Herbal drugs can interact with pharmaceutical drugs in the body, altering their kinetic and dynamic properties. About 5-20% of people worldwide use herbal medicines. Herbal drugs can interact through pharmacokinetic or pharmacodynamic mechanisms. Evidence for interactions comes from animal studies, clinical trials, and case reports. Reasons for interactions include a lack of knowledge about combinations and the potent active ingredients in herbal supplements. Some herbs like garlic, ginger, green tea, and St. John's wort can interact with drugs like anticoagulants, antihypertensives, antidiabetics, and antidepressants. Pharmacists have an important role in advising about and monitoring for potential herb-drug interactions.

1. HERBAL DRUG
INTERACTIONS
UNDER THE GUIDANCE OF PRESENTED BY
P.SUNITHA A.RAVITEJA
B.PHARMACY
IIIRD YR

2. HERBAL DRUG INTERACTIONS
Introduction
 Herbal drugs are mixture of more than one active ingredient.
 When Herbal Drugs and Pharmaceutical drugs are administered together may interact with
each other in body leading to Kinetic and Dynamic alterations.
 Herbs are often administered in combinations with therapeutic drugs raising the Potential
herbal drug interactions.
 An overview of World people 5 – 20% are using the Herbal medicines Or Drugs, because
of
Naturally available
consideration of safe to use
Readily Available over the Counter

3. Herbal Drug interactions
Pharmaco Kinetic Action
• Modify metabolic Pathways in body.
• Mainly occurs in
Gastro Intestinal Tract
Kidney
Liver
Pharmaco Dynamic Action
* Related to action of Herb and Drug.
* Interaction Can be Predicted.
Antagonism
Synergism

4. Evidence For Interactions
Adverse events and drug interactions caused by Herbal Or
Traditional medicines the study of
 Animal study
 Controlled trail
 Single case report
 Multiple case report

5. Reasons for Herb Drug interactions
Clinical lack of adequate Knowledge of Combinations.
Herbal Supplements from Plants sources having the active
ingredients should still be Potent.
No advancement in researches.

6. Garlic
• Garlic contain Active constituent “Allicin”
Basis of concern
•At high doses Blood pressure and maintains the cholesterol level.
• Lead toxicity, prevent the Alzheimer’s disease.
Adverse Reactions
•May Bleeding times with anticoagulants.
• Blood levels and toxicity of Protease Inhibitors(PI’s)like Indinavir, Ritonavir
Some of Herbs Adverse Reactions

7. Ginger
 Ginger contains “gingeberen” constituents
Basis of Concern
 Helps in normal blood circulation
 Remedy for motion sickness and improves absorption in GIT
 It used treat the Colon Cancer and Ovarian cancer
Adverse Reaction
 Effect of antacids
 High blood pressure (Ca+2 channel blockers) interacts with Ginger
• Blood sugar levels, Insulin, chloropromide, Tolbutamide
• React with Other drugs Verapamil, Felodipine, Amlodipine.

8. Green Tea
it has Strong Oxidising agent, flavonoids, Epigallocatechin Gallate
Basis of Concern
 Various bioactive compounds present in Green tea can improve health and lower the risk of Obesity
 L-theonine amino acid can improve he Brain function and makes you Smart
 Reduce the risk of various types of Cancer and Type II diabetes.
Adverse Reactions
 Large amounts may the side effects of Theophylline
 Green tea and Aspirin should not be mixed because they both prevent the Platelets from clotting
 the effect of coronary Vasodilatory Drugs.

9. Turmeric
Basis of concern
 Curcumins of turmeric extracts can cure the Brain tumours
 Curcumins can able to treat the some types of Retinitis pigmentosa of eyes
 Acts as anti-inflammatory, natural pain killer and anti-septic
Adverse Reaction
 the activity of antacids
 Actively participate in blood Glucose level, when taken with anti-diabetic drugs that cause the risk of
low blood sugar levels
 Increase the blood thinning effects with warfarin.

10. Grape Juice
Basis of concern
 Boost the immunity, delay the ageing signs
 Cures the digesting and bowels disorder
 Resveratrol constituent prevents the cancer cells
 Increase the bone strength and maintain cholesterol levels
 Reduces the chances of heart attack
Adverse reaction
• the oral bio availability
• the GIT absorption and bioavailability of statins like Levostatin
• total body metabolic rate.

