Herbal interactions for patients

Antifungal Herbal interaction - As Aloe Moderate, use carefully. Aloe latex possibly reduces absorption of some drugs. This could reduce the effect.1 Moderate possible, use carefully. Aloe latex possibly reduces absorption of some drugs. This could reduce the antifungal effect.1 Unlikely (no interaction found). isavuconazole Unlikely (no interaction found). Moderate possible, use carefully. Aloe latex possibly reduces absorption of some drugs. This could reduce the antifungal effect.1 Unlikely. Unlikely. Unlikely. Moderate possible, use carefully. Aloe latex possibly reduces absorption of some drugs. This could reduce the antifungal effect.1 Unlikely.

Antifungal Herbal interaction - Cs Cannabidiol (CBD) itraconazole Moderate, use carefully. CBD possibly increases itraconazole levels and side effects.2 Itraconazole also possibly increases CBD levels and side effects. Consider reducing CBD dose.4 voriconazole Major – do not take CBD as it can increase voriconazole levels and its side effects.3 posaconazole Moderate, use carefully. Posaconazole possibly increases CBD levels and its side effects. Consider reducing CBD dose.4 isavuconazole Moderate, use carefully. CBD possibly increases isavuconazole levels and side effects.2 Isavuconazole possibly increases CBD levels and side effects. Consider reducing CBD dose.4 fluconazole Moderate, use carefully. Fluconazole possibly increases CBD levels and side effects. Consider reducing CBD dose.4 anidulafungin Unlikely – no interactions found. caspofungin Unlikely – no interactions found. micafungin Unlikely – no interactions found. terbinafine Unlikely – no interactions found. Amphotericin B Unlikely – no interactions found.

Antifungal Herbal interaction - Cs Chaparral itraconazole Theoretical interaction – possible extra side effects on the .5 voriconazole Theoretical interaction – possible extra side effects on the liver.5 posaconazole Theoretical interaction – possible extra side effects on the liver.5

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Interactions key: Mild Moderate Severe isavuconazole Theoretical interaction – possible extra side effects on the liver.5 fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Theoretical interaction – possible extra side effects on the liver.5 Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Cs Chlorella itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Cs Coltsfoot itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Cs Cumin itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found.

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Interactions key: Mild Moderate Severe

Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Es Elecampne itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Es Eucalyptus itraconazole Moderate – use cautiously or avoid. Eucalyptus oil might increase levels of itraconazole and its side effects.6 voriconazole Moderate – use cautiously or avoid. Eucalyptus oil might increase levels of voriconazole and its side effects.6 posaconazole Unknown – no interactions found. isavuconazole Moderate – use cautiously or avoid. Eucalyptus oil might increase levels of isavuconazole and its side effects.6 fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Gs Garlic itraconazole Mild - possible interaction. Use cautiously until more is known about this interaction.7 voriconazole Mild – possible interaction. Use cautiously until more is known about this interaction.7 posaconazole Unknown – no interactions found. isavuconazole Mild - possible interaction. Use cautiously until more is known about this interaction.7 fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. Interactions searched via: https://naturalmedicines.therapeuticresearch.com/tools/interaction- checker.aspx#P

Interactions key: Mild Moderate Severe terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Gs Ginger (tea) itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Ks Knotweed itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Ls Licorice itraconazole Mild – might increase itraconazole levels and its side effects. Use cautiously until more is known about this interaction.8 voriconazole Mild – might increase voriconzole levels and its side effects. Use cautiously until more is known about this interaction.8 posaconazole Unknown – no interactions found. isavuconazole Mild – might increase isavuconazole levels and its side effects. Use cautiously until more is known about this interaction.8 fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

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Interactions key: Mild Moderate Severe

Antifungal Herbal interaction - Ls Lobelia itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Ls Lungwort itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Ms Marshmallow leaf tea itraconazole Moderate – use cautiously. Possible interaction – mucilage in marshmallow may impair absorption of oral drugs. So this might reduce antifungal effect.1 voriconazole Moderate – use cautiously. Possible interaction – mucilage in marshmallow may impair absorption of oral drugs. So this might reduce antifungal effect.1 posaconazole Moderate – use cautiously. Possible interaction – mucilage in marshmallow may impair absorption of oral drugs. So this might reduce antifungal effect.1 isavuconazole Moderate – use cautiously. Possible interaction – mucilage in marshmallow may impair absorption of oral drugs. So this might reduce antifungal effect.1 fluconazole Moderate – use cautiously. Possible interaction – mucilage in marshmallow may impair absorption of oral drugs. So this might reduce antifungal effect.1 anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Moderate – use cautiously. Possible interaction – mucilage in marshmallow may impair absorption of oral drugs. So this might reduce antifungal effect.1 Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Ms Interactions searched via: https://naturalmedicines.therapeuticresearch.com/tools/interaction- checker.aspx#P

Interactions key: Mild Moderate Severe

Mullein itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Os Oregano itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Os Osha root itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Ps Pelargonium root itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found.

