Table 6: Herbal-Drug Interactions of Clinical Concern Herbal-Drug Interaction*
Interaction Rating by Lexicomp and the Natural Medicines Comprehensive Database
Implications for Dentistry
Green Tea – Antiplatelet or anticoagulant agents (aspirin and ibuprofen)
Risk rating = C Level of evidence = D Severity = High Occurrence = Unlikely Risk rating = B Level of evidence = B Severity = Moderate Occurrence = Possible Risk rating = C Level of evidence = D Severity = High Occurrence = Possible Risk rating = C Level of evidence = B Severity = Moderate Occurrence = Possible Risk rating = C Level of evidence = D Severity = Moderate Occurrence = Possible Risk rating = C Level of evidence = B Severity = Moderate Occurrence = Possible
Green Tea can increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.
Horehound – Glucose
Horehound might lower blood glucose. Be aware of use in patients with diabetes.
Turmeric – Antiplatelet or anticoagulant agents (aspirin and ibuprofen)
Turmeric can increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.
Turmeric – Glucose
Turmeric may lower blood glucose levels; be aware of use in patients with diabetes.
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)
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
D • Anecdotal evidence. • In vitro or animal study. • Theoretical based on pharmacology. 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
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