General introduction to interaction and classification. Study of following drugs and their possible side effects and interaction: Hypericum, Kava - Kava, Ginkgo biloba, Ginseng, Garlic, Pepper, and Ephedra.

1. Mr. Rahul Dev
Assistant Professor
Gracious College of Pharmacy, Abhanpur

2. Drug interaction is defined as ‘alteration in the
pharmacological activity of one drug by the concomitant use of
another drug or other substance. The concurrent use of herbs
may increase, mimic or decrease the effect of other drugs’.
Herb-drug interactions occur between herbal medicines and
conventional drugs. These interactions are more common than
drug-drug interactions because herbal medicines contain
multiple pharmacologically active ingredients. While
conventional drugs contain a single ingredient.
Herb-food interactions occur between herbal medicines and
foods.

3. 1. Herb-Herb interactions: Interaction between two herb. Eg: Use of
Piper betel is contraindicated if the individual is taking Garcinia morella,
Basella alba & Sesamum indicum.
2. Herb-Food interactions: interaction between herb and foods. Eg: Milk
should not be administered with garlic, mentha. Leaves of asafoetida
should not be taken with milk because it may cause loss of strength,
complextion, sterility, and many other disorders.
3. Herb-Animal Origin Drug Interaction: interaction between herb and
drug of animal origins. Eg: Meat is contraindicated with Brassica alba.
And equal amount of ghee and honey is contraindicated as per ayurveda.
4. Diseases-Related interaction: Eg: Haritaki cannot be administered in
pregnancy and anorexia.

4. 1. Hypercium
2. Kava-kava
3. Ginkobiloba
4. Ginseng
5. Garlic
6. Pepper
7. Efedra

5. Synonyms: Amber, Amber Touch-and-
Heal, Demon Chaser, Goat weed.
Biological Source: It consists of dried
aerial parts of Hypericum
perforatum of family
Hypericaceae.
Geographical Source: The plant is
native to Europe and Asia but
grows in India in western
Himalaya, China, Canada, Africa,
Australia and United States.

6. Description: It is herbaceous
perennial plant with
extensive, creeping root
system. The plant has erect
branched stems and it can
grow to 1 m hight. The
leaves are opposite, sessile,
narrow, glabrous with entire
margin, oblong about 1-2 cm
long, and are yellow-green in
colour with translucent dots
of glandular tissue. The plant
has bright yellow coloured,
star shaped flowers with
conspicuous black dots. The
flowering occurs between
late spring and early to mid
summer.
Continue…….

7. Chemical Constituents:
The main constituents are Hyperborean and adhyperforin (Prenylated phloroglucinol
derivatives). The plant also contains like:
• Flavonoids: Plant contains rutin, Epigallocatechin, hyperoside, isoquercetin,
quercitrin, quercetin etc.
• Naphthodianthrones: Hypericin, pseudohypericin, protohypericin,
protopseudohypericin.
• Phenolic acids: Chlorogenic acid, caffeic acid, ferulic acid, vanillic acid etc.
• Alkaloids: Vitamins pectin, β-sitosterol, caffeine, vitamin C, carotenoids etc.
• Tannins, volatile oils, saturated fatty acids(stearic acid, myristic acid)
Uses:
It is used in treatment of depression, heart palpitations, moodiness and symptoms of
menopause, mental disorders, premenstural syndrome(PMS), attention deficit-
hyperactivity disorder(ADHD), obsessive-compulsive disorder(OCD), social
phobia,.
It can be used to treat burning feelings in mouth, migraine and other types of headaches
pain, IBS, cancer, HIV/AIDS, weight loss, skin diseases.
Continue…….

8. Alprazolam with Hyperecium: Alprazolam is used for anxiety. Hypercium
can increases the excetion of this drug from the body. Therefore, taking
hypercium with alprazolam reduces the effectiveness of drug.
Amitriptyline with Hypercium: Amitriptyline is used as Antidepressent.
Amitriptyline is broken down by the body. Hypercium can increase the
excretion of this drug from the body. Therefore, taking Hypercium with
Amitriptyline reduces the effectiveness of drug.
Birth Control Pills (Contraceptive Drugs) with Hypercium: Estrogen
present in some birth control pills is broken down by the body and hypercium
can increase this brokendown process. Therefore, taking hypercium with birth
control pills reduces their effectiveness.
Digoxin with Hypercium: Digoxin improves the heart functioning and
hypercium on the other hand can decrease the amount of digoxin absorbed by
the body . Therfore, taking hypercium with digoxin reduces the effectiveness of
drug.

