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types of synergism; the observed effect is equal to or greater than the sum of the two drugs. If
it is greater than the sum, it is called potentiation (supra-additive interaction) [3].
Pharmacodynamic antagonism can be divided into three categories.
a) Chemical Antagonism
Chemical antagonism occurs when one drug is inactivated by another drug as a
result of chemical bonding [3].
b) Physiological Antagonism (Independent Antagonism)
Physical antagonism occurs when a drug acts in the opposite way to reduce or elimi-
nate the action of another drug by acting on opposite receptors or mechanisms [3].
c) Pharmacological Antagonism
Pharmacological antagonism is the interaction of two medicines that can bind to the
same receptor. This antagonism can be competitive or noncompetitive [3].
2.3.2 Pharmacokinetic interactions
Pharmacokinetic interactions occur when one drug influences the pharmacokinetics of
another medication, i.e., absorption, distribution, metabolism, and elimination. One or
more of these factors must be modified and observed experimentally in order to talk about
pharmacokinetic interactions [3].
2.3.2.1 Pharmacokinetic interactions at absorption level
It is the situation where one drug alters the rate and/or degree of absorption of another
drug from the application site. Intera ctions at the absorption level may occur.
- When one drug that affects gastric emptying rate and intestinal transit time changes the
absorption rate of another drug;
- When a drug that alters the pH of the stomach breaks down the pharmaceutical form of
another drug into a solid pharmaceutical form, altering the rate of drug dissolution and,
ultimately, absorption;
- When a drug binds another drug or forms a complex in the stomach or intestinal lumen,
slowing or inhibiting its absorption;
- When a drug disrupts the gastrointestinal epithelium’s absorption mechanisms or the
structure of the epithelium, affecting the absorption of the other drug;
- With interactions at the level of p-glycoprotein and cytochrome 3A (CYP3A) in the intes-
tinal wall, and interact indirectly with drugs like antibacterials by disrupting the reab-
sorption of drugs entering the enterohepatic circulation by disrupting the intestinal flora
[3].
2.3.2.2 Pharmacokinetic interactions at distribution level
These are interactions that can occur as a result of competition between two drugs that are
highly bound to plasma proteins for their binding sites. The higher-affinity drug repels the
lower-affinity drug from its binding site and binds itself. The free fraction of the drug which
is separated from the protein is increased. Since the volume of distribution of the second drug
will increase, an increase in its effect can be expected, but since the volume of body fluid is so
large in comparison to the volume of plasma fluid, it will be diluted in total body fluid vol-
ume, so the increase in free drug will become less significant [3].
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2.3.2.3 Pharmacokinetic interactions at metabolism (biotransformation) level
It is the most prevalent type of pharmacokinetic interactions, and it is the process of chang-
ing the rate of biotransformation of a medicine by inducing or inhibiting the enzyme respon-
sible for the biotransformation of another drug [3].
2.3.2.4 Enzyme inhibition
Drugs that compete for the same enzyme’s catalytic site can inhibit each other’s meta-
bolism. Therefore, if drugs metabolized by the same CYP are consumed at the same time,
there may be an interaction at the level of metabolism. If the metabolism of a drug is inhibited
by another drug, the first drug’s clearance is reduced and the effect of the drug is exacerbated
due to undesirable increases in plasma levels and toxic effects may occur [3].
2.3.2.5 Enzyme induction
Unlike inhibition, it occ urs slowly. With long-term treatment, it is seen as an increase in
enzyme synthesis. As a result of induction, elimination accelerates and drug efficacy de-
creases [3].
2.3.2.6 Pharmacokinetic interactions at excretion level
This type of interaction most often occurs in the form of competition between drugs for the
transport system in the proximal tubule cell during tubular secretion. As a result of the inter-
action, the renal excretion of the drug decreases and the plasma level increases [3].
2.3.3 Pharmaceutical interactions
Interactions that occur before the drug enters the body are called pharmaceutical interac-
tions [3].
