항혈소판약물과 생약제의 상호작용: 리뷰 = A Review of Herbal Interactions with Antiplatelet Drugs

다국어 초록 (Multilingual Abstract)

Objectives : Antiplatelet agents are commonly used worldwide for the prevention ofcardiovascular or cerebrovascular diseases by inhibiting platelet aggregation and thrombus formation.
As the herbal medicine and crude drug market is gradually expanding with increasedpopularity, drug-herb interaction has become a rising topic. The most frequently interactingdrugs with herbs were reported to be antiplatelet agents and anticoagulants. The purpose of thisresearch is to focus on the interactions in antiplatelet agents with herbal medicines in order topresent safe use of these agents, including aspirin or clopidogrel, along with the effective use ofCAM (Complementary and Alternative Medicine).
Methods : This research includes literatures on only the clinical results of drug interactions, primarilyassembled from PubMed and additionally from MedlinePlus Drugs and Supplements Directory, Martindale, Natural Standard, BNF, Stockely’s Herbal Medicines, etc.
Results : Herbs that resulted in teractions with an antiplatelet agent were as follows : aloe vera,garlic, ginger, ginkgo, ginseng, and St. John’s wort. The results were all clinical and had morethan one case. Studies on garlic, ginger, and ginkgo were conducted on healthy adult subjectswhereas the clinical study on St. John’s wort was conducted on patients with stent placed ontheir coronary artery.
Conclusions : Although clinical studies and cases on drug-herb interaction had varied results, theresults could lead to the conclusion that many herbal medicines will have interactions withantiplatelet agents. Therefore, potential interactions should be considered when simultaneouslyusing herbal medicine and conventional medicine prior to treatment. Further research using alarger population is required for more accurate results.

참고문헌 (Reference)

1 황영일, "한양약복합투여시 안전성 유효성 연구" 보건복지부 2006

2 "우리나라 국민의 한방의료 이용실태와 인식도" 보건사회연구원 연구보고서

3 천부순, "와파린과 생약제의 약물 상호작용 리뷰" 한국병원약사회 30 (30): 450-470, 2013

4 조재국, "보건복지부 한국보건사회연구원 보고서" 한방 의료이용 및 한약소비 실태조사 2011

5 한국보건산업진흥원, "미래보건산업기술예측조사" 보건복지부 2006

6 박수진, "국내 한약-양약 상호작용 연구논문 분석을 통한 상호작용 정보 현황파악 및 제공방안에 대한 연구" 대한동의병리학회 24 (24): 543-552, 2010

7 유광현, "고속 스크리닝 기법을 이용한 한약제제의 cytochrome P450 저해능 탐색" 한국생명과학회 17 (17): 334-339, 2007

8 Yeh G.Y., "Use of complementary therapies in patients with cardiovascular disease" 98 (98): 673-680, 2006

9 H. Ishikawa, "The preventive effects of low-dose enteric-coated aspirin tablets on the development of colorectal tumours in Asian patients: a randomised trial" BMJ 63 (63): 1755-1759, 2014

10 Lu W.J., "The effects of ergoloid mesylates and Ginkgo biloba on the pharmacokinetics of ticlopidine" 46 (46): 628-634, 2006

11 Beckert B.W, "The effect of herbal medicines on platelet function : an in vivo experiment and review of the literature" 120 (120): 2044-2050, 2007

12 Lau W.C, "The effect of St John’s Wort on the pharmacodynamic response of clopidogrel in hyporesponsive volunteers and patients: increased platelet inhibition by enhancement of CYP3A4 metabolic activity" 57 (57): 86-93, 2011

13 International Stroke Trial Collaborative Group, "The International Stroke Trial (IST):A randomized trial of aspirin, subcutaneous heparin, both, or neither among 19,435patients with acute ischemic stroke" 349 : 1560-1581, 1997

14 World Health Organization (WHO), "The 10 leading causes of death bybroad income group"

15 Guinot P, "Tanakan inhibits platelet-activatingfactor-induced platelet aggregation in healthy male volunteers" 19 (19): 219-223, 1989

16 Young H.Y, "Synergistic effect of ginger and nifedipine on human platelet aggregation: a study in hypertensive patients and normal volunteers" 34 (34): 545-551, 2006

17 Larkin M., "Surgery patients at risk for herbanaesthesia interactions" 354 (354): 1362-, 1999

18 Vale S., "Subarachnoid haemorrhage associated with Ginkgo biloba" 36 : 9121-, 1998

19 Kim N.J., "Studies on interactions between western and traditional herbal medicines - Effects of CHUNGHYULDAN on the pharmacokinetics and pharmacodynamics of nicardipine in rats" 19 (19): 383-394, 2002

20 Rose K.D, "Spontaneous spinal epidural hematoma with associated platelet dysfunction from excessive garlic ingestion: A case report" 26 (26): 880-882, 1995

21 Rosenblatt M, "Spontaneous hyphema associated with ingestion of Ginkgo biloba extract" 336 (336): 1108-, 1997

22 Rowin J., "Spontaneous bilateral subdural hematomas associated with chronic Ginkgo biloba ingestion" 46 : 1775-1776, 1996

23 Hirakata H., "Sevoflurane inhibits human platelet aggregation and thromboxane A2 formation, possibly by suppression of cyclooxygenase activity" 85 (85): 1447-1453, 1996

24 Thorat M.A, "Role of aspirin in cancer prevention" 15 (15): 533-540, 2013

25 Chan A.L., "Risk of hemorrhage associated with co-prescriptions for Ginkgo biloba and antiplatelet or anticoagulant drugs" 17 (17): 513-517, 2011

