A case report on the probable herb-drug interaction between stevia products and etoricoxib relating to declined kidney function

Abstract

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. © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019.