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Herbal, Drug and Food Interaction
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Shukla and Bigoniya, IJTCM, 2016; Vol. 1(2): 0033-0037
Review Article IJTCM (2016), Vol. 1, Issue 02
International Journal of Traditional and Complementary Medicine
(ISSN: 2474-1361)
Herbal, Drug and Food Interaction
Dr. Alok Kumar Shukla* & Dr. Papiya Bigoniya
Department of Phytochemistry and Pharmacognosy, Radharaman College of Pharmacy, Radhara-
man Group of Institutions, Bhadbhada Road, Ratibad, Bhopal, Madhya Pradesh, INDIA
*Correspondence to Author:
Dr. Alok Kumar Shukla
Associate Professor
Radharaman College of Pharmacy, Radharaman Group of Institutions, Bhadbada Road, Ratibad, Bhopal,
Madhya Pradesh, INDIA.
Phone no. 91-0755-2477941, 09039298670. E. mail: [email protected]
How to cite this article:
Alok Kumar Shukla and Papiya Bigoniya. Herbal, Drug and Food Interaction. International Journal of Tradi-
tional and Complementary Medicine 2016; 1(2): 0024- 0032.
Published September 29 2016.
eSciPub LLC, Houston, TX USA.
Website: http://escipub.com/
IJTCM: http://escipub.com/international-journal-of-traditional-and-complementary-medicine/ 0033
Shukla and Bigoniya, IJTCM, 2016; Vol. 1(2): 0033-0037
But this is not true as Ayurveda states that every
Introduction material in the universe is medicine and thus ex-
erts one or the other therapeutic effect if utilized
All medicines were derived from natural materials properly. But injudicious use may alter the ac-
in the ancient time (1). Most of those early med- tion of drug, the intensity of which may be mild
icines are described under the broad heading to severe or unpredictable. Also activity could be
“herbs,” although that term may prove mislead- synergistic, decreased, antagonistic action or in-
ing. Even though people often think of herbs as crease in the bioavailability.
plants or plant-derived materials, several com-
monly used items were obtained from animals Type of interactions
and minerals. Further, although the term “herbs”
suggests something that is beneficial and has lit- The interactions mentioned in Ayurveda can be
tle potential for harm, numerous toxic materials categorized into herb with herb, herb with food,
were used, such as foxglove, deadly nightshade, herb-animal origin drugs and Drug disease inter-
and jimson weed (Datura). Herbalists some- action.
times processed the herbs to change them from 1. Herb-Herb interaction: Piper betel is contra-
their original form. As the science developed the indicated while taking Garcinia Morella, Basella
researchers attempted and succeeded to iso- alba along with Sesamum indicum (4, 5)
late some active constituents from herbs, so that
the end products were not as nature presented 2. Herb-Food interaction: Combination of
them. For example, aconite was processed ex- Payasa (milk preparation) and Mantha (gruel) is
tensively in China to reduce its toxicity so that contraindicated wine with steamed grains, Rad-
it could more readily be used, and borneol, the ish with milk (4,6)
active constituent found in a few tropical plants,
was isolated centuries ago in relatively pure 3. Herb-animal origin drug interaction: Ka-
form, a translucent crystal, for both internal and potamamsa (meat of pigeon) is contraindicat-
external use. The use of potent and toxic sub- ed with Sarshapataila (Brassica alba). Pork is
stances and the intentional alteration of natural contraindicated with Narikelataila (oil of Coccus
substances are characteristics of production of nucifera), Equal quantity of Madhu (Honey) with
modern drugs. Thus, some issues that arise to- Grutha (Ghee) is contraindicated and this has
day about interactions of herbs and drugs may been proved to produce toxic effect by combina-
have already been encountered in earlier times tion (4, 6)
when herbs were combined with each other (2).
