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Home , Baicalein, Chrysin, Saffron, Scutellaria, Scutellaria lateriflora

and Nutrient- Interaction Table

This table provides an overview of the that have been found to interact with the and nutritional medicines discussed in this book. The table is intended to be used as a quick reference guide only and is not exhaustive. As always, due dili- gence is required on a case-by-case basis when making clinical judgements. If a class of drug is not listed here, there was no known interaction found during litera- ture search at the time of publication. However, for many of the herbal extracts listed in the table, further research is required in order to properly establish (or rule out) evidence for herb-drug interactions. The table is organised by drug class. The level of interaction is indicated using the following key:

• SI = Serious interaction • UC = Use caution • OB = Clinical observation needed • BI = Potential benefi cial interaction • CYP =

© Springer International Publishing Switzerland 2017 185 D. Camfi eld et al. (eds.), Evidence-Based Herbal and Nutritional Treatments for in Psychiatric Disorders, DOI 10.1007/978-3-319-42307-4 186 Herb and Nutrient-Drug Interaction Table cial interaction cial cial interaction cial cial interaction cial ] 8 cial interaction cial ]. Observe in patients who ]. Observe 1 Possible benefi Benefi Possible benefi Discontinue 2–3 weeks prior to [ surgery Avoid combining with Avoid [ consume moderate to high amounts of alcohol Medical supervision and monitoring of patient advised Medical supervision and monitoring of patient advised Possible benefi Recommendations ] Avoid concurrent use. 7 ]. 9 ] 6 , 5 ] 4 , 3 ] ] ] 1 1 1 ] 2 not yet demonstrated in clinical trials cacy Known interaction with CYP [ Known Theoretically based on pharmacological study demonstrated action. In vivo in induced liver effects hepatoprotective damage [ has a synergic effect with CNS effect has a synergic Kava depressants [ Evidence to suggest that NAC promotes the Evidence to suggest that NAC metabolism of alcohol and decreases and heart [ damage to the liver Kava has a synergic effect with CNS effect has a synergic Kava depressants [ Kava has a synergic effect with CNS effect has a synergic Kava depressants [ In vivo studies demonstrated inhibited In vivo morphine tolerance and dependence [ Effi Several studies demonstrating studies demonstrating Several thistle of St Mary’s effect hepatoprotective indicate this herb may reduce hepatic tissue damage related to alcohol consumption [ = additive = additive effect = additive = additive effect = decreased side = decreased side = decreased drug = decreased side = reduced drug = additive = additive effect SI effectiveness BI effects UC BI effects SI UC BI tolerance and dependence BI effects

(St.

Hypericum perforatum wort) John’s Schisandra chinensis Schisandra somnifera Withania Piper methysticum N- N-Acetylcysteine Piper methysticum Herb Potential interaction Evidence Silybum marianum Silybum Piper methysticum

Anaesthetics (general) Codeine Drug class Morphine Alcohol Herb and Nutrient-Drug Interaction Table 187 ] cance cance (continued) 11 cial interaction cial interaction cial ] ] 8 8 cial interaction as well Possible benefi Possible benefi Observe patient with concurrent Observe interaction is use; however, [ unlikely Observe patient with concurrent Observe for use. Interaction risk is low at doses of standardized extracts [ 240 mg/day or lower Observe patient with concurrent Observe interaction is use; however, [ unlikely Unknown clinical signifi Unknown Benefi being a treatment for paracetamol (typically administered overdose in a hospital setting intravenously in the case of overdose) Avoid concurrent use Avoid ] ] Unknown clinical signifi 8 13 ] 7 ] ] 4 7 , ] 3 3 ] ] ] 12 13 10 Based on pharmacological action, may have Based on pharmacological action, may have against liver effect a hepatoprotective damage from paracetamol [ NAC is a proven antidote for is a proven NAC in a as reviewed acetaminophen overdose, 2540 patients. Most protective study of over within 8 h of is taken when NAC paracetamol ingestion [ In vitro seizure models demonstrated [ activity anticonvulsant Demonstrated anticonvulsant activity [ activity Demonstrated anticonvulsant Known interaction with CYP enzymes Known . May cause effecting [ decreased drug effectiveness Based on pharmacological action, may have Based on pharmacological action, may have against liver effect a hepatoprotective damage from paracetamol [ Induction of CYP enzymes, with potentially it has increased drug metabolism; however, not been reported in clinical studies [ One case report of fatal seizure. Possible One case report of fatal acid and interaction with valproic [ reducing drug effectiveness , Induction of CYP enzymes, with potential it has increased drug metabolism; however, on an effect been reported not to have kinetics [ = additive = additive = additive = additive sedative = reduced drug = reduced drug = possible reduced = decreased side = decreased side = decreased side = reduced drug BI effects BI effects UC effects UC effects SI effectiveness BI effects UC effectiveness UC effectiveness OB drug effectiveness

Schisandra chinensis Schisandra Silybum marianum Silybum N-Acetylcysteine Piper methysticum Hypericum perforatum Piper methysticum Hypericum perforatum Ginkgo biloba

Paracetamol Paracetamol Phenobarbitone and phenytoin Phenobarbitone Anticonvulsants Carbamazepine Anticonvulsants Anticonvulsants (general) 188 Herb and Nutrient-Drug Interaction Table ] 11 ] 12 ] 12 Recommendations Avoid concurrent use, unless Avoid under medical supervision. Potential for serotonin syndrome with concurrent use. Use such as extracts low- Ze117 [ patient with concurrent Observe for use. Interaction risk is low at doses of standardized extracts [ 240 mg/day or lower Observe patient due to possible Observe state effects/hypomanic additive Avoid concurrent use, unless Avoid under medical supervision. Potential for serotonergic syndrome with concurrent use. such extract Use low-hyperforin as Ze117 [ Mechanism of interaction patient with Observe unknown. concurrent use ] 15 cant ] 8 ] 7 ] 11 ] 14 , ]. However, clinically signifi ]. However, 8 , 32 7 Case study (combination and kava and kava Case study (combination valerian when preparation) increased lethargy [ combined with A case report in a patient with Alzheimer’s A case report in a patient with Alzheimer’s disease suggested a possible increase in the receptors leading to function of GABA with concurrent use of [ Due to the theories of serotonergic Due to the theories of serotonergic mechanism of action MI, caution should when using in conjunction be exercised wort. with or St. John’s no reported cases of serotonin However, syndrome associated with MI to date [ interactions appear to be dose dependent [ Concurrent use may increase serotonin inhibition [ reuptake Induces CYP enzymes and P-glycoprotein. Pharmacokinetic trials and case studies reporting symptoms of serotonin syndrome [ rmed) = additive = additive effect = potential additive = potential additive = additive = additive effect = additive = additive effect UC BO effects OB (although effects unconfi SI SI

inositol - Herb Potential interaction Evidence Piper methysticum Ginkgo biloba Myo Hypericum perforatum Hypericum perforatum

