This document discusses several potential drug interactions that can occur when drugs are taken with other substances like prescription medications, over-the-counter drugs, herbs, supplements, food, or alcohol. It provides examples of specific herb-drug interactions for St. John's Wort, kava, ginkgo, ginseng, garlic, and white pepper and notes how these herbs can increase or decrease drug levels in the body, potentially causing adverse effects or reducing drug effectiveness. The document emphasizes the importance of avoiding certain combinations and being aware of how foods, herbs, and medications may interact.

2.  When a drug is taken with another substances it
leads to a drug interaction- prescription drugs,
over the counter drugs, alcohol, herbs,
supplements, food, water etc.
 There are various kinds of potential interactions
that have possibility of either increasing or
decreasing drugs concentrations in the body that
could lead to development of drug resistance.
 It could also cause the drug to be ineffective to
treat the condition because the blood levels are
too low, or trigger an overdose because the drug
concentration are too high.

3.  In case of some drug interactions death may
also occurs.
 The general public’s use of herbal products has
increased over the past 10 years.
 Most of the current evidence concerning
interactions between natural products and
drugs is based on known or suspended
pharmacological activity that derived from in
vitro studies.
 More recently, there have been some reliable,
documented case reports, in vivo studies, and
clinical trials that have evaluated herbal-drug
interactions.

4. In the last two decades there has been a
considerable increase in the herbal remedy market.
Interaction between herbal remedies and drugs have
been put on the agenda and received increased
attention. Both serious and less serious adverse
interactions have been reported.
Eg. Reaction between drug cyclosporine and
Hypercium perforatum its called as St. John’s wort
herb and drugs like warfarin and aspirin which are
reported to interact with a range of herbs like garlic,
cranberry, Ginkgo biloba, ginger and grapes.
They are causing unexpected adverse effects of the
drug.

5.  These may occur out of accidental misuse or
due to lack of knowledge about active
ingredient involved in the relevant substances.
Interactions between food and drugs may
reduce or increases the drug effect. Some
commonly used herbs fruits as well as alcohol
may cause failure of the therapy up a point of to
serious alterations of patients' health. The
majority of clinical relevant food drug
interactions are caused by food induced
changes in the bioavailability of the drug.
 There are three types of accepted food- drug
interactions based on their nature and
mechanism of action.

6.  They cause either an increase or decrease
in the oral bioavailability of a drug. The
precipitant agent may modify the function of
enzymes or transport mechanisms that are
responsible for biotransformation.

7.  Interactions affects the systemic or
physiological disposition and occur after the
drug or the nutritional element has been
absorbed from gastro-intestinal tract and
entered the systemic circulation. Changes in
the cellular or tissue distribution, systemic
transport or penetration to specific organs or
tissue can occur.

8.  This interactions refers to the elimination or
clearance of drugs or nutrients, which may
involve the antagonism, impairment or
modulation of renal elimination.
 Eg. Interactions among herb, food,
prescription, non-prescription, OTC drugs.

9.  Grape fruits juice- interacts with calcium channel
blockers such as Calan, Procardia, Nifedipine,
Verapamil, Anti-psychiatric medications, Estrogen,
Oral contraceptives, certain Anti-allergic drugs like
Seldane, Hismanal etc.
 Orange juice- must not be consumed with antacids
containing drugs like aluminum. The orange juice
increases the absorption of aluminum and leads to
constipation.
 Orange juice and milk should be avoided with
taking antibiotics, as they decreases its
effectiveness.

10.  Milk dose not mix with laxatives drug like
Bisacodyl.
 Large amount of oat meal and other high fiber
cereals should not be eaten with digoxin, as it
interferes with drug absorption.
 Leafy green vegetables- high in vitamin K
contents should not be consumed with
Coumadin, as it negates the effects of the drug
and can lead to blood clotting.
 Caffeinated beverages- and Anti-asthmatic
drugs or quinolone antibiotics such as Cipro,
Penetrex, Noroxin and Oral-contraceptives
taken together can cause excessive excitability.

11.  Alcoholic beverages- it tend to increase the
depressive effect of medications such as
Benzodiazepines, Antihistamines,
Antidepressants, Antipsychotics, muscle
relaxant, narcotics, or any drug with sedative
action. Anti-oxidants and beta-carotene intensify
the effect of alcohol on the liver.
 Tomato contains small quantity of a toxic
substance known as Solanine that may cause
headache in certain individuals. An unidentified
constituent in Tomato and tomato-based
products can cause acid reflux, leading to
indigestion, vomiting and heartburn.

