Effect of Moringa oleifera Lam. leaf powder on the pharmacokinetics of nevirapine in HIV-infected adults: a one sequence cross-over study

Abstract

Background Moringa oleifera Lam., an herb commonly consumed by HIV-infected people on antiretroviral therapy, inhibits cytochrome P450 3A4, 1A2 and 2D6 activity in vitro; and may alter the pharmacokinetics (PK) of antiretroviral drugs metabolized via the same pathways. However, in vitro drug interaction activity may not translate to a clinically significant effect. Therefore, the effect of moringa leaf powder on the PK of nevirapine in HIV-infected people was investigated.MethodsAdult patients at steady-state dosing with nevirapine were admitted for 12-h intensive PK sampling following a 21-day herbal medicine washout. Blood sampling was repeated after 14 days of nevirapine and moringa (1.85 g leaf powder/day) co-administration. Nevirapine plasma concentrations were determined by liquid chromatography-tandem mass spectrometry. To assess the effect of moringa on nevirapine PK, the change in nevirapine area under the plasma concentration–time curve (AUC) was determined. The mean difference in pre- and post-moringa nevirapine, maximum concentration (Cmax) and concentration at 12 h (C12h) were also calculated. The PK parameters were compared by assessing the post/pre geometric mean ratios (GMRs) and associated 90% confidence intervals (CIs).ResultsPharmacokinetics analyses were performed on the results from 11 participants for whom complete data were obtained. The post/pre GMRs and associated 90% CIs for nevirapine were 1.07 (1.00–1.14) for the AUC; 1.06 (0.98–1.16) for Cmax and 1.03 (0.92–1.16) for C12h.ConclusionCo-administration of Moringa oleifera Lam. leaf powder at the traditional dose did not significantly alter the steady-state PK of nevirapine. Trial registration number NCT01410058 (ClinicalTrials.gov)

Moringa oleifera leaf powder alters the pharmacokinetics of amodiaquine in healthy human volunteers

“…Some other in vitro studies also suggested that MO inhibits 1A2 and 2D6 activity, although another report showed that the inhibitory effects of Moringa on CYP3A4 and CYP2D6 were not significant when compared to inhibitors like ketoconazole and quinidine . One recent in vivo study, conducted in HIV positive patients in Zimbabwe by Monera‑Penduka et al, to investigate the influence of MO on the PK of nevirapine, also confirmed that MO had less activity on CYP3A4 and CYP2B6 as previously claimed. The authors showed that concurrent use of MO did not considerably alter the steady‑state PK of nevirapine which is known to be mainly metabolized by CYP3A4 and CYP2B6.…”

Potential inhibition of major human cytochrome P450 isoenzymes by selected tropical medicinal herbs—Implication for herb–drug interactions

“…These are higher than 0.88 L/dose estimated by Strandell et al (2004) as the minimum required to elicit further investigation of in vivo inhibitory activity of the plant extract on CYP isoenzyme. However, in vivo study in human showed that M. oleifera did not affect the pharmacokinetic parameters of Nevirapine, a substrate of CYP2C9, CYP2D6, and CYP3A5 (Monera-Penduka et al, 2017). Nonetheless, couse…”

“…() as the minimum required to elicit further investigation of in vivo inhibitory activity of the plant extract on CYP isoenzyme. However, in vivo study in human showed that M. oleifera did not affect the pharmacokinetic parameters of Nevirapine, a substrate of CYP2C9, CYP2D6, and CYP3A5 (Monera‐Penduka et al., ). Nonetheless, couse of Moringa oleifera leave extract with substrates of CYP1A2 and CYP2C9 should be further investigated for possibility of in vivo inhibition of these isoenzymes which may affect therapeutic outcome of coadministered medication.…”

Development and validation of a high performance liquid chromatography method to determine nevirapine in plasma in a resource-limited setting

“…leaf powder on the pharmacokinetics of nevirapine in HIV‑positive adults. 20 Patients were on nevirapine 200 mg twice daily and samples were taken at timed intervals after consumption of Moringa oleifera Lam. (1.85 g).…”