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研究生:陳碧雯
研究生(外文):Bi-Wen Chen
論文名稱:藥物-中草藥與膳食補充品的交互作用
論文名稱(外文):Drug-Herb and Diet Supplement Interactions
指導教授:廖若川
指導教授(外文):Yeuk-Chuen Liu
學位類別:碩士
校院名稱:國立臺灣海洋大學
系所名稱:食品科學系
學門:農業科學學門
學類:食品科學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:465
中文關鍵詞:交互作用藥物中草藥膳食補充品藥物動力學藥物藥效學葡萄柚汁
外文關鍵詞:interactionsdrugherbdiet supplementpharmacokineticpharmacodynamicgrapefruit juice
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由於近年來已開發中國家各方面醫療衛生條件及營養較佳,所以平均壽命延長,導致慢性疾病越趨上升,需長時間復健與治療,使得越來越多人開始注重疾病的預防與治療,除了採用正規由醫師處方之藥物治療以外;另外會使用替代療法來治療或預防疾病,因大多民眾喜歡服用膳食補充品,認為其為天然成份,不會產生不良反應,藥性溫和且副作用小,所以「有病治病,無病強身」的觀念根深蒂固,難以動搖,但別以為天然草本無百害,除了其本身可能具有毒性、副作用外,還可能與某些藥物產生交互作用。

因大部分使用者缺乏此類專有常識,加上醫藥專業人員未詳盡教導其專業知識,誤認天然物質無害,容易忽略與藥物間之交互作用,且此問題其臨床研究相關報導不多,而產生嚴重的交互作用問題,嚴重甚至死亡案例頻繁。

本論文即主要以確切證據的文獻整理做為藥物、中草藥與膳食補充品等交互作用的重要指標,探討其交互作用所衍生的副作用、併發症等相關議題,但由於這些問題其臨床研究相關報導不多,因此提出此文獻整理,俾使能預防及改善其交互作用所產生的危害性使其降至最低。
Recently, the average human life-span in the developed country
prolonged because of better medication, hygiene and nutrient conditions. The chronic diseases also increase as well. Therefore, alternate medicine and diet supplements which claimed to have the abilities of prevention or/and treatments of diseases attract more and more attention. Some popular mistaken believes about the diet supplement are: they are safe and less side effects comparing to medicine because they are from the nature. Thus, most of the people treat the diet supplement as food. In fact, the nature herbs may cause toxic side effect and it may cause the interaction with drugs if both are administered together.

However, most people do not know about the drug-herb interactions. In addition, the medical health professionals do not provide this information to the consumers. Thus, the users consider that nature material are safe and neglect the interaction between diet supplement and medicine. There are few clinical reports about interactions between drug and herb/diet supplement. Nevertheless, many serious consequences, such as death, caused by the interaction between drug and herb/diet supplement have been reported.

