Table 3.

The effects of the selected herbal substances on pharmacokinetics and pharmacodynamics [28,33,34,50,51,52,61,67,68,69,70].

Herb	Active Component	Relevant Metabolizing Enzymes/Transporters/Mechanism of Actions	Pharmacokinetics of Tacrolimus	Impact on Organism
Panax ginseng	Ginsenosides Glycosylated intestinal metabolites	Poor inhibition of CYP2D6; Poor inhibition of P-gp; Poor induction of CYP3A; Promotion of Klotho signalling pathway	Poor increase or lack of impact on TAC serum level	Poor or no aggravation of TAC toxicity, a decrease in oxidative stress with a reduction in TAC-induced nephrotoxicity
Green tea	Catechins Theaflavins	Inhibition of CYPs; Inhibition of P-gp; Promotion of Klotho signalling pathway	Inconclusive data	A decrease in oxidative stress with a reduction in TAC-induced nephrotoxicity
Echinacea purpurea	-	Inconclusive data	Inconclusive data	Inconclusive data
Hypericum perforatum	Hyperforin Hypericin	Induction of CYP3A4; Induction of P-gp	A decrease in TAC serum level	Increased risk of transplant rejection

TAC—tacrolimus; P-gp—P-glycoprotein.