A Case Report on The Probable Herb-Drug Interaction
between Stevia Products and Etoricoxib Relating to Declined
Kidney Function
Tangkiatkumjai M, PhD1, Janma J, MD2, Changsirikulchai S, MD2
Affiliation :
1 Department of Clinical pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhon Nayok, Thailand
2 Division of Nephrology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
Stevia rebaudiana or its metabolites, steviol glycosides, has been used as a sweetener and has shown diuretic effects with
excretion of sodium in long-term use. There is no report on nephropathy related to Stevia. The aim of the present study is to report
a probable herb-drug interaction between Stevia and etoricoxib that may lead to acute kidney injury (AKI). A 47-year-old Thai
woman reported that she took Stevia daily with etoricoxib 90 mg, 2 to 3 times a week for 6 months, and subsequently developed
AKI. Her serum creatinine showed a significant increase. She had euthyroid and did not take any medications during that period.
After the patient discontinued Stevia and etoricoxib, her serum creatinine returned to normal. A probable herb-drug interaction
between Stevia products and etoricoxib was likely to be associated with prerenal AKI.
The authors postulated an interaction with each other’s hemodynamic effects. A causal relationship between AKI and
Stevia was assessed by the modified Naranjo algorithm. This algorithm indicated a probable relationship (5 scores) for Stevia. In
summary, this is the first case report for humans relating to a probable herb-drug interaction between Stevia and etoricoxib
associated with AKI. To prevent AKI, people who would like to use Stevia should be advised to drink large amounts of water and
avoid using Stevia with NSAIDs or COX-2 inhibitors.
Keywords : Stevia, Herb-drug interaction, Acute kidney injury
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