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Curcuminoid Drug Interactions

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Curcuminoid Drug Interactions Author’s copy! Any use beyond the limits of copyright law without the consent of the publisher is prohibited and punishable. This applies in particular to duplications, translations, Special | Curcuminoids microfilming as well as storage and processing in electronic systems. Peer-reviewed | Manuscript received: May 17, 2015 | Revision accepted: August 17, 2015 Curcuminoid drug interactions Alexa Kocher, Christina Schiborr, Jan Frank, Stuttgart Introduction Summary Curcuminoids are lipiphilic secondary The secondary plant metabolite curcumin and the related curcuminoids may be plant metabolites isolated from the valuable in the prevention and treatment of many different degenerative disea- roots of the plant Curcuma longa ses. As curcuminoids are often taken as supplements by some population groups, (turmeric) ( see SCHIBORR et al., it may be asked whether this can lead to changes in the pharmacokinetics or phar- page M636 [1]) and consist of ca. 77 % macodynamics of other drugs taken at the same time. It is particularly important curcumin, 17 % demethoxycurcumin to clarify this issue, as native curcumin only exhibits low bioavailability, but many and 6 % bis-demethoxycurcumin [2]. novel formulations are being developed that enhance its absorption in the small Because of their many health suppor- intestine and thus lead to higher concentrations of the active drug. Cell culture ting activities, they have long been and animal studies have shown that native curcumin can affect xenobiotic meta- used in traditional Chinese medicine bolizing enzymes. There are also effects on the pharmacokinetics of active sub- for the treatment of respiratory di- stances in animal studies and in men. On the other hand, it has not been shown sease, anorexia, diabetic wounds or that curcumin has any adverse effects on the pharmacological activity of other for digestive disorders [3]. Curcumin drugs. However, it must be emphasized that these studies are preliminary rather supplements are freely commercially than conclusive and must be supported by larger scale investigations. It has also available, mostly as capsules or tab- not been investigated whether the formulations with better bioavailability can lets; many people take them to im- influence the pharmacokinetics of other drugs. prove their health. Keywords: curcumin, curcuminoids, turmeric, drug interactions, safety, drug The oral bioavailability of curcumin is low, i.e. it is poorly absorbed, and rapidly metabolized and eliminated. For this reason, curcumin formula- tions with better bioavailability are being sold increasingly often; these give much higher plasma concentra- Older and chronically ill people often attempt to improve their health tions of curcumin than native curcu- min [1]. by taking food supplements. Thus they often take drugs together with People who take curcumin supple- plant extracts that might influence the effects of these drugs. In the ments are often older or chronically present article, we describe the evidence for drug interactions involving ill and have to take medicines every the secondary plant metabolite curcumin and the related curcumioids. day. This article therefore examines Citation: Explanation of terms used: Kocher A, Schiborr C, Frank J (2015) Curcuminoid drug inter- An active substance or drug is the substance in a medicine which actions. Ernahrungs Umschau mediates or causes the active effect. The medicine may also contain one or several additional substances (“excipients”) for different for- 62(11): 188–195 mulations (e.g. tablet or syrups). The preparation of different drug This article is available online: formulations is known as pharmacy and can have a major influence DOI: 10.4455/eu.2015.037 on drug activity. 188 Ernaehrungs Umschau international | 11/2015 whether there is published scientif- is often described by the following availability. Because of incomplete ic evidence for interactions between parameters: absorption and metabolism, an curcuminoids – primarily curcumin • physiological half-time of elimina- orally or enterally administered drug – and medicines (or their active sub- tion (t1/2), has a bioavailability of < 100 %. stances) which may modify their ac- • time to reach the maximum tivity. The focus is on the pharmaco- plasma concentration (tmax), kinetics of various drugs. The effects • maximal plasma concentration The so-called “therapeutic index” of curcumin on drug pharmacodyna- (Cmax) and is an important parameter in asses- mics are mentioned in passing. • area under the concentration time sing the safety of a drug. This is the curve (“area under the curve”, interval between the minimal active AUC) (• Figure 1). and minimal toxic concentration of Key terms the drug [5]. The physiological half-time of eli- Food-drug interaction mination (t1/2) is the time needed for We will use the term “food-drug in- the (plasma) concentration of the ac- Pharmacodynamics (= what the ac- teraction” for changes in the phar- tive substance to sink to 50 % of the tive substance does to the organism) macokinetics or pharmacodynamics