Table 3. Drug interactions of Valerianae radix.
| ATC therapeutic subgroup | ATC pharmacological/chemical subgroup | Drugs | Pharmacokinetic basis of interaction | Pharmacodynamic basis of interaction | Manifestation of interaction | |
|---|---|---|---|---|---|---|
| Antidiarrheals, intestinal anti-inflammatory/antiinfective agents (A07) | Antipropulsives | Loperamide | CYP3A4 | Valeriana is a GABAA agonist, mGlu I agonist, mGlu II antagonist, MAO inhibitor, 5-HT5A agonist, A1 agonist. | additive effect ↑ adverse reaction |
Czigle & Tóth (2016), Kelber, Nieber & Kraft, 2014) |
| Lipid modifying agents (C10) | HMG CoA reductase inhibitors | Lovastatin | CYP3A4 P-gp |
↑ plasma level ↑ adverse reaction (rabdomyolysis) |
Czigle & Tóth (2016) | |
| Antifungals for dermatological use (D01) | Antifungals for topical use, imidazole and triazole derivatives | Ketoconazole | CYP3A4 |
↑ plasma level ↑ adverse reactions |
Czigle & Tóth (2016), Hellum & Nilsen (2008) | |
| Antimycotics for systemic use (J02) | Triazole and tetrazole derivatives | Itraconazole | CYP3A4 |
↑ plasma level ↑ adverse reactions |
Czigle & Tóth (2016), Hellum & Nilsen (2008) | |
| Antineoplastic agents (L01) | Plant alkaloids and other natural products | Etoposide Paclitaxel Vinblastine Vincristine Vindesine |
CYP3A4 |
↑ plasma level ↑ adverse reactions |
Czigle & Tóth (2016), Mooiman et al. (2014) | |
| Anesthetics (N01) | Anesthetics, general | Propofol Thiopental |
Valeriana is a GABAA agonist, mGlu I agonist, mGlu II antagonist, MAO inhibitor, 5-HT5A agonist, A1 agonist. | additive effect ↑ adverse reactions ! do not use combination |
Czigle & Tóth (2016) | |
| Analgesics (N02) | Opioids | Fentanyl Morphine |
Valeriana is a GABAA agonist, mGlu I agonist, mGlu II antagonist, MAO inhibitor, 5-HT5A agonist, A1 agonist. | additive effect ↑ adverse reactions ! do not use combination |
Czigle & Tóth (2016) | |
| Antiepileptics (N03) | Antiepileptics, barbiturates | Phenobarbital | CYP2C9 | Valeriana is a GABAA agonist, mGlu I agonist, mGlu II antagonist, MAO inhibitor, 5-HT5A agonist, A1 agonist. | additive effect ↑ adverse reactions ! do not use combination |
Czigle & Tóth (2016), Dietz et al. (2005) |
| Antiepileptics, benzodiazepine derivatives | Clonazepam | CYP1A2 CYP3A4 |
Valeriana is a GABAA agonist, mGlu I agonist, mGlu II antagonist, MAO inhibitor, 5-HT5A agonist, A1 agonist. | additive effect ↑ adverse reaction ! do not use combination |
Dietz et al. (2005), Kelber, Nieber & Kraft (2014) | |
| Psycholeptics drugs (N05) | Anxiolytic drugs, benzodiazepine derivatives, azaspirodecanedione derivatives | Alprazolam Diazepam Lorazepam Buspirone |
CYP2C9 CYP3A4 |
Valeriana is a GABAA agonist, mGlu I agonist, mGlu II antagonist, MAO inhibitor, 5-HT5A agonist, A1 agonist. |
↑ alprazolam plasma level (19%) ↑ anxiolytic effect ! do not use combination |
Cavadas et al. (1995), Dietz et al. (2005), Kelber, Nieber & Kraft (2014) |
| Hypnotics and sedatives, barbiturates | Pentobarbital Secobarbital |
CYP2C9 | Valeriana is a GABAA agonist, mGlu I agonist, mGlu II antagonist, MAO inhibitor, 5-HT5A agonist, A1 agonist. | additive effect ↑ adverse reaction (hypotension) ! do not use combination |
Cavadas et al. (1995), Czigle & Tóth (2016), Dietz et al. (2005) | |
| Hypnotics, benzodiazepine derivatives | Midazolam Temazepam Triazolam |
CYP2C19 CYP3A4 |
Valeriana is a GABAA agonist, mGlu I agonist, mGlu II antagonist, MAO inhibitor, 5-HT5A agonist, A1 agonist. |
↑ plasma level ↑ anxiolytic effect ! do not use combination |
Cavadas et al. (1995), Czigle & Tóth (2016), Dietz et al. (2005), Mooiman et al. (2014) | |
| Antihistamines for systemic use (R06) | Selective peripheral H1 blocker | Fexofenadine | CYP3A4 Pgp OATP |
Valeriana is a GABAA agonist, mGlu I agonist, mGlu II antagonist, MAO inhibitor, 5-HT5A agonist, A1 agonist. |
↑ plasma level ↑ adverse reactions (sedative/hypnotic effect) |
Czigle & Tóth (2016), Dietz et al. (2005) |
Note:
ATC, Anatomical Therapeutic Chemical Classification System (WHO, 2023); ↑, increase (of); !, warning; A1 receptor, adenosine receptor, subtype A1; GABA, γ-aminobutyric acid; mGlu I, mGlu II receptors, metabotropic glutamate receptors subtype I a II; 5-HT5A receptor, 5-hydroxytryptamine (serotonin) 5A subtype receptor; MAO, monoamine oxidase; H, histamine; OATP, organic anion transporters; P-gp, P-glycoprotein.