Jung Yun Seob, Jin Byung Hak, Choi Ju Eun, Park Min Soo, Kim Young-Woo, Kang Hyung Won, Cho Sunyoung, Kim Choon Ok
Department of Pharmacology, Yonsei University College of Medicine, Seoul, Korea.
Department of Clinical Pharmacology, Severance Hospital, Yonsei University Health System, Seoul, Korea.
Ther Clin Risk Manag. 2024 Feb 26;20:151-160. doi: 10.2147/TCRM.S448090. eCollection 2024.
Herbal medicines are occasionally used in combination with conventional antidepressants to mitigate various depression-associated symptoms. However, there is limited information on herb-antidepressant interactions. In this study, we investigated the pharmacokinetic (PK) effects of four herbal medicines (Gami-soyosan, Banhasasim-tang, Ojeok-san, and Bojungikgi-tang) on escitalopram, a commonly used antidepressant.
In this open-label, fixed-sequence, three-period, crossover study, 18 participants were enrolled and divided into two groups. Each group received a 10 mg oral dose of escitalopram in period 1. Participants took escitalopram once daily and their assigned herbal medicines thrice a day for 7 d in periods 2 (group 1: Gami-soyosan, group 2: Ojeok-san) and 3 (group 1: Banhasasim-tang; group 2: Bojungikgi-tang). The primary endpoints were C and AUC of escitalopram. C and AUC in period 1 were obtained using nonparametric superposition from single-dose data. The PK endpoints were classified according to the CYP2C19 phenotype.
Of 18 participants, 16 completed the study. Systemic exposure to escitalopram resulted in a minor increase in the presence of each herbal medicine. The geometric mean ratios (GMRs, combination with herbal medicines/escitalopram monotherapy) and their 90% confidence intervals (CIs) for C and AUC were as follows: Gamisoyosan- 1.1454 (0.9201, 1.4258) and 1.0749 (0.8084, 1.4291), Banhasasim-tang-1.0470 (0.7779, 1.4092) and 1.0465 (0.7035, 1.5568), Ojeok-san-1.1204 (0.8744, 1.4357) and 1.1267 (0.8466, 1.4996), and Bojungikgi-tang-1.1264 (0.8594, 1.4762) and 1.1400 (0.8515, 1.5261), respectively. Furthermore, no significant differences in the GMRs of C and AUC were observed across different CYP2C19 phenotypes in any of the groups.
The co-administration of escitalopram with Gami-soyosan, Banhasasim-tang, Ojeok-san, or Bojungikgi-tang did not exert significant PK effects on escitalopram. These findings provide valuable insights into the safe use of herbal medicines along with escitalopram.
草药有时会与传统抗抑郁药联合使用，以减轻各种与抑郁相关的症状。然而，关于草药与抗抑郁药相互作用的信息有限。在本研究中，我们调查了四种草药（加味逍遥散、半夏厚朴汤、玉竹散和补中益气汤）对常用抗抑郁药艾司西酞普兰的药代动力学（PK）影响。
在这项开放标签、固定序列、三周期、交叉研究中，招募了18名参与者并分为两组。在第1阶段，每组接受10 mg口服剂量的艾司西酞普兰。参与者每天服用一次艾司西酞普兰，并在第2阶段（第1组：加味逍遥散，第2组：玉竹散）和第3阶段（第1组：半夏厚朴汤；第2组：补中益气汤）每天服用三次指定的草药，共7天。主要终点是艾司西酞普兰的Cmax和AUC。第1阶段的Cmax和AUC是使用单剂量数据的非参数叠加法获得的。PK终点根据CYP2C19表型进行分类。
18名参与者中，16名完成了研究。在每种草药存在的情况下，艾司西酞普兰的全身暴露量略有增加。Cmax和AUC的几何平均比值（GMRs，草药联合用药/艾司西酞普兰单药治疗）及其90%置信区间（CIs）如下：加味逍遥散分别为——1.1454（0.9201，1.4258）和1.0749（0.8084，1.4291），半夏厚朴汤分别为——1.0470（0.7779，1.4092）和1.0465（0.7035，1.5568），玉竹散分别为——1.1204（0.8744，1.4357）和1.1267（0.8466，1.4996），补中益气汤分别为——1.1264（0.8594，1.4762）和1.1400（0.8515，1.5261）。此外，在任何一组中，不同CYP2C19表型的Cmax和AUC的GMRs均未观察到显著差异。
艾司西酞普兰与加味逍遥散、半夏厚朴汤、玉竹散或补中益气汤联合使用对艾司西酞普兰没有显著的PK影响。这些发现为艾司西酞普兰与草药的安全联合使用提供了有价值的见解。
Zotero 插件