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Assessing the Clinical Significance of Botanical Supplementation on Human Cytochrome P450 3A Activity: Comparison of a Milk Thistle and Black Cohosh Product to Rifampin and Clarithromycin

From the Department of Pharmaceutical Sciences (Dr Gurley, Ms Hubbard, Mr Tong, and Dr Breen), Department of Biostatistics (Dr Williams), Department of Anesthesiology (Dr Gentry), and the Small Molecule Mass Spectrometry Facility (Dr Thaden), University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Department of Agricultural Engineering (Dr Carrier), University of Arkansas, Fayetteville, Arkansas; and the Department of Pharmaceutics (Dr Cheboyina), University of Mississippi, University, Mississippi.

Phytochemical-mediated modulation of cytochrome P450 enzymes (CYPs) may underlie many herb-drug interactions. This study's purpose was to assess the effects of milk thistle and black cohosh supplementation on CYP3A activity and compare them to a clinically recognized inducer, rifampin, and inhibitor, clarithromycin. Healthy volunteers were randomly assigned to receive a standardized milk thistle (900 mg) or black cohosh (80 mg) supplement for 14 days. Subjects also received rifampin (600 mg) and clarithromycin (1000 mg) for 7 days as positive controls for CYP3A induction and inhibition, respectively. Midazolam was administered orally before and after each supplementation and control period. The effects of milk thistle, black cohosh, rifampin, and clarithromycin on midazolam pharmacokinetics were determined using noncompartmental techniques. Unlike those observed for rifampin and clarithromycin, midazolam pharmacokinetics was unaffected by milk thistle or black cohosh. Milk thistle and black cohosh appear to have no clinically relevant effect on CYP3A activity in vivo.

Key Words: Cytochrome P450s • botanical supplements • pharmacokinetics • drug interactions

Address for reprints: Bill Gurley, University of Arkansas for Medical Sciences, College of Pharmacy, Department of Pharmaceutical Sciences, 4301 West Markham Street, Slot 522-3, Little Rock, AR 72205.

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