Herbal drugs in milieu of modern drugs

Nazma Inamdar, Shima Edalat, Vikram B. Kotwal, Sunita Pawar


Medicinal herbs are moving from fringe to mainstream use with a greater number of people seeking remedies and health approaches free from side eff ects caused by synthetic chemicals. Most people believe that herbs are harmless plants, but when these are taken concurrently with drugs, interactions are possible. In this review article, we have discussed several popular herbs, and attempted to provide a comprehensive review that summarizes drug-herb interactions. Mustering systematic information about drug-herb interactions will be a Herculean task. Th e hurdles in evaluating herbal drugs include lack of standardization, insuffi cient quality control, overall
under-reporting, etc. Th e challenges posed in evaluating and improving the safety of herbal drugs are the need for standardization and quality control, offi cial compendia, dissemination of information, additional research, pharmacovigilance and regulations. With concentric eff orts to surmount these challenges, the wealth of traditional knowledge can be put to judicious use in the form of herbal
remedies and that it fi nds a rightful place in the health care system.
Key words: Current status, standardization, quality control, regulations, herb-drug interactions

Full Text:



Aslam M, Stockley IH, Interaction between curry ingredient

(karela) and drug (chlorpropamide), Lancet, 1, 1979, 607.

Au AM, Ko R, Boo FO, Hsu R, Perez G, Yang Z, Screening methods

for drugs and heavy metals in Chinese patent medicines, Bull

Environ Contam Toxicol, 65, 2000, 112-119.

Barnes J, Mills SY, Abbot NC, et al, Diff erent standards for reporting

ADRs to herbal remedies and conventional OTC medicines faceto-

face interviews with 515 users of herbal remedies, Br J Clin

Pharmacol, 45, 1998, 496-500.

Baskaran K, Kizar Ahamath B, Radha Shanmugasundaram K,

Shanmugasundaram ER, Antidiabetic eff ect of a leaf extract from

Gymnema sylvestre in non-insulin- dependant diabetes mellitus

patients, Journal Ethnopharmacology, 30, 1990, 295-305.

Bateman J, Chapman RD, Simpson D, Possible toxicity of herbal

remedies, Scott ish Medical Journal, 43, 1998, 7-15.

Bensky D, Gamble A, Kaptchuk T, Chinese Herbal Medicine

Materia Medica, Seatt le: Eastland Press, 1993, 331-332.

Bernardi M, DIntino PE, Trevisani F, et al, Eff ects of prolonged

graded doses of licorice by healthy volunteers, Life Sci, 55, 1994,


Blanc PD, Trupin L, Earnest G, et al, Alternative therapies among

adults with a reported diagnosis of asthma or rhinosinusitis: data

from a population-based survey, Chest, 120, 2001, 1461-1467.

Blumenthal M, Busse WR, Goldberg A, et al, eds, The Complete

German Commission E Monographs: Therapeutic Guide to

Herbal Medicines. Blumenthal M, Austin, Tex: American Botanical

Council, 1998.

Blumenthal M, Interactions between herbs and conventional drugs,

introductory considerations, Herbalgram, 49, 2000, 52-63.

Bon S, Hartmann K, Kuhn M, Johanniskraut: Ein Enzyminduktor?

Schweitzer Apothekerzeitung, 16, 1999, 535-536.

Bos R, Woerdenberg HJ, De Smet PAGM, Scheff er JJC, Valeriana

species. In: De Smet PAGM, Keller K, Hansel R, Chandler RF,

eds. Adverse eff ects of herbal drugs, vol 3. Berlin: Springer, 1997,


Burstein HJ, Gelber S, Guadagnoli E, Weeks JC, Use of alternative

medicine by women with early-stage breast cancer, New Engl J

Med, 340, 1999, 1733-1739.

Chan K, Lo AC, Yeung JH, Woo KS, The effects of danshen

(Salvia miltiorrhiza) on warfarin pharmacodynamics and

pharmacokinetics of warfarin enantiomers in rats, J Pharm

Pharmacol, 47, 1995, 402-406.

