Narrow Therapeutic Index Drugs and Ethno-Botany of Alaska, Montana & Washington

It is currently being investigated as to why populations differ in response to drugs of Narrow Therapeutic Index (NTI). Anecdotally, the Indigenous of the Americas are such a population. Although gene variants have been suggested as potential determinants for these responses, behavioral, environmental and cultural factors have not been investigated. Here we have identified plant medicines and foodstuffs common to three Indigenous populations of Alaska, Montana and Washington for drug-drug interaction investigation. Specifically, we sought drug interaction and Xenobiotic enzyme interaction. A literature review about issues of use prevalence, use variation, route of administration, seasonal variation, and major Absorption, Distribution, Metabolism and Excretion (ADME) pathways was conducted using PubMed (1985-2011) and the University of Washington's Miller Library.  The ethno-botanical research found is written in broad terms and general expected health benefit. It was found that there is a dearth of information about Native American plant use regarding detailed pharmacology and enzymatic metabolism. There is little research on AI/AN plant medicines and foodstuffs to evaluate drug-plant interactions. However, the literature that does exists indicates that there may be further adverse ADME consequences in these populations with regard to NTI drugs if ethno-botanicals are not taken into account by health professionals. Due to the quick pace of pharmacogenomic discovery and its nascent forays into clinical application, this lack of information can potentially lead to untoward conclusions and community harm. Collaborative community based research partnerships between AI/AN communities and researchers are needed to accurately assess and record ethno-botanical use.