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Related Concept Videos

Drug toxicity: Drug–Drug Interaction01:30

Drug toxicity: Drug–Drug Interaction

Drug–drug interactions can precipitate toxicity through multiple mechanisms. Absorption interactions alter how drugs enter the body, exemplified when ranitidine increases the absorption of basic drugs, while cholestyramine decreases the levels of propranolol. Protein binding interactions occur when drugs share the same binding sites on plasma proteins. Drugs like aspirin and warfarin, when bound in excess, can lead to increased free drug concentrations, enhancing the potential for...
Combined Effects of Drugs: Synergism01:27

Combined Effects of Drugs: Synergism

Synergism is a useful mechanism where combining two or more drugs is more effective than each constituent used alone. Such combinations are also called supra-additive interactions. The drugs collectively enhance the final therapeutic effect by acting on different targets. Another advantage is that the low dose of each constituent drug is sufficient to achieve the desired effect. This helps reduce the duration of therapy and lower the adverse effects of these drugs.
Such synergistic combinations...
Pharmacokinetics: Drug–Drug Interactions01:25

Pharmacokinetics: Drug–Drug Interactions

Drug interactions occur when the pharmacological effect of one drug is altered by another substance, either enhancing or diminishing its activity. The drug whose activity is altered is known as the object drug, and the substance causing the alteration is called the agent drug or the precipitant. The net effects of these interactions are mostly undesirable, leading to decreased effectiveness or increased adverse effects. In rare cases, interactions can be beneficial, such as the enhanced...
Pharmacokinetics: Drug–Food and Drug–Viral Interactions01:26

Pharmacokinetics: Drug–Food and Drug–Viral Interactions

A drug interaction occurs when the concurrent use of another drug, food, or an external substance alters the pharmacological activity of a drug. This interaction can modify the action of the original drug, affecting its effectiveness and safety.Drug–food interactions are significant as they impact drug absorption, metabolism, and excretion. For example, grapefruit juice is a well-known disruptor of drug metabolism. It inhibits the cytochrome P450 3A4 enzyme, crucial for the metabolism of many...
Antiepileptic Drugs: Potassium Channel Activators01:20

Antiepileptic Drugs: Potassium Channel Activators

Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
Ezogabine has gained approval as an adjunctive treatment...
Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase01:11

Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase

Genetic polymorphisms in drug targets have emerged as critical determinants of interindividual variability in drug response and toxicity. Pharmacogenomic investigations increasingly focus on identifying these variations to personalize and optimize therapeutic interventions. A drug target may be a receptor, enzyme, or signaling protein involved in pharmacologic responses or disease-related pathways. While early pharmacogenetic studies focused primarily on drug metabolism, current research...

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Related Experiment Video

Updated: May 22, 2026

MEDUSA for Identifying Death Regulatory Genes in Chemo-genetic Profiling Data
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Probable etoposide interaction with Echinacea.

John B Bossaer1, Brian L Odle

  • 1Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA. bossaer@etsu.edu

Journal of Dietary Supplements
|May 22, 2012
PubMed
Summary

Echinacea may worsen chemotherapy side effects. This herbal supplement likely caused severe thrombocytopenia in a lung cancer patient treated with etoposide, a drug metabolized by CYP3A4.

Area of Science:

  • Pharmacology
  • Oncology
  • Herbal Medicine Interactions

Background:

  • Echinacea is a popular herbal supplement for immune support.
  • Echinacea is known to inhibit cytochrome P450 3A4 (CYP3A4) in vitro.
  • Etoposide, a chemotherapy drug for lung cancer, is primarily metabolized by CYP3A4.

Observation:

  • A 61-year-old patient with non-small cell lung cancer developed severe thrombocytopenia during etoposide chemotherapy.
  • The patient was concurrently taking Echinacea, which was discontinued upon discovery.
  • Following Echinacea discontinuation, the patient's platelet count improved, and subsequent chemotherapy cycles were tolerated better.

Findings:

  • This case suggests a potential drug-herb interaction between Echinacea and etoposide.

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  • Echinacea may increase etoposide toxicity, leading to profound thrombocytopenia.
  • The interaction is likely due to Echinacea's CYP3A4 inhibition, affecting etoposide metabolism.

    • Implications:

    • Patients undergoing chemotherapy, particularly with CYP3A4 substrates like etoposide, should avoid Echinacea.
    • Further formal studies are needed to confirm this drug-herb interaction in humans.
    • Clinicians should inquire about herbal supplement use in patients receiving chemotherapy to prevent adverse events.