2.4 Interactions between radiopharmaceutical products and herbal medicines
Drug interactions with radiopharmaceuticals could be known or unknown. Known inter-
actions may result in accurate diagnosis. But unknown interactions are not preferred and
their results are misdiagnosis and reexamination. Possible explanation of these unknown in-
teractions is changing the effectiveness of radiolabeling, radiopharmaceutical modification,
target modification, off-target modification, and altered binding to blood proteins [4].
Nowadays, people’s orientation toward herbal medicine has increased tremendously. It is
undeniable that they are effective in the treatment of some diseases. But, because people
believe that plants are completely innocuous, unintentional and unregulated intake of these
products has increased. However, herbal medicines have the potential to interact with med-
icines, just like other medicines, and this can have negative consequences. It has been shown
in various studies that herbal medicines when used together with radiopharmaceuticals can
alter the biodistribution, radiolabeling and pharmacokinetics of radiopharmaceuticals. This
interaction may have negative consequences, such as misdia gnosis and treatment. Therefore,
doctors and pharmacists should examine patients about herbal medicines they are taking.
The following are some examples of recent studies on the interactions of radiopharmaceu-
ticals with herbal medicines.
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2.4.1 Aloe vera (medicinal aloe)
Aloe vera, is a tropical plant that can grow in hot, dry climates with many approved healing
effects. It features a sticky gel made up of polysaccharides that has been used to treat burns
since ancient times. In addition, it has different medical, cosmetic, nutraceutical uses, with its
anticancer, antidiabetic, antiinflammatory, antiviral properties, in the treatment of X-ray
burns, dermatitis, oriental boil. Alkaloids, saponins , fatty acids, resins, sterols, minerals, vita-
mins, amino acids, enzymes, glycoproteins, and other compounds are hypothesized to
combine synergistically to produce these effects. Despite its extensive use, there is not
much research on its toxicity [5].
The effect of an aqueous extract of A. vera on the biodistribution of sodium pertechnetate in
Wistar rats was investigated by Ref. [5]. An aqueous extract prepared from A. vera leaves was
administered to the treatment gro up by gavage. In the control group, sorbitol was given in the
same route and period. Samples were obtained from the brain, liver, heart, muscle, pancreas,
stomach, femur, kidneys, blood, testis, and thyroid after the subjects were killed. The uptake
of radioactivitywas found to be much higher inthe blood, femur, kidneys,liver, stomach, testis,
and thyroid. There was no significant change in brain, heart, muscle and pancreas.
In addition, in the same study, A. vera was also found to lower cholesterol or glucose
levels. It increased the levels of liver enzymes Aspartate AminoTransferase (AST) and
Alanine AminoTransferase (ALT). A. vera may have hypolipidemic and hypoglycemic effects,
yet it has been proven to be harmful to the liver, according to this study. It was concluded
that A. vera facilitates the uptake of sodium pertechnetate in certain organs and it has been
reported that this will lead to clinical implications in nuclear medicine. For example, it could
lead to a misdiagnosis or incorrect results. Patients may be exposed to unnecessary radiation
as a result of repeated scintigraphy [5].
2.4.2 Annona muricata (soursop)
Annona muricata is also known as graviola. Its leaves are commonly used as an antiinflam-
matory, antispasmodic, and antidysenteric in conditions such as headache, sleeplessness,
cystitis, liver disorders, diabetes, and hypertension. In decoction, it has parasitic, antirheu-
matic, and antineuralgic effects. It is thought to have acetogenins that show selective cytotox-
icity to tum or cells while having no effect on normal cells [6].
