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Safety Monitoring of Herb-Drug Interactions

A Component of Pharmacovigilance

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Abstract

Adverse drug reactions, including those resulting from interactions between herbal medicines and conventional drugs, are a public health problem worldwide. The need for pharmacovigilance for herb-drug interactions (HDIs) is essential for the identification and assessment of risks of using herbal products (questionable safety, efficacy and quality), which are not always tested with rigor, or often not subject to approval by regulatory agencies.

Spontaneous and active surveillance conducted by national pharmacovigilance centres permits a rapid detection of potentially harmful combinations of products. The incidence and prevalence of HDIs are difficult to predict because of the underreporting of adverse effects. It is important for health professionals, consumers, regulatory authorities and suppliers of herbal medicines to be aware of the possible adverse effects and drug interactions caused when herbal medicines are co-administered with conventional drugs. National pharmacovigilance centres continue to play a significant role in increasing awareness of drug safety, in this case with HDIs.

The authors’ objective for this paper is to provide awareness among policy makers responsible for the design of appropriate pharmacovigilance practices and therefore to highlight the importance of pharmacovigilance in the safety monitoring of HDIs.

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References

  1. Butterwek V, Derendorf H. Potential of pharmacokinetic profiling for detecting herbal interactions with drugs. Clin Pharmacokinet 2008; 47(6): 383–97

    Article  Google Scholar 

  2. Lin JH, Lu AY. Inhibition and induction of cytochrome P450 and the clinical implications. Clin Pharmacokinet 1998; 35: 361–90

    Article  PubMed  CAS  Google Scholar 

  3. Ioannides C. Pharmacokinetic interactions between herbal remedies and medicinal drugs. Xenobiotica 2002; 32: 451–78

    Article  PubMed  CAS  Google Scholar 

  4. Vasiliadis HM, Tempier R. Reporting on the prevalence of drug and alternative health product use for mental health reasons: results from a national population survey. J Popul Ther Clin Pharmacol 2011; 18(1): e33–43

    PubMed  Google Scholar 

  5. Delgoda R, Younger N, Barrett C, et al. The prevalence of herbs use in conjunction with conventional medicines in Jamaica. Complement Ther Med 2010 Feb; 18(1): 13–20

    Article  PubMed  Google Scholar 

  6. Elmer GW, Lafferty WE, Tyree PT, et al. Potential interactions between complementary/alternative products and conventional medicines in a medicare population. Ann Pharmacother 2007 Oct; 41(10): 1617–24

    Article  PubMed  Google Scholar 

  7. Müller AC, Kanfer I. Potential pharmacokinetic interactions between antiretrovirals and medicinal plants used as complementary and African traditional medicines. Biopharm Dispos 2011 Nov; 32(8): 458–70

    Article  Google Scholar 

  8. Rispler DT, Sara J. The impact of complementary and alternative treatment modalities on the care of orthopaedic patients. J Am Acad Orthop Surg 2011 Oct; 19(10): 634–43

    PubMed  Google Scholar 

  9. Skalli S, Zaid A, Soulaymani R. Drug interactions with herbal medicines. Ther Drug Monit 2007 Dec; 29(6): 679–86

    Article  PubMed  CAS  Google Scholar 

  10. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000; 343: 1833–8

    Article  PubMed  CAS  Google Scholar 

  11. Samenuk D, Link MS, Homoud MK, et al. Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine. Mayo Clin Proc 2002; 77: 12–6

    Article  PubMed  Google Scholar 

  12. Skalli S, Soulaymani R. A propos des produits Herbalife. L’Officinal 2002; 28: 4

    Google Scholar 

  13. Chung MK. Vitamins, supplements, herbal medicines, and arrhythmias. Cardiol Rev 2004; 12: 73–84

    Article  PubMed  Google Scholar 

  14. Johns Cupp M. Herbal remedies: adverse effects and drug interactions. Am Fam Phys 1999; 59: 1239–47

    Google Scholar 

  15. Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329(7456): 15–9

    Article  PubMed  Google Scholar 

  16. McCabe BJ. Prevention of food-drug interactions with special emphasis on older adults. Curr Opin Clin Nutr Metab Care 2004; 7: 21–6

    Article  PubMed  Google Scholar 

  17. Jordan SA, Cunningham DG, Marles RJ. Assessment of herbal medicinal products: challenges, and opportunities to increase the knowledge base for safety assessment. Toxicol Appl Pharmacol 2010 Mar 1; 243(2): 198–216

    Article  PubMed  CAS  Google Scholar 

  18. Yue QY, Bergquist C, Gerden B. Safety of St John’s wort (Hypericum perforatum). Lancet 2000; 355: 576–7

    Article  PubMed  CAS  Google Scholar 

  19. Jiang M, Park M, Lee HC, et al. Antidiabetic agents from medicinal plants. Curr Med Chem 2006; 13: 1203–18

    Article  Google Scholar 

  20. Izzo AA, Di Carlo G, Borrelli F, et al. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. Int J Cardiol 2005; 98: 1–14

    Article  PubMed  Google Scholar 

  21. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: a systematic review. Drugs 2001; 61: 2163–75

    Article  PubMed  CAS  Google Scholar 

  22. Henderson L, Yue QY, Bergquist C, et al. St John’s wort (Hypericum perforatum): drug interactions and clinical outcomes. Br J Clin Pharmacol 2002; 54: 349–56

