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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]

Metformin

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