In the study of Ref. [6] the effect of hydroalcoholic extract of Annona muricata on the bio-
distribution of dimercaptosuccinic acid (DMSA) labeled
99m
Tc and sodium phytate labeled
99m
Tc radiopharmaceuticals was investigated. In the study conducted with Wistar rats, grav-
iola extract was given to the treatment group by drilling, while the control group was given
water in the same way and period. Half of the treatment group was injected with
99m
Tc-
DMSA and the other half with
99m
Tc-sodium phytate. The same procedure was applied to
the control group. Radioactivity uptake is lower in the spleen, liver, and blood in the
99m
Tc-sodium phytate group compared to the control group. Radioactivity uptake in the
bladder, kidney, and blood decreased considerably in the treatment group compared to
the control group in subjects given
99m
Tc-DMSA. With
99m
Tc-sodium phytate, no significant
difference was found, indicating that its interactions with A. muricata were negligible at the
concentrations in the study. It did, however, interact with
99m
Tc-DMSA, possibly as a result
of biological and/or morphological alterations [6].
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2.4.3 Arctium lappa (greater burdock)
Arctium lappa is a popular herb used in Taiwan for hypertension, gout, arteriosclerosis,
hepatitis, etc. It has been reported that it has antiinflammatory and free radical scavenging
properties. Its arctigenin inhibits in vitro tumor growth and has an antimutagenic effect
[7]. The aim of Ref. [7]’s study was to see the effect of A. lappa on the labeling of blood com-
ponents with
99m
Tc. A solution was obtained from leaves, roots and flowers with saline so-
lution. Blood samples obtained from Wistar rats were incubated with this solution in a
different way to form treatment groups, and blood samples were incubated with saline to
form control groups. Burdock had a considerable effect on the distribution of radioactivity
between the cellular and plasma compartments, according to the results. However, no change
was observed on the uptake of radiation in the proteins of blood cells obtained from blood
samples with burdock. The impact of burdock on the red blood cell membrane can explain
the lowering of radioactivity in the blood cell compartment. There were also morphological
changes in the shape of the red blood cells. Although the exact mechanism of the interaction is
not known, it has been interpreted that damage to the red blood cell membrane may disrupt
ion transport through the cellular membrane, reducing red blood cell
99m
Tc labeling [7].
2.4.4 Artemisia vulgaris L. (mugwort)
Artemisia vulgaris L. is used in traditional Chinese medicine as an analgesic, in acupuncture
therapy, in neonatal jaundice, in gastric ulcers, in hepatitis, and convulsive crises. According
to some studies, it also has an immunomodulatory effect. It is also thought to have antitu-
moral components [8]. Ref. [8] investigated the effect of mugwort on the labeling of blood
components of
99m
Tc. Wistar rats’ blood samples were taken and incubated with various
doses of mugwort extract. Compared with the control group (blood samples incubated
with physiological saline), the uptake of radioactivity by the cellular compartment showed
a significant decrease. As a result, it was determined that mugwort altered the
99m
Tc labeling
of blood cells [8].
2.4.5 Broccoli
Broccoli is a food source belonging to the Brassicaceae family containing bioactive compo-
nents. There are studies showing that this family reduces the risk of cancer [9]. Ref. [9]. eval-
uated the in vitro and in vivo effects of broccoli extract on the biodistribution of
99m
Tc
-labeled glucoheptonate. The TLC (Thin Layer Chromatography) approach was used to
conduct quality control investigations. As a result of the study, there was no significant effect
on the radiol abeling of blood components, but notable changes were observed especially in
the biodistribution studies in the kidneys. Renal involvement was 10 times less in the treat-
ment group. In both the treatment and control groups, the rate of radioactivity in blood com-
ponents was observed to be the same. It is thought that this situation may be related to the
extraction method or extract components [9].
In the literature, changes in biodistribution have been attributed to the presence of a spe-
cific chemical component in the extract or the production of active metabolites that compete
with the radiobiocomplex’s biodistribution [9].
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2.4.6 Caryophyllus aromaticus L. (clove)
Clove has been used to treat dental problems for over 2000 years. It has antiseptic and
anesthetic properties. Ref. [10] conducted a study on the effect of clove extract with
99m
Tc
on the labeling of blood components and on the morphology of red blood cells. The extract
is prepared from dried clove flowers. Blood samples were obtained from Wistar rats. The
experiment was carried out with clove solutions of different concentrations [10].