The objective of this study is to review and analysis of drug-herb/diet supplement interactions based on reported literatures and books. Since the case reports of drug-herb/diet supplement interactions were not published extensively, a grading system was used to reflect the level of available scientific evidence in support of the interactions.
目 錄
頁次
目錄………………………………………………………………………………I
摘要……………………………………………………………………………….i
Abstract……………………………………………………………………...ii
壹、前言 i
貳、研究方法 7
一、資料蒐集方法 7
(一)、利用電腦搜尋方式 7
1、http://medlineplus.gov/ 7
2、http://www.mayoclinic.com/ 9
3、http://www.supplementwatch.com/ 10
4、http://www.ncbi.nlm.nih.gov/ 17
5、http://www.sciencedirect.com/ 18
6、http://www3.interscience.wiley.com/browse/type=JOURNAL 19
7、http://www.biomedcentral.com/info/libraries/oajournals 20
8、http://ods.od.nih.gov/Research/CARDS_Database.aspx......21
9、http://grande.nal.usda.gov/ibids/index.php 22
10、http://www.cfsan.fda.gov/%7Edms/ds-warn.html 23
(二)、參考書籍 23
二、以回顧性方式編撰整理成各論及表格 25
參、藥物動力學(pharmacokinetic)與藥物藥效學(pharmacodynamic)的定義及影響因素 27
一、藥物動力學(pharmacokinetic) 27
(一)、吸收 27
1、pH分配理論的定義 28
2、胃排空速率的定義 28
3、P-glycoprotein的功能 29
(二)、分佈 30
(三)、代謝 31
1、代謝途徑種類可分三類 32
2、代謝物質目前的分類 33
3、影響藥物在體內代謝之因素 34
(1)、內在因素 34
(2)、外在因素 34
4、Cytochrome P450的作用 34
5、Cytochrome P450分類的藥物 35
(四)、排泄 62
1、ABC transporters的結構及在各組織中生理基質 62
2、ABC transporters於生體中之主要的分佈 66
(1)、ABC transporters於小腸的分佈 66
(2)、ABC transporters於血腦障壁之分佈 66
3、ABC transporters的功能及作用 67
4、ABC transporter分類的藥物 69
5、P-glycoprotein與OATP的功能及差異性 77
二、藥物藥效學(pharmacodynamic) 80
肆、食品與藥物產生交互作用及機轉 81
一、果汁與藥物的交互作用 81
(一)、果汁所含之天然成分 81
1、類黃酮的介紹 81
2、類黃酮的功效 85
二、類黃酮的代謝與cytochrome、ABC transporters的關係 85
1、類黃酮與cytochrome的交互作用機轉 86
2、類黃酮與ABC transporter的作用 87
3、類黃酮抑制ABC transporter引起藥物的交互作用 90
三、葡萄柚汁與藥物的交互作用機轉 99
1、葡萄柚汁與心血管疾病藥物的交互作用 99
(1)、葡萄柚汁的作用機轉 99
(2)、葡萄柚汁與降血壓劑的交互作用 102
(3)、葡萄柚汁與抗心律不整劑的交互作用 111
(4)、葡萄柚汁與降血脂劑的交互作用 112
(5)、葡萄柚汁與抗凝血劑的交互作用 113
(6)、葡萄柚汁與強心劑的交互作用 114
2、葡萄柚汁與其他藥物的交互作用 115
(1)、葡萄柚汁與抗過敏作用劑的交互作用 115
(2)、葡萄柚汁與賀爾蒙製劑的交互作用 117
(3)、葡萄柚汁與腸胃蠕動劑的交互作用 118
(4)、葡萄柚汁與免疫抑制劑的交互作用 118
