A Review Article About Digoxin-Herb and Dietary Supplement Interactions

  • Forouzan ahmadpour * Department of clinical pharmacy,School of pharmacy, Lorestan University of Medical Sciences, Khorramabad, Iran Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran https://orcid.org/0000-0002-1142-6088
  • Fatemeh Ahmadpour Department of Clinical biochemistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Keywords: Digoxin, Herb, Interaction

Abstract

Digoxin has a narrow therapeutic index and is the potential drug for interaction with other drugs, herbs and supplements, therefore, regarded to these properties we decided to review the evidence about interaction between herbal-dietary supplements and digoxin. We were collected published articles about this digoxin-herb and supplement interaction for writing a review article. Some the information in this review resulting from, in vitro and animal study that no clinical evidence for them, and others result from clinical evidences. We found fifty herbal products can interact by different mechanism with digoxin and St. John’s wort has the most documented interactions with digoxin.

References

References:

-PAULA GARDINER, RUSSELL PHILLIPS, ALLEN-F. SHAUGHNESSY. Herbal and Dietary Supplement–Drug Interactions in Patients with Chronic Illnesses (Am Fam Physician. 2008;77(1):73-78.

-Adriane Fugh-Berman & E. Ernst, Herb±drug interactions: Review and assessment of report reliability. 2001 J Clin Pharmacol, 52, 587±595.

- Lillian S L Ting, Stephen J Shalansky, Erin Neall, and Mary H H Ensom, Use of Dietary Supplements by Patients Taking Digoxin.

-Dasgupta A., Wu S., Actor J., Olsen M., Wells A., Datta P. Effect of Asian and Siberian ginseng on serum digoxin measurement by five digoxin immunoassays. Significant variation in digoxin-like immunoreactivity among commercial ginsengs. Am. J. Clin. Pathol. (2003) 119 298–303.

-McRae S. Elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng. CMAJ. 1996;155:293-5.

- Dasgupta A, Reyes MA. Effect of Brazilian, Indian, Siberian, Asian, and North American ginseng on serum digoxin measurement by immunoassays and binding of digoxin-like immunoreactive components of ginseng with Fab fragment of antidigoxin antibody (Digibind). Am J Clin Pathol (2005) 124, 229–36. 4.

- Chow L, Johnson M, Wells A, Dasgupta A. Effect of the traditional Chinese medicines Chan Su, Lu-Shen-Wan, Dan Shen, and Asian ginseng on serum digoxin measurement by Tina-quant (Roche) and Synchron LX System (Beckman) digoxin immunoassays. J Clin Lab Anal (2003) 17, 22–7. 5.

- Awang DVC. Siberian ginseng toxicity may be case of mistaken identity. CMAJ (1996) 155, 1237.

- Oga EF, Sekine S, Shitara Y, et al. P-glycoprotein mediated efflux in Caco-2 cell monolayers: the influence of herbals on digoxin transport. J. Ethnopharm., [prepub. online: dx.doi.org/10.1026/j.jep.2012.10.001], 2012

- Berginc K, Zakelj S, Dristl A. In vitro interactions between aged garlic extract and drugs used for the treatment of cardiovascular and diabetic patients. Eur. J. Nutr., 49:373-384, 2010

- Tyler VE. The Honest Herbal, 3rd ed. New York: Pharmaceutical Products Press, 1993, 198.

- Ondieki G, Nyagblordzro M, Kikete S, Liang R, Wang L, He X. Cytochrome P450 and PGlycoprotein-Mediated Interactions Involving African Herbs Indicated for Common Non communicable Diseases. Evidence-Based Complementary and Alternative Medicine, 2017; 1-18

- Mauro VF, Mauro LS, Kleshinski JF, Khuder SA, Wang Y, Erhardt PW. Impact of ginkgo biloba on the pharmacokinetics of digoxin. Am J Ther. 2003;10:24751.

-Hellum BH, Nilsen OG. In vitro inhibition of CYP3A4 metabolism and P-glycoproteinmediated transport by trade herbal products. Basic Clin Pharmacol Toxicol (2008) 102, 466–75.

