Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri

KALKAN, Şule

Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri

Şule KALKAN (Dokuz Eylül Üniversitesi)

Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi

113 7

Yıl: 2017 Cilt: 31 Sayı: 1 Sayfa Aralığı: 41 - 50 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri

Öz:

Bitkisel ürünler hipertansiyon, diyabet, hiperlipidemi ve kanser gibi birçok kronik hastalığın önlenmesi ve tedavisinde kullanılmaktadır. Bitkisel ürünlerin doğal kaynaklı olması güvenli oldukları anlamına gelmemektedir. Bitkisel ürünlerin ilaçlarla birlikte kullanımı ciddi bitkisel ürün-ilaç etkileşimlerine yol açabilmektedir. İlaçlarla etkileştiği rapor edilen bitkiler St. John's wort (Hypericum perforatum), Ginkgo (Ginkgo biloba), Ginseng (Panax ginseng), Ginger (Zingiber officinale), Garlic (Allium sativum), Echinasea ve Valerian'dır. Bu çalışmada sık kullanılan bitkisel ürünlerle, farmakokinetik ve farmakodinamik ilaç etkileşimleri derlenmiştir. Bitkisel ürün kullanımı sitokrom P450 enzimleri (CYP450) ve P-glikoproteinleri (P-gp) inhibisyonu veya indüksiyonu ile ilaçların emilim, dağılım, metabolizma ve atılımlarını değiştirebilir. Farmakokinetik etkileşmeler, ilacın farmakolojik etkisinde azalma ve artmaya yol açabilir. Ayrıca ilaca bağlı yan etki ve toksik etki görülebilir. Bitkisel ürünler ve ilaçlar arasındaki farmakodinamik etkileşmeler ilaç etkisini artıracak aditif ve sinerjistik etkileşimler veya ilaç etkisini azaltacak antagonistik etkileşimler olabilir. Bitkisel ürünlerle etkileşimi tanımlanan ilaçlar antikoagülanlar, antitrombotikler, kardiyovasküler ilaçlar, immunosüpresanlar, sedatifler, antidepresanlar, statinler, antikanser ilaçlar ve anti-HIV ilaçlardır. Bitkisel ürün-ilaç etkileşmeleri özellikle terapötik indeksi dar olan ilaçlarda daha önemlidir. Hekimler hastalarına ilaç reçete ederken bitkisel ürün kullanımını sorgulamalıdır. Etkililiği ve güvenliliği klinik kontrollü araştırmalarla kanıtlanmamış bitkisel ürünler önerilmemelidir.

Anahtar Kelime:

Konular: Farmakoloji ve Eczacılık

DRUG INTERACTIONS IN THE TREATMENT WITH HERBAL PRODUCTS

Öz:

Herbal products are used in the prevention and treatment of many chronic diseases such as hypertension, diabetes, hyperlipidemia and cancer. Herbal products which are obtained from natural sources does not mean that they are safe. The use of herbal products with drugs can lead to serious herbal productdrug interactions. Herbs that are reported to interact with drugs include St. John's wort (Hypericum perforatum), Ginkgo (Ginkgo biloba), Ginseng (Panax ginseng), Ginger (Zingiber officinale), Garlic (Allium sativum), Echinasea ve Valerian. This study was reviewed pharmacokinetic and pharmacodynamic drug interactions with commonly used herbal products. The use of herbal product can alter the absorption, distribution, metabolism and excretion of drugs through inhibition or induction of cytochrome P450 enzymes (CYP450) and P-glycoprotein (P-gp). Pharmacokinetic interactions may lead to an increase or a decrease on pharmacological effect of the drug. Also druginduced side effect and toxic effect may manifest. Pharmacodynamic interactions between herbal products and drugs may be additive or synergistic which will enhance the effect of drugs, or antagonistic, which will reduce the efficacy of drugs. Drugs which interact with herbal products include anticoagulants and antithrombotics, cardiovascular drugs, immunusuppressants, sedatives, antidepressants, statins, anticancer drugs and anti-HIV drugs. Herbal product-drug interactions are especially important for drugs with narrow therapeutic index. Physicians should inquire about use of herbal products to their patients when prescribing medicine. Herbal products which have not proven effectiveness and safety in clinical controlled trials should not be recommended.

