Drug Interactions of Green Tea
Green tea (GT) is among the most common drinks in the world. There are some reports on interactions between GT and some drugs. This paper attempts to provide a comprehensive review of this subject. The data are collected by searching PubMed, Scopus, Web of science, and Embase. The keywords used as search terms are "camellia sinensis", "pharmacodynamics", "pharmacokinetic", "EGCG", and "drug interaction". We have found 24 eligible articles. Finally, the related papers are given in our review. GT is containing polyphenols that interfere with many drugs. The most important of these polyphenol compounds is epigallocatechin-3-gallate (EGCG), which most of the reported interactions are due to the presence of EGCG. Interaction of GT with different drugs occurs in the context of both pharmacodynamics and pharmacokinetics that includes drug absorption, metabolism, and renal excretion. The mechanisms of these interactions consist of increase in the concentration included several medications such as melatonin, midazolam, and amlodipine consuming after GT; these interactions can be toxic. Additionally, it has been reported that serum levels of several drugs such as nadolol, digoxin, amoxicillin, and clozapine are decreased and their efficacy are reduced when they simultaneously administer with GT. The serum concentration of rhodamin 123, quinidine, and doxorubicin have increased when these drugs were co-administered with GT. GT has pharmacodynamics interactions with a few drugs such as a hydrochlorothiazide. As proposed and discussed here, GT has the potential for interactions with numerous other drugs and thus clinicians should be aware of reported and potential interaction of GT with various medications in order to avoid adverse reactions and achieve expected clinical response.
2. Kim T-e, Ha N, Kim Y, et al. Effect of epigallocatechin-3-gallate, major ingredient of green tea, on the pharmacokinetics of rosuvastatin in healthy volunteers. Drug Des Devel Ther 2017;11:1409-16.
3. Han X, Zhang H, Hao H, Li H, Guo X, Zhang D. Effect Of epigallocatechin-3-gallate on the pharmacokinetics of amlodipine in rats. Xenobiotica 2019;49(8):970-4.
4. Asher GN, Corbett AH, Hawke RL. Common herbal dietary supplement—drug interactions. Am Fam Physician 2017;96(2):101-7.
5. Cascorbi I. Drug interactions—principles, examples and clinical consequences. Dtsch Arztebl Int 2012;109(33-34):546-55.
6. Chakraborty M, Kamath JV. Pharmacodynamic interaction of green tea extract with hydrochlorothiazide against ischemia-reperfusion injury-induced myocardial infarction. J Adv Pharm Technol Res 2014;5(3):134-9.
7. Ali B, MS Jamal Q, Shams S, et al. In silico analysis of green tea polyphenols as inhibitors of AChE and BChE enzymes in Alzheimer’s disease treatment. CNS Neurol Disord Drug Targets 2016;15(5):624-8.
8. Shehab NG, Khan RKG, Elgailani ESE, Shawish KYA. Possible intrusive food interaction with oral dabigatran’s anticoagulant activity in a rat models. Tropical Journal of Pharmaceutical Research 2018;17(10):2031-2036.
9. Zhao YH, Abraham MH, Le J, et al. Rate-limited steps of human oral absorption and QSAR studies. Pharm Res 2002;19(10):1446-57.
10. Schanker L. Mechanisms of drug absorption and distribution. Annual Review of Pharmacology 1961;1(1):29-45.
11. Kiss T, Timár Z, Szabó A, et al. Effect of green tea on the gastrointestinal absorption of amoxicillin in rats. BMC Pharmacol Toxicol 2019;20(1):54.
12. Maher HM, Alzoman NZ, Shehata SM, Abahussain AO. UPLC–ESI–MS/MS study of the effect of green tea extract on the oral bioavailability of erlotinib and lapatinib in rats: Potential risk of pharmacokinetic interaction. J Chromatogr B Analyt Technol Biomed Life Sci 2017;1049-1050:30-40.
13. Misaka S, Miyazaki N, Fukushima T, Yamada S, Kimura J. Effects of green tea extract and (−)-epigallocatechin-3-gallate on pharmacokinetics of nadolol in rats. Phytomedicine 2013;20(14):1247-50.
14. Abe O, Ono T, Sato H, et al. Role of (−)-epigallocatechin gallate in the pharmacokinetic interaction between nadolol and green tea in healthy volunteers. Eur J Clin Pharmacol 2018;74(6):775-83.
15. Shan Y, Zhang M, Wang T, et al. Oxidative tea polyphenols greatly inhibit the absorption of atenolol. Front Pharmacol 2016;7:192.
16. Cheeseman HJ, Neal M. Interaction of chlorpromazine with tea and coffee. Br J Clin Pharmacol 1981;12(2):165-9.
17. Ikeda H, Tsuji E, Matsubara T, et al. Incompatibility between propericiazine oral solution and tea-based drink. Chem Pharm Bull (Tokyo) 2012;60(9):1207-11.
