대체 의약품과의 약물 상호 작용

2010

https://www.nps.org.au/australian-prescriber/articles/drug-interactions-with-complementary-medicines-1

Drug interactions with complementary medicines

Drug interactions with complementary medicines

증거 기반 보완 의학 상호 작용

이 표는 최소한 하나의 '주요' 상호작용이 있는 보완 의약품을 보여줍니다.

Table 1
Complementary medicine	Interacting drug	Possible outcome	Severity and level of evidence*	Proposed mechanisms/comment
Black cohosh	Cisplatin	↓ cytotoxic effect	Moderate, level D	Animal data only
	Hepatotoxic drugs e.g. high-dose paracetamol, alcohol	↑ risk of hepatotoxicity	Moderate, level D	Pharmacodynamic additive risk
	CYP2D6 substrates e.g. amitriptyline	↑ substrate levels and drug effect	Moderate, level B	Moderate inhibitor of CYP2D6
Calcium	Quinolone antibiotics, sotalol, tetracycline, thyroxine	↓ drug effect	Moderate, level B	Formation of insoluble salts and decreased absorption
Celery seed	Thyroxine	↓ drug level and effect	Moderate, level D	Mechanism unknown but two case reports
Chamomile (German)	CYP1A2 and CYP3A4 substrates	↑ drug levels	Moderate, level D	Theoretical
	CNS depressants	↑ drug effect	Moderate, level D	Additive sedative effects
Coenzyme Q10	Chemotherapy (e.g. alkylating drugs)	↓ cytotoxic effect	Moderate, level B	May counteract cytotoxic oxidative stress
	Antihypertensives	↑ drug effect	Moderate, level B	Coenzyme Q10 has an antihypertensive effect
	Warfarin	↓ drug effect	Moderate, level D	Coenzyme Q10 may have vitamin K-like effects
Cranberry	Warfarin	↑ drug effect	Moderate, level B	Cranberry has variable effects on CYP3A4, CYP2C9, CYP1A2
Echinacea	CYP1A2 and CYP3A4 substrates e.g. clopidogrel (prodrug), olanzapine, warfarin	↑ substrate levels	Moderate, levels B and D respectively	Inhibition of CYP1A2 and CYP3A4
Evening primrose oil	Antiplatelet drugs, warfarin	↑ drug effect	Major, level B	Contains gamma-linolenic acid, probable anticoagulant
Fenugreek	Hypoglycaemic drugs	↑ drug effect	Moderate, level B	Additive hypoglycaemic effect
	Antiplatelet drugs, warfarin	↑ bleeding risk	Moderate, level D	Antiplatelet activity
Fish oil	Antihypertensive drugs	Additive blood pressure lowering	Moderate, level B	Additive blood pressure-lowering effect found with some antihypertensives.
	Antiplatelet drugs, warfarin	↑ bleeding risk	Minor, level B	Antiplatelet activity in high dose
	Contraceptives, oral	↓ fish oil effects	Moderate, level B	May decrease triglyceride-lowering effects
Garlic	Contraceptives, oral	↓ drug effect	Moderate, level D	Induces CYP3A4
	Saquinavir/non-nucleoside reverse transcriptase inhibitors	↓ drug levels and effect	Major, level B	Induces CYP3A4
	Antiplatelet drugs, warfarin	↑ bleeding risk	Moderate, level D	Theoretical antiplatelet activity
Ginger	Antiplatelet drugs, warfarin	↑ bleeding risk	Moderate, level B	Antiplatelet activity
Ginseng (Panax)	Hypoglycaemic drugs	↓ blood glucose	Moderate, level B	Hypoglycaemic effect. Conflicting evidence.
	Immunosuppressants e.g. azathioprine	↓ drug effect	Moderate level B	Largely theoretical
	CYP2D6 substrates	↑ substrate levels	Moderate, level B	CYP2D6 inhibitor but conflicting evidence
	Stimulants e.g. caffeine	↑ drug effects	Moderate, level B	Additive pharmacodynamic effect
Ginkgo	Anticonvulsants	↑ seizure risk	Moderate, level D	Large amounts of ginkgotoxin can cause neurotoxicity
	Warfarin, antiplatelet drugs	↑ bleeding risk	Major, level D	Antiplatelet activity after several weeks
	CYP2C9 substrates e.g. glipizide, warfarin, celecoxib	↑ substrate levels	Moderate, level D	Inhibits CYP2C9 activity
	CYP1A2, CYP2C19, CYP2D6 and CYP3A4 substrates	↑ substrate levels	Moderate, level B	Potentially inhibits these enzymes
	Hypoglycaemic drugs	↑ ↓ drug effect	Moderate, level B	Variably affects blood glucose concentrations
Glucosamine	Warfarin	↑ bleeding risk	Major, level D	Several case reports of increased INR
Hawthorn	Calcium channel blockers, nitrates, phosphodiesterase inhibitors	↑ drug effect	Major, level D	Additive vasodilator effects
	Digoxin, beta blockers	↑ drug effect	Major, level D	Additive effects on heart rate and/or blood pressure. Hawthorn has cardiotonic effects.
Kava	CNS depressants	↑ drug effect	Major, level A	Additive somnolence