Chen M-F, Shimada F, Kato H, et al, Eff ect of oral administration of

glycyrrhizin on the pharmacokinetics of prednisolone, Endocrinol

Jpn, 38, 1991, 167-175.

Cheng TO, Warfarin danshen interaction, Ann Thorac Surg, 67,

, 892-896.

Chung KF, McCusker M, Page CP, et al, Eff ect of a ginkgolide

mixture in antagonizing skin and platelet responses to platelet

activating factor in man, Lancet, 1, 1987, 248-250.

Dandekar UP, Chandra RS, Dalvi S, et al, Analysis of clinically

important interaction between phenytoin and Shankhapushpi,

an Ayurvedic preparation, J Ethnopharm, 35, 1992, 285-88.

De Smet PAGM, DArcy PF, Drug interactions with herbal and other

non-toxic remedies, In: DArcy PF, McElnay JC, Welling PG, eds.

Mechanisms of drug interactions. Berlin: Springer-Verlag, 1996.

De Smet PAGM, Herbal remedies, N Engl J Med, 347, 2002,


Deahl M, Betel nut-induced extrapyramidal syndrome: an unusual

drug interaction, Mov Disord, 4, 1989, 330-33.

Demott K, St Johns wort tied to serotonin syndrome, Clin

Psychiatry News, 26, 1998, 28.

DeSmet PAGM, Keller K, Hansel R, Chandler RF, Adverse

eff ects of herbal. drugs, Vol. I, Heidelberg: Springer-Veriag,

, 1-72.

DeSmet PAGM, An introduction to herbal pharacoepidemiology,

Journal of Ethnopharmacology, 38, 1995b, 197-208.

Drew AK, Myers SP, Safety issues in herbal medicine,implication

for the health professions, Medical Journal of Australia, 166, 1997,


Eisenberg DM, Davis RB, Ett ner SL, et al, Trends in alternative

medicine use in the United States, 1990 -1997: results of follow -up

national survey, JAMA, 280, 1998, 1569-1575.

Ernst E, Challenges for phytopharmacovigilance, Postgrad Med

J, 80, 2004, 249-250.

Ernst E, Toxic heavy metals and undeclared drugs in Asian herbal

medicines, Trends Pharmacol Sci, 23, 2002a, 136-139.

ESCOP, European ScientiÞ c Cooperative on Phytotherapy. ESCOP

monographs on the medicinal uses of plant drugs, Exeter, UK,

conventional drugs, introductory considerations, Herbalgram,

, 1997, 52-63.

Garges HP, Varia I, et al, Cardiac complications and delirium

associated with valerian root withdrawal, JAMA, 280(18), 1998,


German K, Kumar U, Blackford HN, Garlic and the risk of TURP

bleeding, Br J Urol, 76, 1995, 518.

Giedke H, Breyer-Pfaff U, Critical evaluation of the eff ect of valerian

extracts on sleeps structure and sleep quality, Pharmacopsychiatry,

(6), 2000, 239.

Gordon JB, SSRIs and St Johns wort: possible toxicity?, Am Fam

Phys, 57, 1998, 950.

Guidelines for the Assessment of Herbal Medicines, Document No.

WHO/TRM/91.4, World Health Organization, Geneva, 1991.

Hakas JF, Topical capsaicin induces cough in patient receiving

ACE inhibitor, Ann Allergy, 65, 1990, 322.

Kamboj VP, Herbal medicine, Current Science, 78(1), 2000, 35-39.

Kassler WJ, Blanc P, Greenblatt R, The use of medicinal herbs by

human immunodeÞ ciency virus-infected patients, Arch Intern

Med, 151, 1991, 2281-2288.

Kincheloe L, Herbal medicines can reduce costs in HMO,

Herbalgram, 41, 1997, 49.

Ko RJ, Adulterants in Asian patent medicines, N Engl J Med, 339,

, 847.

Lacombiez L, Bensimon G, Isnard F, et al, Eff ect of yohimbine

on blood pressure in patients with depression and orthostatic

hypertension induced by clomipramine, Clin Pharmacol Ther,

, 1989, 241-251.

Lantz MS, Buchalter E, Giambanco V, St Johns Wort and

antidepressant drug interactions in the elderly, J Geriatr Psychiatr

Neurol, 12, 1999, 7-10.

