Clinical Pharmacy Study of Oral Botanic Medications Based on Rational Dosing Time

OBJECTIVE To promote the rational use of oral botanic medications and relevant academic research. METHODS By retrieving the package inserts and New Clinical Drug Reference Database, relevant food-drug information was identified. Literatures on the influence of dosing conditions (fasted or after meal) on oral bioavailability of botanic medications were reviewed by CNKI and PubMed search (Jan 1989-March 2013). RESULTS There are four imported botanic medications which require administration at the fasted status, i.e., Melilotus extract tablets, Myrtol standardized enteric coated soft capsules, Pagosid tablets and Pygeum African extract capsules. There are 10 domestic prepared traditional Chinese medicines (TCMs) which require administration with the empty stomach. Botanic medications whose bioavailability could be influenced by meal involved Polyphenon E capsules (fasted >non-fasted), frankincense extract formulation, Samul-tang and Timosaponin B-II (together with a standardized high-fat meal >fasted state). Bioavailability of some active ingredients of botanic medications were related to lipophilicity, stability in acidic conditions and presystem loss due to biotransformation. There were 12 prepared TCMs with requirements of circadian rhythm. CONCLUSIONS There is a very poor information on food-drug interaction in current package inserts of botanic medications and poor awareness of special dosing time (fasted or non-fasted) among physicians, nurses and pharmacists. It is necessary to strengthen clinical pharmacy and research in this respect in order to warrant clinical efficacy and avoid toxicity.