Review Article

Salvia miltiorrhiza Roots against Cardiovascular Disease: Consideration of Herb-Drug Interactions

Table 2

Clinical trials on pharmacokinetic Danshen-drug interactions.

Dose regimenEffect and ratio (treatment/control)Reference
DanshenDaily dose (mg/day)Victim drug

Four Danshen extract tablets (each tablet contained an extract of 1 g Danshen), p.o., three times daily for 14 days (days 2–15)Cryptotanshinone,
tanshinone,
tanshinone IIA,
tanshinol,
protocatechuic acid,
salvianolic acid B
3.0
6.0
4.2
19.2
2.4
156
A single oral dose of theophylline at 100 mg on days 1 and 15.No effect[65]
Sodium tanshinone IIA sulfonate injections, i.v., 60 mg/day for 13 daysBaseline and a single oral dose of caffeine at 100 mg on day 13 after injection of placebo or sodium tanshinone IIA sulfonate.CYP1A2 activity (ratio of paraxanthine to caffeine at 6 h in plasma) ratio 1.41;
caffeine AUC ratio 0.87, paraxanthine AUC ratio 1.17
[66]
Four Danshen extract tablets (each tablet contained an extract of 1 g Danshen), p.o., three times daily for 14 days (days 2–15)Cryptotanshinone
tanshinone I,
tanshinone IIA,
protocatechuic aldehyde,
tanshinol,
salvianolic acid B
3.12
6.0
4.44
8.04
20.4
162
A single oral dose of midazolam at 15 mg on days 1 and 16.Midazolam AUC ratio 0.74, ratio 0.69, CL/F ratio 1.35.
No effect on and AUC ratios of midazolam to 1-hydroxymidazolam
[67]
Ethanol extract of Danshen at 1 g, p.o., a single doseTanshinone IIA,
cryptotanshinone,
tanshinone I,
dihydrotanshinone I
106.2
88.0
53.1
13.5
Baseline and a single oral dose of midazolam at 15 mg 0.5 h after administration of 1 g Danshen extract.Midazolam ratio 1.87;
1-hydroxymidazolam ratio 1.68
[33]
Ethanol extract of Danshen at 1 g, p.o., three times a day for 10 days (days 2–11)Tanshinone IIA,
cryptotanshinone,
tanshinone I,
dihydrotanshinone I
318.6
264.0
159.3
40.5
A single oral dose of midazolam at 15 mg of on days 1 and 12 (0.5 h after administration of 1 g Danshen extract).Midazolam ratio 0.20, ratio 0.34, and ratio 0.56, CL/F ratio 6.0; 1-hydroxymidazolam ratio 0.55;
/ ratio 3.0
T89 (225 mg, twice daily, p.o.) and warfarin were given simultaneously for one-week after reaching warfarin steady stateWarfarin dose to maintain international normalized ratio at 1.3–1.9 was selected.T89 has no effect on the steady‐state PK of warfarin[68]
Ethanol extract of Danshen at 1 g, p.o., three times a day for 10 days (days 2–11)Tanshinone IIA,
cryptotanshinone,
tanshinone I
318.6
264.0
159.3
A single oral dose of fexofenadine at 60 mg on days 1 and 12. ratio 0.65, ratio 0.55, CL/F ratio 2.11.
Induction of intestinal P-glycoprotein
[62]

p.o., oral.
i.v., intravenous.