Taxonomic class

Parmeliaceae

Common Trade Names

Iceland Moss, Juvinol Cell and Tissue Formula

Common Forms

Available as capsules, creams, and throat lozenges.

Source

Cetraria islandica, a lichen that grows in the Northern hemisphere, is common in the mountains and heathlands of Iceland. The single-cell green algae are enclosed in a web of fungal hyphae (root filaments). The lichen may be gathered throughout the year, but it seems to be most abundant between May and September. It should be freed from attached impurities and dried in the sun or shade. The entire plant, or lichen, is used for extraction.

Chemical components

C. islandica is bitter and mucilaginous. Constituents include about 50% water-soluble polysaccharides, including lichenin, a linear cellulose-like polymer of beta-D-glucose, and isolichenin, a linear starchlike polymer of alpha-D-glucose. Iceland moss also comprises galactomannans; an acidic, branched polysaccharide containing D-glucose and D-glucuronic acid units; and trace amounts of iron and calcium salts. Other constituents are bitter-tasting lichen acids, including the depsidones fumarprotocetraric acid and protolichesterinic acid . Iceland moss has a high fiber content.

Actions

Protolichesterinic acid from Iceland moss was found to have antibacterial properties against Mycobacterium tuberculosis, Streptococcus pyogenes, and Staphylococcus au reus. It has also exhibited antitumorigenic activity against solid type carcinoma in mice and been potent in vitro in inhibiting activity against the DNA polymerase activity of HIV type 1 reverse transcriptase . Protolichesterinic acid was shown to be antiproliferative and cytotoxic to T-47D and ZR-75-1 cell lines cultured from breast carcinomas and to K-562 from erythro­leukemia. Significant inhibition of 5-lipoxygenase may stimulate these activities and contribute to protolichesterinic acid’s reported anti­inflammatory actions .

Because of their antibacterial properties, the extracts hqve been studied for use in pharmaceutical and cosmetic products. The lichen extracts appear to be safe for use as preservatives without interfering with proprietary ingredients.

Extracts of Iceland moss were found to suppress the growth of Helicobacter pylori, the organism thought to contribute to the cause of gastritis and gastric and duodenal ulcers .

Reported Uses

C. islandica has been used in European medicine to treat asthma, GI disorders such as gastritis, minor ailments (such as throat irritation and cough), and tuberculosis. Cough drops for sore throats and laxative and tonic formulations are available in European pharmacies. In a random­ized trial, Iceland moss was found to prevent dryness and inflammation of the oral cavity in patients who had undergone surgery of the nasal septum and were subjected to prolonged mouth breathing after surgery. Emollient effects were noticeable with daily use of 0.48 mg of Iceland moss lozenges .

The polysaccharides are thought to form a soothing, protective, mucilaginous layer on upper respiratory tract mucosa. In an open clinical trial, 100 patients with bronchial ailments, laryngitis, or pharyngitis were treated with lozenges containing 160 mg of an aqueous extract of Iceland moss. The results were determined to be positive in 86 cases, with good gastric tolerance and lack of adverse effects .

In Iceland, the plant has also been used for symptomatic relief of gastric and duodenal ulcers . Studies of the antitumorigenic and immunostimulating properties of the polysaccharides found comparable carbon clearance assay results as those for the fungal polysaccharide lentinan, which is used clinically in adjuvant cancer therapy in Japan .

Dosage

A decoction can be made by mixing 1 tsp of shredded moss in 1 cup of cold water, which should then be boiled for 3 minutes and taken P.O. b.i.d. Alternatively, 1 to 2 ml of the tincture can be taken P.O. t.i.d.

Of significance, powdered material must be soaked in lye for 24 hours or filtered through ash to properly extricate lichen acids. Studies demonstrate that poorly prepared Iceland moss may contain toxic levels of lead .

Cough drops and laxative and tonic formulations are also available.

Adverse Reactions

GI (with large doses or prolonged use): hepatotoxicity, indigestion, nausea.

Interactions

None reported.

Contraindications And Precautions

Avoid using Iceland moss in pregnant or breast-feeding patients; effects are unknown. The bitterness of Cetraria is detectable in breast milk.

