Herb–drug interactions: an overview of systematic reviews

Abstract

OBJECTIVESThe aim of this overview of systematic reviews (SRs) is to evaluate critically the evidence regarding interactions between herbal medicinal products (HMPs) and synthetic drugs. METHODSFour electronic databases were searched to identify relevant SRs. RESULTSForty-six SRs of 46 different HMPs met our inclusion criteria. The vast majority of SRs were of poor methodological quality. The majority of these HMPs were not associated with severe herb-drug interactions. Serious herb-drug interactions were noted for Hypericum perforatum and Viscum album. The most severe interactions resulted in transplant rejection, delayed emergence from anaesthesia, cardiovascular collapse, renal and liver toxicity, cardiotoxicity, bradycardia, hypovolaemic shock, inflammatory reactions with organ fibrosis and death. Moderately severe interactions were noted for Ginkgo biloba, Panax ginseng, Piper methysticum, Serenoa repens and Camellia sinensis. The most commonly interacting drugs were antiplatelet agents and anticoagulants. CONCLUSIONThe majority of the HMPs evaluated in SRs were not associated with drug interactions with serious consequences. However, the poor quality and the scarcity of the primary data prevent firm conclusions.

The pharmaceutical industry and natural products: historical status and new trends

“…The interaction of drugs with botanical extracts While extracts and multicomponent mixtures are often argued to have higher efficacy than single constituents in the context of phytotherapy, the alternative is that the ingestion of these complex mixtures have greater probability to lead to drug-drug interactions, and in this context many herbs or botanicals are at risk (Posadzki et al 2013). For example, phyto-preparations containing Hypericum perforatum (Saint John's Wort) have demonstrated to cause multiple drug interactions through induction of the cytochrome P450 enzyme CYP3A4 with drugs such as cyclosporin, indinavir, simvastatin, fexofenadine, and digoxin (Hammerness et al 2003).…”

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“…[42][43][44] Reassuringly, we found no significant adverse relationship between supplement use and survival. However, our observation that milk thistle users had slightly higher overall mortality than nonusers is potentially worrisome in light of a recent study of milk thistle use among patients with advanced liver disease.…”

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