Interacciones potenciales entre productos herbolarios con fármacos hipoglucemiantes en adultos mayores con diabetes mellitus, en una zona rural mexicana / Potenciais interacções entre produtos à base de plantas e medicamentos hipoglicemiantes em adultos mais velhos com diabetes mellitus no Mexico rural / Potential interactions between herbal products with hypoglycemic drugs in older adults with diabetes mellitus in rural Mexico

Introducción: El 50% de la población mundial usa tratamientos alternativos como productos herbarios. El 20% los consume de manera simultánea con algún tratamiento farmacológico para el control la Diabetes Mellitus tipo 2; enfermedad prevalente en adultos mayores. Es escasa la información acerca de las interacciones medicamentosas que pudieran producirse, siendo responsables de más de 7,000 muertes al año. Objetivo: Identificar los productos herbarios de mayor consumo del Adulto Mayor con Diabetes Mellitus Tipo 2, en Chapulco, Puebla, México y describir las posibles interacciones medicamentosas entre fármaco hipoglucemiante ­ producto herbario reportados en la literatura científica. Metodología: Estudio observacional, prolectivo, transversal, descriptivo, en una población de 35 adultos mayores diabéticos, con edad promedio de 70±7 años. Para la identificación de los productos herbarios de uso común y sus aplicaciones terapéuticas se aplicó el cuestionario U-PLANMED. Resultados: Se identificaron 50 productos herbarios y 18 combinaciones entre estos a la vez. El 40% de los participantes consumen simultáneamente más de dos productos herbarios con uno o dos fármacos hipoglucemiantes. Entre los productos de mayor consumo se encuentran el nopal (Opuntia ficus-indica L.), la manzanilla (Matricaria chamomilla L.) y el zacate de limón (Cymbopogon citratus DC. Stapf.). Las interacciones medicamentosas potenciales identificadas, principalmente en estudios experimentales en animales, sugieren que, existe una acción hipoglucemiante del producto herbario al aumentar la capacidad orgánica sobre la secreción/liberación de insulina endógena. Conclusiones: Se ha evidenciado la presencia de interacciones medicamentosas ante el consumo simultaneo de fármacos prescritos para el control de la diabetes mellitus tipo 2 con productos herbarios. Es necesario que, los profesionales en atención a la salud identifiquen el uso de dichos productos y orienten a los adultos mayores sobre las posibles repercusiones en los niveles de glucosa ante el consumo.

Introduction: 50% of the world's population uses alternative treatments such as herbal products. Twenty percent use them in conjunction with some form of pharmacological treatment to control type 2 diabetes mellitus, a disease prevalent in older adults. There is little information on the drug interactions that may occur, which are responsible for more than 7,000 deaths per year. Objective: To identify the most consumed herbal products among older adults with type 2 diabetes mellitus in Chapulco, Puebla, Mexico, and to describe the possible drug-drug interactions between hypoglycemic drugs and herbal products reported in the scientific literature. Methodology: Observational, prospective, cross-sectional, descriptive study in a population of 35 diabetic older adults with a mean age of 70±7 years. The U-PLANMED questionnaire was used to identify commonly used herbal products and their therapeutic applications. Results: Fifty herbal products and 18 combinations of them were identified. Forty percent of the participants used more than two herbal products simultaneously with one or two hypoglycemic drugs. The most used products included prickly pear cactus (Opuntia ficus-indica L.), chamomile (Matricaria chamomilla L.), and lemon grass (Cymbopogon citratus DC. Stapf.). Potential drug-drug interactions identified mainly in experimental animal studies suggest that there is a hypoglycemic effect of the herbal product by increasing the organic capacity on endogenous insulin secretion/release. Conclusions: The presence of drug-drug interactions has been demonstrated with the simultaneous consumption of drugs prescribed for the control of type 2 diabetes mellitus with herbal products. It is necessary for health care professionals to recognize the use of such products and to inform older adults about the possible repercussions on glucose levels when consuming them.