18. Ohata T, Ikeda H, Inenaga M, et al. Drug-tea polyphenol interaction (II) complexation of piperazine derivatives with green tea polyphenol. Thermochimica Acta 2017;653:1-7.
19. Oda K, Murakami T. Pharmacokinetic interaction of green tea beverage containing cyclodextrins and high concentration catechins with P‐glycoprotein substrates in LLC‐GA 5‐COL 150 cells in vitro and in the small intestine of rats in vivo. J Pharm Pharmacol 2017;69(12):1736-44.
20. Kim T-E, Shin K-H, Park J-E, et al. Effect of green tea catechins on the pharmacokinetics of digoxin in humans. Drug Des Devel Ther 2018;12:2139-47.
21. Fleisher B, Unum J, Shao J, An G. Ingredients in fruit juices interact with dasatinib through inhibition of BCRP: a new mechanism of beverage-drug interaction. J Pharm Sci 2015;104(1):266-75.
22. Tian D-D, Kellogg JJ, Okut N, et al. Identification of intestinal UDP-glucuronosyltransferase inhibitors in green tea (Camellia sinensis) using a biochemometric approach: application to raloxifene as a test drug via in vitro to in vivo extrapolation. Drug Metab Dispos 2018;46(5):552-60.
23. Jang E, Choi J, Park C, Lee SK, Kim C, Park H, et al. Effects of green tea extract administration on the pharmacokinetics of clozapine in rats. J Pharm Pharmacol 2005;57(3):311-6.
24. Mizuma T, Awazu S. Dietary polyphenols (−)-epicatechin and chrysin inhibit intestinal glucuronidation metabolism to increase drug absorption. J Pharm Sci 2004;93(9):2407-10.
25. Huang S-M, Lertora JJ, Markey SP, Atkinson AJ, editors. Principles of clinical pharmacology. Third ed. Academic Press; 2012.
26. Yuan L, Liu M, Shi Y, Yan H, Han J, Liu L. Effect of (–)-epicatechin-3-gallate and (–)-epigallocatechin-3-gallate on the binding of tegafur to human serum albumin as determined by spectroscopy, isothermal titration calorimetry, and molecular docking. J Biomol Struct Dyn 2019;37(11):2776-88.
27. Satoh T, Fujisawa H, Nakamura A, Takahashi N, Watanabe K. Inhibitory effects of eight green tea catechins on cytochrome P450 1A2, 2C9, 2D6, and 3A4 activities. J Pharm Pharm Sci 2016;19(2):188-97.
28. Jiang X, Sun Y, Shang L, Yang C, Kong L, Zhang Z. Green tea extract-assembled nanoclusters for combinational photothermal and chemotherapy. J Mater Chem B 2019;7(39):5972-82.
29. Jana S, Rastogi H. Effects of caffeic acid and quercetin on in vitro permeability, metabolism and in vivo pharmacokinetics of melatonin in rats: potential for herb-drug interaction. Eur J Drug Metab Pharmacokinet 2017;42(5):781-91.
30. Nishikawa M, Ariyoshi N, Kotani A, et al. Effects of continuous ingestion of green tea or grape seed extracts on the pharmacokinetics of midazolam. Drug Metab Pharmacokinet 2004;19(4):280-9.
31. Paul D, Surendran S, Chandrakala P, Satheeshkumar N. An assessment of the impact of green tea extract on palbociclib pharmacokinetics using a validated UHPLC–QTOF–MS method. Biomed Chromatogr 2019;33(4):e4469.
32. Bajaj P, Chowdhury SK, Yucha R, Kelly EJ, Xiao G. Emerging Kidney Models to Investigate Metabolism, Transport, and Toxicity of Drugs and Xenobiotics. Drug Metab Dispos. 2018 Nov;46(11):1692-1702.
33. Al-Arifi MN, Wajid S, Al-Manie NK, et al. Evaluation of knowledge of Health care professionals on warfarin interactions with drug and herb medicinal in Central Saudi Arabia. Pak J Med Sci 2016;32(1):229-33.
34. Koren R, Lerner A, Tirosh A, et al. The use of complementary and alternative medicine in hospitalized patients with type 2 diabetes mellitus in Israel. J Altern Complement Med 2015;21(7):395-400.
35. Alemdaroglu NC, Dietz U, Wolffram S, Spahn‐Langguth H, Langguth P. Influence of green and black tea on folic acid pharmacokinetics in healthy volunteers: potential risk of diminished folic acid bioavailability. Biopharm Drug Dispos 2008;29(6):335-48.
36. Lu Y, Sun J, Petrova K, et al. Metabolomics evaluation of the effects of green tea extract on acetaminophen-induced hepatotoxicity in mice. Food Chem Toxicol 2013;62:707-21.
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