11. Black Pepper
Basis of concern
• the anti-biotic and anti-bacterial property
• Increase Free radical killing action that stops cancerous activities in body
• Acts like spice in foods and has anti-depressant activity
Adverse reactions
• Black and white pepper decrease how quickly the liver breaks down some medication
*Levostatin
*ketoconazole
*intraconazole
• It will the activity of the antacids
• Black pepper majorly shows interaction increase the AUC of the drugs are
*Phenytoin
*carbamazepine
*propranolol
*rifampicin

12. Cinnamon
Basis of concern
 Anti-microbial agent, mood enhancer
 In arthritis massage therapy and prevents leukemia and
lymphoma cancer
 Used as insect repellent
 Cures &prevents the yeasts infections
 Cinnamon fights with E.coli bacteria in unpasteurized juices
Adverse Reactions
 Taking cinnamon bark along with diabetes medications might cause your blood sugar level to low levels
Like drugs *Glimepride
*insulin
 the risk of toxicity
 Medications that can harm the liver interacts with cinnamon
*carbamazepine
*methyldopa, isoniazid.

13. Clove Buds
Basis of concern
 Cares skin and Gums of teeth
 Used as perfumery agent and flavouring agent
 Clove oil is used for massages and antiseptic
 Expectorant
Adverse Reaction
 Eugenol can increase the blood clotting
 It may the bleeding time with drugs such as Warfarin and Heparin, Aspirin
 In Children the effects of antiepileptic drugs as Phenytoin by damaging liver and kidney.

14. Cayenne
Basis of concern
 Anti-inflammatory, anti-irritant property
 Digestive aid, Prevent migraine Headache
 Maintain the saliva secretion in oral
 Used to treat the snake bite, rheumatism & wounds
Adverse reaction
 Causes the skin irritation and increases the bleeding time with anticoagulants
 Capsicum increases the side effects of cocaine including heart attack and death
 Taking orally for long time lead too severe damage to liver and kidney.

15. Yohimbine
Yohimbe is a Ever green Plant from this Yohimbine is synthesized
Basis of concern
 Yohimbine is “Aphrodisiac” (to stimulate sexual desire)
 Treat the conditions like
*Erectile dysfunction *High B.P
*Chest pain *Depression
Adverse Reaction
 Do not take Yohimbine with MAO inhibitors
*Phenelezine
*Tranylcypromine
 Medications for depression (TA Depressants)also interact With Yohimbine
 Contraindicated with Stimulant drugs Because both will enhance the Heart rate and high B.P.

16. St’s John’s Wart
Hypericum perforatum is the source of St. Johns wort active
constituent “Hypericin”
Basis of concern
 Mainly used to treat Depression and anxiety
 St. John’s wort with Black cohosha can improve the Menopausal symptoms such as hot flashes
Adverse Reactions
 St. John’s wort can increase how quickly body gets rid out of some medications this can cause those drugs less
bioavailable to body
*Alprazolam
*Amitriptyline
 St. John’s wort can interact with the Narcotic drugs and HIV/aids drugs
 Decrease the absorption of drug into body lead to less decrease in effectiveness by some drugs like Digoxin
 It can interact with MAO inhibitors, TCA’s

17. Aloe Vera
Basis of concern
 Aloe Vera juices has alkaline properties so it maintains the pH of hair and scalp
 Used for mainly bowel problems and as high anti-inflammatory
 Aloe Vera gel is highly beneficial for treating the sun burns and Acne
 Anti-histamine property can reduce the problem of sinus and chest pains
Adverse Reaction
 Aloe itself lower blood glucose levels, so it should not take with the anti diabetic drugs (Glyburide)
 It enhance ability of Hydro cortisone to reduce Swelling
 Digoxin and Diuretics don’t take in combinations with aloe gel because they lead to dangerously low levels
potassium (K+) of this important mineral

18. Azadi Rachta Indica
Basis Of concern
 Neem leaf extract treat Dental plaque
 Neem bark will treat the peptic ulcers
 Cures the psoriasis and used as insect repellent
Adverse Reaction
 For longer periods of time it possibly unsafe, it might harm the Kidney and Liver
 Reduced ability to have children(infertility)
 Neem can lower the blood sugar level, so it will interact with anti-diabetic drugs like
*Glyburide
*Glimepride

19. Tulsi
Basis of concern
 Used as nerve tonic and sharpen the memory
 By taking juice of leaves with honey cures the Kidney stones by expelling them in urinary tract
 Reduces blood cholesterol levels in heart and anti-stressing agent
Adverse Reaction
 It will increase the blood clotting time
 Increase the drowsiness with Pheno barbitone
 Stop taking the juice of leaves Or tulsi before going to scheduled surgery, because lead to
increase in bleeding time.

20. Pharmacists Role
Advising
Monitoring
* Reporting issues.

21. Conclusion
Health care professionals and pharmacists have to play
an important role in giving advisory knowledge on
monitoring concurrent use of herbal and conventional
medicines and to collect data for suspected herb-drug
interactions.
We need to bring into lime light about the
herb – drug interactions

22. Thank you