Neutraceuticals, Herb-drug & Herb-food inetractions

Mrs. Pradnya Wadekar Bapat
Assistant Professor
Appasaheb Birnale college of Pharmacy, Sangli

Nutraceuticals
 General aspects, Market, growth, scope and types
of products available in the market.
 Health benefits and role of Nutraceuticals in
ailments like Diabetes, CVS diseases, Cancer,
Irritable bowel syndrome and various Gastro
intestinal diseases.
 Study of following herbs as health food: Alfaalfa,
Chicory, Ginger, Fenugreek, Garlic, Honey, Amla,
Ginseng, Ashwagandha, Spirulina
3/14/2024 Mrs. Pradnya Wadekar Bapat, Asst Prof, ABCP, Sangli 2

Herbal-Drug and Herb-Food Interactions
 General introduction to interaction and
classification.
 Study of following drugs and their possible side
effects and interactions: Hypercium, kava-kava,
Ginkobiloba, Ginseng, Garlic, Pepper & Ephedra.

Nutraceuticals
 Greek Physician Hippocrates, Known as Father of
Medicine. (said several centuries ago) “Let Food be
Your Medicine & Medicines be Your Food” The
Philosophy behind is: “Focus on Prevention”.
 The term “Nutraceutical” was coined from “ Nutrition ” &
“ Pharmaceutical ” in 1989 by Stephen DeFelice MD,
Founder and Chairman of the Foundation for Innovation
in Medicine (FIM).
 Other words used in the context: Dietary supplements,
Functional food, Multi-functional Food, etc

 According to Dr. DeFelice , “Nutraceutical is any
substance that is a food or a part of food that
provides medicinal or health benefits including the
prevention and treatment of disease.”
 Canada redefined it as “a product isolated or
purified from the food generally sold in medicinal
form not assisted with food and demonstrated to
have a physiological benefit and provide protection
against chronic disease.”

 Different countries use different nomenclature for
nutraceuticals
 Canada: nutraceuticals are known as natural and non
prescriptional health products
 USA: Dietery products which include products containing
vitamins, minerals, herbs, amino acids & mos
 Europian union: Food supplements that cover the
concentrated sources of nutrients, substances with
nutritional or physiological effect
 Rusia: Biological active supplements that include mineral
substances, micro and macro elements, some amino
acids some mono and disaccharides, food fibres, mos
present in human body, vitamins, etc
 Japan: Food with health claims that includes food with
nutrient function claims and food for specific health use
 Australia: complementary medicines including herbal,
vitamin, mineral and nutritional supplements

 Nearly two thirds of the world’s 6.1 billion people
rely on the healing power of plant based materials
for many reasons-
 availability,
 affordability,
 safety
 their belief in traditional affordability,
 or belief in traditional cures.
 Medical benefits of food have been explored for
thousands of years Modern nutraceutical industry
began to develop during the 1980s.

 Reasons for growth in global market for
nutraceuticals:
 Cost of medical treatment and hospital has been
increased people prefer health supplements
and nutraceuticals for prevention and prophylaxis
 Malnutrition in developing countries
 Due to work culture , diet pattern and lifestyle is
also changing with increased stress

GLOBAL MARKET OVERVIEW AND GROWTH
OF NUTRACEUTICAL SEGMENT
 The nutraceutical market is predicted to record a revenue of USD 671.30
billion by 2024.
 Developing countries have a high prevalence of non-communicable
diseases like cancer, diabetes, cardiovascular ailments, etc, therefore the
demand for nutraceuticals is expected to rise in these nations.
 Nutraceuticals are also gaining global importance and have become a
part of daily diet due to increased risk of diseases due to improper life
style and people consciously adapting preventive healthcare measures.
 The gradually increasing healthcare expenses are also stimulating the
demand for nutraceuticals.
 Developed countries like United States and Europe have seen an fast
emerging segment of customised products especially functional foods
and beverages.
 Nutraceuticals have become an opportunity for economic growth of many
developing countries which have a rich source of medicinal herbs and
traditional knowledge of such plants, especially India, China and South
American countries.

SCOPE OF NUTRACEUTICALS
 Nutraceuticals are expected to deliver promising
outcomes in the prevention and occurrence of
various diseases resulting due to improper lifestyle
and food habits.
 Various constituent of plants like catechins,
carotenoids, lycopene, polyphenols, PUFA, etc
have been very effective in the prevention and
occurrence of various diseases like cardiovascular,
arthritis cancer, gastrointestinal disorders, etc.