5. Disease related interaction: Haritaki (Ter-
The ancient Indian system of Ayurveda is prac- minalia chebula) contraindicated in pregnancy,
ticing in India since 1500 BC, the main aim of this malnourished, anorexia after bloodletting (7).
system is to preservation of normal health and
curing the diseased one. Ayurveda has focused Common food interactions in Ayurveda
on patient safety and benefits. In fact it is known
that drug safety is a very basic and fundamental For the most part, the possibility of herb-drug in-
concept in medical practice. The current raised teractions had been largely ignored during this
issue with respect to Alternative medicine and revival of medicinal herb use. Ayurveda has
Ayurveda is increasing reports of Adverse Drug mentioned different type of interaction of herb
Reaction (ADR) related to herbal medicine (3). and its formulation. Harmful effect of interaction
This may be due to increase in number of people should be explained to patients and such type of
taking herbal products either as a medicine or food should be avoided during the medication.
as a nutritional supplement. Such reports many Some examples are as follows.
a times neglect to identify the cause behind the • Pippali (Piper longum) prepared with
event which can be pertaining to variety of is- fish fat, Kakmachi (Solanum nigrum)
sues which are already considered in Ayurve- with honey or with roasted meat, Seeds
da but are neglected many a times either due of pushkara (N. nucifera) with honey,
to ignorance or negligence. There is mis-belief Bhallataka (Semecarpus anacardium)
that natural drugs are safe and devoid of toxicity. with hot water, Kampillaka (Mallotus
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Shukla and Bigoniya, IJTCM, 2016; Vol. 1(2): 0033-0037
Table 1: Some reported interactions causing herb
Herbs Source Parts Interactions
S t . Hypericum Tops Warfarin (to cause bleeding); serotonin-uptake inhibitors (to cause mild sero-
John’s perforatum tonin syndrome); indinavir (decreased bioavailability); digitoxin, theophylline,
wort cyclosporin, phenprocoumon, and oral contraceptives (all with reduced bio-
availability)
G i n - Panax gin- Root Antidepressants such as phenelzine sulfate (to cause manic episodes, head-
seng seng aches); warfarin (to cause bleeding or to decrease effectiveness); corticoste-
roids (potentiation); estrogens (potentiation)
Ginkgo Ginkgo bi- Leaf Warfarin (to cause bleeding)
loba
Ginger Zingiber of- R h i - Sulfaguanidine (enhance absorption)
ficinale zome
Garlic Allium sa- Bulb Warfarin (to cause bleeding)
tivum
L i c o - Glycyrrhiza Root Corticosteroids and thiazide diuretics (potentiation); digitalis or other cardiac
rice uralensis glycosides (increased sensitivity)
B u - Bupleurum Root Sedatives (potentiation)
p l e u - falcatum
rum
A s - Astragalus Root Cyclosporine, azathioprine, methotrexate (to impair intended immuno-sup-
traga- m e m b r a - pressive effects).
lus naceus
M a - Ephedra si- Leaf MAO inhibitors (to cause hypertension); cardiac glycosides or halothane (to
huang nica produce cardiac arrhythmia); caffeine (to intensify cardiovascular side ef-
fects)
Aloe Aloe ferox L e a f Cardiac glycosides and antiarrhythmic agents (potentiating by reducing po-
sap tassium via laxative effect)
R h u - Rheum offi- Root Cardiac glycosides and antiarrhythmic agents (potentiating by reducing po-
barb cinale tassium via laxative effect)
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Shukla and Bigoniya, IJTCM, 2016; Vol. 1(2): 0033-0037
philippinensis) with buttermilk should not two anticoagulant drugs are taken. In particular,
be taken; these combinations may lead to the most commonly used Chinese herb for treat-
various harmful effects, even death. ing blood stasis in modern practice is salvia. It
has been reported that salvia may enhance
• Milk should not be taken after intake of the warfarin effects and may cause significant
radish, garlic and bitter gourd (Momordica changes in blood properties. Tang-kuei was also
charantia). Leaves of Ocimum sanctum mentioned as a possible cause of warfarin po-
may cause various types of skin diseases. tentiation (10, 11).