Introdução: 50% da população mundial utiliza tratamentos alternativos como os produtos à base de plantas. Vinte por cento utilizam-nos em conjunto com algum tipo de tratamento farmacológico para controlar a diabetes mellitus tipo 2, uma doença prevalente em adultos mais velhos. Há pouca informação sobre as interacções medicamentosas que podem ocorrer e que são responsáveis por mais de 7.000 mortes por ano. Objetivos: Identificar os produtos fitoterápicos mais consumidos entre os idosos com diabetes mellitus tipo 2 em Chapulco, Puebla, México, e descrever as possíveis interações medicamentosas entre medicamentos hipoglicemiantes e produtos fitoterápicos relatados na literatura científica. Metodologia: Estudo observacional, prospetivo, transversal e descritivo numa população de 35 idosos diabéticos com uma idade média de 70±7 anos. O questionário U-PLANMED foi utilizado para identificar os produtos fitoterápicos mais utilizados e suas aplicações terapêuticas. Resultados: Foram identificados 50 produtos à base de plantas e 18 combinações dos mesmos. Quarenta por cento dos participantes utilizaram mais de dois produtos à base de plantas em simultâneo com um ou dois medicamentos hipoglicemiantes. Os produtos mais utilizados foram o cato de figo da Índia (Opuntia ficus-indica L.), a camomila (Matricaria chamomilla L.) e o capim-limão (Cymbopogon citratus DC. Stapf.). As potenciais interacções medicamentosas identificadas principalmente em estudos experimentais em animais sugerem que existe um efeito hipoglicémico do produto à base de plantas através do aumento da capacidade orgânica na secreção/libertação de insulina endógena. Conclusões: A presença de interacções medicamentosas foi demonstrada com o consumo simultâneo de medicamentos prescritos para o controlo da diabetes mellitus tipo 2 com produtos à base de plantas. É necessário que os profissionais de saúde reconheçam o uso de tais produtos e informem os idosos sobre as possíveis repercussões nos níveis de glicose ao consumi-los.

Lesão hepática induzida por ervas e suplementos alimentares: uma análise agrupada de estudos de caso / Liver injury induced by herbal and dietary supplements: a pooled analysis of case reports

ABSTRACT Background: The intake of dietary supplements and medicinal plants is very popular worldwide. However, these products are not innocuous, and their intake can cause severe damage to health, especially liver injury. Objective: This study aims to describe the clinical cases of dietary supplements-induced liver injury (DSILI) and herb-induced liver injury (HILI), identifying the main products involved and the clinical outcomes related to them. Method: A literature search was performed in PubMed, EMBASE, Google Scholar, and LILACS databases, using the search terms: "Chemical and Drug-Induced Liver Injury", "Dietary Supplements" and "Herbal" and their synonyms. Results: 189 articles were included in the study, totaling 428 clinical cases of drug-induced liver injury. The most frequent agents of liver injury were Herbalife® products, associated with 50 cases, Polygonum multiflorum, with 25 cases, Hydroxycut® products, and green tea, both associated in 19 cases, and Oxyelite Pro® and kava tea, both associated with 16 cases. Most individuals required hospitalization (82.6%) and an important number of cases evolved to death (3.6%), liver transplantation (8.9%), or chronic liver disease (1.9%). Conclusion: The indiscriminate use of dietary supplements and herbal products was associated with an alarming number of cases of liver injury. The mechanisms through which each of the products causes liver damage still need to be better understood, but this review is a warning about the risk associated with the use of products considered harmless by a large part of the population.

RESUMO Contexto: O consumo de ervas medicinais e suplementos alimentares é muito popular no mundo. Contudo, esses produtos não são inócuos e sua ingestão pode causar danos à saúde, especialmente dano hepático. Objetivo: Descrever os casos clínicos de lesão hepática induzida por ervas e suplementos alimentares, identificando os principais produtos envolvidos e as manifestações relacionadas a eles. Métodos: A busca na literatura foi realizada na base de dados PubMed, EMBASE, Google Escolar e LILACS usando as seguintes palavras-chaves: "Chemical and Drug-Induced Liver Injury", "Dietary Supplements", e "Herbal", incluindo seus sinônimos. Resultados: Foram incluídos 189 artigos no estudo, totalizando 428 casos clínicos de lesão hepática induzida por drogas. Os agentes de lesão hepática mais frequentes foram produtos Herbalife, associados a 50 casos, Polygonum Multiflorum, a 25 casos, produtos Hydroxycut e chá verde, ambos associados a 19 casos, e produtos Hydroxycut e chá verde, associados a 16 casos. A maioria dos indivíduos necessitou de hospitalização (82,6%) e um número importante de casos evoluiu para óbito (3,6%), transplante hepático (8,9%) ou doença hepática crônica (1,9%). Conclusão: O uso indiscriminado de suplementos alimentares e ervas foi associado com um número alarmante de casos de lesão hepática. Os mecanismos pelos quais cada um dos produtos causa danos ao fígado ainda precisam ser melhor compreendidos, mas esta revisão é um alerta sobre o risco associado ao uso de produtos considerados inofensivos por grande parte da população.

