心血管疾病中药材循证应用的最新进展英文

RMIT University 10th SCICC, Guangzhou, China, 2008 Recent Progress in the Evidence-Based Application of Herbal Medicines for Cardiovascular Diseases Professor Shufeng Zhou, MD, PhD School of Health Sciences WHO Collaborating Center for Traditional Medicine RMIT University, Bundoora, Victoria 3083 Australia Phone: Tel: +61 3 9925 7794; Fax: +61 3 9925 7178 Email: .au 11 April 2008 RMIT University 10th SCICC, Guangzhou, China, 2008 An Overview of Global Herbal Use All folk medicine includes the use of plant products. 11,145 species of herbal plants worldwide; 534 species of plants for Chinese Medicine. WHO definition botanical origin, without adulteration of any synthetic drugs. Legal status: food supplements (FDA drugs/health foods (SFDA of China). US$25 billion; market value 1015%/per year. 2 billion in Australia. 40% Caucasian and 80% Asians use or used herbs. RMIT University 10th SCICC, Guangzhou, China, 2008 Active Components Biotransformation ExcretionAbsorption Response/Toxicity ? ? ? ? RMIT University 10th SCICC, Guangzhou, China, 2008 Preclinical Stage Phase I Phase II Phase III Phase IV Clinical Trials of Herbal Medicines General acceptance of humans Safety and Efficacy More data on safety and Efficacy RMIT University 10th SCICC, Guangzhou, China, 2008 Challenges for Herbal Clinical trials Dosage poor clinical studies Lack of ADR reporting system RMIT University 10th SCICC, Guangzhou, China, 2008 Types of Clinical Reports on Herb-Drug Interactions N = 85 RMIT University 10th SCICC, Guangzhou, China, 2008 What Herbs Interact with Drugs? N = 85 RMIT University 10th SCICC, Guangzhou, China, 2008 What Drugs Interact with Herbs? N = 85 Drug Properties: narrow therapeutic index; extensive metabolism; substrates of CYPs and/or PgP. RMIT University 10th SCICC, Guangzhou, China, 2008 HerbInteracting drugs DangguiWarfarin Danshen Warfarin Garlic Saquinavir, ritonavir, warfarin, chlorpropamide Ginkgo Trazodone, warfarin, digoxin GinsengAlcohol, phenelzine, warfarin HawthornDigoxin (no change) KavaAlcohol, alprazolam, bromazepam, L-dopa Milk thistleIndinavir PiperinePropranolol, rifampin, sparteine, theophylline, phenytoin RMIT University 10th SCICC, Guangzhou, China, 2008 Toxicity due to Herb-Drug Interactions Herb + DrugToxicity SJW + cyclosporine AOrgan rejection SJW + oral contraceptives Breakthrough bleeding SSRIs (sertraline Zoloft) Anticancer drug: irinotecan (CPT-11) Anticoagulants: warfarin (coumadin), phenprocoumon Antihistamine: fexofenadine Anti-HIV agents: PI: indinavir; RTI: nevirapine Bronchodilator: theophylline Hypoglycemics: tolbutamide Cardiovascualr drugs: digoxin, simvastatin Opiates: methadone, loperamide Oral contraceptives Sedatives: alprazolam & midazolam Immunosuppressants: cyclosporine & tacrolimus RMIT University 10th SCICC, Guangzhou, China, 2008 RMIT University 10th SCICC, Guangzhou, China, 2008 Mechanisms for Herb-Drug Interactions Drug Response Metabolizing enzymes (CYPs) Identical Targets Transporters (PgP) Different Targets Pharmacokinetics (PK) Pharmacodynamics (PD) RMIT University 10th SCICC, Guangzhou, China, 2008 Herb-CYP Interactions HerbCYPs affected SJWMost CYP (mainly CYP3A4) GarlicCYP2C, 2D, 2E, 3A PiperineCYP1A, 2C, 3A Licorice CYP1A, 2A, 2C, 3A KavaCYP1A, 2C, 2D, 3A Ginseng CYP3A4, 2D, 2C Ginkgo CYP2B, 3A BaizhiCYP1A, 2D, 2E, 3A DangguiCYP1A, 3A RMIT University 10th SCICC, Guangzhou, China, 2008 Herb-PgP Interactions HerbModulation of PgP Curcumininhibition Hawthorn? GarlicInhibition GinsengMostly inhibition Green teaInhibition Milk thistleInhibition PiperineInhibition SJWInduction RosemaryInhibition RMIT University 10th SCICC, Guangzhou, China, 2008 RMIT University 10th SCICC, Guangzhou, China, 2008 RMIT University 10th SCICC, Guangzhou, China, 2008 Herbal Labeling What: identity, quantity of contents, identified active ingredient by common name or proprietary blend. How to use: route, dose daily, etc Who: name and place of manufacturer, packer or distributor. What to claim “This statement has not been evaluated by the Food and Drug Administration”. “This product is not intended to diagnose, treat, cure, or prevent any diseases”. - “It is not advisable to use in combination with” RMIT University 10th SCICC, Guangzhou, China, 2008 Acknowledgments Prof. Guangji Wang Prof. Xiyong Yu Prof. Charlie Xue and Chunguang Li Prof. Eli Chan Prof. Wen Xie Prof. Tony Koon Prof. James W Paxton & Bruce Baguley Prof. John O Miners Prof. Ronald G Dickinson Prof. Min Huang & Anlong Xu Prof. Wei Duan Prof. Xiaotian Lee Prof. Ge Lin Prof. Qiang Zhang Prof. Yi-Zhun Zhu National University of Singapore Academic Research Funds Singapore Cancer Syndicate RMIT University Grant for New Institute NICM grant of Australia Auckland Medical Research Foundation New Zealand C