Table 6.
Some examples of pharmacodynamic interactions between herbal products and conventional drugs.
| Medicinal plant | Major active ingredients | Indications | Mechanism of action | Drug candidates for potential interactions | LE | Reference |
|---|---|---|---|---|---|---|
| Vaccinium macrocarpon | Anthocyanins, flavonoids | Antioxidant | VKORC1* genotype dependent interaction | Warfarin | 4 | Mohammed et al. (2008) |
| Ternstroemia pringlei | Essential oils: monoterpenes | Sedative | Sedative synergy | Sedatives, hypnotics | 2 | Balderas et al. (2008) |
| Aspilia africana | Alkaloids, tannins | Malaria | Antagonism | Artemisinin, chloroquine | 1 | Waako et al. (2005), Abii and Onuoha (2011) |
| Digitalis lanata (Grecian foxglove, wooly foxglove) | Acetyldigoxin, digitalin, digoxin, digitoxin, gitalin, lanatosides | Cardiotonic | Positive inotrope | Cardiovascular drugs | 1 | Wood et al. (2003) |
| Anabasis sphylla | Anabasine | Skeletal muscle relaxant | Nicotinic receptor agonist which at high doses produces a depolarizing block of nerve transmission | Muscle relaxants | 1 | Taylor (2000) |
| Anisodus tanguticus | Anisodine, Anisodamine | Used in treating acute circulatory shock in China | Anticholinergic | Cholinomimetics | 1 | Fabricant and Farnsworth (2001) |
| Adonis vernalis (pheasant’s eye, red chamomile) | Adoniside | Cardiotonic | Cardiostimulant | Cardiovascular drugs | 1 | Lange (2000) |
| Areca catechu (Betel nut) | Arecoline | Relaxing drug | Direct acting cholinergic agonist | Cholinergic agents, CNS drugs | 4 | Boucher and Mannan (2002) |
| Peumus boldus (Boldo) | Boldine | Indigestion, constipation, hepatic disorders | Diuretic, choleretic, cholagogue | Diuretics, laxatives | 2 | De Almeida et al. (2000) |
| Rhamnus purshiana (Cascara) | Anthracene glycosides | laxative | Increasing GIT motility | Orally administered drugs | 1 | Fugh-Berman (2000) |
| Larrea tridentata (Chaparral) | Lignans, flavonoids, volatile oils, amino acids | RTI, chicken pox, TB, STI, pain, TB, weight loss | Estrogenic activity, hepatotoxicity | Steroids | 3 | Arteaga et al. (2005) |
| Lyceum barbarum (Chinese wolfberry) | Glycoproteins, polysaccharides, vitamin C | Energy replenishing agent, diabetes, liver, and kidney diseases | Hypoglycemic, immunostimulants | Hypoglycemic agents, immunosuppressants | 3 | He and Liu (2005) |
| Salvia miltiorriza (Danshen) | Tanshinones, phenolic compounds | Cardiovascular diseases | Vasorelaxants, antiplatelets | Warfarin, vasodilators, anticoagulants | 3 | Shi et al. (2005), Wu and Yeung (2010) |
| Angelica sinensis (Dong quai) | Phytoestrogens, flavonoids, coumarins | Gynecological and circulation disorders | Estrogenic, vasorelaxant, anti-inflammatory | Contraceptives, vasodilators, anticoagulants, antiplatelets | 3 | Goh and Loh (2001), Circosta et al. (2006) |
| Harpagophytum procumbes (Devils claw) | Harpagophy cumbens | Musculoskeletal and arthritic pain | Anti-inflammatory, anti-arrhythmic, positive inotropic | Anti-arrhythmias | 3 | Galíndez et al. (2002) |
