This document discusses herb-drug interactions, providing numerous examples of interactions between specific herbs and drugs. It notes that herb-drug interactions are a major cause of death and adverse events. The document then details interactions between herbs used for various systems and conditions, such as the cardiovascular, immune, and central nervous systems, and drugs that act on those same systems. It discusses interactions that occur via effects on cytochrome P450 enzymes. The document concludes by noting some positive interactions where herbs can reduce drug toxicity, as well as examples where herb-drug combinations are more effective than drugs alone.
Drug-Herb interactions (with reference to commonly used herbs)Punit Bhatt
The present presentation is about Drug-Herb interactions. The content was delivered at Dr Subhash Technical College for the Refresher course of Pharmacist. The content covers the commonly used herbs and its interactions with commonly used allopathic drugs.
Drug-Herb interactions (with reference to commonly used herbs)Punit Bhatt
The present presentation is about Drug-Herb interactions. The content was delivered at Dr Subhash Technical College for the Refresher course of Pharmacist. The content covers the commonly used herbs and its interactions with commonly used allopathic drugs.
A Good Agricultural Practice of medicinal plants is a cultivation program designed to ensure optimal yield in terms of both the quality and quantity of any crop intended for health purposes.
Herb drug and herb food interaction ppt by nitesh kumarNITESH KUMAR
HERB DRUG AND HERB FOOD INTERACTION IS AN IMPORTANT CHAPTER IN HERBLA DRUG TECHNOLOGY IN THE SYLLABUS OF B.PHARMACY 6TH SEM. IT GIVES A BETTER UNDERTANDING OF HERB FOOD INTERACTION AND RELATED DRUGS.
LINK FOR VIDEO LECTURES
https://youtu.be/-4nzP2vOGdg
DRUG TECHNICAL ADVISORY BOARD IS IN THE PHARMACY SYLLABUS AND THE QUESTIONS ARE ASKED IN THE PHARMACY EXAMS .
SUCH AS GPAT NIPER AND SEMSESTER EXAM/
Definition of drug interaction, potential of herb-drug interactions,significance of study of herb-drug interactions, reasons for their study, types according to ayurveda, effects & different ways of herb-drug interactions, their mechanism, hypericum, kava lava, ginkgo biloba, ginseng, garlic, pepper, ephedra.
Isolation, Identification and Analysis of PhytoconstituentsDr. Siddhi Upadhyay
Isolation, Identification and Analysis of Phytoconstituents
a) Terpenoids: Menthol, Citral, Artemisin
b) Glycosides: Glycyrhetinic acid & Rutin
c) Alkaloids: Atropine,Quinine,Reserpine,Caffeine
d) Resins: Podophyllotoxin, Curcumin
Challenges in herbal formulation
Steps in herbal drug formulation
Types of conventional herbal formulations
Liquid herbal dosage forms
Solid herbal dosage forms
Other herbal dosage forms
Novel dosage form
Ayurvedic Formulation: Asava, Arishta, Avaleha, Ghrita, Taila, Gutika
Concept of Detoxification: Panchkarma
Final Year B.Pharm (Sem-VIII) Pharmacognosy-III (Mumbai University Syllabus
A Good Agricultural Practice of medicinal plants is a cultivation program designed to ensure optimal yield in terms of both the quality and quantity of any crop intended for health purposes.
Herb drug and herb food interaction ppt by nitesh kumarNITESH KUMAR
HERB DRUG AND HERB FOOD INTERACTION IS AN IMPORTANT CHAPTER IN HERBLA DRUG TECHNOLOGY IN THE SYLLABUS OF B.PHARMACY 6TH SEM. IT GIVES A BETTER UNDERTANDING OF HERB FOOD INTERACTION AND RELATED DRUGS.
LINK FOR VIDEO LECTURES
https://youtu.be/-4nzP2vOGdg
DRUG TECHNICAL ADVISORY BOARD IS IN THE PHARMACY SYLLABUS AND THE QUESTIONS ARE ASKED IN THE PHARMACY EXAMS .
SUCH AS GPAT NIPER AND SEMSESTER EXAM/
Definition of drug interaction, potential of herb-drug interactions,significance of study of herb-drug interactions, reasons for their study, types according to ayurveda, effects & different ways of herb-drug interactions, their mechanism, hypericum, kava lava, ginkgo biloba, ginseng, garlic, pepper, ephedra.