Selective Selective serotonin inhibitors reuptake and serotonin norepinephrine inhibitors reuptake Drug class Antidepressants Atypical () (continued) Herb and Nutrient-Drug Interaction Table 189 ] ] (continued) 11 11 cial interaction cial ] 12 patient and rmed. Observe patient and rmed. Observe Avoid concurrent use, unless Avoid under medical supervision. Potential for serotonergic syndrome with concurrent use. such extracts Use low-hyperforin as Ze117 [ Mechanism of interaction unconfi caution with concurrent exercise for use. Interaction risk is low at doses of standardized extracts [ 240 mg/day or lower Mechanism of interaction unconfi use caution with concurrent use. for Interaction risk is low at doses of standardized extracts [ 240 mg/day or lower Avoid concurrent use to ensure Avoid treatment effectiveness Possible benefi ] 8 ] extract) has extract) 16 ] ]. EGb 761 ]. One ] 12 6 3 11 with cant side effects ] 6 Ginkgo biloba Case study reporting priapism, possibly due [ effects to vasodilation Clinical trial demonstrating increased with concurrent use and decreased effects [ side effects extrapyramidal reported no signifi concurrent treatment [ Based on pharmacological action, may have Based on pharmacological action, may have against drug- effect a hepatoprotective damage [ induced liver (standardized in not demonstrated interaction effects clinical trials [ May decrease plasma levels of tricyclics of tricyclics May decrease plasma levels and increase serotonin [ Pharmacokinetic trials demonstrating decreased blood concentration of with concurrent use [ fexofenadine = reduced drug = additive = additive effect = additive = additive effect and = reduced drug side = reduced drug OB OB reduced side effects BI effects SI effectiveness UC effectiveness

Silybum marianum Silybum Hypericum perforatum Ginkgo biloba Ginkgo biloba Hypericum perforatum

Ginkgo biloba Tricyclics Tricyclics Risperidone Antipsychotics Antihistamines Fexofenadine 190 Herb and Nutrient-Drug Interaction Table ] ] ] ] ] 7 7 7 7 11 ] 11 , 8 ] 11 , 8 Recommendations Observe patient with concurrent Observe interaction is use; however, [ unlikely Use caution with concurrent use; interaction is unlikely however, [ Mechanism of interaction concurrent use. Avoid unknown. for Interaction risk is low at doses of standardized extracts [ 240 mg/day or lower Avoid concurrent use to ensure Avoid [ treatment effectiveness [ treatment effectiveness concurrent use to ensure Avoid [ treatment effectiveness Avoid concurrent use to ensure Avoid [ treatment effectiveness ] 8 ] ] 8 8 ] concurrent use to ensure Avoid ] , ] 7 7 7 7 ] 8 Case report demonstrating reduced causing virologic of effectiveness [ failure Reduced blood levels of , of indinavir, Reduced blood levels demonstrated in pharmacokinetic trail via induction of CYP3A4 [ Increases metabolism of via induction of CYP3A4, demonstrated in pharmacokinetic trail [ One pharmacokinetic trial showed of metronidazole. decreased blood levels no Majority of clinical trials show interaction with CYP isoforms [ Induction of CYP3A4 [ Induction of CYP enzymes. No clinical of interactions [ evidence Reduced blood levels of indinavir of indinavir Reduced blood levels demonstrated in pharmacokinetic trail via induction of CYP3A4 [ = reduced drug = reduced drug = reduced drug = reduced drug = reduced drug = reduced drug = reduced drug SI effectiveness SI effectiveness UC effectiveness SI effectiveness SI effectiveness UC effectiveness SI effectiveness

Herb Potential interaction Evidence Hypericum perforatum Silybum marianum Silybum Hypericum perforatum Ginkgo biloba Hypericum perforatum Silybum marianum Silybum Hypericum perforatum

Drug class Metronidazole Non-nucleoside transcriptase inhibitors Antimicrobials Erythromycin Protease inhibitors Voriconazole Voriconazole (continued) Herb and Nutrient-Drug Interaction Table 191 ] 18 (continued) ] 18 cation. Medical cation. cial interaction. cial cial interaction. cial cial interaction. cial cial interaction. cial interaction. cial interaction. cial interaction. cial cial interaction. cial Potential benefi Monitoring of patient advised with concurrent use Potential benefi Monitoring of patient advised with concurrent use Potential benefi May be useful in assisting from , with withdrawal drug dose modifi supervision and monitoring of patient advised [ Potential benefi Monitoring of patient advised with concurrent use Potential benefi Monitoring of patient advised with concurrent use Potential benefi Monitoring of patient advised with concurrent use Potential benefi Monitoring of patient advised with concurrent use Potential benefi Monitoring of patient advised with concurrent use treatment effectiveness [ treatment effectiveness ] 20 ] A 19 ] concurrent use to ensure Avoid 11 receptors [ receptor A A A ] ] ] ] 17 1 26 23 ] ] 22 25 , , 21 24 Theoretical synergic effect with CNS effect Theoretical synergic depressants. Interacts with GABA Theoretical synergic effect with CNS effect Theoretical synergic depressants. GABA Theoretical synergic effect with CNS effect Theoretical synergic galphimine B been depressant. In vivo to interact with serotonergic shown transmission [ with CNS effect has a synergic Kava depressants [ with CNS effect Theoretical synergic depressants. GABA Induction of CYP enzymes [ Theoretical synergic effect with CNS effect Theoretical synergic transmission [ depressants via GABA Theoretical synergic effect with CNS effect Theoretical synergic depressants [ [ antagonist [ [ Theoretical synergic effect with CNS effect Theoretical synergic depressant, as has been found to interact with GABA = additive = additive effect = additive = additive effect = additive = additive effect = additive effect = additive = additive effect = additive = additive effect = additive = additive effect = additive = additive effect = reduces drug UC UC OB UC UC SI effectiveness OB OB OB

