Interaction between medicinal herbs and drugs is a complex issue with many clinical implications.
Interaction between medicinal herbs and drugs is a complex issue with many clinical implications. Dosage and duration of treatment with herbal medicines are important factors that determine the risk of interactions. It is necessary to be wary of drug-drug interactions in patients taking modern drugs with a narrow therapeutic range.
Why is it important to pay attention to interactions between medicinal herbs and drugs?
Medical staff’s knowledge of drug-medicinal interactions in the human body can help reduce the risk of adverse reactions and take advantage of clinically beneficial reactions.
The clinical risk management model provides a systematic approach to minimizing treatment risks, by noting red flags and assessing, implementing, and implementing appropriate measures. risk reduction measures. These principles are completely consistent with the goal of reducing adverse reactions, drug-drug and drug-herbal interactions, especially with older drugs.
Many interactions between drugs and traditional medicine drugs occur through the mechanism of induction or inhibition of various enzymes belonging to the CYP450 group, glucuronosyltransferase and P glycoprotein (P-Gps). P-Gps are secretory proteins distributed in the intestines, liver and kidneys. In this regard, it is necessary to note the pharmacogenetic differences in drug excretion between Asian and Caucasian populations. Including the pharmacokinetic/pharmacodynamic characteristics of individual drugs to the frequency and severity of drug interactions and adverse effects. Therefore, clinical studies on the pharmacogenetics of drug-drug interactions are necessary in the future.
The treating physician needs to carefully understand the patient’s use of drugs and medicinal herbs, and even ask carefully and take this factor into consideration when prescribing treatment. Often, patients simply think that avoiding taking traditional medicine and modern medicine at the same time is enough to avoid interactions: “just wait a few hours after taking Western medicine and the body will eliminate it.” And taking Oriental medicine will be safe.” This view is not always correct.
Common interactions
Pharmacokinetic interactions
The CYP450 enzyme group includes many mono-oxygenases distributed mainly in the liver and intestines. They are responsible for oxidizing the active ingredients, before binding with glucuronide and then excreted through the urinary tract. The main enzymes involved in drug metabolism are CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP2E1 and CYP3A4. These enzymes can all be induced or inhibited by traditional medicine (and some foods). Inhibition of these enzymes may increase blood concentrations of drugs, whereas induction reduces blood concentrations of drugs and toxic metabolites. Both induction and inhibition processes in clinical practice can negatively affect the therapeutic effects of modern drugs, even causing cumulative toxicity. In addition, interactions between traditional medicine drugs and P glycoproteins may also occur. P-gps is also sensitive to induction and inhibition phenomena also belonging to the CYP450 group. Transport substrates of P-gps are drugs such as digoxin, metronidazole, saquinavir and talinol.
Pharmacodynamic interactions between drugs and medicinal ingredients
In addition to the above pharmacokinetic interactions, pharmacodynamic interactions between the drug and the drug are also at risk of occurring. Some traditional medicine drugs can help reduce the toxicity of modern drugs by protecting healthy cells. In cancer treatment, some medicines also support the effects of chemotherapy drugs through the mechanism of reducing the resistance of cancer cells. Traditional medicine drugs are often used to support cancer treatment such as Astragalus (Astragalus), Huachansu (extracted from Bufo bufo gargarizans resin), Curcumin (turmeric essence). Although there have been studies published in China and a few countries supporting these results. But most of these tests are only at the pre-clinical level or have not met the standards recognized by the FDA (Food and Drug Administration in the US).
Change in absorption
Traditional medicine may change the absorption of common western medicines. For example, medicinal herbs rich in saponins (Anemarrhena asphodeloides, Codonopsis, Gleditsia australis, Polygala and Panax ginseng).
Medications that change gastric pH (Atractylodes macrocephaly – Eucalyptus) may inhibit gastric secretion and interact with omeprazole.
Drugs with laxative effects such as Aloe vera (Aloe vera), Rheum palmatum (Rhubarb) and Sesamum indicum (Black sesame) can change intestinal motility, thereby affecting the drug absorption process. Bupleurum (Saihu) increases intestinal motility.
Piperine in lolot leaves slows down the process of gastric emptying (gastric emptying) and increases intestinal transit time.
Some medications can interact with oral anticoagulants. This interaction is significant in drugs that have blood-generating and blood-activating effects, and hemostatic drugs. The inhibitory effect on platelet aggregation has been demonstrated in Angelica chinensis (Dang Gui), Carthamus tinctoris (Red Flower) and Lycium chinense (Goji berry). Salvia miltiorrhiza (Danshen) may reduce the bioavailability of warfarin and other vitamin K antagonists through increased elimination. Zingiber officinale (Sinh Khuong) and Panax ginseng (Ginseng) increase the risk of bleeding if used with other anticoagulants.
Cistanche deserticola may interact with sympathomimetics, monoamide oxidase receptor inhibitors, selective serotonin reuptake inhibitors, and tricyclic antidepressants. This interaction may cause serotonin syndrome.
Medicinal herbs that have the effect of lowering blood sugar, such as Litchi chinensis (Lychi chinensis – seeds of lychee fruit), and Morinda citrifolia (noni fruit), can interact with antidiabetic drugs.
Medicinal herbs with strong phlegm-reducing effects such as Desmodium styracifolium, Dianthus superbus, D. chinensis, Euphorbia kansui, Lygodium japonicum, Phytolacca acinosa (Thuong Luc) , and Tetrapanax papyrifus (Phong Thao) … can theoretically interact with diuretics. However, the diuretic effect from these medicinal herbs is mainly to excrete water, while the mechanism of modern diuretics is to excrete water with sodium, so these two mechanisms are not completely the same.
The mineralocorticoid (water-retaining) activity of Glycyrrhiza glabra (licorice) may enhance the potassium-wasting effects of laxatives and loop diuretics such as furosemide and ethacrynic acid.
Piperine, found in the lolot leaf plant, inhibits P-Gps and CYP3A4, increasing blood concentrations of substrates of these enzymes such as rifampicine, theophylline, propranolol and phenytoin.
Traditional medicine is an essential part of the Vietnamese healthcare system. Systematic research on Vietnamese indigenous medicinal herbs is essential to provide scientific evidence to demonstrate the folk uses of Vietnamese medicinal plants, and to evaluate effectiveness and safety. In addition, a system to monitor, report and record adverse reactions to traditional medicine drugs will help warn of unwanted reactions or, for traditional medicine drugs that have not been officially recognized, will provide evidence safety proof. Although Vietnam has implemented a Pharmacovigilance program for traditional medicine, in the long term this system still has many points to overcome.
According to Suckhoedoisong