Special considerations

Inform the patient that Iceland moss cannot be recommended for any use because of insufficient data.

Advise the patient to watch for signs of toxicity (abdominal pain; bleeding; change in color of urine, stool, or skin; diarrhea; nausea; vomiting).

Advise the patient to consult a health care provider before using herbal preparations because a treatment that has been clinically researched and proved effective may be available.

Points of Interest

Iceland moss has been exported from Iceland and is used abroad to manufacture herbal medicines (particularly in Germany). Because Iceland is regarded as one of the least polluted countries in the world, the purity of the plants growing in Iceland is desirable. The wild plants are grown organically; fertilizers are not used in the highlands, where many of these plants are found.

Lichens lack roots and derive their energy and nutrients from their surroundings. They are susceptible to contamination by radioactivity and heavy metals. After the Chernobyl accident, the fallout contaminated the lichen in most of Europe, but in Iceland the radioactivity level was almost negligible.

Commentary

Iceland moss derivatives show promise as immunomodulating and antitumorigenic agents, and someday they may find a role in the treatment of H. pylori infections. Further research in human subjects is needed before any conclusions can be drawn. Definitive applications and clinical efficacy are not known. Although the lichen extracts appear to be relatively safe in small amounts, therapeutic application cannot be recommended.

Taxonomic class

Hydrophyllaceae

Common Trade Names

Multi-ingredient preparations: EarSol-HC, Feminease, Fen-Tastic, lerbal Gold Cigarrettes, Lung-Mend, Magic Cigarettes, MouthKote, Nature’s Sunshine SN-X, Nettle-Reishi Virtue, Oragesic, Pretz-D, Pretz Irrigation, Pretz Spray, Respirtone, Respitonic, Tot Tonic, #493 VRM3 Micro Pathogens, Yerba Manza-Eyebright Virute, Yerba Prima,Yerba Santa-Echinacea Virtue, Yerba Santa Resin-Rich Leaf

Common Forms

Available as a liniment, liquid extract (1:5), powder, syrup, and tea.

Source

Active components are derived from the leaves and roots of Eriodictyon californicum (syn. E. glutinosum Benth. and Wigandia californicum Hook. & Am.), an evergreen shrub that belongs to the waterleaf family and is native to the mountains of California, Oregon, and northern Mexico.

Chemical Components

The plant contains various acids (cerotinic, formic, and butyric), a resin (pentacontane, xanthoeriodictyol, priodonal, and chrysoeriodictyol), phenols (eriodictyol, homoeriodictyol, chrysocriol, zanthoeridol, and eridonel), chrysoeriol, cirsimaritin, glycerides of fatty acids, a phytosterol, eriodictyonine, tannins, a volatile oil, sugar, fixed oil, and a gum.

Actions

Physiologic mechanisms of action are poorly described. It is reported that yerba santa exerts expectorant and mildly diuretic effects. Two flavonoid isolates from the plant, cirsimaritin and chrysoeriol, show some promise as anticancer agents .

Reported Uses

Native Americans used yerba santa externally for bruises and inflammation, and they smoked or chewed the leaves for asthma. The herb has also been used to treat bronchial conditions, the common cold, cough, fever, hay fever, hemorrhoids, excessive mucus production, rheumatic pain, sore throat, and tuberculosis. The mashed leaves have been prepared as a poultice to treat insect bites, sores, sprains, and wounds.

Dosage

No consensus exists, but some sources suggest that a tea made from the leaves may be used for asthma, colds, coughs, and tuberculosis. Powdered leaves are used as a stimulating expectorant. A liniment formulation of the leaves is applied topically to reduce fever. Fresh leaves are applied as poultices for bruises, and younger leaves are applied to relieve rheumatism.

Adverse Reactions

None reported.

Interactions

Iron, other minerals: Yerba santa reportedly interferes with the absorption of iron and other minerals when taken internally. Separate administration times.

Contraindications and Precautions

Avoid using yerba santa in pregnant or breast-feeding patients; effects are unknown.

Special Considerations

• Advise the patient not to chew yerba santa leaves because they leave a gummy residue on the teeth.
• Inform the patient that no clinical data sUpport the use of yerba santa for any medical condition.
• Advise the patient not to depend on yerba santa alone to treat such conditions as asthma and tuberculosis.

