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 product-drug 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 drug-induced 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 Kelimeler

• herb,drug,herb-drug interactions,pharmacokinetics

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 Kelimeler

• bitki,ilaç,bitki-ilaç etkileşmeleri,farmakokinetik,farmakodinamik

Kaynakça

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