Anahtar Kelime:

Konular: Farmakoloji ve Eczacılık

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Bent S. Herbal Medicine in the United States: Review of Efficacy, Safety, and Regulation. J Gen Intern Med 2008;23:854-859.
2. Türk Tabipler Birliği Merkez Konseyi. Bitkisel ürünler ve sağlık. Bilimsel çerçeve ve etik açısından yaklaşım. 2012;1-35.
3. Tilburt JC, Kaptchuk TJJ. Herbal medicine research and global health: An ethical analysis. Bull World Health Organ 2008;86:594-599.
4. Stasio MJ, Curry K, Sutton-Skinner KM, Glassman DM. Over -the-Counter Medication and Herbal or Dietary Supplement Use in College: Dose Frequency and Relationship to Self-Reported Distress. J Am Coll Health 2008;56:535-547.
5. Tulunay M, Aypak C, Yikilkan H, Gorpelioglu S. Herbal medicine use among patients with chronic diseases. J Intercult Ethnopharmacol 2015;4:217-220.
6. Kucukoner M, Bilge Z, Isıkdogan A, Kaplan MA, Inal A, Urakci Z. Complementary and alternative medicine usage in cancer patients in southeast of Turkey. Afr J Tradit Complement Altern Med 2013;10:21-25.
7. Merrily A. Kuhn RN. Herbal Remedies: Drug-Herb Interactions. Critical Care Nurse 2002;22:22-35.
8. Dulger G. Herbal drugs and drug interactions. Marmara Pharmaceutical Journal 2012;16:9-22.
9. Karadağ MG, Türközü D, Kapucu DT. Bitkiler ve ilaç etkileşimleri. Göztepe Tıp Dergisi 2013;8:164-170.
10. Krivoy N, Pavlotzky E, Chrubasik S, Eisenberg E, Brook G. Effect of salicis cortex extract on human platelet aggregation. Planta Med 2001;67:209-12.
11. Zhou S, Gao Y, Jiang W, Huang M, Xu A, Paxton JW. Interactions of herbs with cytochrome P450. Drug Metab Rev 2003;35:35-98.
12. Zhou S, Lim LY, Chowbay B. Herbal modulation of Pglycoprotein. Drug Metab Rev 2004;36:57-104.
13. Tarirai C, Viljoen AM, Hamman JH. Herb-drug pharmacokinetic interactions reviewed. Expert Opin Drug Metab Toxicol 2010;6:1515-1538.
14. Tirona RG, Bailey DG. Herbal product-drug interactions mediated by induction. Br J Clin Pharmacol 2006;61:677- 681.
15. Di YM, Li CG, Xue CC, Zhou SF. Clinical drugs that interact with St. John's wort and implication in drug development. Curr Pharm Des 2008;14:1723-1742.
16. Chen Y, Ferguson SS, Negishi M, Goldstein JA. Induction of human CYP2C9 by rifampicin, hyperforin, and phenobarbital is mediated by the pregnane X receptor. J Pharmacol Exp Ther 2004;308:495-501.
17. Moore LB, Goodwin B, Jones SA et al. St. John's wort induces hepatic drug metabolism through activation of the pregnane X receptor. Proc Natl Acad Sci USA 2000;97:7500-7502.
18. POISINDEX®System: Klasco RK (Ed): POISINDEX® System. Truven Health Analytics, Greenwood Village, Colorado (Vol. 167 expires 3/2016).
19. Dannawi M. Possible serotonin syndrome after combination of buspirone and St John's Wort. J Psychopharmacol 2002;16:401.
20. Borrelli F, Izzo AA. Herb-drug interactions with St John's wort (Hypericum perforatum):an update on clinical observations. AAPS J 2009;11:710-727.
21. Saw JT, Bahari MB, Ang HH, Lim YH. Potential drugherb interaction with antiplatelet/anticoagulant drugs. Complement Ther Clin Pract 2006;12:236-241.
22. Matthews MK. Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998; 50:1933-1934.
23. Wang LS, Zhu B, Abd El-Aty AM et al.The influence of St John's Wort on CYP2C19 activity with respect to genotype. J Clin Pharmacol. 2004;44:577-581.
24. Markowitz JS, Donovan JL, DeVane CL et al. Effect of St John's Wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 2003;290:1500- 1504.