12.  Strawberry, Raspberry, spinach and
Rhubarb- contains oxalic acids, which can
aggravate kidney and bladder stones in
susceptible individuals and reduce ability to
absorb iron and calcium. Raspberry contains
naturally Salicylate which can cause allergic
reaction in aspirin sensitive individuals.
 Plums, Peaches, Apricots and Cherries- may
produce allergic reactions in certain
individuals, as it contains Salicylates. It also
cause the food poisoning.

13.  It is also known as St. John’s wort and its extracts
are prepared from the aerial parts of Hypercium
perforatum, which contains several
pharmacological active ingredients, including
naptho-dianthrones, phloroglucinols derivatives
and flavonoids.
 Such extracts are widely used for the treatment of
mild to moderate depression. This herb is
commonly used for various psychopathologic
conditions like depression and anxiety.
 It contains hypercin, a monoamino oxidase (MAO)
inhibitor, an active ingredient in the herb. St. John’s
Wort extract inhibits serotonin, dopamine and
norepinephrine reuptake.

14.  Dry mouth, dizziness and confusion, gastrointestinal
symptoms, allergic reactions and fatigue trouble sleeping
vivid dreams difficulty sitting still nervousness irritability it
might cause severe reactions to sun exposure. Women
may be at risk of severe skin reactions even at usual
doses of St. john’s Wort.
 Interation-
 The interaction of St. John’s wort are probabaly due to the
stimulation of cytochrome P450 isoenzymes CYP3A4,
CYP2C9, CYP1A2 and the transport protein P-glycoprotein
by constituents persent in St. John’s wort.

15.  It includes-
1. Taking hypercium along with Alprazolam might
decreases the effectiveness of alprazolam.
2. Hypercium might also increase your sensitivity
to sunlight. Taking Hypercium along with amino-
levulinic acid might increase the chances of
sunburn, blistering or rashes on area of skin
exposed to sunlight.
3. Hypercium might decreases the effectiveness
of Amitriptiline by increasing breakdown of
Amitriptiline in the body.

16. 4. Taking Hypercium along with birth control pills might
decrease the effectiveness of birth control pills.
5. Hypercium might increases the breakdown of cyclosporine
and decrease the effectiveness of cyclosporine.
6. Hypercium might decreases the effect the digoxin.
7. Hypercium increases a brain chemical called Serotonin.
Some medications for depression also increase the brain
chemical serotonin. Taking hypercium along with these
medications for depression might increase serotonin too
much and cause serious side effects including heart
problems, shivering, and anxiety.
8. Hypercium might increases the effects and side effects of
some medications for pain like meperidine, hydrocodone,
morphine and many others.

17.  Kava kava is an extract that is made from Piper
methysticum, a plant native to pacific islands.
 The name kava comes from polynesia word “ awa”
means bitter.
 The roots of the plant is used to produce a drink
which has sedative, anesthetic, euphoriant
properties.
 Its active ingredients called as Kavalactones.
 It is generally taken by mouth to calm anxiety, stress
and restlessness and to treat insomnia.
 It is also used for attention deficit-hyperactivity
disorder, withdrawal from benzodiazepine drugs,
epilepsy, psychosis, depression, migraines and other
respiratory tract infections, tuberculosis, muscle pain
and to prevent cancer.

18.  Kava extract produces sedation so do not take
kava before driving.
 Kava can cause liver damage.
 The use of Kava for as little as 1-3 months has
resulted in the need for liver transplants and
even death in some people.
 Early symptoms of liver damage include
yellowed eyes and skin (Jaundice), fatigue and
dark urine.

19.  It contains several Kavalactones, the assumed
active principles of Kava extracts, are potent
inhibitors of several enzymes of the CYP450
system.
 That action is assumed to be responsible for
interactions. Kava should not be used with
benzodiazepines, barbiturates, anti-psychotics
and alcohol.
 Along with this patients with Parkinson’s disease
should not use kava products.
 Kava can concentrate in sebaceous oils and
activate an immune response, resulting in a drug
reactions.

20.  Consuming Kava with alcohol, other sedatives, or
muscle relaxants can results in additive effect up to
and including coma.
 Kava may interact with several drugs, including
drugs used for Parkinson’s disease and
benzodiazepines used for anxiety.
 Alcohol and acetaminophen which may injure to
liver, should never be used with Kava.
 Kava may interferes with effect of dopamine and
drugs that are similar to dopamine and may worsen
neurological side effects of drugs that blocks
dopamine.
 For example- Haloperidol.

