UNIT-II

Nutraceuticals
General aspects, Market, growth, scope and types of products available in the market. Health
benefits and role of Nutraceuticals in ailments like Diabetes, CVS diseases, Cancer, Irritable
bowel syndrome and various Gastro intestinal diseases.
Study of following herbs as health food: Alfaalfa, Chicory, Ginger, Fenugreek, Garlic,
Honey, Amla, Ginseng, Ashwagandha, Spirulina
Herbal-Drug and Herb-Food Interactions:
General introduction to interaction and
classification. Study of following drugs and their possible side effects and interactions:
Hypercium, kava-kava, Ginkobiloba, Ginseng, Garlic, Pepper & Ephedra.

Nutraceuticals:
A food or naturally occurring food supplement thought to prevent disease or have other
beneficial effects on human health. Also called functional food.
Any food or part thereof with medicinal or health benefits, which includes vitamins and herbal
products.
Nutraceutical deriving from ‘nutrition and ‘pharmaceutical ’, broadly a food or part of a food
that provides medical or health benefits, including disease treatment and prevention.
Nutraceuticals range from specific nutrients, to dietary supplements, herbal products and
processed foods and include beta-carotene, fish oil, garlic, green tea, oat bran, olive oil and
various herbs. Sometimes called functional foods.
Classification of Nutraceuticals:
Nutrition + Pharmaceuticals Term commonly used in marketing but has no regulatory definition.
Term coined by Dr.Stephen L De Felice, Founder and Chairman of the Foundation for
Innovation in Medicine, New Jersey, USA.
A nutraceutical is any substance considered as a food, or its part which, in addition to its normal
Definition Of Nutraceuticals… nutritional value provides health benefits including the
prevention of disease or promotion of health • Eg:lycopene, beta carotene.
A nutraceutical is “any non-toxic food component that has scientifically proven health benefits,
including disease treatment or prevention.”
Definition: The functional component of the food must be standardized in the nutraceutical
product and produced under good manufacturing practices (GMPs).
Classification 1. Nutraceuticals Based On Their Source:
Plants •Tomato •Garlic •Momordica
Animals •Shark liver oil •Cod-liver oil
Minerals •Calcium •Magnesium •Phosphorus
Micro-Organism •Bifidobacterium •Lactobacilli
Nutraceuticals used in various disease condition Conditions Nutraceuticals •
Allergy relief •Ginkgo biloba •Arthritis support •Glucosamine •
Cancer prevention •Flax seed , Green tea
•Cardiac disease •Garlic •Cholesterol lowering •Garlic •Digestive support •Digestive enzymes
•Diabetic support •Female hormone support •Immunomodulators •Garlic , Momordica
Nutraceuticals As Per The Chemical Groupings CLASS/CHEMICAL GROUPINGS
Examples •Inorganic mineral supplements •Minerals
• Vitamin supplements •Vitamins
•Digestive enzymes • Enzymes •Probiotics •Helpful bacteria •Prebiotics •Digestive enzymes
•Dietry fibers • Fibers-fruits, cereals
1. Class/Chemical Groupings Examples :
Cereals and grains Wheat, Soya bean Health drinks Fruit juice and vitamins Poly
unsaturated fatty acids PUFA Fish oil Antioxidants Natural antioxidants
2. Phytochemicals- a) Flavonoids- b) Isoprenoids- c) Proteins
3. Bioflavonoids
4. Carotenoids
5. Soya proteins

