Herbal Med/F&D Interactions Flashcards
Why is herbal medicine popular?
Viewed as natural (safe, few side effects)
Perceived as validated over generations of use
Seen as lower cost vs conventional medicine
Don’t have to visit healthcare professional
What are general concerns regarding most herbal medicines?
Adverse effects (especially bleeding)
Herb-drug interactions (alter PK properties of drugs by inducing/inhibiting CYPs and UGTs)
Limited number/quality of RCTs
Mixtures with many compounds and inconsistent formulations
Federal regulations and herbal medicines: what do the DSHEA, GMP, and Dietary Supplement and Nonprescription Drug Consumer Protection Act say?
DSHEA: supplements are foods, do not need FDA approval, FDA can regulate manufacturing
GMP: must adhere to good manufacturing practices (no contamination, accurate labeling, consistency)
DSNDCPA: manufacturers have to report all serious supplement-related adverse events to FDA
Milk thistle: major reason for usage (3)
Contains silymarin
Protective effects on liver and management of liver diseases (B)
Lowering cholesterol (C)
Helping T2DM pts with cirrhosis (B)
Glucosamine/chondroitin: major reason for usage
Inflammation (C)
Osteoarthritis (B)
Black cohosh: major reason for usage
Treating menopausal symptoms (C)
Ginkgo: major reason for usage
Memory and concentration (C)
Alzheimers/dementia (B)
Anxiety, other mental disorders (B)
Ginseng: major reason for usage
Overall health, performance and stamina enhancer (B)
Immunostimulation (B)
Ginger: major reason for usage
Antiemetic (A,B,C (variable)) Motion sickness (C)
Echinacea: major reason for usage
Treat or prevent colds and flu (B)
St. John’s wort: major reason for usage
Depression and anxiety (A) Somatoform disorders (B)
Saw palmetto: major reason for usage
BPH (A, but questionable)
Food-drug interactions: the cheese reaction
Cheese, other fermented foods have tyramine, which is metabolized by MAO
MAOIs (uncommon antidepressants) block metabolism of tyramine -> hypertensive response via NE release, can be fatal
Food-drug interactions: the grapefruit juice effect
Grapefruit juice inhibits CYP3A4, increasing plasma lifetimes of many drugs
