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Beyond adverse effects from the herb itself, "adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal." [3] Most of the adverse effects stated in this list are associated with only a small percentage of cases; they should be ...
Secondary metabolites and pigments may have therapeutic actions in humans, and can be refined to produce drugs; examples are quinine from the cinchona, morphine and codeine from the poppy, and digoxin from the foxglove. [1] In Europe, apothecaries stocked herbal ingredients as traditional medicines.
Although many consumers believe that herbal medicines are safe because they are natural, herbal medicines and synthetic drugs may interact, causing toxicity to the consumer. Herbal remedies can also be dangerously contaminated, and herbal medicines without established efficacy, may unknowingly be used to replace prescription medicines. [38]
Plant extracts may interact with conventional drugs, both because they may provide an increased dose of similar compounds, and because some phytochemicals interfere with the body's systems that metabolise drugs in the liver including the cytochrome P450 system, making the drugs last longer in the body and have a cumulative effect. [122]
The interaction between citrus and medication depends on the individual drug, and not the class of the drug. Drugs that interact usually share three common features: they are taken orally, normally only a small amount enters systemic blood circulation, and they are metabolized by CYP3A4. [1]
Herb-drug interactions are drug interactions that occur between herbal medicines and conventional drugs. [18] These types of interactions may be more common than drug-drug interactions because herbal medicines often contain multiple pharmacologically active ingredients, while conventional drugs typically contain only one. [18]
Best known examples of adverse herb‑drug interactions are grapefruit or St John's wort, contraindicated for several medications including Paxlovid and oral contraceptives, but other herbs also affect the CYP enzyme family, showing herb‑drug interactions. [37] [38] [39]
Also, adulteration of some herbal medicine preparations with conventional drugs which may cause serious adverse effects, such as corticosteroids, phenylbutazone, phenytoin, and glibenclamide, has been reported. [44] [45] However, many adverse reactions are due to misuse or abuse of Chinese medicine. [6]
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