Galphimia glauca Valeriana offi cinalis offi Valeriana Hypericum perforatum Melissa offi cinalis Melissa offi incarnata ora Passifl ora laterifl somnifera Withania Piper methysticum Matricaria recutita

Barbiturates 192 Herb and Nutrient-Drug Interaction Table , ] 18 18 ] 18 cation. cation may be cial interaction. cial cial interaction. cial cial interaction. cial cial interaction. cial interaction. cial ] Recommendations Potential benefi Drug dose modifi needed. Monitoring of patient advised with concurrent use [ 28

Potential benefi Monitoring of patient advised with concurrent use Potential benefi Monitoring of patient advised with concurrent use Avoid concurrent use to ensure Avoid [ treatment effectiveness Potential benefi Monitoring of patient advised with concurrent use Potential benefi May be useful in assisting from , withdrawal with drug dose modifi Medical supervision and monitoring of patient advised [ ] 8 ] ] 8 17 ] 1 ]. Case report demonstrated 1 ] 1 ] 27 , 19 Theoretical synergic effect with CNS effect Theoretical synergic depressants. One case study reported throbbing and dizziness, hand tremor, (also combined with muscular fatigue [ valerian) Kava has a synergic effect with CNS effect has a synergic Kava depressants [ increased lethargy and disorientation when increased lethargy combined with [ Theoretical synergic effect. In vivo In vivo effect. Theoretical synergic to interact with galphimine B been shown transmission [ serotonergic Induction of intestinal CYP3A. One reduced pharmacokinetic trail showed plasma [ Theoretical synergic effect with effect Theoretical synergic to benzodiazepines. Apigenin shown interact with receptors [ One pharmacokinetic study. Increased oral One pharmacokinetic study. of [ bioavailability = additive = additive effect = additive = additive effect = additive = additive effect = additive = additive effect = additive = additive effect = reduced drug UC UC OB SI effectiveness OB OB

spp. Herb Potential interaction Evidence Passifl ora incarnata ora Passifl Galphimia glauca Hypericum perforatum Matricaria recutita Echinacea Piper methysticum

Benzodiazepines Drug class (continued) Herb and Nutrient-Drug Interaction Table 193 ] 18 rmed. rmed. rmed. ] (continued) 18 rmed. cial interaction. cial cial interaction. cial interaction. cial cial interaction. cial cance unconfi cance unconfi cance cance unconfi cance ] 12 ] ] cance unconfi cance 18 18 Theoretical interaction. Clinical signifi patient with concurrent Observe use [ Potential benefi Monitoring of patient advised with concurrent use Interaction unlikely. Monitor Interaction unlikely. patient with concurrent use. Use such as extracts low-hyperforin Ze117 [ patient with concurrent Observe use; monitor blood pressure Potential benefi Clinical signifi Monitoring of patient advised with concurrent use [ Potential benefi Clinical signifi patient with concurrent Observe use [ Potential benefi Clinical signifi Medical supervision needed [ ] 23 cial for cial ] ] 12 receptor antagonist [ 11 A ] ] 1 29 ] ]; however, it has been ]; however, 8 18 ower) [ ower) ] ed as 3, 4-dihydroxybenzoic 30 Arginine is generally benefi Arginine health, yet caution should be cardiovascular when taking in conjunction with exercised on heart , due to its effects blood pressure [ Theoretical synergic effect with CNS effect Theoretical synergic depressants. Pharmacokinetic trials reporting Inhibition of CYP enzymes and ABCB1 substrates [ Theoretical synergic effect with CNS effect Theoretical synergic depressants. GABA with CNS effect Theoretical synergic depressants. One case study reported throbbing and dizziness, hand tremor, (also combined with muscular fatigue passionfl Theoretical synergic effect with CNS effect Theoretical synergic depressants [ One case study reported decreased theophylline [ reported not to have an effect on an effect reported not to have theophylline kinetics [ Antiplatelet aggregation compound Antiplatelet aggregation identifi acid [ = increased drug = additive = additive effect = additive = additive effect = lowers = lowers blood = additive = additive effect = possible reduced = increased risk of OB pressure UC effectiveness UC UC OB OB drug effectiveness OB bleeding

Valeriana offi cinalis offi Valeriana Withania somnifera Withania Hypericum perforatum L-Arginine Schisandra chinensis Schisandra Scutellaria ora laterifl Eleutherococcus Eleutherococcus senticosus

Bronchospasmolytics/bronchodilators Theophylline Cardiovascular drugs Cardiovascular Cardiovascular drugs (general) Anticoagulants (general) 194 Herb and Nutrient-Drug Interaction Table ] 18 rmed. rmed. cial interaction. cial cance unconfi cance ] 8 ] 11 rmed. Clinical rmed. Recommendations Interaction not confi Monitor patient with concurrent use Avoid concurrent use Avoid Avoid concurrent use Avoid Potential benefi Clinical signifi Medical supervision needed [ Mechanism of interaction unconfi Interaction implications unclear. for standardized risk is low at doses of 240 mg/day or extracts [ lower Observe patient with concurrent Observe interaction is use; however, [ unlikely Avoid concurrent use Avoid ] ] 8 8 , ] , 7 7 ] 31 8 ] 32 , 8 ] 8 ] , 7 11 Pharmacokinetic trials reporting Inhibition of CYP enzymes and ABCB1 substrates [ An increased bleeding tendency for An increased bleeding tendency and aspirin has been reported in warfarin clinical isolated case studies. However, on effect no additive shown trials have for aspirin, warfarin, platelet aggregation clopidogrel and cilostazol [ Pharmacokinetic trials demonstrating decreased digoxin blood concentrations [ Pharmacokinetic trials demonstrating increase blood concentration of talinolol with concurrent use [ Pharmacokinetic trail and several case studies Pharmacokinetic trail and several clearance and reported increased warfarin [ decrease anticoagulant effect Once case study reported increased plasma it had no of digoxin; however, levels digoxin toxicity symptoms [ Pharmacokinetic trials demonstrated increased LDL with concurrent use of and increased LDL total [ with atorvastatin = increased drug = increased drug = reduced drug = increased risk of = additive = additive effect = reduced drug = reduced drug UC effectiveness OB bleeding SI effectiveness OB SI effectiveness UC effectiveness UC effectiveness

