The DOI matches its Crossref record; 247 of the 247 references it cites were found in a registry or an index.
Interactions Between Herbal Medicines and Prescribed Drugs: An Updated Systematic Review
Abstract
The concomitant use of herbal medicines and pharmacotherapy is wide spread. We have reviewed the literature to determine the possible interactions between seven popular herbal medicines (ginkgo, St John's wort, ginseng, garlic, echinacea, saw palmetto and kava) and conventional drugs. Literature searches were performed using MEDLINE, Cochrane Library and EMBASE and we identified 128 case reports or case series, and 80 clinical trials. Clinical trials indicate that St John's wort (Hypericum perforatum), via cytochrome P450 (CYP) and/or P-glycoprotein induction, reduces the plasma concentrations (and/or increases the clearance) of alprazolam, amitriptyline, atorvastatin, chlorzoxazone, ciclosporin, debrisoquine, digoxin, erythromycin, fexofenadine, gliclazide, imatinib, indinavir, irinotecan, ivabradine, mephenytoin, methadone, midazolam, nifedipine, omeprazole, oral contraceptives, quazepam, simvastatin, tacrolimus, talinolol, verapamil, voriconazole and warfarin. Case reports or case series suggest interactions of St John's wort with adrenergic vasopressors, anaesthetics, bupropion, buspirone, ciclosporin, eletriptan, loperamide, nefazodone, nevirapine, oral contraceptives, paroxetine, phenprocoumon, prednisone, sertraline, tacrolimus, theophylline, tibolone, tryptophan, venlafaxine and warfarin. Ginkgo (Ginkgo biloba) decreases the plasma concentrations of omeprazole, ritonavir and tolbutamide. Clinical cases indicate interactions of ginkgo with antiepileptics, aspirin (acetylsalicylic acid), diuretics, ibuprofen, risperidone, rofecoxib, trazodone and warfarin. Ginseng (Panax ginseng) may interact with phenelzine and warfarin. Kava (Piper methysticum) increases the clearance of chlorzoxazone (a CYP2E1 substrate) and may interact with alprazolam, levodopa and paroxetine. Garlic (Allium sativum) interacts with chlorpropamide, fluindione, ritonavir and warfarin; it also reduces plasma concentrations of chlorzoxazone (a CYP2E1 probe). Echinacea might affect the clearance of caffeine (a CYP1A2 probe) and midazolam (a CYP3A4 probe). No interactions have been reported for saw palmetto (Serenoa repens). Numerous interactions between herbal medicines and conventional drugs have been documented. While the significance of many interactions is uncertain, several interactions, particularly those with St John's wort, may have serious clinical consequences.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Coadministration of herbal drugs with prescribed drugs may result in serious adverse effects.”
From Indian Medicinal Herbs and Formulations for Alzheimer’s Disease, from Traditional Knowledge to Scientific Assessment (2020) · cites this paper as [269]
Citations
Cites
Items 201–247 of 247
Induction of imatinib metabolism by hypericum perforatum
Smith, P. F., Bullock, J. M., Booker, B. M., Haas, C. E., Berenson, C. S., & Jusko, W. J. (2004) · Blood · doi:10.1182/blood-2004-04-1240 · Cited by 41
Bonetto, N., Santelli, L., Battistin, L., & Cagnin, A. (2007) · Cephalalgia · doi:10.1111/j.1468-2982.2007.01430.x · Cited by 41
Herbal medicine: the dangers of drug interaction
Izzo, A. A., Borrelli, F., & Capasso, R. (2002) · Trends in Pharmacological Sciences · doi:10.1016/s0165-6147(02)02059-x · Cited by 40
Self-citationWang, X., Li, J., Su, Q., Guan, S., Chen, J., Du, J. C., He, Y., Zeng, J., Zhang, J., Chen, X., et al. (2008) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2008.03344.x · Cited by 40
