Update of green tea interactions with cardiovascular drugs and putative mechanisms

• Published in: Yàowu shi͡p︡in fenxi Vol. 26; no. 2; pp. S72 - S77
• Main Authors: Werba, José Pablo, Misaka, Shingen, Giroli, Monica Gianna, Shimomura, Kenju, Amato, Manuela, Simonelli, Niccolò, Vigo, Lorenzo, Tremoli, Elena
• Format: Journal Article
• Language: English
• Published: China (Republic : 1949- ) Elsevier B.V 01.04.2018; Food and Drug Administration; Taiwan Food and Drug Administration
• Subjects: Cardiovascular drugs; Case reports; Catechin; Drug dosages; Drugs; Efflux; Glycoproteins; Green tea; Herb–drug interactions; Intestine; Metabolism; P-Glycoprotein; Pharmacodynamics; Pharmacokinetics; Pharmacology; Review; Sildenafil; Simvastatin; Studies; Tacrolimus; Tea; Toxicity; Warfarin; Herb–drug interactions; Green tea; Cardiovascular drugs
• ISSN: 1021-9498; 2224-6614
• DOI: 10.1016/j.jfda.2018.01.008

Many patients treated with cardiovascular (CV) drugs drink green tea (GT), either as a cultural tradition or persuaded of its putative beneficial effects for health. Yet, GT may affect the pharmacokinetics and pharmacodynamics of CV compounds. Novel GT-CV drug interactions were reported for rosuvastatin, sildenafil and tacrolimus. Putative mechanisms involve inhibitory effects of GT catechins at the intestinal level on influx transporters OATP1A2 or OATP2B1 for rosuvastatin, on CYP3A for sildenafil and on both CYP3A and the efflux transporter p-glycoprotein for tacrolimus. These interactions, which add to those previously described with simvastatin, nadolol and warfarin, might lead, in some cases, to reduced drug efficacy or risk of drug toxicity. Oddly, available data on GT interaction with CV compounds with a narrow therapeutic index, such as warfarin and tacrolimus, derive from single case reports. Conversely, GT interactions with simvastatin, rosuvastatin, nadolol and sildenafil were documented through pharmacokinetic studies. In these, the effect of GT or GT derivatives on drug exposure was mild to moderate, but a high inter-individual variability was observed. Further investigations, including studies on the effect of the dose and the time of GT intake are necessary to understand more in depth the clinical relevance of GT-CV drug interactions. [Display omitted] •Green tea and its derivatives interact with several cardiovascular (CV) drugs.•Both pharmacokinetic and pharmacodynamics interactions were reported.•Interactions are mild to moderate, with high inter-individual variability.•The clinical relevance of green tea-CV drug interactions is not yet established.