Points of Interest

• Spanish colonists named this plant yerba santa (holy weed) after learning of its medicinal uses from the American Indians. Yerba santa is available in several OTC herbal preparations and as a pharmaceutical flavoring to mask the flavor of bitter drugs. The liquid extract is also used in foods and beverages.

Commentary

Information regarding the safety and efficacy of yerba santa is scant. No clinical trials or published case reports are available for evaluation. As a result, its use cannot be recommended.

Taxonomic class

Magnoliaceae

Common Trade Names

None known.

Common Forms

Available as liquid extract and powder.

Source

Indigenous to North America, magnolia’s medicinal parts are derived from the bark of the stem and root. The main active components are obtained from the bark of several magnolia species; the flower bud is also used in Chinese medicine. Drying and age cause its volatile, aromatic properties to be lost.

Chemical components

The active components found in the bark are alkaloids (for example, magnocurarine and tubocurarine) and essential oils (for example, magnolol, tetrahydromagnolol, isomagnolol, machiolol, and honokiol).

Actions

Components of magnolia bark have been studied in vitro and in animals for antimicrobial activity in the treatment of periodontal disease , for antifungal activity and as antitumorigenic promoters . The lignans isolated from the flower buds have been studied for their inhibitory effects on tumor necrosis factor-alpha production . Few, if any, data exist from human clinical trials. Magnolol, the active principle of the herb, has anti-inflammatory properties and has been shown to reduce prostaglandin E 2 and leukotriene-B 4 levels in the pleural fluid of mice and to suppress thromboxane-B 2 formation .

Decoctions made from magnolia have been cited to cause uterine contractions.

Reported Uses

Magnolia has been claimed to be useful as an antasthmatic, an anti-inflammatory, a muscle relaxant, and a stimulant. Its use has also been suggested for appetite stimulation, digestive disorders, dysentery, flatulence, nausea, and shortness of breath.

Dosage

No standard dosing is available.

Adverse Reactions

Other: allergic reaction.

Interactions

None reported.

Contraindications and precautions

Magnolia is contraindicated in pregnancy because of empiric uterinestimulating activity (flower buds).

Special considerations

Although primary allergy to magnolia is seldom reported, caution the hypersensitive patient to be wary of allergic reactions to magnolia. One patient, described as having allergies to several sesquiterpene lactone­containing plants, experienced a severe case of chronic lichenfied dermatitis to Magnolia grandiflora .

Advise the patient to consult a health care provider before using herbal preparations because a treatment that has been clinically researched and proved effective may be available.

Advise the pregnant patient not to ingest magnolia.

Points of Interest

A report in an FDA bulletin suggests that a M. stephania preparation may lead to acute renal failure and, possibly, permanent renal dysfunction .

The genus Magnolia is named after Pierre Magnol, a professor of medicine and botany at Montpellier in the early 18th century.

Commentary

Although magnolia is popular in Chinese medicine, scientific information from human trials to support its pharmacologic actions does not exist. Evidence to support claims is lacking. More research is needed before definitive recommendations can be made.

Taxonomic Class

Asteraceae

Common Trade Names

Chicory

Common Forms

Available as the crude herb, extracts, root (roasted and unroasted), and teas.

Source

Active components are extracted from the dried roots of Cichorium intybus, a biennial or perennial herb that is native to Europe. The leaves of young plants are used as potherbs, whereas the leaves of older plants can be blanched and eaten like celery. The roots can be boiled and eaten with butter or, more commonly, can be roasted and added to coffee or tea for a bitter taste. The roasted, dried root is also used as a coffee substitute.

Chemical Components

The flowers contain cichoriin, and the leaves contain carbohydrates, catechol tannins, chicoric acid (dicaffeoyl tartaric acid), flavonoids, glycosides, tartaric acid, and unsaturated sterols and triterpenoids. The roots contain many steam-distillable aromatic compounds. The characteristic aroma of chicory stems from acteophenone. The roots also contain inulin; on roasting, inulin is converted to oxymethylfurfural, which gives off a coffeelike aroma. Chicory also contains maltol, a taste modifier that intensifies the flavor of sugar.

