceae
• Chemical constituents :
• 1. Essential oil – Allin, a sulphur containing
• aminoacid, Allicin – allyl sulphide
• 2. Aminoacid – Leucine, methionine etc
• 3. Vitamins – A,B,C and D
• 4. Fatty acid, mucilage, and albumin
• 5. Minerals – Calcium, Iron, and Zinc

8. Garlic (Allium sativum )
 Garlic used in various conditions like
 Lower blood sugar levels,
 Reduce menstrual pain,
 Lowering blood cholesterol levels and
 Decrease blood pressure

9. • Garlic does not interact with drugs at normal
recommended doses, however exposure to
concentrated garlic extracts for prolonged periods
is reported to interact with several drugs.
• Garlic is reported to affect the blood clotting ,
hence should be avoided in patients taking blood
thinning agents like aspirin and warfarin
• Avoid taking fish oil or vitamin E while you are
taking garlic

10. • Garlic alters the blood sugar level, hence used under
supervision on patients with anti-diabetics.
• It also reported that garlic supplements have
decreased the blood levels of HIV protease inhibitors
(Nevirapine, efavirenz ) when used together.
• SIDE EFFECTS –
• Severe allergic reaction, Skin swelling, Asthma,
Bleeding, Pink eye ( Conjunctivitis)
• Diarrhea, Eczema, Gas(Flatulence), GIT Irritation/
burning, Vomiting, etc

11. GINSENG
• Synonyms: Man root.
• Biological source:
• Ginseng consists of the dried root of various species of
Panax as
• (Korean ginseng) Panax ginseng ,(South China ginseng)
Panax notoginseng, and (American ginseng) Panax
quinquefolius
• Family - Araliaceae.
• Chemical constituents -It mainly contain glycoside
• Ginsenosides (major glycosides).
• Panaxosides glycoside contains aglycone Dammarol

12. Ginseng ( Panax ginseng)
Ginseng is used to improve the body,s resistance to
stress ,
 Boost the immune system and
 Improve the sense of well being and stamina
 It is also to improve physical and mental
performance and treat hepatitis C,
 Symptoms related to menopause,
 Lowering of blood glucose level and
 Controlling blood pressure

13. • Ginseng is reported to affect the blood clotting ,
hence should be avoided in patients taking blood
thinning agents like aspirin and warfarin
• Ginseng is also reported to decrease the activity of
anti- hypertensive resulting in high blood pressure
• Ginseng is also reported to affect the activity of anti-
diabetics drugs, hence should be avoided in such
cases.

14. • Caffeine interacts with Ginseng and can speed up
nervous system, heart beats, high B.P
• SIDE EFFECTS –
• When used chronically -
• Increased or decreased B.P , Diarrhea, Insomnia,
Headache rapid heartbeat
• Mild overdose -
• Dry mouth and Lips, Vomiting, seizures,
convulsions etc

15. Ephedra
• Biological sources – It consists of dried stems of
Ephedra sinica
• Family – Ephedraceae
• Active constituents - It contains alkaloids and non-
alkaloids compounds. Chief constituent is ephedrine
and pseudoephedrine
• Uses – Used to treat bronchial asthma, cold,
allergies

16. Ephedra (Ephedra geradiana)
• Ephedra used to treat allergies, high fever, and
respiratory conditions like asthma, bronchitis,
bronchospasm
• Ephedra contains ephedrine which a potent drug
and stimulates heart, Lungs and nervous system

17. • Overdose or improper use of ephedra results in
various effects like High blood pressure, Heart attack,
Muscle disorders, Seizures, Stroke,Loss of
consciousness and Death
• Ephedra may reduce effectiveness of anti-
hypertensives and could rise the blood pressures.

18. • Ephedra should not be mixed with other central
nervous system stimulants such as amphetamine
and its derivatives as it may enhance
hyperactivity and produce serious conditions.
• Ephedra is reported to affect the blood clotting ,
hence should be avoided in patients taking blood
thinning agents like aspirin and warfarin, as it
may induce bleeding

19. • Ephedra may interact with anti- depressants like
imipramine, clomipramine and mono oxidase
(MAO) inhibiters and enhance their effects
• Ephedra should be avoided in people suffering
from seizures, as it may worsen the onset of
seizures

20. • SIDE EFFECTS –
• Dizziness, Restlessness, Anxiety, Headache, Loss
of appetite, Nausea vomiting
• Do not use ephedra with other stimulants such as
caffeine, coffee, tea etc

21. Kava -Kava
• Kava beverages are produced from the kava plant
Piper methysticum, a pepper plant
• They act much like alcohol on human brain , thus
making one feel calm, relaxed, and happy. The
plant is also thought to relieve pain, prevent
seizures and relax muscles