Changes were seen in the labeling of blood samples with the highest concentration of
extract. The results suggested that it is related to the oxidant and cytotoxic properties in
the clove solution. The impacts on ion transport systems and alterations in red blood cell
membrane structure are another point of view. Qualitative morphological analyzes also
showed change in red blood cell shape. However, this result could not be confirmed by quan-
titative analysis. Interacting with the cellular membrane structure or oxidative/chelating ac-
tions is thought to cause this alteration. As a result, it has been discovered that cloves have an
interaction with
99m
Tc [10].
2.4.7 Cassia angustifolia (alexandrian senna)
It is a plant from the Fabaceae family that is used to treat serious gastrointestinal issues
such as constipation among the public. It has a laxative effect with anthraquinone glycosides
and antifungal activity with triterpenoid glycosides [11 ]. In their study, Ref. [11] investigated
the effect of senna extract on the labeling of blood components of
99m
Tc and the effect on the
biodistribution of sodium pertechnetate. Blood samples were used in the study with
99m
Tc. In
the biodistribution study, sodium pertechnetate was administered to the ocular vascular
network and the treatment group was given senna extract while the control group was given
physiological saline. Senna had no laxative or toxic effects at the dose used in the Wistar rat
study. According to the results, no effect on the labeling of blood components by
99m
Tc was
found. The lack of oxidant properties of the metabolites is assumed to be the reason for this.
The reducing agent tin (II) chloride, will not be oxidized by C. angustifolia’s metabolites.
Senna extract did not lower sodium pertechnetate uptake in the gastrointestinal system,
but it did in the thyroid, liver, pancreas, lung, and blood. Human results are inconclusive
as these st udies have been done in animals ([11].
2.4.8 Cinnamomum zeylanicum (cinnamon)
Cinnamon is a frequently used spice all over the world. Cinnamon has been used since
ancient times for gastrointestinal disorders, loss of appetite, vasodilation, and colds. It con-
tains essential oils, tannins, phenolic acids, cinnamaldehyde, eugenol, cinnamophyllin, and
coumarin [12]. Ref. [12] investigated the effect of cinnamon on
99m
Tc labeled blood compo-
nents and morphology of red blood cells. Blood samples were taken from Wistar rats and
incubated with varied doses of cinnamon extract. As a result of the study, it was found
that high doses of cinnamon extract changed the uptake of
99m
Tc in plasma and cellular cells.
The morphology of the red blood cells remained unchanged. Cinnamon affected the labeling
due to its chelating effect and/or its effect on the membrane structure associated with ion
transport, according to the results [12].
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2.4.9 Ginkgo biloba (maidenhair tree)
Ginkgo biloba is a plant use d in ischemic and neurological damage [13]. Ref. [13] investi-
gated the effect of G. biloba extract on the labeling of
99m
Tc on red blood cells and plasma pro-
teins. The results indicated that G. biloba might affect the labeling of blood components. It was
clear from this interaction that it was concentration-dependent [13]).
2.4.10 Hypericum perforatum (St. John’s wort)
St. John’s wort is a medicinal plant that is used to treat a variety of ailments. It is used to
treat depression, diarrhea, dyspepsia, neuralgia, and rheumatism as an antiviral and diuretic.
Because it competes with CYP3A4 enzymes, it can interact with a wide range of medicines
and cause side effects [14]. In a study by Ref. [14], St. John’s wort was found to reduce sperm
duct contractility. Tin (II) chloride can also produce free radicals, which can have negative
effects on the male reproductive system. (It has the potential to lower the quality of sperm
and have unfavorable effects on reproductive performance.)
Ref. [14] investigated the effect of Hypericum perforatum on
99m
Tc’s blood component label-
ing (used as a stannous chloride reducing agent) and on the male reproductive system. St.
John’s wort is thought to cause oxidation of tin (II) salt directly or indirectly. According to
the results, St John’s wort alters the
99m
Tc labeling of blood components obtained from Wistar
rats’ blood. St. John’s Wort is also thought to protect the male reproductive system against the
effects of heavy metals like tin (II) chloride [14].