TYPES OF NUTRACEUTICAL PRODUCTS AVAILABLE IN THE MARKET
FUNCTIONAL
FOODS
CEREALS
BAKERY & CONFECTIONARY
DAIRY
SNACKS
FUNCTIONAL FATS, OILS
BABY FOODS
FUNCTIONAL
BEVERAGES
ENERGY DRINKS
SPORTS DRINKS
FORTIFIED JUICES
DAIRY & DAIRY BEVERAGES
TEA, COFFEE
DIETARY
SUPPLEMENTS
VITAMINS
MINERALS
BOTANICALS
ENZYMES
FATTY ACIDS
PROTEINS PROTEINS
PROBIOTICS
PREBIOTICS

Nutra-
ceuticals
Polyunsaturated
fatty acid
Probiotics
Prebiotics
Dietary fibres
Antioxidants

Classification of nutraceuticals
 Inorganic mineral supplements
 Eg: calcium, magnesium, manganese, boron, copper, zinc,
phosphorous, etc.
 Antioxidants They are present in fruits, vegetables and
fishes. They are used to prevent the reactive oxygen species
and free scavenging radicals.
 Eg: Vit-E, C, A, Beta carotene.
 Poly unsaturated fatty acids (PUFA) These are fatty acids
which contain more than one double bond and include
essential fatty acids.
 Eg: Omega-3-fatty acids, safflower oil, corn oil, soyabean
oil, fish oil.

 Probiotics These are living microorganisms, which when taken
with or without food intestinal microbial balance and functioning of
large intestine,
 Eg: Bifidobacterium, Lac chilli, Saccharomyces cerevisiae, etc.
 Prebiotics These are non digestible substances that
provide beneficial effects and protection to the
probiotics from gastric acid and digestive enzymes.
They also promote the growth of probiotic bacteria.
 Eg Oligo fructose, Inulin, Galacto-oligosaccharides,
Lactulose.
 Dietary fibres They are two types viz:- water soluble
fibres and water insoluble fibres. They are present rats,
vegetables, grains, legumes, etc. They are used to
correct constipation, bowel irregularities, haemorrhoids.

Health benefits and role of nutraceuticals in
Diabetes
 Diabetes Diabetes mellitus is characterized by abnormally high
levels of blood glucose, either due to insufficient insulin
production, or due to its ineffectiveness.
 The most common forms of diabetes are type I diabetes (5%), an
autoimmune disorder, and type II diabetes (95%), which is
associated with obesity.
 Lipoic acid is an universal antioxidant, for the treatment of diabetic
neuropathy.
 It is possible that lipoic acid may be more effective as a long-term
dietary supplement aimed at the prophylactic protection of
diabetics from complications.
 Dietary fibers from psyllium have been used extensively both as
pharmacological supplements, food ingredients, in processed food
to aid weight reduction, for glucose control in diabetic patients and
to reduce lipid levels in hyperlipidemia
 Extracts of bitter melon and cinnamon have the potential to treat
and possibly prevent diabetes.

 Flavones are phytoestrogens
 Soy isoflavones have been proven to be useful in
diabetes type II, heart diseases, osteoporosis and
certain cancers
 Omega 3 fatty acids have been suggested to reduce
glucose intolerance in diabetic patients
 For synthesis of omega 3 fatty acid, insulin is required.
Ethyl esters of omega 3 fatty acid may be potentially
beneficial for diabetese
 However it has been suggested that Nutraceuticals with
meaningful doses of combinations may substantially
prevent and presumably could be marketed legally

Health benefits and role of nutraceuticals CVS
diseases
 Cardiovascular diseases (CVD) refers to group of
disorders of the heart and blood vessels and
include hypertension (high blood pressure),
coronary heart disease (heart attack), cerebro
vascular disease (stroke), heart failure, peripheral
vascular disease, etc.
 Majority of the CVD are preventable and
controllable.
 It was reported that low intake of fruits and
vegetables is associated with a high mortality in
cardiovascular

Nutraceuticals in cancer treatment
 The leading cause for death of adult is cancer.
 Treatment of cancer involves expensive and
traumatic use of drugs, surgery and irradiation.
 Nutraceuticals have the ability to control and
regulate the DNA damaging factors in cancer cells
and DNA transcription in tumors.
 The herbal-based dietary supplements (or
Nutraceuticals) known to antagonize therapy.
 The research says that phytochemical are proven to
be the potential to interfere even with the late- stage
cancer and altering the metastatic spread of cancer