25. Dresser GK, Schwarz UI, Wilkinson GR, Kim RB. Coordinate induction of both cytochrome P4503A and MDR1 by St John's wort in healthy subjects. Clin Pharmacol Ther 2003;73:41-50.
26. Johne A, Schmider J, Brockmöller J et al. Decreased plasma levels of amitriptyline and its metabolites on comedication with an extract from St. John's wort (Hypericum perforatum). J Clin Psychopharmacol 2002;22:46-54.
27. Xu H, Williams KM, Liauw WS, Murray M, Day RO, McLachlan AJ. Effects of St John's wort and CYP2C9 genotype on the pharmacokinetics and pharmacodynamics of gliclazide.Br J Pharmacol 2008;153:1579-1586.
28. Jiang X, Williams KM, Liauw WS et al. Effect of St John's wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol 2004;57:592-599.
29. Johne A, Brockmöller J, Bauer S, Maurer A, Langheinrich M, Roots I. Pharmacokinetic interaction of digoxin with an herbal extract from St John's wort (Hypericum perforatum). Clin Pharmacol Ther 1999;66:338-645.
30. Portolés A, Terleira A, Calvo A, Martínez I, Resplandy G. Effects of Hypericum perforatum on ivabradine pharmacokinetics in in healthy volunteers: an openlabel,pharmacokinetic interaction clinical trial. J Clin Pharmacol 2006;46:1188-1194.
31. Tannergren C, Engman H, Knutson L, Hedeland M, Bondesson U, Lennernäs H. St John's wort decreases the bioavailability of R- and S-verapamil through induction of the first-pass metabolism. Clin Pharmacol Ther 2004;75:298-309.
32. Sugimoto K, Ohmori M, Tsuruoka S et al. Different effects of St John's wort on the pharmacokinetics of simvastatin and pravastatin. Clin Pharmacol Ther 2001;70:518-524.
33. Hebert MF, Park JM, Chen YL, Akhtar S, Larson AM. Effects of St. John's wort (Hypericum perforatum) on tacrolimus pharmacokinetics in healthy volunteers. J Clin Pharmacol 2004;44:89-94.
34. Frye RF, Fitzgerald SM, Lagattuta TF, Hruska MW, Egorin MJ. Effect of St John's wort on imatinib mesylate pharmacokinetics. Clin Pharmacol Ther 2004;76:323-329.
35. Piscitelli SC, Burstein AH, Chaitt D, Alfaro RM, Falloon J. Indinavir concentrations and St John's wort. Lancet 2000;355:547-548.
36. Janetzky K, Morreale AP. Probable interactions between warfarin and ginseng. Am J Health Syst Pharm 1997;54:692-693.
37. Yuan CS, Wei G, Dey L et al. Brief communication: American ginseng reduces varfarin's effect in healthy patients: A randomized, controlled trial. Ann Int Med 2004;141:23-27.
38. Lesho EP, Saullo L, Udvari-Nagy S. 76-year-old woman with erratic anticoagulation. Cleve Clin J Med 2004;71:651-6.
39. Kim YS, Pyo MK, Park KM et al. Antiplatelet and antithrombotic effects of a combination of ticlopidine and ginkgo biloba ext (EGb 761). Thromb Res 1998;91:33-38.
40. Hellum BH, Hu Z, Nilsen OG. The induction of CYP1A2,CYP2D6 and CYP3A4 by six trade herbal products in cultured primary human hepatocytes. Basic Clin Pharmacol Toxicol 2007;100:23-30.
41. Hellum BH, Hu Z, Nilsen OG. Trade herbal products and induction of CYP2C19 and CYP2E1 in cultured human hepatocytes. Basic Clin Pharmacol Toxicol 2009;105:58- 63.
42. Kupiec T, Raj V. Fatal seizures due to potential herbdrug interactions with Ginkgo biloba. J Anal Toxicol 2005;29:755-788.
43. Mauro VF, Mauro LS, Kleshinski JF, Khuder SA, Wang Y, Erhardt PW. Impact of Ginkgo biloba on the pharmacokinetics of digoxin. Am J Ther 2003;10:247-251.
44. Qi LW1, Wang CZ, Du GJ, Zhang ZY, Calway T, Yuan CS. Metabolism of ginseng and its interactions with drugs. Curr Drug Metab 2011;12:818-822.