Leatherdale BA, Panesar RK, Singh G, et al, Improvement in

glucose tolerance due to Momordica charantia (karela), BMJ, 282,

, 1823-1824.

Lipp FJ, The effi cacy, history and politics of medicinal plants,

Alternative Therapy and Health Medicine, 2, 1996, 36-41.

Lord GM, Cook T, Arlt VM, Schmeiser HH, Williams G, Pusey CD,

Urothelial malignant disease and Chinese herbal nephropathy,

Lancet, 358, 2001, 1515-1516.

Lord GM, Tagore R, Cook T, Gower P, Pusey CD, Nephropathy

caused by Chinese herbs in the UK, Lancet, 354, 1999, 481-482.

Marcus DM, Grollman AP, N Engl J Med, Botanical medicines, N

Engl J Med, 347(25), 2002, 2073-2076.

McRae S, Elevated serum digoxin levels in a patient taking digoxin

and Siberian ginseng, Can Med Assoc J, 155, 1996, 293-295.

Murphy JM, Preoperative considerations with herbal medicines,

American Organization of Registered Nurses Journal, 69, 1999,


Mustapha A, Yakasai IA, Aguye IA, Eff ect of Tamarindus indica

L on the bioavailability of aspirin in healthy human volunteers,

Eur Drug Metab Pharmacokinet, 21, 1996, 223-226.

Nortier JL, Martinez M-CM, Schmeiser HH, et al, Urothelial

carcinoma associated with the use of a Chinese herb (Aristolochia

fangchi), N Engl Med, 342, 2000, 1686-1692.

Page RL, Lawrence JD, Potentiation of warfarin by dong quai,

Pharmacotherapy, 19, 1999, 870-876.

Perlman BB, Interaction between lithium salts and ispaghula husk,

Lancet, 335, 1990, 416.

Rao JK, Mihaliak K, Kroenke K, et al, Use of complementary

therapies for arthritis among patients of rheumatologists, Ann

InternMed, 131, 1999, 409-416.

Rosenblatt M, Mindel J, Spontaneous hyphema associated with

ingestion of ginkgo biloba extract, N Engl J Med, 336, 1997,1108.

Rowin J, Lewis SL, Spontaneous bilateral subdural hematomas

associated with chronic Ginkgo biloba ingestion, Neurology, 46,

, 1775-1776.

Schulze J, Raasch W, Siegers C-P, Toxicity of kava pyrones, drug

safety and precautions- a case study, Phytomed, 10, 2003,68-73.

Shaw D, Leon C, Kolev S, Murray V, Traditional remedies and

food supplements: a Þ ve year toxicological study (1991-1995),

Drug Saf, 17, 1997, 342-356.

Strader DB, Bacon BR, Lindsay KL, et al, Use of complementary

and alternative medicine in patients with liver disease, Am J

Gastroenterol, 97, 2002, 2391-2397.

Tam LS, Chan TYK, Leung WK, Critchley JAJH, Warfarin

interactions with Chinese traditional medicines; danshen and

methyl salicylate medicated oil, Aust NZ J Med, 1995, 25, 257.

Taylor RFH, Al-Jarad N, John LME, Betel-nut chewing and asthma,

Lancet, 339, 1992, 1134-1136.

Vale S, Subarachnoid haemorrhage associated with ginkgo biloba,

Lancet, 352, 1998, 36.

Winslow LC, Kroll DJ, Herbs as medicines, Archives of Internal

Medicine, 158, 1998, 2192-2199.

Yongchaiyuda S, Rungpitarangi V, Bunyapraphatsara N, et al,

Antidiabetic activity of Aloe Vera L. juice. Clinical trial in new

cases of diabetes mellitus, Phytomedicine, 3, 1996, 241-243.

Zhu M, Chan KW, Ng LS, et al, Possible inß uences of ginseng on

the pharmacokinetics and pharmacodynamics of warfarin in rats,

J Pharm Pharmacol, 51, 1999, 175-180.

DOI: http://dx.doi.org/10.22377/ijgp.v2i1.385


  • There are currently no refbacks.