Carotenoids : One of the most widespread groups of naturally occurring pigments. These
compounds largely are responsible for the red, yellow and orange color of fruits and vegetables
and also are found in many dark green vegetables
Coffeic acid : An acid obtained from coffee tannin, as a yellow crystalline substance.
Arteriosclerosis: Condition in which the walls of arteries become hard and thick, sometimes
interfering with blood circulation.
Antioxidant: A substance that blocks or inhibits the actions of free radicals, molecules that speed
up the aging process and contribute to illness. Free radicals are found in rancid fats and oils and
environmental hazards
Amino acid: One of the building blocks of protein.
Complementary and alternative medicine (CAM): A group of diverse medical and health care
systems, practices and products that presently are not considered part of conventional medicine.
Complementary medicine is used together with conventional medicine. Alternative medicine is
used in place of conventional medicine
 A process that wraps or binds the minerals in amino acids, it uses an agent, such as the
chemical compound EDTA, to remove heavy metals from the body. Chelation
Genetically engineered food: A food substance that has foreign genes inserted into its
genetic code.
Genetic engineering can be done with plants, animals or microorganisms. Scientists can move
desired genes from one plant into another and even from an animal to a plant, or vice versa.
Ferulic acid: A compound, C10H10O4, related to vanillin and obtained from certain plants.
Flavanoids: A class of water-soluble plant pigments.  A complex protein produced by cells that
acts as a catalyst in specific biochemical reactions. Enzyme
Isoflavones: A class of organic compounds and bio molecules related to the flavonoids . They
act as phytoestrogens , which are thought by many to be useful in treating cancer
Phenols: Also known under the older name of carbolic acid, a colorless crystalline solid with a
typical sweet tarry odor. Nutrient: Any substance that can be metabolized by an organism to
give energy and build tissue.
Mineral: A naturally occurring inorganic substance with a definite and predictable chemical
composition and physical properties.  Sulfur-containing compounds that largely are responsible
for the typical flavor of cruciferous vegetables. sothiocyanates
Polyols: Chemical compounds containing multiple hydroxyl groups. Sugar alcohols, a class of
polyols, commonly are added to foods because of their lower caloric content Plant stanols and
sterols : Essential components of plant cell membranes that resemble cholesterol structurally.
Plant sterols are present naturally in small quantities in many fruits, vegetables, nuts, seeds,
cereals, legumes, vegetable oils and other plant sources. Plant stanols occur in even smaller
quantities than plant sterols in many of the same sources.  Compounds that occur naturally in
plants (phyto) and under certain circumstances can have actions like human estrogen.
Phytoestrogens
Thiols: Compounds containing the functional group composed of a sulfur atom and a hydrogen
atom. Vitamin: An org Sulfides: Refers to several types of chemical compounds containing
sulfur.  Saponins: Any of various plant glucosides that form soapy lathers when mixed and
agitated with water. They are used in detergents, foaming agents and emulsifiers.  Probiotics:
Dietary supplements containing potentially beneficial bacteria or yeast.  Food substances that
promote the growth of certain bacteria (generally beneficial) in the intestines. Prebiotics anic
substance essential in small quantities to normal metabolism.
Dietary Supplements : Probiotics, Prebiotics, Antioxidants, Enzymes, etc
Herbals/Phytochemicals : Herbs or Botanical products  Nutrients : Substances which have
established Nutritional functions e.g. Vitamins, Minerals, Amino Acids, Fatty acids, etc.
Most common Nutrients used/ supplemented as Nutraceutical are: Minerals and Vitamins.
OR in combination OR in combination with other antioxidantsNUTRIENTS
Vitamin D: Essential for formation of bones and teeth, helps the body to absorb and use
calcium. Vitamin A :Acts as antioxidant, essential for growth and development, maintains
healthy vision, skin and mucous membranes, may aid in the prevention and treatment of certain
cancers and in the treatment of certain skin disorders. Vitamins Fat Soluble Vitamins
Vitamin E : Antioxidant, helps to form blood cells, boosts immune system Vitamin K :
Essential for Vitamin B 2 : Energy metabolism, maintain healthy eye, skin and nerve function.
Vitamin B 1 : Helps in carbohydrate metabolism, essential for neurological function.  Vitamin
C : Antioxidant, necessary for healthy bones, gums, teeth and skin. Helps in wound healing,
prevent from common cold. Water Soluble Vitamins blood clotting.
Vitamin B 12 : Help in producing genetic material, formation of RBC, maintenance of CNS,
synthesis of amino acids, involved in metabolism of protein, fat and carbohydrate. Vitamin B 6
: Helps to produce essential proteins, convert proteins in to energy.
Vitamin B 3 : Energy metabolism, brain function
Pantothenic acid : Aids in synthesis of cholesterol, steroids, and fatty acids, crucial for
intraneuronal synthesis of acetylcholine Folic acid : Helps in RBC formation, formation of
genetic material of cell, very much essential during pregnancy
Taurine : Helps in retinal photoreceptor activity, bile acid conjugation, WBC antioxidant
activity, CNS neuromodulation, platelet aggregation, cardiac contractibility, sperm motility,
insulin activity . Inositol : For amino acid transport and movement of Potassium and sodium. 
Choline : Lipotropic agent, used to treat fatty liver and disturbed fat metabolism .  L-
Carnitine : Helps in oxidation of fatty acids, role in oxidative phosphorylation . Vitamins like
Compounds
Phosphorous : energy production, phosphorylation process, bone and teeth, for genetic
material. Magnesium : for healthy nerve and muscle function, bone formation.  Iron : Helps in
energy production, helps to carry and transfer oxygen to tissues.  Calcium : essential for
building bone and teeth and maintaining bone strength,important in nerve, muscle and glandular
function. Minerals
Chromium : with insulin it helps to conversion of carbohydrate and fat into energy. Copper :
essential for Hb and collagen production, healthy function of heart, energy production,
absorption of Iron from digestive tract. Iodine proper gland, function of Thyroid .  Cobalt :
essential component of Vit. B 12,but ingested cobalt is metabolised in vivo to form the B 12
coenzymes.
Trace Elements
Zinc: Essential for cell reproduction, for development in Neonates, wound healing, production of
sperm and testosterone hormone, Selenium: Antioxidant, functioning of heart muscle, part of
GPX Ginger: carminative, antiemetic, treatment of dizziness Garlic: Antibacterial, antifungal,
antithrombotic, antiinflammatory,  Evening Primrose oil: Dietary supplement of linoleic acid,
treatment of atopic eczema,  Aloe vera: Anti-inflammatory, emollient, wound healing,
Herbals enzyme,
Vegetables, fruits, whole grain, herbs, nuts and various seeds contain an abundance of phenolic
compounds, terpenoids, sulphur compounds, pigments etc. that has been associated with
protection / treatment of certain disease conditions, Green tea: Antioxidant, reduces risk of
CVD, enhances humoral and cell mediated Immunity,  Ginseng: Adaptogen,

