Cassia
Cinnamon/Drug Interactions:
AlcoholAlcohol: Fish exposed to ethanol and cinnamaldehyde had greater adverse effects on fetal development when combined, compared to their individual effects (342). Alzheimer's agentsAlzheimer's agents: In laboratory research, chloroform extracts of Cinnamomum cassia produced marginal neuronal cell protection from direct betaA(1-42) insult (8). Theoretically, concurrent use of cinnamon with Alzheimer's agents may cause beneficial, additive effects. AnalgesicsAnalgesics: In animal research, an ethanolic extract of Cinnamomum zeylanicum possessed an antinociceptive effect (343). Theoretically, concurrent use of cinnamon with analgesic agents may have additive effects. Antiarrhythmic agentsAntiarrhythmic agents: Cinnamon has demonstrated antiarrhythmic properties in animal studies (133; 32; 33; 134; 13; 43). The effects of cinnamon with antiarrhythmic agents are not well understood. AntiasthmaticsAntiasthmatics: Asthma and other chronic respiratory symptoms were seen in spice factory workers (326; 327; 262). AntibioticsAntibiotics: In vitro, cinnamon has demonstrated antibacterial properties (344; 63; 345; 49; 44; 346; 46; 347). A synergistic antimicrobial effect was noted when chlorhexidine was used in combination with essential oils of cinnamon, tea tree (Melaleuca alternifolia), manuka (Leptospermum scoparium), Leptospermum morrisonii, arnica, eucalyptus, and grapefruit against biofilm and planktonic cultures of Streptococcus mutans and Lactobacillus plantarum (39). Theoretically, concurrent use of cinnamon with antibiotic agents may have additive effects. According to secondary sources, concomitant use of cinnamon with tetracyclines may slow the absorption and reduce blood levels of tetracycline antibiotics. This effect may be due to adsorption of tetracycline by cinnamon. Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In animal research, cinnamon bark, cinnamaldehyde, and two other Cinnamomum species (C. altissimum and C. pubescens) decreased platelet counts after long-term use (96; 29; 348; 349). Cinnamic aldehyde inhibited arachidonic acid release and thromboxane B2 formation, which may contribute to reduced platelet aggregation (350). Theoretically, concurrent use of cinnamon with anticoagulants or antiplatelets may increase the risk of bleeding. Antidiabetic agentsAntidiabetic agents: In vitro and in animal research, cinnamon lowered blood glucose levels and acted as an insulin mimetic (97; 98; 99; 100; 101; 102; 103; 104; 105; 106; 107; 108; 109; 92; 110; 111; 112; 113; 96; 114; 115; 116; 117; 118; 119; 120; 121; 122). Human research, however, has demonstrated conflicting results (123; 124; 125; 103; 126; 127; 128; 129). Theoretically, concurrent use of cinnamon with blood sugar-lowering agents may have additive effects and increase the risk of hypoglycemia. AntifungalsAntifungals: Cinnamon has demonstrated antifungal effects in vitro (351; 352; 353; 354; 186; 355) and inhibited candidiasis in humans (187; 356). In laboratory research, Cinnamomum cassia in combination with amphotericin B displayed additive antifungal effects and was less toxic compared to amphotericin B alone (357). Theoretically, concurrent use of cinnamon with antifungal agents may have additive effects. Antigout agentsAntigout agents: According to secondary sources, cinnamon may interact with gout agents.AntihypertensivesAntihypertensives: Cinnamomummigao oil reduced systolic and diastolic arterial blood pressure in animal research (134). In animal research, whole cinnamon and aqueous extracts reduced systolic blood pressure elevations, as well as a genetic component of elevated blood pressure (358). Human research also demonstrated a reduction in systolic blood pressure upon treatment with Cinnulin PF? (122). Theoretically, concurrent use of cinnamon with antihypertensive agents may have additive effects and increase the risk of hypotension. Anti-inflammatory agentsAnti-inflammatory agents: In vitro, cinnamon bark may exert anti-inflammatory properties (30; 18). Theoretically, concurrent use of cinnamon with anti-inflammatory agents may have additive effects. Antilipemic agentsAntilipemic agents: In animal research, Cinnamomum zeylanicum significantly decreased serum total cholesterol and triglyceride concentrations and markedly increased HDL cholesterol levels (136; 137; 138). In animal research, cinnamate, a phenolic compound in cinnamon bark, produced higher high-density lipoprotein (HDL) cholesterol levels and a lower atherogenic index compared to lovastatin (137). Cinnamate inhibited hepatic 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase activity (137). In hamsters, a water extract of cinnamon (Cinnulin PF?) inhibited the postprandial overproduction of apo B48-containing lipoproteins and serum triglyceride levels, and inhibited cluster of differentiation (CD) 36 and microsomal triglyceride transfer protein (MTTP) (359). However, these results were in contrast to another study that did not show any cholesterol-lowering effect in serum and liver cholesterol levels of rats when included in the diet at about fivefold the normal human intake level (51). Theoretically, concurrent use of cinnamon with antilipemic agents may have additive effects. Antineoplastic agentsAntineoplastic agents: In vitro and in animal research, cinnamon exerted antitumor and antigenotoxic effects (70; 21; 72; 71). Theoretically, concurrent use of cinnamon with antineoplastic agents may have additive effects. Antiobesity agentsAntiobesity agents: In a clinical trial studying the effects of Cinnulin PF?, compared with placebo, the treatment group noted increases in lean mass (+1.1%: 53.7 ? 11.8kg [pre] to 54.3 ? 11.8kg [post], p<0.002) (122). Antiretroviral agentsAntiretroviral agents: In clinical research, Cinnamomum cassia bark extract inhibited virus-induced cytopathogenicity in MT-4 cells infected with HIV (50). Theoretically, concurrent use of cinnamon with antiretroviral agents may have additive effects. Antispasmodic agentsAntispasmodic agents: According to secondary sources, cinnamon may have antispasmodic effects. Theoretically, concurrent use of cinnamon with antispasmodic agents may have additive effects.Antiviral agentsAntiviral agents: According to clinical research, Cinnamomum cassia bark extract may be effective against HIV-1 and HIV-2 replication in terms of inhibition of virus-induced cytopathogenicity in MT-4 cells infected with HIV (50). Theoretically, concurrent use of cinnamon with antiviral agents may have additive effects. AspirinAspirin: Aspirin (acetylsalicylic acid) reduced contact urticaria reactions caused by cinnamic aldehyde and cinnamic acid, due to the inhibitory effects of aspirin on prostaglandin bioformation (272). Cytochrome P450-modifying agentsCytochrome P450-modifying agents: In vitro, cinnamon or its constituents may interact with hepatic microsomal cytochrome P450 (93; 94; 95; 360). Cinnamon bark inhibited aminopyrine N-demethylation in rat liver microsomes. O-methoxycinnamaldehyde (OMCA), isolated from Cinnamomi cortex, was identified as the component that inhibited drug oxidations catalyzed by CYP1A2 and CYP2E1 (361). Cinnamomum burmannii bark inhibited CYP3A4 and 2D6 via erythromycin N-demethylation and dextromethorphan O-demethylation activities in human liver microsomes (362). Theoretically, cinnamon may alter the levels of drugs metabolized by cytochrome P450, specifically 1A2 and 2E1. Dermatologic agentsDermatologic agents: In human research, rash and hives have been reported following cinnamon administration (102; 135). DexamethasoneDexamethasone: In animal research, dexamethasone inhibited nonimmunologic contact urticaria reactions to cinnamic acid and cinnamic aldehyde (273). Drugs that affect GABADrugs that affect GABA: In animal research, cinnamon may exert an anxiolytic effect via regulation of the serotonergic and GABAergic systems (363). Theoretically, concurrent use with other drugs that affect GABA may cause additive effects. EstrogensEstrogens: Cinnamomi cortex as a component of the unkei-to combination product stimulated estradiol secretion in laboratory research (364). Theoretically, concurrent use of cinnamon with estrogens may have additive effects. Gastrointestinal agentsGastrointestinal agents: Nausea and abdominal pain have been reported with cinnamon use (209; 210). HepatotoxinsHepatotoxins: In animal research on the essential oil of Cinnamomum cassia stem bark, coumarin was isolated (93). Due to the potential for high levels of coumarin, European health agencies have recently warned against the consumption of large amounts of Cinnamomum aromaticum (cassia) due to coumarin being a constituent (173; 132). However, in vitro, Cinnamomum verum was reported to be relatively nonhepatotoxic in both rat MH1C1 and human HepG2/C3A liver cells when a cluster analysis was used (213). ImmunosuppressantsImmunosuppressants: In vitro and in animal research, cinnamon demonstrated immunomodulatory effects (55; 130; 131; 56). Theoretically, cinnamon may alter the effects of immunosuppressants. IndomethacinIndomethacin: In animal research, indomethacin inhibited nonimmunologic contact urticaria reactions to cinnamic acid and cinnamic aldehyde (273). InsecticidesInsecticides: In a clinical trial, (E)-cinnamaldehyde (CA) and cinnamyl alcohol (CL) appeared to be effective against Aedes aegypti (L.) female