Table 8: Additional Herbal-Drug Interactions of Note Herbal-Drug Interaction
Interaction Rating by Lexicomp and the Natural Medicines Comprehensive Database
Implications for Dentistry
Acacia – Amoxicillin
Risk rating = D Level of evidence = B Severity = Moderate Occurrence = Likely Risk rating = C Level of evidence = C Severity = High Occurrence = Probable Risk rating = X Level of evidence = C Severity = Moderate Occurrence = Likely Risk rating = C Level of evidence = C Severity = High Occurrence = Probable Risk rating = X Level of evidence = B Severity = High Occurrence = Probable Risk rating = B Level of evidence = A Severity = High Occurrence = Probable Risk rating = C Level of evidence = B Severity = High Occurrence = Probable Risk rating = B Level of evidence = B Severity = Moderate Occurrence = Possible Risk rating = C Level of evidence = B Severity = High Occurrence = Probable Risk rating = X Level of evidence = B Severity = High Occurrence = Probable Risk rating = D Level of evidence = B Severity = High Occurrence = Probable Risk rating = C Level of evidence = A Severity = High Occurrence = Probable Risk rating = C Level of evidence = B Severity = High Occurrence = Probable Risk rating = X Level of evidence = B Severity = High Occurrence = Probable
Acacia can reduce the absorption of amoxicillin.
Alcohol – Acetaminophen
Alcohol-containing beverages taken with acetaminophen can increase the risk of hepatotoxicity.
Alcohol – Metronidazole
Metronidazole can cause a disulfiram-like reaction when taken with alcohol.
Alcohol – CNS* depressants (codeine, hydrocodone, oxycodone, alprazolam, diazepam, lorazepam, midazolam, triazolam, zaleplon, zolpidem, and diphenhydramine) Arsenic – Macrolide antibiotics (azithromycin, clarithromycin, and erythromycin)
Alcohol can increase the risk of drowsiness and motor reflex depression when combined with other CNS depressants. Arsenic could have an additive effect with macrolide antibiotics and prolong the QT interval, causing ventricular arrhythmias.
Berberine – Glucose
Berberine might lower blood glucose. Be aware in diabetic patients.
Bitter orange – Midazolam
Bitter orange juice can significantly inhibit CYP3A4 metabolism of midazolam and increase drug levels and the risk for adverse effects. Cinnamon may lower blood glucose levels; be aware of use in patients with diabetes. Cocoa can inhibit platelet adhesion, aggregation, and activity, increasing the risk of bleeding. Ephedra could have an additive effect with macrolide antibiotics and prolong the QT interval, causing ventricular arrhythmias.
Cinnamon – Glucose
Cocoa – Antiplatelet or anticoagulant drugs (aspirin and ibuprofen)
Ephedra – Macrolide antibiotics (azithromycin, clarithromycin, and erythromycin)
Grapefruit juice – CYP3A4 substrates (clarithromycin, erythromycin, clindamycin, hydrocodone, lidocaine, alprazolam, diazepam, midazolam, triazolam, zaleplon, and zolpidem) Kava – CNS depressants (codeine, hydrocodone, oxycodone, alprazolam, diazepam, lorazepam, midazolam, triazolam, zaleplon, zolpidem, and diphenhydramine) l-Tryptophan – CNS depressants (codeine, hydrocodone, oxycodone, alprazolam, diazepam, lorazepam, midazolam, triazolam, zaleplon, and zolpidem) Sida cordifolia – Macrolide antibiotics (azithromycin, clarithromycin, and erythromycin)
Grapefruit juice can inhibit cytochrome CYP3A4 metabolism of drugs, causing increased drug levels.
Kava can increase the risk of drowsiness and motor reflex depression when combined with other CNS depressants. l-Tryptophan can increase the risk of drowsiness and motor reflex depression when combined with other CNS depressants. Sida cordifolia could have an additive effect with macrolide antibiotics and prolong the QT interval, causing ventricular arrhythmias.
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