Podophyllum

Podophyllum/Drug Interactions:

  • AntiarthriticsAntiarthritics: Preliminary human research suggests that podophyllum may be helpful for rheumatoid arthritis (30).
  • AntibioticsAntibiotics: Podophyllotoxin is used as a natural isosteric aza analogue compound for the preparation of an oxazolidinone ring in order to produce an antibiotic class to overcome bacterial resistance with easy synthesis and difficult inactivation (62).
  • AntihypertensivesAntihypertensives: Systemic absorption of podophyllum resin may result in tachycardia, according to secondary sources.
  • Antineoplastics (e.g., antimiotic agents including paclitaxel, vincristine)Antineoplastics (e.g., antimiotic agents including paclitaxel, vincristine): According to two case reports and a clinical study, one of the mechanisms of action is podophyllum interrupts cellular mitosis at metaphase (32; 33; 34). Podophyllum may interact with drugs that have a similar mechanism. Additionally, antineoplastic agents may cause neutropenia. Concurrent use of podophyllum and antineoplastic agents may cause further bone marrow suppression.
  • AntipsychoticsAntipsychotics: According to an animal study, podophyllum toxicity may cause a worsening of extrapyramidal symptoms that may occur with antipsychotic agents (35). Systemic toxicity of podophyllum may cause hallucinations and confusion, according to secondary sources.
  • CNS stimulantsCNS stimulants: Systemic toxicity of podophyllum may cause dizziness and convulsions, according to secondary sources.
  • Dermatologic agentsDermatologic agents: In clinical research, topical podophyllum products were an effective treatment for wart clearance (29; 36; 38). In clinical research, local site reactions, such as irritation, itchiness, pain, swelling, and ulcerations were described with topical application of podophyllum and podophyllotoxin (29; 36; 37; 38).
  • Gastrointestinal agentsGastrointestinal agents: Altered or bad taste, bitter taste, pain, and slight tenderness of the tongue was reported in subjects receiving podophyllum 25% solution for oral hairy leukoplakia lesions (42; 33; 55). Patients receiving oral CPH 82 for rheumatoid arthritis reported gastrointestinal discomfort (diarrhea and abdominal pain) (30). Episodes of bowel obstruction were reported secondary to treatment with etoposide, a podophyllotoxin, in an elderly gentleman with extensive stage small cell lung cancer (SCLC) (56). Podophyllum may also cause nausea, vomiting, and bloody-watery diarrhea. Gastrointestinal toxicity (nausea, vomiting, stomatitis) has been shown to occur in about 20-30% of patients given recommended dosages of etoposide (52).
  • Heart rate regulating agentsHeart rate regulating agents: Systemic absorption of podophyllum resin may result in tachycardia, according to secondary sources.
  • HematologicsHematologics: Podophyllum may cause neutropenia, according to secondary sources. Combination chemotherapy with epiPodophyllotoxin in individuals with adult T-cell leukemia/lymphoma resulted in reports of secondary acute myeloid leukemia (AML) (59; 60).
  • HepatotoxinsHepatotoxins: In an animal study, degenerative changes were observed in the liver after ingestion of podophyllum (31).
  • LaxativesLaxatives: Podophyllum has been historically used as a laxative. Patients receiving oral CPH 82 for rheumatoid arthritis reported diarrhea (30). Concurrent use of podophyllum and other laxatives may result in an additive effect and cause dehydration and electrolyte disturbances (usually fluid depletion and accumulation of electrolytes).
  • Muscle relaxantsMuscle relaxants: Podophyllum toxicity may cause muscle paralysis, ataxia, and hypotonia, according to secondary sources. In a case report of four patients, concurrent use of a podofyllotoxin-containing cytotoxic drug and simvastatin resulted in severe muscle adverse effects including muscle fatigue, weakness, soreness, pain, and rhabdomyolysis (39).
  • Neurologic agentsNeurologic agents: Systemic toxicity of podophyllum may cause hallucinations, confusion, dizziness, and convulsions. These symptoms may be delayed in onset and prolonged in duration, according to secondary sources.
  • Ophthalmic agentsOphthalmic agents: Combination chemotherapy with epiPodophyllotoxin resulted in reports of retinoblastoma (60).
  • Radioprotective agentsRadioprotective agents: Preliminary research suggests that an aqueous extract of podophyllum, quercetin, and podophyllotoxin may protect against radiation damage and have antioxidant effects (63; 64; 65; 66). These podophyllum constituents also seem to increase apoptosis and phagocytosis of cells damaged by radiation. The radioprotective effects of Podophyllum hexandrum exhibited in mice may be partially explained by its antioxidant effects (65). Podophyllum hexandrum has exhibited antioxidant effects in vitro (64). Podophyllum, in a dose-dependent manner, chelated Fe2+ more efficiently than Fe3+ and also modulated Fe2+/Fe3+ ratio. Podophyllum's antioxidant properties as seen through chelation and modulation of redox state of iron ions may contribute towards its radioprotective manifestation.
  • Renal agentsRenal agents: Urinary retention and renal failure may occur as a result of podophyllum toxicity, according to secondary sources.
  • SimvastatinSimvastatin: Simvastatin and podophyllum products share the common CYP3A4 enzyme pathway. In a case report of four patients, concurrent use of a podophyllotoxin-containing cytotoxic drug and simvastatin resulted in severe muscle adverse effects including muscle fatigue, weakness, soreness, pain, and rhabdomyolysis (39).

