Pharmacological Evidence on Drug-Herbal Interactions on the Human Body: Drug-herb Interactions Between Cardiovascular Drugs and Chinese Herbs

Introduction

In recent years, a deadly infectious disease known as Coronavirus disease 2019 (COVID-19) had spread rapidly and inflicted a worldwide pandemic. According to the International Journal of Infectious Diseases, more than 1.5 million positive cases were recorded globally about four months after SARS-CoV-2 infection had been first discovered in China (Shah et al., 2020). It is different from the SARS outbreak in 2003. Traditional Chinese Medicine (TCM) had displayed efficacy in combating COVID-19 throughout the treatment, with 2000 years of experience in preventing and treating epidemics and plagues. Furthermore, Chinese herbal medicines also have the potential to be one of the therapeutics aids in treating diseases and act as potential materials in maintaining the proper health of humans worldwide.

Based on the Basic and Clinical Pharmacology (14^th Edition), a drug may be defined as any substance that brings about a change in biologic function through its chemical actions in the most general sense (Bertram, 2018). A drug is usually used to regulate the biological system in the human body by acting as an agonist or antagonist to the specific receptor. Over time, botanical products sales have increased obviously and more well-known in popularity, especially in the United Stated since National Health Interview Survey had recently revealed that almost 20% of Americans consume this kind of product (Grimstein & Huang, 2018).

However, a crucial issue about the safety quality of Chinese herbal medicines is lacking evidence-based toxicological review on herb-drug interactions. With the high demand for TCM, there will be quite a concern about the quality and safety of using Chinese herbs in therapeutic treatment. A guideline had been given for industry stated by the Food and Drug Administration (FDA), a sponsor should reach an agreement with the appropriate Office of New Drug (OND) review division about the methods they plan to use for arriving at acceptable dose levels in safety pharmacology and toxicity in order to use for safety monitoring during human clinical studies (Food and Drug Administration, 2016).

Therefore, assessing the potential herb-drug interactions is necessary to ensure clinical safety and to prevent any untoward effects. Over the past 40 years, clinical studies have identified a variety of adverse effects on herb-drug interactions. Common mechanisms include modulation of drug-metabolic enzymes, which leads to irreversible impacts. According to the National Law Act, it is imperative for all practitioners to improve their practice standards and monitor patients' health care effectively to provide more quality and safe healthcare services to the public (Kim et al., 2013). Doctors and physicians should constantly double-check if patients see numerous prescribers or visit multiple hospital settings before prescribing drugs to avoid pharmaceutical toxicity. Chinese herbal medicines are an essential part of TCM practice. Thus, the elevation and classification of toxic in herb-drug interactions are helpful to ensure the safety usage by practitioners in optimizing the effectiveness of treatment strategies (Kim et al., 2013). According to World Health Organization (WHO), cardiovascular diseases caused about 17.9 million people died, accounting for 32% of all global deaths in 2019 (World Health Organization, 2021). In the following section, our literature review will be focusing on cardiovascular drugs due to the high global mortality rate of cardiovascular diseases.