Hawthorn Berries And Ginkgo Biloba Drug Interactions

Hawthorn Berries And Ginkgo Biloba Drug Interactions – Despite the lack of sufficient information on the safety of herbal products, their use as alternative and/or complementary medicine is popular worldwide. There is also growing interest in medicinal herbs as precursors of pharmacologically active substances. Concomitant use of herbal products and conventional medications is a significant concern. Herb-drug interactions (HDIs) are the single most important clinical outcome of this practice. Using a structured assessment procedure, evidence of ADI is presented with varying degrees of clinical significance. Although the HDI potential for a number of herbal products is derived from nonhuman studies, some HDIs are well established through human studies and documented case reports. Various mechanisms of pharmacokinetic AD have been identified and include changes in gastrointestinal function that affect drug absorption; induction and inhibition of metabolic enzymes and transport proteins; and changes in the renal excretion of drugs and their metabolites. Due to the intrinsic pharmacological properties of phytochemicals, the occurrence of pharmacodynamic ADI is also known. Effects may be synergistic, additive, and/or antagonistic. Poor reporting by patients and the inability of health care providers to promptly detect AIDs have been identified as major factors limiting the large-scale collection of clinically relevant AIDs. An overview detailing the underlying mechanism and nature of the available evidence and the importance of pharmacokinetic and pharmacodynamic ADI is provided. There is a need to increase awareness of ADI among health professionals and drug discovery scientists. Due to the increasing number of pharmacologically active substances of plant origin, the potential for ADI should always be assessed during the non-clinical safety evaluation phase of the drug development process. More clinically relevant research is needed in this area, as current information on HDI is insufficient for clinical use.

Consumption of medicinal herbs and herbal products is increasing worldwide, both in developing and developed countries (Cheng et al., 2002; Bodeker, 2007; Mitra, 2007). Medicinal plants have been the main agents of primary health care for many centuries before the advent of modern medicine (Sheeja et al., 2006). However, their use has declined in most developed western countries during the industrialization and urbanization of the last century (Ogbonnia et al., 2008). The past two decades have seen a resurgence in the consumption of medicinal plants. According to the World Health Organization, approximately 70% of the world’s population currently uses medicinal herbs as complementary or alternative medicine (Wills et al., 2000). More than 40% of American adults consume herbal products for one medical reason or another (Tachjian et al., 2010). A recent study of 2,055 US patients found no significant gender or social differences in traditional medicine consumption patterns (Kessler et al., 2001). Consumption levels have been particularly exponential in Canada (Calixto, 2000), Australia (Bensoussan et al., 2004), as well as in Europe (Capasso et al., 2003), where the highest sales of herbal products are reported in Germany and France. ). In Africa, there are continuous additions to the list of medicinal herbs, and the level of consumption is also increasing. Between 60-85% of Africans use herbal medicines commonly in combination (Van Wyk et al., 2009).

Hawthorn Berries And Ginkgo Biloba Drug Interactions

Indications for herbal remedies vary as they are used to treat many ailments (Ernst, 2005). Research shows that 67% of women use herbs for perimenopausal symptoms, 45% use them during pregnancy, and more than 45% of parents give their children herbal remedies for various medical conditions (Ernst, 2004). Regulations in many countries do not require demonstration of therapeutic efficacy, safety or quality of herbal medicines, as most are promoted as natural and harmless (Khomsi et al., 2004; Routledge, 2008). However, it is reasonable that herbs are not without side effects, as some are toxic (Desiga-Campos et al., 2007; Patel et al., 2011). A recent study showed a common pattern of concurrent use of herbs and prescription drugs. Kaufman et al. (2002) reported that 14-16% of American adults consume herbal supplements concurrently with commonly prescribed medications. Also, 49.4% of Israeli herbal users use them with prescription drugs (Giveon et al., 2004). This is important considering that less than 40% of patients disclose their use of herbal supplements to their health care providers and many physicians are unaware of the potential risks of herb-drug interactions (HDI; Klepser et al., 2000). ).

