Possible Interaction: Saquinavir and Garlic

“All tested phytochemicals (except S-allyl L-cysteine) and aged garlic extract inhibited CYP3A4 metabolism of both drugs and modulated hepatic distribution of the corresponding saquinavir and darunavir metabolites.”

“ Allium sativum (garlic) decreased the area under the plasma concentration-time curve (AUC) and maximum plasma concentration of saquinavir , but not ritonavir and paracetamol (acetaminophen), in volunteers.”

“In-vivo studies showed a significant decrease in saquinavir ’s area under curve (AUC) after garlic consumption [2, 3].”

“Because of the observed in vitro interactions between aged garlic extract and HIV protease inhibitors (darunavir, saquinavir ), any alterations of in vivo liver transport in the presence of garlic phytochemicals could also significantly influence darunavir/saquinavir hepatocyte intracellular concentrations and hence their bioavailabilities.”

“ Garlic extracts have been shown to decrease drug exposure for saquinavir , a P-glycoprotein and cytochrome P450 3A4 substrate.”

“Finally, garlic may enhance the pharmacological effect of anticoagulants (e. g. warfarin, fluindione) and reduce the efficacy of anti-AIDS drugs ( i. e. saquinavir).”

“In the presence of garlic , the mean saquinavir area under the curve (AUC) during the 8-h dosing interval decreased by 51%, trough levels at 8 h after dosing decreased by 49%, and the mean maximum concentrations (Cmax) decreased by 54%.”

“Physicians are warned, for example, that patients should discontinue the use of garlic pills at least seven days before surgery, and that garlic can interact with insulin, warfarin, cyclosporine, and saquinavir.”