Herb Potential interaction Evidence Hypericum perforatum Hypericum perforatum Schisandra chinensis Schisandra Ginkgo biloba Eleutherococcus Eleutherococcus senticosus Ginkgo biloba Hypericum perforatum Warfarin Warfarin Warfarin Warfarin and aspirin Digoxin Drug class Talinolol Talinolol Hypolipidaemics (simvastatin, atorvastatin) (continued) Herb and Nutrient-Drug Interaction Table 195 ] 18 rmed. rmed. rmed. rmed. ] (continued) 11 ] 11 ] cial interaction. cial cial interaction. cial ] cial interaction. cial 1 cance unconfi cance cance unconfi cance cance unconfi cance cance unconfi cance 11 decrease treatment [ effectiveness Clinical signifi Medical supervision needed with risk of concurrent use. Low interaction [ Possible benefi Medical supervision needed standardized extracts at doses of standardized extracts [ 240 mg/day or lower Potential benefi Clinical signifi Medical supervision needed [ Medical supervision needed with concurrent use Medical supervision needed. Low Medical supervision needed. Low risk of interaction [ Potential benefi Clinical signifi ] 26 ] Clinical signifi ] for Interaction risk is low ] concurrent use as may Avoid 33 11 7 ]. Based on pharmacological 34 Induces CYP enzymes [ Inhibits P-glycoprotein [ action, may reduce drug toxicity In vivo studies reported reduced drug side In vivo and for effects were doxorubicin; enhanced drug effects [ found for concurrent use with Theoretical synergistic effect, more research effect, Theoretical synergistic is needed Induces CYP enzymes [ May decrease paclitaxel and doxorubicin May decrease paclitaxel metabolism [ Based on pharmacological action, may reduce drug toxicity = additive = additive effect = reduced treatment = reduced drug effect = additive = additive effect = reduced drug side = reduced drug side = reduced drug BI effects UC OB and enhanced effects drug effects UC side effects SI effectiveness UC UC

Withania somnifera Withania Ginkgo biloba Eleutherococcus Eleutherococcus senticosus Hypericum perforatum Rosmarinus cinalis offi Silybum marianum Silybum Silybum marianum Silybum

Chemotherapeutics Chemotherapy (general) Cisplatin 196 Herb and Nutrient-Drug Interaction Table ] 11 rmed. ] cance. ] 1 ] 11 11 ] cial interaction. cial cance unconfi cance 11 [ Recommendations Avoid concurrent use [ Avoid Avoid concurrent use as may Avoid decrease treatment effectiveness. [ hyperforin extracts Use low- May increase sedative effect. effect. May increase sedative clinical signifi Unknown May reduce treatment patients effectiveness. symptoms. withdrawal may have Monitor patients. Use low- [ hyperforin extracts Potential benefi Clinical signifi Medical supervision needed. Low risk of interaction [ Monitor patients with concurrent use Avoid concurrent use with Avoid of high-hyperforin extracts Hypericum treatment effectiveness. Monitor treatment effectiveness. patients ] ] 8 8 , 1 ] concurrent use. May reduce Avoid 7 ]. Induces ] 8 36 , 8 ] 7 ] 26 ] 1 ] 35 Case report described reduced activity of Case report described reduced activity Possible dopamine antagonist [ levodopa. Based on pharmacological action, may no Clinical trials show reduce drug toxicity. on pharmacokinetics of irinotecan [ effect Decrease plasma concentration of it decreased drug side irinotecan; however, [ effects Kava has a synergic effect with CNS effect has a synergic Kava depressants [ CYP2D2 [ Induction of CYP2D2 enzyme [ Theoretical increase in drug [ effectiveness Clinical trial reported decreased plasma concentration of methadone [ Induction of CYP3A4 enzymes; however, Induction of CYP3A4 enzymes; however, is not found to occur with this effect [ extracts low-hyperforin = reduced drug = additive = additive effect = reduced drug = additive = additive effect = reduced drug side = reduced drug = reduced drug = reduced drug UC effectiveness BI effects SI effectiveness UC SI effectiveness OB SI effectiveness UC effectiveness

Herb Potential interaction Evidence Silybum marianum Silybum Hypericum perforatum Piper methysticum Hypericum perforatum Withania somnifera Withania Hypericum perforatum Hypericum perforatum Piper methysticum