- Etheridge AS, Black SR, Patel PR, So J, Mathews JM. An in vitro evaluation of cytochrome P450 inhibition and p-glycoprotein interaction with goldenseal, Ginkgo biloba, grape seed, milk thistle, and ginseng extracts and their constituents. Planta Med (2007) 73, 731–41

- Bhardwaj RK, Glaeser HG, Becquemont L, Klotz U, Gupta SK, Fromm MF. Piperine, a Major Constituent of Black Pepper, Inhibits Human Pglycoprotein and CYP3A4.The Journal of Pharmacology and Experimental Therapeutics, 2002; 302: 645–650

-Han Y, Tan TMC, Lim L-Y. In vitro and in vivo evaluation of the effects of piperine on P-gp function and expression. Toxicol Appl Pharmacol (2008) 230, 283–9.

- Gareth E Lim, BSc, Timao Li, PhD, and Harpal S Buttar, DVM, PhD. Interactions of grapefruit juice and cardiovascular medications: A potential risk of toxicity. Exp Clin Cardiol. 2003 Summer; 8(2): 99–107.

- Mallhi TH, Sarriff A, Adnan AS, Khan YH, Qadir MI, Hamzah AA, Khan AH. Effect of Fruit/Vegetable-Drug Interactions on CYP450, OATP and p-Glycoprotein: A Systematic Review. Trop J Pharm Res, 2015; 14(10): 1927-1935.

- Hou XL, Takahashi K, Tanaka K, Tougou K, Qiu F, Komatsu K, Takahashi K, Azuma J. Curcuma drugs and curcumin regulate the expression and function of P-gp in Caco-2 cells in completely opposite ways. International journal of pharmaceutics, 2008; 358(1-2): 224-229.

- Reilly CA, Yost GS. Metabolism of capsaicinoids by P450 enzymes: a review of recent findings on reaction mechanisms, bio-activation, and detoxification processes. Drug Metab Rev (2006) 38, 685–706

Hellum BH, Hu Z, Nilsen OG. The induction of CYP1A2, CYP2D6 and CYP3A4 by six trade herbal products in cultured primary human hepatocytes. Basic Clin Pharmacol Toxicol (2007) 100, 23–30.

- Longerich L, Johnson E, Gault MH. Digoxin-like factors in herbal teas. Clin Invest Med (1993) 16, 210–18.

-Fushimi R, Tachi J, Amino N, Miyai K. Chinese medicine interfering with digoxin immunoassays. Lancet 1989;1:339.

-Cheng TO. Herbal interactions with cardiac drugs. Arch Intern Med 2000;160:870–1.

-Morishita S1, Shoji M, Oguni Y, Ito C, Higuchi M, Sakanashi M. Pharmacological actions of "kyushin," a drug containing toad venom: cardiotonic and arrhythmogenic effects, and excitatory effect on respiration Am J Chin Med. 1992;20(3-4):245-56.

-Amitava Dasgupta, Laura Kidd Brian J. Poindexter, Roger J. Bick. Interference of hawthorn on serum digoxin measurements by immunoassays and pharmacodynamic interaction with digoxin. Arch Pathol Lab Med. 2010;134:1188–1192

-Tankanow R., Tamer H.R., Streetman D.S. et al. Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha). J. Clin. Pharmacol. (2003) 43 637– 642.

-Chang Q, Zuo Z, Harrison F, Chow MS. Hawthorn. J Clin Pharmacol. 2002;42:605-12.

-Davidson P, Hancock K, Leung D, et al. Traditional Chinese medicine and heart disease: what does Western medicine and nursing science know about it? Eur J Cardiovasc Nurs. 2003;2:171-181.

- Newell C A, Anderson L A, Phillipson J D. Herbal Medicines: A Guide for Healthcare Professionals. London: Pharmaceutical Press, 1996, 244.

-Laitinen L, Takala E, Vuorela H, Vuorela P, Kaukonen AM, Marvola M. Anthranoid laxatives influence the absorption of poorly permeable drugs in human intestinal cell culture model (Caco-2). Eur J Pharm Biopharm (2007) 66, 135–45.

- Boudreau MD, Beland FA. An evaluation of the biological and toxicological properties of Aloe barbadensis (Miller), Aloe Vera. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev (2006) 24, 103–54.

- Tatro D (ed.). Drug interaction facts. St. Louis, MO: Facts and Comparisons, 1999: 446.

- Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998;158:2200–11.

- Huang KC. The Pharmacology of Chinese Herbs. 2nd edition. Boca Raton, FL: CRC Press, 1999:69–72.

