Interações entre plantas medicinais recomendadas pela ANVISA e fármacos: uma revisão de literatura

Abstract

Drug interactions are defined as the reaction that occur between two or more drugs when they are used concomitantly and result in changes in the action of a drug. Medicinal plants are plant species used for therapeutic purposes and play an important role in maintaining health. However, the use of medicinal plants with drugs may result in drug interaction, which may cause changes in the pharmacokinetics or pharmacodynamics of the drug, resulting in possible risks to a person’s health. The medicinal plants used in Brazil are regulated by ANVISA through its official documents, such as the Farmacopeia Brasileira, the Formulário de Fitoterápicos and the Memento fitoterápico. The objective of this study was to analyze the evidences of drug interactions reported in the literature with medicinal plants legitimized by ANVISA and drugs. The literature review was carried out from october to december of 2019 in the Web Of Science, Science Direct and PubMed databases and in the Stockley's Herbal Medicines Interactions book using as key-words the scientific names of each species and “interactions”. The collected data were organized according to the drug classes that interacted with medicinal plants. Of the 136 species contained in ANVISA's official documents, 67 (49%) showed evidences of drug interactions with a total of 37 drug classes and 69 (51%) species didn’t present evidences of interactions. The plant species that presented the greatest number of evidences of interactions were Hypericum perforatum (St. John’s wort) and Ginkgo biloba (ginkgo), with 43 and 25 interactions, respectively. The drug classes that presented the highest number of interactions with medicinal plants were anticoagulant drugs, antiplatelet drugs and antimicrobial drugs, most of them acting on cytochrome P450 enzymes. The use and prescription of medicinal plants with drugs should be made with caution, as interactions that may endanger the patient’s health might occur, as well as to encourage the investigation of their use by the patient at the time of anamnesis, since it may result in interactions that may cause risk to the patient’s health.