|Black cohosh ||2D6 inhibitor || |
Avoid combination with hepatotoxic drugs due to possible association with hepatotoxic effects.
May see additive effects with antihypertensive medications.
1A2: caffeine, clopidogrel, diazepam, estradiol, warfarin, olanzapine, ropinirole, propranolol
2C9: celecoxib, ibuprofen, losartan, torsemide, warfarin
2C19: warfarin, citalopram, diazepam, omeprazole, phenytoin
2D6: amitriptyline, haloperidol, metoprolol, ondansetron, paroxetine, risperidone, tramadol, venlafaxine
2E1: acetaminophen, ethanol, theophylline
3A4: CCBs, antifungals, glucocorticoids, fentanyl, lidocaine, protease inhibitors, contraceptives, cyclosporine, NNRTIs
P-glycoprotein: digoxin, chemotherapy agents, cyclosporine, NNRTIs
|Kava ||See comments || |
Preliminary and contradicting evidence regarding CYP (1A2, 2C9, 2C19, 2D6, and 3A4) and p-glycoprotein interactions with kava.
Synergistic effects possible with CNS; use with caution.
May cause additive toxicity when combined with hepatotoxic drugs. Contraindicated with liver disease.
|Red yeast rice ||3A4 substrate || |
Contains naturally occurring lovastatin; all lovastatin interactions apply.
Concomitant use of inducers/inhibitors of 3A4 can alter the metabolism of red yeast rice.
May cause additive toxicity when combined with hepatotoxic drugs.
Increased risk of myopathies if combined with cyclosporine, “statins,” niacin, and gemfibrozil.