HERBAL MEDICINES OR DIETARY SUPPLEMENTS AND PHENYTOIN AYURVEDIC MEDICINES
A case report, and an animal study, indicate that an antiepileptic Ayurvedic herbal preparation, SRC (Shankhapushpi), can markedly reduce serum phenytoin levels, leading to an increased seizure frequency if the phenytoin dosage is not raised. SRC is a syrup prepared from Convolvulus pluricaulis leaves, Nardostachys jatamansi rhizomes, Onosma bracteatum leaves and flowers, and the whole plant of Centella asiatica, Nepeta hindostana and Nepeta elliptica.
Shankhapushpi (SRC) is given because it has some antiepileptic activity but there is little point in combining it with phenytoin if the outcome is a fall in serum phenytoin levels, accompanied by an increase in seizure frequency. For this reason concurrent use should be avoided. It would seem prudent to be similarly cautious with the use of fosphenytoin, a prodrug of phenytoin.
Shankhapushpi (SRC) is given because it has some antiepileptic activity but there is little point in combining it with phenytoin if the outcome is a fall in serum phenytoin levels, accompanied by an increase in seizure frequency. For this reason concurrent use should be avoided. It would seem prudent to be similarly cautious with the use of fosphenytoin, a prodrug of phenytoin.