Cited by 102HIV/AIDS drug development and treatmentComplementary and Alternative Medicine StudiesPharmacogenetics and Drug Metabolism

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HIV/AIDS: Interactions between Natural Health Products and Antiretroviral Drugs: Pharmacokinetic and Pharmacodynamic Effects

Lee, Lawrence S., Andrade, Adriana S. A., Flexner, Charles·2006·Clinical Infectious Diseases

DOI 10.1086/507894

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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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See all 102

Authors: Lee, L. S., Andrade, A. S. A., & Flexner, C.
Affiliations: Johns Hopkins University (US)
Corresponding author: Flexner, Charles
ORCID: Lee, Lawrence S.
Andrade, Adriana S. A.
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
DOI: 10.1086/507894
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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HIV/AIDS: Interactions between Natural Health Products and Antiretroviral Drugs: Pharmacokinetic and Pharmacodynamic Effects

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