Phytochemicals could provide health benefits as:

1. Substrate for biochemical reactions
2. Cofactors of enzymatic reactions
3. Inhibitors of enzymatic reactions
4. Absorbents that bind toPhytochemicals & eliminate undesirable constituent in the intestine
5. Scavengers of reactive or toxic chemicals,
6. Enhance the absorption and / or stability of essential nutrients
7. Selective growth factor for beneficial bacteria
8. Fermentation substrate for beneficial bacteria
9. Selective inhibitors of deleterious intestinal bacteria,Diet rich in nutraceuticals along with
regular exercise, stress reduction and maintenance of healthy body weight will maximise health
and reduce disease risk. Manipulating the foods, the concentration of active ingredients can be
increased.  Concentration, time and duration of supply of nutraceuticals influence human
health.  Nutraceuticals are present in most of the food ingredients with varying concentration .

1- Alfalfa •Syn: Wilayati gawuth, lusan

•Source: dried seeds & whole flowering plant of Medicago sativa •Family: Leguminosae

Constituents: •Leaves: Carotenoids, Triterpenoid saponin (medicagenic acid),isoflavonoids

(genistein, daidzein) •Seeds: L-canavaine, betaine, trigonelline •Protein, amino acids, Vitamins,
minerals , enzymes.
Indications: •Principal: Hypercholesterolemia; source of nutrients including vitamins •Major:
Diabetes; malfunctioning of thyroid gland •Minor: Kidney, bladder & prostate disorders: asthma
& arthritis •Contraindications: •History of SLE, children under 18, pregnant & breast feeding
•Dose: 5-10 g dried herb three times daily; 5-10 ml liquid extract 1:1 in 25% alcohol, three times
daily •Classical Use: •Nutritive, digestive aid, ulcer, nervousness & insomnia

