Bitter kola lowers effectiveness of antibiotics for treating TB — Experts

Most herbal products are used with prescription drugs and have been found to affect the efficacy of many prescription drugs. Now, in a new study, experts say individuals with tuberculosis should avoid intake of bitter kola because this can reduce the efficiency of rifampicin, a broad spectrum antibiotic.

In a new study, researchers had investigated the possible implications of taking rifampicin at the same time with bitter kola and found that it significantly reduced the ability of body tissues, including the lungs, to absorb the antibiotic. The lung is the region where Mycobacterium tuberculosis, the organism that causes tuberculosis inhabits.

According to them, the presence of bitter kola decreased the concentration of rifampicin in the lung tissue that can totally eradicate the tuberculosis-causing microorganism. This is an indication of an actual herb-drug interaction and a reduction in the efficacy of tuberculosis therapy.

The significance of food-drug interaction is well recognised. An interaction can determine whether there is any increase or decrease in pharmacokinetic properties of a drug in the presence of an interacting substrate because this has the potential to influence therapeutic outcomes. It could, for instance, result in the presence of resistant strains of the organism due to exposure to suboptimal dose.

Rifampicin is a medicine that helps to treat tuberculosis and meningococcal meningitis. The World Health Organisation (WHO) has recommended that tuberculosis should be treated with a combination of anti-TB drugs, preferably in fixed-dose combinations (FDC) to enhance compliance.

Rifampicin is one of the first-line and most important anti-TB drugs approved for use in combination with other anti-TB drugs for the treatment of TB. The drug is recommended to be taken before breakfast to prevent suboptimal or failed treatment that can result from interaction with another drug, food or herb.

Bitter kola is often referred to as a “wonder plant” because all of its parts are medicinal. Its seed has been used for many health problems which include liver disease, cold, cough aphrodisiac, voice coarseness, and neurodegenerative diseases such as multiple sclerosis.

There are no reports of harmful effects resulting from overdosing with bitter kola; hence it is safe for consumption. Also, in Nigeria, many individuals on antibiotics therapy also consume bitter kola habitually or as a result of the general belief that it has anti-infective properties.

The scientists had studied what the body does to rifampicin, and in particular the lungs when it is taken simultaneously with bitter kola using an animal model. Albino rats in group A received rifampicin 10 mg/kg alone orally; Group B and C received 100 mg/kg and 200 mg/kg of bitter kola extract respectively for 10 days and on day 11, rifampicin 10 mg/kg was given.

Blood samples were withdrawn from each group at different time intervals respectively. Blood samples were also withdrawn from the lungs in each group after 24 hours and examined to determine the concentration of rifampicin in the lungs.

Bitter kola significantly decreased the concentration of rifampicin in the lungs by 32 per cent and 39 per cent at the two doses tested respectively, indicating that the intake of bitter kola simultaneously with rifampicin impairs the bioavailability of rifampicin and its penetration into the lungs.

The 2020 study on the effect of bitter Kola on pharmacokinetic parameters of Rifampicin was in the African Journal of Biomedical Research. It involved Ebere E. Ayogu; Okpalaoka O.; Amorha K.C.; and Okonta M.J at the Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka in collaboration with Nduka S.O. at the Nnamdi Azikiwe University Awka, Anambra State.

They declared that the method by which bitter kola reduced the antibiotic’s ability to penetrate into the lungs still needs to be investigated, but could be attributed to some factors relating to its constituents.

The researcher, therefore, advised patients and health practitioners against a simultaneous consumption of rifampicin and bitter kola. “If both of them should be taken, a time interval should be observed to avoid interactions,” they said.

Previous analysis of bitter kola shows that it contains chemical substances such as flavonoids and metallic ions like aluminum, magnesium, calcium, copper. The complex formed is usually non-absorbable which results in a reduction in the amount of drug absorbed by the lung.

Also, intake of bitter kola has been reported to decrease the absorption of other antibiotics like penicillin and cephalexin as well as drugs like quinine.

Basically, some foods need to be avoided while taking antibiotics because they interfere with their effectiveness. These include grapefruits and grapefruit juice, as well as dietary supplements containing minerals like calcium that can stop the body from breaking down and correctly absorbing the medication.

Also, some research indicates that foods fortified with high doses of calcium, such as some orange juices, can interfere with the absorption of certain antibiotics

Drinking alcohol while on one of the antibiotics like metronidazole and tinidazole can cause a serious reaction and symptoms such as nausea, abdominal pain, hot flashes, a fast or irregular heartbeat, headaches and dizziness.

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