    Article  PubMed  CAS  Google Scholar 

  23. Kawaguchi A, Ohmori M, Tsuruoka S, et al. Drug interaction between St John’s and quazepam. Br J Clin Pharmacol 2004; 58: 403–10

    Article  PubMed  CAS  Google Scholar 

  24. Mills E, Wu P, Johnston BC, et al. Natural health product-drug interactions: a systematic review of clinical trials. Ther Drug Monit 2005; 27: 549–57

    Article  PubMed  Google Scholar 

  25. Wang EJ, Barecki-Roach M, Johnson WW. Quantitative characterization of direct P-glycoprotein inhibition by St John’s wort. J Pharm Pharmacol 2004; 56: 123–8

    Article  PubMed  CAS  Google Scholar 

  26. Ruschitzka F, Meier PJ, Turina M, et al. Acute heart transplant rejection due to Saint John’s wort. Lancet 2000; 355: 548–9

    Article  PubMed  CAS  Google Scholar 

  27. Hennessy M, Kelleher D, Spiers JP, et al. St. John’s wort increases expression of P-glycoprotein: implications for drug interactions. Br J Clin Pharmacol 2002; 53: 75–82

    Article  PubMed  CAS  Google Scholar 

  28. Zhou W, Chai H, Lin HL, et al. Molecular mechanisms and clinical applications of ginseng root for cardiovascular disease. Med Sci Monit 2004; 8: RA187–92

    Google Scholar 

  29. De Smet PA. Health risks of herbal remedies. Drug Saf 1995; 13: 81–93

    Article  PubMed  Google Scholar 

  30. Bartels CL, Miller SJ. Herbal and related remedies. Nutr Clin Pract 1998; 12: 5–9

    Article  Google Scholar 

  31. Poppenga RH. Herbal medicines: potential for intoxication and interactions with conventional drugs. Clin Tech Small Anim Pract 2002; 17: 6–18

    Article  PubMed  Google Scholar 

  32. Singh SR, Levine M. Natural health product use in Canada:patterns of use and the risk of interactions with pharmaceuticals. Clin Pharmacol Ther 2004; 75: 28

    Article  Google Scholar 

  33. Kaufman DW, Kelly JP, Rosenberg L, et al. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 2002; 287: 337–44

    Article  PubMed  Google Scholar 

  34. Makino T, Inagaki T, Komatsu KI, et al. Pharmacokinetic interactions between Japanese traditional medicine (Kampo) and modern medicine (III): effect of Sho-seiryu-to on the pharmacokinetics of azelastine hydrochloride in rats. Biol Pharm Bull 2004; 27: 670–3

    Article  PubMed  CAS  Google Scholar 

  35. Alvarez-Requejo A, Carvajal A, Begaud B, et al. Underreporting of adverse drug reactions: estimate based on a spontaneous reporting scheme and sentinel system. Eur J Clin Pharmacol 1998; 54(6): 483–8

    Article  PubMed  CAS  Google Scholar 

  36. Hazell L, Shakir SAW. Under-reporting of adverse drug reactions: a systematic review. Drug Saf 2006; 29(5): 385–96

    Article  PubMed  Google Scholar 

  37. Walji R, Boon H, Barnes J, et al. Consumers of natural health products: natural-born pharmacovigilantes? BMC Complement Altern Med 2010 Feb 25; 10: 8

    Article  PubMed  Google Scholar 

  38. Aronson JK. Classifying drug interactions. Br J Clin Pharmacol 2004; 58: 343–4

    Article  PubMed  CAS  Google Scholar 

  39. Fitzgerald P. Pharmacovigilance inspections. Indian J Pharmacol 2008; 40 Suppl. 1: S21–3

    PubMed  Google Scholar 

  40. Murray E, Pollack L, White M, et al. Clinical decision-making: patient’ preferences and experiences. Patient Educ Couns 2007; 65: 189–96

    Article  PubMed  Google Scholar 

  41. Lexchin J. Is there still a role for spontaneous reporting of adverse drug reactions? CMAJ 2006; 174: 191–2

    PubMed  Google Scholar 

  42. Wysowski DK, Swartz L. Adverse drug event surveillance and drug withdrawals in the United States, 1969–2002: the importance of reporting suspected reactions. Arch Intern Med 2005; 165: 1363–9

    Article  PubMed  Google Scholar 

  43. Berry DC, Knapp PR, Raynor DK. Is 15% very common: informing people about the risks of medication side effects. Int J Pharm Prac 2002; 10: 145–51

    Article  Google Scholar 

  44. Kales HC, Blow FC, Welsh DE, et al. Herbal products and other supplements: use by elderly veterans with depression and dementia and their caregivers. J Geriatr Psychiatry Neurol 2004; 17: 25–31

    Article  PubMed  Google Scholar 

  45. Woodward KN. The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products. Hum Exp Toxicol 2005; 24: 219–33

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

No sources of funding were used to prepare this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Department of Pharmacovigilance, Moroccan Poison Control and Pharmacovigilance Center, Rabat, Morocco

    Souad Skalli & Rachida Soulaymani Bencheikh

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  1. Souad Skalli
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  2. Rachida Soulaymani Bencheikh
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Correspondence to Souad Skalli.

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Skalli, S., Bencheikh, R.S. Safety Monitoring of Herb-Drug Interactions. Drug Saf 35, 785–791 (2012). https://doi.org/10.1007/BF03261975

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