- Mashour NH, Lin GI, Frishman WH. Herbal medicine for the treatment of cardiovascular disease: clinical considerations. Arch Intern Med. 1998;158:2225-2234.

- Eddleston M, Ariaratnam CA, Sjöström L, et al. Acute yellow oleander (Thevetia peruviana) poisoning: cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside concentrations on presentation to hospital. Heart. 2000;83:301-6.

- Li HY, Xu W, Su J, Zhang X, Hu LW, Zhang WD. In vitro and in vivo inhibitory effects of glycyrrhetinic acid on cytochrome P450 3A activity. Pharmacology. 2010;86:287-92.

-FetrowCW,AvilaJR.Professional’sHandbookofComplementaryand Alternative Medicines. Springhouse, PA: Springhouse Publishing, 1999:708–11.

- Nordstrom M., Melander A., Robertsson E., Steen B. Influence of wheat bran and of a bulk-forming ispaghula cathartic on the bioavailability of digoxin in geriatric in-patients. Drug Nutr. Interact. (1987) 5 67–69.

- Brinker F. Herb contraindications and drug interactions, 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998: 85.

-Dresser, G.K. et al. (2003) Coordinate induction of both cytochrome P4503A and MDR1 by St John's wort in healthy subjects. Clin Pharmacol Ther 73 (1), 4150

-Fugh-Berman, A. (2000) Herb-drug interactions. Lancet 355 (9198), 134-138

-Hu, Z. et al. (2005) Herb-drug interactions: a literature review. Drugs 65 (9), 12391282

-Langheinrich M, Roots I. Pharmacokinetic interaction of digoxin with an herbal extract from St John's wort (Hypericum perforatum). Clin Pharmacol Ther 1999; 66:338-45.

-Johne A., Brockmoller J., Bauer S., Maurer A., Langheinrich M., Roots I. Pharmacokinetic interaction of digoxin with an herbal extract from St John’s wort (Hypericum perforatum). Clin. Pharmacol. Ther. (1999) 66 338–345.

-Henderson L, Yue QY, Bergquist C, Gerden B, Arlett P. St John's wort (Hypericum perforatum): drug interactions and clinical outcomes. Br J Clin Pharmacol. 2002;54:349-56.

-Piscitelli SC, Burstein AH, Chaitt D, et al. Indinavir concentrations and St. John's wort. Lancet . 2000;355:547-548.

-Mueller S.C., Uehleke B., Woehling H. et al. Effect of St John’s wort dose and preparations on the pharmacokinetics of digoxin. Clin. Pharmacol. Ther. (2004) 75 546–557.

-Barnes J., Anderson L. A., Phillipson J. D. Herbal medicines. A guide for healthcare professionals. London: Pharmaceutical Press, 2002

-Hennessy M, Kelleher D, Spiers JP et al. St. John's Wort increases expression of Pglycoprotein: implications for drug interactions. Br J Clin Pharmacol 2002; 53(1): 75-82. 24

-Dürr D, Stieger B, Kullak-Ublick GA, Rentsch KM, Steinert HC, Meier PJ, et al. St John’s Wort induces intestinal Pglycoprotein/MDR1 and intestinal and hepatic CYP3A4. Clin Pharmacol Ther. 2000;68:598–604.

-Arold G, Donath F, Maurer A, Diefenbach K, Bauer S, Henneicke-von Zepelin HH, et al. No relevant interaction with alprazolam, caffeine, tolbutamide, and digoxin by treatment with a low-hyperforin St John’s wort extract. Planta Med. 2005;71:331–7.

-Gurley BJ, Swain A, Hubbard MA, Williams DK, Barone G, Hartsfield F, et al. Clinical assessment of CYP2D6-mediated herb–drug interactions in humans: effects of milk thistle, black cohosh, goldenseal, kava kava, St. John’s wort, and Echinacea. Mol Nutr Food Res. 2008;52:755–63.

- Huupponen R., Seppala P., Iisalo E. Effect of guar gum, a fibre preparation, on digoxin absorption in man. Eur. J. Clin. Pharmacol. (1984) 26 279–281.

- Wahed A, Dasgupta A. Positive and negative in vitro interference of Chinese medicine danshen in serum digoxin measurement. Elimination of interference by monitoring free digoxin concentration. Am J Clin Pathol. 2001;116:403-8.

