文档介绍：Elmer et al. Ann Pharmacother. 2007;40:1617- for Detecting and Advising on Herbal/Drug Interactions–Is the patient taking any herbal supplements?–Does the herbal have efficacy for the intended use?–Is the product reliable? (.,what are they REALLY taking?)–Is the Rx drug one with a narrow therapeutic margin?Evaluation of Herbal/Drug Interactions?Speculative or Theoretical–. St. John’s Wort and tyramine containing foods due to MAOI effects or evening primrose oil and risk for bleeds with warfarin?In vitro effects–. ginkgo and microsomal studies showing inhibition of CYP2C9?In vivo - animal studies–. kava and alcohol?In vivo - human case reports–. ginkgoand warfarin bleeds?In vivo - healthy human volunteer studies–. indinivir and St. John’s Wort?In vivo - clinical studies in patientsImportant Criteria for Evaluation of a Human Herbal/Drug Interaction Report?Reputable standardized product used and carefully described??Product used analyzed for pounds??Same batch used throughout study??Doses appropriate??Steady state study to discern CYP induction??Is observation consistent with known mechanisms of action??Is observation consistent with literature observations??Randomized, placebo controlled human volunteer study with appropriate n?Top 20 Selling Herbals for 2007- Mass MarketHerbalGram 2008;78:61-62?ProductM $ % change rank in 2006–1. soy25-171–2. cranberry24+243–3. garlic 20-132–+125–5. saw palmetto17- 64–6. echinacea16- 96–7. black cohosh 09-–8. milk thistle09-–9. ginseng08+ 310–10. St. John’s wort08- 69–11. Green tea 05- 711– primrose oil04- 912–13. valerian03- 913–14. Horny goat weed02- 214Red indicates risk for drug interactionsTop 20 Selling Herbals for 2007- Mass MarketHerbalGram 2008;78:61-62?ProductM $ % change rank in 2004–15. bilberry02- 915– seed02- 916–17. Yohimbe01-1517–18. red clover01-1318–19. Horse chestnut seed01-2119–20. -2020Total (all herbs)268+ indicates potential ris