Table 6: Herbal-Drug Interactions of Clinical Concern
Interaction Rating by Lexicomp and the Natural Medicines Comprehensive Database
Herbal-Drug Interaction* Turmeric – CYP3A4 substrates (clarithromycin, clindamycin, erythromycin, dexamethasone, hydrocodone, lidocaine, alprazolam, diazepam, midazolam, and triazolam) Valerian – CYP3A4 substrates (clarithromycin, clindamycin, erythromycin, dexamethasone, hydrocodone, lidocaine, alprazolam, diazepam, midazolam, and triazolam)
Implications for Dentistry
Risk rating = C Level of evidence = D Severity = Moderate Occurrence = Possible Risk rating = C Level of evidence = B Severity = Moderate Occurrence = Possible
Turmeric can inhibit CYP3A4 and increase levels of drugs metabolized by this enzyme.
Valerian can inhibit CYP3A4 and increase levels of drugs metabolized by this enzyme.
*Readers may consult the sections in which individual herbs are discussed for more details about their interaction with cytochrome isoenzymes. Note . Adapted from “Lexicomp Online for Dentistry, by Wolters Kluwer, n.d., retrieved from http://webstore.lexi.com/ONLINE-Software- for-Dentists; and “About Natural Medicines Comprehensive Database,” by the Natural Medicines Comprehensive Database, n.d.a, retrieved from http://naturaldatabase.therapeuticresearch.com/Content.aspx?cs=&s=ND&page=aboutdbhtml&xsl=generic#ratings
Table 7: Descriptions of Levels of Evidence Level of Evidence Description A
• High-quality randomized controlled trial. • High-quality meta-analysis (quantitative systematic review).
• Nonrandomized clinical trial. • Nonquantitative systematic review. • Lower-quality randomized controlled trial.
B
• Clinical cohort study. • Case-control study. • Historical control. • Epidemiologic study.
• Consensus. • Expert opinion.
C
• Anecdotal evidence. • In vitro or animal study. • Theoretical based on pharmacology.
D
Note. Adapted from “About Natural Medicines Comprehensive Database,” by the Natural Medicines Comprehensive Database, n.d.a, retrieved from http://naturaldatabase.therapeuticresearch.com/Content.aspx?cs=&s=ND&page=aboutdbhtml&xsl=generic#ratings MEDICAL AND DENTAL IMPLICATIONS FOR DRUG INTERACTIONS WITH SPECIFIC HERBAL MEDICATIONS
A similar list of the herbal supplements not known to be involved in any significant herbal-drug interactions includes: ● Aloe vera. ● Beta-sitosterol. ● Cannabidiol (CBD). ● Cranberry. ● Garlic. ● Ivy leaf.
Of the top 20 most common herbal medications that OHCPs are likely to encounter (shown in Table 1) and the list of drugs commonly used in dentistry (shown in Table 2), the medications that are not known to be involved in any significant herbal-drug interactions include: • Azithromycin. • Cephalexin.
• Benzocaine (topical). • Dyclonine (topical). • Lidocaine (topical). • Tetracaine (topical). • Albuterol. • Epinephrine.
• Chlorhexidine (topical). • Clotrimazole (topical). • Fluconazole. • Metronidazole.
● Red rice yeast. ● Saw palmetto. ● Wheat grass/Barley grass.
• Flumazenil. • Naloxone. • Nitroglycerine. • Oxygen.
• Nystatin. • Penicillin. • Articaine. • Epinephrine
In other words, these drugs and herbal medications may be considered the safest supplements from the lists in Tables 1 and 2.
Elderberry Orally, elderberry is used for influenza (the flu) and H1N1 “swine” flu. It is also used as a laxative; as a means to stimulate immune function (for example, in patients with
HIV/AIDS); as a means to control pain, such as that seen with chronic fatigue syndrome, allergic rhinitis, sinusitis, sciatica, neuralgia, and cancer; and as a diuretic and
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