initial value. The rate of absorption signifi es the biological activity of an of a drug caused by the uptake of a of a substance can be estimated from active substance [6]. food component [4]. the time (tmax) to reach the max- imum plasma concentration (Cmax). Food-drug interactions can lead to The area under the concentration time changes in pharmacokinetics and/ The term “pharmacokinetics” (= curve (“area under the curve”, AUC) or pharmacodynamics and modify what the organism does to the ac- refl ects the subject‘s exposure to the the activity and safety profi le of the tive substance) means the sum of drug or nutrient. medicine (side effects = adverse drug all processes to which the active The “bioavailability” describes the reactions) in this way. Thus, a re- substance is subject in the body proportion of a drug or nutrient that duction in the bioavailability of a and includes its absorption, distri- is available to systemic circulation in drug can lead to treatment failure. bution, metabolism and excretion. the body. Intravenous administra- On the other hand, enhanced bio- The kinetic profi le of a substance tion is defi ned as giving 100 % bio- availability can lead to enhanced ac- Maximal plasma Side effects (plasma concentration (Cmax) concentration too high) Therapeutic index Substanz X Treatment failure Substance X [nmol/L Plasma] (plasma concentration too low) [mmol/l plasma] Time of maximal plasma Time [h] concentration (tmax) Fig. 1: Typical plasma concentration time curve for a drug The pharmacokinetics of a substance can be determined by measuring the maximal concentration (Cmax), the time to reach the max- imal concentration (tmax), and the “area under the curve” (AUC), which refl ects individual exposure to a substance. The therapeutic index describes the concentration range in which the drug is therapeutically active and lies between the minimal effective and the minimal toxic concentrations of the active substance. Ernaehrungs Umschau international | 11/2015 189 Special | Curcuminoids tivity and also possibly to enhanced enzymes. Incubation of human absorption and transport proces- drug toxicity (• Figure 1) [4]. These liver cell microsomes with a cur- ses and metabolism [10]. The op- interactions can be split into various cuminoid extract led to 50 % in- posite effect was observed in a categories: hibition of different CYP450s at rat model. In this study, the ani- (1) Inactivation of the drug ex vivo, the following concentrations: mals were fed for 2 weeks with i.e. outside the body, CYP2C19, 7.4 μmol/L; CYP2B6, 1 % curcumin per kg feed and then (2) Interactions which modify 9.4 μmol/L; CYP2C9, 13.5 the microsomes were isolated from presystemic transport (absorp- μmol/L; CYP3A, 25.3 μmol/L. the intestine and liver. The UGT tion), CYP2D6, CYP1A2 and CYP2E1 activity increased 5.4-, 6.7- and (3) Interactions which modify syste- were only very weakly inhibited 7.2-fold in the proximal, middle mic metabolism and drug elimi- [10]. On the other hand, another and distal sections of the small in- nation, and in vitro study with microsomes testine, respectively. In comparison (4) Interactions which directly influ- found that CYP3A4 and 2D6 were to the control, there was a 3.1-fold ence drug activity (pharmacody- not inhibited by up to 58.3 μmol/L increase in the large intestine and a namics), e.g. by binding to tar- curcumin, while 58.3 μmol/L cur- 1.5-fold increase in the liver [13]. get structures such as receptors. cumin inhibited CYP2C9 and 2C8 by 10.5 % and 22.5 %, respective- ly [11]. The effects of curcumin Effect of curcumin on mem- Effect of curcuminoids on can also be tissue-specific. After brane transporters enzymes that metabolize feeding rats for 4 days with cur- As the present article cannot pursue foreign compounds cumin (60 mg/kg body weight all interactions between curcumin [BW]), there was a 42 % reduction and membrane transport proteins, The following cell culture and ani- in the intestinal content of CYP3A the discussion will be restricted to mal studies examined the influence protein, but a 91 % increase in the multidrug resistance protein 1 of curcumin on enzymes that me- liver content of this protein [12]. (MDR1; also known as P-glycopro- tabolize foreign compounds. These tein [P-Gp]). MDR1 is a transport studies provide preliminary evidence protein in the plasma membrane and Influence of curcumin on phase that curcumin might influence drug is mainly expressed in the liver, kid- II metabolisms metabolism. neys, gastrointestinal tract and the Curcumin can also affect phase II blood-brain barrier. In the liver, it is enzymes. Thus 12.1 μmol/L and 5.2 expressed on the canalicular apical Modulation of phase I μmol/L of a curcuminoid extract lead side of the membrane (towards the metabolism by curcumin to 50 % inhibition of UGT and SULT lumen), in the intestine on the apical Microsomes are membrane frag- activity, respectively, in colon adeno- membrane of the mucosal cells and in ments of the endoplasmic reticu- carcinoma cells (LS180 cells), an the kidney on the brush border mem- lum that contain active CYP450 intestinal cell model to examine brane of the proximal tubulus cells.
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