Table 4.
Effects and mechanisms of drug–herb interaction.
| Herb | Drug | Effect | Mechanism |
|---|---|---|---|
| Green tea | lisinopril | plasma concentration ↓ | |
| nadolol | plasma concentration ↓ | OATP1A2 and OATP2B1 inhibition, ↓ absorbtion, (OATP)1A2-mediated uptake ↓ | |
| amlodipine | cytochrome P450 system inhibition | ||
| Garlic | nifedipine | intestinal metabolism ↑, plasma concentration ↑ | |
| valsartan and losartan | intestinal absorption ↓, plasma concentration ↓ | intestinal transporters↓ | |
| carvedilol | LDH ↓, CK-MB ↓, antioxidant ↑ | ||
| atenolol | cardiac workload↓ | oxidative stress↓ | |
| propranolol | SBP ↓, cholesterol, tryglicerides, glucose ↓ | ||
| Aloe vera | general effect | intestinal transit time ↓, intestinal absorption ↓ | |
| Ginkgo biloba | losartan/ EXP3174 | plasma concentration ↑/plasma concentration ↓ | |
| talinolol | plasma concentration ↑ | ||
| Berberine | losartan/ EXP3174 | plasma concentration ↑/plasma concentration ↓ | inhibition of CYP2D6, CYP3A4 and CYP2C9 |
| irbesartan | plasma concentration ↑ | ||
| Ginseng | fimasartan/amlodipine/hydrochlorothiazide | no interaction | |
| furosemide | resistance | ||
| Celery (Apium graveolens) | non | no interaction | |
| Nigella sativa | amlodipine | HR ↓ | |
| losartan | plasma concentration ↑ | inhibition of CYP3A4 and CYP2C9 enzyme activity | |
| metoprolol | enhancing effect | ||
| Cinnamon | nicotine | time-dependent inhibition of CYP2A6 | |
| Wild thyme | non | no interaction | |
| Ginger | amlodipine | enhancing effect | |
| losartan | plasma concentration ↑ | inhibition of CYP enzymes | |
| clopidogrel | competitive inhibitory effect on CYP2C19 enzyme |
Abbreviations: (OATP)1A2/2B2: human organic anion-transporting polypeptide 1A2/2B2; LDH: lactate dehydrogenase; CK-MB: creatine kinase muscle–brain; SBP: systolic blood pressure; HR: heart rate; CYP2D6: cytochrome P 450, family 2, subfamily D, member 6; CYP3A4: cytochrome P 450, family 3, subfamily A, member 4; CYP2C9: cytochrome P 450, family 2, subfamily C, member 9; CYP2A6: cytochrome P 450, family 2, subfamily A, member 6; CYP2C19: cytochrome P 450, family 2, subfamily C, member 19; CYP: cytochrome P 450; EXP3174: losartan carboxylic acid. Symbols ↑ and ↓ represent the stimulating or inhibiting effect of the substance on the presented drugs metabolization and bioavailability.