{
    "abstract": "Cassia angustifolia is a species of plant from the Senna family that has traditionally been used as a laxative in different herbal products and commercial medicines. Even though there are few documented drug-plant interactions, the use of C.\u00a0angustifolia with different drugs may have additive effects, such as with other laxatives or potassium-depleting diuretics. Its use also increases peristalsis which, may reduce drug absorption. The combination with digoxin has been associated with an increased risk of digoxin toxicity, probably due to an increase in plasma digoxin concentrations and hypokalaemia. We present a case with supratherapeutic trough concentration of tacrolimus, an immunosuppressive agent, and a herbal product in a liver transplant patient after concomitant intake of tacrolimus and a herbal product based on C.\u00a0angustifolia, suggesting a possible drug-lant interaction through by P-glycoprotein. We observed an increase in the patient's blood concentration 2.8-fold and the area under the curve at\u00a0steady state\u00a02.1-fold. This interaction could be of clinical relevance, given the dose-dependent side effects of tacrolimus, such as nephrotoxicity, neurotoxicity, hypertension, hyperglycaemia, or electrolyte alterations.",
    "authors": [
        {
            "affiliation": "Pharmacy, Clinical Pharmacokinetics Unit, Dr.Balmis General University Hospital, Alicante, Spain.\nAlicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.",
            "firstname": "Iv\u00e1n",
            "initials": "I",
            "lastname": "Beltr\u00e1-Pic\u00f3"
        },
        {
            "affiliation": "Pharmacy, Clinical Pharmacokinetics Unit, Dr.Balmis General University Hospital, Alicante, Spain.\nAlicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.",
            "firstname": "Marcos",
            "initials": "M",
            "lastname": "D\u00edaz-Gonz\u00e1lez"
        },
        {
            "affiliation": "Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.\nPharmacy and Pharmaceutical Technology, Miguel Hernandez University of Elche, Alicante, Spain.",
            "firstname": "Ricardo",
            "initials": "R",
            "lastname": "Nalda-Molina"
        },
        {
            "affiliation": "Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.\nPharmacy and Pharmaceutical Technology, Miguel Hernandez University of Elche, Alicante, Spain.",
            "firstname": "Amelia",
            "initials": "A",
            "lastname": "Ramon-Lopez"
        },
        {
            "affiliation": "Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.\nHepatology and Liver Unit, Dr. Balmis General University Hospital, Alicante, Spain.",
            "firstname": "Sonia",
            "initials": "S",
            "lastname": "Pascual-Bartolom\u00e9"
        },
        {
            "affiliation": "Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.\nHepatology and Liver Unit, Dr. Balmis General University Hospital, Alicante, Spain.",
            "firstname": "Cayetano F",
            "initials": "CF",
            "lastname": "Miralles-Maci\u00e0"
        },
        {
            "affiliation": "Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.\nHepatology and Liver Unit, Dr. Balmis General University Hospital, Alicante, Spain.",
            "firstname": "Mar\u00eda",
            "initials": "M",
            "lastname": "Rodr\u00edguez-Soler"
        },
        {
            "affiliation": "Pharmacy, Clinical Pharmacokinetics Unit, Dr.Balmis General University Hospital, Alicante, Spain.\nAlicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.",
            "firstname": "Patricio",
            "initials": "P",
            "lastname": "M\u00e1s-Serrano"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2024 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.",
    "doi": "10.1111/bcp.16079",
    "journal": "British journal of clinical pharmacology",
    "keywords": [
        "food/herbal drug interactions",
        "immunosuppression",
        "liver",
        "pharmacokinetic\u2013pharmacodynamic",
        "transplantation"
    ],
    "methods": null,
    "publication_date": "2024-04-25",
    "pubmed_id": "38657592",
    "results": null,
    "title": "Cassia angustifolia and tacrolimus interaction in a liver transplant patient, a case report.",
    "xml": "<Element 'PubmedArticle' at 0x788503bfc1d0>"
}