Actions

Chicory is commonly used as a water-soluble or alcoholic extract. The water-soluble fraction is thought to exhibit sedative effects and, therefore, may antagonize the stimulating effects from coffee and tea. Alcohol extracts have demonstrated anti-inflammatory activity . Although little information exists regarding chicory use in humans, several animal studies have shown that it reduces the cardiac rate by an action similar to that of quinidine, suggesting its possible usefulness in treating arrhythmias. Interesting information surrounds the potential application of chicory to reduce the risk of colon cancer.

Reported Uses

In herbal lore, chicory is primarily touted as a coffee or tea additive because of its ability to antagonize the CNS stimulation brought on by these substances. It has also been used as a coffee substitute because of its coffeelike aroma and taste. In folk medicine, chicory root is used as a diuretic and laxative; human data are lacking for these uses.

Dosage

Little information is available.

Crude herb: 3 g P.O. daily.

Adverse Reactions

Skin: contact dermatitis .

Interactions

None reported.

Contraindications And Precautions

There are no known contraindications for chicory. Use it cautiously in patients with cardiac disease because of its potential action on the heart.

Special Considerations

Inquire about chicory use when taking the patient’s drug history.

Advise the patient with cardiac disease to avoid using chicory or to use it cautiously.

Although no known chemical interactions have been reported in clinical studies, consideration must be given to the pharmacologic properties of the herbal product and the potential for exacerbation of the intended therapeutic effect of conventional drugs.

Points of Interest

Chicory has been shown to take up the fungicide quintozene through its roots, which may lead to colonization with certain bacteria in the soil and subsequent contamination of the plant.

Commentary

Chicory has a long history of traditional use. Because of its flavor and aroma, the root has been used as a substitute for coffee and tea. Unlike coffee, chicory may exhibit sedative properties, which may explain its traditional use in offsetting the stimulant properties of teas and coffee. These claims are unproven. The plant may have some use as an antiarrhythmic, but further studies are needed. Its use as a laxative is also unclear and should be reserved until human trials are completed. Of greatest interest is the potential application of chicory and its dietary fructans, inulin and oligofructose, as colon carcinogenesis inhibitors.

Taxonomic class

Asteraceae

Common Trade Names

Tansy Ragwort

Common Forms

Available as fresh and dried herb.

Source

The leaves, seeds, and flowers of Senecio jacobaea are commonly used. Ragwort is a member of the daisy family and native to North America.

Chemical Components

Limited information exists on the chemical composition of Senecio species. The volatile oil has been described for some species . Pyrrolizidine alkaloids (floridanine, florosenine, otosenine, and senecio nine) are the chief components isolated from the leaves, seeds, and flowers.

Actions

Several texts report that ragwort has an astringent, cooling, analgesic effect when applied topically or gargled. It is also claimed to have diuretic, weak expectorant, and uterine stimulant properties.

Reported Uses

Emollient poultices have been made from leaves. Plant “juice” has been used as a wash for bee stings, burns, rheumatism, and cancerous ulcers and as a gargle for ulcerations in the mouth and throat. Claims for use of the plant have also been made for treating functional amenorrhea and menopausal neurosis. These claims lack sufficient clinical trial data to validate their application.

Dosage

Only external use of the herb is recommended. Poultices are made by applying the bruised, fresh plant directly on the affected area. Dried herb can be used by soaking it in warm water before applying. A gargle is made by soaking the plant in warm water and then straining.

Adverse Reactions

GI: hepatotoxicity, nausea, vomiting.

Respiratory: pulmonary edema or effusion.

Interactions

Hepatotoxins: Increased risk of hepatotoxicity. Avoid administration with ragwort.

Contraindications and Precautions

Ragwort is contraindicated in patients who are susceptible to hepatic dysfunction. Avoid its use in pregnant or breast-feeding patients; effects are unknown.

Special Considerations

• Pyrrolizidine alkaloids are metabolized to hepatotoxic pyrrolic compounds. Death resulting from hepatic failure has been reported in animals and humans.
• Monitor liver function test results.
• Advise the patient to report signs and symptoms of hepatic dysfunction (abdominal pain, fatigue, fever, jaundice).
• Advise women to avoid using ragwort during pregnancy or when breast-feeding.