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Interactions key: Mild Moderate Severe anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found. Antifungal Herbal interaction - Ps Peppermint oil itraconazole Moderate - possible interaction, use cautiously. Peppermint oil might increase levels of itraconazole and its side effects.6 voriconazole Moderate - possible interaction, use cautiously. Peppermint oil might increase levels of voriconazole and its side effects.6 posaconazole Moderate - possible interaction, use cautiously. Peppermint oil might increase levels of posaconazole and its side effects.6 isavuconazole Moderate - possible interaction, use cautiously. Peppermint oil might increase levels of isavuconazole and its side effects.6 fluconazole Moderate - possible interaction, use cautiously. Peppermint oil might increase levels of fluconazole and its side effects.6 anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Ps Plantain Leaf (black psyllium) itraconazole Moderate – probable interaction. Might slow or reduce absorption of some oral drugs. Take it 30-60 minutes after itraconazole.9 voriconazole Moderate – probable interaction. Might slow or reduce absorption of some oral drugs. Take it 30-60 minutes after voriconazole.9 posaconazole Moderate – probable interaction. Might slow or reduce absorption of some oral drugs. Take it 30-60 minutes after posaconazole.9 isavuconazole Moderate – probable interaction. Might slow or reduce absorption of some oral drugs. Take it 30-60 minutes after isavuconazole.9 fluconazole Moderate – probable interaction. Might slow or reduce absorption of some oral drugs. Take it 30-60 minutes after fluconazole.9 anidulafungin Unknown – no interaction found. caspofungin Unknown – no interaction found. micafungin Unknown – no interaction found. terbinafine Moderate – probable interaction. Might slow or reduce absorption of some oral drugs. Take it 30-60 minutes after terbinafine.9 Amphotericin B Unknown – no interaction found.

Antifungal Herbal interaction - Ss Sage itraconazole Moderate – possible interaction. Use with caution, as sage might increase levels of itraconazole and its side effects.10,11

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Interactions key: Mild Moderate Severe voriconazole Moderate – possible interaction. Use with caution, as sage might increase levels of voriconazole and its side effects.10,11 posaconazole Moderate – possible interaction. Use with caution, as sage might increase levels of voriconazole and its side effects.11 isavuconazole Moderate – possible interaction. Use with caution, as sage might increase levels of isavuconazole and its side effects. 10 fluconazole Unknown - no interactions found. anidulafungin Unknown - no interactions found. caspofungin Unknown - no interactions found. micafungin Unknown - no interactions found. terbinafine Unknown - no interactions found. Amphotericin B Unknown - no interactions found.

Antifungal Herbal interaction - Ss St. John’s Wort (SJW) itraconazole Severe interaction – do not take this combination. SJW can reduce levels of itraconazole. So SJW can reduce the antifungal effect.12, 13 voriconazole Severe interaction – do not take this combination. SJW reduces exposure to voriconazole and increases its removal from the body. So SJW can reduce the antifungal effect.14 posaconazole Unknown – no interactions found. isavuconazole Severe interaction – do not take this combination. SJW can reduce levels of isavuconazole. So SJW can reduce the antifungal effect. 12, 13 fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Ts (in diffuser) itraconazole Unknown – no interactions found. voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Ts Thyme itraconazole Unknown – no interactions found. Interactions searched via: https://naturalmedicines.therapeuticresearch.com/tools/interaction- checker.aspx#P

Interactions key: Mild Moderate Severe voriconazole Unknown – no interactions found. posaconazole Unknown – no interactions found. isavuconazole Unknown – no interactions found. fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Antifungal Herbal interaction - Ts Turmeric (contains curcumin) itraconazole Moderate – possible interaction. Turmeric and curcumin might increase levels of itraconazole and its side effects.15,16 voriconazole Moderate – possible interaction. Turmeric and curcumin might increase levels of voriconazole and its side effects.15 posaconazole Unknown – no interactions found. isavuconazole Moderate – possible interaction. Turmeric and curcumin might increase levels of isavuconazole and its side effects.15 fluconazole Unknown – no interactions found. anidulafungin Unknown – no interactions found. caspofungin Unknown – no interactions found. micafungin Unknown – no interactions found. terbinafine Unknown – no interactions found. Amphotericin B Unknown – no interactions found.

