Table 2.
Top selling HMPs and how available data are presented in PharmActa regarding potential drug–herb interactions.
| HMP | Proposed Use | Potential Drug Interactions | Pharmacological Mechanisms | Patients-Diseases | Clinical Significance | PharmActa | Reference |
|---|---|---|---|---|---|---|---|
| Horehound | respiratory ailments | - | - | - | - | monitor for clinical significant DHIs | - |
| Cranberry | bladder and kidney ailments | anticoagulant and antiplatelet therapy | PK and PD | CVD and clot disorders | Research level-clinical data suggest no interaction | use with caution | [75] |
| Echinacea | immune stimulant | antipsychotics, antidepressants, immunosuppressants | PK and PD | CNS disorders | Under specific circumstances-Precautions to minimize any risk | monitor for clinical significant DHIs | [17,26,27,28,61] |
| Green Tea | antioxidant | anticoagulant and antiplatelet therapy | PD | CVD and clot disorders | Research level-clinical data suggest no interaction | use with caution | [76] |
| Black Cohosh | PMS and menopause symptoms | amiodarone, fexofenadine, glyburide, simvastatin, atorvastatin | PK | CVD and clot disorders | Research level-clinical data suggest no interaction | use with caution | [26,27,51,58] |
| Garcinia | weight loss | ciprofloxacin, quinine | PK | bacterial infections and muscular disorders | Research level-clinical data suggest no interaction | use with caution | [25] |
| Flax Seed/Flax oil | CVD problems and diabetes | anticoagulant and antiplatelet therapy | PD | CVD and clot disorders | Research level-clinical data suggest no interaction | use with caution | [77] |
| Ginger | reduce nausea and inflammation | tacrolimus | PK | allogeneic organ transplant | Under specific circumstances-Precautions to minimize any risk | monitor for clinical significant DHIs | [32,58,61,78] |
| Ivy leaf | expectorant | - | - | - | Research level-clinical data suggest no interaction | use with caution | [32,79] |
| Turmeric | antiinflamantory | CVD drugs, antidepressants, anticoagulants, antibiotics, chemotherapeutic agents, and antihistamines | PK | CVD and clot disorders, CNS disorders, Cancer, bacterial infections, allergies | Under specific circumstances-Precautions to minimize any risk | monitor for clinical significant DHIs | [32,80] |
| Valerian | anxiety and insomnia | benzodiazepines and sedatives | PD | Under specific circumstances-Precautions to minimize any risk | monitor for clinical significant DHIs | [26,27,81] | |
| Fenugreek | diabetes and PMS | hypoglycaemic, anticoagulant, and antiplatelet therapy | PD | diabetes, CVD and clot disorders | research level-clinical data suggest no interaction | use with caution | [82] |
| Yohimbe | erectile dysfunction - weight loss | MAOIs, clonidine, | PD | CNS disorders, prostate hypertrophy, kidney disease | avoid co-administration | use alternative due to clinical significant DHIs | [20] |
| Aloe | constipation, diabetes, acne and inflamation | digoxin, antidiabetic drugs | PD | HF, diabetes | under specific circumstances-precautions to minimize any risk | monitor for clinically significant DHIs | [61,83] |
| Saw Palmeto | prostate surgery | antibiotics, anticoagulant, and antiplatelet therapy | PD | CVD and clot disorders, bacterial infections, | research level-clinical data suggest no interaction | use with caution | [26,27,28,84] |
| Milk Thistle | liver problems | losartan, warfarin, phenytoin, diazepam | PK | CVD and preoperative period | research level-clinical data suggest no interaction | use with caution | [26,51,85] |
| Garlic | reducing cholesterol and blood pressure | colchicine, digoxin, doxorubicin, qunidine, rosuvastatin, dexamethasone, nifedipine, verapamil, saquinavir, indinavir, ritonavir, rifampicin, reserpine, carbamazepine | PK | arthritis, CVD, cancer, HIV | under specific circumstances-precautions to minimize any risk | monitor for clinically significant DHIs | [26,28,32,51,83,86] |
| Coconut Oil | eczema and improve HDL cholesterol levels | - | - | - | - | use with caution | - |
| Eldeberry | Constipation and flu symptoms | immunosuprresants, hypoglycemic | PD | transplantation, diabetes | research level-clinical data suggest no interaction | use with caution | [78] |
| Cinnamon | diabetes and lowering cholesterol | anticoagulant and antiplatelet therapy | PD | CVD and clot disorders | research level-clinical data suggest no interaction | use with caution | [87] |
