Interactions Between Herbs and Anti-infective Medications

  • Surulivelrajan Mallayasamy
  • Scott R. PenzakEmail author
Part of the Infectious Disease book series (ID)


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.


Complementary and alternative medications (CAM) Herb Herbal supplement St. John’s wort Hyperforin HIV protease inhibitor Cytochrome P450 (CYP) P-Glycoprotein (P-Gp) USP Verified HIV 


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Pharmacy PracticeMCOPS, Manipal UniversityManipalIndia
  2. 2.Department of PharmacotherapyUniversity of North Texas System College of PharmacyFort WorthUSA

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