 Numerous nutraceuticals have shown to regulate
specific tumour suppressor genes and cancer
driving genes.
 By utilizing a daily diet of Nutraceuticals, we can
inhibit the over- expressed oncogenes unique to
that form of cancer.
 There are many cellular mediators involved to be
manipulated from initial development of a single
cell, to invasion, angiogenesis, proliferation,

Phytochemical effective against cancer:
Polyphenoic compound: They act by inhibition of
carcinogenesis process and supress progression of cancer.
Eq.
 Epigallocatechin: present in green tea, have antitumor
properties.
 Resveratrol: It is used in treatment of cancer because 9f its
antiproliferative action. Present in grapes, Blueberries,
peanuts.
Flavonoid: It can affect the mRNA level of genes important in
cell cycle controll and apoptosis. Some favonoid like
genistien modulate topoisomerase II activity. It has strong
estrogen agonist activity and inhibit growth activity of breast
cancer cells.
Curcumin: Chemopreventive in nature. It act as antineoplastic
agent causing cell cycle arrest and induces apoptotic signals.

.
Vitamins and mineral: Vitamin A, C, E and trace elements
like selenium can prevent cancer. Ascorbic acid is reported
to induce apoptosis through cell cycle arrest. Appropriate
dose of supplements like vit. C, E and zinc, calcium
reduces the chance of thyroid, bladder and breast cancer.
capsacin: Use in treatment of ovarian carcinoma. It inhibit
growth and induces apoptosis of cancer cells.
lycopene: It inhibit proliferation of cells, use in t/t of prostate
, gastric and lung cancer.
Chestnut: Antioxidant in nature, used to treat gastric and
mild prostate cancer.
Ginseng: Used to treat various cancer such as colon, liver,
lung and breast being antioxidant in nature.

Nutraceuticals Bioactive
compound
Source Mechanism
Eugenol Cloves Inhibition of cell proliferation
Inhibition of cell proliferation
Diosgenin Fenugreek Supresses proliferation of
cancerous cells and inhibits NFκβ
activity
Piperine Pepper Inhibition of cell proliferation
Allicin Garlic Induces apoptosis
Beta-carotene, lycopene Tomatoes Induces apoptosis
Quercetin Black tea Induces apoptosis
6-gingerol Ginger Acts as anti-inflammatory and as
5-HT3 receptor antagonist
Limonene Citrus oils Has inhibitory effect on cell
migration on cancerous

Irritable bowel syndrome and various Gastro
intestinal diseases
 Inflammatory bowel disease (IBD) is a chronic
gastrointestinal disorder characterized by relapsing
inflammation and severe mucosal damage in the intestine
 There are two common forms of IBD, namely, ulcerative
colitis (UC) and Crohn’s disease (CD), which are generally
associated with diarrhea, nausea, abdominal pain, fatigue,
rectal bleeding, weight loss, anxiety, etc
 Prebiotics and probiotics appear to alter the gut microbiome
by increasing biodiversity and increasing the production of
butyrate, an anti-inflammatory and antineoplastic agent of
the gut.
 Fish oil acts as a direct anti-inflammatory agent as well as an
immune regulator.
 Curcumin and Boswellia both are anti-inflammatory agents
that act on a variety of receptors, and vitamin D affects cell
growth and immune system regulation.

Alfalfa
 BS- Medicago sativa family fabaceae
 Alfalfa is an herb.
 the leaves, sprouts, and seeds are used to make medicine.
 Alfalfa is used for kidney conditions, bladder and prostate
conditions, and to increase urine flow.
 It is also used for high cholesterol, asthma, osteoarthritis,
rheumatoid arthritis, diabetes, upset stomach, and a
bleeding disorder called thrombocytopenic purpura.
 Alfalfa is used as a source of vitamins A, C, E, and K4; and
minerals calcium, potassium, phosphorous, and iron. It is
used in High cholesterol.
 Taking alfalfa seeds seems to lower total cholesterol and
“bad” low-density lipoprotein (LDL) cholesterol in people with
high cholesterol levels. Kidney problems, Bladder problems,
Prostate problems, Asthma, Arthritis and Diabetes

 Chemical constituents: Raw alfalfa seed sprouts are
93% water, 2% carbohydrates, 4% protein, and
contain negligible fat.
 It is rich in chlorophyll, carotente, proteins and
minerals.
 Vit B, C, D, E and K

Chicory

Chicory
 Synonym: Achicoria, Barbe de Capucin, Blue Sailors
 Biological source: It is a perennial herbaceous plant
consists of seeds, roots, n dried, above-ground parts of
Cichorium intybus Linn belonging to family Asteraceae
 Constituents: Raw chicory leaves are 92% water, 5%
carbohydrates, 2% protein, and contain negligible fat. In
a 100 gram reference amount, raw chicory leaves
provide 3 calories and significant amounts (more than
20% of the Daily Value) of vitamin K vitamin A, vitamin
C, some B vitamins, and manganese. Vitamin E and
calcium an present in moderate amounts. Raw endive is
94 % water and has low nutrient content.