22. Kava ( Piper methysticum)
• It is an herb
• Has antianxiety ,
• Pain relieving,
• Muscle relaxing and
• anticonvulsant effects

23. • Kava should not be taken with drugs which act on
nervous system such as
• Barbiturates,
• Antidepressants,
• Antipsychotics and
• Alcohol
• Kava has also reported to produce hepatotoxic
effects when taken with some drugs

24. • It is reported that the use of kava with central
nervous system depressants can increase the
risk of drowsiness and motor reflex depression
• SIDE EFFECTS –
• Allergic skin reactions,
• Dizziness, Drowsiness, Enalaged pupils, GIT
upset, Headache, Hepatitis (Acute), Liver
damage

25. Ginkobiloba
• Biological sources – It consists of dried leaves of
Ginko biloba
• Family – Ginkgoaceae
• Active constituents - It contains flavonoland
flavonoid glycosides like ginkolides, ascorbic acid,,
catechin etc
• Uses – Used to treat asthma, cough, and treatment
of glaucoma and other eye diseases

26. Ginkgo biloba (Maiden hair tree)
• It has been used to treat symptoms of
• Alzheimer,s disease
• Dementia
• Parkinson,s disease and
• To enhance the memory capabilities

27. • Ginkgo is reported to decrease the antiviral
effects of drugs used in HIV such as indinavir
or efavirenz
• Ginkgo can also alter the actions of drugs
metabolized through liver such as omeprazole,
fluvastatin and donepezil

28. • Ginkgo should be avoided in patients who are on
anticonvulsants, blood thinners and antidiabetic
drugs
• Ginkgo is reported to interact with over 250
drugs, hence patient should take proper
consultation before using it.
• SIDE EFFECTS –
• Allergic skin reactions, Dizziness, Constipation,
Forceful heartbeat Stomach upset, Headache,
Liver and thyroid cancer

29. Pepper
• Biological sources – It consists of dried fruit of
Piper nigrum
• Family – Piperaceae
• Active constituents - It contains alkaloids. Chief
constituent is Piperine
• Uses – Used to treat arthritis, asthma, bronchitis,
diarrhea, colic and head ache

30. Pepper (Piper nigrum )
• Black pepper contains piperine as the chief
constituent.
• It is used as spices as well as carminative, and
treat arthritis
• Used in asthma
• Used in stomach upset
• Used in sinus infection

31. • Piperine is reported to inhibit various
cytochrome enzymes, resulting in increased
blood level of certain drugs like
• Carbamazapine ,Midazolam, Diclofenac
Phenytoin and Warfarin

32. • Black pepper might increase the risk of
bleeding when mixed with anticoagulants or
blood thinning drugs like
• Aspirin, heparin,warfarin etc
• Black pepper might produce additive effect
with anti-diabetic drugs and increase the risk
of hypo-glycaemia

33. • Black pepper might increase the blood level
of cefotaxime and cyclosporine resulting in
increased drug effects as well as side effects.
• Black pepper might increase the blood levels
there by of enhancing the effects as well as
side effects of anticancer drugs, anti-
hypertensives, anti-convulsants and some
antibiotics.

34. • SIDE EFFECTS –
• If large quantities of black pepper are taken by
mouth, there is a possibility that they may
accidentally penetrate the lungs.
• There has also been a report of death due to this
accident consumption. It is especially common in
children.

35. Hypericum
• Biological sources – It consists of fresh plant
material or dried arial parts of Hypericum perforatum
• Family – Hyperiaceae
• Active constituents - It contains
Napthodianthrones, flavonoids and phenolic acids
• The chief constituent is hypericin
• Uses – Used to treat insomnia, asthma, cough, and
antidepressant

36. Hypericum perforatum
• It is a proper drug used to treat depression
• The active constituent of this herb is known as
Hypercin
• Hypercin as similar effects on the brain as that
of Mono amino oxidase (MAO) inhibitors
(antidepressants)

37. • If take together, it may produce dangerous drug
interactions resulting in
• Rapid rise in blood pressure ,
• Severe head ache,
• Collapse and death.

38. • Hypercin has also reported to produce
interactions with immune suppressant drug,
cyclosporine,
• Antiviral drug indinavir,
• Oral contraceptives,
• Digitoxin etc
• Resulting in increased sensivity to light,
anxiety, dizziness , dry mouth and sexual
disfunction.

39. • SIDE EFFECTS –
• Allergic skin reactions like itching, skin rash,
• GIT – Abdominal pain, gas, Constipation, nausea and
Vomiting
• Dizziness, Restlessness, Dry mouth, Insomnia, Sleep
disturbances, anger etc

40. Enlist four dietary supplements
• Vitamins
• Minerals
• Enzymes
• Fatty acids
• Proteins
• Botanicals
• Probiotics
• Prebiotics