Drug Interactions In The Treatment With Herbal Products

Year 2017, Volume: 31 Issue: 1, 41 - 50, 26.05.2017

Şule Kalkan

Abstract

Herbal
products are used in the prevention and treatment of many chronic diseases such
as hypertension, diabetes, hyperlipidemia and cancer. Herbal products which are
obtained from natural sources does not mean that they are safe. The use of
herbal products with drugs can lead to serious herbal product-drug
interactions. Herbs that are reported to interact with drugs include St. John’s
wort (Hypericum perforatum), Ginkgo (Ginkgo biloba), Ginseng (Panax ginseng), Ginger (Zingiber officinale), Garlic (Allium sativum), Echinasea ve Valerian.
This study was reviewed pharmacokinetic and pharmacodynamic drug interactions
with commonly used herbal products. The use of herbal product can alter the
absorption, distribution, metabolism and excretion of drugs through inhibition
or induction of cytochrome P450 enzymes (CYP450) and P-glycoprotein (P-gp).
Pharmacokinetic interactions may lead to an increase
or a decrease on pharmacological effect of the drug. Also drug-induced side
effect and toxic effect may manifest. Pharmacodynamic interactions between
herbal products and drugs may be additive or synergistic which will enhance the
effect of drugs, or antagonistic, which will reduce the efficacy of drugs.
Drugs which interact with herbal products include anticoagulants and
antithrombotics, cardiovascular drugs, immunusuppressants, sedatives,
antidepressants, statins, anticancer drugs and anti-HIV drugs. Herbal
product-drug interactions are especially important for drugs with narrow
therapeutic index. Physicians should inquire about use of herbal products to
their patients when prescribing medicine. Herbal products which have not proven
effectiveness and safety in clinical controlled trials should not be recommended.

Keywords

herb, drug, herb-drug interactions, pharmacokinetics

Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri

Abstract

Bitkisel ürünler
hipertansiyon, diyabet, hiperlipidemi ve kanser gibi birçok kronik hastalığın önlenmesi
ve tedavisinde kullanılmaktadır. Bitkisel ürünlerin doğal kaynaklı olması
güvenli oldukları anlamına gelmemektedir. Bitkisel ürünlerin ilaçlarla birlikte
kullanımı ciddi bitkisel ürün-ilaç etkileşimlerine yol açabilmektedir.
İlaçlarla etkileştiği rapor edilen bitkiler St. John’s wort (Hypericum perforatum), Ginkgo (Ginkgo biloba), Ginseng (Panax ginseng), Ginger (Zingiber officinale), Garlic (Allium sativum), Echinasea ve
Valerian’dır. Bu çalışmada sık kullanılan bitkisel ürünlerle, farmakokinetik ve
farmakodinamik ilaç etkileşimleri derlenmiştir. Bitkisel ürün kullanımı
sitokrom P450 enzimleri (CYP450) ve P-glikoproteinleri (P-gp) inhibisyonu veya
indüksiyonu ile ilaçların emilim, dağılım, metabolizma ve atılımlarını
değiştirebilir. Farmakokinetik etkileşmeler, ilacın farmakolojik etkisinde
azalma ve artmaya yol açabilir. Ayrıca ilaca bağlı yan etki ve toksik etki
görülebilir. Bitkisel ürünler ve ilaçlar arasındaki farmakodinamik etkileşmeler
ilaç etkisini artıracak aditif ve sinerjistik etkileşimler veya ilaç etkisini
azaltacak antagonistik etkileşimler olabilir. Bitkisel ürünlerle etkileşimi
tanımlanan ilaçlar antikoagülanlar, antitrombotikler, kardiyovasküler ilaçlar,
immunosüpresanlar, sedatifler, antidepresanlar, statinler, antikanser ilaçlar ve
anti-HIV ilaçlardır. Bitkisel ürün-ilaç etkileşmeleri özellikle terapötik
indeksi dar olan ilaçlarda daha önemlidir. Hekimler hastalarına ilaç reçete
ederken bitkisel ürün kullanımını sorgulamalıdır. Etkililiği ve güvenliliği
klinik kontrollü araştırmalarla kanıtlanmamış bitkisel ürünler önerilmemelidir.

Keywords

bitki, ilaç, bitki-ilaç etkileşmeleri, farmakokinetik, farmakodinamik

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