 Health benefits:
 Chicory root is rich in inulin fiber which is a dietary fiber. Inulin is
also a prebiotic
 Inulin is a soluble fiber that holds water, it can be used as a low-
calorie option to replace fat in certain recipes. There are some
studies that say that chicory can help lower blood sugar and treat
diabetes as well. Soluble fiber in general is known for its ability to
decrease the glycemic index in foods and lessen inlles resistance.
 It can improve. digestive health
 Chicory contains manganese and vitamin B6,
 Manganese is a vasodilator with anti-oxidative properties that
helps to improve blood flow to the brain as well as fight free-
radicals. It can also increase the speed that electrical signals pass
through the brain to improve overall brain function.
 Chicory has anti-inflammatory qualities that help to treat
osteoarthritis and to reduce pain.
 Chicory root extracts may improve skin barrier function. They may
also treat the dryness that accompanies the aging process
 Chicory extract can protect the liver from oxidative damage.
 Chicory can help prevent renal injury and help to treat kidney
disorders

Ginger
Synonym: Sunthi,
Biological source: It consists of rhizome obtained from Zingiber
officinale belonging tofamily Zingiberaceae
Chemical Constituents: Raw ginger is composed of 79 % water,
18% carbohydrates, 2% protein, and 1% fat.It conatins
moderate amounts of vitamin B6 and the dietary minerals,
magnesium and manganese, but otherwise is low in nutrient
content. Ginger oil contains zingiberine, bisaboline, curcumene.
Resins contain phenolic keteones such as gingerols, shogoals,
zingerone and other compounds. Ginger is commonly used for
various types of "stomach problems," including motion
sickness, morning sickness, colic, upset stomach, gas,
diarrhea, irritable bowel syndrome (IBS), nausea, nausea
caused by cancer treatment, nausea caused by HIV/AIDS
treatment, nausea and vomiting after surgery, as well as loss of
appetite.

Health benefits:
 Ginger has a very long history of use in various forms of traditional and
alternative medicine. It's been used to aid digestion, reduce nausea and
help fight the flu and common cold, to name a few of its purposes.
 Gingerol is the main bioactive compound in ginger. It's responsible for
much of ginanti-inflammatory and antioxidant ger's medicinal properties.
Gingerol has powerful effects certain types of
 It may help relieve nausea and vomiting for people undergoing surgery.
 It may help for weight loss
 It help to treat osteoarthritis which involves degeneration of the joints in
the body, leading to symptoms such as joint pain and stiffness.6. Its
lower blood sugars and improve heart disease risk factors
 It helps to treat chronic indigestion
 One of the traditional uses of ginger is for pain relief, including menstrual
pain.
 It helps to lower cholesterol levels
 Ginger has been used as an alternative remedy for several forms of
cancer.
 It improves brain function and protect against Alzheimer's disease
 Gingerol I can help lower the risk of infections, as it helps to inhibit
growth of many bacteria.

Fenugreek
 Source: It consists of seeds of the plant Trigonella foenum-
graecum, belonging to the Family: Leguminosae.
 Chemical Constituents
 It contains alkaloids (Gentiamine, Trigonelline), flavonoids,
coumarins, proteins, amino acids and steroidal saponins.
 Uses
 Demulcent
 Laxative
 Nutritive
 Expectorant
 Used in the treatment of anorexia, dyspepsia, gastritis,
diabetes and high cholesterol

Garlic
 Source
 It consists of dried bulbs of Allium sativum, belonging to the Family:
Liliaceae.
 Chemical constituents
 Garlic contains, carbohydrates, proteins, fats, mucilage, volatile oils
and minerals. The volatile oil contain allin, allicin, allyl propyl disulfide,
diallyl disulfide. Minerals contain phosphorous, iron and copper.
 Uses
 Carminative
 Aphrodisiac
 Expectorant
 Stimulant
 Disinfectant.
 Anthilmintic
 Antibacterial.
 Antihypertensive.
 Hypocholestremic

Honey
 Source: Honey is a sugar like secretion deposited in
honeycomb by the bees Apis mellifera, A dorsata
and other species of Apis, belonging to the Family:
Apidae.
 Honey is an aqueous solution containing 35%
glucose, 45% fructose and 2% sucrose.
 Uses
 It is used as demulcent sweetening agent,
nutrient, antiseptic and expectorant

, Amla
 Source: It consists of fruits of the plant Emblica
officinalis and Phyllanthus emblica, belonging to the
Family: Euphorbiaceae
 Chemical constituents:
 It contains Vitamin-C (ascorbic acid), calcium, iron
and phosphorous
 Uses
 It is used as Diuretic, Laxative.
 Used in the treatment of Anaemia, Diarrhoea,
Jaundice
 Fruits are used to prepare shampoos and hair oils.

