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01 Stockley's Herbal Medicines Interactions PRELIMS 1.

HidX`aZn h =ZgWVa BZY^X^cZh >ciZgVXi^dch:Y^iZY Wn :a^oVWZi] L^aa^Vbhdc! HVbjZa 9g^kZg VcY @VgZc 7 VmiZgStockley s HerbalMedicines InteractionsStockley s HerbalMedicines InteractionsA guide to the Interactions of Herbal Medicines ,dietary supplements and nutraceuticals withconventional medicinesEditorsElizabeth Williamson, BSc, PhD, MRPharmS, FLSS amuel Driver, BScKaren Baxter, BSc, MSc, MRPharmSEditorial StaffMildred Davis, BA, BSc, PhD, MRPharmSRebecca E Garner, BScC Rhoda Lee, BPharm, PhD, MRPharmSAlison Marshall, BPharm, DipClinPharm, PGCertClinEd, MRPharmSRosalind McLarney, BPharm.

Herbal and Complementary Medicines, which advises the BPC on standards for herbal drugs for the pharmaceutical industry. As a team therefore, we feel we have unrivalled experience in assessing herb–drug interactions, and we believe that ours is a unique collaboration. Herbal medicines are, more than ever, receiving attention,

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Transcription of 01 Stockley's Herbal Medicines Interactions PRELIMS 1.

1 HidX`aZn h =ZgWVa BZY^X^cZh >ciZgVXi^dch:Y^iZY Wn :a^oVWZi] L^aa^Vbhdc! HVbjZa 9g^kZg VcY @VgZc 7 VmiZgStockley s HerbalMedicines InteractionsStockley s HerbalMedicines InteractionsA guide to the Interactions of Herbal Medicines ,dietary supplements and nutraceuticals withconventional medicinesEditorsElizabeth Williamson, BSc, PhD, MRPharmS, FLSS amuel Driver, BScKaren Baxter, BSc, MSc, MRPharmSEditorial StaffMildred Davis, BA, BSc, PhD, MRPharmSRebecca E Garner, BScC Rhoda Lee, BPharm, PhD, MRPharmSAlison Marshall, BPharm, DipClinPharm, PGCertClinEd, MRPharmSRosalind McLarney, BPharm.

2 MSc, MRPharmSJennifer M Sharp, BPharm, DipClinPharm, MRPharmSDigital Products TeamJulie McGlashan, BPharm, DipInf Sc, MRPharmSElizabeth King, Dip BTEC by the Pharmaceutical PressAn imprint of RPS Publishing1 Lambeth High Street, London SE1 7JN, UK100 South Atkinson Road, Suite 200, Grayslake, IL 60030-7820, USA#Pharmaceutical Press 2009is a trade mark of RPS PublishingRPS Publishing is the publishing organisation of the Royal Pharmaceutical Society of Great BritainFirst published 2009 Typeset by Data Standards Ltd, Frome, SomersetPrinted in Great Britain by TJ International, Padstow, CornwallISBN 978 0 85369 760 2 All rights reserved.

3 No part of this publication may be reproduced, stored in a retrieval system or transmitted inany form or by any means, without the prior written permission of the copyright publisher makes no representation, express or implied, with regard to the accuracy of the informationcontained in this book and cannot accept any legal responsibility or liability for any errors or omissions that maybe catalogue record for this book is available from the British LibraryContentsPrefaceviAbbreviationsvii iGeneral Considerations1 Structure of the publication1 Data selection2 Nomenclature2 Incidence of Herbal Medicines Interactions 2 Who uses Herbal Medicines ?