2-Chicory

•Syn: Kaasani •Source: dried leaves & roots of Cichorium intybus

•Family: Compositae •GS: Europe, US, Canda

•Constituents: escutetin glycoside: flavonoids, tannin, triterpenoids, unsaturated sterols,

umbeliferon, scopoletin •Indications: •Principal: loss of appetite & dyspepsia •Other: Jaundice,
gall bladder, liver problem, intestinal worms & diabetes

•Dose: •Infusion: 2-4 g single •Powder: 3 g daily

3-Fenugreek •Syn: Medhika, Methi

•Source: dried ripe seeds of Trigonella foenum- graecum •Family: Leguminosae
•GS: tropical-subtropical region
•Constituents: Steroidal saponin, fenugreekine, trigonellin, diosgenin •Indication:
•Principal: diabetes, hyperlipidemia, hypercholesterolemia, •Major: Digestive aid,
increase milk production, ulcer, •Minor: upper respiratory tract infection, menopausal
symptoms, arthritis
•External: •Local inflammation, wound, burn, eczema and boils •Dose: •Internal: 6 g of
drug •External: 50 g of drug in 250 ml water
4- Garlic •Syn: Lasun •Source: dried bulbs of Allium sativum •Family: Liliaceae
•GS: Central asia, India
•Constituents: sulphur containing compounds disulphides: allicin, allyl propyl disulphide,
diallyldisulphide oxide, inorganic materials, methyl allyl trisulphide, scordinins, selenium
•Indication: •Principal: hypertension, diabetes, hypercholesterolemia, hyperlipidaemia, •Major:
ear infection, vaginitis, helicobacter pylori infection, cold •Minor: GI aid, spasm, digestive aid,
flatulence •Contraindication: •10 days before elective surgery •Dose: •One fresh garlic clove 1
to 2 times daily •4 g of garlic •8 ml of essential oil.
5- Honey •Syn: Madhu •Source: sugar secretion deposited in honey comb by bees Apis
mellifera, Apis dorsata •Family: Apidae Order: Hymenoptera
•GS: Africa, Australia, New Zealand, India, California
•Constituents: glucose, fructose, sucrose, maltose, gum, traces of succinic acid, acetic
acid, dextrin, formic acid, coloring mattervitamin traces, •pollen grain •Enzyme: Invertase,
diastase, inulase •Proteins
•Indication: nutritive, in cough
6- Amla •Syn: Amalaki, Indian gooseberry •Source: dried ripe fruits of Phyllanthus emblica
•Family: Euphorbiaceae
•GS: India, Srilanka, Myanmar
•Constituents: Hydrolysable tannins: Gallic acid, Ellagic acid, vitamin C, amino acids,
phyllemblin
•Indication: As a rejuvenative herb, it nourishes body tissues and accelerates the cell
regeneration process. •As a powerful antioxidant, Emblic Myrobalan helps scavenge free
radicals linked to premature aging. •It helps in building the body’s immune system and
provides resistance against many diseases, especially those of the respiratory tract.
7- Ginseng •Syn: Ninjin •History: human body root
•Source: dried roots of Panax ginseng (Korea), Panax quinquefolium (US)
•Family: Araliaceae
•Constituents: •Ginsenosides: dammarol •Panaxosides: oleanic acid, panaxodiol,
panaxotriol •chikusetsusaponin
•Indication: •Principal: physical-mental exhaustion, stress, fatigue •Major:
hyperglycemia, erectile dysfunction, menopausal symptoms, aging, CVS
•Contraindication: •Coronary thrombosis, acute illness, pregnancy •Dose: •Decoction: 0.6-
2 g daily in the morning
8- Ashwagandha •Syn: Withania •History: smells like horse foot
•Source: dried roots of Withania somnifera •Family: Solanaceae
•GS: India •Constituents: triacontane, dihydroxystigmasterol, amino acid •Alkaloid:
withanine, somnine •Steroid lactone: Withanolides, withaferine A, withanone
•Indication: sedative, alterative, diuretic, emetic, dyspepsia, flatulence, liver complains,
asthma, nervic tonic •Dose: 3-6 g
9- Spirulina •Source: blue-green algae, Spirulina platensis & Spirulina maxima
•Family: Oscillatoriaceae •GS: US, Thailand, Mexico, India, China
•Constituents: proteins, protenous nitrogen, total organic nitrogen, lipid, fatty acid,
Vitamin F •Carbohydrate: glycogen, rhamnose •Vitamin: B complex, beta carotene •Algal
protein: phycobiliprotein
•Indication: immunostimulatory, hypolipidemic, antiviral, anti-inflammatory and
anticancer effect

What is herbal drug interaction?

