The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo

Gorski, J. Christopher; Huang, Shiew‐Mei; Pinto, Amar G.; Hamman, Mitchell A.; Hilligoss, Janna; Zaheer, Narjis A.; Desai, Mehul; Miller, Margaret A.; Hall, Stephen D.

doi:10.1016/j.clpt.2003.09.013

Cited by 256 publications

(244 citation statements)

References 53 publications

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“…Herbal medicines (eg, St John's wort or echinacea), may alter drug pharmacokinetics through inhibition of the cytochrome P450 system, resulting in prolonged drug effect and altered (increased or decreased) blood drug concentrations. [111][112][113][114][115][116] Kava may increase the effects of sedatives by potentiating ␥-aminobutyric acid inhibitory neurotransmission, and valerian may itself produce sedation that apparently is mediated through modulation of ␥-aminobutyric acid neurotransmission and receptor function. 117,118 Drugs such as erythromycin, cimetidine, and others may also inhibit the cytochrome P450 system, resulting in prolonged sedation with midazolam as well as other medications competing for the same enzyme systems.…”

Section: Documentation At the Time Of Sedationmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Coté¹,

Wilson²

2006

Pediatrics

515

150

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The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision; careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications; appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure; a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction; a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation, as well as an appreciation for drug interactions; appropriate training and skills in airway management to allow rescue of the patient; age-and size-appropriate equipment for airway management and venous access; appropriate medications and reversal agents; sufficient numbers of people to carry out the procedure and monitor the patient; appropriate physiologic monitoring during and after the procedure; a properly equipped and staffed recovery area; recovery to presedation level of consciousness before discharge from medical supervision; and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children. INTRODUCTIONInvasive diagnostic and minor surgical procedures on pediatric patients outside the traditional operating room setting have increased in the last decade. As a consequence of this change and the increased awareness of the importance of providing analgesia and anxiolysis, the need for sedation for procedures in physician offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, and ambulatory surgery centers has also markedly increased. In recognition of this need for both elective and emergency use of sedation in nontraditional

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Section: Documentation At the Time Of Sedationmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Coté¹,

Wilson²

2006

Pediatrics

515

150

View full text Add to dashboard Cite

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“…Subsequently, multiple clinical trials of drug-botanical dietary supplement interactions were carried out using different extracts of milk thistle, and all revealed no drug interaction effects. It was pointed out by Brantley et al (2014) that, to their knowledge, no mathematical modeling had been Drug-Botanical Dietary Supplement PK Interactions CYP1A (Lin et al, 1998); CYP3A4 (Guo et al, 2001) CYP2D6 (Tang et al, 2006) (Paolini et al, 1999); CYP2B6, CYP2C8, CYP2C9, CYP2C19 (Johne et al, 1999;Lefebvre et al, 2004); CYP3A4 (Johne et al, 1999;Gorski et al, 2004;Lefebvre et al, 2004); UGT1A1 (Guo et al, 2013) CYP1A2 (Kent et al, 2002); CYP2B6 (Lefebvre et al, 2004) ---Plant sterols (e.g., sitosterol) MDR1 (Nabekura et al, 2008); MRP1 (Chow et al, 2006)…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetic interactions between drugs and botanical dietary supplements

Sprouse¹,

Breemen²

2015

Planta Med

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The use of botanical dietary supplements has grown steadily over the last 20 years despite incomplete information regarding active constituents, mechanisms of action, efficacy, and safety. An important but underinvestigated safety concern is the potential for popular botanical dietary supplements to interfere with the absorption, transport, and/or metabolism of pharmaceutical agents. Clinical trials of drug-botanical interactions are the gold standard and are usually carried out only when indicated by unexpected consumer side effects or, preferably, by predictive preclinical studies. For example, phase 1 clinical trials have confirmed preclinical studies and clinical case reports that St. John's wort (Hypericum perforatum) induces CYP3A4/CYP3A5.However, clinical studies of most botanicals that were predicted to interact with drugs have shown no clinically significant effects. For example, clinical trials did not substantiate preclinical predictions that milk thistle (Silybum marianum) would inhibit CYP1A2, CYP2C9, CYP2D6, CYP2E1, and/or CYP3A4. Here, we highlight discrepancies between preclinical and clinical data concerning drug-botanical interactions and critically evaluate why some preclinical models perform better than others in predicting the potential for drug-botanical interactions. Gaps in knowledge are also highlighted for the potential of some popular botanical dietary supplements to interact with therapeutic agents with respect to absorption, transport, and metabolism.

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“…Step in the Phytomedicine/Drug Development Process 149 significantly lower AUC and 34% increase in systemic clearance of the drug (127). CYP3A4 was inhibited by single dose administration of ritonavir, chronic administration resulted in an induction of same enzyme (128).…”

Section: Pharmacokinetics and Drug Interactions Of Herbal Medicines: mentioning

confidence: 99%

Pharmacokinetics and Drug Interactions of Herbal Medicines: A Missing Critical Step in the Phytomedicine/Drug Development Process

Obodozie¹

2012

Readings in Advanced Pharmacokinetics - Theory, Methods and Applications

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The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo

Cited by 256 publications

References 53 publications

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Pharmacokinetic interactions between drugs and botanical dietary supplements

Pharmacokinetics and Drug Interactions of Herbal Medicines: A Missing Critical Step in the Phytomedicine/Drug Development Process

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