Corticosteroids: Pharmacodynamic Interactions

Interactions between immunosuppressive drugs (other than calcineurininhibitors)�andherbsarereviewed.�Thebenefitsof� combining corticosteroids with Salvia miltiorrhiza (Chinese sage), Allium sativum (garlic), Allium cepa (onion), Panax no- toginseng (sanchi ginseng), Tripterygium wilfordii (thunder duke vine),* and Zingiber officinale (ginger) are discussed. The impact of Citrus x paradisi (grapefruit), Hypericum perforatum (St. John'swort),�Glycyrrhiza glabra, and G. uralensis (licorice) on corticosteroid pharmacokinetics is reviewed. Interactions of Ni- gella sativa (black cumin), Paeonia lactiflora (white peony) root without bark, thunder duke vine, licorice, and glycyrrhizin with methotrexate (used in immunosuppressive doses, compared to chemotherapeutic doses), positive and negative, are discussed. Little research is available on interactions with azathioprine, 6-mercaptopurine, sirolimus, cyclophosphamide, and myco- phenolate with herbs, but the studies that exist are reviewed, including those on Artemisia absinthium (wormwood), thunder dukevine,�St.�John'swort,�silymarin,�glycyrrhizin,�Astragalus membranaceus (astragalus), and the Chinese herbal formula Qing Re Huo Xue Tang.