9. Medications changed by the Liver [Cytochrome P-450 3A4(CYP3A4)
Substrates] with Hypercium: Some drugs like lovastatin, ketoconazole,
itraconazole, fexofenadine etc, are changed and broken down by the liver.
Hypercium can increase how fast liver breakes down these drugs. Therefore,
taking hypercium with such drugs reduces their effectiveness.
Medication for pain (Narcotic Drugs) with Hypercium: Some medications
for pain, Eg:, meperidine, hydrocodone, morphine etc, are broken down by the
body and hypercium can decrease this breakdown process. Therefore, taking
hypercium with such drugs increases their effectiveness and side effects.
Medication that increases sensitivity to sunlight (photosensitizing drugs)
with Hypercium: Some medications, eg., amtriptyline, ciprofloxacin,
norfloxacin, ofloxacin, livofloxacin etc can increase sensitivity to sunlight.
Hypercium can also increase sensitivity to sunlight. Therefore, taking
hypercium with such drugs increases the chances of sunburn, blistering or
rashes on areas of skin exposed to sunlight.
Continuous……..

10. Tramadole with Hypercium: Tramadole increases serotonin level in the
brain, and hypercium can also increase serotonin. Therefore, taking hypercium
with Tramadole leads to too much serotonin that can cause serious side effects
like heart problems, nausea, headache and anxiety.
Imatinib with Hypercium: Imatinib is a type of cancer growth blocker
called as a tyrosine kinase inhibitor(TKI). It is broken by the body and
hypercium increases this breakdown process. Therfore, taking hypercium with
imatinib reduces the effectiveness of drug.
Continuous……..

11. St. John’s wort when taken orally upto 12 weeks, it is considered to be safe. Its
possible side effects includes trouble sleeping, vivid dreams, restlessness,
anxiety, irritability, stomach upset, fatigue, dry mouth, dizziness, headache, skin
rash, and diarrhoea.
In persons taking antidepressant drugs it can cause agitation, hallucination,
fever, fast heart rate, nausea, vomiting, diarrhoea etc.
Continue…….

12. Synonyms: Ava Pepper, Ava Root, Awa
Biological Source: It consists of dried
roots of plant Piper methysticum
belonging to family Piperaceae.
Geographical Source: The plant is found
in Melanesia, Micronesia, Polynesia. It
grows well in shade and moist areas.
Description: It is shrub and has heart
shaped leaves and woody steams. The
stems are green with swollen nodes.
The male flowers are approximately
six inches log solitary, auxiliary, with
greenish white spikes. The female
flowers are rare. The fruits are berries
with one seed.

13. Chemical Constituents:
Dried kava root consists of 12% water, 43% starch & 20% fibers, protein,
sugars, and minerals. The main phytoconstituents found in kava roots are
kavalectones, chalcones and other flavanonos. Kawain, 7,8-dihydrokawain,
methysticin, 7,8-dihydromethysticin, yangonin and demethoxy yangonin are main
kavalactones present in plants. Minor constituents found in kava are three
chalcones, flavokavain A, flavokavain B, and flavokavain C and toxic alkaloid
pipermethystine.
Uses:
• Kava kava may decrease anxiety, stress, insomnia and menopausal symptoms.
• It may used in treatment of cancer, attention deficit-hyperactivity disorder,
epilepsy, psychosis, depression, chronic fatigue syndrome and headaches.
• It also used in treatment of common cold, respiratory tract infections, tuberculosis,
muscle pain, urinary tract infections, skin diseases and wounds etc.
Continue…….

