Drug interaction potential of soy extract and Panax ginseng

To determine if soy extract or Panax ginseng increases the urinary excretion of the 6-beta-hydroxycortisol/cortisol ratio as a marker of cytochrome P450 (CYP) 3A enzyme induction, subjects received a soy extract containing 50 mg isoflavones twice daily (n = 20) or Panax ginseng 100 mg standardized to 4% ginsenosides twice daily (n = 20) for 14 days. Neither Panax ginseng nor soy extract significantly altered the urinary 6-beta-OH-cortisol/cortisol ratio, suggesting that unlike St. John's wort, they are not CYP3A inducers. Studies in vitro using human liver microsomes were performed to determine the effect of soy extract on probe substrates of CYP and UDP glucuronosyltransferase (UGT). Unhydrolyzed soy extract produced very little inhibition of CYP1A2, CYP2A6, and CYP2D6 and a trend of activation of CYP3A4. Hydrolyzed soy extract showed inhibition of all of the CYPs tested, particularly CYP2C9 and CYP3A4. UGT2B15 was the only UGT significantly inhibited. Even though both soy extract and ginseng have been shown to activate CYP3A4 in vitro, there is a lack of an in vitro correlation with the in vivo effects.