Botanical-Drug Interactions

Most pharmacokinetic and pharmacodynamic botanical-drug interaction studies and clinical cases in the literature evaluated the quantitative... 

In view of the multiplicity of CYPs and the many possible botanical-drug interactions, highly efficient clinical study designs using CYP probe cocktails have been explored. Following successful application to St. John s wort, other botanicals that have been evaluated in this fashion include echinacea (42), saw palmetto (43), garlic (39), peppermint oil, and ascorbyl palmitate (44). The results are summarized in Table 1. Curbicin, a botanical... 

Most literature reports of pharmacodynamic botanical-drug interaction involve the anticoagulant warfarin, likely because it has therapeutic end points such as the INR and PT, which are routinely closely monitored. In addition, most botanicals possess anticoagulant and/or antiplatelet activities, and their combined use with warfarin provides a good example of pharmacodynamic interaction with additive pharmacological effect. 

While defining the overall pharmacokinetic or pharmacodynamic basis of botanical-drug interactions may be relatively straightforward, attempts to explain the underlying mechanism of altered drug concentrations or to predict the magnitude and significance of the interaction is certainly not easy. There are several factors that contribute to this difficulty, and they are briefly discussed below. 

All chapters, especially the last two, contain information that has not been published previously. The chapter on solid-liquid extraction technologies, for example, presents and discusses both theoretical and practical aspects of these technologies, from fundamental concepts of equilibrium and mass transfer to equipment selection and design. Similarly, the chapter on safety of botanicals reviews safety issues of botanicals associated with misidentification of plant species, misuse of products, product adulteration and botanical/drug interactions. 

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