(5)、葡萄柚汁與抗病毒劑的交互作用 119
(6)、葡萄柚汁與抗生素製劑的交互作用 120
(7)、葡萄柚汁與抗黴菌劑的交互作用 121
(8)、葡萄柚汁與精神科用藥的交互作用 122
(9)、葡萄柚汁與抗瘧藥的交互作用 125
(10)、葡萄柚汁與男性性功能改善劑的交互作用 126
(11)、葡萄柚汁與治療偏頭痛藥的交互作用 127
(12)、葡萄柚汁與降血糖劑的交互作用 128
(13)、葡萄柚汁與減輕體重劑的交互作用 128
(14)、葡萄柚汁與麻醉劑的交互作用 129
(15)、葡萄柚汁與類固醇製劑的交互作用 129
3、葡萄柚汁與藥物產生交互作用其機轉未知 130
(1)、葡萄柚汁與降血壓劑的交互作用 130
(2)、葡萄柚汁與抗心律不整劑的交互作用 131
(3)、葡萄柚汁與抗過敏作用劑的交互作用 131
(4)、葡萄柚汁與荷爾蒙製劑的交互作用 132
(5)、葡萄柚汁與精神科用藥的交互作用 133
(6)、葡萄柚汁與抗瘧劑的交互作用 134
(7)、葡萄柚汁與類固醇製劑的交互作用 135
(四)、青檸檬汁、柚子汁、蔓越莓汁、紅酒與藥物的交互作用 141
(五)、柳橙汁與藥物的交互作用 145
二、牛乳與藥物之交互作用 151
1、牛乳與藥物之交互作用機轉 151
三、茶、咖啡、酸性飲料與藥物之交互作用 154
四、高脂肪食品與藥物之交互作用 155
1、高脂肪食品與藥物之交互作用機轉 155
五、高蛋白食品與藥物之交互作用 161
1、高蛋白食品與藥物之交互作用機轉 161
六、高纖維食品與藥物之交互作用 162
1、高纖維食品與藥物之交互作用機轉 162
伍、含酪胺食品與藥物之交互作用 163
一、含酪胺食品的來源 163
二、含酪胺食品與藥物之交互作用機轉 164
陸、酒類與藥物之交互作用 165
一、酒精的代謝 165
二、酒精與藥物之交互作用 166
(一)、解熱鎮痛劑與酒精的交互作用 166
1、Acetaminophen與酒精的交互作用 166
(1)、Acetaminophen引起肝臟傷害的臨床表徵 167
(2)、Aetaminophen的代謝機轉 167
(3)、Acetaminophen與酒精的交互作用 170
2、Aspirin與酒精的交互作用 173
(二)、精神科用藥與酒精的交互作用 173
(三)、麻醉劑與酒精的交互作用 175
(四)、制酸劑與酒精的交互作用 176
(五)、治療心血管藥與酒精的交互作用 176
(六)、抗生素製劑與酒精的交互作用 177
(七)、抗嘔吐劑與酒精的交互作用 177
(八)、抗原蟲劑與酒精的交互作用 177
三、酒精中毒之解毒方法 178
(一)、急性酒精中毒之解毒方法 178
1、N-acetylcysteine的解毒機轉與作用 178
(二)、酒精中毒的解毒劑與戒癮劑 180
四、酒精與藥物交互作用之表格整理 184
柒、維生素/礦物質與藥物之交互作用及機轉 186
一、維生素/礦物質與藥物之交互作用機轉 186
捌、膳食補充品與心血管疾病藥物之交互作用 191
一、膳食補充品與抗凝血劑之交互作用及機轉 192
(一)、臨床常用抗凝血劑的種類及作用機轉 193
(二)、膳食補充品與抗凝血劑併用的風險性 194
(三)、血小板的凝集反應 196
(四)、與抗凝血劑產生交互作用的膳食補充品 197
(五)、藥效學探討膳食補充品與抗凝血劑之交互作用及機轉 200
1、含香豆素成分之膳食補充品與抗凝血劑的交互作用 200
2、含水楊酸成分之膳食補充品與抗凝血劑的交互作用 213
3、具抑制血小板凝集活性之膳食補充品與抗凝血劑的
交互作用 215
4、與維生素有關之膳食補充品與抗凝血劑的交互作用 219
5、抑制抗凝集作用之膳食補充品與抗凝血劑的交互作用 222
6、增加纖維蛋白溶解之膳食補充品與抗凝血劑的交互作用 224
7、抑制thromboxane synthetase活性膳食補充品與抗凝血劑
的交互作用 225
8、抑制血小板活化因子PAF之膳食補充品與抗凝血劑的交互作用 227
(六)、藥物動力學探討膳食補充品與抗凝血劑之交互作用及機轉 229
1、具誘導酵素作用之膳食補充品與抗凝血劑的交互作用 229
2、具抑制酵素作用之膳食補充品與抗凝血劑的交互作用 231
(七)、膳食補充品與抗凝血劑產生交互作用其機轉未知 232
(八)、膳食補充品與抗凝血劑產生交互作用的臨床實例 240
1、銀杏與ticlopidine, clopidogrel, cilostazol
的交互作用……240
2、人參、貫葉連翹與aspirin, warfarin的交互作用 252
3、枸杞與warfarin的交互作用 263
4、生薑與phenprocoumon的交互作用 264
二、膳食補充品與降血壓藥之交互作用及機轉 266
