Liquorice, a unique “guide drug” of traditional Chinese medicine: A review of its role in drug interactions

Ethnopharmacological relevanceLiquorice is the root of Glycyrrhiza uralensis Fisch. or Glycyrrhiza glabra L., Leguminosae. It is a widely used herbal medicine native to southern Europe and parts of Asia and has beneficial applications in both the medicinal and the confectionery sectors. Unlike its usage in Europe, liquorice in traditional Chinese medicine is commonly combined with other herbs in a single prescription, as a unique “guide drug” to enhance the effectiveness of other ingredients, to reduce toxicity, and to improve flavor in almost half of Chinese herbal formulas. A review on phytochemical and pharmacological research to explain this unique “guide” effect is suggested for future investigations.Materials and methodsThe information was collected from scientific journals, books, and pharmacopeia. The studies about the traditional uses, randomized controlled trials, chemical, pharmacological and pharmacokinetic data related to liquorice–herb/drug interaction or combination were included in the review.ResultsAccording to recent reports, the “guide” effect of liquorice is partially through components transformed in liquorice–drug interaction; altering enzyme activity of P450 isoforms, as evidenced by induction of model probe substrates; and modulation of drug transporter proteins such as intestinal P-glycoprotein.ConclusionThe overview and comparison of traditional uses of liquorice with recent pharmacological studies and randomized controlled trials provide new insights into this ancient drug for future investigations and clinical use, especially in drug combination.

Graphical abstract"Regulation of cytochrome P450 enzymes may partially explain the guide effect of liquorice in drug interactions".Figure optionsDownload full-size imageDownload high-quality image (224 K)Download as PowerPoint slide