Table 3.
Some herbal products known to interact with CYP and efflux proteins.
| Medicinal Plant and parts used | Scientific name | Major constituents | Mechanism of drug interactions | Candidates for interactions | LE | Reference |
|---|---|---|---|---|---|---|
| Cranberry (fruit extract) | Vaccinium macrocarpon | Anthocyanins, flavonoids | Inhibition of CYP enzymes and P-gp | Warfarin, CYP1A2, 2C9, and 3A4 substrates | 4 | Li et al. (2009), Kim et al. (2010b), Roberts and Flanagan (2011), Hamann et al. (2011) |
| Dong quai (root) | Angelica sinensis | Flavonoids, coumarins | Inhibition of CYP1A2, 3A4, and P-gp | CYP substrates | 3 | Scott and Elmer (2002), Tang et al. (2006), Sevior et al. (2010) |
| Gan cao (root) | Glycyrrhiza uralensis | Glycyrrhizin | CYP2C9 and 3A4 induction | Warfarin, Lidocaine, CYP2C9, and 3A4 substrates | 2 | Mu et al. (2006), Tang et al. (2009) |
| Garlic (bulb) | Allium sativum | Allicin, phytoncide | CYP 3A4 and P-gp induction | Saquinavir, warfarin, CYP2D6, and 3A4 substrates | 4 | Markowitz et al. (2003a), Cox et al. (2006), Berginc and Kristl (2012) |
| Germander (leaves) | Teucrium chamaedrys | Saponins, flavonoids, diterpenoids | Production of toxic CYP3A4-induced metabolites | CYP3A4 inducers like Phenobarbital, rifampicin | 3 | De Berardinis et al. (2000), Savvidou et al. (2007) |
| Ginseng (root) | Panax ginseng | Ginsenosides | Inhibition and induction of CYP2C9, 2C19, 2D6, and 3A4 activity | Imatinib, CYP2E1, and 2D6 substrates | 4 | Gurley et al. (2005a), Bilgi et al. (2010), Malati et al. (2011) |
| Grape seed (seed oil) | Vitis vinifera | Proanthocyanidin, resveratrol | Decreased CYP2C19, 2D6, and 3A4 activity | CYP2C19, 2D6, and 3A4 substrates | 4 | Nishikawa et al. (2004) |
| Kava kava (root) | Piper methysticum | Kavalactones | Decreased CYP1A2, 2D6, 2E1, and 3A4 activity | CYP substrates | 4 | Gurley et al. (2005b), Teschke (2010), Sarris et al. (2011) |
| Liquorice (root) | Glycyrrhiza glabra | Inhalant | Inhibition of CYP2B6, 2C9 and 3A4 | CYP2B6, 2C9 and 3A4 substrates | 4 | Kent et al. (2002), Al-Deeb et al. (2010), Methlie et al. (2011) |
| St John’s wort (aerial parts) | Hypericum perforatum | Hyperforin, hypericin, flavonoids | Inhibition and induction of CYP and P-gp | Orally administered CYP substrates | 4 | Hu et al. (2005), Hafner et al. (2009), Lau et al. (2011) |
LE, level of evidence.