Cassia angustifolia is a species of plant from the Senna family that has traditionally been used as a laxative in different herbal products and commercial medicines. Even though there are few documented drug-plant interactions, the use of C. angustifolia with different drugs may have additive effects, such as with other laxatives or potassium-depleting diuretics. Its use also increases peristalsis which, may reduce drug absorption. The combination with digoxin has been associated with an increased risk of digoxin toxicity, probably due to an increase in plasma digoxin concentrations and hypokalaemia. We present a case with supratherapeutic trough concentration of tacrolimus, an immunosuppressive agent, and a herbal product in a liver transplant patient after concomitant intake of tacrolimus and a herbal product based on C. angustifolia, suggesting a possible drug-lant interaction through by P-glycoprotein. We observed an increase in the patient\'s blood concentration 2.8-fold and the area under the curve at steady state 2.1-fold. This interaction could be of clinical relevance, given the dose-dependent side effects of tacrolimus, such as nephrotoxicity, neurotoxicity, hypertension, hyperglycaemia, or electrolyte alterations.

Metabolomics is a rapid and sensitive tool for the detection of dynamic metabolic compositions in the study of systemic metabolic consequences. However, it is also susceptible to a tiny variation of pre-analytical handling procedures. To provide reproducible results, specific knowledge on metabolites perturbance along with different freeze-thaw cycles (FTCs) is needed for further metabolomics studies. In this paper, five FTCs of germinated Cassiae Semen (CS) were chosen as a case study to investigate the influence of FTC effect based on UHPLC-Q-Orbitrap-MS and NMR technologies. A total of 108 metabolites were relatively quantified by LC-MS and NMR analyses. Principal component analysis (PCA) showed that the first and second FTC samples are welly separated from the other groups; however, the extent of FTC-induced effects are smaller after the third cycle. Upon five consecutive FTCs, alterations which consisted of decreased stachyose, sucrose, norrubrofusarin-6-O-β-d-glucopyranoside, and quercetin 3-(3″-acetylgalactoside), as well as increased phenylalanine, leucine, isoleucine, methionine, phenylalanine, mannose, gluconic acid, and valine, could be observed. FTC does not exert the same effect on all metabolites. Although a large number of secondary metabolites were stable when subjected to five FTCs, FTC effects may lead to false-positive in the discovery of biomarker. In the case of reusing plant seed samples, no more than three consecutive freeze-thaw cycles were found advisable. This work provides unique perspectives on the FTC effects, which may fill in some existing gaps in the knowledge of the stability of plant metabolites during sample pre-handling.