Isolation, Identification and Analysis of PhytoconstituentsDr. Siddhi Upadhyay
Isolation, Identification and Analysis of Phytoconstituents
a) Terpenoids: Menthol, Citral, Artemisin
b) Glycosides: Glycyrhetinic acid & Rutin
c) Alkaloids: Atropine,Quinine,Reserpine,Caffeine
d) Resins: Podophyllotoxin, Curcumin
Challenges in herbal formulation
Steps in herbal drug formulation
Types of conventional herbal formulations
Liquid herbal dosage forms
Solid herbal dosage forms
Other herbal dosage forms
Novel dosage form
Ayurvedic Formulation: Asava, Arishta, Avaleha, Ghrita, Taila, Gutika
Concept of Detoxification: Panchkarma
Final Year B.Pharm (Sem-VIII) Pharmacognosy-III (Mumbai University Syllabus
Ellen Kamhi PhD RN and Eugene Zampieron ND . All health providers should be aware of the possibility of interactions between pharmaceutical agents and botanical supplements. This is an introduction to a full course on Drug Nutrient Depletions and Herb Drug Interaction. In this intro, we describe drugs that can cause depletions through a variety of biochemical mechanisms. Depletion of nutrients can lead to alterations in physiology leading to side effects, symptoms or other conditions and disease.
We also review significant herb/drug interactions, and provide a review of databases and information relating to this topic.
Presentation gives an overview of the inter-relationship between nutrition and pharmacy. Its importance is an imperative consideration in patient care. The presentation begins with an introduction to both areas but then focuses on specific drug-nutrient interactions with specific drug categories.
Drug interaction final edition -- animatedAhmed Omar
this is a lecture of " drug interactions " , shows:
-definitions
-types
-mechanisms
-high risk people
-how to handle a drug interaction
-resources
-online app.
...........
hope u enjoy the lecture :)
discusses about the interaction of certain drugs with some food materials and explains in detail about the effect of food on absorption, distribution, metabolism and excretion. Also dicsussed about the pharmacodynamic and pharmacogenomic aspects
Dr. Surana Ajaykumar Rikhabchand
HOD and Assistant Professor,
Department of Pharmacognosy,
S.M.B.T.College of Pharmacy,
Dhamangaon, Nashik
Mb no. 09657296551
this ppt deals with different types of drug interactions with examples and highlights important principles in monitoring drug therapy....for better understanding of complexity of multiple drug usage (polypharmacy)
Drug Drug Interactions_27-01-2024_Dr. Jeenal Mistry.pdfDr Jeenal Mistry
In pharmaceutical sciences, drug interactions occur when a drug's mechanism of action is affected by the concomitant administration of substances such as foods, beverages, or other drugs. A popular example of drug-food interaction is the effect of grapefruit in the metabolism of drugs.
Interactions may occur by simultaneous targeting of receptors, directly or indirectly. For example, both Zolpidem and alcohol affect GABAA receptors, and their simultaneous consumption results in the overstimulation of the receptor, which can lead to loss of consciousness. When two drugs affect each other, it receives the name of a drug-drug interaction. The risk of a drug-drug interaction (DDI) increases with the number of drugs used.
A large share of elderly people regularly use five or more medications or supplements, with a significant risk of side-effects from drug-drug interactions.
Drug interactions can be of three kinds:
additive (the result is what you expect when you add together the effect of each drug taken independently),
synergistic (combining the drugs leads to a larger effect than expected), or
antagonistic (combining the drugs leads to a smaller effect than expected).
It may be difficult to distinguish between synergistic or additive interactions, as individual effects of drugs may vary.
Direct interactions between drugs are also possible and may occur when two drugs are mixed before intravenous injection. For example, mixing thiopentone and suxamethonium can lead to the precipitation of thiopentone.
Following file comprises of information about interactions taking place between herbs-drug, herbs-herbs, it also highlights some of the cases of clinical laboratory test interactions taking place due to use of herbal medicines.
Adverse drug reaction- Drug Interaction .pptxMangeshBansod2
Classifications - Excessive pharmacological effects, secondary pharmacological effects, idiosyncrasy, allergic drug reactions, genetically determined toxicity, toxicity following sudden withdrawal of drugs, Drug interaction- beneficial interactions, adverse interactions, and pharmacokinetic drug interactions, Methods for detecting drug interactions,
spontaneous case reports and record linkage studies, and Adverse drug reaction reporting and management.
Personalized medicine involves the prescription of specific therapeutics best suited for an individual based on their genetic or proteomic profile. This talk discusses current approaches in drug discovery/development, the role of genetics in drug metabolism, and lawful/ethical issues surrounding the deployment of new health technology. I highlight some bioinformatic roles in the drug discovery process, and discuss the use of semantic web technologies for data integration and knowledge discovery..
