Clinically Relevant Herb–Drug Interactions: A 30-Year Historical Assessment

Abstract

The Dietary Supplement Health and Education Act, a legislative measure ushering in a novel class of complementary healthcare products known as dietary supplements, will mark its 30th anniversary in October 2024. Over this 30-year period, dietary supplement usage evolved from a few hundred products made up mostly of vitamins, minerals, and select botanical extracts to more than 75,000 single- and multi-ingredient products that are now regular staples in the American healthcare system and used by half of all U.S. consumers. One of the fastest-growing segments of the dietary supplement market during this 3-decade interval has been those products formulated with botanical extracts. Coincident with the growing popularity of botanical dietary supplements (BDS) has been their concomitant ingestion with conventional prescription medications. BDS are complex mixtures of phytochemicals oftentimes exhibiting complex pharmacology. Formulated as concentrated phytochemical extracts, BDS are vehicles for a host of plant secondary metabolites rarely encountered in the typical diet. When taken with prescription drugs, BDS may give rise to clinically significant herb–drug interactions (HDI). Pharmacodynamic HDI describe interactions between phytochemicals and conventional medications at the drug receptor level, while pharmacokinetic HDI stem from phytochemical-mediated induction and/or inhibition of human drug metabolizing enzymes and/or transporters. This review summarizes BDS identified over the last 30 years that pose clinically relevant HDI and whose mechanisms are either pharmacodynamically or pharmacokinetically mediated.

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Notes on contributors

Bill J. Gurley

Bill J. Gurley, is a Principal Scientist at the National Center for Natural Products Research at the University of Mississippi, Oxford, MS. His research interests include mechanisms of herb-drug interactions, toxicity of multiple-component herbal dietary supplements, phytochemical modu-lation of human drug-metabolizing enzymes and drug transport proteins, pharmacokinetics of phytochemicals in humans, botanical supplement use in special populations, and dosage form performance of dietary supplement formulations. Gurley has more than 25 years of experience in conducting pre-clinical and clinical research on botanical dietary supplements.