2.4.11 Nectandra membranacea (white cinnamon)
White cinnamon is thought to have analgesic, anti-inflammatory, antipyretic, and hypo-
tensive properties, as well as the potential to be used as an antitumor agent [15]. In the study
of Ref. [15] on the effect of N. membranacea on the bioavailability of sodium pertechnetate, it
was observed that the uptake was increased in the thyroid and muscle. Uptake in the brain,
liver, heart, kidney, spleen, stomach, pancreas , lung, ovary, blood, and bone did not change
significantly. In the heart, kidney, and thyroid, the percentage of radioactivity in tissues
increased. Therefore, it is among the plants that should be considered in interaction with ra-
diopharmaceuticals [15].
2.4.12 Passiflora edulis f. flavicarpa (passionflower)
In Turkey, it is known as passionflower and is widely used. It contains ascorbic acid and
carotenoids [16]. Ref. [16] conducted an in vitro experimental study on the effect of passion fruit
on the
99m
Tc labeling of bloodcomponents and the morphology of red blood cells. As a result of
this study, it was observed that P. flavicarpa decreased the uptake of
99m
Tc in plasma proteins
and did not affect the labeling. The morphological structur e of the red blood cells had changed.
The explanation for this could be that some components in P. flavicarpa’s composition alter the
shape of red blood cells’ membranes. The labeling, however, was unaffected. It’s assumed that
this is because the components in P. flavicarpa have no effect on ion transport [16].
2.4.13 Peumus boldus (boldo)
It is an herbal medicine with traditional use unique to the coastal part of Chile. It contains
flavonoids, which have antioxidant prope rties. If used for 3 days in a row, it may be harmful
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to the liver. It causes local anesthesia at high dosages [17]. Ref. [17] conducted a study on the
effects of Peumus boldus tincture on
99m
Tc labeling of red blood cells and plasma proteins.
There is a significant increase in
99m
Tc up-take with Peumus boldus. High concentrations
have also been shown to affect the labeling of plasma proteins. Due to the antioxidant prop-
erty of Peumus boldus, the tin (II) ion was protected from oxidation, and thus the pertechnetate
ions were further reduced and the amount of radioactivity bound to the red blood cells
increased by increasing the labeling of the red blood cells [17].
2.4.14 Pisidium guajava (guava)
Pisidium guajava is a plant belonging to the Myrtaceae family. The aqueous extract of guava
leaves is widely utilized in gastrointestinal tract diseases, central nervous system diseases.
Guava teas are used for cough, asthma attacks, bronchitis, and pulmonary diseases. Also,
they have also been reported to be effective against strains such as Aeromonas hydrophila,
Shigella spp, Vibrio spp, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Bacil-
lus subtilis [18]. Ref. [18] investigated the effects of aqueous extract of guava leaves on the
labeling of blood components of
99m
Tc. Guava extract was given to the experimental group
in a Wistar rat experiment, while saline was given to the control group. As a result of the
study, it was observed that aqueous guava extract can compete with
99m
Tc in binding to
plasma proteins only at high concentrations.
The process of
99m
Tc labeling red blood cells depends on the entry of tin and pertechnetate
ions into the cells via ion channels . As a result, with quercetin and/or other components that
bind and/or block calcium or ion channels in guava extract, the transport of tin ions becomes
difficult and
99m
Tc’s labeling of blood cells is reduced [18].
2.4.15 Rosmarinus officinalis (rosemary)
Rosemary, which has been used since ancient times, is high in antioxidants. People in
Turkey use it to treat hyperglycemia [19]. Ref. [19] investigated the effects of rosemary on
99m
Tc-sulfur colloid uptake and
99m
Tc-sulfur colloid biodistribution in blood components.
Up-take is increased in the liver, lung, kidney, testis, and bladder. Blood component radio-
labeling was also hampered. It has also been discovered to have an impact on biodistribution.
In rosemary-fed rats, liver absorption was significantly increased [19].
