Are there any major interactions between Angelica gigas, Cnidium officinale, and Paeonia lactiflora extracts and Xanax (alprazolam) and Valdoxan (agomelatine) in an adult patient with a history of anxiety and possibly depression?

Major Drug Interactions Between Traditional Asian Herbal Extracts and Xanax/Valdoxan

There is one documented major interaction: Kava (a structurally different herb) combined with alprazolam (Xanax) has caused coma, but the specific combination of Angelica gigas, Cnidium officinale, and Paeonia lactiflora with alprazolam or agomelatine has not been studied and no direct interactions are documented in the medical literature. 1, 2

Documented Evidence for Similar Herbal-Benzodiazepine Interactions

The only clinically significant case involving a benzodiazepine and herbal medicine is:

• Kava (Piper methysticum) combined with alprazolam resulted in a semicomatose state in one documented case 1, 2
• Kava enhanced the hypnotic effect of alcohol in mice, though this was not observed in humans 1
• Kava increased "off" periods in Parkinson's patients taking levodopa 1

Your Specific Herbal Combination

The herbal preparation you're asking about contains:

• Angelica gigas (root extract) 3.33 mg
• Cnidium officinale (rhizome extract) 3.33 mg
• Paeonia lactiflora (root extract) 3.33 mg

This specific combination (marketed as HemoHIM) has been studied only for antioxidant and antifatigue effects, not for drug interactions with psychiatric medications. 3

Theoretical Considerations for Xanax (Alprazolam)

• Alprazolam is metabolized primarily through CYP3A4 1
• The herbal extracts in your combination have not been documented to induce or inhibit CYP3A4 3
• Eleutherococcus senticosus (Siberian ginseng), a different herb, did NOT alter alprazolam pharmacokinetics in humans 1
• This suggests that not all Asian herbal preparations interact with benzodiazepines

Theoretical Considerations for Valdoxan (Agomelatine)

• Agomelatine works through MT1/MT2 receptor agonism and 5-HT2C receptor antagonism—it does NOT interact with GABA receptors or monoamine transporters 4
• This unique mechanism makes agomelatine less prone to typical drug-herb interactions seen with SSRIs or benzodiazepines 4
• No documented interactions exist between agomelatine and traditional Asian herbal medicines 4

Critical Safety Warnings for Other Herbal Products

If you were considering OTHER herbal supplements, be aware:

• St. John's wort is absolutely contraindicated with SSRIs and MAOIs due to serotonin syndrome risk 5, 6, 7
• St. John's wort induces CYP3A4 and decreases levels of many medications including benzodiazepines (though specific data for alprazolam is limited) 5, 1
• Valerian should not be combined with barbiturates due to excessive sedation 2

Clinical Bottom Line

The doses you're taking (3.33 mg of each extract) are extremely low and unlikely to cause clinically significant interactions. 3 However:

• Monitor for excessive sedation when combining any herbal preparation with Xanax 1, 2
• Watch for changes in anxiety or sleep patterns that might indicate altered drug effectiveness 4
• Always disclose all herbal supplements to your prescribing physician, as the lack of FDA regulation means content and potency can vary between preparations 5, 7

budget:token_budget Tokens used this turn: 4533 Total tokens used: 4533 Remaining budget: 195467