Herbal Medicine & Food/Drug Interactions

Question 1

What is Arteminisinin (Qinghaosu) effective for?

Answer 1

• Artemisinin is effective against all the malaria-causing protozoal organisms.
• In 2001 WHO recommended the adoption of artemisinin-based combination therapy for treatment of uncomplicated malaria => used widely in Sub-Saharan African countries as first line treatment

Question 2

What are common adverse effects/pharmacological interferences of herbal medicines?

Answer 2

• Anti-platelet effects
• Anti-coagulant effects
  
  • Both cause an increase in bleeding risk
• Cytochrome P450, UGTs, P-glycoprotein interferences

Question 3

What is Ephedra?

Answer 3

• Active components of Ephedra are ephedrine and pseudoephedrine
• In combination with caffeine => facilitates weight loss

Question 4

What are the adverse effects of Ephedra?

Answer 4

• High Blood Pressure
• Tachycardia
• CNS excitation
• Arrhythmia
• Myocardial infarction
• Stroke
• Banned in dietary supplements in 2004 by FDA

Question 5

Why do some herbal medicines significantly alter the pharmacokinetic properties of administered drugs

Answer 5

• Herbal medicines share the same drug metabolizing enzymes and drug transporters
  
  • Herbal medicines can alter the pharmacokinetic properties of administered drugs by inhibiting and/or inducing metabolic enzymes (CYP/UGT) and the drug transporter P-gp)

Question 6

What is the negative interaction between St. John’s Wort and cyclosporine?

Answer 6

St. John’s Wort diminishes the concentration of cyclosporine.

Question 7

What are the protective effects of Milk Thistle?

Answer 7

• Protective effects on the liver and management of liver diseases
  
  • Cirrhosis, drug-induced hepatotoxicity, hepatitis
    
    • Hepatitis => fewer and milder symptoms of liver disease
  • Reducing insulin resistance in type 2 diabetics with cirrhosis

Question 8

What are the uses/positive effects of Glucosamine/Chondroitin (sulfate)?

Answer 8

• Inflammation

- Osteoarthritis => pain relief for moderate-severe osteoarthritis

Question 9

How does glucosamine/chondroitin sulfate act in osteoarthritis?

Answer 9

• Glucosamine supplements glycosaminoglycans (key component of cartilage)
  
  • Slows the degeneration of cartilage in osteoarthritis

Question 10

What are the side effects associated with glucosamine/chondroitin sulfate?

Answer 10

• GI complaints
• Headaches
• Pain
• Leg edema
• Allergic reaction
• Drug interaction

Question 11

What are the claimed uses of Black Cohosh?

Answer 11

-Treatment of menopausal symptoms (hot flashes and mood disturbances)

Question 12

What are the claimed uses of Gingko?

Answer 12

• Improves memory and concentration
  
  • Alzheimer’s disease/ other dementias
  • Conflicting data, but some studies have shown improved cognitive performance in healthy adults and dementia patients
• Cardiovascular disease and circulatory disorders
• Tinnitus
• Sexual dysfunction
• Asthma and bronchitis
• Stress

Question 13

What are the claimed uses of Ginseng?

Answer 13

• Overall health
• Performance
• Stamina enhancer
• Immunostimulation

Question 14

What are the claimed uses of Ginger?

Answer 14

• Anti-emetic

- treatment of nausea, vomitting, motion sickness

Question 15

What are the claimed uses of Echinacea?

Answer 15

• Used to treat prevention of colds/flu/other viral infections

Question 16

What are the claimed uses of St. John’s wort?

Answer 16

• Used to treat mild/moderate depression/anxiety

- watch out for concerns of herb-drug interactions

Question 17

What are the claimed uses of Saw Palmetto?

Answer 17

• BPH => benign prostatic hypertrophy

* studies demonstrate conflicting evidence

Question 18

What is the Cheese reaction?

Answer 18

• Cheese contains tyramine (a monoamine found in many fermented foods)
  
  • Tyramine is metabolized by MAO (monoamine oxidase)
  • Tyramine is metabolism is blocked when taking MAO inhibitor => class of anti-depressants
    => potentiates sympathetic cardiovascular activity by releasing NorEpi=> Hypertensive response

Question 19

What is the grapefruit juice effect?

Answer 19

• Grapefruit juice can inhibit the intestinal cytochrome => P450 enzyme CYP3A4 (metabolizes many drugs)
  
  • Inhibition of CYP3A4 leads to increased plasma lifetime of drugs to dramatically different degrees