Irinotecan Drug class Dopaminergics Levodopa Opioids Thyroid hormones Methadone, and oxycodone Hormone-based Oral contraceptives (etinilestradiol and desogestrel, etinilestradiol and norethindrone) Methadone (continued) Herb and Nutrient-Drug Interaction Table 197 ] ] 18 11 rmed. ] 11 cance. cance. (continued) cial interaction. cial cance unconfi cance ] 11 Unknown clinical signifi Unknown Monitor patients with concurrent use concurrent use Avoid Avoid concurrent use Avoid Potential benefi Clinical signifi Medical supervision needed [ Avoid concurrent use Avoid May reduce treatment Monitor patients. effectiveness. [ extracts Use low-hyperforin May reduce treatment Monitor patients. effectiveness. risk of interaction [ Low May reduce treatment Monitor patients. effectiveness. such extracts Use low-hyperforin as Ze117 [ Unknown clinical signifi Unknown Monitor patients with concurrent use ] 8 ] 8 ] ] 11 11 ] ] ] 7 11 18 Pharmacokinetic trials reporting Inhibition of CYP enzymes and ABCB1 substrates [ Pharmacokinetic trial in which Kava Pharmacokinetic trial in which Kava inhibited CYP2E1 [ Theoretical based on pharmacological action. In vitro hypoglycaemic action reported [ Clinical trial demonstrated deceased plasma chlorzoxazone [ Theoretical based on pharmacological action, may reduce drug toxicity Theoretical based on immunostimulant action Pharmacokinetic trial demonstrated increased incidence of hypoglycaemia, with deceased plasma gliclazide [ Clinical trial demonstrated deceased plasma [ Clinical trial demonstrated deceased plasma chlorzoxazone [ = increased drug = reduced drug = reduced drug = reduced drug = additive = additive effect = reduced drug = reduced drug UC effectiveness UC = reduced drug effectiveness OB SI effectiveness UC and side effectiveness effects UC effectiveness UC effectiveness SI = reduced drug effectiveness SI effectiveness

Eleutherococcus Eleutherococcus senticosus Hypericum perforatum Schisandra chinensis Schisandra Silybum marianum Silybum Eleutherococcus Eleutherococcus senticosus Piper methysticum Hypericum perforatum Hypericum perforatum Hypericum perforatum

Immunosuppressants Muscle relaxants Chlorzoxazone Hypoglycaemics Gliclazide Tacrolimus Tacrolimus Cyclosporine 198 Herb and Nutrient-Drug Interaction Table ]. Observe 12 ] 11 Recommendations Interaction unlikely [ Interaction unlikely patient with concurrent use. Use extracts low-hyperforin Mechanism of interaction patient with Observe unknown. concurrent use. Interaction risk for standardized extracts is low at doses of 240 mg/day or [ lower ]; 7 ] 12 ] 8 however, it has been reported not to have an it has been reported not to have however, on the drugs kinetics [ effect Pharmacokinetic trial in which ginkgo reduced blood concentrations of and omeprazole sulphone [ Reduction in plasma ibuprofen reported [ Reduction in plasma ibuprofen = reduced drug = possible reduced

UC effectiveness OB drug effects

Herb Potential interaction Evidence Hypericum perforatum Ginkgo biloba anti-infl ammatory drugs (NSAIDS) anti-infl Nonsteroidal Ibuprofen Drug class Proton-pump inhibitors Proton-pump Omeprazole (continued) References

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A Amsterdam Preoperative Anxiety and Acoustic startle response (ASR) , 42, 43 Information Scale (APAIS) , 143 Acute Psycho-Activity Self-Rating Scale , 23 Anaesthetics , 186 Adaptogens Analgesics , 186 Ashwagandha Anticonvulsants , 187 dose of , 158 Antidepressants , 188–189 effi cacy, evidence of , 34–35, 39 Antihistamines , 189 mechanisms of action , 34 Antimicrobials , 190 benefi ts and role , 4, 159 Antipsychotics , 189 combination preparations , 49–50 Anxiety disorders , 11, 103, 129 Gotu Kola dementia, guise of clinical studies , 43 diagnosis and treatment mechanisms of action , 42 plan , 161–165 preclinical studies , 42–43 discussion , 163 safety , 43–44 presenting complaint , 161 Roseroot treatment outcome , 163 clinical studies , 40–41 masked, developmental disorders mechanisms of action , 40 diagnosis and treatment plan , 160–161 preclinical studies , 40 discussion , 161 safety , 41 presenting complaint , 159–160 Schisandra n -3FAs , 107 clinical studies , 47–48 effi cacy, evidence of , 108 mechanisms of action , 47 mechanisms of action , 107–108 preclinical studies , 47 nutraceuticals (See Nutraceuticals ) safety , 48 nutritional and herbal treatments Siberian Ginseng cellular effects , 4 clinical studies , 45–46 direct neurotransmitter effects , 3–4 mechanisms of action , 44–45 evidence-base studies , 2–3 preclinical studies , 45 vs. pharmaceuticals , 2–3 summary of , 36–38 pharmaceutical treatments , 2 ADAPT-232 tablets , 48–49 prevalence , 1 ADHD . See Attention-defi cit hyperactivity , 106 disorder (ADHD) effi cacy, evidence of , 106–107 Alcohol , 26, 186 mechanisms of action , 106 Alzheimer’s disease (AD) , 61, 63 psychiatric conditions , 110

© Springer International Publishing Switzerland 2017 201 D. Camfi eld et al. (eds.), Evidence-Based Herbal and Nutritional Treatments for Anxiety in Psychiatric Disorders, DOI 10.1007/978-3-319-42307-4 202 Index

