Review Article

Therapeutic Risk and Benefits of Concomitantly Using Herbal Medicines and Conventional Medicines: From the Perspectives of Evidence Based on Randomized Controlled Trials and Clinical Risk Management

Table 1

Herb-drug interactions based on randomized controlled trials.

Significant pharmacokinetic HDIs with potential or actual clinical relevanceSignificant pharmacodynamic HDIs with potential or actual clinical relevanceNeutral HDIs lack of potential clinical relevance

Baicalin + rosuvastatin [11]Free and Easy Wanderer Plus + carbamazepine [46]Liu Wei Di Huang Wan + substrates of CYP2C19, CYP2D6, or CYP3A4 (cocktail phenotyping study) [61]
St. John’s wort + warfarin [13, 14]Shakuyaku-kanzo-to + antipsychotic agents [47]Citrus aurantium, Echinacea purpurea, milk thistle, saw palmetto extracts, Ginkgo biloba, or Panax ginseng + substrates of CYP1A2, CYP2D6, CYP2E1, or CYP3A4 (cocktail phenotyping study) [32, 33, 62]
St. John’s wort + oral oxycodone [15]Saffron aqueous extract + olanzapine [48]Curcuminoid/piperine extract + substrates of CYP3A, CYP2C9, UGT, or SULT (cocktail phenotyping study) [63]
St. John’s wort + oral S-ketamine [18]Saffron + fluoxetine [49, 50]St. John’s wort + substrates of CYP3A4, CYP1A2, CYP2C9, or P-gp (cocktail phenotyping study) [64]
St. John’s wort + cyclosporine [19]Ginkgo biloba extract + haloperidol [51]Woohwangcheongsimwon suspension + bupropion (CYP2B6 phenotyping study) [65]
St. John’s wort + irinotecan [20]Cranberry + warfarin [52]Ginkgo biloba extracts + flurbiprofen (CYP2C9 phenotyping study) [66]
Echinacea + warfarin [23]Ginkgo biloba extract + iodine-131 therapy [53]Milk thistle and black cohosh supplementation + digoxin (P-gp phenotyping study) [67]
American ginseng + warfarin [24]Radix/rhizoma notoginseng extract + aspirin [54]Silibinin + nifedipine (CYP3A4 phenotyping study) [68]
Ginkgo biloba extracts + simvastatin [25]Bergamot polyphenolic fraction + rosuvastatin [55]Turmeric extract + nifedipine (CYP3A4 phenotyping study) [69]
Eurycoma longifolia water-based extract + propranolol [26]Total ginsenosides + ulinastatin [56]Grape seed extract + dextromethorphan (CYP2D6 phenotyping study) [70]
Yin Zhi Huang + omeprazole [27]Fuzheng Yiliu decoction + chemotherapy [57]Radix Astragali extract + fexofenadine (P-gp phenotyping study) [71]
Dehusked Garcinia kola seed + quinine [29]St. John’s wort + low-dose oral contraceptive [58]Hawthorn preparation + digoxin (P-gp phenotyping study) [72]
Berberine + cyclosporine [30]St. John’s wort product + atorvastatin or simvastatin [59, 60]Standardized goldenseal, kava-kava, milk thistle, or black cohosh supplement + digoxin (P-gp phenotyping study) [73, 74]
St. John’s wort + substrates of CYP3A (phenotyping study) [3133]St. John’s wort + repaglinide or boceprevir [75, 76]
St. John’s wort + substrates of P-gp (phenotyping study) [3436]Ginkgo biloba extracts + ticlopidine, cilostazol, clopidogrel, voriconazole, or raltegravir [7781]
St. John’s wort + substrates of CYP2C19 (phenotyping study) [37, 38]Ginkgo or ginger + warfarin [82]
Effect of Ginkgo biloba extracts on P-gp [39]Aged garlic extract + warfarin [83]
Rhodiola rosea + substrates of CYP2C9 (phenotyping study) [40]Garlic extract + ritonavir [84]
Goldenseal + substrates of CYP3A or CYP2D6 (phenotyping study) [41, 42]Panax ginseng + warfarin [86]
Genistein + substrates of CYP3A or P-gp (phenotyping study) [44]Milk thistle extract + indinavir [87]
Berberine + substrates of CYP2D6, CYP2C9, and CYP3A4 [45]Lavender oil preparation (Silexan) + oral contraceptive containing ethinyl estradiol and levonorgestrel [88]
Sho-saiko-to, Rikkunshito, or Saireito + ofloxacin [89]
Tong Xin Luo, Nao Xin Tong, Guan Mai Ning, or Yin Xing Ye + simvastatin [90]
Paeoniae Radix + valproic acid [91]

Notes. P-gp, P-glycoprotein; CYP, cytochrome P450; UGT, UDP-glucuronosyltransferase; SULT, sulfotransferase.