Department of Pharmacy, The First Affiliated Hosptial, College of Medicine, Zhejiang University, Hangzhou, China.
J Thromb Thrombolysis. 2019 Oct;48(3):491-499. doi: 10.1007/s11239-019-01945-3.
The use of traditional Chinese medicine (TCM) has obtained more and more acceptance all over the world due to its multi-target and multi-level function characteristics. Clopidogrel is a major therapeutic option to reduce atherothrombotic events in patients with acute coronary syndrome, recent myocardial infarction, recent stroke or established peripheral arterial disease. These patients probably take TCM. Are there any interactions between clopidogrel and TCM? Whether TCM will affect the efficacy of clopidogrel or increase the adverse reactions of bleeding? Clarifying this information will help physicians make better use of TCM. A literature search was carried out using Web of Science, PubMed and the Cochrane Library to analyze the pharmacokinetic or pharmacodynamic interactions of clopidogrel and TCM. Some herbs can increase the AUC or C of clopidogrel, such as Scutellarin, Danggui, Gegen, Sauchinone and Dengzhan Shengmai capsules. Whereas others can decrease clopidogrel, for example, Ginkgo and Danshen. Furthermore, some herbs can increase the AUC or C of clopidogrel active metabolite, including Ginkgo and Xuesaitong tablet. And others can decrease the clopidogrel active metabolite, such as Scutellarin, Danshen, Fufang Danshen Dripping Pill and Dengzhan Shengmai capsules. Additionally, Schisandra chinensis, Danggui, Gegen and Fufang Danshen Dripping Pill can decrease the AUC or C of the clopidogrel inactive metabolite, while Curcumin on the contrary. The pharmacodynamics of Panax notoginseng, Notoginsenoside Ft1, Hypericum perforatum, Shexiang baoxin pills, Naoxintong capsule increased the antiplatelet activity compared with clopidogrel alone, while Danshen decreased the platelet inhibition. In adverse reactions, Danggui can enhance the adverse effects of clopidogrel on the bleeding time. With more awareness and understanding on potential drug-herb interactions of clopidogrel and TCM, it may be possible to combine clopidogrel with TCM herbs to yield a better therapeutic outcome.
由于中药（TCM）具有多靶点、多层次的功能特点，其在世界各地的应用越来越受到认可。氯吡格雷是降低急性冠脉综合征、近期心肌梗死、近期卒中和已确诊外周动脉疾病患者动脉粥样血栓事件的主要治疗选择。这些患者可能会同时使用 TCM。氯吡格雷与 TCM 之间是否存在相互作用？TCM 是否会影响氯吡格雷的疗效或增加出血的不良反应？明确这些信息将有助于医生更好地利用 TCM。通过 Web of Science、PubMed 和 Cochrane Library 进行文献检索，分析氯吡格雷与 TCM 的药代动力学或药效动力学相互作用。一些草药可以增加氯吡格雷的 AUC 或 C，例如黄芩素、当归、葛根、升麻酮和灯盏生脉胶囊。而其他草药则可以降低氯吡格雷的浓度，例如银杏叶和丹参。此外，一些草药可以增加氯吡格雷活性代谢物的 AUC 或 C，包括银杏叶和血栓通片。而其他草药则可以降低氯吡格雷活性代谢物的浓度，如黄芩素、丹参、复方丹参滴丸和灯盏生脉胶囊。此外，五味子、当归、葛根和复方丹参滴丸可以降低氯吡格雷无活性代谢物的 AUC 或 C，而姜黄素则相反。三七、三七总皂苷 Ft1、贯叶金丝桃、麝香保心丸、脑心通胶囊的药效学与单独使用氯吡格雷相比增加了抗血小板活性，而丹参则降低了血小板抑制作用。在不良反应方面，当归可以增强氯吡格雷对出血时间的不良反应。随着对氯吡格雷与 TCM 潜在药物-草药相互作用的认识和理解的提高，可能可以将氯吡格雷与 TCM 草药联合使用，以获得更好的治疗效果。
