Table 7.

Drug–herbal interactions encountered

Herbal supplement	Interacting drug	Type of interaction	Details
Calcium	Aspirin	Pharmacokinetic	Enhanced renal elimination of salicylates, due to urinary alkalinization
Calcium	Aspirin	Pharmacokinetic (elimination)	Enhanced renal elimination of salicylates, due to urinary alkalinization
Niacin	Simvastatin	Pharmacodynamic	Increased risk of myopathy and rhabdomyolysis
Biotin	Metformin	Pharmacodynamic	Hypoglycaemia. Biotin stimulates glucokinase, resulting in increased synthesis of glycogen, and also stimulates the secretion of insulin in the pancreas of rats, both glucose-lowering effects [16]
Midro tea	Famotidine	Pharmacokinetic (absorption)	Reduces absorption of famotidine
Cranberry	Famotidine	Pharmacodynamic	Antagonizes effect of famotidine by reducing gastric pH
Camomile tea	Ciclosporine (metabolism)	Pharmacokinetic	Camomile inhibits CYP3A4 and ciclosporin levels may rise