| Echinacea species | Alkamides, phenols, polysaccharides | Upper respiratory tract infections | Immunostimulants | Immunosuppressants | 3 | Barnes et al. (2005) |
| Trigonella foenum-graecum (Fenugreek) | Alkaloids, flavonoids, saponins | Diabetes, hypercholesterolemia | Antilipidemic, hypoglycemic, cholagogue | Oral hypoglycemic agents | 2 | Tripathi and Chandra (2010), Moorthy et al. (2010), Baquer et al. (2011) |
| Tanacetum parthenium (Feverfew) | Parthenolide, tanetin | Headache, fever, arthritis | Inhibition of serotonin and prostaglandin release, thus altering platelet function | Antiplatelets, anticoagulants | 2 | Rogers et al. (2000) |
| Allium sativum (Garlic) | Allins | Hypercholesterolemia, prevention of arteriosclerosis | Antihypertensive, antidiabetic, antiplatelet, antilipidemic | Propranolol, hypoglycemic agents, anticoagulants | 3 | Asdaq et al. (2009), Asdaq and Inamdar (2011) |
| Zingiber officinale (Ginger) | Zingerone, gingerols | Nausea, dyspepsia | Antiemetic, antiplatelet, antiulcer | Diclofenac, anticoagulants | 3 | Lala et al. (2004), Young et al. (2006) |
| Ginko biloba (Ginko) | Flavonoids, ginkgolides, ginkgolic acid | Cardioprotection, dementia, antioxidant | Alteration in platelet function | Anticoagulants, antiplatelets | 3 | Yagmur et al. (2005) |
| Panax ginseng (Ginseng) | Triterpene saponins (ginsenosides) | Loss of energy and memory, stress, male sexual dysfunction | Immunomodulatory, hypoglycemic | Immunosuppressants, hypoglycemic agents | 3 | Wilasrusmee et al. (2002), Ni et al. (2010) |
| Chelidonium majus (Greater celandine) | Alkaloids | Gallstones, dyspepsia | Hepatotoxicity | Liver-dependent metabolism | 3 | Crijns et al. (2002), Gilca et al. (2010) |
| Camellia sinensis (Green tea) | Polyphenols, caffeine | Cardiovascular diseases, prevention of cancer | Antioxidants, CNS stimulants, antilipidemic | Sedatives, hypnotics, and anxiolytics | 1 | Ferrara et al. (2001) |
| Cyamopsis tetragonolobus (Guar gum) | Galactomannan, lipids, saponin | Diabetes, obesity, hypercholesterolemia | Hypoglycemic, antilipidemic | Hypoglycemic agents | 2 | Mukhtar et al. (2006) |
| Callilepsis laureola (Impila) | Atractyloside | GIT disorders, fertility, cough, worm infestations | Hepatotoxicity | Liver-dependent metabolism | 3 | Stewart et al. (2002) |
| Lycopodium serratum (Jin Bu huan) | Tetrahydropalmatine | Sedative, analgesic | Hepatotoxicity | CNS drugs | 3 | Emma (2008) |
| Piper methysticum (Kava) | Kavapyrones | Anxiety, insomnia | Anxiolytic, anesthetic, muscle relaxants | Sedative/hypnotic/anxiolytics | 2 | Feltenstein et al. (2003) |
| Catha edulis (Khat) | Cathinone | Loss of energy | CNS stimulant, indirect sympathomimetic | Antihypertensives, anti-arrhythmic, vasodilators | 1 | Al-Habori (2005) |
| Glycyrrhiza glabra (Liquorice) | Glycyrrhizinic acid | Gastric ulcer, catarrhs, inflammation | Antiulcer, aldosterone-like effects (mineralocorticoid actions) expectorant, anti-inflammatory | Diuretics, antihypertensives | 3 | Armanini et al. (2002) |
| Ephedra species (Ma-huang) | Ephedrine | Weight loss | Hepatotoxicity | CNS drugs | 3 | Shekelle et al. (2003) |