mosquitoes (196). Neurologic agentsNeurologic agents: In animal research, cinnamon may exert an anxiolytic effect via regulation of the serotonergic and GABAergic systems (363). Theoretically, concurrent use with other herbs or supplements that affect GABA may cause additive effects. PhotosensitizersPhotosensitizers: Alpha-amyl cinnamic aldehyde, cinnamic alcohol, cinnamic aldehyde, and alpha-amyl cinnamic aldehyde have all been identified as increasing phototoxicity (139). SympathomimeticsSympathomimetics: In animal research, TRPA1 agonists, such as cinnamaldehyde, activated the sensory nerves and induced adrenaline secretion via the central nervous system (365). Theoretically, concurrent use with sympathomimetics may cause additive effects. TerfenadineTerfenadine: In human research, terfenadine did not inhibit contact urticaria reactions caused by cinnamic aldehyde (271). TetracyclinesTetracyclines: According to secondary sources, concomitant use of cinnamon with tetracyclines may slow the absorption and reduce blood levels of tetracycline antibiotics. This effect may be due to adsorption of tetracycline by cinnamon.Cinnamon/Herb/Supplement Interactions:
Alzheimer's agentsAlzheimer's agents: In laboratory research, chloroform extracts of Cinnamomum cassia produced marginal neuronal cell protection from direct betaA(1-42) insult (8). Theoretically, concurrent use of cinnamon with Alzheimer's herbs may cause beneficial, additive effects. AnalgesicsAnalgesics: In animal research, an ethanolic extract of Cinnamomum zeylanicum possessed an antinociceptive effect against both acetic acid-induced writhing and hot plate-induced thermal stimulation in mice (343). Theoretically, concurrent use of cinnamon with analgesic agents may have additive effects. AntiarrhythmicsAntiarrhythmics: Cinnamon has demonstrated antiarrhythmic properties in animal studies (133; 32; 33; 134; 13; 43). The effects of cinnamon with antiarrhythmic agents are not well understood. AntiasthmaticsAntiasthmatics: Asthma and other chronic respiratory symptoms were seen in spice factory workers (326; 327; 262). AntibacterialsAntibacterials: In vitro, cinnamon has demonstrated antibacterial properties (344; 63; 345; 49; 44; 346; 46). Theoretically, concurrent use of cinnamon with other antibacterial agents may have additive effects. According to secondary sources, concomitant use of cinnamon with tetracyclines may slow the absorption and reduce blood levels of tetracycline antibiotics. This effect may be due to adsorption of tetracycline by cinnamon. Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In animal research, cinnamon bark, cinnamaldehyde, and two other Cinnamomum species (C. altissimum and C. pubescens) decreased platelet counts after long-term use (96; 29; 348; 349). Cinnamic aldehyde inhibited arachidonic acid release and thromboxane B2 formation, which may contribute to reduced platelet aggregation (350). Theoretically, concurrent use of cinnamon with anticoagulants or antiplatelets may increase the risk of bleeding. AntifungalsAntifungals: Cinnamon has demonstrated antifungal properties in vitro (351; 352; 353; 354; 186; 355) and inhibited oral candidiasis in humans (187; 356). In laboratory research, Cinnamomum cassia in combination with amphotericin B displayed additive antifungal effects and was less toxic compared to amphotericin B alone (357). Theoretically, concurrent use of cinnamon with antifungal agents may have additive effects. Antigout agentsAntigout agents: According to secondary sources, cinnamon may interact with gout agents.Anti-inflammatory herbsAnti-inflammatory herbs: In vitro, cinnamon bark exerted anti-inflammatory properties (30; 18). Theoretically, concurrent use of cinnamon with anti-inflammatory agents may have additive effects. Antilipemic agentsAntilipemic agents: In animal research, Cinnamomum zeylanicum significantly decreased serum total cholesterol and triglyceride concentrations and markedly increased HDL cholesterol levels (136; 137; 138). In animal research, cinnamate, a phenolic compound in cinnamon bark, produced higher high-density lipoprotein (HDL) cholesterol levels and a lower atherogenic index compared to lovastatin (137). Cinnamate inhibited hepatic 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase activity (137). In hamsters, a water extract of cinnamon (Cinnulin PF?) inhibited the postprandial overproduction of apo B48-containing lipoproteins and serum triglyceride levels, and inhibited cluster of differentiation (CD) 36 and microsomal triglyceride transfer protein (MTTP) (359). However, these results were in contrast to another study that did not show any cholesterol-lowering effect in serum and liver cholesterol levels of rats when included in the diet at about fivefold the normal human intake level (51). Theoretically, concurrent use of cinnamon with antilipemic agents may have additive effects. Antineoplastic agentsAntineoplastic agents: In vitro and in animal research, cinnamon exerted antitumor and antigenotoxic effects (70; 21; 72; 71). Theoretically, concurrent use of cinnamon with antineoplastic agents may have additive effects. Antiobesity herbs and supplementsAntiobesity herbs and supplements: In a clinical trial studying the effects of Cinnulin PF?, compared with placebo, the treatment group noted increases in lean mass (+1.1%: 53.7 ? 