Herbal Modulators of Drug-Induced Gastrointestinal Toxicity: A Pharmacognostic Review of Pre-Clinical Evidence and Potential Co-Administration Approac

Drug-induced gastrointestinal (GI) toxicity triggers complications. GI protectants are prescribed to relieve GI complications caused by NSAIDs, antibiotics and anticancer drugs. However, they also cause side effects. Recently, there is an interest in multi-target gastroprotective herbs. This study is a systematic review aimed to evaluate pre-clinical evidence regarding herbal modulators with gastroprotective potential against drug-induced GI toxicity. Articles between 1989 and 2024 were included. Various combinations of keywords, such as gastrointestinal toxicity, plants, herbs, anti-cancer, antibiotic, and NSAID were used in five databases: WOS, PubMed, Google Scholar, Scopus, and Embase. In vitro, animal, and clinical studies were used to explore gastroprotective herbal compounds mitigating drug-induced GI toxicity. Articles without full text, duplicates, and unpublished papers were excluded. Eight medicinal plants comprising of Aloe vera, Foeniculum vulgare, Zingiber officinale, Camellia sinensis, Curcuma longa, Nigella sativa, Glycyrrhiza glabra, and Calendula officinalis were included. The findings are systematically presented in four tables demonstrating gastrotoxic drugs and mechanisms responsible for gastric adverse effects, gastroprotective medicinal plants with their principal phytochemical constituents and pharmacological activities, documented herb–drug interactions and their broader therapeutic relevance, and key therapeutic dosages and commonly used formulations. Results of this study showed the potency of herbal agents against GI toxicities of the mentioned medicines. These results suggest that the reported plants have various gastroprotective effects and may be co-administered to mitigate the GI toxicity. However, clinical and more studies are required to ensure the potency and safety of the herbal agents.