26 Lee A., "Possible Interaction Between Sevoflurane and Aloe vera" 38 (38): 1651-1654, 2004

27 Ruggeri Z.M., "Platelets in atherothrombosis" 8 (8): 1227-1234, 2002

28 Aruna D., "Pharmacodynamic interaction studies of Ginkgo biloba with cilostazol and clopidogrel in healthy human subjects" 63 (63): 333-338, 2007

29 Badimon L., "Lipoproteins, platelets and atherothrombosis" 62 (62): 1161-1178, 2009

30 Qi L.W., "Isolation and analysis of ginseng: advances and challenges" 28 (28): 467-495, 2011

31 Kellermann A.J., "Is there a risk of bleeding associated with standardized Ginkgo biloba extract therapy?" 31 (31): 490-502, 2011

32 Lawson L.D., "Inhibition of whole blood platelet-aggregation by compounds in garlic clove extracts and commercial garlic products" 65 (65): 141-156, 1992

33 Koch E, "Inhibition of platelet activating factor (PAF)-induced aggregation of human thrombocytes by ginkgolides: considerations on possible bleeding complications after oral intake of Ginkgo biloba extracts" 12 (12): 10-16, 2005

34 Kim B. H., "Influence of ginkgo biloba extract on the pharmacodynamics effects and pharmacokinetic properties of ticlopidine: an open-label, randomized, twoperiod, two-treatment, two-sequence, single-dose crossover study in healthy Korean male volunteers" 32 (32): 380-390, 2010

35 "Homepage of natural standard research collaboration"

36 Kaye A.D., "Herbal medicines: current trends in anesthesiology practice-a hospital survey" 12 (12): 468-471, 2000

37 Tattelman E., "Health effects of garlic" 103-106, 2005

38 Fessenden J.M, "Gingko biloba: a case report of herbal medicine and bleeding postoperatively from a laparoscopic cholecystectomy" 67 (67): 33-35, 2001

39 Koo K.L., "Gingerols and related analogues inhibit arachidonic acid-induced human platelet serotonin release and aggregation" 103 (103): 387-397, 2001

40 Burnham B.E., "Garlic as a possible risk factor for postoperative bleeding" 95 (95): 213-, 1995

41 German K., "Garlic and the risk of TURP bleeding: A case report" 76 (76): 518-, 1995

42 Wojcikowski K., "Effects of garlic oil on platelet aggregation: a double-blind placebo-controlled crossover study" 18 (18): 29-34, 2007

43 Kiesewetter H., "Effect of garlic on platelet aggregation in patients with increased risk of juvenile ischaemic attack" 45 (45): 333-336, 1993

44 Connolly S.J, "Effect of clopidogrel added to aspirin in patients with atrial fibrillation" 360 (360): 2066-2078, 2009

45 Gardner C.D, "Effect of Ginkgo biloba (EGb 761) and aspirin on platelet aggregation and platelet function analysis among older adults at risk of cardiovascular disease: a randomized clinical trial" 18 (18): 787-793, 2007

46 Homepage of MedlinePlus, "Drugs, Herbs, and supplements"

47 Wolf H.R., "Does ginkgo biloba special extract EGb 761 provide additional effects on coagulation and bleeding when added to acetylsalicylic acid 500mg daily?" 7 (7): 163-172, 2006

48 Rahman K., "Dietary supplementation with aged garlic extract inhibits ADP-induced platelet aggregation in humans" 130 (130): 2662-2665, 2000

49 Christine A.H, "Dietary Supplement Adverse Events: Report of a One-Year Poison Center Surveillance Project" 4 (4): 84-92, 2008

50 Ali M., "Consumption of a garlic clove a day could be beneficial in preventing thrombosis" 53 (53): 211-212, 1995

51 Ulbricht C., "Clinical evidence of herb-drug interactions:a systematic review by the natural standard research collaboration" 9 : 1063-1120, 2008

52 Cina C.A, "Carotid endarterectomy for symptomatic carotid stenosis (Cochrane Review on CDROM)" 1 : 2001

53 Chen Z.M, "CAST : randomised placebocontrolled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial)Collaborative Group" 349 : 1641-1649, 1997

54 Guh J.H., "Antiplatelet effect of gingerol isolated from Zingiber officinale" 47 (47): 329-332, 1995

55 Kim Y.S, "Antiplatelet and antithrombotic effects of a combination of ticlopidine and Ginkgo biloba Ext (EGb 761)" 91 (91): 33-38, 1998

56 Teng C.M., "Antiplatelet actions of panaxynol and ginsenosides isolated from ginseng" 990 (990): 315-320, 1989

57 Vazquez B, "Antiinflammatory activity of extracts from Aloe vera gel" 55 (55): 69-75, 1996

58 Yokubol B, "Anesthesia with sevoflurane, but not isoflurane, prolongs bleeding time in humans" 13 (13): 193-196, 1999

59 Tsen L.C, "Alternative medicine use in presurgical patients" 93 (93): 148-151, 2000

60 Vogler B.K., "Aloe vera: a systematic review of its clinical effectiveness" 49 (49): 823-828, 1999

61 Apitz-Castro R., "Ajoene, the antiplatelet principle of garlic, synergistically potentiates the antiaggregatory action of prostacyclin, forskolin, indomethacin and dypiridamole on human platelets" 42 (42): 303-311, 1986

62 Steiner M., "Aged garlic extract, a modulator of cardiovascular risk factors: a dose-finding study on the effects of AGE on platelet functions" 131 (131): 980-984, 2001

63 CAPRIE Steering Committee, "A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE)" 348 : 1329-1339, 1996

64 Benjamin J., "A case of cerebral haemorrhage-can Ginkgo biloba be implicated?" 77 (77): 112-113, 2001