11.8kg [pre] to 54.3 ? 11.8kg [post], p<0.002) (122). AntioxidantsAntioxidants: Cinnamon bark has been shown to contain very high concentrations of antioxidants (366). Several animal and in vitro studies have demonstrated the antioxidant effects of the essential oil obtained from the bark of Cinnamomum zeylanicum and its main components (367; 368; 369; 57; 370; 371; 372; 373). Etheric, methanolic, and aqueous cinnamon extracts have also inhibited oxidative processes in vitro (374; 375; 47; 376; 377; 378; 379; 19). In human research, a dried aqueous extract of cinnamon (Cinnulin PF?), increased antioxidant status (185). Theoretically, concurrent use of cinnamon with antioxidants may have additive effects. Antispasmodic herbs and supplementsAntispasmodic herbs and supplements: According to secondary sources, cinnamon may have antispasmodic effects. Theoretically, concurrent use of cinnamon with antispasmodic agents may have additive effects.AntiviralsAntivirals: According to clinical research, Cinnamomum cassia bark extract may be effective against HIV-1 and HIV-2 replication in terms of inhibition of virus-induced cytopathogenicity in MT-4 cells infected with HIV (50). Theoretically, concurrent use of cinnamon with antiviral agents may have additive effects. ArtemisiaArtemisia: In laboratory research, when Cinnamomum camphora was mixed with Artemisia princeps Pamp. (in a 1:1 mixture), a synergistic insecticidal effect was noted (380). Cytochrome P450-modifying agentsCytochrome P450-modifying agents: In vitro, cinnamon or its constituents may interact with hepatic microsomal cytochrome P450 (93; 94; 95; 360). Cinnamon bark inhibited aminopyrine N-demethylation in rat liver microsomes. O-methoxycinnamaldehyde (OMCA), isolated from Cinnamomi cortex, was identified as the component that inhibited drug oxidations catalyzed by CYP1A2 and CYP2E1 (361). Cinnamomum burmannii bark inhibited CYP3A4 and 2D6 via erythromycin N-demethylation and dextromethorphan O-demethylation activities in human liver microsomes (362). Theoretically, cinnamon may alter the levels of drugs metabolized by cytochrome P450, specifically 1A2 and 2E1. CloveClove: According to a review, synergistic antibacterial effects have been observed between cinnamaldehyde and eugenol, a constituent of clove (381). EphedraEphedra: Components of ephedra reportedly interact with cinnamon; however, details of this interaction are not well documented (382). Gastrointestinal agentsGastrointestinal agents: Nausea and abdominal pain have been reported with cinnamon use (209; 210). Hepatotoxic agentsHepatotoxic agents: In animal research on the essential oil of Cinnamomum cassia stem bark, coumarin was isolated (93). Due to the potential for high levels of coumarin, European health agencies have recently warned against the consumption of large amounts of Cinnamomum aromaticum (cassia) due to coumarin being a constituent (173; 132). However, in vitro, Cinnamomum verum was reported to be relatively nonhepatotoxic in both rat MH1C1 and human HepG2/C3A liver cells when a cluster analysis was used (213). HypotensivesHypotensives: Cinnamomummigao oil reduced systolic and diastolic arterial blood pressure in animal research (134). Human research also demonstrated a reduction in systolic blood pressure upon treatment with Cinnulin PF? (122). In animal research, whole cinnamon and aqueous extracts have been found to reduce systolic blood pressure elevations, as well as a genetic component of elevated blood pressure (358). Theoretically, concurrent use of cinnamon with antihypertensive agents may have additive effects and increase the risk of hypotension. ImmunosuppressantsImmunosuppressants: In vitro and in animal research, cinnamon has demonstrated immunomodulatory effects (55; 130; 131; 56). Theoretically, cinnamon may alter the effects of immunosuppressants. Insect repellantsInsect repellants: In a clinical trial, (E)-cinnamaldehyde (CA) and cinnamyl alcohol (CL) appeared to be effective against Aedes aegypti (L.) female mosquitoes (196). Neurologic