Analysis of a clinically important interaction between phenytoin and Shankhapushpi, an Ayurvedic preparation

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Abstract

During the course of routine plasma drug level monitoring, an unexpected loss of seizure control and reduction in plasma phenytoin levels was noticed in two patients who were also taking ‘Shankhapushi’ (SRC), an Ayurvedic preparation. Therefore, the present study was undertaken in rats to investigate any SRC-phenytoin interaction from both pharmacokinetic (serum levels) and phar- macodynamic (electroshock seizure prevention) aspects. Single dose SRC and phenytoin (oral/i.p.) coadministration did not have any effect on plasma phenytoin levels but decreased the antiepileptic activity of phenytoin significantly. On multiple-dose co- administration, SRC reduced not only the antiepileptic activity of phenytoin but also lowered plasma phenytoin levels. SRC itself showed significant antiepileptic activity compared to placebo and is worth further investigation. However, the clinical combination of SRC with phenytoin is not advised.

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    Citation Excerpt :

    Besides, patients already on AEDs enhance their risk of toxicity by ingesting botanicals that may also compromise AED activity [108,109]. Drug–herbal interactions have been demonstrated for some herbal preparations and AEDs, for example Shankpushpi, an Ayurvedic medication, which interacts with phenytoin, lowering its serum levels and, thus, increasing the likelihood of seizures [108]. Similarly, Mentat (BR16A) [110], another Ayurvedic medication, when administered with phenytoin, suppresses the latter's metabolism and, when given with carbamazepine, increases its bioavailability [109].

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