Herbal Interactions with Cardiac Medications: A Comprehensive Review of Potential Interactions between Herbal Drugs and Commonly Prescribed Cardiac Medications.

BACKGROUND: The concomitant use of herbal remedies in conjunction with conventional cardiac medications has increased significantly in recent years, primarily due to improvements in the quality standards of herbal medicines and the pervasive belief that natural products pose no harm to the human body. Contrary to this belief, multiple phytoconstituents found in herbal products have the potential to interact with conventional cardiac drugs, potentially resulting in severe adverse effects.

Objective: This review aimed to elucidate the intricacies of these interactions highlighting herbal medications that interact with established pharmaceuticals used for the treatment of cardiovascular disorders. Moreover, the review draws attention to safety concerns and preventative steps that should be taken by patients and medical professionals.. This endeavor is vital to avert adverse events stemming from such interactions.

Methods: Our approach entailed a comprehensive literature review employing keywords such as "mechanisms of herb-drug interactions," "herbal medications," and "cardiovascular disorders." The drugs presented in this review were selected based on their popularity among the general population, frequency of their employability, and potential to manifest drug interactions. We sourced pertinent information from reputable databases, including PubMed, Scopus, and Elsevier.

Results: Heart or blood vessel disorders are referred to as cardiovascular diseases (CVDs), which include conditions such as heart failure, stroke, hypertensive heart disease, and peripheral arterial disease. The primary underlying factor for the development of CVDs is dyslipidemia, which can be treated with classical antihyperlipidemic drugs such as statins, ezetimibe, and PCSK9-inhibitors. The use of herbal remedies is often unregulated, and there is a lack of scientific evidence supporting their use, particularly in the management of heart failure. Patients may not disclose their use of herbal remedies to health care practitioners, which can result in potential harm.

Conclusion: Uncontrolled dyslipidemia leads to hypercholesterolemia, which can result in atherosclerotic plaques and blocked arteries and veins. Herbal remedies and botanical products are also used to prevent or treat illnesses, and many prescription pharmaceuticals are made from plant compounds. Herbal remedies are often preferred because of the belief that they are safe and have no potential to cause harm. However, there is insufficient scientific data to support the use of herbal remedies, especially when treating heart disease. Using herbal remedies in conjunction with medicinal pharmaceuticals may result in unfavorable effects.

A trimethoxy flavonoid isolated from stem extract of Tabebuia chrysantha suppresses angiogenesis in angiosarcoma.

OBJECTIVES: This research aimed to evaluate the antiangiogenic activity of isolated flavonoid 4a,5,8,8a-tetrahydro-5-hydroxy-3,7,8-trimethoxy-2-(3,4-dimethoxyphenyl) chromen-4-one (TMF) from Tabebuia chrysantha. STAT3-MMP9 signalling is a signal transduction mechanism that promotes angiogenesis in various cancers. METHODS: The tumour xenografting chicken embryo chorioallantoic membrane (CAM) model-based ex vivo assay was used to evaluate the activity of TMF. The Western blot, densitometric analysis and quantitative real-time polymerase chain reaction (qRT-PCR) were performed to evaluate the activity of the MMP9. Zebrafish embryos were used to evaluate embryotoxicity, and in vitro free radical scavenging activity of flavonoid was also elucidated. KEY FINDINGS: This research assessed the high level of STAT3, p-ERK, VEGF-R and MMP9 in the tissue extract of the control group, and also, the suppression of angiogenesis in the treatment groups was due to scavenged ROS and RNS, dephosphorylation of STAT3 and ERK, and suppression of MMP9 gene expression. CONCLUSION: The isolated flavonoid named TMF from T. chrysantha functions as specific regulators of target proteins of angiosarcoma. The STAT3-MMP9 signalling may be used as an effective prognostic marker of angiosarcoma.

Stem extract of Tabebuia chrysantha induces apoptosis by targeting sEGFR in Ehrlich Ascites Carcinoma.

ETHNOPHARMACOLOGICAL RELEVANCE: The plant Tabebuia chrysantha (Jaq.) Nicholson (Bignoniaceae) is commonly known as "Golden Goddess" in the Southern part of India and "Golden Trumpet Tree " in Central America. Stems of this plant have been traditionally used for antioxidant, anti-inflammatory, antimicrobial and anticancer actions. AIM OF THE STUDY: To evaluate the antitumor activity of methanol extract of Tabebuia chrysantha stem (METC). MATERIALS AND METHODS: The in vivo antitumor potential of METC against Ehrlich Ascites Carcinoma (EAC) in Swiss albino mice was assessed by evaluating tumor volume, viable and nonviable tumor cell count, tumor weight, hematological parameters, biochemical parameters, and antioxidant parameters. The in vitro antitumor potential of METC at different concentrations (100, 200, 400, 800, 1000) µg/mL has been evaluated, by using the MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] and Trypan blue dilution assay for a period of 3 h treatment. Before that, the crude extract was pre-screened for cytotoxicity property using Brine shrimp lethality bioassay. RESULTS: Phytoconstituents 2-Hydroxynaphthalene-1,4-dione, ß-lapachone and 2-((dimethylamino)methyl)-3-methoxynaphthalene-1,4-dione were isolated from the METC. Their occurrence and structures were determined by HPLC chromatography, UV spectroscopy, and 1D and 2D NMR spectroscopies respectively. The extract showed a direct cytotoxic effect on EAC cells in a dose-dependent manner with IG50 value 463.27 µg/mL in MTT assay and 443.58 µg/mL in trypan blue dilution assay. The METC (300 mg/kg) and 5-FU (30 mg/kg) exhibited significant (p < 0.001) decrease in tumor volume, tumor weight and viable cell count of EAC-treated mice. Also, hematological profile, tissue parameters such as lipid peroxidation, reduced glutathione, superoxide dismutase, and catalase were reverted to the normal levels compared to the EAC control group. The Western blotting analysis demonstrated apoptosis of carcinoma was due to inhibition of soluble epidermal growth factor receptor proteins (sEGFR) expression in the blood. CONCLUSION: The antitumor potential of the stem extract of T chrysantha was due to naphthaquinones and polyphenol content in the crude extract and so T chrysantha could be a cytotoxic plant to control tumor growth.