Herb-drug Interactions in Neuropsychiatric Pharmacotherapy – A Review of Clinically Relevant Findings

Abstract

: The management of neuropsychiatric disorders relies heavily on pharmacotherapy. The use of herbal products as complimentary medicine, often concomitantly, is common among patients taking prescription neuropsychiatric drugs. Herb-drug interaction, a clinical consequence of this practice, may jeopardize the success of pharmacotherapy in neuropsychiatry. Besides the well-known ability of phytochemicals to inhibit and/or induce drug-metabolizing enzymes and transport proteins, several phytoconstituents are capable of exerting pharmacological effects on the central nervous system. The consequent pharmacokinetic and pharmacodynamic interactions with orthodox medications often result in deleterious clinical consequences. This study reviewed the relevant literature and identified 13 commonly used herbal products – celery, echinacea, ginkgo, ginseng, hydroxycut, kava, kratom, moringa, piperine, rhodiola, St John’s wort, terminalia/commiphora ayurvedic mixture and valerian – which have shown clinically relevant interactions with prescription drugs used in the management of neuropsychiatric disorders. The clinical focus is aimed to provide easily accessible information that will be of interest to clinicians, researchers, and the drug-consuming public.

DDID: a comprehensive resource for visualization and analysis of diet–drug interactions

“…Hence, understanding the effects and mechanisms of various DDIs is crucial. In our research, foods mainly consist of items consumed by humans to sustain life, provide energy, promote growth (such as grains, vegetables, fruits), while herbs primarily pertain to dietary supplements like herbal products, nutritional supplements to benefit health [ 9 ]. Therefore, DDIs are classified into food–drug interactions (FDIs) and herb–drug interactions (HDIs) [ 7 , 8 ].…”

Usage Patterns of Traditional Chinese Medicine for Patients with Bipolar Disorder: A Population-Based Study in Taiwan

“…According to a review study, CAM therapies for BD include omega-3 fatty acids, St. John's wort, herbal products, S-adenosyl-L-methionine, aromatherapy massage, therapeutic massage, yoga, Chinese oral medicine, and acupuncture [12]. St. John's wort can relieve mild to moderate depression but has the potential to induce mania because it can induce cytochrome P450 enzyme activity, accelerating the metabolism of antipsychotics and reducing antipsychotics' control of mania and hypomania [13]. S-adenosyl-L-methionine can treat major depressive disorder but induces mania with an unclear mechanism [14,15].…”

Investigation of Herb-Drug Interactions between Xylopia aethiopica, Its Principal Constituent Xylopic Acid, and Antidepressants

“…With 60% of the global population using herbal medicine, the risk of herb-drug interactions is very high [13][14][15][16][17]. Clinically, caution is advised in herb-neuropsychiatric drug coadministrations as they have been revealed to cause harmful side efects and complications through pharmacodynamic and pharmacokinetic interactions [18,19]. A herb with a potentially high risk of interacting with antidepressants is the widely used Xylopia aethiopica, as its hydroethanolic extract and isolate, xylopic acid, have been discovered to possess antidepressant-like activities via mechanisms similar to those of classical antidepressants [3,11,20].…”