A Looming For Interactions between Indigenous and Prescription Drugs

Pawar M.P.¹*, Patil N.P.² and Baviskar D.T.¹

¹Institute of Pharmaceutical Education, Boradi Tal-Shirpur, Dist-Dhule

²Dr.P.R.Ghogrey Senior Science College, Dhule

ABSTRACT:

In our society, indigenous drugs are, not only used, but sometimes overused and often their use is combined with prescription chemical drugs. On the other hand, the physicians do not know about the concurrent use of indigenous drugs with prescription drugs. Sometimes these factors can lead to either, a therapeutic failure or, a drug interaction or, an accentuation of the known toxicities of the chemical prescription drugs. it is essential to advise the diabetic patients on oral hypoglycemic drugs to avoid the unsupervised concurrent self-treatment with these indigenous drugs to prevent hypoglycemia. It is also worthwhile to keep in view that proper monitoring of Ayurvedic and allopathic drugs have not become possible, so far. In present study, suggestion of proposing Ayurvedic Pharmacoepidemiology as a New Discipline seems to be defensible and with its proper functioning the above objectives can be achieved.

INTRODUCTION:

India has the most ancient heritage of traditional medicine. Though the allopathic drugs are very effective, traditional medicine is also very important part of health care. Herbal drugs are of great importance to the health of individuals and communities. Moreover commercially Ayurvedic drugs can make a dent in international market, which are walking towards alternative medicine for the ailments to which even allopathic system has no answer.

Diabetes with its complications is a disease showing a high mortality worldwide in line with other diseases such as cancer, cardiovascular disorders. The mortality of diabetes has persisted and there are many reports that the diabetic patients have a high risk of having some related complications in eye, kidney and heart. The symptoms of diabetes may vary but its main three complaints are excessive water intake, excessive urination and excessive food intake.

Object: The patients prefer the concurrent use of indigenous drugs with prescription drugs which can lead to drug interaction. Hence the object of this study to focus on this fact to avoid the severe drug interaction

DISCUSSION:

The indigenous agents which interact with oral hypoglycemic drugs and produce hypoglycemia are discussed here with its details.

Garlic (Allium sativum) a scientifically proven remedy for hyper-cholesterolemia has also shown anticoagulant effect and enhanced fibrinolytic activity in the various clinical trials.¹

Additive pharmacological actions of garlic and aspirin or, anticoagulants may lead to bleeding. Thus, it is essential to advise the patients on oral-anticoagulants and low dose aspirin to avoid unsupervised self-treatment with garlic. Detailed history revealed co-administration with phenytoin of an Ayurvedic preparation ‘Shankhapushpi’. An experimental trial has further confirmed that Shankhapusphi co-administration reduced the plasma phenytoin levels as well as the antiepileptic activity of phenytoin.²

In one such case, proper dietary history of the patient has revealed that ‘Karela fruit juice’ (Momordica charantia) was also being taken as self-treatment concurrently with chlorpropamide.³ Hypoglycemic action of Karela has been reported in the various experimental trials. The resultant hypoglycemia of such an interaction was due to an additive synergism in the pharmacological actions of Karela and chlorpropamide. Isapgula husk is a well known household remedy for diverse bowel disorders. In a clinical trial, the chronic use of this agent in adolescent girls has produced a reduction in plasma levels of iron and calcium by promoting their urinary excretion.⁴ Thus, in patient with iron deficiency anaemia and osteoporosis, it is essential to advise the patients to avoid the chronic use of isapgula husk to ensure therapeutic success of the supplemental therapy.

Liquorice (Glycyrrhiza glabra) a common household treatment for chronic cough, sore throat, gastritis etc. has active principles with a steroid-like structure and which possess mineralocorticoid activity in large doses. The chronic overuse of this agent or its derivatives have been reported to produce reversible hypertension, heart failure, oedema and hypokalaemia.⁵ The initial step in the management of these disorders is to stop the use of liquorice immediately besides, institution of proper drug therapy, otherwise, the chances of drug interactions or, therapeutic failure are there. Hypoglycemia has been sometimes reported in a diabetic patient even with a minimal dose of oral hypoglycemic drug.

Septilin (an Ayurvedic drug for inflammatory disorders and bacterial infection) co-administration with carbamazepine reduced carbamazepine (CBZ) plasma concentrations during the absorption phase.⁶ Ginkgo biloba (an Ayurvedic drug for diabetes mellitus related circulatory disorders, dementia, impotence etc.) co-administration with CBZ and sodium valproate reduced the plasma levels of these drugs.⁷ Caffeine intake has been shown to increase the plasma half-life (two-fold) and reduce the bioavailability by 32% of CBZ in normal human volunteers.⁸ Grapefruit juice resulted in significantly high peak, trough concentration and AUC of CBZ probably by inhibiting CYP3A4 enzyme in gut wall and liver.⁹ Thus, it is essential to advise epileptic patients to avoid unsupervised concurrent use of Shankhapushpi with phenytoin, Sptilin with CBZ, Ginkgo biloba with both CBZ and sodium valproate. The epileptic patients on CBZ should also be advised to restrict the use of caffeine/ xanthine and grapefruit juice. Fenugreek is a scientifically proven remedy for diabetes mellitus and it reduces insulin resistance.

