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International Journal of Phytomedicine and Phytotherapy

Table 3 Mechanism of herb-drug interactions

From: Common phyto-remedies used against cardiovascular diseases and their potential to induce adverse events in cardiovascular patients

Scientific/vernacular name Ethnopharmacological use Suggested mechanism Likely nature of effect Reference
Aesculus
hippocastanum/horse chestnut
Venous insufficiency SM aesculin a hydroxycoumarin; ↑ anticoagulants. A, I [2]
Aloe barbadensis/aloe vera Laxative, hypercholesterolemia Laxative; causes hypokalemia: ↑ cardiac glycosides and antiarrhythmic drugs. I [82]
Ammi visnaga/khella Muscle spasms SM khellin; inhibits cytochrome P 450 enzymes: anticoagulants ↑, calcium channel blockers. Not known [85]
Angelica sinensis/angelica Antitumour, antiinflammatory, analgesic, antispasmodic, dyspepsia, infection Decreases prothrombin time ↑; anticoagulants, calcium channel blockers. A [88]
Cassia senna/senna Laxative Causes hypokalemia; ↑ cardiac glycosides + antiarrhythmic drugs and calcium channel blockers. I [84]
Chondrus crispus/irish moss Ulcers, gastritis Exerts anti-thrombin activity similar to heparin; ↑ anticoagulants and antihypertensives. Not known [58]
Cimifuga racemosa/black cohosh Gynaecological ailments and premenstrual tension Inhibits CYP3A4 Not known [42, 76]
Glycyrrhiza glabra/licorice Gastric ulcers Causes hypokalemia reduces water and sodium excretion ↑; cardiac glycosides, ↓ thiazide and loop diuretics. A, I [86]
Hapagophytum Procumbens/devil’s claw Anti-inflammatory Inhibits cytochrome P 450 enzymes mainly CYP1A2 and CYP2D6; ↑ anticoagulants, statins and antihypertensives. A [55]
Hydrastis Canadensis/golden seal Antiinflammatory, antimicrobial Inhibits cytochrome P 450 enzymes mostly CYP3A4 and CYP2D6; ↑ antihypertensives, calcium channel blockers and digoxin Anta, A [56]
Oleum Oenotherae Biennis/evening primrose oil Menopausal symptoms Inhibits platelet activating factor; anticoagulants Unknown [87]
Zingiber officinalis/ginger Antiemetic Inhibits thromboxane synthase, acts as a prostacyclin agonist and large doses enhance hypothrombinaemia ↑; platelet inhibitors, anticoagulants and antihypertensives. A [89]
  1. Key:↑; Induces effect of ↓; Suppresses effect of, A agonism, SM secondary metabolite, I inhibition, Anta antagonism