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herbal extract interactions with p450 enzyme in anti-HIV drugs
Sep 11, 2001

Hi. I am HIV positive and doing well on Sustiva/Combivir . Someone sold me a liquid natural supplement called "Intra Lifestyles" which contains a long list of herbal extracts. In doing some research on the web concerning possible risks, I found a page on this website ( which outlines certain herbal extracts that "might" interact with the p450 enzyme, one of the same enzymes involved with Sustiva. One of these extracts (ginseng) is on the list of ingredients of the supplement I bought. I intend to do more research on how reputable the manufacturer is, but regardless I am somewhat hesitant about taking the supplement at all. Any comments or suggestions you might have would be much appreciated. Also, the article listed garlic as a possible interaction with p450. Would it be correct to assume a little bit of garlic in cooked food would not be a problem, but better to stay away from high dose garlic supplements if one wants to be "safe" until more information is available? Thanks you for you time. RT - Toronto

Response from Ms. Fields-Gardner

Dear RT,

Your caution is appropriate, especially when it comes to saving your working anti-HIV regimen. There has been very little research into the potential for interactions between antiretrovirals or other medications and extracts or herbs. It seems that we learn about problems once they are reported in people who lose ground because of it.

You are right that it is the supplement form that is more likely to be concentrated enough to warrant concern (compared to the garlic cloves you have in spaghetti sauce, for instance). Garlic can have an additive effect with antihypertensive, lipid-lowering, oral anti-diabetic, and analgesic medications. It may also be counter productive if you are on synthroid for hypothyroidism.

Ginseng has the potential to interact with antihypertensive medications yielding an increase in blood pressure and interfere with estrogen, oral contraceptives, and anti-diabetic therapies. Ginseng may also increase insulin resistance and glucose tolerance when mixed with a regimen containing protease inhibitors.

For more information on herbal therapies, check out the resources on

Best wishes!

extreme weakness
Wasting/weight anomoly

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