Pharmacologically relevant drug interactions of sulfonylurea antidiabetics with common herbs

Abstract

Introduction: Sulfonylurea antidiabetics are insulin secretogogues useful in the treatment of type 2 diabetic patients. The probability of adverse drug interactions is high in patients taking sulfonylureas and other drugs including herbal medicines. The present review is aimed to present the herbal drugs having interacting potentials with sulfonylurea antidiabetics. Methods: The databases such as PubMed, Google Scholar, Science Direct, Directory of open access journals (DOAJ) and reference lists were searched using the keywords drug interactions, Sulfonylureas, pharmacodynamic interactions, antidiabetic herbs, pharmacokinetic interactions and CYP2C9. Results: Sulfonylureas are primarily metabolized by CYP2C9 enzyme and the herbs like St. John's wort and Ginkgo biloba induce CYP2C9-mediated metabolism of sulfonylureas while fruit juices like Pomegranate juice and Pineapple juice inhibit their metabolism. In addition, the antidiabetic herbal supplements such as Bitter melon, Fenugreek, Cinnamon, Gymnema, Ginseng, Ginger, Garlic, Aloe vera, Sesame, Andrographis paniculata and Neem potentiate the hypoglycemic activity of sulfonylureas, pharmacodynamically. Conclusion: Some herbal supplements are capable of interacting pharmacokinetically and pharmacodynamically with sulfonylurea antidiabetics.