14. Sedative (CNS depressants) with Kava: Sedatives eg., clonazepam,
lorazepam, phenobarbital etc., cause sleepiness and drowsiness and kava also
cause sleepiness. Therefore, taking kava with sedatives cause too much
sleepiness.
Levodopa with Kava: Levodopa affects the brain by increasing dopamine
level. Kava can decrease dopamine level in brain. Therefore, taking kava with
levodopa reduces the effectiveness of drug.
Medications that can Harm the Liver(Hepatotoxic drugs) with Kava: Some
medication can harm the liver, eg., acetaminophen, fluconazole, itraconazole etc.
Kava can also harm the liver. Therefore, taking kava with these medicine can
increase the risk of liver damage.
Medication changed by the liver [Cytochrome P-450 1A2(CYP1A2)
Substrates] with Kava: Some medications are changed and broken down by the
liver, eg., clozapine, cyclobenzaprine, fluvoxamine, imipramine, olanzapine,
pentazocine, propranolo etc. Kava can decrease how fast liver breaks down these
medications. Therefore, taking kava with these drugs increase their effects and
side effects.
Continue…….

15. Medications changed by the Liver [Cytochrome P-450 2C9(CYP2C9)
Substrates] with Kava: Some medications are changed and broken down by
the liver, eg., amitriptyline, diazepam, celecoxib, diclofenac, glipizide,
ibuprofen, losartan, phenytoin, piroxicam, torsemide etc. Kava can decrease
how fast liver breakes down these medications. Therefore, taking kava with
these drugs increase their effects and side effects.
Medications changed by the Liver [Cytochrome P-450 2C19(CYP2C19)
Substrates] with Kava: Some medications are changed and broken down by
the liver, eg., clomipramine, cyclophosphamide, diazepam, lansoprazole,
omeprazole, lansoprazole, phenytoin, progesterone etc. kava can decrease how
fast liver breakes down these medications. Therefore, taking kava with these
drugs increase their effects their effects and side effects.
Medications changed by the Liver [Cytochrome P-450 2D6(CYP2D6)
Substrates] with Kava: Some medications are changed and broken down by
the liver, eg., clozapine, codiene, ondansetron, tramadol, trazodone etc. kava can
decrease how fast liver breakes down these medications. Therefore, taking kava
with these drugs increase their effects and side effects.
Alprazolam with Kava: Alprazolam can cause drowsiness and kava can also
cause drowsiness. Therefore, taking kava with alprazolam may cause too much
drowsiness.
Continuous……..

16. Kava-kava is safe when taken orally for a short-term. Its extracts have been
safely used under medical supervision for up to 6 months. However, after
taking kava one cannot drive or operate machinery safely. It can cause liver
damage. Using kava for 1-3 months may urge the need for liver transplants and
even cause death. Early symptom of liver damage include jaundice, fatigue, and
dark urine.
However, these cases are rare as most patients using kava do not experience
liver toxicity. Some experts believe that liver toxicity in such cases be directly
linked to kava and other factors may have contributed to these toxic effects.
Continue…….

17. Synonyms: Ginkgo, Gingko, Maidenhair tree.
Biological Source: It consists of dried leaves of
plant Ginkgo biloba L belonging to family
Ginkgoaceae.
Geographical Source: The plant is widely
distributed in China, Korea And Japan.
Description: it is deciduous tree with through
branches having elongated and spur shoots.
The leaves are fan-shaped, alternate, leathery
with parallel venation; and occur in clusters.
The leaves turn bright yellow, and then fall
within 15 days during autumn. The male and
female plants occur in 1:1 ratio. Seeds are
yellow colour, drupe like with long
penduncle; outer coat is freshy and inner coat
stony.

18. Chemical Constituents:
The leaves of the plant mainly consist of flavonoid glycosides(24%),
proanthocyanidins(7%) and terpenoids. The major phytoconstituents are Quecetin-
3-β-D glucoside, Quercitin, Rutin. The minor constituents include Quercetin,
Kaempferol and Isorhamnetin etc. terpene lactones present in plant are Gingolida
A, Gingkolide C, Bilobalide and Ginkgotoxin. It contains diterpenes like
Ginkgolides A, B, C and J and the sesquiterpene, bilobalide.
Uses:
• It acts as anti-inflammatory and hepatoprotective agent.
• The plant has antilipidemics, antidiabetic and antioxidant activity.
• It reduces anxiety and treats dementia related to Alzheimer’s diseases.
• The plant also acts as anti-allergic, anti-inflammatory, anti-viral, anti-proliferative,
anti-tumorigenic, and anti-carcinogenic agent.
Continue…….