Ginseng
 Source: It consists of roots of the plant Panax ginseng
and other species of Panar, belonging to the Family:
Araliaceae.
 Chemical constituents:
 Ginseng contains saponins, glycosides, volatile oils,
sterols, polysaccharides, minerals, vitamin-B.
pantothenic acid and biotin.
 Uses
 It is used as adaptogenic.
 It relieves stress and fatigue.
 Used in hypertension, diabetes, psychogenic
impotence and child psychiatric disorders.

Ashwagandha
 Source: It consists of dried roots and stem bases of the plant
Withania somnifera, belonging to the Family: Solanaceae,
 It contains alkaloids and steroidal lactones. Alkaloids
contain withanine, somniferine. somnine, tropine, two acyl
steryl glucosides sitoindosine-7 and sitoindosine-8
 Uses
 Sedative.
 Hypnotic.
 Hypotensive.
 Respiratory stimulant.
 Immunomodulatory agent
 Anti-stress agent
 Anti-arthritic.

Spirulina
 Source:It is blue green algae obtained from Spirulina
maxima or Spirulina platensis, belonging to the Family:
Oscillatoriaceae.
 It contains 50-70% proteins, 5-6% lipids. Lipids contain
essential fatty acids like linoleic acid, oleic acid, palmitic
acid. It also contains glycolipids and sulfolipids, various
vitamins like vitamin-B1, B2, B3. It contains iron and an
enzyme superoxide dimutase which has free radical
scavenging effects and help full in atherosclerosis,
arthritis, diabetes, cataract stress and aging.
 Uses
 Immune stimulant
 Anticancer Antiviral
 Hypocholestremic.
 Appetite stimulant.

Herbal-Drug and Herb-Food Interactions
 Herbal medicine include herba drug as dry powders or
in form of extract along with exciepients
 There is misbelief that natural drugs are safe and
devoid of toxicity.
 Herbal medicines also can cause adverse drug
reaction, which are many time not reported or
recognized by patient due to negligance.
 Interaction- is said to occus when the effect of one drug
is changed by presence of another substance, including
herbal medicine, foo, drink, environmental and chemical
agents.
 As a result reduced efficacy of dru or enhanced toxicity
of drug is observed

Type of interactions
1) Herb-Herb interaction: @ herbs consumed together ↑ or↓
pharmacological activity of individual drug or ↑ or↓ toxicity of of
individual drug .
Piper betel is contraindicated while taking Garcinia morella,
Basella alba (velbhendi) along with Sesamum indicum
2) Herb-Food interaction:
wine with steamed grains, Radish with milk
3) Herb-animal origin drug interaction:
Pork is contraindicated with Narikelataila (oil of Coccus
nucifera), Equal quantity of Madhu (Honey) with Grutha (Ghee) is
contraindicated and this has been proved to produce toxic effect by
combination
4) Disease related interaction:
Haritaki (Terminalia chebula) contraindicated in pregnancy,
malnourished, anorexia after bloodletting, Ephedrine-containing
herbal products have been associated with adverse cardiovascular
events, seizures and even death

CLASSIFICATION OF HERB-DRUG/ HERB- FOOD
INTERACTIONS
PHARMACOKINETIC
• Alter ADME of individual
of both drugs compared
with expected behavior of
each drug/herb/food
when taken individually
• They occur due to
modification in
concentration of drug
• Herb-drug or herb-food
can have same or
different effects in the
organism
PHARMACODYNAMIC
• Related to action of herb
and drug
• Interactions can be
predicted
• Antagonism or
Synergism is observed
• It can further be classified
into additive, synergistic
or antagonistic

EFFECTS OF HERBS ON PHARMACOKINETICS
Increased Decreased
Absorption Ginger Green
Tea Black
Pepper
Fibres, Mucilage
herbs
Metabolism Guggul Grape fruit
Excretion Laxative Diuretic
herbs
Liquorice