Jugos de fruta y productos herbáceos como perpetradores de interacciones farmacocinéticas mediadas por enzimas metabolizadoras y transportadores de membrana. Relevancia en clínica / Pharmacokinetic interactions of fruit juices and herbal preparations

Drug disposition in the human body is strongly influenced by transporters and metabolizing enzymes expressed in key organs including intestine, liver and kidney. Since drugs and chemicals present in foods such as fruit juices and herb-based products are substrates of the above-mentioned proteins, there is a high probability of pharmacokinetic interactions. Findings from preclinical and clinical studies helped to characterize the mechanisms by which the components of fruit juices and herbs act as perpetrators of pharmacokinetic interactions. The aim of this review is to provide an overview of pharmacokinetic fruit juice- and herb-drug interactions that could be relevant in the clinical setting.

Attitudes, Knowledge and Practice of Herbal Remedy Use among the Population Visiting Pharmacies and Health Care Providers in Alexandria, Egypt: A Cross-Sectional Study

Aims: To show the levels of awareness, attitude, practices and socioeconomic factors related to consuming herbal products among Alexandrian citizen visiting pharmacies. The findings of this study are meant also to show the practices and beliefs of healthcare providers regarding using herbal remedies in treatment, including advising patients, reporting adverse effects and possessing knowledge about specific herb-drug interactions. Study Design: people visiting pharmacies as well as pharmacists in their pharmacies and physicians in their clinics were invited to complete a questionnaire about their knowledge and personal experience in the consumption of herbal remedy. Anonymity was guaranteed. Questionnaire consists of three parts: demographic data, personal experience and a part concerning health care providers. Place and Duration of Study: Study area is the city of Alexandria, Egypt from the 1st July through September 2018. Methodology: This is a descriptive cross-sectional study that used a self-administered, questionnaire from 213 participants (153+ 60 health care providers HCPs). Results: Almost half the respondents preferred to be treated with herbs because they believed that herbs are safe. But they are not the proper choice to cure chronic diseases. Only 25% of herb users recorded suffering from side effects. The most common source of information about herbs was via internet, followed by family and friends, television and other types of media. Herbal remedies were purchased mainly from outlets other than pharmacies. The willingness to buy such products was not affected by participants’ education level or their monthly income. The public didn’t feel it’s important to mention any herbal remedy they consume to their physician; similarly HCPs did not ask them. Generally, it was shown that HCPs have inadequate knowledge about herbs. Conclusion: The prevalence of herb usage is moderate among the Alexandrian population. And it is imperative to educate HCPs about the benefits, risks and interactions of herbal supplements.

The Mitigating Effect of Jatropha curcas L. Latex against Genotoxicity Induced by Doxorubicin

Jatropha curcas (Euphorbiaceae) is a multiple purpose lacticiferous plant with potential for biodiesel production and medicinal uses. There is in the literature different analyses about the toxic and cytogenotoxic effects of J. curcas extracts, but few information about latex toxicity. In addition, few models were employed to evaluate the toxicity response to J. curcas latex, and the toxicity in in vivo mammal’s model has not been tested yet. The cytotoxic, mutagenic and antimutagenic potential of J. curcas latex were investigated using mouse bone marrow erythrocytes. The results indicated a cytotoxic and mutagenic potential of this latex to mammalian cells. But, when J. curcas latex was co-administrated with doxorubicin (DXR – chemotherapy medication), a reduction in the number of micronuclei was observed, indicating an interaction between J. curcas latex and DXR. The interaction of latex with DXR can cause a reduction in the activity of this drug and impair the treatment of its users. Moreover, there is a lack of data on herb–drug interactions, what should be more investigated to safeguard the wellbeing of patients.

Intravenous lipid emulsion therapy for cardiac arrest and refractory ventricular tachycardia due to multiple herb intoxication

Herbal products have been used for therapeutic purposes for a long time. However, many herbs can be toxic and even life-threatening. If refractory ventricular tachycardia (VT) is caused by herbal products and shows no response to conventional therapy, intravenous lipid emulsion (ILE) therapy can be considered. We report a case of herbal intoxication leading to refractory VT, which was successfully treated with ILE therapy. A 36-year-old woman with aplastic anemia presented with mental changes. She had taken an unknown herbal decoction three days before visiting the hospital. Soon after coming to the hospital, she went into cardiac arrest. Cardiopulmonary resuscitation was performed, and return of spontaneous circulation with VT was achieved. Synchronized cardioversion was then performed and amiodarone was administered. However, VT with pulse continued, so ILE therapy was attempted, which led to the resolution of VT.