19. Ibuprofen with Ginkgo: Ginkgo can slow blood clotting and ibuprofen can
also slow blood clotting. Therefore, taking ginkgo with ibuprofen slows down
blood clotting too much and increases the risk of bruising and bleeding.
Anticoagulant/Antiplatelet Drugs with Ginkgo: Some medications can slow
blood clotting, eg., aspirin, diclofenac, ibuprofen, naproxen, heparine, warfarin
etc. Ginkgo can also show blood clotting. Therefore, taking ginkgo with these
medications slows down blood clotting too much and increases the risk of
bruising and bleeding.
Alprazolam with Ginkgo: Taking ginkgo with alprazolam can reduce the
effectiveness of drug.
Trazodone with Ginkgo: Trazodone affects the chemicals in brain and ginkgo
can also affects the chemicals in brain. Therefore, taking ginkgo with trazodone
can cause serious side effects in brain.
Medication changed by the liver [Cytochrome P-450 1A2(CYP1A2)
Substrates] with Ginkgo: Some medications are changed and broken down by
the liver, eg., clozapine, cyclobenzaprine, fluvoxamine, imipramine, olanzapine,
pentazocine, propranolo etc. Ginkgo can decrease how fast liver breaks down
these medications. Therefore, taking ginkgo with such drugs increase their effects
and side effects.
Continue…….

20. Medications changed by the Liver [Cytochrome P-450 2C9(CYP2C9)
Substrates] with Ginkgo: Some medications are changed and broken down by
the liver, eg., amitriptyline, diazepam, celecoxib, diclofenac, glipizide,
ibuprofen, losartan, phenytoin, piroxicam, torsemide etc. Ginkgo can decrease
how fast liver breakes down these medications. Therefore, taking ginkgo with
these drugs increase their effects and side effects.
Medications changed by the Liver [Cytochrome P-450 2C19(CYP2C19)
Substrates] with Ginkgo: Some medications are changed and broken down by
the liver, eg., clomipramine, cyclophosphamide, diazepam, lansoprazole,
omeprazole, lansoprazole, phenytoin, progesterone etc. Ginkgo can decrease
how fast liver breakes down these medications. Therefore, taking ginkgo with
these drugs can reduce their effectiveness.
Medications changed by the Liver [Cytochrome P-450 2D6(CYP2D6)
Substrates] with Ginkgo: Some medications are changed and broken down by
the liver, eg., clozapine, codiene, ondansetron, tramadol, trazodone etc. Ginkgo
can decrease how fast liver breakes down these medications. Therefore, taking
Ginkgo with these drugs increase their effects and side effects.
Continuous……..

21. Ginkgo can cause possible side effects such as stomach upset, headache,
dizziness, constipation, increase is force of heartbeat, and allergic skin reactions
etc.
High dose of leaf extract may increase the risk of liver and thyroid cancers.
It may increase the risk of bruising and bleeding.
Gingko seeds may cause seizures and death.
It is not safe in pregnancy and lactation.
Continue…….

22. Synonym:. Panax, Pannag, American ginseng,
Asiatic ginseng, Korean ginseng, Tartar root,
Western ginseng.
Biological Source : It consists of dried root
of plant Panax species- Panax ginseng(Korean),
Panax notoginseng(China), Panaxquinguefolium
(America), belongs to family Araliaceae.
Geographical Source: Canada, China, England, France,
germany, Holland, Japan, Korea, USA, Russia.
Description: Ginseng is deciduous perennial plant. There
are two forms, red and white ginseng. It grows well in
shade. The leaves are five fingered, compound with five
pointed and toothed leaflets. Plant bears tiny white or
greenish-yellow flowers from single, bell like cluster, red
berries, and a yellowish brown root. Thick roots show
human like shape.