    • Podophyllum/Herb/Supplement Interactions:

  • AntiarthriticsAntiarthritics: Preliminary human research suggests that podophyllum may be helpful for rheumatoid arthritis (30).
  • AntibacterialsAntibacterials: Podophyllotoxin is used as a natural isosteric aza analogue compound for the preparation of an oxazolidinone ring in order to produce an antibiotic class to overcome bacterial resistance with easy synthesis and difficult inactivation (62).
  • AntihypertensivesAntihypertensives: Systemic absorption of podophyllum resin may result in tachycardia, according to secondary sources.
  • Antineoplastics (e.g., antimiotic agents)Antineoplastics (e.g., antimiotic agents): According to two case reports and a clinical study, podophyllum may interrupt mitosis and prevent cell division (32; 33; 34). Additionally, antineoplastic agents may cause neutropenia. Concurrent use of podophyllum and antineoplastic agents may cause an increase in neutropenia.
  • AntioxidantsAntioxidants: Preliminary research suggests that an aqueous extract of podophyllum, quercetin, and podophyllotoxin may have antioxidant effects (63; 64; 65; 66). Podophyllum hexandrum has exhibited antioxidant effects in vitro (64; 65).
  • AntipsychoticsAntipsychotics: According to an animal study, podophyllum toxicity may cause a worsening of extrapyramidal symptoms and neurologic side effects that may occur with some antipsychotic agents (35). Systemic toxicity of podophyllum may cause hallucinations and confusion, according to secondary sources.
  • Dermatologic agentsDermatologic agents: In clinical research, topical podophyllum products were an effective treatment for wart clearance (29; 36; 38). In clinical research, local site reactions, such as irritation, itchiness, pain, swelling, and ulcerations were described with topical application of podophyllum and podophyllotoxin (29; 36; 37; 38).
  • Gastrointestinal agentsGastrointestinal agents: Altered or bad taste, bitter taste, pain, and slight tenderness of the tongue was reported in subjects receiving podophyllum 25% solution for oral hairy leukoplakia lesions (42; 33; 55). Patients receiving oral CPH 82 for rheumatoid arthritis reported gastrointestinal discomfort (diarrhea and abdominal pain) (30). Episodes of bowel obstruction were reported secondary to treatment with etoposide, a podophyllotoxin, in an elderly gentleman with extensive stage small cell lung cancer (SCLC) (56). Podophyllum may also cause nausea, vomiting, and bloody-watery diarrhea. Gastrointestinal toxicity (nausea, vomiting, stomatitis) has been shown to occur in about 20-30% of patients given recommended dosages of etoposide (52).
  • Heart rate regulating agentsHeart rate regulating agents: Systemic absorption of podophyllum resin may result in tachycardia, according to secondary sources.
  • HematologicsHematologics: Podophyllum may cause neutropenia, according to secondary sources. Combination chemotherapy with epiPodophyllotoxin in individuals with adult T-cell leukemia/lymphoma resulted in reports of secondary acute myeloid leukemia (AML) (59; 60).
  • HepatotoxinsHepatotoxins: In an animal study, degenerative changes were observed in the liver after ingestion of podophyllum (31).
  • LaxativesLaxatives: Podophyllum has been historically used as a laxative. Patients receiving oral CPH 82 for rheumatoid arthritis reported diarrhea (30). Concurrent use of podophyllum and other laxatives may result in an additive effect and cause dehydration and electrolyte disturbances.
  • Muscle relaxantsMuscle relaxants: Podophyllum toxicity may cause muscle paralysis, ataxia, and hypotonia, according to secondary sources. In a case report of four patients, concurrent use of a podofyllotoxin-containing cytotoxic drug and simvastatin resulted in severe muscle adverse effects including muscle fatigue, weakness, soreness, pain, and rhabdomyolysis (39).
  • Neurologic agentsNeurologic agents: Systemic toxicity of podophyllum may cause hallucinations, confusion, dizziness, and convulsions. These symptoms may be delayed in onset and prolonged in duration, according to secondary sources.
  • Ophthalmic agentsOphthalmic agents: Combination chemotherapy with epiPodophyllotoxin resulted in reports of retinoblastoma (60).
  • Radioprotective agentsRadioprotective agents: Preliminary research suggests that an aqueous extract of podophyllum, quercetin, and podophyllotoxin may protect against radiation damage and have antioxidant effects (63; 64; 65; 66). These podophyllum constituents also seem to increase apoptosis and phagocytosis of cells damaged by radiation. The radioprotective effects of Podophyllum hexandrum exhibited in mice may be partially explained by its antioxidant effects (65). Podophyllum hexandrum has exhibited antioxidant effects in vitro (64). Podophyllum, in a dose-dependent manner, chelated Fe2+ more efficiently than Fe3+ and also modulated Fe2+/Fe3+ ratio. Podophyllum's antioxidant properties as seen through chelation and modulation of redox state of iron ions may contribute towards its radioprotective manifestation.
  • Renal agentsRenal agents: Urinary retention and renal failure may occur as a result of podophyllum toxicity, according to secondary sources.
  • StimulantsStimulants: Systemic toxicity of podophyllum may cause dizziness and convulsions, according to secondary sources.

    • Podophyllum/Food Interactions:

  • Insufficient available evidence.

    • Podophyllum/Lab Interactions:

  • Blood pressureBlood pressure: Systemic absorption of podophyllum resin may result in tachycardia, according to secondary sources.
  • Heart rateHeart rate: Systemic absorption of podophyllum resin may result in tachycardia, according to secondary sources.
  • Liver panelLiver panel: In an animal study, degenerative changes were observed in the liver after ingestion of podophyllum (31).
  • White blood cell (WBC) countWhite blood cell (WBC) count: According to unsubstantiated reports, podophyllum may cause neutropenia, so WBC should be monitored for any reductions.