Herbal Medicines as a Factor in Delirium

Khawaja, Imran S.; Marotta, Rocco; Lippmann, Steven

doi:10.1176/ps.50.7.969a

Cited by 42 publications

(15 citation statements)

References 3 publications

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“…Also the case reports are by no means convincing [55,56]. At present therefore a relevant risk of pharmacodynamic interactions is not proven by valid clinical observations.…”

Section: Discussionmentioning

confidence: 96%

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Valerian: No evidence for Clinically Relevant interactions

Kelber¹,

Nieber²,

Kraft³

2012

Planta Med

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In recent popular publications as well as in widely used information websites directed to cancer patients, valerian is claimed to have a potential of adverse interactions with anticancer drugs. This questions its use as a safe replacement for, for example, benzodiazepines. A review on the interaction potential of preparations from valerian root (Valeriana officinalis L. root) was therefore conducted. A data base search and search in a clinical drug interaction data base were conducted. Thereafter, a systematic assessment of publications was performed. Seven in vitro studies on six CYP 450 isoenzymes, on p-glycoprotein, and on two UGT isoenzymes were identified. However, the methodological assessment of these studies did not support their suitability for the prediction of clinically relevant interactions. In addition, clinical studies on various valerian preparations did not reveal any relevant interaction potential concerning CYP 1A2, 2D6, 2E1, and 3A4. Available animal and human pharmacodynamic studies did not verify any interaction potential. The interaction potential of valerian preparations therefore seems to be low and thereby without clinical relevance. We conclude that there is no specific evidence questioning their safety, also in cancer patients.

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“…Also the case reports are by no means convincing [55,56]. At present therefore a relevant risk of pharmacodynamic interactions is not proven by valid clinical observations.…”

Section: Discussionmentioning

confidence: 96%

“…Another patient (39-year-old female) had taken for two month a daily dose of two tablets of a St. John's wort preparation and one tablet of a valerian preparation and additionally Loperamide [56]. After this time, she was hospitalized with a severe delirium.…”

Section: Pharmacodynamic Interactionsmentioning

confidence: 99%

Valerian: No evidence for Clinically Relevant interactions

Kelber¹,

Nieber²,

Kraft³

2012

Planta Med

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“…It is a phenylpiperidine derivative with a chemical structure similar to opiate receptor agonists that does not cross the blood-brain barrier (121). A brief episode of acute delirium, possibly induced by exposure to SJW, valerian, and loperamide has been reported (122). The mechanism of this interaction is presently unknown.…”

Section: Drugs Acting On the Gastrointestinal Tractmentioning

confidence: 99%

Herb–Drug Interactions with St John’s Wort (Hypericum perforatum): an Update on Clinical Observations

Borrelli

Izzo

2009

AAPS J

238

190

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Abstract. St John's wort (SJW) extracts, prepared from the aerial parts of Hypericum perforatum, contain numerous pharmacologically active ingredients, including naphthodianthrones (e.g., hypericin and its derivatives), phloroglucinols derivatives (e.g., hyperforin, which inhibits the reuptake of a number of neurotransmitters, including serotonin), and flavonoids. Such extracts are widely used for the treatment of mild-to-moderate depression. As a monotherapy, SJW has an encouraging safety profile. However, relevant and, in some case, life-threatening interactions have been reported, particularly with drugs which are substrate of cytochrome P450 and/or P-glycoprotein. Well-documented SJW interactions include (1) reduced blood cyclosporin concentration, as suggested by multiple case reports as well as by clinical trials, (2) serotonin syndrome or lethargy when SJW was given with serotonin reuptake inhibitors, (3) unwanted pregnancies in women while using oral contraceptives and SJW, and (4) reduced plasma drug concentration of antiretroviral (e.g., indinavir, nevirapine) and anticancer (i.e., irinotecan, imatinib) drugs. Hyperforin, which is believed to contribute to the antidepressant action of St John's wort, is also strongly suspected to be responsible of most of the described interactions.