(一)、臨床常用降血壓劑的種類及作用機轉 269
(二)、與降血壓劑產生交互作用的膳食補充品 273
(三)、藥效學探討膳食補充品與降血壓劑之交互作用及機轉 277
1、具擬腎上腺素性作用劑功效之膳食補充品與降血壓劑的
交互作用 277
2、具礦質類固醇活性之膳食補充品與降血壓劑的交互作用 279
3、具利尿活性之膳食補充品與降血壓劑的交互作用 280
4、具降血壓活性之膳食補充品與降血壓劑的交互作用 281
5、具強心活性之膳食補充品與降血壓劑的交互作用 283
6、具瀉下作用之膳食補充品與降血壓劑的交互作用 284
7、具刺激咳嗽作用之膳食補充品與降血壓劑的交互作用 285
8、具雌性激素作用之膳食補充品與降血壓劑的交互作用 287
9、具有競爭性α2-拮抗劑作用之膳食補充與降血壓劑的交互作用 288
(四)、藥物動力學探討膳食補充品與降血壓劑之交互作用及機轉 289
1、具誘導酵素作用之膳食補充品與降血壓劑的交互作用 289
2、具抑制酵素作用之膳食補充品與降血壓劑的交互作用 292
三、膳食補充品與抗心律不整劑之交互作用及機轉 293
(一)、臨床常用抗心律不整劑的種類及作用機轉 294
(二)、與抗心律不整劑產生交互作用的膳食補充品 295
(三)、藥效學探討膳食補充品與抗心律不整劑之交互作用及機轉 296
(四)、膳食補充品與抗心律不整劑產生交互作用其機轉未知 304
四、膳食補充品與降血脂劑之交互作用及機轉 306
(一)、臨床常用降血脂劑的種類及作用機轉 307
(二)、與降血脂劑產生交互作用的膳食補充品 308
(三)、藥效學探討膳食補充品與降血脂劑之交互作用及機轉 308
(四)、藥物動力學探討膳食補充品與降血脂劑之交互作用及機轉 310
1、具誘導酵素作用之膳食補充品與降血脂劑的交互作用………..310
(五)、膳食補充品與降血脂劑產生交互作用其機轉未知 311
五、膳食補充品與強心劑之交互作用及機轉 314
(一)、臨床常用強心劑的種類及作用機轉 315
(二)、與強心劑產生交互作用的膳食補充品 316
(三)、藥效學探討膳食補充品與強心劑之交互作用及機轉 318
(四)、藥物動力學探討膳食補充品與強心劑之交互作用及機轉 326
1、具誘導酵素作用之膳食補充品與強心劑的交互作用 326
2、具抑制酵素作用之膳食補充品與強心劑的交互作用 332
(五)、膳食補充品與強心劑產生交互作用其機轉未知 333
六、膳食補充品與利尿劑之交互作用及機轉 337
(一)、臨床常用利尿劑的種類及作用機轉 338
(二)、與利尿劑產生交互作用的膳食補充品 339
(三)、藥效學探討膳食補充品與利尿劑之交互作用及機轉 340
(四)、與膳食補充品與利尿劑產生交互作用其機轉未知 347
玖、膳食補充品與降血糖劑之交互作用 350
一、臨床常用的降血糖劑 350
(一)、胰島素(insulin) 350
(二)、口服降血糖藥 350
1、磺胺?類(sulfonylurea) 350
2、非磺醯?素(meglitinides) 350
3、雙胍類(biguanides) 350
4、 Thiazolidinediones 350
5、α-配糖?抑制劑alpha-glucosidase inhibitors 350
二、膳食補充品及降血糖劑交互作用及機轉 350
(一)、以藥效學探討膳食補充品與降血糖劑之交互作用及機轉………350
(二)、以藥物動力學探討膳食補充品與降血糖劑之交互作用及機轉…353
(三)、膳食補充品與降血糖劑產生交互作用其機轉未知……………..354
三、膳食補充品及治療糖尿病之藥物交互作用之表格整理 357
拾、結論 360
拾壹、參考文獻 363
壹、前言 363
參-一、藥物動力學與藥物藥效學的定義及影響因素 365
肆-一、果汁與藥物的交互作用 369
肆-二、牛乳與藥物之交互交用 376
肆-三、茶、咖啡、酸性飲料與藥物之交互作用 378
肆-四、高脂肪食品與藥物之交互作用 379
肆-五、高蛋白食品與藥物之交互作用 380
肆-六、高纖維食品與藥物之交互作用 381
伍、含酪胺食品與藥物之交互作用 382
陸、酒類與藥物之交互作用 383
柒、維生素/礦物質與藥物之交互作用及機轉 385
捌-一、膳食補充品與心血管疾病藥物之交互作用 386
捌-一-(一)、膳食補充品與抗凝血劑之交互作用及機轉 387
捌-一-(二)、膳食補充品與降血壓劑之交互作用及機轉 401
捌-一-(三)、膳食補充品與抗心律不整劑之交互作用及機轉 412
捌-一-(四)、膳食補充品與降血脂劑之交互作用及機轉 420
捌-一-(五)、膳食補充品與強心劑之交互作用及機轉 426
捌-一-(六)、膳食補充品與利尿劑之交互作用及機轉 435
捌-二、膳食補充品與降血糖劑之交互作用及機轉 444
拾壹、參考文獻
壹、前言

