Potential pharmacokinetic and pharmacodynamic herb-drug interactions of Andrographis paniculata (Burm. f.) and andrographolide: A systematic review

Abstract

Introduction: Herb–drug interactions (HDIs) in pharmacokinetics and pharmacodynamics can occur when natural compounds are used in combination with drugs. This study aimed to review the potential interaction of Andrographis paniculata (Burm. f.) extract (APE) and its primary compound andrographolide (AND) with several drugs exhibiting various pharmacological activities.Methods: In this systematic review, articles were collected from international databases such as PubMed, Science Direct, Springer Link, and Scopus until August 2021. The following keywords were used: Andrographis paniculata, andrographolide, HDI, drug interaction, pharmacokinetics, and pharmacology. This review was written in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), SYRCLE’s risk of bias (RoB) tool for animal intervention studies, and Cochrane RoB 2 tool to analyze the RoB for qualitative assessment.Results: Twelve articles were included in accordance with the inclusion and exclusion criteria of this study. Five studies explored the potential of HDIs for combining APE with drugs and AND with theophylline, etoricoxib, nabumetone, naproxen, and tolbutamide. Five studies focused on AND in combination with aminophylline and doxofylline, meloxicam, glyburide, glimepiride, metformin, and warfarin. Two studies tested the combination of APE with gliclazide and midazolam. The HDI mechanism involving the inhibition or induction of cytochrome P450 enzyme expression was dominant in influencing the drug’s pharmacokinetic profile. Pharmacological studies on the combination of several drugs, particularly anti-inflammatory and antidiabetic drugs, showed a synergistic activity.Conclusion: APE and AND have potential pharmacokinetic and pharmacodynamic HDIs with various drugs. This study can be used as a therapeutic consideration in clinical aspects related to the possibility of HDIs of A. paniculata (Burm. f.).

Evaluation the effectiveness of Andrographis paniculata aqueous extract on hepatotoxicity and CD44 gene expression in male rabbits treated with butylated hydroxytoluene (BHT)

“…Table (1) indicates that oral administration with a 100mg / kg dose of A. paniculata extract led to no significant differences in the rate of liver enzymes (ALP, ALT and AST), and this is agreement with (Owoade et al, 2022;Salunkhe & Patil (2018;Shi etal., 2020;Dey etal., 2020;Nasir etal., 2013) The absence of a significant difference in liver enzymes in the current paper may be due to the role of the plant used as an effective drug in treating many different diseases and disorders to the organs, such as the liver (Sundhani et al, 2022), During the study period, BHT caused the harmful effect on the liver through the production of free radicals and stimulation of oxidative stress. It has been proven that the aqueous extract of A. paniculata played an effective role in scavenging free radicals, as this plant contains many active active compounds such as andrographiold, Andrographolide, Andographoside and Newandrographolide in addition to many other important active compounds that scavenge free radicals and protect the liver from oxidative stress caused by harmful substance and thus regulate the work of liver enzymes (Saunkhe & Patil, 2018(Benny et al, 2021).…”

Potential pharmacokinetic interactions with concurrent use of herbal medicines and a ritonavir-boosted COVID-19 protease inhibitor in low and middle-income countries

“…The aerial parts have been documented in the treatment of the common cold, hypertension, malaria, and snakebites ( Okhuarobo et al, 2014 ). A. paniculata has the potential for HDIs, particularly when taken in combination with drugs metabolized by CYP3A, CYP2C9, and CYP2C19, through both induction and inhibition ( Sundhani et al, 2022 ). Balap et al (2017) reported that co-administration of A. paniculata extract with naproxen, a CYP2C9 substrate in humans, decreased systemic exposure to naproxen in rat models.…”

Pharmacokinetic Herb-Drug Interactions of Glipizide with Andrographis paniculata (Burm. f.) and Andrographolide in Normal and Diabetic Rats by Validated HPLC Method

“…APE exhibits glucose-lowering efficacy in rats by increasing the mRNA and protein expression of GLUT-4 and insulin expression in pancreatic beta cells [ 56 , 57 ]. A study reported evidence of an increase in the pharmacological action of the medicine (synergistic effect) when the anti-inflammatory agents etoricoxib and naproxen were combined with APE [ 58 ].…”