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Table 2 Potential herb-drug interactions (HDIs), severity and mechanism identified among respondents reporting the use of herbal and natural products with prescription medicines (n = 181)

From: Pregnancy, prescription medicines and the potential risk of herb-drug interactions: a cross-sectional survey

Herbal/Natural Product Prescribed Medicine Interaction Rating Mechanism of Interaction
Aloe (12) Insulin (1) Moderate Additive effects, lower blood glucose levels lead to increased risk of hypoglycaemia.
Chamomile (29) Diazepam (1) Moderate Additive effects of benzodiazepines, lead to increased risk of CNS depression, psychomotor impairment.
Propranolol (1) Moderate Inhibition of CYP1A2 and CYP2D6 (in vitro and in vivo). Increase levels of drugs metabolized by this enzyme.
Diclofenac (1) Moderate Inhibition of CYP2C9 (in vitro). Increase levels of drugs metabolized by this enzyme.
Ondansetron (1) Minor Inhibition of CYP1A2 (in vitro and in vivo). Increase levels of drugs metabolized by this enzyme.
Chlorpromazine (1) Moderate Inhibition of CYP2D6 (in vitro). Increase levels of drugs metabolized by this enzyme.
Dyhidrocodeine (2) Moderate Additive effects of codeine, lead to increased risk of CNS depression, psychomotor impairment.
Co-codamol (1) Moderate Additive effects of codeine, lead to increased risk of CNS depression, psychomotor impairment.
Cranberry (42) Diazepam (1) Moderate Inhibition of CYP2C9 (in vitro), contradictory results in clinical research. Increase levels of drugs metabolized by this enzyme.
Diclofenac (1) Moderate Inhibition of CYP2C9 (in vitro), contradictory results in clinical research. Increase levels of drugs metabolized by this enzyme
Fish oil (24) Progesterone pessaries (2) Moderate Progesterone may interfere with the triglyceride lowering effects of fish oils.
Dalteparin (2) Moderate Additive effects, lead to increased risk of bleeding.
Enoxaparin (1) Moderate Additive effects, lead to increased risk of bleeding.
Labetolol (2) Moderate Additive effects with antihypertensive, lead to increased risk of hypotension.
Methyldopa (1) Moderate Additive effects with antihypertensive, lead to increases risk of hypotension.
Ginger (50) Metformin (1) Moderate Additive effects, might increase insulin level and/or decrease blood glucose levels, may lead to hypoglycemia.
Insulin (2) Moderate Additive effects, might increase insulin level and/or decrease blood glucose levels, may lead to hypoglycemia.
Aspirin (4) Moderate Inhibit thromboxane synthetase and decrease platelet aggregation lead to increased risk of bleeding.
Nifedipine (1) Major Significantly inhibits platelet aggregation, synergetic effects, may lead to potential cardiovascular and cerebrovascular complications.
Ginseng (4) Metformin (1) Moderate Additive effects, might increase insulin level and/or decrease blood glucose levels, may lead to hypoglycemia.
Diazepam (1) Moderate Additive effects of benzodiazepines, lead to increased risk of CNS depression, psychomotor impairment
Grapefruit (8) Itraconazole (1) Moderate Might affect absorption and might increase or decrease itraconazole levels.
Propranolol (1) Moderate Inhibition of CYP1A2 (preliminary evidence). Increase levels of drugs metabolized by this enzyme.
Diclofenac (1) Moderate Inhibition of CYP2C9 (preliminary evidence), contradictory results in clinical research. Increase levels of drugs metabolized by this enzyme.
Omeprazole (1) Moderate Inhibition of CYP2C19 (preliminary evidence), contradictory results in clinical research. Increase levels of drugs metabolized by this enzyme.
Sage (1) Co-codamol (1) Moderate Inhibition of CYP2D6 (in vitro). Increase levels of drugs metabolized by this enzyme.