EFFECT OF HERBS ON PHARMACODYNEMICS
 Additive effect: D (A,B)=A+B
 Anticoagulant with Gingko biloba
 Synergistic effect: D (A,B)>A+B
 Hypoglycemic drug + Gymnema sylvestre.
 Antagonistic effect: D (A,B)< A+B
 Fluphenazine –Procyclidine (Anticholinergic drug
used in parkinsonism) + betel nut

Herb- drug and herb-food interactions
 Allopurinol + low protein diet &/or Lack of fluids
Eating a low protein diet while on this medication
will result in higher blood levels of this medication. It
is advised to drink plenty of fluids
 Antacids (Aluminum / Magnesium hydroxide /
Simethicone, Aluminum carbonate basic, Aluminum
hydroxide) + high protein diet  High protein meals
may lead to a decrease in the neutralizing capacity
of the antacid
 Calcium channel blockers (Felodipine, Nifedipine,
Amlodipine)+ grapefruit juice higher than desired
blood levels of the medications

 Carbamazepine or Cyclosporine or Cisapride +
grapefruit juice higher than desired blood levels of
the medications
 Cephalosporins (Cefotetan ,Cefoperazone,
Cefamandole, Cefmetazole, Moxalactam) or
Furazolidone or Metronidazole + alcoholic
beverages/ cough syrups containing alcohol
“disulfiram reaction” characterized by flushing,
vomiting, very fast breathing , and very fast heart
rate
 Doxycycline + dairy products and food and drugs
high in calcium, magnesium, or iron lower than
desired doxycycline blood levels

 Iron (Ferrous sulfate/ Ferrous gluconate) + foods high in
Vitamin C  increased absorption of iron in body
 Iron (Ferrous sulfate/ Ferrous gluconate) + dairy
products  reduced absorption of iron in body
 Fluoroquinolones (Ciprofloxacin, Levofloxacin,
Gatifloxacin, Sparfloxacin) + calcium-rich foods,
mineral supplements, and caffeine reduced
absorption of drug in body
 Furazolidone + tyramine containing foods like cheeses,
aged meats, smoked or pickled fish, yeast, red wine,
beer (alcoholic and non-alcoholic), figs, avocados,
bananas, caffeine, chocolate and the herbal product
ginseng flushing, chills, increased blood pressure,
increased heart rate, abnormal heartbeats,
restlessness, and insomnia.

 Oral diabetic agents (Chlorpropramide, Glimepiride,
Glipizide, Glyburide)+ alcoholic beverages 
disulfiram reaction
 Tetracycline + dairy products and food and drugs
high in calcium, magnesium, or iron reduced
absorption of iron in body
 Warfarin + Vitamin K rich foods like Dark green
leafy vegetables, spinach, kale, broccoli, lettuce,
turnips cabbage, green tea, brussels sprouts,
soybean & vegetable oil, beef liver, raw
cauliflower may alter the blood thinning response
you will have to the drug warfarin.

Hypericum
 St. John's wort
 BS- plants belonging to family Hypericaceae
 It is considered poisonous to livestock.
 H. perforatum is the most commonly used species
especially in Europe as an herbal substitute
for prescription drugs to treat depression, and is also
sold as a dietary supplement.
 It is used topically to heal wounds and to treat the skin
irritation caused by psoriasis
 It is also used to treat attention deficit hyperactivity
disorder, social anxiety, hepatitis, irritable bowel
syndrome, diabetic nerve pain or burning mouth
syndrome
 Asthma, allergic medicine
 Cough or cold medicine

DO NOT TAKE/USE WITH CAUTION INTERACTION
Avoid tyramine containing foods
such as aged cheeses, sour cream,
yogurt, liver (beef or chicken),
smoked or pickled fish, yeast, red
wine, beer (alcoholic and non-
alcoholic),soy sauce, broad beans,
avocados.
Interaction causes symptoms
associated with a histamine release
reaction resulting in flushing, chills,
hypertension, tachycardia,
palpitations, restlessness, and
insomnia
Prescription antidepressants (i.e.
Monoamine Oxidase Inhibitors,
Selective Serotonin Reuptake
Inhibitors, and other antidepressant
medications)
There is some concern that
prescription antidepressants taken
together with St. John’s wort could
interact with each other and lead to
adverse side effects including

Use caution with Digoxin,
Theophylline, & Amitriptyline
Concomitant administration may lead to
decreased serum concentrations of these
agents. Monitor serum drug
concentrations for efficacy/toxicity. Avoid
combination of Indinavir and St. John’s
Wort.
Use caution with Warfarin Concomitant administration may lead to
lowering of the INR
Use caution with oral
contraceptives
Reports of breakthrough bleeding have
been identified with concomitant
administration