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2. Magee, K. A. (2005) Herbal therapy: A review of
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Orthodontics Craniofacial Researches 8: 60–74.

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8. Patsalos, P. N. and Perucca, E. (2003) Clinically
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9. Cross, J. T. (2001) Fluoroquinolones. Seminars in
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M. and Blondeau, J. M. (2004) Fluoroquinolones:
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resistance. Survery of Ophthlmology 49: S73-S77.

11. Psomas, G., Tarushi, A., Efthimiadou, E. K., Sanakis,
Y., Raptopoulou, C. P. and Katsaros, N. (2006)
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參-一、藥物動力學與藥物藥效學的定義及影響因素

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肆-一、果汁與藥物的交互作用

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J. J., Cnubben, N. H. P., Groten, J. P., Bladeren, P. J.
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7. Chiang, H. M., Fang, S. H., Wen, K. C., Hsiu, S. L.,
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8. Pal, D. and Mitra, A. K. (2006) MDR- and CYP3A4-mediated
drug-herbal interactions. Life Sciences 78: 2131-2145.

9. Wang, Y. H., Chao, P. D. L., Hsiu, S. L., Wen, K. C. and
Hou, Y. C. (2004) Lethal quercetin-digoxin interaction
in pigs. Life Sciences 74: 1191-1197.

10. Patsalos, P. N. and Perucca, E. (2003) Clinically
important drug interactions in epilepsy: general
features and interactions between antiepileptic drugs.
Lancet Neurology 2: 347–356.


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review. ClinicalPediatric Emergency Medicine 6: 93-102.

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13. Morawiecka, I. B. (2000) Cisapride (PrepulsidR):
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26. Izzo, A. A., Carloa, G. D., Borrellia, F. and Ernst, E.
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30. Kakar, S. M., Paine, M. F., Stewart, P. W.and Watkins,
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31. Edwards, D. J., Fitzsimmons, M. E., Schuetz, E. G.,
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40. Lilja, J. J., Patinen, L. J. and Neuvonen, P. J.
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42. Bailey. D. G. (2004) Grapefruit juice–drug interaction
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43. 高惠娟編譯,呂嘉陞修訂。(1997) 第十五章,用於治療高血壓的藥物,
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47. Wunderlich, S. M. (2004) Food and drug interactions.
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48. Hu, Z., Yang, X., Ho, P. C., Chan, S. Y., Heng, P.
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50. Iza, M. (2000) Cisapride (PrepulsidR): Interactions
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51. 楊聖信、許桂森、林君穎、張國志合譯. (1996) 第四十七章,細菌核
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52. Sahi, J., Reyner, E. L., Bauman, J. N., Gueneva-
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135–140.

53. Ho, P. C. and Saville, D. J. (2001) Inhibition of human
CYT 3A4 activity by grapefruit Juice flavonoid,
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Pharmacy Pharmaceutical Sciences 4: 217-277.

54. Bailey, D. G., Dresser, G. K. and Bend, J. R. ( 2003).
Bergamottin, lime juice, and red wine as inhibitors of
cytochrome P450 3A4 activity: Comparison with
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55. Grenier, J., Fradette, C., Morelli, G., Merritt, G. J.,
Vranderick, M. and Ducharme, M. P. (2006) Pomelo juice,
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56. Dresser, G. K., Bailey, D. G., Leake, B. F.,
Schwarz, U. I., Dawson, P. A.,Freeman, D. J. and Kim,
R. B. (2002) Fruit juices inhibit organic anion
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decrease the oral availability of fexofenadine.
American Society for Clinica Pharmacology and
Therapeutics 71: 11-20.