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
3. Introduction
• Global Increase
– demand for herbs/herbal formulations
• 25,000 Plant based formulations – Available
• 1.5 Million Practioners of Traditional
Medicinal system
• 25% of all modern medicines – directly
/indirectly derived from plants
• 60% of antitumour and antimircobial
medicines are derived from plants
3
4. • 5 billion/yr industry
• More than 700 therapeutic herbs and
phytomedicines sold in German Pharmacies
• Approximately 70% Physicians prescribe
registered herbal remedies
• 7800 Medicinal drug manufacturing Units India
4
5. Purpose for use of Herbal Medicine?
Health Benefit
Total
Shoppers
(1000)
Female
(711)
Male
(289)
Ensure overall good health
88%
91%
82%
Reduce fat intake
81%
84%
72%
Doctor’s advice
73%
75%
69%
Weight Reduction/Control
73%
76%
67%
Reduce cholesterol levels
72%
74%
66%
Reduce the risk of a specific condition or illness
66%
69%
59%
Improve stamina or energy level
64%
65%
60%
Desire to manage or treat specific health
condition on their own
63%
65%
56%
Cope with food intolerance
48%
50%
43%
Manage Stress
46%
46%
44%
Manage allergies
41%
45%
33%
Slow down the aging process
39%
41%
35%
5
8. 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
8
9. Interactions between Immunomodulatory
herbs and drugs
Herb
Drug/ Class of
drugs
Mechanism of Herb – Drug
Interaction
Astragalus
(ASTRAGALUS
MEMBRANACEUS)
Azathioprine
Cyclosporine
Methotrexate
Antagonism
Borage
(BORAGO
OFFICINALIS)
Hypnotics
Potentiation
Echinacea
(ECHINACEA
PURPUREA)
Acetaminophen
Potentiation of Hepatotoxicity
Corticosteroids
Cyclosporine
Antagonism
Fexofenadine
Itraconazole
Lovastatin
Inhibition of CYP3A4 leading to
increase in drug concentration
9
10. Ginseng
Digoxin
Increased drug concentrations
Induction of CYP2C9
Opioid
analgesics
Decreased activity of opioids – clear
mechanism is unknown
Phenelzine
and MAO
inhibitors
Increased CNS side effects due to
additive effect
Warfarin
Shankpushpi
(CONVOLVULUS
PLURICAULIS)
Induction of CYP3A4
Hexobarbital
(PANAX
GINSENG)
Amlodipine
Alteration of INR value
Phenytoin
Decreased therapeutic effect
10
11. Interactions between herbs used for
cardiovascular disorders and drugs
• GARLIC
– Antihyperglycemic effect when it was co –
administered with chlorpropamide
– Decreases – bioavailabilty of saquinavir –
induction of P- glycoprotein (P – gP)
11
12. Cont….
GUM GUGGULU (COMMIPHORA
MUKUL)
– It may produce an additive effect with
anticoagulants
– It is believed to act as a thyroid
stimulating agent – avoid the co –
administration with thyroid drugs
– Guggul - predicted to decrease the
absorption of beta blockers and calciumchannel blockers
12
13. Interactions between herbs used for central
nervous system disorders and drugs
Herb
Areca (ARECA
CATECHU)
Drug/Class
of drugs
Procyclidine
Mechanism of Herb Drug Interaction
Antagonistic effect on drug – leading to extra
pyramidal syndrome
Capsicum
ACE
(CAPSICUM
inhibitors
FRUTESCENCE,
CAPSICUM
Theophylline
ANNUM)
Increased risk of developing cough
Chasteberry
(VITEX AGNUS
– CASTUS)
Dopamine
receptor
antagonists
Interferes with the activity of drugs
Feverfew
(TANACETUM
PARTHENIUM)
Antimigraine
Drugs
Potentiation of drug effect
Warfarin
Additive antiplatelet effect due to inhibition of
platelet aggregation
Enhanced bioavailability can lead to theophylline
toxicity
13
14. Ginkgo (GINKGO
BILOBA)
Aspirin
Clopidogrel
Ticlopidine
Increased risk of bleeding
Digoxin
Increased bioavailability of digoxin
Diltiazem
Increased bioavailability of drug
Ibuprofen
Intracerebral mass bleeding due to inhibition of
