Herb-drug interactions with Danshen (Salvia miltiorrhiza): a review on the role of cytochrome P450 enzymes

Xuelin Zhou; Kelvin Chan; John H.K. Yeung

doi:10.1515/dmdi-2011-0038

Article

Herb-drug interactions with Danshen (Salvia miltiorrhiza): a review on the role of cytochrome P450 enzymes

Xuelin Zhou , Kelvin Chan and John H.K. Yeung

Published/Copyright: March 2, 2012

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Drug Metabolism and Personalized Therapy

From the journal Volume 27 Issue 1

Abstract

Danshen, the dried root and rhizome of Salvia miltiorrhiza Bunge, is a widely used medicinal plant for the treatment of cardiovascular diseases in China and a complementary medicine in the West. Danshen is indexed in the 2010 ChinesePharmacopoeia, with more than 35 formulations and concoctions containing Danshen water-extracts, ethanolic extracts or their combination, which are rich in phenolic acids and different levels of tanshinones. There are rare reports on the adverse effects of Danshen preparations. It is, however, well-known that Danshen leads the anticoagulation failure of warfarin. The Danshen-warfarin interaction may be mediated via both pharmacodynamic and pharmacokinetic mechanisms. This review does not summarize recent progress, but the effects of Danshen and its active ingredients on the interactions of cytochrome P450 (CYP450) and drug transporters, as well as the analysis of ingredients, and the metabolism and pharmacokinetics that are related to these interactions. Tanshinones play significant roles in the inhibition and induction of several CYP450 isozymes. It can be concluded that precautions should be taken when using Danshen preparations rich in tanshinones for CYP-related herb-drug interactions.

Keywords: cytochrome P450; herb-drug interaction; probe substrate; Salvia miltiorrhiza; warfarin

Corresponding authors: John H.K. Yeung, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China Phone: +852 26096864, Fax: +; Kelvin Chan, Faculty of Pharmacy, The University of Sydney, NSW 2006, and Centre for Complementary Medicine Research, University of Western Sydney, Australia Phone: +61 2 91141485, Fax: +61 2 9351 4391,

Received: 2011-12-30

Accepted: 2012-2-6

Published Online: 2012-03-02

Published in Print: 2012-03-01

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https://doi.org/10.1515/dmdi-2011-0038

Keywords for this article

cytochrome P450; herb-drug interaction; probe substrate; Salvia miltiorrhiza; warfarin