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HIV/AIDS: Interactions between Natural Health Products and Antiretroviral Drugs: Pharmacokinetic and Pharmacodynamic Effects
Abstract
Concurrent use of natural health products (NHPs) with antiretroviral drugs (ARVs) is widespread among human immunodeficiency virus-infected patients. This article reviews the clinical pharmacokinetic and pharmacodynamic interactions between NHPs and ARVs. Many NHPs are complex mixtures and are likely to contain organic compounds that may induce and/or inhibit drug metabolizing enzymes and drug transporters. Although the weight of evidence for the effects of certain NHPs varies and many studies of these products lack scientific rigor, it has been observed that St. John's wort clearly induces cytochrome P450 3A4 and P-glycoprotein and reduces protease inhibitor and nonnucleoside reverse-transcriptase inhibitor concentrations, thereby increasing the likelihood of therapeutic failure. Limited clinical research suggests that intake of garlic and vitamin C results in reductions in ARV concentrations. The intake of milk thistle, Echinacea species, and goldenseal inhibits cytochrome P450 enzymes in vitro and may increase ARV concentrations, but by clinically unimportant amounts. Intake of fish oil reduces ARV-induced hypertriglyceridemia without significantly affecting lopinavir concentrations. Before recommending the use of NHPs as adjuncts to ARV use, studies should first exclude significant pharmacokinetic interactions and ensure that ARV efficacy is maintained.
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“Allium poisoning symptoms may appear after one day or several days of its ingestion based on the amounts taken [129].”
From Chemical Constituents and Pharmacological Activities of Garlic (Allium sativum L.): A Review (2020) · cites this paper as [129]
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PHYTOCHEMICAL ANALYSIS OF Turnera diffusa WILLD
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Farmacocinética poblacional de Lopinavir y Ritonavir en pacientes adultos infectados por el VIH
Moltó, J. (2008) · TDX (Tesis Doctorals en Xarxa)
Clinical Pharmacokinetic Interactions between Herbal Supplements and Anticancer Drugs
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Problems assotiatet with herbal medicines use.
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Suplementação vitamínica e infeção HIV: Racional e evidência
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“According to recent epidemiological reports, ~40% of Americans use CAM “natural products” including herbal medicines, botanicals, and other dietary supplements during their lifetime [10-14].”
BackgroundGenetic-Based Biomarkers in Psychiatry: An Integrative Approach
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Drug interactions in HIV and AIDS
Flexner, C. W., & Pham, P. A. (2010) · Elsevier eBooks · doi:10.1016/b978-0-323-04579-7.00245-8
Self-citationAntiretroviral Therapy that Includes, Protease Inhibitors - Induced Hepatotoxicity: A Review
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“Moreover, there is a potential for interaction with nutritional supplements.(39) Physicians should also be aware that patients with chronic viral hepatitis coinfection have additional impairment of CYP3A activity in the presence of ritonavir, compared to HIV patients without viral hepatitis, even at the low doses of 1…”
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“These herbal substances could induce enzymes involved in the metabolism of antiretroviral drugs resulting in low plasma concentrations of the drugs or alternatively inhibit the enzymes resulting to higher plasma concentrations of the drugs which would exacerbate their toxicity (Lee et al., 2006).”
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Herb–nutrient–drug interactions
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Metadata
- Authors
- Lee, L. S., Andrade, A. S. A., & Flexner, C.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Flexner, Charles
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-10-15
- Volume
- 43
- Issue
- 8
- Pages
- 1052-1059
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2111738803
- Cited by
- 102
- References
- 78
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 6 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 5 · 2014: 2 · 2013: 8 · 2012: 14
- FWCI
- 3.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Complementary and Alternative Medicine
- National Center for Complementary and Integrative Health (F05-AT 02031, F05AT002031)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
- Keywords
- natural health products, antiretroviral drugs, drug interactions, HIV/AIDS, pharmacokinetic interactions, pharmacodynamic interactions, Hypericum perforatum, CYP3A4, P-glycoprotein, protease inhibitors, non-nucleoside reverse transcriptase inhibitors, garlic, vitamin C, Silybum marianum, Echinacea, goldenseal, fish oil, lopinavir, drug-metabolizing enzymes, drug transporters
- MeSH terms
- Biological Availability, Cytochrome P-450 Enzyme System, Humans, Plant Extracts, Plants, Medicinal, Glucuronosyltransferase, ATP Binding Cassette Transporter, Subfamily B, Member 1, Herb-Drug Interactions, Anti-Retroviral Agents, Cytochrome P-450 CYP3A
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