Abstract
A plethora of active compounds found in herbal medicines can serve as substrate for enzymes involved in the metabolism of xenobiotics. When a medicinal plant is co-administered with a conventional drug and little or no information is known about the pharmacokinetics of the plant metabolites, there is an increased risk of potential herb-drug interactions. Moreover, genetic polymorphisms in a population may act to predispose individuals to adverse reactions. The use of herbal medicines is rapidly increasing in many countries, particularly Brazil where the vast biodiversity is a potential source of new and more affordable treatments for numerous conditions. Accordingly, the Brazilian Unified Public Health System (SUS) produced a list of 71 plant species of interest, which could be made available to the population in the near future. Physicians at SUS prescribe a number of essential drugs and should herbal medicines be added to this system the chance of herb-drug interactions further increases. A review of the effects of these medicinal plants on Phase 1 and Phase 2 metabolic mechanisms and the transporter P-glycoprotein was conducted. The results have shown that approximately half of these medicinal plants lack any pharmacokinetic data. Moreover, most of the studies carried out are in vitro. Only a few reports on herb-drug interactions with essential drugs prescribed by SUS were found, suggesting that very little attention is being given to the safety of herbal medicines. Here we have taken this information to discuss the potential interactions between herbal medicines and essential drugs prescribed to Brazilian patients whilst taking into account the most common polymorphisms present in the Brazilian population. A number of theoretical interactions are pinpointed but more pharmacokinetic studies and pharmacovigilance data are needed to ascertain their clinical significance.
Highlights
Consumption of herbal medicines has been increasing worldwide over the past few years
The World Health Organization (WHO) estimates that 65–80% of the population relies on herbal medicines as a primary source of treatment (Rahman and Singhal, 2002)
The aim of this article is to provide an overview and critical evaluation of the pharmacokinetic data of medicinal plants to be used in the Brazilian health system
Summary
Consumption of herbal medicines has been increasing worldwide over the past few years. The World Health Organization (WHO) estimates that 65–80% of the population relies on herbal medicines as a primary source of treatment (Rahman and Singhal, 2002). These statistics are in line with Brazil, where 66% of the population have no access to commercial medicines (Trojan-Rodrigues et al, 2012). Even when access is granted, popular use of herbal medicines is often due to poor medical and pharmaceutical assistance and the high cost of treatment with conventional drugs (Silveira et al, 2008). A consequence of this increased use of phytotherapy has been a higher number of case reports on adverse reactions caused by uncontrolled consumption of herbal medicines (Silveira et al, 2008)
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