Anxiety disorders (cont .) Barquinha , 126 SAMe , 109 BDNF . See Brain-derived neurotrophic effi cacy, evidence of , 109–110 factor (BDNF) mechanisms of action , 109 Beck Anxiety Inventory scores , 23 SJW , 104, 115 Beck hopeless scale (BHS) , 129 effi cacy, evidence of , 105 Benzodiazepines , 12, 192–193 mechanisms of action , 104 Benzofl avone (BZF) , 18, 19 , 110 Berocca™ , 88 clinical considerations , 111–115 Bitter , 142 effi cacy, evidence of , 111 effi cacy, evidence of , 143 mechanisms of action , 111 mechanisms of action , 142 Anxiety sensitivity index (ASI) , 129 in vivo studies , 142 Anxioton , 180–182 Borderline personality disorder (BPD) , 131 Anxious depression , 162 BPRS . See Brief Psychiatric Rating APAIS . See Amsterdam Preoperative Anxiety Scale (BPRS) and Information Scale (APAIS) Brahmi Arginine effi cacy, evidence of benefi cial effects , 95 acute clinical studies , 59 effi cacy, evidence of , 89–90 chronic clinical studies , 59 mechanisms of action , 89 preclinical studies , 58–59 ASD . See Autism spectrum disorder (ASD) mechanisms of action , 58 Ashwagandha Brain-derived neurotrophic factor effi cacy, evidence of (BDNF), 111 clinical studies , 35, 39 Brief Psychiatric Rating Scale preclinical studies , 34–35 (BPRS), 24, 129 safety , 39 Bronchodilators , 193 mechanisms of action , 34 Bronchospasmolytics , 193 Attention-defi cit hyperactivity disorder B (ADHD), 105 effi cacy, evidence of Autism spectrum disorder (ASD) , 160 anxiety , 86–87 Ayahuasca , 123 depression , 85–86 clinical considerations , 133–135 mood measures , 85 constituents , 123–124 research fi ndings , 84 effi cacy, evidence of stress-reducing effects , 85 anxiety and panic , 129 mechanisms of action , 84 depression , 130 Hoasca Project, therapeutic effects observed in , 127–128 C substance dependence , 131–133 Camellia sinensis . See Tea mechanisms of action , 124 Cannabinoid B1 receptors , 143 modern uses of , 126–127 Cardiovascular drugs , 193–194 psycho-socio-cultural signifi cance , Centella asiatica . See Gotu Kola 124–126 Centrophenoxine , 162 therapeutic potential and widespread Cervical dystonia use , 133 diagnosis and treatment plan , 156 therapeutic potential data , 134 discussion , 156 Ayahuasca tourism , 127 presenting complaint , 156 treatment outcome , 156 CES . See Cranial electrotherapy stimulation B (CES) Bacopa monnieri . See Brahmi Baicalein , 22 calming and relaxing effects , 19 Banisteriopsis caapi (Spruce ex. Griseb) , 123 effi cacy, evidence of , 20–21 Barbiturates , 191 mechanisms of action , 20 Index 203

Chemotherapeutics , 195 SAMe , 109 Chronic anxiety , 2, 19, 24, 157 effi cacy, evidence of , 109–110 Citrus aurantium . See Bitter orange mechanisms of action , 109 Clinical Global Impression of change SJW , 104, 115 (CGI) , 92 effi cacy, evidence of , 105 Clinical Global Impression of Improvement mechanisms of action , 104 (CGI-I) scale, 41, 63 zinc , 110 Clinical Global Impression Scale (CGI-S) clinical considerations , 111–115 score , 93–94 effi cacy, evidence of , 111 Cognitive mechanisms of action , 111 Brahmi Cranial electrotherapy stimulation (CES) , 158 acute clinical studies , 59 sativus . See Saffron chronic clinical studies , 59 Cyracos® . See Lemon balm mechanisms of action , 58 Cytochrome (CYP) P450 pathways , 115 preclinical studies , 58–59 clinical considerations , 73–74 ginkgo D clinical studies , 61 (DHEA) , 158 mechanisms of action , 60 Dementia preclinical studies , 60–61 diagnosis and treatment plan , 161–165 herbal medicines, list of , 65–67 discussion , 163 lemon balm presenting complaint , 161 acute studies , 63 treatment outcome , 163 clinical cohorts, research in , 63 Depression mechanisms of action , 62 with anxiety , 169 preclinical studies , 62 assessment of patient , 170–171 diagnosis and treatment plan , 171–172 effi cacy, evidence of , 72–73 effective stand-alone and adjunctive mechanisms of action , 72 , 174 sage naturopathic approach , 173 effi cacy, evidence of , 70–71 presenting complaint , 169–170 mechanisms of action , 70 treatment outcome , 173 tea ayahuasca , 130 clinical studies , 68–69 SJW , 105 mechanisms of action , 64 Depression Anxiety and Stress Scale preclinical studies , 68 (DASS) , 86, 170, 182 Cognitive defi cits , 57 Developmental disorders Combination preparations , 49–50 diagnosis and treatment plan , 160–161 Comorbid anxiety , 103 discussion , 161 n -3FAs , 107 presenting complaint , 159–160 effi cacy, evidence of , 108 DHEA . See Dehydroepiandrosterone (DHEA) mechanisms of action , 107–108 Diagnostic and Statistical Manual III - Revised refractory depression with , 169 (DSM-III-R) criteria, 61 assessment of patient , 170–171 Dimensional Anxiety and Depression diagnosis and treatment plan , 171–172 Scale , 41 effective stand-alone and adjunctive Dopaminergics , 196 antidepressant, 174 naturopathic approach , 173 presenting complaint , 169–170 E treatment outcome , 173 Echinacea /purple cone fl ower , 143 saffron , 106 effi cacy, evidence of , 144–145 effi cacy, evidence of , 106–107 mechanisms of action , 143–144 mechanisms of action , 106 in vivo studies , 144 psychiatric conditions , 110 Echium amoenum . See Iranian 204 Index

Eleutherococcus senticosus . See Siberian Global Rating Scale (GRS) , 35 Ginseng Gotu Kola Elevated plus maze (EPM) , 87, 142 clinical studies , 43 (EGCG) , 64, 68, 69 mechanisms of action , 42 Exercise , 179 preclinical studies , 42–43 Eye movement desensitization and safety , 43–44 reprocessing (EMDR), 159