Leaves of asofoetida (Ferula narthex) or
ripe fruit of lakucha (Artocarpus lakoocha) Examples can be cited of bleeding tendency af-
should not be taken with honey and ter intake of Phenprocoumon along with ginger,
milk; it may cause loss of strength and warfarin with Fenugreek, claw, garlic, mango
complexion and may lead to oligospermia, or papaya (12,); decrease in activity of Lithium
sterility and many other diseases, even when consumed along with herbal diuretics like
death (8). Tribulus terrestris, Syzygium cuminii (13).These
can be bizarre reactions since interacted herb
• Intake of bhallataka seeds with hot water has no role in the event, as in Phenytoin along
and kampillaka with buttermilk are also with Convolvulus pluricaulis (Shankapushpi)
unwholesome and may cause various leading to loss on seizure control thus difficult to
ailments in the body. Shilajatu should predict (14).
not be taken with kakmachi and meat of
pigeon. Fruits of lakucha and decoction of Conclusion
masha should not be taken in combination. Not all subjects taking interacting drugs or foods
Paste of sesame seeds with leaf of black experience adverse consequences, but it is ad-
cumin (Nigella rubra Linn.) may cause visable to take due precautions to avoid mishaps
diarrhea (9). in all cases where interactions are possible. The
food-drug and drug-drug interactions occur by
Herb drug interaction in modern system of following two basic mechanisms. The predom-
medicine inant mechanism for these interactions is the
Green vegetables (especially broccoli, spinach, inhibition of cytochrome P450 3A4 in the small
peas, cabbage, and cucumbers) were found intestine, resulting in a significant reduction of
to have a measurable impact on anticoagulant drug presystemic metabolism. Another mecha-
therapy. The main active ingredient in the green nism is the inhibition of P-glycoprotein, a trans-
vegetables is vitamin K. It has coagulation pro- porter that carries drug from the enterocyte back
moting qualities that overcome the effects of the to the gut lumen, resulting in a further increase in
anticoagulant drug, thus making the therapy less the fraction of drug absorbed (15). Recent stud-
effective (the drug dosage has to be increased). ies on Ayurvedic food-drug interactions reported
Vitamin K is produced by intestinal bacteria; use that the possible mechanism of actions of inter-
of antibiotics that inhibit intestinal bacteria can actions between foods and drugs mentioned in
also change the vitamin K content of the pa- Ayurveda are formation of chelates or complex-
es leading to inadequate absorption, and antag-
tient’s blood.
onism also plays a vital role (16, 17-19).
Teas, pills, and other forms of herbal prepa-
rations generally have low levels of vitamin K, Therefore, when drug absorption is considered
due to the relatively small amount of leafy tops a critical matter, such as cases where a subopti-
(the main source of this vitamin) that are con- mal dose of the drug has the potential to signifi-
sumed. Still, many herbs are reputed to have cantly influence the outcome of a disease, the
anticoagulant properties that were investigated drug should not be taken along with meals, nu-
because of the importance of anticoagulation tritional supplements, or herbs. There are some
therapy. The concern that arises is whether or exceptions, such as when small amounts of food
not these herbs will further reduce platelet ag- are considered protective against irritant actions
gregation and, as a result, increase the chance of the drug, or when there are specific foods are
of spontaneous hemorrhage, as can occur when known to improve absorption of the drug (for
IJTCM: http://escipub.com/international-journal-of-traditional-and-complementary-medicine/ 0035
Shukla and Bigoniya, IJTCM, 2016; Vol. 1(2): 0033-0037
example, a small amount of fatty food may en- herbs: an overview. Journal of Herbal
hance absorption of a drug that disperses more Medicine and Toxicology 6:1-14.
easily in fats). 13. Pyevich D, Bogenschutz MP (2001). Herbal
diuretics and lithium toxicity. American Journal
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