肆-二、牛乳與藥物之交互作用

1. Maniscalco, B. S. and Taylor, K. A. (2004) Calcification
in coronary artery disease can be reversed by EDTA-
tetracycline long-term chemotherapy. Pathophysiology 11:
95–101.

2. Wunderlich, S. M. (2004) Food and drug interactions.
Handbook of Drug Interactions. (Ch 19) Humana Press,
Totowa, USA. Ed. by Mozayani, A.and Raymon, L. P. pp.
379-392.

3、林松洲編譯。(1999) 第十八章,化學療法、消毒,應用藥理學,
豪峰出版社,台北, pp. 571-572。

4. 高惠娟編譯,呂嘉陞修訂。(1997) 第三十七章,抑制蛋白質合成
的抗微生物藥物,圖解藥理學,合記圖書,台北, p. 177。

5. Cross, J. T. (2001) Fluoroquinolones. Seminars in
Pediatric Infectious Diseases 12: 211-223.

6. Joseph M.and Blondeau, J. M. (2004) Fluoroquinolones:
Mechanism of action, classification, and development of
resistance. Survery of Ophthlmology 49: S73-S77.

7. Manzi, S. and Shannon, M. (2005) Drug interactions: A
review. clinical Pediatric Emergency Medicine 6: 93-102.

8. Psomas, G., Tarushi, A., Efthimiadou, E. K., Sanakis,
Y., Raptopoulou, C. P.and Katsaros, N. (2006) Synthesis,
structure and biological activity of copper (II)
complexes with oxolinic acid. Journal of Inorganic
Biochemistry 100: 1764–1773.

9. Knight-Klimas, T. C. and Boullata, J. I. (2004) Drug–
nutrient interactions in the elderly. Handbook of Drug-
Nutrient Interaction. (Ch 20) Humana Press, Totowa, USA.
Ed. by Boullata, J. I. and Armenti, V. T. pp. 363-410.

10. Btaiche, I. F. and Kraft, M. D. Nutrients that may
optimize drug effects. Handbook of Drug–Nutrient
Interactions. (Ch.10) Humana Press, Totowa, USA. Ed. by
Boullata, J. I. and Armenti, V. T. pp. 195-216.































肆-三、茶、咖啡、酸性飲料與藥物之交互作用

1. Btaiche, I. F. and Kraft, M. D. Nutrients that may
optimize drug effects. Handbook of Drug-Nutrient
Interactions. (Ch 10) Humana Press, Totowa, USA. Ed. by
Boullata, J. I. and Armenti, V. T.pp. 195-216.

2. Knight-Klimas, T. C. and Boullata, J. I. (2004) Drug–
nutrient interactions in the elderly. Handbook of Drug- Nutrient Interaction. (Ch 20)Humana Press, Totowa, USA.
Ed. by Boulilata, J. I., Arnenti, V. T.and Malonem, M.
pp. 363-41.

3. Wunderlich, S. M. (2004) Food and drug interactions.
Handbook of Drug Interactions. (Ch 20) Humana Press,
Totowa, USA. Ed. by Mozayani, A. and Raymon, L. P. pp.
379-392.






















肆-四、高脂肪食品與藥物之交互作用

1. Btaiche, I. F. and Kraft, M. D. (2004)Nutrients that may
optimize drug effects. Handbook of Drug–Nutrient
Interactions. (Ch 10) Humana Press, Totowa, USA. Ed. by
Boullata, J. I. and Armenti, V. T. pp.195-216.

2. Knight-Klimas, T. C. and Boullata, J. I. (2004) Drug-
nutrient interactions in the elderly. Handbook of Drug-
Nutrient Interaction. (Ch 20) Humana Press, Totowa, USA.
Ed. by Boulilata, J. I., Arnenti, V. T.and Malonem, M.
pp. 363-410.

3. 林松洲編譯。(1999) 第十八章,化學療法、消毒,應用藥理學,
豪峰出版社,台北,pp. 571-572。

4. Wunderlich, S. M. (2004) Food and drug interactions.
Handbook of Drug Interactions. (Ch 20) Humana Press,
Totowa, USA. Ed. by Mozayani, A.and Raymon, L. P. pp.
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伍、含酪胺食品與藥物之交互作用

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陸、酒類與藥物之交互作用

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