Page 140 - 2018 SP Product Guide

Recommended Action Avoid long-term use at doses > 100 mg/day glycyrrhizin unless under close supervision. U Place patients on a high potassium diet. Monitor (low level of risk at normal doses). Contraindicated unless under close supervision at doses > 40 mg/day glycyrrhizin. Monitor (medium level of risk) in hepatically- impaired patients. Monitor (low level of risk at normal doses). Monitor (low level of risk at normal doses). Avoid long-term use at doses

Case report (patient taking herbal laxative containing licorice (1.2 g/day) and rhubarb (Rheum spp., 4.8 g/day)).
high dose, however effect has been demonstrated in sensitive individuals at low doses (licorice containing
Hypokalemia demonstrated in case reports and clinical studies, usually from long-term intake and/or very
100 mg/day of glycyrrhizin). Side effects would be common at 400 mg/day of glycyrrhizin. 179,207,208

In addition to digoxin, patient was also taking a potassium-depleting diuretic. 209

reduced side effects related to the diuretic activity of drug. 210 Clinical study: in women with PCOS addition of licorice extract (containing about 463 mg/day glycyrrhizin) Hypokalemia demonstrated in case reports and clinical studies, usually from long-term intake and/or very high dose, 179,207,208 however effect has been demonstrated in patients for ongoing treatment with herbal medicines containing glycyrrhizin at doses of 80–240 mg/day. 211 C

Basis of Concern Herb Alone Herb and Drug Herb or Constituent Alone Herb and Drug first week. 219 Herb Alone dosage unknown). 220

Potential Interaction May cause hypokalemia which can potentiate the toxicity of the drug. Spironolactone (potassium-sparing diuretic): Reduce side effects of drug. Thiazide and loop (potassium-depleting) diuretics: The combined effect of licorice and the drug could result in excessive potassium loss. 9 May decrease drug clearance. May decrease drug level. May decrease drug level. May result in excessive potassium loss. May slow or reduce absorption of drug

Immunosuppressives eg sirolimus Potassium-depleting drugs other than thiazide and loop diuretics eg corticosteroids, stimulant laxatives Marshmallow Root Althaea officinalis Prescribed medication Hypoglycemic drugs including Immunosuppressives eg sirolimus

Drug Digoxin Diuretics Midazolam Omeprazole Warfarin insulin Losartan Metronidazole Nifedipine Ornidazole Talinolol

Herb-Drug Interaction Chart • MediHerb Product Catalog 2018 139
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