Herb-drug interactions are drug interactions that occur between herbal medicines and
conventional drugs. ... The most commonly implicated herbs involved in such interactions are
those containing St. John's Wort, magnesium, calcium, iron, or ginkgo.
Introduction:
Many medicinal herbs and pharmaceutical drugs are therapeutic at one dose and toxic at
another. Interactions between herbs and drugs may increase or decrease the pharmacological or
toxicological effects of either component. Synergistic therapeutic effects may complicate the
dosing of long-term medications e.g. herbs traditionally used to decrease glucose concentrations
 in diabetes could theoretically precipitate hypoglycaemia if taken in combination with
conventional drugs .
Herbal medicines are ubiquitous: the dearth of reports of adverse events and interactions
probably reflects a combination of under-reporting and the benign nature of most herbs used.
Due to the increasing use of herbal and other dietary supplements, healthcare providers and
consumers need to know whether problems arise by using these preparations in combination with
conventional drugs . The use of herbal products has dramatically increased over the past decade,
driving physicians to become educated in regard to potential herbal complications and drug
interactions. From 1990 to 1997, the market of herbal product increased by 48%, with 42% of
the population using alternative treatments and spending an estimated $27 billion on them .
Herbal products are widely available, relatively inexpensive, and often make alluring but
unsubstantiated claims. Herbal medicine appeals to consumers who believe that natural herbal
products are preferable to synthetic pharmaceuticals. Usually herbal preparations are well
thought-out more safe than pharmaceutical drugs although there are some potential adverse
reactions from taking both together .

What foods interact with drugs?

 Warfarin and Vitamin K. ...
 Insulin, Oral Diabetic Agents, and Alcohol. ...
 Digoxin, High-Fiber Diets, and Herbs. ...
 Statins and Grapefruit. ...
 Calcium Channel Blockers and Grapefruit. ...
 Erectile Dysfunction Drugs and Grapefruit. ...
 Acetaminophen and Alcohol. ...
 Antibiotics and Dairy Products.