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HDI is one of the most important clinical concerns in the concomitant use of herbs and prescription drugs. The need for polypharmacy in the treatment of many diseases further increases the risk of AHD in patients. In addition to being responsible for the poor oral bioavailability of many drugs, the ability of CYPs in the gut and liver to metabolize many structurally unrelated compounds is responsible for a large number of documented drug-drug and drug-food interactions (Quintieri et al., 2008). . Given that oral delivery of this drug is most widely used in the treatment of many diseases, drug interactions in this case change both the bioavailability and pharmacokinetic disposition of the drug. This variation in plasma drug concentrations and the resulting poor control is a concern, especially for drugs with a narrow therapeutic window or a rapid dose-response profile (Aungst, 2000; Perucca, 2006). The risk of pharmacokinetic drug interactions poses two main extremes of difficulty – pharmacotoxicity and treatment failure. The first may be caused by inhibition of metabolic enzymes responsible for drug metabolism and clearance, and the second may be a consequence of enzymatic induction leading to acceleration of drug metabolism. This is in addition to the inherent pharmacodynamic effects of herbal products, which may include potentiating, additive, antagonism, or neutralizing effects.

Until recently, HDI was often overlooked by doctors for several reasons. Most of the trained physicians do not have adequate knowledge about herbal medicines and their potential for drug interactions (Clement et al., 2005; Ozcakir et al., 2007; Fakeye and Onyemadu, 2008); herbal products also vary greatly in composition depending on source and packaging (Liang et al., 2004; Sousa et al., 2011); Most patients do not feel the need to disclose their herbal consumption to physicians, who rarely ask them (Cassidy, 2003; Howell et al., 2006; Chao et al., 2008; Kennedy et al., 2008). Further challenges related to herbal medicines include scientific misidentification, product contamination and adulteration, mislabeling, instability of the active ingredient, variability in collection procedures, and failure of patient disclosure (Boullata and Nace, 2000). A recent systematic review of herbal and prescription drug interactions by Izzo and Ernst (2009) provides more details.

Herbal products are composed of a complex mixture of pharmacologically active phytochemicals (Mok and Chau, 2006), most of which are secondary metabolites formed by the shikimate, acetate-malonate, and acetate-mevalonate pathways. These components include phenols (such as tannins, lignins, quinolones and salicylates), phenolic glycosides (such as flavonoids, cyanogens and glucosinolates), terpenoids (sesquiterpenes, steroids, carotenoids, saponins, irides, alkalpoids, pesticides). polysaccharides (such as gums and mucilage), resins, and often essential oils that include some of the above-mentioned classes of phytochemicals (Wills et al., 2000; Wang et al., 2008). This complexity increases the risk of clinical drug interactions.

Therefore, the current review aims to review the known and recently reported HDI with an interest in the available evidence and its mechanism. The review was conducted by systematically searching MEDLINE, PUBMED, EMBASE, and COCHRAINE databases for original studies and case reports on ADI using the following search terms or combinations thereof: “drug-herb,” “herb-drug,” “interaction,” “cytochrome P450, ” “plant,” “extract,” “drug,” “concomitant administration,” “herbal and orthodox drugs.” Appropriate search terms were used to locate various individual medicinal herbs used in Africa, the Americas, Asia, Europe, and Australia. Reported interactions and their mechanisms, search and accumulation with orthodox drugs. The search was limited to publications in English, not by date or place of publication.

Ginkgo Biloba Review

The clinical manifestations of ADI vary depending on the herbs and drugs involved. A typical clinical presentation of HDI includes enhanced effects of oral corticosteroids in the presence of licorice (Glycyrrhiza glabra; Liao et al., 2010); Increased effect of warfarin on bleeding in the presence of garlic (Allium sativum; Borrelli et al., 2007), dong quai (Angelica sinensis; Nutescu et al., 2006) or danshen (Salvia miltiorrhiza; Chan, 2001) ; reduction in blood levels of nevirapine, amitriptyline, nifedipine, statins, digoxin, theophylline, cyclosporine, midazolam, and steroids, with concomitant administration of St. John’s wort (SJW; Hypericum perforatum; De Maat et al., 2001; Henderson et al., 2001). ; John et al., 2002; Mannel, 2004; Borrelli and Izzo, 2009), reduced the oral bioavailability of prednisolone in the presence of the Chinese herbal product xiao-chai-hu tang (sho-saiko-to; Fu-Berman, 2000); ginseng (Panax ginseng)-induced mania in patients receiving antidepressants (Engelberg et al., 2001); the production of extrapyramidal effects by combining antipsychotic drugs with betel nut (Areca catechu; Huang et al., 2003; Coppola and Mondola, 2012); increased blood pressure