23. Chemical Constituents:
Major constituents of ginseng are ginsenosides which are triterpene
glycosides or saponins. Barry of ginseng contains indole alkaloid, ginsenine, β-
sitosterol,daucosterine etc. Barry also consists of saponins. Ginseng also contains
polyacetylenes.
It consists of poplyphenolic compounds such as salicylic acid, ascorbic acid, rutin etc.
Polysaccharides are also present in Ginseng roots.
Seeds of ginseng showed presence of new dammarane-type triterpene ketone, two
dammarane type and lupane type triterpenes and aromatic oligoglycoside, three sterol
glycosides and three dammarane type triterpene oligoglycosides etc.
Uses:
• It used to treat depression, anxiety, general and chronic fatigue syndrome, multiple
sclerosis, anemia, chronic bronchitis, swine flue, pre-diabetes and diabetes.
• It also used for treatment fo fever, inflammation of the stomach lining(gastritis),
COPD, HIV/AIDS, fertility problems, for boosting the immune system.
• It has wide applications in treating bleeding disorders, loss of appetite, vomiting,
diziness, headache, hearing loss, common cold and flue, heart failure, high blood
pressure etc.
Continue…….

24. Alcohol with Ginseng: The body breaks down alcohol to get rid of it. Taking
Panax ginseng with alcohol can increase this breakdown process.
Caffiene with Ginseng: Caffiene can speed up the nervous system, make the
individual feel jittery, and speed up the heartbeat. Panax ginseng can also speed
up the nervous system. Therefore, taking ginseng with caffeine can cause serious
problems, like increased heart rate and high blood pressure.
Insulin with Ginseng: insulin is used to decrease blood sugar, and Panax
ginseng can also reduces blood sugar. Therefore, taking ginseng with insulin can
reduce blood sugar too much.
Medications changed by the Liver [Cytochrome P-450 2D6(CYP2D6)
Substrates] with Giinseng: Some medications are changed and broken down by
the liver, eg., clozapine, codiene, ondansetron, tramadol, trazodone etc. Ginseng
can decrease how fast liver breakes down these medications. Therefore, taking
Ginseng with these drugs increase their effects and side effects.
Medication for depression with Ginseng: Some medication are used for
depression and can stimulate the body, eg., phenelzine etc, Panax ginseng can
also stimulate the body. Therefore, taking ginseng with such medications cause
too much stimulation and give rise to effects like headache, restlessness, insomnia
and anxiousness.
Continue…….

25. Anti-Diabetes drugs with Ginseng: Anti-diabetes medications, e.g.,
glimepiride, pioglitazone, chlorpropamide, glipizide, tolbutamide etc., are used
to lower blood sugar. Panax ginseng can also reduces blood sugar. Therefore,
taking ginseng with such medications can reduce the blood sugar too much.
Immunosuppresents with Ginseng: Immunosuppresents, e.g., cyclosporine,
daclizumab, mycophenolate, tacrolimus, sirolimus, pednisone,
coerticosteroids(glucocorticoids) etc., decrease the immune system. But, Panax
ginseng increases the immune system. Therefore, taking ginseng with such
medications reduces their effectiveness.
Anticoagulant/Antiplatelet Drugs with Ginseng: some medication slow
down blood clotting, e.g., aspirin, diclofenac, ibuprofen, naproxen, delteparin,
heparin, warfarin etc. Panax ginseng can also slow down blood clotting.
Therefore, taking ginseng with such medications increases the chance of
bruising and bleeding.
Stimulant drugs with Ginseng: Stimulant drugs, e.g., diethylpropion,
epinephrine, pseudoephedrine, etc. speed up the nervous system and make
individuals feel jittery and speed up their heartbeat. Panax ginseng can also
speed up nervous system. Therefore, taking ginseng with such medications can
cause serious problems, like increased heart rate and high blood pressure.
Continuous……..

26. Panax ginseng is unsafe when taken orally for a long-term(more than 6
months).
The most common side effect of ginseng is insomnia.
The less common side effects include menstural problems, breast pain,
increased heart rate, high or low blood pressure, headache, loss of appatite,
diarrhoea, itching, rash, dizziness, mood changes, and veginal bleeding.
The uncommon side effects include sever rash called Stevens-Johnson
syndrome, liver damage, and sever allergic reactions.
Continue…….

