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Drug Interactions in Infectious Diseases: Mechanisms and Models of Drug Interactions pp 205–242Cite as

Interactions Between Herbs and Anti-infective Medications

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Part of the book series: Infectious Disease ((ID))

Abstract

Use of complementary and alternative medications (CAM), including herbal supplements, continues to rise throughout the Western world. This includes patients taking anti-infective medications, particularly individuals with HIV infection. A number of herbal supplements have been shown to modulate cytochrome P450 (CYP)-mediated drug metabolism and certain transport proteins, including the efflux transporter P-glycoprotein (P-gp). Most notably, St. John’s wort is a well-described inducer of CYP3A4 and P-gp and can lower the systemic exposure of anti-infective medications metabolized and/or transported by these proteins. Additional herbal supplements such as Echinacea purpurea, Ginkgo biloba, and Panax ginseng also modulate CYP3A4 to a lesser degree. Assessing herbal preparations for their potential to interact with prescription medications is difficult, due to the lack of ingredient standardization between products. Future studies of herb-drug interaction should be conducted in humans, employ a rigorous study design, and use herbal products that are US Pharmacopeia (USP) or otherwise independently verified. Clinicians caring for patients who elect to use CAM should exhibit a nonjudgmental attitude and document the name, manufacturer, dosage, and start and stop dates of all herbal products. Herb-drug interactions should be considered in the face of unexpected toxicity or therapeutic failure.

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Authors and Affiliations

  1. Department of Pharmacy Practice, MCOPS, Manipal University, Manipal, India

    Surulivelrajan Mallayasamy

  2. Department of Pharmacotherapy, University of North Texas System College of Pharmacy, Fort Worth, TX, USA

    Surulivelrajan Mallayasamy & Scott R. Penzak

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  1. Surulivelrajan Mallayasamy
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Correspondence to Scott R. Penzak .

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  1. College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA

    Manjunath P. Pai

  2. Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA

    Jennifer J. Kiser

  3. Division of Pharmacy Practice and Administration, UMKC School of Pharmacy at MSU, Springfield, Missouri, USA

    Paul O. Gubbins

  4. College of Pharmacy and Medicine, University of Illinois at Chicago, Chicago, Illinois, USA

    Keith A. Rodvold

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Mallayasamy, S., Penzak, S.R. (2018). Interactions Between Herbs and Anti-infective Medications. In: Pai, M., Kiser, J., Gubbins, P., Rodvold, K. (eds) Drug Interactions in Infectious Diseases: Mechanisms and Models of Drug Interactions. Infectious Disease. Humana Press, Cham. https://doi.org/10.1007/978-3-319-72422-5_6

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