Clinically relevant pharmacokinetic herb-drug interactions in antiretroviral therapy

Authors: FASINU, PIUS - University Of Mississippi; GURLEY, BILL - University Arkansas For Medical Sciences (UAMS); WALKER, LARRY - University Of Mississippi

Submitted to: Current Drug Metabolism
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/30/2015
Publication Date: 11/2/2015
Citation: Fasinu, P.S., Gurley, B.J., Walker, L.A. 2015. Clinically relevant pharmacokinetic herb-drug interactions in antiretroviral therapy. Current Drug Metabolism. 17(1):52-64.

Interpretive Summary: Over half of Americans consume medicinal herbal products as supplements or complimentary medicine. In most cases, these herbal products are taken along with prescription drugs. The ability of herbal products to disrupt, interfere or alter the ways prescription drugs work (herb-drug interaction) has been identified as the major clinical concern in concomitant herb-drug use. Herb-drug interaction could be dangerous in infectious diseases where therapy failure may result. HIV/AIDS is one the many chronic diseases managed by both prescription drugs and several supplements purportedly for immune boosting. The literature is replete with information on the potential of several herbal product to interact with antiretroviral drugs. In the current study, a review of the literature was conducted to identify herbal products that have been shown to interact with HIV/AIDS drugs through real clinical studies as against laboratory-based or animal studies. As shown in the paper, there is sufficient ground to warrant the avoidance of concurrent administration of antiretroviral (ARVs) drugs with St John’s wort (Hypericum perforatum), black pepper (Piper species) and grapefruit juice. Other botanicals that require caution in the use with antiretrovirals include African potato (Hypoxis hemerocallidea), ginkgo (Ginkgo biloba), ginseng (Panax species), garlic (Allium sativum), goldenseal (Hydrastis canadensis) and kava kava (Piper methysticum). The knowledge of clinically significant herb-drug interaction will be important in order to avoid herb-induced risk of sub-therapeutic exposure to ARVs (which can lead to viral resistance) or the precipitation of toxicity (which may lead to poor compliance and/or discontinuation of antiretroviral therapy).

Technical Abstract: For healthcare professionals, the volume of literature available on herb-drug interactions often makes it difficult to separate experimental/potential interactions from those deemed clinically relevant. There is a need for concise and conclusive information to guide pharmacotherapy in HIV/AIDS. In this review, the bases for potential interaction of medicinal herbs with specific antiretroviral drugs are presented, and several botanicals are discussed for which clinically relevant interactions in humans are established. Such studies have provided, in most cases, suf- ficient ground to warrant the avoidance of concurrent administration of antiretroviral (ARVs) drugs with St John’s wort (Hypericum perforatum), black pepper (Piper species) and grapefruit juice. Other botanicals that require caution in the use with antiretrovirals include African potato (Hypoxis hemerocallidea), ginkgo (Ginkgo biloba), ginseng (Panax species), garlic (Allium sati- vum), goldenseal (Hydrastis canadensis) and kava kava (Piper methysticum). The knowledge of clinically significant herb-drug interac- tion will be important in order to avoid herb-induced risk of sub-therapeutic exposure to ARVs (which can lead to viral resistance) or the precipitation of toxicity (which may lead to poor compliance and/or discontinuation of antiretroviral therapy).