1 / 35

Drug Interaction of Herbal and Western Medicines

Drug Interaction of Herbal and Western Medicines. 胡幼圃 教授兼主任 Prof. Oliver Yoa-Pu Hu, Ph.D. Dean Research, Development and Continuing Education National Defense Medical Center Taipei, Taiwan, R.O.C. Outline. Current Status of Herbal or Traditional Medicines in Eastern and Western World

derora
Download Presentation

Drug Interaction of Herbal and Western Medicines

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Drug Interaction of Herbal and Western Medicines 胡幼圃 教授兼主任 Prof. Oliver Yoa-Pu Hu, Ph.D. Dean Research, Development and Continuing Education National Defense Medical Center Taipei, Taiwan, R.O.C. EHFG 5-8, Oct. 2005

  2. Outline • Current Status of Herbal or Traditional Medicines in Eastern and Western World • Adverse Events and Drug-Interaction Caused by Herbal or Traditional Medicines • Evidences Based Drug-Interaction Caused by Herbal or Traditional Medicines • Conclusions and Suggestions EHFG 5-8, Oct. 2005

  3. Current Status of Herbal or Traditional Medicines in Eastern and Western World EHFG 5-8, Oct. 2005

  4. Insurance Paid for Herbal Medicines • German health insurance paid $283 million in reimbursements for prescribed ginkgo, St. John’s wort, mistletoe, saw palmetto, ivy, hawthorn, stinging nettle root, myrtol, phytosterols, and cucurbita in 2003. • French health insurance paid $91 million in partial reimbursements for ginkgo, saw palmetto, and pygeum prescriptions with a total value of $196 million in 2002. NEJM352:12, 2005 EHFG 5-8, Oct. 2005

  5. European Market for Over-The-Counter Herbal Medicines in 2003 Distribution of the $4.96 Billion European Market for Over-the-Counter Herbal Medicines in 2003. *Taiwan Herbal Medicines market was 4.0 billion in 2002 NEJM352:12, 2005 EHFG 5-8, Oct. 2005

  6. Herbal Medicines in US • In a 1990 survey of 1,539 adults, 33.8% of respondents used herbal medicines or nutritional supplements. • By 1997, the number had increased to 42.1%, with most people paying the cost out-of-pocket. • Approximately 40% of patients who use alternative therapies do not disclose this information to their doctor. AM J Ophthalmol138:639, 2004 EHFG 5-8, Oct. 2005

  7. Adverse Events and Drug-Interaction Caused by Herbal or Traditional Medicines EHFG 5-8, Oct. 2005

  8. Effect of Various CYP Isoforms by Herbal Constituents (I) (from Zizyphi fructus) CME = Crude methanolic extract; DAD = Diallyl disulfide; DAS = Diallyl sulfide; H = Human; M = Mouse; PH = Primary Hepatocytes; PXR = Pregnane X receptor; R = Rat; SJW = St. John’s wort. Drug Metabolism Reviews35:35, 2003 EHFG 5-8, Oct. 2005

  9. Effect of Various CYP Isoforms by Herbal Constituents (II) CME = Crude methanolic extract; DAD = Diallyl disulfide; DAS = Diallyl sulfide; H = Human; M = Mouse; PH = Primary Hepatocytes; PXR = Pregnane X receptor; R = Rat; SJW = St. John’s wort. Drug Metabolism Reviews35:35, 2003 EHFG 5-8, Oct. 2005

  10. Effect of Various CYP Isoforms by Herbal Constituents (III) CME = Crude methanolic extract; DAD = Diallyl disulfide; DAS = Diallyl sulfide; H = Human; M = Mouse; PH = Primary Hepatocytes; PXR = Pregnane X receptor; R = Rat; SJW = St. John’s wort. Drug Metabolism Reviews35:35, 2003 EHFG 5-8, Oct. 2005

  11. Known Pharmacokinetic Herb-Drug Interactions (I) Drug Metabolism Reviews35:35, 2003 EHFG 5-8, Oct. 2005

  12. Known Pharmacokinetic Herb-Drug Interactions (II) Drug Metabolism Reviews35:35, 2003 EHFG 5-8, Oct. 2005

  13. Potential Interactions between Herbs and Conventional Drugs (I) NEJM347:2046, 2002 EHFG 5-8, Oct. 2005

  14. Potential Interactions between Herbs and Conventional Drugs (II) NEJM347:2046, 2002 EHFG 5-8, Oct. 2005

  15. Potential Interactions between Herbs and Conventional Drugs (III) NEJM347:2046, 2002 EHFG 5-8, Oct. 2005

  16. Evidence Based Drug-Interaction Caused by Herbal or Traditional Medicines and Food EHFG 5-8, Oct. 2005

  17. Simvastatin • HMG-CoA reductase inhibitor • As a substrate for both CYP3A4 and P-gp • Bioavailability < 5% EHFG 5-8, Oct. 2005

