Page 142 - 2018 SP Product Guide
P. 142

Recommended Action  Take at least 2 hours away from medication.  Monitor (medium level of risk).  Monitor (low level of risk).  Monitor (medium level of risk).  In patients with known clopidogrel  resistance: Monitor (medium level of risk). In other patients: Monitor (risk is unknown).  Contraindicated.  Contraindicated.  Monitor (medium level of risk).  Hyperforin-rich extracts:   Monitor (medium level of risk).  Low-hyperforin extracts:   Monitor (low level of risk).
























                     Theoretical concern based on absorbent properties of slippery elm. Theoretical concern. An open clinical trial demonstrated no effect on carbamazepine pharmacokinetics in healthy  volunteers. 266  Case report: increase in seizures in patient taking several antiepileptic drugs, two of which are not  metabolized by cytochrome P450. 267  Clinical study (healthy volunteers; clinical significance unclear): increased  excretion of a mephenytoin metabolite in extensive












               Basis of Concern  Clinical study.  Clinical studies. 269,270  Clinical study. 276  extracts. 270,280,283,284  Nifedipine: Clinical studies. 113,286  Verapamil: Clinical study. 287  Clinical studies. 288-291  Case report. 292  patient with benign prostatic hyperplasia. 298  Case report. 299  Clinical study. 300













               Potential Interaction  May slow or reduce absorption of drugs. St John’s Wort GG   Hypericum perforatum  (See also Tannin-containing herbs)  Decreases drug levels. 262  May decrease drug levels via CYP   induction. 263-265  Decreases drug levels. Clopidogrel: May potentiate effects of drug.  Phenprocoumon: Decreases plasma drug   levels. Warfarin: Decreases drug levels and INR.  Decreases drug levels, and is probably  dependent upon the hyperforin content. 280  Decreas






                   Slippery Elm Bark  Ulmus rubra  Anticonvulsants eg carbamazepine,  mephenytoin, phenobarbitone,   Antihistamine eg fexofenadine  Antiplatelet and anticoagulant   Calcium channel antagonists   Cancer chemotherapeutic drugs    Docetaxel (intravenous)  HIV non-nucleoside transcriptase   inhibitors eg nevirapine  HIV protease inhibitors eg indinavir










               Drug  Prescribed medication  Amitriptyline  phenytoin  drugs  Benzodiazepines  eg irinotecan, imatinib  Clozapine  Digoxin  Finasteride




                                                                         Herb-Drug Interaction Chart • MediHerb  Product Catalog 2018  141
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