Greater Celandine - Actemra (Tocilizumab) Interaction

Interaction Details

Tocilizumab is classified as belonging to the following category: Hepatotoxic Drugs

There is some concern that greater celandine can adversely affect the liver. Greater celandine has been linked to many cases of hepatotoxicity. Theoretically, concomitant use with other potentially hepatotoxic drugs might increase the risk of developing liver damage. Some of these drugs include acarbose (Precose, Prandase), amiodarone (Cordarone), atorvastatin (Lipitor), azathioprine (Imuran), carbamazepine (Tegretol), cerivastatin (Baycol), diclofenac (Voltaren), felbamate (Felbatol), fenofibrate (TriCor), fluvastatin (Lescol), gemfibrozil (Lopid), isoniazid, itraconazole, (Sporanox), ketoconazole (Nizoral), leflunomide (Arava), lovastatin (Mevacor), methotrexate (Rheumatrex), nevirapine (Viramune), niacin, nitrofurantoin (Macrodantin), pioglitazone (Actos), pravastatin (Pravachol), pyrazinamide, rifampin (Rifadin), ritonavir (Norvir), rosiglitazone (Avandia), simvastatin (Zocor), tacrine (Cognex), tamoxifen, terbinafine (Lamisil), valproic acid, and zileuton (Zyflo).

Interaction Rating

Likelihood of Occurrence

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists

References

• Benninger J, Schneider HT, Schuppan D, et al. Acute hepatitis induced by greater celandine (Chelidonium majus). Gastroenterology 1999;117:1234-7.
• Stickel F, Poschl G, Seitz HK, et al. Acute hepatitis induced by Greater Celandine (Chelidonium majus). Scand J Gastroenterol 2003;38:565-8.
• Moro PA, Cassetti F, Giugliano G, et al. Hepatitis from greater celandine (Chelidonium majus L.): Review of literature and report of a new case. J Ethnopharmacol 2009;124:328-32.
• Stickel, F., Seitz, H. K., Hahn, E. G., and Schuppan, D. [Liver toxicity of drugs of plant origin]. Z.Gastroenterol. 2001;39(3):225-227.
• Hardeman, E., Van, Overbeke L., Ilegems, S., and Ferrante, M. Acute hepatitis induced by greater celandine (Chelidonium majus). Acta Gastroenterol.Belg. 2008;71(2):281-282.
• Gilca, M., Gaman, L., Panait, E., Stoian, I., and Atanasiu, V. Chelidonium majus--an integrative review: traditional knowledge versus modern findings. Forsch.Komplementmed. 2010;17(5):241-248.
• Teschke, R., Glass, X., and Schulze, J. Herbal hepatotoxicity by Greater Celandine (Chelidonium majus): causality assessment of 22 spontaneous reports. Regul.Toxicol.Pharmacol. 2011;61(3):282-291.
• Teschke, R., Glass, X., Schulze, J., and Eickhoff, A. Suspected Greater Celandine hepatotoxicity: liver-specific causality evaluation of published case reports from Europe. Eur.J Gastroenterol.Hepatol. 2012;24(3):270-280.
• Teschke, R., Frenzel, C., Glass, X., Schulze, J., and Eickhoff, A. Greater Celandine hepatotoxicity: a clinical review. Ann.Hepatol. 2012;11(6):838-848.

Interaction Details

Tocilizumab is classified as belonging to the following category: Immunosuppressants

Preliminary clinical research suggests that taking a specific semi-synthetic derivative of the greater celandine constituent chelidonine (Ukrain; not available in North America) might stimulate immune responses in cancer patients. Theoretically, taking greater celandine might decrease the effects of immunosuppressive therapy. Immunosuppressant drugs include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), and other corticosteroids (glucocorticoids).

Interaction Rating

Likelihood of Occurrence

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists

References

• Staniszewski, A., Slesak, B., Kolodziej, J., Harlozinska-Szmyrka, A., and Nowicky, J. W. Lymphocyte subsets in patients with lung cancer treated with thiophosphoric acid alkaloid derivatives from Chelidonium majus L. (Ukrain). Drugs Exp.Clin Res 1992;18
• Nowicky, J. W., Staniszewski, A., Zbroja-Sontag, W., Slesak, B., Nowicky, W., and Hiesmayr, W. Evaluation of thiophosphoric acid alkaloid derivatives from Chelidonium majus L. ("Ukrain") as an immunostimulant in patients with various carcinomas. Drugs Ex

Tocilizumab Overview

• Tocilizumab injection is used alone or in combination with other medications to relieve the symptoms of certain types of arthritis and other conditions including:

  • rheumatoid arthritis (a condition in which the body attacks its own joints, causing pain, swelling, and loss of function) in adults who have not been helped by other disease-modifying antirheumatic drugs (DMARDs),

  • giant cell arteritis (a condition that causes swelling of blood vessels, especially in the scalp and head) in adults,

  • systemic sclerosis-associated interstitial lung disease (SSc-ILD; also known as scleroderma-associated ILD: a lung disease that involves scarring of the lungs) in adults,

  • polyarticular juvenile idiopathic arthritis (PJIA; a type of childhood arthritis that affects five or more joints during the first six months of the condition, causing pain, swelling, and loss of function) in children 2 years of age or older.

  • systemic juvenile idiopathic arthritis (SJIA; a condition in children that causes inflammation in different areas of the body, causing fever, joint pain and swelling, loss of function, and delays in growth and development) in children 2 years of age or older,

  • cytokine release syndrome (a severe and possibly life-threatening reaction) in adults and children 2 years of age or older after receiving certain immunotherapy infusions.

• Tocilizumab injection is in a class of medications called interleukin-6 (IL-6) receptor inhibitors. It works by blocking the activity of interleukin-6, a substance in the body that causes inflammation.

Greater Celandine - More Interactions

Greater Celandine interacts with 591 drugs

Interaction Rating Key

These severity listings are for informational use only. Never start, stop or otherwise change your therapy before speaking with your provider.