INDIAN MEDICINAL PLANTS WITH ANTIDIABETIC ACTIVITY: A COMPREHENSIVE REVIEW OF PHYTOCONSTITUENTS AND THERAPEUTIC MECHANISMS

The simultaneous use of traditional herbal remedies (HRs) and contemporary pharmaceuticals presents a significant risk of pharmacological interactions that can alter drug metabolism, efficacy, and patient safety. This systematic review aims to thoroughly examine these interactions, identify the most common occurrences, clarify their underlying mechanisms, and provide therapeutic recommendations for safe co-administration. Methods: A systematic search was conducted across PubMed, MEDLINE, and the Cochrane Library for literature published up to July 2024. The review included data from clinical trials, observational studies, and comprehensive reviews. The quality of the studies was assessed using the Cochrane risk-of-bias tool and the Newcastle-Ottawa Scale. Results: From an initial screening of 3,245 records, 50 studies were chosen for qualitative synthesis and 20 for quantitative analysis. Key findings indicate that the modulation of cytochrome P450 (CYP) enzymes and various drug transporters frequently mediates these interactions. This modulation results in significant changes in the pharmacokinetics and pharmacodynamics of co-administered pharmaceuticals. Notable examples include St. John’s Wort affecting immunosuppressants and various herbal teas impacting the effectiveness of anticoagulants. Conclusion: Pharmacological interactions between HRs and conventional drugs are a common and clinically significant issue. Healthcare professionals must diligently monitor patients for these interactions and be prepared to adjust treatment regimens to ensure optimal patient safety. Furthermore, high-quality research is essential to establish comprehensive, evidence-based guidelines for the safe concurrent use of herbal and conventional medicines.