Interactions with Botanical Products

University of Texas Health Science Center at San Antonio, San Antonio, and College of Pharmacy, University of Texas at Austin, Austin, 

Center for Drug Evaluation and Research (CDER), Eood and Drug Administration, Silver Spring, Maryland, U.S.A. 

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With the support that has been provided since its creation, NCCAM has invested in a broad array of scientific research projects that span the spectrum from basic research, such as interactions between botanical products and conventional drags, to the conduct of clinical trials to study the safety and efficacy of CAM modalities. The NCCAM portfolio also includes support for research training and education grants. In addition, the Center disseminates information through the NCCAM Clearinghouse (info nccam.nih.gov) and the NCCAM website (http //www.nccam.nih.gov). 

The nature of plants having secondary metabolites as defensive agents greatly increases the expectation that there will be interactions with other botanical products and drugs. If well-established traditional botanical products are used according to directions, they are likely a low risk. Risk increases when botanical products are combined with conventional drug therapies and lies in the possibility of unknown natural product-drug interactions. Other risks include product deviation due to misidentification of species, the lack of standardization, or adulteration. Most of the interactions have been reported with cytochrome P-450 (CYP) 3A4, but there are interactions with other metabolism enzymes and transport proteins. 

By the same token, not all Chinese botanical products are compatible with each other. Classic Chinese herbal texts have mentioned 18 Incompatibles (Shi Ba Fan) and 19 Counteractions (Shi Jiu Wei). The 18 Incompatibles refer to a classic list of 18 botanical product botanical product interactions,... 

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