safetyriskБезопасность и риск фармакотерапииSafety and Risk of Pharmacotherapy2312-78212619-1164Federal State Budgetary Institution ‘Scientific Centre for Expert Evaluation of Medicinal Products’ of the Ministry of Health of the Russian Federation (FSBI ‘SCEEMP’)10.30895/2312-7821-2020-8-4-165-177safetyrisk-193Research ArticleОБЗОРЫREVIEWSБезопасность лекарственных растительных препаратов: клинико-фармакологические аспектыSafety of Herbal Medicines: Clinical and Pharmacological Aspectshttps://orcid.org/0000-0003-0123-3044ДемидоваО. А.DemidovaO. A.

Демидова Ольга Александровна, кандидат фармацевтических наук. Петровский б-р, д. 8, стр. 2, Москва, 127051

Olga A. Demidova, Cand. Sci. (Pharm.).8/2 Petrovsky Blvd, Moscow 127051

demidova@expmed.ruhttps://orcid.org/0000-0002-1441-3418АрхиповВ. В.ArkhipovV. V.

Архипов Владимир Владимирович, доктор медицинских наук, профессор.Петровский б-р, д. 8, стр. 2, Москва, 127051

Vladimir V. Arkhipov, Dr. Sci. (Med.), Professor.8/2 Petrovsky Blvd, Moscow 127051

arkhipov@expmed.ruhttps://orcid.org/0000-0002-9198-8661ЖуравлеваМ. В.ZhuravlevaM. V.

Журавлева Марина Владимировна, доктор медицинских наук, профессор.Петровский б-р, д. 8, стр. 2, Москва, 127051

Marina V. Zhuravleva, Dr. Sci. (Med.), Professor.8/2 Petrovsky Blvd, Moscow 127051

zhuravleva@expmed.ruhttps://orcid.org/0000-0003-3855-5899АлександроваТ. В.AlexandrovaT. A.

Александрова Татьяна Владимировна, кандидат медицинских наук.Петровский б-р, д. 8, стр. 2, Москва, 127051

Tatiana V. Alexandrova, Cand. Sci. (Med.).8/2 Petrovsky Blvd, Moscow 127051

aleksandrova@expmed.ruhttps://orcid.org/0000-0002-6077-4273АлександровА. А.AlexandrovA. A.

Александров Алексей Александрович.Петровский б-р, д. 8, стр. 2, Москва, 127051

Alexey A. Alexandrov.8/2 Petrovsky Blvd, Moscow 127051

elmed@yandex.ruНаучный центр экспертизы средств медицинского применения Министерства здравоохранения Российской ФедерацииРоссияScientific Centre for Expert Evaluation of Medicinal ProductsRussian Federation20200610202084165177Copyright © Демидова О.А., Архипов В.В., Журавлева М.В., Александрова Т.В., Александров А.А., 20202020Демидова О.А., Архипов В.В., Журавлева М.В., Александрова Т.В., Александров А.А.Demidova O.A., Arkhipov V.V., Zhuravleva M.V., Alexandrova T.A., Alexandrov A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.risksafety.ru/jour/article/view/193

Лекарственные растительные препараты широко представлены в общем ассортименте российского рынка лекарственных средств. Сложный комплекс биологически активных веществ, содержащихся в таких препаратах, определяет не только их терапевтическую эффективность, но и может стать причиной возникновения нежелательных реакций. Цель работы: анализ информации о нежелательных реакциях, причинах и особенностях их возникновения при применении лекарственных растительных препаратов. Показано, что гепатотоксическое и нефротоксическое действие биологически активных веществ таких препаратов требуют особого внимания, поскольку нарушения со стороны печени и почек могут сопровождаться развитием состояний, угрожающих жизни. Подробно рассмотрены нежелательные реакции со стороны печени, в том числе синдром синусоидальной обструкции, вызываемые токсичными биологически активными веществами из группы пирролизидиновых алкалоидов. Систематизированы данные о лекарственных препаратах растительного происхождения и токсичных биологически активных веществах, вызывающих острые и хронические формы повреждения почек. Проанализированы возможные клинически значимые взаимодействия, возникающие при совместном применении лекарственных растительных препаратов с другими лекарственными средствами вследствие фармакокинетических и фармакодинамических взаи­модействий. Для повышения безопасности фармакотерапии необходимо продолжение исследований по сбору, систематизации и анализу информации о нежелательных реакциях, возникающих при применении лекарственных растительных препаратов в виде монотерапии и в сочетании с другими лекарственными препаратами.

Herbal medicines make up a large part of all medicinal products in the Russian market. Complex combinations of biologically active substances that are used as components in herbal medicines not only determine their therapeutic efficacy, but can also cause adverse reactions. The aim of this review was to analyse data on adverse effects of herbal medicines, and reasons and mechanisms behind their development. Special attention should be given to hepatotoxic and nephrotoxic effects of biologically active substances that are used as components in herbal medicines, because liver and kidney failure may lead to life-threatening conditions. The paper addresses hepatic adverse effects, including sinusoidal obstruction syndrome, caused by toxic biologically active substances of the pyrrolizidine alkaloids group. The paper summarises data on herbal medicines and toxic biologically active substances causing acute kidney injury and chronic kidney disease. It analyses potential clinically significant interactions that may occur during co-use of herbal and other types of medicines due to their pharmacokinetic and pharmacodynamic interactions. Further research involving collection, systematisation, and analysis of adverse effects of herbal medicines used alone or in combination with other medicinal products is needed to improve the safety of pharmacotherapy.

 

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The authors declare that there are no conflicts of interest present.