Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea; Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
Phytomedicine. 2021 Jan;81:153435. doi: 10.1016/j.phymed.2020.153435. Epub 2020 Dec 6.
Although herbal medicines (HMs) are widely used worldwide, information concerning their interactions with conventional medicines (CMs) is sparse. In particular, stroke affects a high proportion of elderly people with impaired hepatic and renal function. Stroke is often accompanied by various complications and is commonly treated via the co-administration of HMs and CMs in Asia.
We aimed to investigate the effects of co-administration of HMs and CMs on liver and kidney function in patients with stroke. We estimated the prevalence of drug-induced liver injury (DILI) or herb-induced liver injury (HILI) and drug-induced acute kidney injury (DIAKI) or herb-induced acute kidney injury (HIAKI) in patients co-administered HMs and CMs.
This was a retrospective study that reviewed the electronic medical records of 401 patients with stroke in a single hospital.
The prevalence of DILI or HILI and types of liver injury was examined according to abnormal increases in liver tests. The probable causality between drug or herb administration and liver injury was assessed using the Roussel Uclaf Causality Assessment Method. In addition, the prevalence of DIAKI or HIAKI was estimated using the Kidney Disease Improving Global Outcomes acute kidney injury stage criteria and related medical records.
Out of a total of 401 patients, only four (1.0%) developed liver injury. Two cases of DILI (0.5%) and two cases of HILI (0.5%) were reported. Moxifloxacin and ebastine were the CMs that caused hepatotoxicity. Chungpyesagan-tang and Yeoldahanso-tang were the HMs that caused liver toxicity. Even in cases showing severe liver damage, alkaline phosphatase levels remained less than five times the normal value, and liver function test values recovered within 14 days. There were no cases of DIAKI or HIAKI in this cohort.
These results suggest that if appropriately prescribed by experts, the co-administration of CMs and HMs is safe and does not adversely affect liver and kidney function in patients with stroke. To support these results, further large-scale multicenter prospective studies and toxicological studies based on the interaction between HMs and CMs are warranted.
尽管草药（HM）在全球范围内广泛使用，但有关其与常规药物（CM）相互作用的信息却很少。特别是，中风影响了很大一部分肝功能和肾功能受损的老年人。中风常伴有各种并发症，在亚洲通常通过同时使用 HM 和 CM 来治疗。
我们旨在研究同时使用 HM 和 CM 对中风患者肝肾功能的影响。我们估计了同时使用 HM 和 CM 的中风患者中药物性肝损伤（DILI）或草药性肝损伤（HILI）以及药物性急性肾损伤（DIAKI）或草药性急性肾损伤（HIAKI）的发生率。
这是一项回顾性研究，对一家医院的 401 名中风患者的电子病历进行了回顾。
根据肝功能检查异常升高，检查 DILI 或 HILI 的发生率和肝损伤类型。使用 Roussel Uclaf 因果关系评估方法评估药物或草药给药与肝损伤之间的可能因果关系。此外，根据肾脏病改善全球结局急性肾损伤分期标准和相关病历估计 DIAKI 或 HIAKI 的发生率。
在总共 401 名患者中，只有 4 名（1.0%）发生了肝损伤。报告了 2 例 DILI（0.5%）和 2 例 HILI（0.5%）。引起肝毒性的 CM 是莫西沙星和依巴斯汀。引起肝毒性的 HM 是川芎茶调散和银翘散。即使在显示严重肝损伤的情况下，碱性磷酸酶水平仍保持在正常值的五倍以下，肝功能检查值在 14 天内恢复。本队列中无 DIAKI 或 HIAKI 病例。
这些结果表明，如果由专家适当开具处方，同时使用 CM 和 HM 是安全的，不会对中风患者的肝肾功能产生不利影响。为了支持这些结果，需要进行进一步的大型多中心前瞻性研究和基于 HM 和 CM 相互作用的毒理学研究。
