Multiple drugs interaction
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Various toxicities: case report A 38-year-old woman developed fatigue, nervousness, heart palpitation, rash and muscle twitching following concomitant administration of copper/gugulipid/manganese/pantothenic-acid/potassium-iodide/selenium/tyrosine/withania-somnifera, dioscorea-villosa/rubus-idaues/scutellaria-lateriflora/serenoa-repens/silybum-marianum/vitex-agnus-castus, unspecified multivitamin and progesterone for hormone disorder [not all dosages and routes stated]. The woman, who had hormone disorder, developed adverse events including fatigue, heart palpitation, nervousness, rash and muscle twitching. At the onset of events, she had started receiving dioscorea-villosa/rubus-idaues/scutellaria-lateriflora/serenoarepens/silybum-marianum/vitex-agnus-castus [femMED] capsule four times a day. Prior to the event, she was also taking an unspecified multivitamin along with green tea extract twice a day for about one year, and a topical progesterone 100mg cream (compounded in the pharmacy) once daily for around 5 months. It was suggested that, she may have reacted badly to scullcap and wild yam, which was present in dioscorea-villosa/rubus-idaues/scutellaria-lateriflora/serenoa-repens/silybum-marianum/vitexagnus-castus product. Hence, she was started on copper/gugulipid/manganese/pantothenic-acid/potassium-iodide/selenium/ tyrosine/withania-somnifera [Thyrosense] capsule four times a day at that time. However, the adverse events continued. The woman’s herbal medications were stopped as per the physicians advice, after which the adverse events resolved. After some time following medications discontinuation, she experienced unspecified adverse events following consumption of a cup of green tea. A pharmacokinetic interaction between vitamins, herbal medicines and progesterone was suspected. Further in vitro analysis was performed to valuate the potential of these products to affect CYP-mediated metabolism. The analysis revealed that both herbal medications and vitamins have potential to inhibit the P450-mediated metabolism, that affect disposition of progesterone leading to pharmacokinetic interaction [duration of treatments to reaction onsets not stated]. Tam TW, et al. Inhibition of human cytochrome P450 metabolism by blended herbal products and vitamins. Journal of Pharmacy and Pharmaceutical Sciences 14: 1-16, No. 803497954 1, Jan 2011. Available from: URL: http://doi.org/10.18433/j3n30w
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Reactions 22 Aug 2020 No. 1818
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