Ginkoba biloba
 Some people use it for other problems related to poor blood
flow in the body leg pain when walking claudication) and
Raynaud's syndrome (a painful response to cold, especially
in the fingers and toes).
 including Ginkgo leaf is also used for thinking disorders
related to depression, Lyme disease and chemotherapy.
•Ginkgo leaf is often taken by mouth for
memory disorders .
• It is also used for conditions like
Alzheimer's disease & memory especially
in older people.
•It conditions include, dizziness, vertigo,
ringing in the ears, headache,
loss/difficulty in concentrating, mood
disturbances, and hearing disorders.
BS: leaves of Ginkgo
biloba
Family: Ginkgoaceae.

Interaction
 May ↑ bleeding with anticoagulants like aspirin,
clopidogrel, diclofenac, ibuprofen, naproxen,
dalteparin, enoxaparin, heparin, warfarin
 May ↑ activity and side effects of MAO inhibitors
 Increases blood pressure when combined with a
thiazide diuretic and even caused coma
 Increases the digoxin plasma levels

DO NOT TAKE/USE WITH
CAUTION
INTERACTION
Use caution with antiplatelet
agents, Warfarin, and Vitamin
E.
Aspirin + Gingko ® increased
inhibition of platelet
aggregation.
Gingko acts as blood thinner and
therefore the use of this agent with
other blood thinning agents could
increase the risk for stroke or
excessive bleeding. Monitor
PT/INR values.

Kava kava
 a root found on-kavakava or-
Kava South Pacific islands.
 Kava has a calming effect:
may relieve anxiety,
restlessness, sleeplessness,
and stress-related symptoms
such as muscle tension or
spasm.
 Kava also can prevent
convulsions and relax
muscles.

Interaction
 Kava has caused liver failure in previously healthy people.
 You should not use kava for longer than 3 months without
consulting your doctor.
 Long-term kava use may result in: problems.Liver- -
Shortness of breath (reversible). (reversible).rash,
scalyhair,skin, Facial puffiness or swelling (reversible).
 Before you use kava, consider that it: Should not be
combined with alcohol or psychotropic medicines.
 Alcohol exaggerates kava's sedating effect.
 Can affect how fast you react, making it unsafe to drive or
use heavy machinery.
 May gradually be less powerful as you use it.
 Eventually may cause temporary yellowing of and nails.
 Can cause an allergic skin reaction (rare).

Alcohol, Antianxiety agents,
Anti-Parkinson’s
Medications, Hypnotics,
Muscle relaxants and
Sedatives
Kava Kava can potentiate the effects
of agents that depress the central
nervous system, causing over-
sedation and coma. It may also
induce tremors, abnormal
movements, or muscle spasms that
may decrease the effectiveness of
anti-Parkinson’s medications or may
potentiate the extrapyramidal
movements seen with antipsychotic
medications.

Ginseng
 Roots of Panax ginseng (Korean ginseng), Panax
notoginseng (South China ginseng), and Panax
quinquefolius (American ginseng) belonging to
family Araliaceae
 Uses:
 Immunomodulator
 Both stimulant and sedative properties
 Useful in adrenal and thyroid dysfunction
 In gastritis and aneamia
 As aphrodiasic
 Externally in cosmetics

 Interaction :
 The body breaks down alcohol to get rid of it. Taking
Panax ginseng might increase how fast your body gets rid
of alcohol.
 Taking Panax ginseng along with caffeine might cause
serious problems including increased heart rate and high
blood pressure.
 Taking Panax ginseng along with insulin might cause your
blood sugar to be too low.
 Some medications used for depression like phenelzine
(Nardil), tranylcypromine (Parnate) with ginseng might
cause too much stimulation. This might cause side effects
such as anxiousness, headache, restlessness, and
insomnia.
 Panax ginseng might decrease blood sugar. Taking Panax
ginseng along with diabetes medications might cause your
blood sugar to go too low.