	CYP1A2, CYP2D6, CYP2C9, CYP2E1, CYP3A4 substrates	↑ substrate levels	Moderate, level B		Kava potentially inhibits these enzymes
	P-glycoprotein substrates	↑ substrate levels	Moderate, level D
Lactobacillus acidophilus	Immunosuppressants	↑ risk of infection	Moderate, level D
	Antibiotics	↓ drug effect	Moderate, level D
Milk thistle	CYP2C9 substrates e.g. amitriptyline, phenytoin, warfarin	↑ drug effect	Moderate, level B	Inhibits CYP2C9, glucuronidase and organic anion transporting polypeptide 1B1. Conflicting evidence.
Noni juice	Warfarin	↓ drug effect	Moderate, level D	Contains vitamin K
Olive leaf	Antihypertensive drugs	↑ drug effect	Moderate, level B	Additive antihypertensive effects
	Hypoglycaemic drugs	↑ drug effect	Moderate, level B	Additive hypoglycaemic effects
Psyllium	Carbamazepine, lithium	↓ drug effect	Moderate, level D	Decreases gastrointestinal absorption of other drugs
	Hypoglycaemic drugs	↑ drug effect	Moderate, level B	Additive hypoglycaemic effects
Selenium	Antiplatelet drugs, warfarin	↑ drug effect	Moderate, level D	Selenium dose of 10 microgram/kg/day can increase bleeding time
	Statins, niacin	↓ drug effect	Moderate, level A	Selenium plus beta carotene, vitamins C and E decreased the lipid-lowering effect
Senna	Digoxin, diuretics	↑ drug effect	Moderate, level D	Additive potassium loss with long-term use or high doses of senna
St John's wort	Alprazolam	↓ drug levels & effect	Major, level B	Increased clearance; half-life reduced by 50%
	Amitriptyline	↑ drug effect	Major, level B		Increased risk of serotonin syndrome
	Antidepressants, tramadol	↑ drug effect	Major, level D
	Pethidine	↑ drug effect	Major, level D
	Triptans	↑ drug effect	Moderate, level D
	Clopidogrel	↑ bleeding risk	Moderate, level B	Increased conversion to active metabolite
	CYP1A2, CYP2C9, CYP3A4 substrates e.g. imatinib, indinavir, tacrolimus, carbamazepine, phenytoin	↓ drug levels & effect	CYP3A4 =Major, level B CYP1A2, CYP2C9 = Moderate, level B	Induces CYP enzymes
	Non-nucleoside reverse transcriptase inhibitors, protease inhibitors	↓ drug levels & effect	Major, level B	Induces CYP3A4
	Oral contraceptives	↓ drug levels	Major, level B	Risk of breakthrough bleeding/contraceptive failure
	P-glycoprotein substrates e.g. digoxin, fexofenadine, irinotecan	↓ drug levels & effect	Major, level B	Induces intestinal P-glycoprotein
	Simvastatin	↓ drug levels	Moderate, level B	Statin levels reduced by up to 28%
	Warfarin	↓ drug effect	Major, level B	Induces CYP1A2, CYP2C9 and CYP3A4
Valerian	Alprazolam	↑ drug levels	Major, level B	CYP3A4 inhibitor. Alprazolam increased by 19% in one study.
	CNS depressants	↑ drug effect	Major, level D	Pharmacodynamic effect
	CYP3A4 substrates	↑ substrate effect	Moderate, level D
Vitamin E	Antiplatelet ,warfarin	↑ bleeding risk	Moderate, level B	Antiplatelet activity
	Chemotherapy	↓ drug effect	Moderate, level D	Possible antagonism of oxidative stress
CYP INR CNS	cytochrome P450 international normalised ratio central nervous system
* Interaction rating adapted from Natural Medicines Comprehensive Database.11 The level of severity (major, moderate, minor) has been calculated using the evidence and probability of harm. This rating is linked with a generic recommendation for management. Natural Medicines Comprehensive Database.11에서 적용한 상호 작용 등급은 피해의 증거 및 확률을 사용하여 심각도(중증, 중등, 경미) 수준을 계산했습니다. 이 등급은 관리를 위한 일반적인 권장 사항과 연결되어 있습니다.
Major	심각한 부작용이 발생할 수 있으므로 환자가 이 조합을 사용하지 않도록 강력히 권장합니다. 사용하는 경우 잠재적인 부작용에 대해 환자를 면밀히 모니터링해야 합니다.
Moderate	심각한 부작용이 발생할 수 있으므로 주의해서 사용하거나 병용을 피하십시오. 사용하는 경우 잠재적인 부작용을 모니터링합니다.
Minor	상호작용의 가능성이 있음을 유의하십시오. 발생할 수 있는 증상과 그에 따른 조치에 대해 환자에게 알립니다.
Level of evidence ratings: AHigh-quality randomised controlled trial or meta-analysis BNon-randomised clinical trial, literature review, clinical cohort or case-control study, historical control or epidemiologic study CConsensus or expert opinion DAnecdotal evidence; in vitro or animal study or theoretical based on pharmacology ---------------------------------------------------------------------------------------------------------- A=고품질 무작위 대조 시험 또는 메타 분석 B=비무작위 임상 시험, 문헌 검토, 임상 코호트 또는 사례 대조군 연구, 과거 대조군 또는 역학 연구 C=Consensus 또는 전문가 의견 D=일화적 증거; 시험관 내 또는 동물 연구 또는 약리학 기반 이론

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