Phytotherapy as an integrative and complementary practice: investigation of the risk of herb-drug interactions with Diabetes mellitus type II treatment
DOI:
https://doi.org/10.70151/7h2ns833Keywords:
Diabetes, Plant-Drug interactionsAbstract
This study aimed to investigate the occurrence of plants, used in herbal medicines dispensed in a manipulation pharmacie´s network, that could compromise the effectiveness or toxicity of antidiabetics through pharmacokinetic interactions. The prescribed herbal medicine´s data as well vegetal active pharmaceutical ingredient´s data were collected, with consent, in dispensed prescription´s records in nine units of a manipulation pharmacie´s network in the State of Rio de Janeiro, Brazil, in the city of Rio de Janeiro (8) and Petrópolis (1). Five thousand two hundred and twenty - four records of phytotherapeutics, corresponding to IFAV obtained from ninety-three plant species, were found. The frequency of vegetal species and their therapeutical uses was determined. Among the most frequent species, the major therapeutic indication was weight-loss or obesity-related dysfunctions, such as hypolipemic or hypoglycaemic actions. The highest frequency species was: Garcinia cambogia, Citrus aurantium, Camellia sinensis, Equisetum arvense, Gymnema sylvestre, Cordia ecalyculata, Centella asiatica, Tribulus terrestris, Plantago psyllium, Cynara cardunculus, Citrus sinensis, Cassia nomame, Ilex paraguariensis, Griffonia simplicifolia, Capsicum annuum, Zingiber officinale, Panax ginseng, Irvingia gabonensis e Passiflora incarnata. Searches were performed in SCIENCE DIRECT and PUBMED databases about pharmacokinetic interactions involving the most dispensed species as well CYP(2C8, 2C9, 3A4, 2C19) and P-gp, BCRP e OCT. Only 53% of the prescribed species were studied in this subject, most of them using in vitro models. In conclusion, the literature review suggests caution in the use of Camellia sinensis, Centella asiatica, Gymnema sylvestre and Panax ginseng associated with sulfonylureas and glinides and Equisetum arvense concomitantly with pioglitazone due to the possibility of potentiation of the adverse effects caused by metabolism´s decrease of these antidiabetics. Little has been studied about the risks in the use of these species in conjunction with oral antidiabetic drugs and, as Phytotherapy is an Integrative Practice, prescribers must be aware of the risks involved in the concomitant use of antidiabetics with herbal medicines related to the species mentioned above and, at the time of its use, take preventive measures to detect possible therapeutic failures or adverse events. If these occur, the notification to the National Health Surveillance Agency (ANVISA) must be done as well.
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