27. Synonym: Lasuna, Lashan, Lahsun.
Biological Source : It consists of bulbs of Allium
sativum, belonging to family Liliaceae.
Geographical Source: It is distributed in central Asia,
Southern Europe, USA and India.
Description: It is bulbous perennial herb, similar to
onion. Plant consists of underground bulbs which are
rounded, composed of up to 15 smaller bulblets known as
cloves. Cloves and bulbs are covered by a whitish or
pinkish membranous coat. The stem is tall, erect and
flowering with pink or purple flowers. Leaves are sword
shaped, leaves attached to an underground stem. Hard
neck varieties produce a flower stem while soft neck
variety does not produce it. Garlic has strong pungent
smell due to organosulphur compounds.

28. Chemical constituents:
The main sulphur containing compound present in garlic is glutamyl cysteins. It
hydrolyzed to form alliin.
When garlic is crushed alliin reacts with the enzyme alliinase to form allicin.
Alliicin has strong odour and is therapeutically active.
Allicin is also highly unstable, get oxidized easily and gets broken down to
sulfur compounds such as diallyl sulfide(DAS), diallyl disulfide(DADS), diallyl
trisulfide(DATS), ajoene and hydrogen sulphide.
Garlic shows presence of germanium, magnesium, selenium, zinc, vitamin A, C
and volatile oil.
It also consists of 65% water, 28% carbohydrate, 2.3% organosulphur
compounds, 2% proteins, 1.2% free aminoacids, 1.5% fiber, 0.15% lipids,
0.08% phytic acid, 0.07% saponins.
Use:
•It acts as carminative, expectorant, stimulant.
•It is also used to treat fever, hyperlipidemia, bronchial asthama, TB, GIT
disorders, diabetes and infections.
Continue…….

29. Isoniazid with Garlic: Garlic decreases the absorbed levels of isoniazid in
body. Therefore, taking garlic with isoniazid reduces the effectiveness of drug.
Medication used for HIV/AIDS[Non-Nucleoside Reverse Transcriptase
Inhibitors (NNRTIs)] with Garlic: Some medications used for HIV/AIDS, e.g.,
neviraprine, delavirdine, and efavirenz are broken down by the body. Garlic
increases this breakdown process. Therefore, taking garlic with these medications
reduces their effectiveness.
Birth control pills(Contraceptive drugs) with Garlic: Some estrogen-
containing birth pills e.g., ethinyl estradiol and levonorgestrel, ethinyl estradiol
and norethindrone, etc. are broken down by the body. Garlic can increase this
breakdown process. Therefore, taking garlic with such medications reduces their
effectiveness.
Medication that slow Blood Clotting(Anticoagulant/Antiplatelet Drugs)
with Garlic: Some medications delay blood clotting, e.g., aspirin, clopidogrel,
dicofenac, ibuprofen, neproxen, heparin, warfarin etc. Garlic also delays blood
clotting. Therefore, taking garlic with such medications can increase the chances
of bruishing and bleeding.
Continue…….

30. Medications changed by the Liver [Cytochrome P-450 2E1(CYP2E1)
Substrates] with Garlic: Certain drugs are converted and broken down by the
liver, e.g., acetaminophen, chlorzoxazone, ethanol, theophylline, and anaesthetic
drugs during surgery like halothane, isoflurane and methoxyflurane. Garlic oil
can decrease how fast the liver breaks down these medications. It also effects
the metabolism of the medications that are converted by the liver. Therefore,
taking garlic oil with such medications either potentiates their action or elevates
their side effects.
Medications changed by the Liver [Cytochrome P-450 3A4(CYP3A4)
Substrates] with Garlic: Certain drugs are converted and broken down by the
liver, e.g., ketoconazole, itraconazole, fexofenadine, triazolam etc. garlic can
increase how fast the liver breakes down these medications. Therefore, taking
garlic with such medications can increase the chance of bruising and bleeding.
Continuous……..

31. Oral intake of garlic is usually safe. Garlic has been researched for up to 7
years and proved to be safe. Upon oral consumption, garlic causes bed breath, a
burning sensation in the mouth or stomach, heartburn, gas, nausea, vomitting,
body odour, and diarrhoea.
Raw garlic worsens these side effects.
Garlic can also raise the risk of bleeding. Reports suggest cases of bleeding
after surgery upon ingestion of garlic.
Asthma problem and some other allergic reactions are seen in people working
with garlic.
Garlic skin products, like gels, pastes and mouthwashes containing garlic are
safe and can be used for up to 3 months; but sometimes might might cause skin
damage like a burn.
Raw garlic application to the skin should be avoided as it may cause severe
skin irritation.
Continue…….

