PT - JOURNAL ARTICLE AU - Jialin Liu AU - Suzanne Banuvar AU - Marlos Viana AU - Elena Barengolts AU - Shao-Nong Chen AU - Guido F. Pauli AU - Richard B. Van Breemen TI - <strong>Pharmacokinetic Interactions of a Licorice Dietary Supplement with Cytochrome P450 Enzymes in Female Participants</strong> AID - 10.1124/dmd.122.001050 DP - 2022 Jan 01 TA - Drug Metabolism and Disposition PG - DMD-AR-2022-001050 4099 - http://dmd.aspetjournals.org/content/early/2022/11/03/dmd.122.001050.short 4100 - http://dmd.aspetjournals.org/content/early/2022/11/03/dmd.122.001050.full AB - Licorice, the roots and rhizomes of Glycyrrhiza glabra L., has been used as a medicinal herb, herbal adjuvant, and flavoring agent since ancient times. Recently, licorice extracts have become popular as dietary supplements used by females to alleviate menopausal symptoms. Exposure to licorice products containing high levels of glycyrrhizic acid can cause hypokalemia, but independent from this effect, preclinical data indicate that licorice can inhibit certain cytochrome P450 (CYP) enzymes. To evaluate whether or not clinically relevant pharmacokinetic interactions of licorice with CYP enzymes exist, a Phase 1 clinical investigation was carried out using a licorice extract depleted in glycyrrhizic acid (content &lt;1%) and a cocktail containing caffeine, tolbutamide, alprazolam, and dextromethorphan, which are probe substates for the enzymes CYP1A2, CYP2C9, CYP3A4/5, and CYP2D6, respectively. The botanically authenticated and chemically standardized extract of roots from G. glabra was consumed by 14 healthy menopausal and post-menopausal female participants twice daily for two weeks. The pharmacokinetics of each probe drug were evaluated immediately before and after supplementation with the licorice extract. Comparison of the average areas under the time-concentration curves (AUCs) for each probe substrate in serum showed no significant changes from licorice consumption, while time to reach peak concentration for caffeine and elimination half-life for tolbutamide showed small changes. According to the U.S. Food and Drug Administration guidance, which is based on changes in the AUC of each probe substrate drug, the investigated licorice extract should not cause any clinically relevant pharmacokinetic interactions with respect to CYP3A4/5, CYP2C9, CYP2D6, or CYP1A2. Significance Statement Despite GRAS status, the licorice species, Glycyrrhiza glabra, has been associated with some toxicity. Preclinical studies suggest that G. glabra might cause pharmacokinetic drug interactions by inhibiting several cytochrome P450 enzymes. This Phase 1 clinical study addressed these concerns by evaluating clinically relevant effects with respect to CYP3A4/5, CYP2C9, CYP2D6, and CYP1A2. These results showed that a standardized G. glabra extract did not cause any clinically relevant pharmacokinetic drug interactions with four major cytochrome P450 enzymes.