Bees, Ginseng and MAOIs Revisited
Shader, R. I., & Greenblatt, D. J. (1988) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-198808000-00001 · Cited by 38
A possible cause of cardiovascular collapse during anesthesia: long-term use of St. John’s Wort
Irefin, S. A. (2000) · Journal of Clinical Anesthesia · doi:10.1016/s0952-8180(00)00199-9 · Cited by 38
Garlic for peripheral arterial occlusive disease
Jepson, R. G., Kleijnen, J., & Leng, G. C. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000095.pub2 · Cited by 37
Effect of Ginseng on Plasma Levels of Ethanol in the Rat
Lee, Y. K., Pantuck, C. B., & Pantuck, E. J. (1993) · Planta Medica · doi:10.1055/s-2006-959595 · Cited by 37
homme, R. L. F. A. L., Dijkema, T., van der Ven, A. J. A. M., & Burger, D. M. (2006) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/01.qai.0000234089.41785.c8 · Cited by 36
Herberg, K. W. (1993) · PubMed · Cited by 35
Drug interaction of herbal tea containing St. John's wort with cyclosporine
Alscher, M. D., & Klotz, U. E. (2003) · Transplant International · doi:10.1111/j.1432-2277.2003.tb00345.x · Cited by 34
Drug interaction of herbal tea containing St. John's wort with cyclosporine
Alscher, M. D., & Klotz, U. E. (2003) · Transplant International · doi:10.1007/s00147-003-0560-z · Cited by 32
Garlic and diabetes mellitus phase II clinical trial.
Sitprija, S., Plengvidhya, C., Kangkaya, V., Bhuvapanich, S., & Tunkayoon, M. (1987) · PubMed · Cited by 32
In vivoassessment of herb–drug interactions: Possible utility of a pharmacogenetic approach?
Tomlinson, B., Hu, M., & Lee, V. W. Y. (2008) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.200700454 · Cited by 31
Unexplained decrease of cyclosporin trough levels in a compliant renal transplant patient
Mandelbaum, A., Pertzborn, F., Martin‐Facklam, M., & Wiesel, M. (2000) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/15.9.1473 · Cited by 31
McIntyre, M. (2000) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2000.6.115 · Cited by 30
Herbal Medicines: Can We Do without Pharmacologist?
Calapai, G., & Caputi, A. P. (2007) · Evidence-based Complementary and Alternative Medicine · doi:10.1093/ecam/nem095 · Cited by 30
Effect of Ginkgo biloba extract on microsomal enzyme induction.
Jc, D., Barré, J., Guinot, P., Duchier, J. L., Cournot, A., & Tillement, J. P. (1989) · PubMed · Cited by 30
[Generalized livedo during severe chloralose poisoning].
Fourel, D., Moriconi, M., Garo, B., Renault, A., L'Her, E., & Boles, J. M. (2000) · PubMed · Cited by 30
ST. JOHN'S WORT AND ORAL CONTRACEPTIVES: REASONS FOR CONCERN?
Murphy, P. A. (2002) · Journal of Midwifery & Women s Health · doi:10.1016/s1526-9523(02)00321-5 · Cited by 28
Perioperative considerations in the management of the patient taking herbal medicines
Leak, J. A. (2000) · Current Opinion in Anaesthesiology · doi:10.1097/00001503-200006000-00016 · Cited by 28
St. John’s Wort: Effect on CYP2D6 Activity Using Dextromethorphan–Dextrorphan Ratios
Roby, C. A., Dryer, D. A., & Burstein, A. H. (2001) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-200110000-00013 · Cited by 28
Effects of ginseng on ethanol induced sedation in mice
Koo, M. W. L. (1998) · Life Sciences · doi:10.1016/s0024-3205(98)00545-1 · Cited by 26
Garlic Interaction with Fluindione: A Case Report
Pathak, A., Léger, P., Bagheri, H., Sénard, J., Boccalon, H., & Montastruc, J. (2003) · Therapies · doi:10.2515/therapie:2003060 · Cited by 26
Bell, E. C., Ravis, W. R., Chan, H. M., & Lin, Y.-J. (2007) · Annals of Pharmacotherapy · doi:10.1345/aph.1k316 · Cited by 25
Hypoglycemic and hypolipidaemic effects of garlic in sucrose fed rabbits.