Medicinal Plants and Herbal Medicines for Oral Health Promotion: Analysis of Students and Professionals Knowledge

Aims: Verify the indications of medicinal plants and herbal medicines carried out by professors and academics of the dentistry course, and their knowledge about the interaction of medicinal plants and herbal medicines with medications of continuous use. Materials and Methods: An evaluation instrument was applied to professors who practice the profession of dental surgeon and students of the dentistry course on the indication of herbal and phytotherapeutic products to their clients in the clinic and in the office. Results: A total of 52 subjects participated in the research, providing a total of 5 different types of plants cited and 1 herbal medicine, highlighting Malva sylvestris, and not reporting the knowledge of the subjects on any type of drug interaction. Conclusion: There is a lack of knowledge among professional dental surgeons and students about the use and benefit of natural resources such as medicinal plants and herbal medicines.

Traditional Chinese medicine: herb-drug interactions with aspirin

Traditional Chinese medicine (TCM)-based herbal therapies have gained increasing popularity worldwide, raising concerns of its efficacy, safety profile and potential interactions with Western medications. Antithrombotic agents are among the most common prescription drugs involved in herb-drug interactions, and this article focused on aspirin, one of the most widely used antiplatelet agents worldwide. We discussed herbs that have potential interactions by exploring Western and TCM approaches to thrombotic events. Common TCM indications for these herbs were also highlighted, including possible scenarios of their concurrent usage with aspirin. With greater awareness and understanding of potential herb-drug interactions, TCM and Western physicians may collaborate more closely to identify, treat and, most importantly, prevent adverse drug events.

Effects of traditional herbal formulae on human CYP450 isozymes / 中国结合医学杂志

<p><b>OBJECTIVE</b>To assess the effects of traditional herbal formulae Sijunzi Decoction (, Sagunja-tang, SJZD), Siwu Decoction (, Samul-tang, SWD), Bawu Decoction (, Palmul-tang, BWD) and Shiquan Dabu Decoction (, Sipjeondaebo-tang, SDD) on the activities of human cytochrome P450 (CYP450), a drug-metabolizing enzyme.</p><p><b>METHODS</b>Herbal formula water extracts were filtered and lyophilized after the powder extracts were dissolved in distilled water. The activities of major human CYP450 isozymes (CYP3A4, CYP2C19, CYP2D6 and CYP2E1) were measured using in vitro fluorescence-based enzyme assays. The inhibitory effects of the herbal formulas on the activities of CYP450 were characterized as half maximal inhibition concentration (IC) values.</p><p><b>RESULTS</b>All the tested herbal formulae inhibited CYP2C19 activity (IC: SJZD, 83.28 μg/mL; SWD, 235.54 μg/mL; BWD, 166.82 μg/mL; SDD, 178.19 μg/mL); SJZD (IC= 196.46 μg/mL), SWD (IC= 333.42 μg/mL) and SDD (IC= 163.42 μg/mL) inhibited CYP2E1-mediated metabolism; whereas BWD exhibited comparatively weak inhibition of CYP2E1 (IC= 501.78 μg/mL). None of the four herbal formulas significantly affected CYP3A4 or CYP2D6.</p><p><b>CONCLUSIONS</b>These results suggest that SJZD, SWD, BWD and SDD could potentially inhibit the metabolism of co-administered synthetic drugs whose primary route of elimination is via CYP2C19. In addition, clinically relevant pharmacokinetic interactions could occur when SJZD, SWD or SDD is co-administered with drugs metabolized by CYP2E1. Our findings provide information for the safety and effective clinical use of these four classic herbal formulas.</p>

Research progress in interaction between chemical components of Glycyrrhizae Radix and cytochrome P450 enzyme / 中草药

Glycyrrhizae Radix is the dry roots or rhizomes of Glycyrrhiza uralensis, G. inflate, and G. glabra, which was used in clinical therapy combined with other drugs. In this paper, we summarized the recent studies in domestic and overseas on the interaction between the components of Glycyrrhizae Radix and the cytochrome P450 enzyme (CYP), including, 1) the CYP enzymes involved the metabolism of the chemical components of Glycyrrhizae Radix; 2) the inhibition and induction of chemical components of Glycyrrhizae Radix on the activity of CYP enzyme; 3) the progress in the study on the potential herbal-drug interactions in clinical use of Glycyrrhizae Radix preparations. Further studies on the interactions between the chemical components in Glycyrrhizae Radix and the main drug metabolic enzymes have the great significance for guiding the efficacy enhancing, detoxification, and compatibility of Chinese materia medica, which is very important to avoid the clinical herb-drug interactions.