H F Hamilton Anxiety Rating Scale (HARS) , 41 FEWP . See Free and Easy Wanderer Plus Hamilton Anxiety Scale (HAMA) , 15–16, (FEWP) 19, 20, 35 Folate (B9) , 87 Hamilton Depression Rating Scale Free and Easy Wanderer Plus (HAMD), 105, 130, 146 (FEWP), 162, 163 Hamilton Rating Scale for Anxiety (-A) Free Rating Scale for Anxiety (FRSA) , 63 scores, 61 Hamilton's Brief Psychiatric Rating Scale (BPRS), 43 G Herbal anxiolytics GABA . See Gamma-aminobutyric acid chamomile (GABA) effi cacy, evidence of , 20–21 GAD . See Generalized anxiety disorder mechanisms of action , 20 (GAD) galphimia Galphimia effi cacy, evidence of , 21–22 effi cacy, evidence of mechanisms of action , 21 clinical studies , 22 kava preclinical studies , 21 effi cacy, evidence of , 15–17 mechanisms of action , 21 mechanisms of action , 12, 15 in vivo studies , 18 medicines overview , 13–14 Galphimia glauca . See Galphimia passionfl ower Galphimine A , 21 effi cacy, evidence of , 19 Galphimine B , 21 mechanisms of action , 18 Gamma-aminobutyric acid (GABA) , 3, 11, skullcap 15, 18, 20, 159 effi cacy, evidence of , 23 Gamma-aminobutyric acid-A receptors , 62 mechanisms of action , 22 General Health Questionnaire (GHQ-28) , 39 sleep disorders , 11 Generalized anxiety disorder (GAD) , 41, 177 valerian assessment of patient clinical considerations , 25–27 diagnosis and treatment plan , 179 effi cacy, evidence of , 24–25 initial assessment , 178 mechanisms of action , 24 ongoing assessment , 178–179 Herbal medicines , 180, 182 prescribed treatment , 179–180 product reliability , 5 therapeutics goals , 179 regulatory control, lack of , 4–5 NAC , 93–94 systematic scientifi c studies , 4 presenting complaint , 177–178 therapeutic effects, determining refl ection , 182 factors of , 5 treatment outcome , 180–181 Herb and nutrient-drug interaction table Generally Recognized as Safe (GRAS) , 115 alcohol , 186 Ginkgo anaesthetics , 186 effi cacy, evidence of analgesics , 186 clinical studies , 61 anticonvulsants , 187 preclinical studies , 60–61 antidepressants , 188–189 mechanisms of action , 60 antihistamines , 189 Ginkgo biloba . See Ginkgo antimicrobials , 190 Index 205

antipsychotics , 189 clinical cohorts, research in , 63 barbiturates , 191 preclinical studies , 62 benzodiazepines , 192–193 mechanisms of action , 62 bronchospasmolytics/bronchodilators , 193 Listed medicines (AUST L) , 4–5 cardiovascular drugs , 193–194 L- , 68–69, 156 chemotherapeutics , 195–196 Lysine dopaminergics , 196 effi cacy, evidence of , 89–90 hormone-based medication , 196 mechanisms of action , 89 hypoglycaemics , 197 immunosuppressants , 197 muscle relaxants , 197 M NSAIDS , 198 MADRS . See Montgomery-Asberg opioids , 196 Depression Rating Scale proton-pump inhibitors , 198 (MADRS) Hoasca Project , 127–128 , 181 Homocysteine (HCy) , 84 bioavailability , 95 Hormone-based medication , 196 dietary source , 87 5-HT2A receptor , 133, 135 effi cacy, evidence of , 88 Hypericum perforatum . See St John's wort mechanisms of action , 87–88 (SJW) Matricaria recutita . See Chamomile Hypoglycaemics , 197 M B P . See Mesolimbic brain pathway (MBP) Measure Yourself Medical Outcome Profi le (MYMOP2), 182 I Medicine and Healthcare Regulatory Agency IDEAA . See Institute for Applied Amazonian (MHRA), 5 Ethnopsychology (IDEAA) Melissa offi cinalis . See Lemon Balm; Lemon Immunosuppressants , 197 balm Impact of Event Scale (IES) , 86, 91 Menstrual Health Questionnaire (MHQ) , 88 Indian Ginseng . See Ashwagandha Mesolimbic brain pathway (MBP) , 133 Institute for Applied Amazonian Methylenetetrahydrofolate reductase Ethnopsychology (IDEAA), 131 (MTHFR) , 84 In vitro rat brain homogenate assays , 11 MHQ . See Menstrual Health Questionnaire Iranian borage , 145 (MHQ) effi cacy, evidence of , 146 M I . See Myo-inositol (MI) mechanisms of action , 145 Milk thistle , 147 in vivo studies , 145 effi cacy, evidence of clinical studies , 148–149 preclinical , 147–148 K mechanism of action , 147 Kava Monoamine oxidase (MAO) , 124 effi cacy, evidence of Montgomery-Asberg Depression Rating Scale anxiolytic activity , 15–16 (MADRS), 130 mental function , 16–17 Mood disorders , 103 hepatotoxicity , 12 n -3FAs , 107 mechanisms of action , 12, 15 effi cacy, evidence of , 108 Kava Anxiety Depression Spectrum Study mechanisms of action , 107–108 (KADSS), 15–16 saffron , 106 , 12, 15 effi cacy, evidence of , 106–107 mechanisms of action , 106 psychiatric conditions , 110 L SAMe , 109 Lemon balm , 160 effi cacy, evidence of , 109–110 effi cacy, evidence of mechanisms of action , 109 acute studies , 63 SJW , 104, 115 206 Index

