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The Pediatric Forum
July 2005

Herb-Drug Interaction Implications in Pediatric Practice: An Overview of Pharmacokinetic Trials

Arch Pediatr Adolesc Med. 2005;159(7):690-692. doi:10.1001/archpedi.159.7.692

The use of natural health products (NHPs) among children and youth is on the rise and may be as high as 70% among certain pediatric populations (eg, children with chronic conditions: asthma, hyperactivity, cancer, cystic fibrosis, eating disorders).15 The potential for interactions between NHPs and drugs may be increased in pediatric populations because of altered metabolism and excretion. Natural health products administered in conjunction with conventional medications can affect drug pharmacokinetics (absorption, distribution, metabolism, and excretion). Herb-drug interactions are primarily due to altered biotransformation; in particular, herbs may cause induction (or inhibition) of the hepatic cytochrome P450 isozymes, rendering the index drug less (or more) active. We recently published a systematic review to determine the methodological quality of clinical trials examining the possible interactions of St John’s wort with conventional drugs.6 Since interactions between NHPs (ie, St John’s wort) and prescription medications in children are of increasing concern we have used similar methods to investigate this issue in children. Our objectives were to determine the prevalence of pharmacokinetic clinical investigations of NHP-drug interactions and their relevance to the pediatric populations.

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