Abstract:
BACKGROUND:In-depth information of potential drug-herb interactions between warfarin and herbal compounds with suspected anticoagulant blood thinning effects is needed to raise caution of concomitant administration. The current study aimed to investigate the impact of co-administration of pomegranate peel and guava leaves extracts, including their quality markers namely; ellagic acid and quercetin, respectively, on warfarin's in vivo dynamic activity and pharmacokinetic actions, in addition to potential in vitro cytochrome P450 enzymes (CYP) inhibition. METHODS:Influence of mentioned extracts and their key constituents on warfarin pharmacodynamic and kinetic actions and CYP activity were evaluated. The pharmacodynamic interactions were studied in Sprague Dawley rats through prothrombin time (PT) and International Normalized Ratio (INR) measurements, while pharmacokinetic interactions were detected in vivo using a validated HPLC method. Furthermore, potential involvement in CYP inhibition was also investigated in vitro on isolated primary rat hepatocytes. RESULTS:Preparations of pomegranate peel guava leaf extract, ellagic acid and quercetin in combination with warfarin were found to exert further significant increase on PT and INR values (p < 0.01) than when used alone (p < 0.05). Pomegranate peel extract showed insignificant effects on warfarin pharmacokinetics (p > 0.05), however, its constituent, namely, ellagic acid significantly increased warfarin Cmax (p < 0.05). Guava leaves extract and quercetin resulted in significant increase in warfarin Cmax when compared to control (p < 0.01). Furthermore, guava leaves extract showed a significant effect on changing the AUC, CL and Vz. Significant reduction in CYP2C8, 2C9, and 3A4 was seen upon concomitant use of warfarin with ellagic acid, guava leaves and quercetin, unlike pomegranate that insignificantly affected CYP activities. CONCLUSION:All combinations enhanced the anticoagulant activity of warfarin as the results of in vivo and in vitro studies were consistent. The current investigation confirmed serious drug herb interactions between warfarin and pomegranate peel or guava leaf extracts. Such results might conclude a high risk of bleeding from the co-administration of the investigated herbal drugs with warfarin therapy. In addition, the results raise attention to the blood-thinning effects of pomegranate peel and guava leaves when used alone.
journal_name
BMC Complement Altern Medjournal_title
BMC complementary and alternative medicineauthors
Alnaqeeb M,Mansor KA,Mallah EM,Ghanim BY,Idkaidek N,Qinna NAdoi
10.1186/s12906-019-2436-5subject
Has Abstractpub_date
2019-01-24 00:00:00pages
29issue
1issn
1472-6882pii
10.1186/s12906-019-2436-5journal_volume
19pub_type
杂志文章abstract:BACKGROUND:Dichrostachys cinerea (L.) Wight et Arn. (Mimosaceae) is largely used in ethno-medically across Africa, and mainly employed for the treatment of asthma in Ivory Coast and Gabon. The paper analyses the relaxation induced by the methanolic extract of D. cinerea (Edici) in the guinea-pig trachea preparations (G...
journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/1472-6882-11-23
更新日期:2011-03-17 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
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更新日期:2019-11-21 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/s12906-019-2735-x
更新日期:2019-11-12 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/1472-6882-14-146
更新日期:2014-05-04 00:00:00
abstract:BACKGROUND:Nigerian Cannabis sativa (hemp) causes male gonadotoxicity by inducing hyperprolactinemia, down-regulation of hypothalamic-pituitary-testicular axis, and oxidative stress. Benin republic hemp has been preferred by illicit users in Nigeria but its effect on male fertility is not understood. This study determi...
journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/s12906-019-2541-5
更新日期:2019-06-17 00:00:00
abstract:BACKGROUND:Punica granatum (pomegranate), an edible fruit originating in the Middle East, has been used as a traditional medicine for treatment of pain and inflammatory conditions such as peptic ulcer. The numerous risks associated with nonsteroidal anti-inflammatory drugs (NSAIDs) for treatment of pain and inflammatio...
journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/s12906-017-1555-0
更新日期:2017-01-14 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/1472-6882-14-98
更新日期:2014-03-12 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
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更新日期:2017-05-03 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/1472-6882-12-190
更新日期:2012-10-22 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/1472-6882-12-104
更新日期:2012-07-20 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章,随机对照试验
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更新日期:2013-03-08 00:00:00
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pub_type: 杂志文章
doi:10.1186/1472-6882-13-163
更新日期:2013-07-08 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
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更新日期:2016-07-26 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/s12906-015-0579-6
更新日期:2015-03-05 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/s12906-017-2023-6
更新日期:2017-12-13 00:00:00
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journal_title:BMC complementary and alternative medicine
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doi:10.1186/1472-6882-13-168
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journal_title:BMC complementary and alternative medicine
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更新日期:2014-06-18 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2006-07-07 00:00:00
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journal_title:BMC complementary and alternative medicine
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更新日期:2013-11-13 00:00:00
abstract:BACKGROUND:Few studies have investigated the prevalence and characteristics of potentially inappropriate Kampo medication use among elderly ambulatory patients taking any prescribed Kampo medications. METHODS:A retrospective cross-sectional study was conducted using electronic medical records. All patients aged 65 yea...
journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/s12906-018-2228-3
更新日期:2018-05-11 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/1472-6882-11-67
更新日期:2011-08-22 00:00:00
abstract:BACKGROUND:Isoflavones are naturally occurring plant chemicals belonging to the "phytoestrogen" class. The aim of the present study was to examine the effects of isoflavones obtained from Cordyceps sinensis (CSIF) on development of estrogen deficiency-induced osteoporosis in ovariectomized rats. METHODS:After the rats...
journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/1472-6882-14-484
更新日期:2014-12-13 00:00:00
abstract:BACKGROUND:Moringa stenopetala has been used in traditional health systems to treat diabetes mellitus. The aim of this study was to investigate the antidiabetic activity of aqueous ethanol and n-butanol fraction of Moringa stenopetala leaves in streptozotocin (STZ) induced diabetic rats. METHODS:The aqueous ethanol ex...
journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
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更新日期:2015-07-18 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/1472-6882-11-43
更新日期:2011-05-26 00:00:00
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journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/s12906-019-2640-3
更新日期:2019-09-05 00:00:00
abstract:BACKGROUND:Osteoarthritis (OA) is a degenerative joint disease that results in the destruction of cartilage. Edible Bird's Nest (EBN) extract contains important components, which can reduce the progression of osteoarthritis and helps in the regeneration of the cartilage. The present study aimed to investigate the effec...
journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
doi:10.1186/1472-6882-13-19
更新日期:2013-01-22 00:00:00
abstract:BACKGROUND:Complementary traditional Chinese medicine (TCM) has been used to treat patients with cerebral palsy (CP). However, large-scale surveys examining its use in the treatment of CP and associated disorders are lacking. METHODS:We enrolled 11,218 patients ≤ 18 years of age with CP in the Taiwanese National Healt...
journal_title:BMC complementary and alternative medicine
pub_type: 杂志文章
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更新日期:2017-03-14 00:00:00