Mood disorders (cont .) Nutrient-drug interaction table effi cacy, evidence of , 105 alcohol , 186 mechanisms of action , 104 anaesthetics , 186 zinc , 110 analgesics , 186 clinical considerations , 111–115 anticonvulsants , 187 effi cacy, evidence of , 111 antidepressants , 188–189 mechanisms of action , 111 antihistamines , 189 Mood-elevating nutraceuticals , 111–113 antimicrobials , 190 Muscle relaxants , 197 antipsychotics , 189 MYMOP2 . See Measure Yourself Medical barbiturates , 191 Outcome Profi le (MYMOP2) benzodiazepines , 192–193 Myo-inositol (MI) bronchospasmolytics/bronchodilators , 193 clinical effects , 95 cardiovascular drugs , 193–194 effi cacy, evidence of , 90 chemotherapeutics , 195–196 mechanisms of action , 90 dopaminergics , 196 hormone-based medication , 196 hypoglycaemics , 197 N immunosuppressants , 197 N-Acetylcysteine (NAC) muscle relaxants , 197 clinical effects , 95–96 NSAIDS , 198 effi cacy, evidence of , 93–94 opioids , 196 mechanisms of action , 93 proton-pump inhibitors , 198 n -3FAs . See Omega-3 polyunsaturated fatty Nutrition , 180 acids (n -3FAs) Nutritional medicines . See Nutraceuticals N -methyl-D-aspartate (NMDA) , 87 Nutritional supplementation , 180 N, N-Dimethyltryptamine (DMT) , 124, 126 Nonsteroidal anti-infl ammatory drugs (NSAIDS), 198 O Noradrenaline , 17 Obsessive-compulsive disorder (OCD) , 39, NSAIDS . See Nonsteroidal anti-infl ammatory 105 drugs (NSAIDS) MI , 91–92 Nutraceuticals NAC , 94 arginine OCD . See Obsessive-compulsive disorder benefi cial effects , 95 (OCD) effi cacy, evidence of , 89–90 Omega 3 fatty acids , 181 mechanisms of action , 89 Omega-3 polyunsaturated fatty acids B vitamins ( n -3FAs) , 107 effi cacy, evidence of , 84–87 effi cacy, evidence of , 108 mechanisms of action , 84 mechanisms of action , 107–108 lysine Open-fi eld test , 142 effi cacy, evidence of , 89–90 Opioids , 196 mechanisms of action , 89 magnesium bioavailability , 95 P effi cacy, evidence of , 88 Panic disorder , 91, 129 mechanisms of action , 87–88 Passifl ora incarnata . See Passionfl ower MI Passionfl ower clinical effects , 95 anxiolytic effects , 17–18 effi cacy, evidence of , 90 effi cacy, evidence of , 19 mechanisms of action , 90 mechanisms of action , 18 NAC negative cognitive effects , 26 clinical effects , 95–96 Perceived Stress Scale (PSS) , 39, 86 effi cacy, evidence of , 93–94 Pharmaceutical treatments , 2 mechanisms of action , 93 , 162 overview , 82–83 Piper methysticum . See Kava Index 207

Polyvalence , 3 Roseroot Post-traumatic stress disorder (PTSD) , 155 clinical studies , 40–41 diagnosis and treatment plan , 158–159 mechanisms of action , 40 discussion , 159 preclinical studies , 40 MI , 91 safety , 41 presenting complaint , 157–158 Potential herbal anxiolytics , 139 bitter orange , 142 S effi cacy, evidence of , 143 S-Adenosyl methionine (SAMe) , 84, 109 mechanisms of action , 142 effi cacy, evidence of , 109–110 in vivo studies , 142 mechanisms of action , 109 clinical considerations , 149–150 refractory depression with comorbid Echinacea /purple cone fl ower , 143 anxiety , 169 effi cacy, evidence of , 144–145 assessment of patient , 170–171 mechanisms of action , 143–144 diagnosis and treatment plan , 171–172 in vivo studies , 144 effective stand-alone and adjunctive Iranian borage , 145 antidepressant, 174 effi cacy, evidence of , 146 naturopathic approach , 173 mechanisms of action , 145 presenting complaint , 169–170 in vivo studies , 145 treatment outcome , 173 milk thistle , 147 Saffron , 106 effi cacy, evidence of , 147–149 effi cacy, evidence of , 106–107 mechanism of action , 147 mechanisms of action , 106 summary of , 140–141 psychiatric conditions , 110 Profi le of Mood States (POMS) , 69 Sage Proton-pump inhibitors , 198 effi cacy, evidence of PTSD . See Post-traumatic stress disorder anxiolytic properties , 70 (PTSD) cognitive function , 71 Purple cone fl ower , 143 mechanisms of action , 70 effi cacy, evidence of , 144–145 Salidroside , 40 mechanisms of action , 143–144 Salvia spp . See Sage in vivo studies , 144 SAMe . See S-Adenosyl methionine (SAMe) Santo Daime , 126, 129 Schisandra Q clinical studies , 47–48 Quality of Life Scale , 182 mechanisms of action , 47 preclinical studies , 47 safety , 48 R Scutellaria laterifl ora . See Skullcap Refractory depression , 169 . See Herbal anxiolytics assessment of patient , 170–171 Selective serotonin reuptake inhibitor diagnosis and treatment plan , 171–172 (SSRI), 12, 86, 130, 135 effective stand-alone and adjunctive Serotonin reuptake transporters , 128 antidepressant, 174 Siberian Ginseng naturopathic approach , 173 clinical studies , 45–46 presenting complaint , 169–170 mechanisms of action , 44–45 treatment outcome , 173 preclinical studies , 45 Registered medicines (AUST R) , 5 Silybum marianum . See Milk thistle Relaxation techniques , 180 S J W . See St John's wort (SJW) Rhodiolarosea . See Roseroot Skullcap Rosemary effi cacy, evidence of , 23 effi cacy, evidence of mechanisms of action , 22 anxiety , 72–73 Sleep disorders , 11 cognitive function , 72 Social phobia , 93–94, 105 mechanisms of action , 72 Somatoform disorders , 105 208 Index

SSRI . See Selective serotonin reuptake V inhibitor (SSRI) Valerian STAI . See State-trait-anxiety inventory clinical considerations , 25–27 (STAI) effi cacy, evidence of State-trait-anxiety inventory (STAI) , 43, 89, clinical studies , 24–25 129, 143 preclinical studies , 24 St John's wort (SJW), 104, 115 mechanisms of action , 24 effi cacy, evidence of sedative actions , 25 anxiety and psychiatric disorders , 105 Valeriana spp . See Valerian depression , 105 Vegetalismo , 126 mechanisms of action , 104 B12 , 109 Stress , 33 supplements , 177 diagnosis and treatment plan , 156 discussion , 156 presenting complaint , 156 W treatment outcome , 156 Withania somnifera (WS) . See Ashwagandha Substance dependence , 131–133 Synergism , 3 Y Yale-Brown Obsessive Compulsive Scale T (Y-BOCS) , 39, 91, 92, 94, 146, 148 Takiwasi programs , 131 Young Mania Rating Scale (YMRS) , 130 T e a effi cacy, evidence of clinical studies , 68–69 Z mechanisms of action , 64 Zinc , 110 preclinical studies , 68 clinical considerations , 111–115 Therapeutic Good Administration (TGA), effi cacy, evidence of , 111 Australia, 4 mechanisms of action , 111 , 159 Transient anxiety , 2

U U D V . See Uniao de Vegetal (UDV) Uniao de Vegetal (UDV) , 126