Incorporating traditional Chinese medicine with modern pharmacotherapy is a common practice in the management of various health conditions, yet it underscores the need for understanding possible herb-drug interactions. A study investigating the effects of Danshen tablets (DST), a widely used Chinese multi-herbal formula, on the pharmacokinetics of amlodipine, a calcium channel blocker for coronary heart disease, has provided valuable insights into potential health implications. This comprehensive article delves into the research findings, explores the implications of mixing DST with amlodipine, and suggests effective dosing strategies for clinical practice.
Introduction
Amlodipine, a widely-prescribed medication for hypertension and coronary artery disease, has a well-established mechanism and pharmacokinetic profile in isolation. However, when amlodipine is administered alongside Danshen tablets, a Chinese multi-herbal formula recognized for its efficacy in cardiovascular treatments, questions arise regarding the pharmacokinetic behavior of the drug.
Zhang Haixia and colleagues from the Affiliated Hospital of Weifang Medical University focused on bridging this knowledge gap. Their research, titled “Effects of Danshen tablets on pharmacokinetics of amlodipine in rats,” was published in the journal “Pharmaceutical Biology” in December 2019 (DOI: 10.1080/13880209.2019.1604768).
The groundbreaking study aimed to unravel the mysteries of herb-drug interactions by analyzing how DST affects the pharmacokinetics of amlodipine, using a male Sprague-Dawley rat model. It is an essential read for physicians and pharmacists who often grapple with the complexities of polypharmacy involving synthetic drugs and herbal supplements.
Methodology
The investigative team adopted a rigorous scientific approach. Six male Sprague-Dawley rats were administered 1 mg/kg of amlodipine either with or without prior treatment of DST at a dose of 100 mg/kg for seven days. The researchers utilized high-precision liquid chromatography-tandem mass spectrometry (LC-MS/MS) to measure the concentration of amlodipine in the blood plasma of the rats. They also assessed the metabolic stability of amlodipine using rat liver microsomes (RLM) to understand the metabolic interactions prompted by DST.
Results
The research findings were significant. Pretreatment with Danshen tablets markedly expedited the metabolism of amlodipine in RLM. Pharmacokinetic parameters demonstrated significant alterations; the presence of DST reduced amlodipine’s maximum concentration (Cmax) and increased its clearance rate from the body. It suggested that when co-administered, Danshen tablets could potentially lead to a reduced therapeutic effect of amlodipine due to a faster metabolic rate.
Implications for Medical Practice
The study’s outcomes ignite a discussion around the importance of careful drug prescription and monitoring. Patients consuming both Danshen tablets and amlodipine should be assessed for any reduction in the blood-pressure-lowering effects of amlodipine, as the herb-drug interaction could necessitate an adjustment in the clinical dose of amlodipine for desired therapeutic outcomes.
Literature Review
The groundbreaking nature of this study is framed against prior research in the field. For instance, a prospective study by Adake et al., 2015, showcased a comparison of amlodipine with other antihypertensive agents, without factoring in potential herbal interactions. The findings by Zhang and team extend such knowledge to the realm of complementary medicine.
Other studies such as those by Hsiao et al., 2015, and Jia et al., 2018, have also addressed the pharmacokinetics of amlodipine, but the present research underscores the complexities added by the involvement of traditional Chinese medicine. This broader context of multidisciplinary treatment options points to a burgeoning area in patient care that requires cautious navigation.
Scientific and Clinical Collaboration
The research accentuates the crucial role of interdisciplinary collaboration between traditional Chinese medicine practitioners and clinical pharmacologists. Sharing insights and knowledge would further the understanding of herb-drug interactions and lead to safer, more effective treatment protocols.
Keywords
1. Amlodipine Danshen interaction
2. Herb-drug pharmacokinetics
3. Traditional Chinese medicine and hypertension
4. Amlodipine dosage adjustment
5. Cardiovascular drug metabolism
Conclusion
The study conducted by Zhang Haixia and colleagues marks a pivotal addition to the existing literature on herb-drug interactions. It emphasizes the need for awareness among healthcare professionals about the pharmacokinetic changes that can occur when traditional herbal formulas are combined with modern pharmaceuticals. The intricate dance between synthetic drugs and natural compounds is complex and necessitates a personalized approach to patient care. Ensuring optimal therapeutic outcomes entails navigating these interactions with precision, backed by robust scientific research.
References
1. Adake P, Somashekar HS, Mohammed Rafeeq PK, Umar D, Basheer B, Baroudi K. (2015). Comparison of amlodipine with cilnidipine on antihypertensive efficacy and incidence of pedal edema in mild to moderate hypertensive individuals: a prospective study. Journal of Advanced Pharmaceutical Technology & Research. DOI:10.4103/2231-4040.154596
2. Hsiao HL, Langenickel TH, Greeley M, Roberts J, Zhou W, Pal P, Rebello S, Rajman I, Sunkara G. (2015). Pharmacokinetic drug-drug interaction assessment between LCZ696, an angiotensin receptor neprilysin inhibitor, and hydrochlorothiazide, amlodipine, or carvedilol. Clinical Pharmacology Drug Development. DOI:10.1002/cpdd.160
3. Jia Y, Liu J, Xu J. (2018). Influence of grapefruit juice on pharmacokinetics of triptolide in rats grapefruit juice on the effects of triptolide. Xenobiotica. DOI:10.1080/00498254.2017.1328346
4. Zhang C, Gao Z, Niu L, Chen X. (2018). Effects of triptolide on pharmacokinetics of amlodipine in rats by using LC-MS/MS. Pharmaceutical Biology. DOI:10.1080/13880209.2018.1436077
5. Zhang Haixia H, Han Xiuyuan X, Li Yiqing Y, Li Hangao H, Guo Xichun X. (2019). Effects of Danshen tablets on pharmacokinetics of amlodipine in rats. Pharmaceutical Biology. DOI:10.1080/13880209.2019.1604768
About the Authors
Zhang Haixia and the team at the Department of Pharmacy, Affiliated Hospital of Weifang Medical University, PR China, have taken a formidable step towards understanding the interplay between traditional medicine and modern pharmacotherapeutics. Their research not only adds to the global knowledge base but also guides clinical practice in a tangible and impactful manner.