2.4.16 Sechium edule (chayote)
Sechium edule is a subtropical plant with a diuretic effect [20]. Ref. [20] investigated the ef-
fect of S. edule on the labeling of blood components in diabetic and healthy female rats. In the
diabetic group who received S. edule, radioactivity in blood cells increased. The efficacy of
radiolabeling was found to be normalized in the diabetic group. S. edule improves both blood
component labeling and biodistribution, according to this study. It is thought to provide this
effect with the oxidant active metabolites it produces [20].
2.4.17 Thuya occidentalis (arborvitae)
Thuya occidentali s is used as expectorant, diuretic, antihelmintic, stimulant, and in the treat-
ment of rheumatism. It is used for the treatment of cystitis and prostatic hypertrophy in
elderly men and urinary incontinence in women [21]. Ref. [21] examined the effect of
T. occidentalis with
99m
Tc on the labeling of red blood cells and plasma proteins. According
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to the results of the in vitro study, the labeling of red blood cells with
99m
Tc may be reduced
depending on T. occidentalis concentration. In this study, it was thought that direct inhibition,
damage to the plasma membrane, or competition of ions for the same binding site coul d be
the reason for this interaction [21].
2.4.18 Uncaria tomentosa (cat’s claw)
Uncaria tomentosa has been used in Peru for over 2000 years, but it was first introduced to
Europe in the 1990s as a supplemental medicine for AIDS and cancer. It has antidepressant,
antiinflammatory, antimutagenic, antihypertensive, antiviral, antiulcer, cytoprotective, and
immune system regulating properties [22]. In a study with Wistar rats [22], looked at the in-
fluence of cat claw on the biodistribution of sodium pertechnetate. The uptake of sodium per-
technetate in the heart, pancreas, and muscles is significantly reduced, according to the
results of the study [22].
Table 13.1 below provides a summary of these interactions.
2.5 Radioprotection by plant products
2.5.1 Broccoli
Tin chloride (Tin (II) chloride) is the most widely used reducing agent in the preparation of
99m
Tc radiopharmaceutical cold kits. It has been reported that Tin (II) chloride has a lethal
effect on E. coli with its cytotoxic and genotoxic effects. Its genotoxic action can occur either
directly on deoxyribonucleic acid (DNA) or indirectly through the generation of free radicals
[23]. In the study of Ref. [23] the effect of broccoli extract against the toxic effects of tin (II)
chloride in E. coli ATCC 25922 strain was evaluated. High Pressure Liquid Chrom atography
(HPLC) and Thin Layer Chromatography (TLC) analyses followed by antitoxicity and dose
response studies were performed on the bacterial strain. Broccoli was found to have a
dose-dependent protective effect against the toxic effects of tin (II) chloride in E. coli in this
study. Its mechanism of action is uncertain; however, it is assumed to be related to its anti-
oxidant properties. Broccoli can be considered among new preventive options in patients us-
ing
99m
Tc radiopharmaceuticals [23].
2.5.2 Ginkgo biloba
There are different opinions about the genotoxicity of tin (II) chloride. It can suppress the im-
mune response, alter geneexpression, and induce tumorigenesis inthe thyroidgland in rodents.
It has the ability to produce reactive oxygen species as well as destroy plasmid DNA. It has the
ability to produce reactive oxygen species, which cause oxidative stress [24]. Ref. [24] looked
into the effect of Ginkgo biloba extract on tin (II) chloride damage protection. Although several
researchers have shown that G. biloba has an antioxidant effect, this study has shown that it
also has an oxidant effect. Furthermore, DNA damage was seen in blood samples incubated
with tin (II) chloride, whereas no DNA changes were observed in blood samples
incubated with Ginkgo biloba. This protective action is assumed to be due to hydroxyl groups
reacting with tin ions, reducing the generation of free radicals and protecting cells from oxida-
tion. The DNA damage caused by tin (II) chloride was validated in this investigation. G. biloba
has been found to have a protecting impact as well as a damaging effect [24].
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TABLE 13.1 Studies on the interaction of herbal medicines with radiopharmaceuticals.