There is experimental evidence that Fenugreek powder became ineffective in both normal and diabetic rats on concurrent administration of rifampicin suggesting that in clinical trials with use of Fenugreek the caution may be applied while using rifampicin in diabetic patients.¹⁰ Like drug-drug interactions, inter-system drug interactions sometimes, can also have desirable and useful outcomes. Co-administration of Regulipid, a herbal formulation with diethylcarbamazine has been reported to decrease chyluria in patients with filariasis.¹¹ In an experimental trial Liv 100 – a herbal preparation has been reported to protect against hepatotoxic effects of antitubercular drugs isoniazid, rifampicin and pyrazinamide.¹²

The actual incidence of such interactions is very high in our country which can be estimated from the facts:

1. More than 600 million people rely on Ayurvedic drugs who are more likely to combine their unsupervised use with prescription chemical drugs.¹³

2. ‘Country’ medicines (desi davai i.e. unofficial preparations of Ayurveda or Unani or unknown category) are sold openly and the number of people who use them is also very large.

3. The incidence of adulteration of Ayurvedic drugs with allopathic drugs is very high as, more than 50 percent of Ayurvedic drugs and 60 percent of drugs of unknown category have been reported to be adulterated with corticosteroids.¹⁴

4. Indications of Ayurvedic plants with no information about their adverse effects are highly advertised in media which further promote their unsupervised use with prescription chemical drugs.

5. Simultaneous prescribing of Ayurvedic and allopathic drugs by some doctors and practitioners of Indian System of Medicine can also result in interactions.

6. The reverse pharmacology path adopted for Ayurvedic drugs by the various research centers like ICMR, CSIR, DBT etc. can also lead to such interactions as, use of these drugs in patients is based on the rich biodiverse phytopharmacological leads from Ayurveda with little information about their active principles, pharmacokinetics, pharmacodynamics, adverse reactions etc.

CONCLUSION:

Thus, rational prescribing is not possible until and unless intersystem drugs interactions is prevented. ADR monitoring of Ayurvedic drugs, data collection of desirable intersystem drugs interactions are essential and useful information must be imparted to medical graduates, postgraduates and medical practitioners. Free sale of unofficial Ayurvedic preparations should be prohibited. Good quality control of Ayurvedic drugs should be ensured to prevent their adulteration. But, the problem is which discipline should be made responsible for achieving the desired goals? It is also worthwhile to keep in view that proper monitoring of allopathic drugs have not become possible, so far. In present study, implication of intended Ayurvedic Pharmacoepidemiology as a New Discipline seems to be justified and with its proper accomplishment the preferred objectives can be achieved.

REFERENCES:

1. Sheela, C.G.; Augusti, K.T. Antidiabetic effects of S-allyl cysteine sulphoxide isolated from garlic Allium sativum Linn. Indian J. Exp. Biol. 1992; 30:523–526.

2. Kshirsagar NA, Dalvi SS, Joshi MV, et al. Phenytoin and Ayurvedic preparation - clinically important interactions in epileptic patients. JAPI 1992; 40:354-5.

3. Rahane AL, Gattani SG. Food-drug interaction - a case study: in proceedings of International conference of society of Pharmacovigilance India, on 8-9 feb, 2002 at SN MedicalCollege, Agra.

4. Rai J, Singh J. Isapgula Husk - an update article. JAPI2002;50:576-7.

5. Rai J. Liquorice : Useful/Harmful. The Indian Practitioner 1998;51: 840.

6. Garg SK, Islam AS, Kumar N. Effect of Septilin - a herbal preparation on pharmacokinetics of carbamazepine in rabbits. Indian J Physiol Pharmacol 1998; 42:527-33.

7. Manocha A, Pillai KK, Husain Z. Influence of Ginkgo biloba on the effect of anticonvulsants. Indian J Pharmacol 1996; 28:84-7.

8. Vaz J, Kulkarni C, David J, Joseph T. Influence of caffeine on pharmacokinetic profile of sodium valproate and carbamazepine in normal human volunteers. Indian J Exp Bio 1998; 36:112-4.

9. Garg SK, Kumar N, Bhargava VK, Prabhakar SK. Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy. Clinic Pharmacol Therap 1998;64:286-8.

10. M AL-Habori and A Raman. (1998) Antidiabetic and hypocholesterolaemic effects of fenugreek Phytotherapy Research, 12, 233-242.

11. Saraswathy SD, Suja V, Gurumurthy P, Shyamala Devi CS. Effect of Liv 100 against antitubercular drugs (isoniazid, rifampicin and pyrazinamide) induced hepatotoxicity in rats. Indian J Pharmacol 1998;30:233-8.

12. Samal KK, Panda RS, Parija BL, et al. Herbal preparation in treatment of chyluria of filarial origin. JAPI 1995;43:876.

13. Vaidya ADB, Vaidya RA, Nagral SI. Ayurveda and different kind of evidence: From Lord MacCaulay to Lord Walton (1835 to 2001 AD). JAPI 2001; 49:534-7.

14. Bhatia A, Gupta U, Tayal G. Adulteration of drugs of alternative systems of medicine with corticosteroids. JAPI 2003; 51:634.

Received on 15.03.2011

Accepted on 14.04.2011

© A&V Publication all right reserved

Research Journal of Pharmaceutical Dosage Forms and Technology. 3(3): May-June 2011, 93-95