 1. Warfarin and Vitamin K

Warfarin (Coumadin) is a blood-thinning medication that helps treat and prevent blood
clots. Eating certain foods, especially those rich in vitamin K, can diminish warfarin’s
effectiveness. The highest concentrations of vitamin K are found in green leafy
vegetables such as kale, collards, spinach, turnip greens, Brussels sprouts, broccoli,
scallions, asparagus, and endive.
 “It’s not that patients should avoid foods that contain vitamin K,” advises Zive. “Rather,
they should keep their intake consistent from day to day.”
 He describes a scenario that could spell trouble for an older adult: “If a doctor tells a
patient that they should lose weight and they, in turn, start to eat more greens, their
vitamin K intake will go up, and this will counteract the anticlotting action of warfarin.”
 2. Insulin, Oral Diabetic Agents, and Alcohol
An alcoholic drink can increase or prolong the effects of insulin or oral diabetic agents
(pills) and thus lead to hypoglycemia or low blood sugar. The glucose-lowering action of
alcohol can last as long as eight to 12 hours. Symptoms of hypoglycemia include
nervousness, sweating, trembling, intense hunger, weakness, palpitations, confusion,
drowsiness, and ultimately coma.
 With a doctor’s approval, and in the absence of other health conditions such as
pancreatitis, elevated triglycerides, and neuropathy, older adults with diabetes may be
 able to enjoy up to two drinks per day. A drink is defined by the American Diabetes
Association as a 12-ounce beer, a 5-ounce glass of wine, or 1.5 ounces of a distilled
beverage such as whiskey, vodka, or gin. Individuals can reduce the risk of low blood
sugar by having alcoholic drinks at mealtime or by having a snack along with the drink.
 In addition, certain oral diabetic medications such as chlorpropamide (Diabinese) can
cause dizziness, flushing, and nausea when taken along with alcohol.
 3. Digoxin, High-Fiber Diets, and Herbs
Digoxin (Digitalis, Digitek, Lanoxin) is used to strengthen the contraction of the heart
muscle, slow the heart rate, and promote the elimination of fluid from body tissues.
 Dietary fiber, specifically insoluble fiber such as wheat bran, can slow down the
absorption of digoxin and lessen its effectiveness. To prevent this, elders should take
digoxin at least one hour before or two hours after eating a meal.
 Herb use can also affect digoxin. For example, ginseng can elevate blood levels of
digoxin by as much as 75%, while St. John’s Wort decreases blood levels of this drug by
25%.
 “It’s important for the patient to recognize signs of digoxin toxicity,” says Zive. “These
include a yellow tint to vision and the appearance of halos around objects, as well as
weakness, confusion, dizziness, and nausea and vomiting.”
 4. Statins and Grapefruit
Statins are highly effective cholesterol-lowering drugs. Unfortunately, says Zive,
“Drinking grapefruit juice or eating fresh grapefruit can increase the amount of some
statins in your blood and lead to potentially greater side effects of these drugs.”
 Side effects of statins include muscle soreness and liver abnormalities reflected in high
transaminase levels (serum glutamic-oxaloacetic transaminase and serum glutamic
pyruvic transaminase) on a blood test.
 This interaction is especially strong with simvastatin (Zocor) and lovastatin (Altoprev),
milder with atorvastatin (Lipitor), and nonexistent for pravastatin (Pravachol), so it’s
important for elders to check whether their prescribed statin drugs do interact before
giving up vitamin C-rich grapefruit.
 5. Calcium Channel Blockers and Grapefruit
Calcium channel blockers are prescribed for high blood pressure. A natural element
found in grapefruit latches onto the intestinal enzyme called CYP3A4, which alters the
breakdown of the calcium channel blockers, possibly resulting in excessively high blood
levels of the drug, along with an increased risk of serious side effects.
 It doesn’t take a jumbo serving of grapefruit to produce a deleterious effect either. For
example, a single 6-ounce glass of juice can reduce levels of CYP3A4 by nearly 50%.
This effect dissipates slowly. One study indicated that one third of the impact on
CYP3A4 from grapefruit juice was still evident a full 24 hours later.
 The interaction between grapefruit and calcium channel blockers is strongest, for
example, with felodipine (Plendil), nicardipine (Cardene), and nisoldipine (Sular) and
weaker with amlodipine (Norvasc), diltiazem (Cardizem), and nifedipine (Adalat).
 Tangelos, a cross between a tangerine and grapefruitlike pomelo and Seville oranges, a
bitter citrus fruit used to make marmalades, can have the same deleterious effects as
grapefruit on both statins and calcium channel blockers.
 6. Erectile Dysfunction Drugs and Grapefruit
Although unproven, evidence points to the likely fact that grapefruit juice gives a boost to
 blood levels of erectile dysfunction drugs such as sildenafil (Viagra). This may seem like
a boon to some men, but it could trigger headaches symptomatic of fatal or near fatal
conditions, flushing, or low blood pressure.
 7. Acetaminophen and Alcohol
The over-the-counter pain reliever acetaminophen (Tylenol) and alcohol don’t mix.
“Two or more alcoholic drinks per day can increase the liver toxicity of Tylenol,” says
Zive. “This toxicity can happen even if a patient takes less than the maximum 4 grams, or
eight tablets, of Tylenol per day.”
 This interaction can be especially problematic in older adults, says Zive, since the liver’s
ability to diminish drugs decreases with age. “The liver of a 65 year old doesn’t function
the same way it did at age 25,” he says.
 8. Antibiotics and Dairy Products
Dairy products such as milk, yogurt, and cheese can delay or prevent the absorption of
antibiotics such as tetracyclines and ciprofloxacin (Cipro). This occurs because the
calcium in such foods binds to the antibiotics in the stomach and upper small intestine to
form an insoluble compound.
 To avoid problems, Zive recommends taking an antibiotic one hour before or two hours
after a meal.
 However, there’s no need to avoid milk and dairy with all antibiotics. For example, it’s
recommended that metronidazole (Flagyl) should be taken with water or milk to prevent
stomach upset.
 9. MAOIs and Tyramine-Containing Foods
Monoamine oxidase inhibitors are an older type of antidepressant still prescribed, albeit
less frequently, due to their serious side effects.
 “Foods containing tyramines, such as some red wines, malt beer, smoked fish, aged
cheeses, and dried fruits, can cause a hypertensive crisis or severe and dangerous
elevation in blood pressure when taken with this class of antidepressants,” says Zive.
 10. Antithyroid Drugs and Iodine-Rich Foods
Antithyroid drugs are compounds that interfere with the body’s production of thyroid
hormones, thereby reducing the symptoms of hyperthyroidism. According to a broad
body of research, Americans’ high-iodine diets account for the lower remission rate of
hyperthyroidism in those who are prescribed antithyroid drugs.
 Antithyroid drugs work by preventing iodine absorption in the stomach. A high-iodine
diet requires higher doses of antithyroid drugs. The higher the dose of antithyroid drugs,
the greater the incidence of side effects that include rashes, hives, and liver disease.
 The richest dietary sources of iodine are seafood and seaweed, such as kelp and nori.
Iodine is also found in iodized salt and to a lesser extent in eggs, meat, and dairy
products.
 Classification:

Drug-disease interactions. .
Drug-drug interactions.
Drug-food interactions,
Drug-laboratory test interactions. Chemical-drug interactions.
An interaction occurs when pharmacokinetics or pharmacodynamics of drug are changed.
 CAUSES: Multiple prescribersPoly pharmacy , Multiple prescribersPoly pharmacy ,
Genetic make up, Specific population like E.g., females, elderly, obese, malnourished,
critically ill patient, transplant recipient. Specific illness E.g. Hepatic disease, Renal
dysfunction. Narrow therapeutic index drug: Cyclosporine, Digoxin, Insulin, Lithium ,
Antidepressant, Warfarin etc

MECHANISM OF DRUG INTERACTION : Pharmacokinetics involve the effect of a

drug on another drug kinetic that includes absorption ,distribution , metabolism and
excretion.

Pharmacodynamics are related to the pharmacological activity of the interacting drugs

E.g., synergism , antagonism, altered cellular transport effect on the receptor site.

THE NET EFFECT OF THE DRUG INTERACTION : • Generally quantitative i.e.

increased or decreased effect. • Seldom qualitative i.e. rapid or slower effect. • Precipitation of
newer or increased adverse effect.

PHARMACOKINETIC INTERACTIONS: These interactions are those in which ADME

properties of the object drug is altered by the precipitant and hence such interactions are also
called as ADME interactions”.

The resultant effect is altered plasma concentration of the object drug. These are classified as:
1.Absorption interactions 2.Distribution interactions 3.Metabolism interactions 4.Excretion
interactions.

ABSORPTION INTERACTIONS: It mainly includes:. Alteration in GI pH. Malabsorption

syndrome. Alteration of GI micro flora.  Complexations and adsorption.  Inhibition of GI
enzymes. Alteration in gut motility.

1-Kava

Kava (piper methysticum), also known as tonga, kava kava and intoxicating pepper, is derived
from the dried root of the pepper plant family, and is grown and used in the South Pacific Islands
for social and ceremonial purposes . In addition, it is sold as an alternative medicine in health
food shops to be used as an anxiolytic and sedative.

