Imatinib and Panax Ginseng: A Potential Interaction Resulting in Liver Toxicity

  title={Imatinib and Panax Ginseng: A Potential Interaction Resulting in Liver Toxicity},
  author={Naveen Bilgi and Kimberly Bell and Ashwin N. Ananthakrishnan and Ehab Atallah},
  journal={Annals of Pharmacotherapy},
  pages={926 - 928}
OBJECTIVE: To report a case of imatinib-induced hepatotoxicity after concurrent ginseng ingestion in a patient with chronic myelogenous leukemia (CML). CASE SUMMARY: A 26-year-old man with CML who had taken imatinib 400 mg daily for 7 years with no complications presented with right upper quadrant pain. Laboratory test results included alanine aminotransferase 1069 U/L, aspartate aminotransferase 481 U/L, alkaline phosphatase 124 IU/L, total bilirubin 1.4 mg/dL, albumin 4.0 g/dL, and… 

Elevated liver enzymes resulting from an interaction between Raltegravir and Panax ginseng: a case report and brief review

It is suggested that ginseng is involved in the episode through an interaction resulting in elevated plasma concentrations of raltegravir, and clinicians should be alert when managing patients on other CYP3A4-metabolized drugs or previous liver-damaging conditions.

Imatinib and liver toxicity

The case of a patient who was started on adjuvant treatment with imatinib following resection of a primary gastrointestinal stromal cell tumour of jejunum and developed severe hepatotoxicity is reported.

Pharmacology and pharmacokinetics of imatinib in pediatric patients

This review attempts to provide an overview of the literature on pharmacology, pharmacokinetic, and pharmacogenetic of imatinib concerning pediatric CML treatment and points towards the potential benefits of regular drug monitoring.

Factors Influencing the Steady-State Plasma Concentration of Imatinib Mesylate in Patients With Gastrointestinal Stromal Tumors and Chronic Myeloid Leukemia

Only 10 countries have reported the mean concentrations of IM in GISTs or CML patients and the clinical outcomes in different ethnic groups and populations, and there is not sufficient information on the pharmacokinetic parameters altered by drug combinations with IM that could help in investigating the actual drug interactions.

Oral antineoplastic agent interactions with medicinal plants and food: an issue to take into account

A review of interactions of medicinal plants and food should be taken into account in the management of OAAs, since more than half have interactions with MPs and food, of which 70.3 % are considered important.

High-Dose Asian Ginseng (Panax Ginseng) for Cancer-Related Fatigue

PG is safe and improves CRF fatigue as well as overall quality of life, appetite, and sleep at night and Randomized controlled trials of PG for CRF are justified.

Herbal Interaction With Chemotherapeutic Drugs—A Focus on Clinically Significant Findings

Six herbal products namely echinacea, garlic, ginseng, grapefruit juice, milk thistle, and St John's wort are identified which have shown interactions with chemotherapeutic agents in humans and should be of interest to the public.

Recent advances in understanding the hepatotoxicity associated with protein kinase inhibitors

Pluripotent stem cell-derived hepatocyte-like cells and genotyping of leucocyte antigen showed early promise in identifying the individuals who were highly susceptible to KI hepatotoxicity and warrant further investigation.

Herb-anticancer drug interactions in real life based on VigiBase, the WHO global database

Phytovigilance should be considered more by health care professionals to best treat cancer patients and for better integrative care, as well as proposed a pharmacokinetic or pharmacodynamic interaction mechanism.

Drug Interactions with Herbal Medicines

The present article summarizes herbal medicine-drug interactions involving mainly inhibition or induction of cytochrome P450 enzymes and/or drug transporters and describes the clinical implications of these interactions.



Imatinib mesylate-induced acute liver failure in a patient with gastrointestinal stromal tumors

In cases of imatinib-induced acute hepatitis, the administration of prednisolone may be useful in the resolution of the acute episode and allow the reintroduction of a drug without risking recurrence of hepatitis.

Effects of imatinib (Glivec) on the pharmacokinetics of metoprolol, a CYP2D6 substrate, in Chinese patients with chronic myelogenous leukaemia.

Co-administration of a high dose of imatinib resulted in a small or moderate increase in metoprolol plasma exposure in all patients regardless of CYP2D6 status, suggesting that Imatinib has a weak to moderate inhibition on CYP 2D6 in vivo.

Early Imatinib Mesylate-Induced Hepatotoxicity in Chronic Myelogenous Leukaemia

A patient who experienced immediate dominant cholestatic damage of the liver and mild hepatocyte damage during imatinib mesylate therapy differs from most reports showing dominantly acute hepatitis with necrosis associated with the use of imatinIB mesylates.

Approval summary: imatinib mesylate capsules for treatment of adult patients with newly diagnosed philadelphia chromosome-positive chronic myelogenous leukemia in chronic phase.

  • John R. JohnsonP. Bross R. Pazdur
  • Medicine, Biology
    Clinical cancer research : an official journal of the American Association for Cancer Research
  • 2003
Imatinib showed clinically and statistically significantly better results for time-to-progression to accelerated phase or blast crisis, progression-free survival, complete hematological response rate, and cytogenetic response rate than the combination of IFN-alpha and cytarabine.

Pharmacovigilance: Effects of herbal components on human drugs interactions involving Cytochrome P450

This review documents the involvement of CYP enzymes in the metabolism of known available drugs and herbal products and the interactions between herbal constituents & CYP enzyme showing potential drug-herb interactions.

Clinical Assessment of Effects of Botanical Supplementation on Cytochrome P450 Phenotypes in the Elderly

Elderly subjects, like their younger counterparts, are susceptible to herb-mediated changes in CYP activity, especially those involving St John’s wort, and concomitant ingestion of botanical supplements with prescription medications should be strongly discouraged in the elderly.

Interaction of Imatinib Mesilate with Human P-Glycoprotein

Observations demonstrate that imatinib mesilate is a substrate as well as a modulator of human P-gp, suggesting thatImatinib Mesilate drug interactions may occur via P- gp, and it is necessary to consider the pharmacokinetic and pharmacodynamic interactions of imatinIB mesilates with other drugs via P -gp.

High rates of durable response are achieved with imatinib after treatment with interferon α plus cytarabine: results from the International Randomized Study of Interferon and STI571 (IRIS) trial

This is the largest analysis to date describing the efficacy of imatinib in patients who have received prior therapies for chronic myeloid leukemia and it demonstrates excellent responses to this treatment.

The Inhibitory Effects of Herbal Components on CYP2C9 and CYP3A4 Catalytic Activities in Human Liver Microsomes

  • N. HeT. Edeki
  • Chemistry, Biology
    American journal of therapeutics
  • 2004
It is concluded that the components of ginseng and ginkgo biloba screened are capable of inhibiting CYP2C9- and CYP3A4-mediated metabolic reactions, and the findings suggest that quercetin and ginsenoside Rd have the potential to interact with conventional medicines that are metabolized by CYP 2C9 and CYA4 in vivo.

The role of CYP3A4 and p-glycoprotein in fod-drug and herb-drug interactions.

Grapefruit juice is known now to inhibit CYP3A4 and P-GP to increase drug bioavailability, however, it also inhibits OATP to increaseDrug bioavailability.