Interacciones medicamento – nutriente y medicamento – planta medicinal en el tratamiento farmacológico de diabetes: revisión sistemática. Cuenca 2018

Abstract

Background. Type II diabetes mellitus is a chronic disease with a high prevalence worldwide and metformin is the first line oral antidiabetic therapy for its treatment. The possible interactions between this drug with nutrients and/or medicinal plants are not as known, which can lead to adverse drug reactions and influence in the pharmacological treatment efficacy. Objective. Summarize the scientific evidence about clinical relevant aspects of metformin-nutrient and metformin-medicinal plant interactions in diabetes drug therapy. Methodology. Qualitative systematic review of original articles published in the electronic databases PubMed, Scopus and BVS about interactions between metformin with nutrients or medicinal plants. Results. Through the application of the search equations designed for this study, 1.110 potential articles were obtained, of which 20 met the inclusion criteria. Among them, nine reported pharmacodynamic interactions: seven of synergism and two of antagonism, while two reported pharmacokinetic interactions and nine did not report any interaction. Conclusions Co-administration of metformin with macronutrients in some cases appears to be safe, while in others antagonism, reduced bioavailability and absorption are reported. Vitamins C and E supplementation as well as the intake of insoluble fiber, spirulin, white mulberry, St. John's wort and nopal present synergism with metformin, while it is also reported that Morus alba linne, Puerariae radix, stevia and chinese herbal products Di Huang Wan, despite its hypoglycemic properties do not present interactions with metformin