Abstract
AimsWe assessed the drug interaction profile of fermented red ginseng with respect to the activity of major cytochrome (CYP) P450 enzymes and of a drug transporter protein, Pโglycoprotein (Pโgp), in healthy volunteers.MethodsThis study was an openโlabel crossover study. The CYP probe cocktail drugs caffeine, losartan, dextromethorphan, omeprazole, midazolam and fexofenadine were administered before and after 2 weeks of fermented red ginseng administration. Plasma samples were collected, and tolerability was assessed. Pharmacokinetic parameters were calculated, and the 90% confidence intervals (CIs) of the geometric mean ratios of the parameters were determined from logarithmically transformed data. Values were compared between before and after fermented red ginseng administration using analysis of variance (anova).ResultsFifteen healthy male subjects were evaluated, none of whom were genetically defined as a poor CYP2C9, CYP2C19 or CYP2D6 metabolizer based on genotyping. Before and after fermented red ginseng administration, the geometric leastโsquare mean metabolic ratio (90% CI) was 0.901 (0.830โ0.979) for caffeine (CYP1A2) to paraxanthine, 0.774 (0.720โ0.831) for losartan (CYP2C9) to EXP3174, 1.052 (0.925โ1.197) for omeprazole (CYP2C19) to 5โhydroxyomeprazole, 1.150 (0.860โ1.538) for dextromethorphan (CYP2D6) to dextrorphan, and 0.816 (0.673โ0.990) for midazolam (CYP3A4) to 1โhydroxymidazolam. The geometric mean ratio of the area under the curve of the last sampling time (AUClast) for fexofenadine (Pโgp) was 1.322 (1.112โ1.571).ConclusionNo significantly different drug interactions were observed between fermented red ginseng and the CYP probe substrates following the twoโweek administration of concentrated fermented red ginseng. However, the inhibition of Pโgp was significantly different between fermented red ginseng and the CYP probe substrates. The use of fermented red ginseng requires close attention due to the potential for increased systemic exposure when it is used in combination with Pโgp substrate drugs.
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