platelet aggregation
Nicardipine
Induction of CYP 3A4 leading to decreased activity
of drug
Omeprazole
Induction of CYP2C9
Thiazide diuretics
Increase in blood pressure
Trazodone
Induction of CYP3A4
Warfarin
Increased risk of bleeding
14
15. Green tea
(CAMELIA SINENSIS)
Warfarin
Increased risk of bleeding
Guarana(PAULLINIA
CUPANA)
Caffeine/
Respiratory
stimulants
Potentiation of activity
Kava
(PIPER
METHYSTICUM)
Alprazolam
Potentiation of
sedation
Anesthetics
Prolongation of
anesthesia
Levodopa
Antagonism
Lemon balm (MELISSA
OFFICINALIS)
CNS depressants
Additive CNS effects
Thyroid hormones
Inhibits binding of
thyroid hormones to TSH
receptors
Sage (SALVIA
MITILIORRHIZA)
Warfarin
Increased risk of bleeding
Diazepam
Induction of enzymes
15
16. St.John’s wort
(HYPERICUM
PERFORATUM)
Amitryptyline
Induction of CYP3A4
Cyclosporine
Induction of CYP3A4 and P - gP leading to
decrease in drug concentration and rejection
of transplanted organ
Digoxin
Induction of P – gP
Fexofenadine
Inhibition of P - gP
Indinavir,
Saquinavir
Induction of CYP 3A4
Loperamide
Acute delirium – mechanism unknown
16
17. St.John’s wort
(HYPERICUM
PERFORATUM)
Methadone
Induction of CYP 3A4, 2C8 and CYP 2D6
leading to decrease in drug concentration
Oral
Contraceptives
Failure of contraception due to induction of
CYP3A4
Piroxicam
Photosensitizing
drugs
Increased risk of phototoxicity
Quazepam
Induction of CYP 3A4
Sertraline
Inhibits vesicular uptake of monoamines
leading to serotonergic syndrome
Simvastatin
Induction of CYP3A4
Tacrolimus
Immuno graft rejection due to induction of
CYP enzymes
17
18. St.John’s wort
(HYPERICUM
PERFORATUM)
Theophylline
Induction of CYP1A2 leading to decreased
concentration of drug
Thyroid stimulating
hormone
Elevation of TSH levels
Venlaxafine
Serotonin syndrome – Inhibition of
serotonin reuptake and MAO Inhibition
Verapamil
Induction of CYP3A4, leading to decreased
bioavailabilty
Warfarin
Induction of CYP3A4 and CYP2C9
Valerian
(VALERIANA
OFFICINALIS)
Barbiturates
Additive sedation
Yohimbine
(PAUSINYSTALIA
YOHIMBE)
Clomipramine
Increased blood pressure
18
19. Herb – drug interactions due to alteration of
cytochrome P450 enzymes in in - vitro models
Herb
CYP Enzyme
In – vitro model
ANGELICA
DAHURICA
Inhibits CYP3A4
Inhibtis multidrug-resistant and
methicillin-resistant strains of
Staphylococcus aureus
Liver microsomes
Devil’s Claw
(HARPOGOPHYTUM
PROCUMBENS)
CYP2C8,CYP2C19,
CYP3A4,CYP1A2,
CYP2D6
Human kidney (HK-2) proximal
tubule cell line
Echinacea
(ECHINACEA
PURPUREA)
Inhibits
CYP2C19,
CYP2D6
Baculovirus expressed CYP
enzymes
19
21. Herb
CYP Enzyme
In – vitro model
Liquorice
(GLYCYRRHIZA
GLABRA)
CYP3A4, CYP2C9
Human recombinant enzymes
Schizandra
(SCHIZANDRA
CHINENSIS)
Inhibits CYP3A4
Liver microsomes
Silymarin
(SILYBUM
MARIANUM)
Inhibits CYP3A4
CYP2C9
Human hepatocytes/ Human
recombinant enzymes
Valerian
(VALERIANA
OFFICINALIS)
Inhibits CYP3A4,
CYP2C9 and CYP2C19
Cytochrome P450 CYP3A4
supersomes
Vinca
(CATHARANTHUS
ROSEUS)
Inhibits CYP2D6
Human Liver Microsomes
21
22. Interactions between other herbs and drugs
• Artemesinin
– Artemisinin, - decreases – omeprazole
bioavailability - induction of CYP2C19 activity
(Svensson et al., 1998).
1998
• Foeniculum vulgare
– Decrease the rate of absorption of ciprofloxacin chelation of the drug (Zhu et al., 1999).
1999
22
23. Cont….
• Liquorice
– Antihypertensive drugs - synergistic effect
(Cumming et al., 2003)
– Hydrocortisone - pseudoaldosteronism (Beate
et al., 1999)
– Oral contraceptives - hypertension, edema and
hyperkalemia (Gerty et al., 1997).
