Effect of Moringa oleifera on the Pharmacokinetics and Pharmacodynamics of Pioglitazone
Authors: Bharathi Koganti , Sandhya Mamindla , Prasad KVSRG 
Published: November 2023

Millions of people today use herbs either as food or in the form of medicine along with other medications. Many of the herbs can interact with these medications, causing either potentially dangerous side effects or improved/reduced benefits from the medication. The present study was performed to determine the influence of moriga, on the pharmacokinetics and pharmacodynamics of pioglitazone. Pharmacokinetic and pharmacodynamic studies were conducted in normal and alloxan induced diabetic rabbits and rats respectively, with oral administration of selected doses of pioglitazone, moringa and their combination. The normal and diabetic rabbits were divided into three groups and each group contains four rabbits, while normal and diabetic rats were divided into four groups and each group contains six rats. The in vivo experimental protocol was approved by the Institutional Animal Ethical Committee (CPCSEA/Regd. No.1657/2013/09). Blood samples were collected at regular intervals of time and were analysed for glucose by GOD/POD method and for pioglitazone by HPLC method respectively. Body weights were also measured every week. Pharmacokinetic parameters were calculated by non‐compartmental pharmacokinetic analysis using Kinetica™ software (version 4.4.1 Thermo Electron Corporation, U.S.A). All values of the pharmacokinetic and pharmacodynamic interaction studies were expressed as mean ± SEM. The data was statistically evaluated using one way analysis of variance (ANOVA) followed by Tukey's, multiple comparison test using Graph Pad Prism 5 computer software. The combination of pioglitazone(1.5mg/kg) and moringa (400mg/kg) was found to produce significant differences in pharmacokinetic parameters of pioglitazone like AUC, t1/2, Ke, Cl/F, Vd/F when given in combination with moringa in normal and diabetic rabbits. The combination of pioglitazone(3mg/kg) and moringa (800mg/kg) was found to reduce the glucose levels and body weights significantly than pioglitazone. In the normal rabbits pharmacokinetic interaction was seen at elimination level when moringa was given in single dose, while the interaction was found to be at absorption and elimination levels when moringa was given in multiple doses. In the diabetic condition the interaction was found to be different. In the single dose treatment the interaction was found at metabolism and elimination decreasing the AUC, whereas in the multiple dose treatment it was at elimination and metabolism level increasing the AUC. The alterations are more pronounced in multiple dose treatment groups, indicating the significance of long term exposure of moringa in diabetic condition (in both rats and rabbits) treated by pioglitazone and thus it may apply to diabetic patients under pioglitazone treatment. The results of increased AUC of pioglitazone under moringa exposure suggest an interaction indicating decreased metabolism of pioglitazone as a result of CYP3A4 inhibition and thereby producing a potentiating effect. Moringa enhanced the bioavailability of pioglitazone by inhibiting the CYP3A4 enzyme. Hence, moringa might be beneficial when used in combination with pioglitazone in diabetic patients and an adjustment of dose of pioglitazone may be necessarySupport or Funding InformationThe work was funded by Sri Padmavati Mahila Viswavidyalayam under the support given for the research work.