21.  It is commonly known as Ginkgo or maidenhair tree. It
belongs to the family Ginkgoaceae.
 It is native plant of China and also widely cultivated.
 Extracts obtained from ginkgo leaves contains phenolic
acids. Proanthocynidine, flavonoids, glycosides and
terpene trilactones, ginkgolides and bilobalides.
 Ginkgo contains high level of flavonoids and terpenoids,
antioxidants that provides protection againest oxidative
cell damage from harmful free radicals hence reduces the
risk of cancer.
 The leaves also contains unique ginkgo bioflavones as
well as alkylphenols and polyphenols.
 So it is used as dietary suppliments. and in treatment of
high blood pressure.

22.  Generally it produces minor side effects like
stomach upset, headache, dizziness, constipation,
forceful heartbeat, and allergic skin reactions.
Ginkgo leaf extract may increase the risk of liver
and thyroid cancers.
 Ginkgo fruit and pulp can cause severe allergic
skin reactions and irritation of mucous
membranes. Ginkgo leaf extract might increase
the risk of bruising and bleeding. Ginkgo thins the
blood and decreases its ability to form clots.
Ginkgo leaf extract can cause allergic skin
reactions in some people.

23.  Ginkgo should be avoided with other herbal/
health supplements that can affect blood
clotting. This includes capsicum, clove, garlic,
ginger, panax ginseng and turmeric.
 Avoid using ginkgo with herbal/ health
supplements that can increase your risk of
seizures. This includes EDTA, folic acid,
GHB(Gamma hydroxybutyrate), glutamine,
juniper, L-carnitine, Melatonin, Rosemary,
Wormwood etc.

24.  Ginkgo should be avoided in-
1. Any type of infections.
2. Anxiety or depression.
3. Asthma or allergies.
4. Cancer
5. High blood pressure, high cholesterol or heart
conditions.
6. Migraine, headache.
7. Rheumatoid arthritis or autoimmune disorders.
8. Psychiatric disorders.
9. Do not take ginkgo with combinations –
1. Warfarin(Coumadin, Jantoven)
2. Insulin and oral diabetic medicines.
3. Narcotic medicines.
4. NSAIDS.

25.  Panax ginseng is a plant that grows in Korea,
China, Siberia.
 It is generally taken by mouth to improve
thinking, concentration, memory, to treat
Alzeimer’s disease, physical stamina and to
prevent muscle damge from exercise.
 Panax ginseng is also used in depression,
anxiety, fatigue, multiple sclerosis and for
boosting the immune system.

26.  The most common side effect is trouble
sleeping(insomnia). Others are menstrual
problems, breast pain, increased heart rate,
high or low blood pressure, headache, loss of
appetite, diarrhea, itching, rashes, dizziness,
mood changes and vaginal bleeding.

27.  Ginseng should be avoided in following medical
conditions-
1. Diabetes
2. Hormone sensitive condition such as breast
cancer, uterine cancer, ovarian cancer,
endometrioses.
3. Uterine fibroids.
4. Insomnia.
5. A mental disorder.
6. An upcoming surgery.
7. Ginseng interacts with- medicines for diabetes,
Warfarin, medicines for depression and immuno-
suppressants.

28.  It interact with ACE inhibitors(Blood pressure
medications)- Captopril, Benazepril,
Enalapril.
 Calcium channel blockers- Amlodipine,
Diltiazem, Nifedipine.
 Anti-coagulants and Anti-platelets- it increse
the risk of bleeding with Aspirin, Warfarin,
Clopidigrel.
 Caffeine- ginseng make effect of caffeine
stronger which cause hyperactivity,
nervousness, sweating, insomnia, irregular
heartbeats.

29.  Diabetes medicines including insulin- Ginseng
lowers blood sugar levels, that increases risk of
hypoglycemia, or low blood sugar.
 Stimulant drugs- Ginseng may increase the
stimulant effect and side effect of some
medications in use that cause hyperactivity, over
excitations disorders.
 Morphine- Ginseng may blocks the pain relief
effect of morphine.
 Immuno-suppressants- Ginseng increases the
immune system and that interact with effect of
drugs to treat an auto-immune diseases.

30.  Garlic is a herb and commonly used in food and
flavoring gents.
 Garlic contains good amount of Allicin, Allin these
are active ingredient of garlic.
 Odorless garlic is contain little to no allicin.
 It is used to treat high blood pressure, coronary
artery disease, stomach cancer, colon cancer or
rectal cancer, and preventing tick bites.
 Garlic is applied to the skin may be possibly effective
in treatment of fungal skin infections such as
ringworm, Itching.
 It is also used in high cholesterol, stomach ulcers
caused by H. pylori, cancer, or circulation problems
in the legs.