4 3 Herbal medicine use in specific patientgroups3 Differences in Herbal use in specificpopulation groups4 Attitudes to the use of Herbal medicines5 Interactions between Herbal medicinesand conventional drugs6 Variability of Herbal medicines6 Mechanisms of interactions7 Pharmacokinetics7 Cytochrome P450 isoenzymes7 drug transporter proteins9 Pharmacodynamic interactions10 Drawing your own conclusions10 Interaction monographs A to Z by herbalmedicinal product13 Index403 PrefaceThis first edition ofStockley s Herbal Medicines Interactionsis an exciting new addition to the Stockley family ofproducts, and one that has been several years in the planningand execution.

5 When researchingStockley s drug Inter-actionswe had noticed the growing wealth of experimentaldata on Herbal Medicines , which does not fall within the briefof Stockley, which is primarily a clinically based referencework. However, it seemed somewhat of an omission tooverlook what is obviously valuable information in what canalmost be considered a new field of drug Interactions . Wetherefore reached the point where we decided that it wasworth producing a book dedicated to this information;however, little did we realise what a journey we d be takingourselves a group dedicated to the study of drug Interactions , andthe provision of clinically relevant data (aided by the largenumber of practising pharmacists we have on our team), wefelt well equipped to deal with the Interactions data.

6 Theherbal Medicines side of things was, however, not somethingthat we were particularly familiar with, and we were greatlyrelieved to be approached by Elizabeth Williamson, with avery similar idea to our own, but with a wealth of knowledgeon Herbal Medicines with which to guide us. Liz is widelypublished in the field of Herbal Medicines , and is a memberof a number of bodies that consider many aspects of herbalmedicine use, such as the British Pharmacopoeia Commis-sion. Liz is the Chair of the Expert Advisory Group forHerbal and Complementary Medicines , which advises theBPC on standards for Herbal drugs for the pharmaceuticalindustry.

7 As a team therefore, we feel we have unrivalledexperience in assessing herb drug Interactions , and webelieve that ours is a unique Medicines are, more than ever, receiving attention,both from the public and healthcare professionals alike, withmany countries now undertaking registration schemes fortraditional Medicines . However, healthcare professionals stillfreely admit their lack of knowledge in this area, and surveyssuggest that patients often rely on friends and family foradvice about Herbal Medicines . Never has there been a moreappropriate time to advise healthcare professionals so thatthey can provide balanced, helpful advice to patients wishingto take Herbal Medicines with their conventional aim, as ever, has therefore been to critically evaluate thepublished literature and present it in a familiar, easy-to-handle format, so that the busy healthcare professional canquickly access the information and apply it to their publication attempts to answer the same questionsthat we address inStockley s drug Interactions , namely.

8 Are the drugs and substances in question known tointeract or is the interaction only theoretical andspeculative?.If they do interact, how serious is it?.Has it been described many times or only once?.Are all patients affected or only a few?.Is it best to avoid these two substances altogether orcan the interaction be accommodated in some way?.And what alternative and safer drugs can be usedinstead?Stockley s Herbal Medicines Interactionsfollows the sameeasy-to-read format as our other publications, with the textorganised into a series of individual monographs, all with acommon format.

9 In addition, we have included sections on:nomenclature, to help users identify Herbal Medicines thatthey or their patients may be familiar with under a differentname; uses, so that those less familiar with herbalmedicines can put their use into context; and constituents,to allow us to address Interactions that occur as a result of asubstance common to several plants. A pharmacopoeiasection is also included for those Herbal Medicines , dietarysupplements and nutraceuticals that have entries in thelatest editions (at time of press) of theBritish Pharmaco-poeia, theEuropean Pharmacopoeiaand theUnited StatesPharmacopoeia.

10 An indication of the constituents that theherbal medicine may be standardised for is also providedwhere necessary, but note that this does not necessarilymeanthatall marketed products are standardised in thisway. In addition, we have added the simple, intuitiveratings system that users ofStockley s Interaction AlertsandStockley s drug Interactions Pocket Companionwillalready be familiar with all Stockley products, the text is written for aworldwide audience. Terminology has been carefully con-sidered and international terms have been added where itwas thought helpful to do so.


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