Interactions searched via: https://naturalmedicines.therapeuticresearch.com/tools/interaction- checker.aspx#P

Interactions key: Mild Moderate Severe

References

1. Brinker F. Herb contraindications and drug interactions 2nd ed. Sandy OR. Eclectic Medical Publications. 1998. 2. Yamaori S, Ebisawa J, Okushima Y et al. Potent inhibition of human 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resourcinol moiety Life Sci 2011; 88(15-16): 730-6. 3. Harvey DJ. Absorption, distribution and biotransformation of the cannabinoids. Marijuana and medicine. 1999; 91-103. 4. Epidiolex (cannabidiol) prescribing information. Greenwich Biosciences, Inc., Carlsbad, CA, 2019. Available at: www.epidiolex.com/sites/default/files/EPIDIOLEX_Full_Prescribing_Information.pdf (accessed 5/9/2019) 5. Estes JD, Stolpman D, Olyaei A, et al. High prevalence of potentially hepatotoxic herbal supplement use in patients with fulminant hepatic failure. Arch Surg 2003;138:852-8.. View abstract. 6. Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the ativity of six major cytochrome P450 using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom 2004:18:2273-81. 7. Gallicano K, Foster B, Choudhri S. Effect of short-term administration of garlic supplements on single- dose in healthy volunteers. Br J Clin Phamacol 2003;55(2):199-202. 8. Kent UM, Aviram M, Rosebblat M. Hollenberg PF. The licorice root derived isoflavan glabridin inhibits the activities of human cytochrome P4502 3A4, 2B6 and 2C9. Drug Metab. Dispos 2002;30:709-15. 9. Semen plantaginis in: WHO Monographs on selected medicines plants, volume 1. World Health Organization, Geneva, 1999. Available at https://apps.who.int/medicinedocs/en/d/Js2200e/22.html Accessed 11 March 2020. 10. Foster BC, Vandenhoek S, Hana J et al. In vitro inhibition of human cytochrome P450-mediated metabolism of marker substrates by natural products. Phytomedicine 2003;10:334-42. 11. Hellum BH and Nilsen OG. In vitro inhibition of CYP3A4 metabolism and P-glycoprotein-mediated transport by trade herbal products. Basic Clin Pharmacol Toxicol. 2008;102(5):466-475. 12. Roby CA, Anderson GD, Kantor E et al. St. John Wort’s: Effect on CYP3A4 activity. Clin Pharmacol Ther 2000;67:451-7. 13. Hennessy M, Kelleher D, Spiers JP et al. St John’s Wort increases expression of P-glycoprotein: implications for drug interactions. Br J Clin Pharmacol 2002:53:75-82. 14. Dolton MJ, Mikus G, Weiss J et al. Understanding variability with voriconazole using a population pharmacokinetic approach: implications for optimal dosing. J Antimicrob Chemother 2014;69(6):1633-41. 15. Appiah-Opong R, Commandeur JN, Vugt-Lussenburg B and Vermeulen NP. Inhibition of human recombinant cytochrome P450s by curcumin and curcumin decomposition products. Toxicology 6-3- 2007;235(1-2):83-91. 16. Junyaprasert VB, Soonthorncharennon N, Thongpraditchote S, Murakami T and Takano M. Inhibitory effect of Thai plant extract on P-glycoprotein mediated efflux. Phytother. Res. 2006;20(1);79-81.

Some of these references cited in the Natural Medicines Database are very old, but from searching PubMed, I was unable to find more recent citations. Interactions searched via: https://naturalmedicines.therapeuticresearch.com/tools/interaction- checker.aspx#P

Interactions key: Mild Moderate Severe

Interactions searched via: https://naturalmedicines.therapeuticresearch.com/tools/interaction- checker.aspx#P

Interactions key: Mild Moderate Severe