Because there is no cure for multiple sclerosis (MS), patients with chronic demyelinating disease often turn to herbal medications and dietary supplements to increase their prescribed medications, emphasizing the need for patient education in this space, in particular with increasing use of the latter. alternative treatments.
Results of a recent systematic review, published in Herbal medicine research, could serve as potential guidelines for the safety of mixing 14 conventional MS drugs (disease-modifying therapies) and herbal or supplement drugs, its authors note.
Following their review of 129 articles identified in PubMed and Web of Science up to October 31, 2019, the authors made recommendations on what to avoid, potential interactions to watch out for, and what is safe and not. had no significant drug interactions (DDI). The herbal medications and supplements they included were based on their appearance in the literature and the available information on interactions.
Cannabis use while taking selective serotonin reuptake inhibitors (SSRIs) or nonsteroidal anti-inflammatory drugs should be monitored due to the potential for interaction. For example, although taking a 400 mg dose of modafinil (Provigil), which is used off-label in patients with MS, plus a 15 mg dose of oral Δ9-tetrahydrocannabinol (THC) is considered As safe, chronic use of THC with aspirin, naproxen and indomethacin in vivo may reduce the effectiveness and potency of the latter.
Additionally, chronic cannabis use with SSRIs can lead to vasoconstriction, “suggesting that before prescribing drugs affecting serotonergic transmission, the patient’s cannabis use should be addressed,” the authors said.
Only clinically insignificant interactions were found for the simultaneous use of cytochromes P450 1A1, CYP1A2 and CYP1B1 and cannabidiol and cannabinol in vitro. No interactions were found between cannabis and CYP3A4.
The recommended daily doses of Panax ginseng and Ginko biloba should not be exceeded, note the authors. This is based on reports of bleeding events involving the brain and eyes with the concomitant use of ibuprofen and G biloba or aspirin and G biloba, respectively. G biloba The extract has also been shown to increase the hepatotoxicity of paracetamol in vitro.
For P ginseng, the authors found that a dose of 0.5 mL / kg of Panax notoginseng saponins significantly induce CYP1A2 activity in rats, but P ginseng the extract did not significantly affect CYP1A2 in vivo. In addition, no significant DDI was observed between drug metabolizing CYP enzymes and a purified ginseng extract in another study.
The authors recommend continued assessment of potential risks when patients consider higher doses of herbal remedies and supplements, with their review also covering recommendations for turmeric, ginger, cranberry, vitamin C, vitamin D. , fatty acids, probiotics, melatonin and glucosamine.
“The increasing use of herbal medicines and dietary supplements in patients with MS makes it crucial to establish the safety risks associated with the simultaneous use of disease-modifying drugs and herbal drugs and / or food supplements, ”they concluded. “The results of this review confirm the need for more studies regarding the interactions between MS-modifying drugs and herbal drugs and / or dietary supplements.”
Overall, the lowest risks of potential DDI were seen in patients taking conventional MS medications who also took ginger, cranberry, vitamin D, fatty acids, turmeric, probiotics or glucosamine.
Petersen MJ, Bergien SO, Staerk D. A systematic review of possible interactions for herbal drugs and dietary supplements used concomitantly with drugs that modify disease or relieve symptoms of multiple sclerosis. Phytother Res. Published online February 24, 2021. doi: 10.1002 / ptr.7050