  18. In Vitro Inhibiting CYP3A4 in Liver Microsomes with Herbal and Food Constituents (PC: ketoconazole) EHFG 5-8, Oct. 2005

  19. Effect of HUCHE015 on Total Simvastatin Absorption on Female SD Rats by Oral *12.3 g of green-tea leaf contain 20 mg of HUCHE015 EHFG 5-8, Oct. 2005

  20. PK Parameters of Simvastatic Acid of Female SD Rats after Oral SimvastatinSimvastatin 50 mg/kg in DMSO and HUCHE015 20 mg/kg in DMSO *12.3 g of green-tea leaf contain 20 mg of HUCHE015 EHFG 5-8, Oct. 2005

  21. Fluvastatin • HMG-CoA reductase inhibitor • Specifically and extensively metabolized by CYP2C9 • Oral bioavailability: 20-30% EHFG 5-8, Oct. 2005

  22. Fluvastatin in SD Rats after Orally Administered Fluvastatin with or without Herbal Constituents *The herbal constituents is HUCHE070 that is very rich in Eupatorium odoratum. The dose is 9.3 mg/kg EHFG 5-8, Oct. 2005

  23. Fluvastatin PK Parameters in SD Rats after Orally Administered Fluvastatin with or without Herbal Constituents EHFG 5-8, Oct. 2005

  24. Nalbuphine • Narcotic analgesics • k-agonist, m-antagonist • Advantage: low tolerance、 addiction、 and respiratory depression • Drawback: short duration • Mainly Metabolized by UGT2B7 • Oral bioavailability less than 5% EHFG 5-8, Oct. 2005

  25. Nalbuphine in SD Rats after Oral Nalbuphine with or without Herbal Constituents *The HUCHE035 is very rich in Artemisia capillaris and the dose is 4.5 mg/kg. EHFG 5-8, Oct. 2005

  26. PK Parameters for SD Rats after Oral Nalbuphine with or without Herbal Constituents EHFG 5-8, Oct. 2005

  27. Conclusions and Suggestions (I) • Evidences from in vitro and in vivo studies has indicated that the constituents of herbal preparation, even food, interact with various drug metabolic enzymes extensively. • High throughput screening assays combine with in vivo or clinical study will be a useful strategy to examine the herb-drug interactions EHFG 5-8, Oct. 2005

  28. Conclusions and Suggestions (II) • Medical and pharmaceutical communities had been slow to respond to this important issue • Government, industry and medical societies should vigorously examine the possible drug interaction with the most commonly used herbal drugs • Drug Insert should clearly indicate the clinically significant drug interaction with commonly used herbs, dietary supplements, healthy food and traditional medicines EHFG 5-8, Oct. 2005

  29. Thanks for your attention EHFG 5-8, Oct. 2005

  30. Problems Caused from Herbal Medicines • Potential adulterants and contaminations that can affect the quality of herbal remedies • Plants containing belladonna or pyrrolizidine alkaloids, microorganisms, aflatoxins, bacterial endotoxin, pesticides, fumigation agents, toxic metals and Drugs • Potential adverse effects of herbal remedies and their major constituents • Cardiotoxicity: aconire root ruber • Hepatoxicity: certain herbs rich in anthranoids and protoberberine alkaloids, green-tea leaf • Neurotoxicity or convulsions: Kava rhizome • Renal toxicity: -Aescin (saponin mixture from horse-chestnut seed) NEJM347:2046, 2002 EHFG 5-8, Oct. 2005

  31. EHFG 5-8, Oct. 2005

  32. Potential Adulterants and Contaminants that Can Affect the Quality of Herbal Remedies NEJM347:2046, 2002 EHFG 5-8, Oct. 2005

  33. Potential Adverse Effects of Herbal Remedies and Their Major Constituents NEJM347:2046, 2002 EHFG 5-8, Oct. 2005

  34. Effects of St. John’s Wort Constituents on the Activity of Various CYPs Drug Metabolism Reviews35:35, 2003 EHFG 5-8, Oct. 2005

  35. Induction of Various CYP Isoforms by Herbal Constituents (I) Drug Metabolism Reviews35:35, 2003 EHFG 5-8, Oct. 2005

More Related