Plant name
Part of the
plant used The aim of the study
Type of
operation
Route of
application
Results of the
study
Publication
Tag
Aloe vera Leaves Effect on the
biodistribution of
sodium pertechnetate
In vivo
and
in vitro
Enteral Radioactivity
uptake was
significantly
increased in blood,
femur, kidneys,
liver, stomach,
testis, and thyroid,
that is, increased
uptake of sodium
pertechnetate.
[5]
Annona
muricata
- Effect on the
biodistribution of
99mTc-DMSA and
99mTc-sodium
phytate
In vivo
and
in vitro
Oral Reduction of
radioactivity uptake
of 99mTc-sodium
phytate in spleen,
liver, and blood,
99mTc-DMSA in
bladder, kidney,
and blood.
[6]
Arctium lappa Leaf, root,
flowers
Effect on the labeling
of blood components
with 99mTc
In vitro Incubating
blood samples
Decreased
radioactivity in the
blood cell
compartment and
morphological
changes in red
blood cells
[7]
Artemisia
vulgaris L.
Leaves Effect on the labeling
of blood components
with 99mTc
In vitro Incubating blood
samples
Decreased
radioactivity in the
blood cell
compartment
[8]
Broccoli Whole in
powder
Effect of 99mTc-
glucoheptonate on
biodistribution and
labeling of blood
components
In vitro
and
in vivo
Enteral The uptake in the
kidneys was
approximately 10
times less and the
radioactivity ratios
in the blood
components were
similar
[9]
Caryophyllus
aromaticus L.
Dried
flowers
Labeling of blood
components with
99mTc and its
effect on red blood
cell morphology
In vitro Incubating blood
samples
Decreased
radioactivity and
binding rate of
blood components
and changes in the
shape of red blood
cells
[10]
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TABLE 13.1 Studies on the interaction of herbal medicines with radiopharmaceuticals.dcont’d
Plant name
Part of the
plant used The aim of the study
Type of
operation
Route of
application
Results of the
study
Publication
Tag
Cassia
angustifolia
- Effect of senna extract
on 99mTc labeling of
blood components and
effect on
biodistribution of
sodium pertechnetate
In vitro
and
in vivo
Incubating blood
samples þ ocular
Senna extract
reduced the uptake
of sodium
pertechnetate in
thyroid, liver,
pancreas, lung, and
blood. There was no
effect on 99mTc
labeling blood
components
[11]
Cinnamomum
zeylanicum
Powder Effect of 99mTc on
labeling blood
components and
morphology of red
blood cells
In vitro Incubating blood
samples
Cinnamon extracts
have been found to
alter the labeling of
blood constituents
with 99mTc. It did
not change the
morphology of the
red blood cells
[12]
Ginkgo biloba Greenleaves Effect of 99mTc on
labeling of red blood
cells and plasma
proteins
In vitro Incubating blood
samples
Decreased
radiolabeling of
blood components
[13]
Hypericum
perforatum
Powder Effect of 99mTc on
labeling blood
components
In vitro Incubating blood
samples
Decreased
radiolabeling of
blood components
[14]
Nectandra
membranacea
Leaves Effect on the
bioavailability of
sodium pertechnetate
In vitro Enteral Involvement in the
thyroid and muscle
is increased
[15]
Passiflora
edulis f.
flavicarpa
Fruit Effect of 99mTc on
labeling blood
components and
morphology of red
blood cells
In vivo
and
in vitro
Incubating blood
samples
It decreased the up-
take of 99mTc in
plasma proteins and
did not affect the
labeling. Changes in
the morphological
structure of red
blood cells
[16]
Peumus boldus Any part as
a tincture
Effects of 99mTc on
labeling of red blood
cells and plasma
proteins
In vitro Incubating blood
samples
Labeling of red
blood cells and
increased
radioactivity
[17]
Pisidium
guajava
Leaves Effect of 99mTc on
labeling blood
components
In vitro Incubating blood
samples
Decreased
radiolabeling of
blood cells
[18]
(Continued)
2. Radiopharmaceuticals 317
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