- Yu X-Y, Lin S-G, Zhou Z-W, Chen X, Liang J, Liu P-Q, Duan W, Chowbay B, Wen J-Y, Li C-G, Zhou S-F. Role of P-glycoprotein in the intestinal absorption of tanshinone IIA, a major active ingredient in the root of Salvia miltiorrhiza Bunge. Curr Drug Metab (2007) 8, 325–40.

-Yu X-Y, Zhou Z-W, Lin S-G, Chen X, Yu X-Q, Liang J, Duan W, Wen J-Y, Li X-T, Zhou S-F. Role of ATP-binding cassette drug transporters in the intestinal absorption of tanshinone IIB, one of the major active diterpenoids from the root of Salvia miltiorrhiza. Xenobiotica (2007) 37, 375–415

-Dasgupta A, Actor JK, Olsen M, Wells A, Datta P. In vivo digoxin-like immunoreactivity in mice and interference of Chinese medicine Danshen in serum digoxin measurement: elimination of interference by using a chemiluminescent assay. Clin Chim Acta (2002) 317, 231–4.

-Dasgupta A, Kang E, Olsen M, Actor JK, Datta P. New enzyme-linked chemiluminescent immunosorbent digoxin assay is free from interference of Chinese medicine DanShen. Ther Drug Monit (2006) 28, 775–8.

-Datta P, Dasgupta A. Effect of Chinese medicines Chan Su and Danshen on EMIT 2000 and Randox digoxin immunoassays: wide variation in digoxin-like immunoreactivity and magnitude of interference in digoxin measurement by different brands of the same product. Ther Drug Monit (2002) 24, 637–44.

- Dasgupta A, Peterson A, Wells A, Actor JK. Effect of Indian Ayurvedic medicine ashwagandha on measurement of serum digoxin and 11 commonly monitored drugs using immunoassays: study of protein binding and interaction with Digibind. Arch Pathol Lab Med (2007) 131, 1298–1303.

- Dasgupta A, Kang E, Olsen M, Actor JK, Datta P. Interference of Asian, American, and Indian (Ashwagandha) ginsengs in serum digoxin measurements by a fluorescence polarization immunoassay can be minimized by using a new enzyme-linked chemiluminescent immunosorbent or turbidimetric assay. Arch Pathol Lab Med (2007) 131, 619–21. 3.

- Kuhn M. Complementary Therapies for Health Care Providers. Philadelphia, Pa: JB Lippincott; 1999.

- Gurley BJ, Swain A, Barone GW, Williams DK, Breen P, Yates CR, Stuart LB, Hubbard MA, Tong Y, Cheboyina S. Effect of goldenseal (Hydrastis Canadensis) and kava kava (Piper methysticum) supplementation on digoxin pharmacokinetics in humans. Drug Metab Dispos (2007) 35, 240–5.

- Salphati L, Benet LZ. Metabolism of digoxin and digoxigenin digitoxosides in rat liver microsomes: involvement of cytochrome P4503A. Xenobiotica. 1999;29:171-85.

-Gurley BJ, Barone GW, Williams DK, Carrier J, Breen P, Yates CR, Song P-f, Hubbard MA, Tong Y, Cheboyina S. Effect of milk thistle (Silybum marianum) and black cohosh (Cimicifuga racemosa) supplementation on digoxin pharmacokinetics in humans. Drug Metab Dispos (2006) 34, 69–74.

- Dalvi SS, Nadkarni PM, Gupta KC. Effect of Asparagus racemosus (Shatavari) on gastric emptying time in normal healthy volunteers. J Postgrad Med (1990) 36, 91–4

- Herbal and Dietary Supplement–Drug Interactions in Patients with Chronic Illnesses PAULA GARDINER, MD, MPH, Harvard Medical School, Boston, Massachusetts RUSSELL PHILLIPS, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts ALLEN F. SHAUGHNESSY, PharmD, Tufts University Family Medicine Residency Program at Cambridge Health Alliance, Cambridge, Massachusetts, Am Fam Physician. 2008;77(1):73-78.

- Peng SX, Ritchie DM, Cousineau M, Danser E, Dewire R, Floden J. Altered oral bioavailability and pharmacokinetics of P-glycoprotein substrates by coadministration of biochanin A. J Pharm Sci (2006) 95, 1984–93

Published
2021-08-04
Section
Review Article