In vitro Study on Herb-drug Interactions of Zuojin Pills Based on Cytochrome P450 / 中国药师

Objective: To explore the in vitro inhibition effect of Zuojin pills on 6 cytochrome P450 isoenzymes ( CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6 and CYP3A4) in human liver microsomes. Methods:The water extract of Zuojin pills, Cop-tidis Rhizoma and Euodiae Fructus was respectively incubated with human liver microsomes in the presence of seven probe substrates of CYP450 isoenzymes, and seven metabolites of cytochrome P450 probe substrate ( paracetamol/CYP1A2, 6α-hydroxypaclitaxel/CYP2C8, 4-hydroxydiclofenac/CYP2C9, 4-hydroxymephenytoin/CYP2C19, dextrorphan/CYP2D6, 6β-hydroxytestosterone/CYP3A4 and 1-hydroxymidazolam/CYP3A4) were simultaneously measured by LC-MS/MS, and the inhibitory effects were evaluated with IC50 value. Results:The IC50 value of Zuojin pills on CYP2D6, CYP1A2 and CYP3A4_T was 11. 6, 77. 4 and 97. 0 μg·ml-1 , respec-tively. The other IC50 values were from 334 to 690μg·ml-1 on CYP2C8, CYP2C9, CYP2C19 and CYP3A4_M isoenzymes. The IC50 value of Coptidis Rhizoma on CYP2D6, CYP1A2 and CYP3A4_T was 5. 8, 36. 8 and 59. 2 μg·ml-1 , respectively. The other IC50 values were from 163 to 476 μg·ml-1 on CYP2C8, CYP2C9, CYP2C19 and CYP3A4_M isoenzymes. The IC50 value of Euodiae Fructus on CYPs was over 107 μg·ml-1 . Conclusion:Zuojin pills shows notable inhibitory effect on CYP2D6, and weak inhibitory effects on CYP1A2 and CYP3A4_T. Coptidis Rhizoma has similar effects on CYPs and may be the main herbal medicine in the formu-la. Therefore, much attention should be paid to the combination of Zuojin pills and the drugs metabolized by human CYP2D6 in clin-ics.

Simultaneous interstitial pneumonitis and cardiomyopathy induced by venlafaxine / Pneumonite intersticial e miocardiopatia simultâneas induzidas por venlafaxina

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor used as an antidepressant. Interindividual variability and herb-drug interactions can lead to drug-induced toxicity. We report the case of a 35-year-old female patient diagnosed with synchronous pneumonitis and acute cardiomyopathy attributed to venlafaxine. The patient sought medical attention due to dyspnea and dry cough that started three months after initiating treatment with venlafaxine for depression. The patient was concomitantly taking Centella asiatica and Fucus vesiculosus as phytotherapeutic agents. Chest CT angiography and chest X-ray revealed parenchymal lung disease (diffuse micronodules and focal ground-glass opacities) and simultaneous dilated cardiomyopathy. Ecocardiography revealed a left ventricular ejection fraction (LVEF) of 21%. A thorough investigation was carried out, including BAL, imaging studies, autoimmune testing, right heart catheterization, and myocardial biopsy. After excluding other etiologies and applying the Naranjo Adverse Drug Reaction Probability Scale, a diagnosis of synchronous pneumonitis/cardiomyopathy associated with venlafaxine was assumed. The herbal supplements taken by the patient have a known potential to inhibit cytochrome P450 enzyme complex, which is responsible for the metabolization of venlafaxine. After venlafaxine discontinuation, there was rapid improvement, with regression of the radiological abnormalities and normalization of the LVEF. This was an important case of drug-induced cardiopulmonary toxicity. The circumstantial intake of inhibitors of the CYP2D6 isoenzyme and the presence of a CYP2D6 slow metabolism phenotype might have resulted in the toxic accumulation of venlafaxine and the subsequent clinical manifestations. Here, we also discuss why macrophage-dominant phospholipidosis was the most likely mechanism of toxicity in this case.