Zacharias, N. T., Sebastian, K., Philip, B., & Augusti, K. T. (1980) · PubMed · Cited by 25
Herbal medicines and postoperative haemorrhage
Jayasekera, N., Moghal, A., Kashif, F., & Karalliedde, L. D. (2005) · Anaesthesia · doi:10.1111/j.1365-2044.2005.04276.x · Cited by 24
Beer, A.-M., & Ostermann, T. (2001) · Medizinische Klinik - Intensivmedizin und Notfallmedizin · doi:10.1007/pl00002231 · Cited by 23
Association Between Priapism and Concurrent Use of Risperidone and Ginkgo biloba
Lin, Y., Chu, S.-J., & Tsai, S. (2007) · Mayo Clinic Proceedings · doi:10.4065/82.10.1289 · Cited by 23
Toxic delirium possibly caused by loperamide
Schwartz, R. H., & Rodriguez, W. J. (1991) · The Journal of Pediatrics · doi:10.1016/s0022-3476(05)83407-9 · Cited by 21
Ginsenoside Rg1 inhibits the brain cAMP phosphodiesterase activity in young and aged rats
Stancheva, S. L., & Alova, L. G. (1993) · General Pharmacology The Vascular System · doi:10.1016/0306-3623(93)90435-z · Cited by 20
Serotonin syndrome resulting from an herbal detox cocktail
Bryant, S. M., & Kolodchak, J. (2004) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2004.09.013 · Cited by 19
Ernst, E. (2000) · Focus on Alternative and Complementary Therapies · doi:10.1111/j.2042-7166.2000.tb02303.x · Cited by 18
Self-citationJohne, A., Perloff, E. S., Bauer, S., Schmider, J., Mai, I., ller, J. R. B., & Roots, I. (2004) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-004-0823-3 · Cited by 17
Herb-drug interactions. St. John's wort and prescription medications.
BRESSLER, R. C. (2005) · PubMed · Cited by 16
Effects of Ginkgo biloba on Blood Coagulation Parameters
Savović, J., Wider, B., & Ernst, E. (2005) · Evidence-Based Integrative Medicine · doi:10.2165/01197065-200502030-00007 · Cited by 15
Self-citationMilton, J. C., & Abdulla, A. (2007) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2007.02962.x · Cited by 14
Baravkar, A., Sawant, S. D., .B, B. S., & Dhabale, P. (2009) · Indian Journal of Pharmacy Practice · Cited by 14
Etogo-Asse, F., Boemer, F., Sempoux, C. L., & Geubel, A. P. (2008) · PubMed · Cited by 13
Cranwell-Bruce, L. A. (2008) · PubMed · Cited by 12
Ginko, Vioxx and excessive bleeding--possible drug-herb interactions: case report.
Hoffman, T. (2001) · PubMed · Cited by 11
Book Review: Cardiopulmonary bypass: principles and practice, 2nd edn
Anderson, J. (2001) · Perfusion · doi:10.1177/026765910101600213 · Cited by 8
Rubin, D. T., McGovern, B. G., & Kopelman, R. I. (2006) · The American Journal of Medicine · doi:10.1016/j.amjmed.2006.04.007 · Cited by 8
Herberg, K. W. (1993) · Blutalkohol · Cited by 6
Millepertuis, corticoïdes, cocaïne, alcool… et un premier épisode maniaque
Saraga, M., & Zullino (2005) · Praxis · doi:10.1024/0369-8394.94.23.987 · Cited by 6
Interactions between Drugs and Natural Medicines
Ernst, E. K. (2000) · Focus on Alternative and Complementary Therapies · doi:10.1111/j.2042-7166.2000.tb02449.x · Cited by 5
Self-citationEffet de l'extrait de Ginkgo biloba sur les paramètres biologiques endocriniens.