CAUTION
INTERACTION
agents and Warfarin,
Phenelzine, Digoxin
Ginseng may interact with Warfarin by
decreasing the efficacy of Warfarin or
reversing the drug’s effects. Monitor
PT/INR values.
Combined use may lead to psychoactive
stimulation; avoid coadministration.
May interfere with Digoxin activity or
monitoring

 Ginseng is contranindicated with some medications
that decrease the immune system include
azathioprine, basiliximab, cyclosporine,
prednisone, corticosteroids as it stimulates immune
system
 May slow down blood clotting with anticoagulants
like aspirin, clopidogrel, diclofenac, ibuprofen,
naproxen, dalteparin, enoxaparin, heparin, warfarin

Garlic
 Garlic is the ripe bulb of Allium sativum Linn., belonging to
family Liliaceae.
 Garlic is carminative, aphrodisiac, expectorant, stimulant,
and used in fevers, coughs, febrifuge in intermittent fevers,
respiratory diseases such as chronic bronchitis, bronchial
asthma, whooping cough, and tuberculosis.
 It is also used in atherosclerosis and hypertension.
 In Germany, garlic is consumed as a complement in the diet
of hyperlipidemic patients and for the prophylaxis of the
vascular changes induced by ageing.
 The garlic can cause gastrointestinal distress and alters
breath and skin odour. Garlic or its constituents exhibit
various biological activities, such as antibacterial, antifungal,
antiviral, antitumor, and antidiabetic effects.

 Hypotension with ACE inhibitors (prils).
 With antiplatelet drugs, it increases risk of bleeding.
Itself antiplatelet.
 Reduces the metabolism of chlorzoxazone.
 May ↑ bleeding times with anticoagulants
 ↓ blood levels and toxicity of protease inhibitors like
ritonavir, indinavir….etc

CAUTION
INTERACTION
agents (aspirin) and
warfarin
Garlic (therapeutic doses) reduces
platelet aggregation and increases
fibrinolytic activity, therefore monitor
bleeding times and PT/INR in patients on
antiplatelet agents and warfarin
Use caution with Blood
pressure medications
Garlic decreases blood pressure and
therefore may potentiate blood pressure
medications

Pepper
 BS: Black pepper is the fruit of Piper nigrum from the
Piperaceae family and is used as both a spice and a
medicine.
Uses:
1. Carminative.
2. Stomachic.
3. Stimulant
5. Antiarthritis
6. Antimalerial
7. Useful in sore throat, piles and dyspepsia
8. Useful in treatment of gonorrhea and chronic bronchitis.

 Interaction:
 Black and white pepper might decrease how quickly
the liver breaks down some medications lovastatin,
ketoconazole, Itraconazole, chlorzoxazone etc.
 It will decrease the action of antacids
 The black pepper majorly shows interaction and
increase the AUC of The drugs are:Phenytoin,
Carbamazepine, tranquilizers in healthy volunteers
Propranolol (Inderal), Rifampin, Theophylline in
patients with pulmonary tuberculosis.

Ephedra
 Ephedra consists of the dried aerial parts of Ephedra
gerardiana Wall, Ephedra sinica Stapf, Ephedra
equisetina Bunge, Ephedra nebrodensis Tineo and
other Ephedra species, belonging to family
Ephadreaceae.
 Uses: Ephedrine is antiallergenic, antiasthmatic,
antispasmodic, decongestant, cough suppressant,
stimulant and vasoconstrictor.
 Pseudoephedrine is decongestant, cough
suppressant and norpseudoephedrine is peripheral
vasodilator used to treat angina.
 As a whole it is decongestant; it opens sinuses,
increases sweating, dilates bronchioles (antiasthmatic
use), diuretic, CNS stimulant, raises blood pressure,
alleviates aches and rheumatism, alleviates hay
fever/colds, etc.

Interaction
 Medications that can cause an irregular heartbeat (QT
interval-prolonging drugs) like amiodarone,
disopyramide, dofetilide, ibutilide, procainamide,
quinidine, sotalol, thioridazine, and many others
interacts with EPHEDRA
 Taking ephedra along with methylxanthines like
aminophylline, caffeine, and theophylline might cause
side effects such as jitteriness, nervousness, a fast
heartbeat, high blood pressure, and anxiety.
 Taking ephedra along with dexamethasone (Decadron)
might decrease the effectiveness of dexamethasone
(Decadron).
 Taking ephedra with ergot derivatives might increase
blood pressure too much.

 By increasing blood sugar, ephedra might decrease
the effectiveness of diabetes medications.
 MAO
 Medications used to prevent seizures
(Anticonvulsants) interacts with EPHEDRA and
reduce its effectiveness

DO NOT TAKE/USE WITH CAUTION
WITH:
INTERACTION
Caffeine, Decongestants
(Pseudoephedrine or
Phenylpropanolamine), Weight
loss agents (containing
Phenylpropanolamine)
Taking Ephedra with other
stimulants can increase the risk of
hypertension, arrhythmias,
nervousness, heart attack, or
stroke
MAO inhibitors There is a possible risk of
hypertension or coma

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