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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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