32. Synonyms: Black pepper, Kali miri, Pippali.
Biological Source: It consists of dried fruits of the
plant Piper nigrum belonging to family
Piperaceae.
Geographical Source: The plant grows well in
Brazil, Indonesia and India.
Description: The plant grows well in shade and need
support. The leaves are heart shaped, alternate
with palmate veins. The male and female flowers
are small, monoecious and separate. The fruits are
drup eith single seed and red in colour when
mature. The single stem shows 20-30 spikes of
fruits. The fruits are globular brownish to
black in colour, with uneven surface, seeds
are almost brown or black, with aromatic
odour and pungent taste.

33. Chemical constituents:
Fruite contain 1.0-2.5 per cent volatile oil.
The main pharmacologically active principle is pungent alkaloid piperine.
Plant also shows presence of phytoconstituents such as Dihydro-pipericide,
Guineensine, pentadienoyl as piperidine,Tricholein, piperamide, pipperettine,
pipericide, piperine, etc.
The volatile oil consists of phytoconstituents such as sabinene, limonene
camphene, cinnamic acid, benzaldehyde and eugenol.
Use:
•It acts as antihypertensive, antiplatelet, antioxidant, anticancer,
antiasthamatic, analgesic, anti-inflammatory.
•Black pepper shows therapeutic activity such as antidiarrhoeal,
antispasmodic, antidepressants, immunomodulatory, anticonvulsant, anti-
thyroid, antibacterial, hepatoprotective etc.
•It also shows insecticidal and larvicidal activities.
•It acts as bioenhancers and increases absorption of many drugs and
nutrients.
Continue…….

34. Carbamazepine with black and white pepper: Black and white pepper can
elevate the amounts of carbamazepine absorbed by the body. They also shows the
breakdown of carbamazepine in the body. Therefore, taking pepper with
carbamazepine can raise the amount of drug in the body and increase the chances
of side effects.
Lithium with black and white pepper: Black and white pepper produce
diuretics like affects. They reduce the breakdown and excretion of lithium from
the body. Therefore, pepper with lithium increases the level of drug in body and
produces serious side effects.
Medications changed by the Liver [Cytochrome P-450 3A4(CYP3A4)
Substrates] with Pepper: Certain drugs are converted and broken down by the
liver, e.g., ketoconazole, itraconazole, fexofenadine, triazolam etc. Black and
white pepper slows breakes down of these medications. Therefore, taking pepper
with such medications can increase the chance of side effects.
Phenytoin with Black and White Pepper: Black and white pepper can elevate
the absorption of phenytoin, and thus its concentration in the body. Therefore,
taking pepper with phenytoin increases the effects and side effects of drug.
Continue…….

35. Propranolol with Black and White Pepper: Black and white pepper can
enhence the absorption of propranolol, and thus its concentration in the body.
Therefore, taking pepper with propranolol increases the effects and side effects
of drugs.
Rifampin with Black and White Pepper: Black and white pepper can
enhence the absorption of rifampin, and thus its concentration in the body.
Therefore, taking pepper with rifampin increases the effects and side effects of
drugs.
Theophylline with Black and White Pepper: Black and white pepper can
enhence the absorption of theophylline, and thus its concentration in the body.
Therefore, taking pepper with theophylline increases the effects and side effects
of drugs.
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36. Black pepper is considered safe if orally ingested in amounts found in foods.
There is no evidence to prove that oral consumption of black pepper as a
medicine is safe.
Black pepper oil is applied to skin and inhaled through nose or mouth and is
said to be safe.
Black pepper gives a burning after taste and causes stomach disturbance.
Its exposure to eyes must be avoided or else it causes a burning sensation.
Cough may occur if black pepper oil is inhaled through nose or mouth.
Some individual may get allergic to black pepper.
On oral consumption of black pepper in large amounts, it can accidentally reach
the lungs and cause death; this incident mostly occurs in children.
Continue…….

