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Table 1 Herb–antidiabetic drug co-administration studies

From: Interactions between antidiabetic drugs and herbs: an overview of mechanisms of action and clinical implications

Herb Co-administered anti-diabetic drug Experimental/clinical study Observation References
Aloe vera Glibenclamide Clinical Additive effect on blood glucose lowering [39, 40]
Andrographis paniculata NA Experimental Antihyperglycaemic effect
Inhibits CYP2C19 activity
[83, 84]
Cassia Glibenclamide Experimental Comparable effect to glibenclamide [87]
Ginseng (Ginsenoside CK) Metformin Experimental Combined treatment with CK—ginsenoside and metformin has shown enhanced effect compared to individual compounds. Significant improvements were observed in plasma glucose and insulin levels [45]
Karela-Bitter melon (Momordicacharantia) Metformin Clinical Significant decrease in serum glucose was observed in combination of fruit juice extract at half the normal dose of metformin [48]
Glibenclamide Clinical Significant decrease in serum glucose was observed in combination of fruit juice extract at half normal dose of glibenclamide [48]
Metformin Experimental Fruit juice showed significant hypoglycemic effect in combination in normal, STZ- and alloxan-diabetic rats [49,50,51]
Ginger (Zingiber officinale) Glibenclamide Experimental Combination with ginger extract reduces blood glucose level greater than glibenclamide alone [54]
A sub-optimal dose of glibenclamide in combination with herb extract showed similar effects as a full therapeutic dose of glibenclamide
Metformin Experimental Ginger reduces hyperglycaemia and improved renal dysfunction in diabetic rats at reduced metformin dose. Combination of metformin and ginger juice ameliorates gentamicin nephrotoxicity [55, 56, 117]
Lycium-Berberislyceum royle Antidiabetics Experimental Significant reduction in glucose [85]
Prickly pear cactus (Nopal) Glipizide Clinical Hypoglycaemic adverse reaction with combination [58]
Sesame oil Glibenclamide Clinical Improved anti-hyperglycaemic effect in combination [61]
Fenugreek Metformin Experimental Significant reduction in plasma glucose level [64]
Glibenclamide Experimental Seed extract and glibenclamide inhibited induced hepatic lipid peroxidation and exhibited higher antioxidant activity [64]
Garlic Metformin Experimental Herb is capable of affecting the pharmacokinetics of metformin resulting in reduced blood glucose level [66]
Experimental Combination therapy has better reducing effect on blood glucose level [67]
Garlic with metformin in combination attenuates drug induced tubular toxicity
Experimental Significant decrease in blood glucose level [68, 69]
Gymnema Metformin Experimental Decrease in bioavailability of metformin when given in combination with herbal tea; the combination did not decrease the serum glucose level compared to metformin alone [73]
Experimental Gymnema sylvestre orally in chemically induced diabetic rats causes decreases in bioavailability of metformin and increase in blood glucose- therefore negative interaction observed [74]
Experimental Beneficial pharmacodynamic effects on blood glucose reduction by combination compared to individual metformin; but reduced metformin bioavailability [75]
St. John’s wort Metformin Clinical Decreased renal clearance of metformin but no other pharmacokinetic effects. However SJW decreased the area under glucose concentration-time curve. Improved glucose tolerance by enhancing insulin secretion independently of insulin sensitivity in male subjects taking metformin [77]
Repaglinide Clinical No effect on blood glucose lowering and insulin elevating effects of repaglinide. No significant effect on pharmacokinetics and pharmacodynamics of repaglinide [78]
Radix astragali Pioglitazone Experimental Co-administration did not affect pharmacokinetics of pioglitazone [80]
Scutellaria Metformin Experimental Significant elevations of plasma and pancreatic levels and reduction of plasma and hepatic levels of triglycerides and cholesterol [118]
Herb enhanced the antidiabetic action of metformin