Points of Interest

• In South Africa, some Senecio species are used as food.

Commentary

Because there are well-documented cases of human and animal poisonings, ragwort presents an unacceptable risk and should not be used for any medicinal purpose.

Taxonomic Class

Rutaceae

Common Trade Names

None reported.

Common Forms

The two forms of tangerine peel are aged tangerine peel and green (young) tangerine peel. It is available as a peel and in pill form.

Source

After tangerines ripen, the skins are collected and dried.

Chemical Components

Tangerine peel contains dietary fibers and bioflavonoids (naringin and hesperidin). Tangerine seeds contain three limonoids: limonin, nomilin, and obacunone .

Actions

Information regarding the mechanism of action of tangerine peel is limited. Naringin acts as an antimicrobial and hesperidin acts as a blood pressure depressant. Both bioflavonoids have been pharmacologically evaluated as potential anticancer agents and anti-inflammatories and are thought to be associated with preventing hyperlipidemia.

Reported Uses

Tangerine peel has been used to treat anorexia, bloating, diarrhea, flatulence, hyperlipidemia, indigestion, muscle pain, nausea, and vomiting. It can also be used as a diuretic, an expectorant, and a sedative.

Dosage

None reported.

Adverse Reactions

None reported.

Interactions

None reported.

Contraindications and Precautions

Some sources suggest that tangerine peel may be contraindicated in patients who have a dry cough or red tongue or in those who are spitting up blood. The red tongue could be a sign of inflammation or infection, which would be aggravated and cause pain in tangerine peel is taken.

Special Considerations

Advise the patient to consult a health care provider before using herbal preparations because a treatment that has been clinically researched and proved effective may be available.

Instruct the patient to report new adverse reactions if using tangerine peel.

Although no known chemical interactions have been reported in clinical studies, consideration must be given to the pharmacologic properties of the herbal product and the potential for exacerbation of the intended therapeutic effect of conventional drugs.

Points of Interest

Tangerine peel essential oil is popular in aromatherapy.

A red or orange peel is favored by some herbalists.

Commentary

Because of the lack of human clinical data, the use of tangerine peel is not recommended. One study in rats appears to show a connection between tangerine peel extracts and the prevention of hyperlipidemia, but further clinical trials are needed to confirm its safety and efficacy.

ALTERNATIVE NAMES: COMMON HOLY BASIL, GARDEN BASIL, SWEET BASIL

Taxonomic Class

Lamiaceae

Common Trade Names

None known.

Common Forms

Available as chopped or powdered leaves and a tea.

Source

The crude drug is derived from the leaves of Ocimum basilicum (sweet or Common basil) or Ocimum sanctum (holy basil), members of the mint family (Labiatae).

Chemical Components

The active components of basil include eugenol, linalool, and methyl chavicol (estragole). Other components include monoterpenes (such as camphor, cineol, geraniol, and ocimene), phenylpropanes (such as methyl cinnamate), and sesquiterpenes.

Actions

In human trials, O. sanctum and Ocimum album significantly lowered urine glucose as well as fasting and postprandial blood glucose levels in 40 patients with type 2 diabetes. Total cholesterol levels were also slightly decreased .

Animal studies have revealed some peripherally mediated analgesic effects of the fixed oil of O. sanctum . Another trial in guinea pigs found antasthmatic and anti-inflammatory properties in extracts from fresh leaves and the essential oils of O. sanctum leaves . In studies with rats, 0. basilicum components (aqueous extracts, flavonoid glycosides, and methanol extracts) were found to have anti ulcerative effects .

Reported uses

Basil is claimed to possess analgesic, anti-inflammatory, antioxidant, antiseptic, antiulcerative, and hypoglycemic properties.

Dosage

The dosage reported in one trial was 2.5 g of fresh, dried leaf powder once daily . A tea can be made by placing 2.5 g of fresh, dried leaf powder in 1/2 cup of water, straining, and drinking once or twice daily, as needed.

Adverse Reactions

Hepatic: hepatocellular carcinoma.