37. Synonyms: Yellow horse, Yellow astringent, Pinellia, Ma-huang, Mahuang.
Biological Source: It consists of dried young stem of Ephedra
gerardiana(India), Ephedra nebrodensis(India), Ephedra sinica(China),
Ephedra equistina of family Ephedraceae.
Geographical Source: Ephedra is native northern
China and Inner part of Mongolia. It also grows
in southern Europe, North Africa to Asia as well
as in the mountains of North and South America.
Ephedra plants typically grow in dry and desert
regions.
Description: Ephedra is an evergreen shrub 2-3 feet
hight and has no leaves. Stems are green, jointed,
smooth, woody, branching. During flowering, it
shows small yellow-green buds. It has scale like
leaves, cone like reproductive structures and
bright red or orange berry like fruits.

38. Chemical constituents:
Ephedra consists of 1.0% of amino alkaloids such as ephedrine,
pseudoephedrine(isoephedrine), norpseudoephedrine(cathine), noreephedrine,
methylephedrine, methylpseudoephedrine, including quinoline and 6-
hydroxykynurenic acid and tannins.
Use:
It is used in:
•Asthama,
•Bronchitis,
•Bronchospasm,
•Allergies,
•Nasal congestion,
•Colds,
•Flu, fever and other breathing problems.
Continue…….

39. Anticonvulsants with Ephedra: Mediacations used to prevent convulsions,
e.g., phenobarbital, valproic acid, gabapentin, carbamazepine, phenytoin etc.,
effect the chemicals in brain. Ephedra can also affects these chamicals. Therfore,
ephedra with anticonvulsants can decrease their effectiveness.
Anti-Diabetes drugs with Ephedra: Medications for diabetes e.g.,
glimepiride, insulin, pioglitazone, chlorpropamide, glipizide etc., lower blood
sugar levels. Ephedra on the contrary raises blood sugar concentration. Therefore,
taking ephedra with anti-diabetics can decrease their effectiveness.
Medications for Depression (MAIOs) with Ephedra: Ephedra bear chamical
agents that act as body stimulants. Some anti-depressants, e.g., phenelzine,
tranylcypromine etc., increase these chemicals. Therefore, taking ephedra with
anti-depressents can cause serious side effects like fast heartbeat, high blood
pressure, seizures and nervousness.
Ergot Derivatives with Ephedra: Ergot derivatives e.g., bromocriptine,
dihydroergotamine, ergotamine and pergolide, are known to increase blood
pressure. Ephedra can also raise blood pressure. Therefore, taking ephedra with
ergot derivatives can increase blood pressure to lethal state.
Continue…….

40. Dexamethasone with Ephedra: Dexamethasone is broken down by the body
for its removal. Ephedra can increase this breakdown process. Therefore, taking
ephedra with dexamethasone can decrease the effectiveness of druug.
Stimulant drugs with Ephedra: Stimulant drugs, e.g., diethylpropion,
epinephrine etc., exaggerate the nervous system and cause feeling of jitteriness
and elevated heartbeat. Ephedra also stimulates the nervous system. Therefore,
taking ephedra with stimulant drugs can give rise to serious problems, like
grater heart rate and high blood pressure.
Methylxenthines with Ephedra: Methylxenthines, e.g., aminophylline,
caffiene and theophylline, stimulate the body. Ephedra can potentiate the effects
of methylxanthines. Therefore, taking ephedra with methylxentines can produce
side effects like nervousness, fast heartbeat, high blood pressure and anxiety.
Continuous……..

41. Consumption of ephedra or its active ingrediants should be avoided as it is
unsafe for children as well as adults.
It is a very harmful drug or can put individual in disabling conditions.
Ephedra can cause high blood pressure, heart attacks, muscle disorders,
seizures, strokes, irregular heartbeat, loss of consciousness and even death.
These side effect is worsen if ephedra is taken in high doses or for long term.
Doses greater than 32mg/day may increase the risk of haemorrhagic stroke up
to three times
The serious side effects are of greater concern than any potential benefit.
Some minor serious side effects of ephedra are dizziness, restlessness, anxiety,
irritability, heart pounding, headache, loss of appetite, nausea and vomiting.
Continue…….