Kavalactones (also called kava pyrones), the active component of kava, cause dose‐dependent
effects on the central nervous system such as sedation, hypnosis and possibly anti‐epileptic and
neuroprotective properties. The sedative effect is produced by enhanced GABA‐mediated
inhibitory neurotransmission .
Long‐term use of kava leads to abuse potential (addiction, tolerance and withdrawal) and kava
dermopathy (reversible, scaly cutaneous eruptions)

2-Ginseng

Ginseng is the most expensive and probably the most popular herb sold worldwide. There are
three main subspecies of ginseng: Panax ginseng, Panax quinquefolius and Panax
pseudoginseng. Panax ginseng is the preparation most commonly used and its biological activity
is ascribed to ginsenoside, a glycosylated steroid. Ginseng has been used traditionally in Chinese
medicine as a stimulant, tonic and diuretic. Other purported benefits include immunomodulation,
mood elevation, increased vitality and hypoglycaemia. The immunomodulatory effects have only
been demonstrated in studies on mice . The mood elevation effects may be mediated by an
increased glucocorticoid synthesis caused by ginseng that has been demonstrated in rat studies .
A double‐blind, placebo‐controlled study of 36 newly diagnosed Type II diabetics reported
hypoglycaemic effects of ginseng mediated by ginsenoside Rb2 . In vivo rat studies reported
increased numbers of insulin receptors and enhanced insulin release.

Anecdotal reports of adverse effects of ginseng include hypertension , nervousness and insomnia
, especially when taken in large doses. It is suggested that these are mediated by the central
stimulant effects of ginseng . Skin rashes have also been reported. Weak oestrogenic properties
may cause vaginal bleeding and mastalgia in some patients . The lack of uniformity on dose,
duration of treatment, species of ginseng used, potential for contaminants in the preparation and
concurrent medication makes it difficult to assess the significance of these anecdotal reports.

3-Ephedra

Traditionally, it was used for asthma and bronchitis and is now used to increase energy levels,
suppress appetite, stimulate the central nervous system and as an aphrodisiac [ Ephedra, also
known as Ma Huang, is marketed under names such as ‘Herbal Ecstasy’, ‘Natural Ecstasy’,
‘Cloud. Only one randomised, controlled trial of a liquid containing ephedra for the common
cold is listed in the Cochrane database .

Ephedra contains alkaloids such as ephedrine, pseudo‐ephedrine, methylephedrine and

norpseudo‐ephedrine, obtained from the roots and branches of a shrub native to central Asia .
Ephedrine is the predominant active component and is a non‐catecholamine sympathomimetic
agent that acts directly and indirectly at alpha‐ and beta‐adrenergic receptors, causing increased
blood pressure and heart rate, relaxation of bronchial and gastrointestinal smooth muscle, central
nervous system stimulation and mydriasis.
There are numerous reports of adverse reactions to dietary supplements containing ephedra . In
Australia, restrictions have been placed on the ephedrine content of marketed products for
several years. In the USA, where ephedra‐containing products have not been restricted until
recently, there have been at least 43 cases of serious adverse reactions related to the use of
ephedra, including hypertension, palpitations, tachycardia, cerebrovascular accidents and
seizures . There are also case reports of myocardial infarction, myocarditis, fatal cardiac
arrhythmias, acute hepatitis, mania, psychosis, nephrolithiasis, anxiety, tremors and insomnia .

Absolute contra‐indications to products containing ephedra include ischaemic heart disease,

hypertension, cerebrovascular disease, thyroid disease, diabetes, psychiatric disorders,
prostamegaly and pregnancy or lactation. In fact, the risks to anyone taking ephedra are difficult
to justify, as it has no demonstrated benefit.

4-Ginkgo biloba

Ginkgo biloba (maidenhair tree), considered a living fossil , is now grown worldwide as an
ornamental tree and as a source of herbal medicine. Ginkgo extract contains several flavonoids,
terpenoids and organic acids that are believed to protect vascular walls and nerve cells by acting
as free radicals and by inhibiting platelet activating factors . It can decrease erythrocyte
aggregation and blood viscosity.

What is ginkgo biloba good for?

Researchers believe that ginkgo improves cognitive function because it promotes good blood
circulation in the brain and protects the brain and other parts from neuronal damage. However,
other research suggests that ginkgo may not improve memory among people who are healthy.