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“…Estes sintomas poderiam ser os resultados da interação entre hipérico e loperamida, valeriana e loperamida, hipérico e valeriana ou a combinação dos três agentes. Portanto, enquanto esta possível interação não for adequadamente conhecida, recomenda-se a monitoração do paciente durante o uso concomitante de loperamida e valeriana (Khawaja;Marotta;Lippmann, 1999;Micromedex, 2006).…”

Section: Antidiarréicosunclassified

Potenciais interações entre fármacos e produtos à base de valeriana ou alho

Alexandre¹,

Bagatini²,

Simões³

2008

Rev. bras. farmacogn.

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RESUMO:Atualmente, as potenciais interações entre fármacos e plantas medicinais e/ ou medicamentos fi toterápicos são objetos de inúmeros estudos. Tais estudos são motivados pelo fato de que a fi toterapia é amplamente utilizada em associação com diversos fármacos. Nesta revisão, as informações sobre as principais interações entre produtos elaborados com valeriana ou alho foram localizadas, avaliadas e sistematizadas. Verifi cou-se que tais plantas podem alterar os perfi s farmacocinéticos e/ou farmacodinâmicos de diversos fármacos, podendo provocar conseqüências graves aos pacientes. A valeriana pode aumentar os efeitos adversos dos benzodiazepínicos, reduzir a biodisponibilidade dos fármacos metabolizados pelo sistema P450-CYP3A4 e provocar hemorragias graves quando utilizada juntamente com anticoagulantes orais e antiplaquetários. O alho pode aumentar a biodisponibilidade dos relaxantes musculares, potencializar os efeitos terapêuticos e adversos dos hipoglicemiantes, provocar hemorragias quando administrado juntamente com anticoagulantes orais e antiplaquetários e reduzir a biodisponibilidade dos anti-retrovirais inibidores de protease. Porém, tais potenciais interações não são consensos na literatura, visto que há limitações metodológicas e diferenças signifi cativas entre os estudos localizados. Mesmo assim, o uso de produtos à base de valeriana ou alho, associado com determinados fármacos, deve ser adequadamente monitorado por um profi ssional da área da saúde. Unitermos:Valeriana offi cinalis, Valerianaceae, Allium sativum, Liliaceae, interações medicamentosas, valeriana, alho.ABSTRACT: "Potential interactions between drugs and valerian or garlic herbal medicines". At present, potential herbal-drug interactions are subject of great interest, because herbal medicines are often administered in combination with synthetic drugs. The aim of this paper was to review the literature in order to identify reported interactions between valerian or garlic herbal medicines and drugs, as well as to evaluate and summarize this information. Valerian or garlic herbal medicines could modify pharmacokinetics and/or pharmacodynamic profi les of several drugs and might lead to serious clinical consequences. Valerian could increase the adverse effects of benzodiazepines and could decrease the bioavailability of drugs metabolized by CYP3A4. Furthermore, valerian could cause severe bleeding when taken with oral anticoagulants and/or antiplatelet agents. Garlic could increase the bioavailability of muscle relaxants, could increase the therapeutic and adverse effects of hypoglycemic agents, could cause bleeding when taken with oral anticoagulants and/or antiplatelet agents, and could decrease the area under the plasma concentration curve of protease inhibitors. However, such potential herbal drug interactions are not consensual, because the reported studies present several limitations and signifi cant differences among them. Therefore, concomitant use of herbal medicines and drugs has to be properly monitored by health care profe...

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Herbal Medicines as a Factor in Delirium

Cited by 42 publications

References 3 publications

Valerian: No evidence for Clinically Relevant interactions

Valerian: No evidence for Clinically Relevant interactions

Herb–Drug Interactions with St John’s Wort (Hypericum perforatum): an Update on Clinical Observations

Potenciais interações entre fármacos e produtos à base de valeriana ou alho

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