Possible differential induction of phase 2 enzyme and antioxidant pathways by American ginseng, Panax quinquefolius

Human immunodeficiency virus (HIV)-infected patients often take herbal medicines, which may interact with antiretrovirals. American ginseng induces phase 2 and antioxidant enzymes in vitro and might increase the clearance of zidovudine and/or enhance antioxidant activity. Ten healthy volunteers received 300 mg of zidovudine orally before and after 2 weeks of treatment with a ginsenoside-enriched American ginseng extract 200 mg twice daily. This ginseng extract induced the phase 2 enzyme quinone reductase with an average concentration of doubling of enzyme activity of 190 μg/mL. Total ginsenoside content was 8.5 ± 0.5%. Pharmacokinetic profiles of zidovudine and oxidative stress marker concentrations were measured post-zidovudine dose. American ginseng does not significantly affect the formation clearance of zidovudine to its glucuronide (ratio post- to pre-American ginseng = 1.17; 90% confidence interval: 0.95-1.45; P =.21), total clearance (ratio = 0.97; 0.82-1.14; P = .70), or plasma zidovudine AUC_0-8 (ratio = 1.03; 0.87-1.21; P =.77). Oxidative stress biomarkers are reduced post-American ginseng (F2-isoprostane ratio = 0.79; 0.72-0.86; P <.001; 8-hydroxy-deoxyguanosine ratio = 0.74; 0.59-0.92; P =.02). Two weeks of American ginseng does not alter zidovudine pharmacokinetics but reduces oxidative stress markers.