A venlafaxina é um inibidor de recaptação de serotonina e noradrenalina utilizado como antidepressivo. A variabilidade individual ou interações entre fitoterápicos e fármacos podem causar toxicidade induzida por drogas. Relatamos o caso de uma paciente de 35 anos diagnosticada com pneumonite intersticial e miocardiopatia dilatada atribuídas à venlafaxina. A paciente procurou atendimento médico devido a dispneia e tosse seca, que começaram três meses após iniciar tratamento com venlafaxina para depressão. Concomitantemente tomava suplementos fitoterápicos contendo Centella asiatica e Fucus vesiculosus. A radiografia e a CT de tórax revelaram doença pulmonar parenquimatosa (micronódulos difusos e opacidades em vidro fosco) e, simultaneamente, foi diagnosticada uma miocardiopatia por ecocardiograma, que revelou uma fração de ejeção ventricular esquerda (FEVE) de 21%. Uma investigação ampla foi realizada, incluindo LBA, estudos de imagem, detecção de doenças autoimunes, cateterismo cardíaco direito e biópsia miocárdica. Após a exclusão de outras etiologias e a aplicação da Escala de Probabilidade de Reações Adversas a Medicamentos de Naranjo, foi assumido o diagnóstico de pneumonite/miocardiopatia síncronas associadas à venlafaxina. Já foi demonstrado que os suplementos fitoterápicos utilizados pela paciente podem inibir a isoenzima do complexo enzimático citocromo P450, responsável pelo metabolismo da venlafaxina. Após a descontinuação da venlafaxina, verificou-se uma rápida melhora clínica com regressão das alterações radiológicas e normalização da FEVE. Este é um importante caso de toxicidade cardiopulmonar induzida por droga. A administração circunstancial de inibidores da isoenzima CYP2D6 e a presença de um fenótipo de metabolização lenta de CYP2D6 podem ter resultado na acumulação tóxica da venlafaxina e na manifestação clínica subsequente. Aqui, é discutida a hipótese de a fosfolipidose macrofágica ser o mecanismo de toxicidade.

Potenciais interações entre fármacos e produtos à base de valeriana ou alho / Potential interactions between drugs and valerian or garlic herbal medicines

Atualmente, as potenciais interações entre fármacos e plantas medicinais e/ou medicamentos fitoterápicos são objetos de inúmeros estudos. Tais estudos são motivados pelo fato de que a fitoterapia é amplamente utilizada em associação com diversos fármacos. Nesta revisão, as informações sobre as principais interações entre produtos elaborados com valeriana ou alho foram localizadas, avaliadas e sistematizadas. Verificou-se que tais plantas podem alterar os perfis farmacocinéticos e/ou farmacodinâmicos de diversos fármacos, podendo provocar conseqüências graves aos pacientes. A valeriana pode aumentar os efeitos adversos dos benzodiazepínicos, reduzir a biodisponibilidade dos fármacos metabolizados pelo sistema P450-CYP3A4 e provocar hemorragias graves quando utilizada juntamente com anticoagulantes orais e antiplaquetários. O alho pode aumentar a biodisponibilidade dos relaxantes musculares, potencializar os efeitos terapêuticos e adversos dos hipoglicemiantes, provocar hemorragias quando administrado juntamente com anticoagulantes orais e antiplaquetários e reduzir a biodisponibilidade dos anti-retrovirais inibidores de protease. Porém, tais potenciais interações não são consensos na literatura, visto que há limitações metodológicas e diferenças significativas entre os estudos localizados. Mesmo assim, o uso de produtos à base de valeriana ou alho, associado com determinados fármacos, deve ser adequadamente monitorado por um profissional da área da saúde.

At present, potential herbal-drug interactions are subject of great interest, because herbal medicines are often administered in combination with synthetic drugs. The aim of this paper was to review the literature in order to identify reported interactions between valerian or garlic herbal medicines and drugs, as well as to evaluate and summarize this information. Valerian or garlic herbal medicines could modify pharmacokinetics and/or pharmacodynamic profiles of several drugs and might lead to serious clinical consequences. Valerian could increase the adverse effects of benzodiazepines and could decrease the bioavailability of drugs metabolized by CYP3A4. Furthermore, valerian could cause severe bleeding when taken with oral anticoagulants and/or antiplatelet agents. Garlic could increase the bioavailability of muscle relaxants, could increase the therapeutic and adverse effects of hypoglycemic agents, could cause bleeding when taken with oral anticoagulants and/or antiplatelet agents, and could decrease the area under the plasma concentration curve of protease inhibitors. However, such potential herbal drug interactions are not consensual, because the reported studies present several limitations and significant differences among them. Therefore, concomitant use of herbal medicines and drugs has to be properly monitored by health care professionals.