| Green Coffee Extract | antioxidant for diabetes and heart disease | adenosine, anticoagulant and antiplatelet therapy, MAOIs, CVD drugs | PD | CVD and clot disorders, CNS disorders, Inflammatory bowel disease | under specific circumstances-precautions to minimize any risk | monitor for clinical significant DHIs | [88] |
| Boswellia | anti-inflammatory in asthma and arthritis | - | - | - | - | monitor for clinical significant DHIs | - |
| Ginkgo | adaptogen for dementia and fatigue | clopidogrel, aspirin, warfarin | PD | under specific circumstances-precautions to minimize any risk | monitor for clinical significant DHIs | [20,26,28,30,51,61,85] | |
| Plant Sterols | lower cholesterol levels | LLTs | PD | dyslipidemias | research level-clinical data suggest no interaction | use with caution | [89] |
| Senna | constipation | digoxin, warfarin | PD | avoid co-administration | use alternative due to clinical significant DHIs | [90] | |
| Acaí | antioxidant | - | - | - | - | - | |
| Guarana | CNS stimulant | adenosine, anticoagulant and antiplatelet therapy, MAOIs, CNS drugs | PD | CVD and clot disorders, CNS disorders | under specific circumstances-precautions to minimize any risk | monitor for clinically significant DHIs | [91] |
| Rhodiola | adaptogen | loasartan, warfarin, clopidogrel | PK | CVD and clot disorders | under specific circumstances-precautions to minimize any risk | monitor for clinically significant DHIs | [92,93,94,95,96,97] |
| Bioflavonoid Complex | antioxidant | digoxin, anticoagulant and antiplatelet therapy, CVD, cancer medications | PK | CVD and clot disorders, Cancer | moderate | monitor for clinical significant DHIs | [85] |
| Red Yeast rice | lower cholesterol levels | LLTs, CVD drugs | PK and PD | dyslipidemias, CVD | under specific circumstances-precautions to minimize any risk | monitor for clinically significant DHIs | [92,96] |
| Ginseng (siberian) | adaptogen and heart disease | digoxin | PK | heart failure | under specific circumstances-precautions to minimize any risk | monitor for clinically significant DHIs | [26,28,30,51,61,68] |
| Horny Goat Weed | erectile dysfunction, PMS, osteoporosis | CVD, anticoagulant and antiplatelet therapy | PD | CVD and clot disorders | research level-clinical data suggest no interaction | use with caution | [98] |
| Yerba Mate | CNS stimulant | adenosine, anticoagulant and antiplatelet therapy, MAOIs, CNS drugs | PD | CVD and clot disorders, CNS disorders | research level-clinical data suggest no interaction | use with caution | - |
| Fennel | digestive problems, pregnancy | Contraceptives, tamoxifen, ciprofloxacin | PK | birth control, breast cancer, infections | under specific circumstances-precautions to minimize any risk | monitor for clinically significant DHIs | [78] |
| Beta Glucans | lower blood cholesterol | LLTs, CVD drugs | PK and PD | dyslipidemias, CVD | under specific circumstances-precautions to minimize any risk | monitor for clinically significant DHIs | [99] |
| Maca | female hormone imbalance, menstrual problems, chronic fatigue syndrome | - | - | - | - | - | - |
| St. John’s Wort | antidepressant | anticancer, CNS drugs, LLTs, PPIs, antiretroviral, hypoglycemic, antihistamine, CVD drugs, antimicrobials, hormonal agents, immunosuppressants | PK and PD | arthritis, CVD, cancer, CNS disorders, diabetes, HIV, infections, allergies, transplantation | avoid co-administration | use alternative due to clinical significant DHIs | [15,28,56,58,59,61,62] |
| Wheatgrass/Barley | diabetes, lower cholesterol and for weight loss | - | - | Inflammatory bowel disease | under specific circumstances-precautions to minimize any risk | monitor for clinical significant DHIs | [88] |
| Goji Berry | antioxidant, diabetes, blood pressure | warfarin and antiplatelet | PD | CVD and clot disorders | under specific circumstances-precautions to minimize any risk | monitor for clinical significant DHIs | [100] |
| Chia Seed/Chia oil | omega-3 fatty acids and antioxidants | - | - | - | - | - |
DHIs: Drug-Herb interactions; PK: Pharmacokinetics; PD: Pharmacodynamics; CVD: Cardio-Vascular Diseases; CNS: Central Nervous System; MAOIs: Monoamine Oxidase Inhibitors; HF: Heart Failure; HIV: Human Immunodeficiency Virus; HDL: High Density Lipoproteins; LLTs: Lipid Lowering Therapies; PPIs: Proton Pump Inhibitors; PMS: Premenstrual Syndrome.