31.  Garlic is possibly safe when taken for a short
period of time but has some common side
effects-
 Redness, swelling, or blistering(when applied
to the skin)
 Bleeding (nosebleeds, bleeding gums)
 Unpleasant breath or body odor.
 Heartburn, burning in your mouth or throat.
 Nausea, vomiting, gases
 Diarrhea

32.  Interaction of Garlic is due to the fact that it
competitively inhibits the activity of CYP3A4 in
drug metabolism. This property is responsible for
increased clearance and decreases
bioavailability various drugs.
 It is avoided with taking-
 Acetaminophen
 Birth control pills
 Chlorzoxasone
 Cyclosporine
 Theophylline
 Warfarin
 HIV or AIDS medicines
 Medicines used to prevent blood clots

33.  NSAIDS
 Avoid garlic in the following conditions-
 Any type of infections.
 Anxiety and depression.
 Asthma and allergies
 Cancer
 Erectile dysfunction
 High blood pressure, high cholesterol, or a heart
condition
 Migraine, headache
 Psoriasis, rheumatoid arthritis, or other
autoimmune disorders
 A psychiatric disorder

34.  White pepper grows in tropical Asian countries.
Black pepper and white pepper both come from
the same plant but they are prepared differently.
Black pepper is made by cooking and drying the
ripe seeds.
 Pepper is generally taken by mouth for upset
stomach, malaria, a bacterial infection that
causes diarrhea and in cancer. Pepper contains
a chemical called Piperine.
 It reduces pain, improve breathing, and reduce
inflammation.
 Piperine also improves brain function.

35.  Pepper is safe when taken by mouth in little
amounts. It might have a burning after taste.
Taking large amounts of it by mouth can
accidently get into the lungs.
 It should be avoided in following conditions-
 Pregnancy
 Breast feeding
 Bleeding conditions
 Diabetes
 Surgery

36.  Lithium reacts with black pepper and white
pepper- Black pepper and white pepper might
have an effect like diuretic. Pepper might
decreases metabolism and excretion of lithium.
 P- glycoprotein substrates interact with pepper-
some drugs are moved by pumps in cells. Black
and white pepper might make these pumps
inactive or less active and increase how much of
medications get absorbed by the body. This
might cause more side effects from some
medications.

37.  Phenytoin interacts with pepper- Black and
white pepper might increase absortion of
phenytoin in the body.
 Propranalol interacts with pepper- pepper
might increase absorption of propranalol in
the body. Taking black and white pepper
along with propranalol might increases the
effect and side effects of propranalol.

38.  Ephedra is medicinal preparation obtained from
the plant Ephedra sinica, Ephedra gerardiana.
From Ephedraceae family.
 Its branches and tops are used in medicines,
sometimes the roots or whole plant can also be
used.
 Ephedra is used for weight loss and obesity and
to improve athletic performance.
 It is also used for allergies and hay fever, nasal
congestion, in respiratory tract conditions such
as bronchospasm, asthma and bronchitis.

39.  It is also used for colds, flu, swine flu, fever,
chills, headache, inability to sweat, joint and
bone pain, and as a Water pill to increase
urine flow in patients who have fluid
retention.
 Ephedra contains ephedrine as major
chemical constituent which stimulates the
heart, lungs, and the nervous system.

40.  Ephedra is not safe in adults and children's.
 Ephedra can cause severe life- threatening or
disabling conditions as its use is linked to high
blood pressure, heart attacks, muscle disorders,
seizures, strokes, irregular heart beats, loss of
consciousness and death.
 Ephedra can also cause less serious side
effects like dizziness, restlessness, anxiety,
irritability, heart pounding, headache, loss of
appetite, nausea, vomiting and others.

41.  Drug that can cause an irregular heartbeat
interact with Ephedra. It can cause increase the
speed heartbeat. Taking Ephedra along with
medications that can cause an irregular
heartbeat might causes serious side effects
including heart attack.
 Methyxanthines interacts with ephedra as it can
stimulate the body. Methylxanthines also
stimulates the body. Taking ephedra along with
methylxanthines might cause side effects such
as nervousness, fast heartbeat, high blood
pressure and anxiety.

42.  Taking Ephedra along with Dexamethasone
might decreases the effectiveness of
Dexamethasone.
 Medications for depression (MAOI’s)
interacts with Ephedra as it contains
chemicals that stimulates the body. Taking of
these two combinations might cause serious
side effects including fast heart beat, high
blood pressure, seizures, nervousness.
 Anti-diabetics are interact with Ephedra
which decreases effectiveness of diabetes
medications.

43. Thank You…