Felber, J. P. (1986) · La Presse Médicale · Cited by 2
Research works printed but not linked: 20
- Gardiner, 2008, Am Fam Physician, 77, 73
- Ernst, 2003, Perfusion, 16, 175
- Cranwell-Bruce, 2008, Medsurg Nurs, 17, 52
- Calapai, 2007, Alternat Med, 4, 41
- Bush, 2007, Alternat Ther Health Med, 13, 30
- Laroche, 1998, Can J Infect Dis, 9, 471P
- Sunter, 1991, Pharm J, 246, 772
- Hoffman, 2001, Hawaii Med J, 60, 290
- Shader, 1988, J Clin Psychopharmacol, 8, 235
- Bon, 1999, Schweitzer Apothekerzeitung, 16, 535
- Gordon, 1998, Am Fam Phys, 57, 950
- Etogo-Asse, 2008, Acta Gastroenterol Belg, 71, 36
- Prost, 2000, Presse Med, 29, 1285
- Gwilt, 1994, Cancer Epidemiol Biomarkers Prev, 3, 155
- Duche, 1989, Int J Clin Pharmacol Res, 9, 165
- Donath, 1999, Eur J Clin Pharmacol, 55, A22
- Ernst, 2005, Perfusion, 18, 52
- Kiefer, 2003, Am Fam Physician, 68, 1539
- Bressler, 2005, Geriatrics, 60, 21
- Erickson, 1999, Drug Metab Dispos, 27, 1488
Cited by
Sorted by citations
Complementary and alternative medicine use among adults: United States, 2002
Barnes, P. M., Powell‐Griner, E., McFann, K., & Nahin, R. L. (2004) · Seminars in Integrative Medicine · doi:10.1016/j.sigm.2004.07.003 · Cited by 2,183
Coté, C. J., & Wilson, S. L. (2019) · PEDIATRICS · doi:10.1542/peds.2019-1000 · Cited by 1,407
Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review
James, P., Wardle, J., Steel, A., & Adams, J. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-000895 · Cited by 508
Jamu: Indonesian traditional herbal medicine towards rational phytopharmacological use
Elfahmi, E., Woerdenbag, H. J., & Kayser, O. (2014) · Journal of Herbal Medicine · doi:10.1016/j.hermed.2014.01.002 · Cited by 469
Bacopa monniera, a reputed nootropic plant: An overview
Russo, A., & Borrelli, F. (2005) · Phytomedicine · doi:10.1016/j.phymed.2003.12.008 · Cited by 447
Metadata
- Authors
- Izzo, A. A., & Ernst, E.
- Affiliations
- University of Naples Federico II (IT)
- University of Exeter (GB)
- Corresponding author
- Izzo, Angelo A.
- Ernst, Edzard
- ORCID
- Izzo, Angelo A.
- Venue
- Drugs
- Published
- 2009-09
- Volume
- 69
- Issue
- 13
- Pages
- 1777-1798
- ISSN
- 0012-6667 (ISSN-L)
- OpenAlex
- W1794469725
- Cited by
- 801
- References
- 247
- Citations by year
- 2026: 43 · 2025: 35 · 2024: 14 · 2023: 28 · 2022: 35 · 2021: 26 · 2020: 42 · 2019: 43 · 2018: 35 · 2017: 41 · 2016: 32 · 2015: 34 · 2014: 68 · 2013: 61 · 2012: 69
- FWCI
- 10.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drugs (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Natural Compound Pharmacology Studies
- Keywords
- herb-drug interactions, Hypericum perforatum, Ginkgo biloba, Panax ginseng, kava, garlic, Echinacea, saw palmetto, cytochrome P450 induction, P-glycoprotein, drug interactions
- MeSH terms
- Clinical Trials as Topic, Cytochrome P-450 Enzyme System, Humans, Herb-Drug Interactions
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