23
24. Cont….
•
Silymarin
• potentiate the effects of antiarrhythmic drugs
(Gyonos et al., 2001)
2001
• Increases - pharmacological activity of cisplatin
(Scambia et al., 1996),
1996
• Decreases the blood concentrations of
– indinavir (Piscitelli et al., 2002)
2002
– losartan (Han et al., 2009) and
2009
– metronidazole (Chon et al., 2005)
2005
24
25. Interactions between herbs and drugs acting on blood
B
L
O
O
D
C
L
O
T
T
I
N
G
ALTERATION OF INR
Herbs containing coumarins:
Arnica, celery, chlorella, danshen, dong quai,
chamomile, fenugreek, goldenseal, guar gum, horse
chestnut seeds, papain, passionflower, red clover,
sweet
clover, boldo
Herbs containing vitamin K:
Eg: Acerola, agrimony, stinging nettle, plantain
INHIBITION OF PLATELET AGGREGATION
Bilberry, cayenne, bromelain, capsicum, European
mistletoe, feverfew, garlic
INHIBITION OF PLATELET ACTIVATING
FACTOR (PAF)
Garlic, Ginkgo and saw palmetto
25
26. PREDICTED - HDI
• Bearberry (ARCTOSTAPHYLOUS UVA URSI)
• Estrogens/Oral contraceptives - May ↓ response to estrogen
• Lipid lowering drugs – Possibility of additive effect
• Black Cohosh (CIMIFUGA RACEMOSA)
– Lipid lowering drugs - Possibility of additive effect
• Bladderwrack (FUCUS VESICULOSUS)
– Hypoglycemic drugs - Possibility of additive effect
• Blue Cohosh (CAULOPHYLLUM
THALICTROIDES) - Nitrates and Calcium channel
blockers - May antagonize the hypertensive effect
26
27. • Chamomile (MATRICARIA RECUTITA) Iron - May inhibit iron absorption
• Chaste tree berry (VITEX AGNUS – CASTUS)
- Dopamine receptor antagonists (Phenothiazines) May antagonize drug effect
• Devil’s claw (HARPAGOPHYTUM
PROCUMBENS) - Antiarrhythmic drugs - May
interfere with drug activity
• Echinacea (ECHINACEA PURPUREA) –
Corticosteroids/ Cyclosporine – May nullify the
effect of drug
27
28. • Guarana (PAULLINIA CUPANA)
– Adenosine - May lower response
– Benzodiazepine - Drugs may be less
effective
• Hawthorn (CRATAEGUS LAEVIGATA,
C. MONOGYNA, C. PINNATIFIDA,
C.OXYCANTHA)
– Anesthetics - May enhance hypotension
28
29. Herbs to be avoided prior to
surgery
•
•
•
•
•
•
•
Ephedrine – 24 hrs
Garlic/Garlic products – 7 days
Ginkgo – 36 hrs
Ginseng – 7 days
Kava – 24 hrs
St.Johns Wort – 5 days
Valerian – weeks before
surgery by tapering
29
30. THE OTHER SIDE OF HERB –
DRUG INTERACTIONS
• Aromatic herbs such as ginger can be used to
prevent drug-induced nausea
• Milk thistle can be used to prevent the liver
toxicity associated with drugs
• Capsaicin reduces gastric mucosal damage
induced by aspirin
30
31. Cont….
• Combination of aqueous extract of
Chinese medicinal plant Tripterygium
wilfordi and cyclosporine significantly
increases the heart and kidney allograft
survival compared to cyclosporine alone
• Garlic prevents the formation of toxic
metabolites of paracetamol .
31
32. Cont….
• Co – administration of ginkgo with
antipsychotics (haloperidol) in chronic
schizophrenic patients reduces extra
pyramidal side effects associated with
haloperidol
• Centella asiatica can also be used as an
adjunctive medication for patients with
epilepsy due to its additive anticonvulsant
activity
32
33. Cont….
Momordica charantia is reported to
augment the hypoglycemic effect of
rosiglitazone which can be used to reduce
the dose of rosiglitazone to achieve
enhance therapeutic effect with minimum
side effects
33
34. Cont….
• Piperine can be used as bioavailability
enhancer for several drugs and studies
bolster that piperine enhances the
bioavailability of propranolol which can be
used as a means to achieve better therapeutic
control and improved patience compliance
34
35. Cont….
• Ginseng is considered to be potent
adjuvant for delivery of vaccines which
have been proven to induce higher or
similar antibody titres than vaccines
adjuvanted with aluminium hydroxide
35
36. Cont….
• Rosemary (Rosmarinus officinalis) has
chemopreventive effect as it increases
efflux and intracellular accumulation of
doxorubicin and vinblastine
• Silybinin enhances the antitumour activity
of cisplatin
36