Hidden Risks in Herbal Remedies: Pharmacist Strategies for Managing Herb– Drug Interactions in Indian Clinical Practice

The concurrent use of herbal and modern pharmacological therapies is a growing trend in India, particularly in the management of chronic diseases. However, the perception that herbal medicines are inherently safe has contributed to a silent but rising risk of herb–drug interactions (HDIs), which may compromise therapeutic efficacy or patient safety. This literature-based analytical review explores clinically significant HDIs with a focus on herbs frequently used in Indian households and Ayurvedic practice. Databases including PubMed, Scopus, Micromedex®, and Stockley’s Herbal Medicines Interactions were consulted for peer-reviewed articles and pharmacological data published between 2013 and 2024. To enrich clinical applicability, we include simulated case examples and practice-based scenarios reflecting real-world complexity. Results indicate that herbs like St. John's Wort, ashwagandha, ginseng, tulsi, garlic, and turmeric can significantly alter the pharmacokinetics and pharmacodynamics of widely prescribed drugs such as warfarin, metformin, lisinopril, and SSRIs. This paper proposes pharmacist-led interventions, including proactive counseling, integration of digital interaction-checking tools, and regulatory recommendations to mitigate HDI risks.