Elevated liver enzymes resulting from an interaction between Raltegravir and <i>Panax ginseng</i>: a case report and brief review

Mateo‐Carrasco, Héctor; Gálvez-Contreras, María C.; Fernández-Ginés, Francisco D; Nguyen, Timothy

doi:10.1515/dmdi-2012-0019

Cited by 21 publications

(7 citation statements)

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“…A number of antiretroviral medications including protease inhibitors (lopinavir and ritonavir) and non-nucleoside reverse transcriptase inhibitors (efavirenz and nevirapine) with narrow therapeutic indices and elimination via hepatic metabolism are susceptible to HDI. HIV patients experienced signs of toxicity and detectable levels of viral load while taking raltegravir plus lopinavir/ritonavir [58] or efavirenz [59] with ginseng and G. biloba, respectively. The mechanism of ginseng-raltegravir interaction is unknown, as several conflicting outcomes have been reported on the influence of various active ingredients of ginseng on CYP450 enzymes [103][104][105].…”

Section: Discussionmentioning

confidence: 99%

Critical evaluation of causality assessment of herb–drug interactions in patients

Awortwe

Makiwane

Reuter

et al. 2018

Brit J Clinical Pharma

114

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The aim of this review was to assess the severity of adverse drug reactions (ADRs) due to herb-drug interactions (HDI) in patients taking herbs and prescribed medications based on published evidence. Electronic databases of PubMed, the Cochrane Library, Medline and Scopus were searched for randomized or nonrandomized clinical studies, case-control and case reports of HDI. The data were extracted and the causal relationship of ADRs as consequences of HDI assessed using Horn's drug interaction probability scale or Roussel Uclaf Causality Assessment Method scoring systems. The mechanism of interaction was ascertained using Stockley's herbal medicine interaction companion. Forty-nine case reports and two observational studies with 15 cases of ADRs were recorded. The majority of the patients were diagnosed with cardiovascular diseases (30.60%), cancer (22.45%) and renal transplants (16.32%) receiving mostly warfarin, alkylating agents and cyclosporine, respectively. HDI occurred in patients resulting in clinical ADRs with different severity. Patients may poorly respond to therapeutic agents or develop toxicity due to severe HDI, which in either scenario may increase the cost of treatment and/or lead to or prolong patient hospitalization. It is warranted to increase patient awareness of the potential interaction between herbs and prescribed medicines and their consequences to curb HDI as a potential health problem.

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Section: Discussionmentioning

confidence: 99%

Critical evaluation of causality assessment of herb–drug interactions in patients

Awortwe

Makiwane

Reuter

et al. 2018

Brit J Clinical Pharma

114

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“…This was attributed to an interaction between raltegravir and self-medicated ginseng started 39 days earlier. The mechanism of this interaction has not been elucidated and the patient had many associated risk factors [60].…”

Section: Ginseng (Panax Sp)mentioning

confidence: 99%

Interactions between antiretroviral therapy and complementary and alternative medicine: a narrative review

Bordes

Leguelinel-Blache

Lavigne

et al. 2020

Clinical Microbiology and Infection

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…One case report described a patient with a history of HIV and chronic hepatitis C on raltegravir and lopinavir/ritonavir admitted for transaminitis, jaundice, and evidence of liver failure after starting ginseng. The authors noted a clinical improvement in symptoms and lab data with cessation of the CAM product [112].…”

Section: Cam Products Thought To Interact With Arv Therapymentioning

confidence: 96%

A Review of the Toxicity of HIV Medications II: Interactions with Drugs and Complementary and Alternative Medicine Products

et al. 2015

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For many patients today, HIV has become a chronic disease. For those patients who have access to and adhere to lifelong antiretroviral (ARV) therapy, the potential for drugdrug interactions has become a real and life-threatening concern. It is known that most ARV drug interactions occur through the cytochrome P450 (CYP) pathway. Medications for comorbid medical conditions, holistic supplements, and illicit drugs can be affected by CYP inhibitors and inducers and have the potential to cause harm and toxicity. Protease inhibitors (PIs) tend to inhibit CYP3A4, while most nonnucleoside reverse transcriptase inhibitors (NNRTIs) tend to induce the enzyme. As such, failure to adjust the dose of coadministered medications, such as statins and steroids, may lead to serious complications including rhabdomyolysis and hypercortisolism, respectively. Similarly, gastric acid blockers can decrease several ARV absorption, and warfarin doses may need to be adjusted to maintain therapeutic concentrations. Illicit drugs such as methylenedioxymethamphetamine (MDMA, "ecstasy") in combination with PIs lead to increased toxicity, while the concomitant administration of sedative drugs such as midazolam and alprazolam in patients taking PIs can result in prolonged sedation, delayed recovery, and increased length of stay. Even supplements like St. John's Wort can alter PI concentrations. In theory, any drug that is metabolized by CYP has potential for a pharmacokinetic drug-drug interaction with all PIs, cobicistat, and most NNRTIs. When adding a new medication to an ARV regimen, use of a drug-drug interaction software and/or consultation with a clinical pharmacist/pharmacologist or HIV specialist is recommended.

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Elevated liver enzymes resulting from an interaction between Raltegravir and Panax ginseng: a case report and brief review

Cited by 21 publications

References 0 publications

Critical evaluation of causality assessment of herb–drug interactions in patients

Critical evaluation of causality assessment of herb–drug interactions in patients

Interactions between antiretroviral therapy and complementary and alternative medicine: a narrative review

A Review of the Toxicity of HIV Medications II: Interactions with Drugs and Complementary and Alternative Medicine Products

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