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Exploring Herbal Medicine: Applying Epidemiology Principles

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Special Issue Editor

Special Issue Information

Dear Colleagues,

Herbal medicine stands at the intersection of traditional practices and modern healthcare, offering potential therapeutic benefits. Delving into the epidemiological aspects of herb therapies is crucial in harnessing their efficacy and ensuring patient safety.

This Special Issue will bridge the gap between herbal medicine and epidemiology, focusing on a range of herbal treatments and their interactions, outcomes, and safety profiles.

We welcome original research articles and reviews that explore the epidemiological principles underlying herbal medicine. Potential themes for submissions include, but are not limited to, the following:

Epidemiological studies on the utilization and safety of specific herbal remedies;
Investigations into the effectiveness of herbal interventions in population health;
Evaluations of herbal drug interactions and their implications;
Assessments of the public health impacts of herbal medicine use;
Analyses of traditional knowledge and contemporary epidemiological practices in herbal medicine research.

We look forward to receiving your insightful contributions to this Special Issue, which will enrich our understanding of herbal medicine through the lens of epidemiology.

Dr. Christos Kontogiorgis
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacoepidemiology is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

natural products
herbal medicines
medicinal plants
ethnopharmacology
pharmacoepidemiology
drug utilization
real-world data evidence
herbal toxicity
population-based studies
public health
herbal products regulations
medicinal plants pharmacovigilance
herbal drugs’ efficacy and safety
herbal products and drug interactions
pharmacological mechanisms
medicinal products development and quality assurance
traditional medicine
adverse effects
medicinal plant therapies

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Published Papers (1 paper)

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Review

29 pages, 1879 KB

Open AccessFeature PaperReview

Pharmacoepidemiological Data on Drug–Herb Interactions: Serotonin Syndrome, Arrhythmias and the Emerging Role of Artificial Intelligence

by Marios Spanakis, Evangelos Bakaros, Stella-Natalia Papadopoulou, Agapi Fournaraki and Emmanouil K. Symvoulakis

Pharmacoepidemiology 2025, 4(4), 22; https://doi.org/10.3390/pharma4040022 - 9 Oct 2025

Viewed by 1758

Abstract

Herbal medicinal products are increasingly used alongside conventional medicines, raising the risk of potential interactions such as pharmacodynamic drug–herb interactions (PD-DHIs) that can cause serious adverse drug reactions (ADRs). This review aims to present available pharmacological, clinical and pharmacoepidemiological literature regarding potential DHIs associated with serotonin syndrome or cardiac arrhythmias. Furthermore, it assesses the current evidence using the Oxford Centre for Evidence-Based Medicine (CEBM) 2009 framework. Serotonin syndrome most often results from combining serotonergic herbs (e.g., St. John’s wort) with antidepressants like serotonin reuptake inhibitors (SSRIs), as supported by repeated case reports and mechanistic plausibility (CEBM Level 3, Grade C). Other herbs such as black cohosh, ginseng, Syrian rue, turmeric, rhodiola, ashwagandha, and L-tryptophan/5-HTP have been linked to serotonin syndrome when used with SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), or monoamine oxidase inhibitors (MAOIs), but evidence is limited (Levels 4–5, Grade D). For cardiac arrhythmias, PD-DHIs arise when herbs interact with drugs that alter cardiac electrophysiology—such as QT-prolonging agents, psychotropics, antiarrhythmics or digoxin—thereby amplifying arrhythmogenic risk. Ephedra with sympathomimetics is strongly associated with arrhythmias (Level 2–3, Grade B). Licorice may potentiate digoxin and QT-prolonging drugs via hypokalemia (Level 4, Grade C). Other related PD-DHIs include aconite with antiarrhythmics, bitter orange or caffeine with QT-prolonging psychotropics, yohimbine with cardiovascular agents, and aloe or senna with digoxin. Overall, the evidence for PD-DHIs varies from moderate to weak but large-scale pharmacoepidemiological data is scarce. Future approaches, including artificial intelligence with explainable machine learning and network pharmacology, may integrate mechanistic, clinical, and real-world data to improve early detection or prediction of PD-DHIs. However, several specific challenges must be addressed. Therefore, it is crucial for healthcare providers in both clinical and community settings to increase their awareness of these interactions and ADRs to ensure the safe use of herbal remedies alongside conventional therapies. Full article

(This article belongs to the Special Issue Exploring Herbal Medicine: Applying Epidemiology Principles)

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