agentsNeurologic agents: In animal research, cinnamon may exert an anxiolytic effect via regulation of the serotonergic and GABAergic systems (363). Theoretically, concurrent use with other herbs or supplements that affect GABA may cause additive effects. PhotosensitizersPhotosensitizers: Alpha-amyl cinnamic aldehyde, cinnamic alcohol, cinnamic aldehyde, and alpha-amyl cinnamic aldehyde have all been identified as increasing phototoxicity (139). PhytoestrogensPhytoestrogens: Cinnamomi cortex as a component of the unkei-to combination product stimulated estradiol secretion in laboratory research (364). Theoretically, concurrent use of cinnamon with estrogens may have additive effects. SympathomimeticsSympathomimetics: In animal research, TRPA1 agonists, such as cinnamaldehyde, have been shown to activate the sensory nerves and induce adrenaline secretion via the central nervous system (365). Theoretically, concurrent use with sympathomimetics may cause additive effects. Vitamin EVitamin E: In laboratory research, pretreatment with vitamin E markedly prevented cinnamaldehyde-mediated apoptosis (383). Cinnamon/Food Interactions:
CarrotsCarrots: In laboratory research, a low concentration of cinnamaldehyde enhanced the taste of carrot broth (384). Foods containing cloveFoods containing clove: According to a review, synergistic antibacterial effects have been observed between cinnamaldehyde and eugenol, a constituent of clove (381). Foods containing vitamin EFoods containing vitamin E: In laboratory research, pretreatment with vitamin E markedly prevented cinnamaldehyde-mediated apoptosis (383). Cinnamon/Lab Interactions:
Blood pressureBlood pressure: In animal research, Cinnamomummigao oil reduced systolic and diastolic arterial blood pressure (134). In animal research, whole cinnamon and aqueous extracts have been found to reduce systolic blood pressure elevations, as well as a genetic component of elevated blood pressure (358). Human research also demonstrated a reduction in systolic blood pressure upon treatment with cinnamon (122; 179). Carbon clearance testCarbon clearance test: A polysaccharide isolated from the bark of Cinnamomum cassia Blume was found to exert reticuloendothelial system-potentiating activity in a carbon clearance test (54). Coagulation panelCoagulation panel: In animal research, cinnamon bark, cinnamaldehyde, and two other Cinnamomum species (C. altissimum and C. pubescens) decreased in platelet counts after long-term use (96; 29; 348; 349). Cinnamic aldehyde inhibited arachidonic acid release and thromboxane B2 formation, which may contribute to reduced platelet aggregation (350). EstrogensEstrogens: Cinnamomi cortex as a component of the unkei-to combination product stimulated estradiol secretion in laboratory research (364). Heart rateHeart rate: In animal research, various cinnamon species (133; 32; 134; 13; 43), including Cinnamomummigao (33), decreased heart rate. Hemoglobin A1CHemoglobin A1C: In humans, significantly decreased HbA1C has been demonstrated with cassia cinnamon treatment and Chinese Cinnamomum aromaticum (191; 178). A significant benefit with regard to average change in HbA1C was also reported in humans (179). Lipid profileLipid profile: In animal research, Cinnamomum zeylanicum significantly decreased serum total cholesterol and triglyceride (TG) concentrations and markedly increased HDL cholesterol levels (136; 137). In animal research, cinnamate, a phenolic compound in cinnamon bark, produced higher high-density lipoprotein (HDL) cholesterol levels and a lower atherogenic index compared to lovastatin (137). Cinnamate inhibited hepatic 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase activity (137). In hamsters, a water extract of cinnamon (Cinnulin PF?) inhibited the postprandial overproduction of apo B48-containing lipoproteins and serum triglyceride levels, and inhibited cluster of differentiation (CD) 36 and microsomal triglyceride transfer protein (MTTP) (359). However, these results were in contrast to another study that did not show any cholesterol-lowering effect in serum and liver cholesterol levels of rats when included in the diet at about fivefold the normal human intake level (51). Human data, however, have demonstrated conflicting results (191; 182). A significant reduction in TG levels was reported in humans with extract made from bark of Chinese Cinnamomum aromaticum (178). Urate levelsUrate levels: Oral administration of Cinnamomum cassia oil significantly reduced serum and hepatic urate levels in hyperuricemic mice (48). In normal mice, urate levels in liver, but not in serum, were altered, with a dose-dependent decrease after C. cassia oil treatment.