Horny Goat Weed (Epimedium grandiflorum)
Herba Epimedii and Increased Opioid Cravings While on Buprenorphine: A Case Report
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Herba Epimedii, commonly known as yin yang huo, inyokaku, and horny goat weed, is a traditional Chinese herbal medicine utilized for treating osteoporosis and enhancing libido. Studies conducted in vitro have demonstrated that Herba Epimedii interacts with the enzyme cytochrome P450 3A4 (CYP3A4). This interaction poses a potential risk for drug-drug interactions, particularly with medications metabolized by CYP3A4, such as buprenorphine. This paper presents a case of a patient experiencing exacerbated opioid cravings following the initiation of Herba Epimedii. This is the first reported case supporting this interaction, emphasizing the necessity of screening for alternative medicines in patients undergoing medication-assisted treatments for opioid use disorder.
| Question | ||
|---|---|---|
| 1. Are there previous credible reports in humans? | NA | NA |
| 2. Is the interaction consistent with known interactive properties of the precipitant drug? | Yes | Yes |
| 3. Is the interaction consistent with known interactive properties of the object drug? | Yes | Yes |
| 4. Is the event consistent with the known or reasonable time course of the interaction (onset and/or offset)? | Yes | Yes |
| 5. Did the interaction remit upon de-challenge of the precipitant drug with no change in the object drug? | NA | NA |
| 6. Did the interaction reappear when the precipitant drug was re-administered with continued use of object drug? | Skipped | Skipped |
| 7. Are there reasonable alternative causes? | Unk/NA | Unk/NA |
| 8. Was the object drug detected in the blood or other fluids in concentrations consistent with the interaction? | Unk/NA | Unk/NA |
| 9. Was the drug interaction confirmed by objective evidence consistent with the effects on the object drug (other than from question 8)? | Yes | Yes |
| 10. Was the interaction greater when the precipitant drug dose was increased or less when the precipitant drug dose was decreased? | NA | NA |
(>8 = Highly Probable; 5-8 = Probable; 2-4 = Possible; <2 = Doubtful) | (4) | (4) |