45. Liu Y, Zhang JW, Li W et al. Ginsenoside metabolites, rather than naturally occurring ginsenosides, lead to inhibition of human cytochrome P450 enzymes. Toxicol Sci 2006;91:356-364.
46. Bilgi N, Bell K, Ananthakrishnan AN, Atallah E. Imatinib and Panax ginseng: a potential interaction resulting in liver toxicity. Ann Pharmacother 2010;44:926-928.
47. Gurley BJ, Gardner SF, Hubbard MA et al. Clinical assessment of effects of botanical supplementation on cytochrome P450 phenotypes in the elderly - St John's wort, garlic oil, Panax ginseng and Ginkgo biloba. Drug Aging 2005;22:525-539.
48. Sompon W, Virapong P. Cytochrome P450 enzyme mediated herbal drug interactions (Part 1). EXCLI Journal 2014;13:347-391.
49. Foster BC, Foster MS, Vandenhoek S et al. An in- vitro evaluation of human cytochrome P450 3A4 and Pglycoprotein inhibition by garlic. J Pharm Pharm Sci 2001;4:176-184.
50. Loizou GD1, Cocker J. The effects of alcohol and diallyl sulphide on CYP2E1 activity in humans: a phenotyping study using chlorzoxazone. Hum Exp Toxicol 2001;20:321-327.
51. Hajda J1, Rentsch KM, Gubler C, Steinert H, Stieger B, Fattinger K. Garlic extract induces intestinal Pglycoprotein, but exhibits no effect on intestinal and hepatic CYP3A4 in humans. Eur J Pharm Sci 2010;41:729- 735.
52. Gorski JC, Huang SM, Pinto A et al. The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo. Clin Pharmacol Ther 2004;75:89-100.
53. Gurley BJ, Gardner SF, Hubbard MA et al. In vivo assessment of botanical supplementation on human cytochrome P450 phenotypes: Citrus aurantium, Echinacea pur-purea, milk thistle, and saw palmetto. Clin Pharmacol Ther 2004;76:428-440.
54. Penzak SR, Robertson SM, Hunt JD et al. Echinacea purpurea significantly induces cytochrome P450 3A activity but does not alter lopinavir-ritonavir exposure in healthy subjects. Pharmacotherapy 2010;30:797-805.
55. Kelber O, Nieber K, Kraft K. Valerian: no evidence for clinically relevant interactions. Evid Based Complement Alternat Med 2014;2014:879396. doi: 10.1155/2014/879396.

APA	KALKAN Ş (2017). Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri. , 41 - 50.
Chicago	KALKAN Şule Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri. (2017): 41 - 50.
MLA	KALKAN Şule Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri. , 2017, ss.41 - 50.
AMA	KALKAN Ş Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri. . 2017; 41 - 50.
Vancouver	KALKAN Ş Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri. . 2017; 41 - 50.
IEEE	KALKAN Ş "Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri." , ss.41 - 50, 2017.
ISNAD	KALKAN, Şule. "Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri". (2017), 41-50.

APA	KALKAN Ş (2017). Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi, 31(1), 41 - 50.
Chicago	KALKAN Şule Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi 31, no.1 (2017): 41 - 50.
MLA	KALKAN Şule Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi, vol.31, no.1, 2017, ss.41 - 50.
AMA	KALKAN Ş Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi. 2017; 31(1): 41 - 50.
Vancouver	KALKAN Ş Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi. 2017; 31(1): 41 - 50.
IEEE	KALKAN Ş "Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri." Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi, 31, ss.41 - 50, 2017.
ISNAD	KALKAN, Şule. "Bitkisel Ürünlerle Tedavilerde İlaç Etkileşmeleri". Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi 31/1 (2017), 41-50.