| Carica papaya (Papaya) | Papain | GIT disorders | Alteration in platelet functions | Anticoagulants, antihypertensives | 2 | Ono et al. (2000) |
| Mentha pulegium (Pennyroyal) | Pulgenone | Abortifacient, herbal tonic | Hepatotoxicity | Most drugs | 2 | Sztajnkrycer et al. (2008) |
| Heliotropium species, senecio species, symphytum crotalaria (Pyrrolizidines) | Pyrrolizidine alkaloids | Herbal teas and enemas | Hepatotoxicity | Liver-metabolized drugs | 2 | Huxtable and Cooper (2000) |
| Eleutherococcus senticosus (Siberian ginseng) | Eleutherosides | Loss of energy and memory, stress, male sexual dysfunction | Immunomodulatory, anti-inflammatory, antitumor | Immunosuppressants | 4 | Szolomicki et al. (2000) |
| Glycine max (Soya) | Phytoestrogens | Menopausal symptoms, prevention of heart diseases and cancer | Hepatoprotective, anti-osteoporosis | Contraceptives | 4 | Albert et al. (2002) |
| Tamarindus indica (Tamarind) | Saponins, flavonoids, sesquiterpenes, tannins | Stomach disorder, jaundice | Alteration in platelet functions | Anticoagulants | 3 | Scott et al. (2005) |
| Atropa belladonna (Deadly nightshade) | Atropine | Motion sickness, GIT disorders | Anticholinergic | Cholinergic drugs | 1 | Ulbricht et al. (2008) |
| Camellia sinensis, Theobroma cacao, Thea species | Caffeine | CNS stimulant | CNS stimulant | CNS drugs | 1 | Ashihara and Crozier (2001) |
| Cissampelos pareira (Velvet) | Cissampeline | Skeletal muscle relaxant | Muscle relaxants | Muscle relaxants | 2 | Bafna and Mishra (2010) |
| Convallaria majalis (Lily of the valley) | Convallatoxin | Cardiotonic | Cardiostimulant | Cardiovascular drugs | 3 | Knight and Walter (2002) |
| Rauwolfia canescens; Rauwolfia serpentina | Deserpidine, reserpine | Antihypertensive, tranquilizer | Antihypertensive | Cardiovascular drugs | 3 | Emilio et al. (1998) |
| Octea glaziovii | Glasiovine | Antidepressant | Antidepressant | CNS drugs | 3 | Maridass and De Britto (2008) |
| Black henbane, stinking nightshade, henpin | Hyoscyamine | GIT disorders | Anticholinergic | Cholinergic drugs | 3 | Gilani et al. (2008) |
| Khetin | Kheltin | Asthma | Bronchodilator | Anti-asthma drugs | 1 | Ziment and Tashkin (2000) |
| Ouabain tree | Ouabain | Cardiotonic | Cardiostimulant | Cardiovascular drugs | 1 | Schoner (2000) |
| Calabar bean | Physostigmine | Cholinesterase inhibitor | Cholinergic drugs | 3 | Hsieh et al. (2008) | |
| Jaborandi, Indian hemp | Pilocarpine | Purgative | Parasympathomimetic | Cholinergic drugs | 3 | Agra et al. (2007) |
| White false hellebore | Protoveratrines A, B | Antihypertensives | Antihypertensive | Cardiovascular drugs | 3 | Gaillard and Pepin (2001) |
| squill | Scillarin A | Cardiotonic | Sedative | Cardiovascular drugs | 1 | Marx et al. (2005) |
| Jimsonweed | Scopolamine | Sedative | Sedative | Cardiovascular drugs | 2 | Ayuba and Ofojekwu (2005) |
| Tetrandrine | Antihypertensive | Antihypertensive effects | Cardiovascular drugs | 2 | Yao and Jiang (2002) | |
| Yohimbe | Yohimbine | Aphrodisiac | Vasodilatory | Cardiovascular drugs | 2 | Ajayi et al. (2003) |
*VKORC1, vitamin K epoxide reductase complex subunit 1.