Understanding the relevance of herb–drug interaction studies with special focus on interplays: a prerequisite for integrative medicine

Abstract

Integrative medicine refers to the blending of conventional and evidence-based complementary medicines and therapies with the aim of using the most appropriate of either or both modalities for ultimate patient benefits. One of the major hurdles for the same is the chances of potential herb–drug interactions (HDIs). These HDIs could be beneficial or harmful, or even fatal; therefore, a thorough understanding of the eventualities of HDIs is essential so that a successful integration of the modern and complementary alternative systems of medicine could be achieved. Here, we summarize all the important points related to HDIs, including types, tools/methods for study, and prediction of the HDIs, along with a special focus on interplays between drug metabolizing enzymes and transporters. In addition, this article covers future perspective, with a focus on background endogenous players of interplays and approaches to predict the drug–disease–herb interactions so as to fetch the desired effects of these interactions.

Current Antivirals and Novel Botanical Molecules Interfering With Herpes Simplex Virus Infection

“…However, botanical drug interactions with other drugs have been reported and undesirable side effects may occur (Tachjian et al, 2010;Ekor, 2014;Lee et al, 2016;Borse et al, 2019). At present, the World Health Organization has developed guidelines to reinforce safety monitoring of botanical medicines using pharmacovigilance systems, as well as encouraging quality controls during production by using modern manufacture techniques and applying good manufacturing practices (WHO, 2000(WHO, , 2004.…”

Ayurveda botanicals in COVID-19 management: An in silico- multitarget approach

“…are also being treated with these drugs along with their ongoing prescriptions 4 . Along with modern therapeutic agents, patients are also being treated with drugs from traditional medicinal system like Ayurveda 82,37 .…”

“…These associated comorbidities of COVID-19 are being continually treated along with anti-SARS-COV-2 therapy.Here, we propose the use of Rasayana botanicals for COVID-19 prophylaxis (both pre and post COVID-19) as well as anti-SARS COV-2 activity. This can lead to the chances of HDIs, which maybe harmful/bene cial/fatal 37 . Therefore, with the help of Swiss-ADME data ( Table).This indicatesthat athigher concentrations (generally more than therapeutic dose), these extracts may produce pharmacokinetic HDI in vivo 38 .Based on the above results, these phytoconstituents or Rasayana botanicals may produce bene cial pharmacokinetic-pharmacodynamic interactions in vivo, with the anti-viral and diseasemodifying drugs that are currently being prescribed for COVID-19.…”

“…Considering the COVID-19 complex pathogenesis there is concomitant administration of multiple drugs/herbs which may leads to risk of herb-drug interactions (HDIs) 37 .Therefore, the probable pharmacokinetic-pharmacodynamic HDI were explored based on data generated from Swiss-ADME and available literature.…”

Effectiveness and Safety of Herbal Medicine for Atopic Dermatitis: An Overview of Systematic Reviews

“…Some herbs including St. John's wort, ginger, liquorice, Scutellariae radix, and quercetin have been known to decrease the bioavailability of cyclosporine, while other herbs including grapefruit juice, cannabidiol, chamomile, resveratrol, Serenoa repens , Echinacea , and berberine have been known to increase the bioavailability [ 48 ]. This herb-drug interaction is an important issue in current clinical settings, especially in terms of CIM, and should be taken into account when establishing an optimal holistic treatment strategy [ 49 ]. The results of meta-analysis suggest that there was no difference in the incidence of AEs between HM combined with CM and CM alone, but the level of evidence evaluated by GRADE was very low.…”