Metabolic: hypoglycemia.

Interactions

Insulin, sulfonylureas, other antidiabetics: May increase hypoglycemic effects. Avoid administration with basil.

Contraindications And Precautions

Avoid using basil in pregnant or breast-feeding patients because of the potential for increased menstrual flow and the mutagenic effects of estragole. Use cautiously in diabetic patients.

Special Considerations

Monitor the diabetic patient for hypoglycemia if he consumes basil in quantities that exceed amounts typically used for foods.

Instruct the patient to avoid long-term use of basil because of its potential multiage effect. Strangle is a known expatiating in animals.

Advise the female patient not to use basil during pregnancy or when breast-feeding.

Points of interest

Cultivation practices and soil variations can significantly change the chemical composition of basil.

Commentary

Few human studies examine the effects of basil for medicinal purposes. One study showed significant reductions in blood glucose levels, which led the investigators to comment on basil’s usefulness in the treatment of type 2 diabetes . Although the results of this small study are suggestive, they have not yet been duplicated in a large, controlled trial. Claims of efficacy in other diseases have not been substantiated in human trials.

Comfrey Herb Description - Drug Interactions, Dosage and Some of its Useful Properties

Taxonomic Class

Boraginaceae

Common Trade Names

Wise Woman Comfrey Salve. Several combination products are avail­able, including Alticort, Atri-Res, Black Ointment, C&F Formula, Comfrey/Aloe Capsules, Comfrey and Fenugreek, EB5 Footcare Formula, EB5 Toning Formula, #483 Oxox Cell Activator, Goldenseal Salve, H-Complex, Heal-All Salve, Kytta-Plasma f, Kytta-Salbe F, Liniment Virtue, Muco-Plex, Mucoplex, Mustard Salve, Pain-Less Rub, Plantain Salve, Procomfrin, Respa-Herb, Simicort, Super Salve, T­ANEM, T-ASMA, T-BC, T-BF, Traumaplant, T-SLC, and T-ULe.

Common Forms

Comfrey is available as a blended plant extract also known as “green drink,” homeopathic preparations, a poultice or liniment, a tea (dried leaf and whole root), and a topical cream or ointment and in bulk roots or leaves, capsules, elixir, mucilaginous decoctions, powder, and tincture. Pyrrolizidine alkaloid (PA)-free comfrey preparations are also available. Commercial root preparations are available, but they are not recommended for internal or external use because of their high concentration of PAs. Comfrey is available in combination products in veterinary medicine for topical treatment of muscle strains and ruptures and for oral administration as an antidiarrheal.

Source

An oil is extracted from the leaves and roots of Symphytum officinale, a member of the borage family. Comfrey is a perennial herb that grows in temperate regions, including western Asia, North America, and Australia.

Chemical Components

Comfrey contains a few compounds that show medicinal activity. Mucilage, a mucopolysaccharide of fructose and glucose, is concentrated in the root up to 29%. Allantoin, asparagine, beta-sitosterol, consolicine, consolidine, isobanerenol, lithospermic acid, PAs (up to 0.7% in dried root materials), rosmarinic acid, silicic acid, stigmasterol, symphytocynoglossin, tannins, and triterpenoids (including symphytoxide A) are also found in the plant.

Actions

Mucilage is reported to possess demulcent properties by forming a protective film to soothe irritation and inflammation. Allantoin is claimed to be a cell-growth stimulator, accounting for comfrey’s ability to stirn ulate wound healing and tissue regeneration. Tannin provides the as­tringent properties and rosmarinic acid imparts anti-inflammatory properties. The triterpenoid symphytoxide A is reported to possess hypotensive activity.

Reported Uses

The application of comfrey is limited to claims for healing wounds. Historically, comfrey was used for several internal ailments, such as ulcers of the bowel, stomach, liver, and gallbladder, but because the alkaloids are converted to toxic metabolites by liver enzymes after being ingested, internal use is no longer recommended.

External application of comfrey products is not considered as dangerous as oral administration. Externally, it is used for bruises and sprains and to promote bone healing.

The anti-inflammatory effects of comfrey were analyzed in 41 patients with musculoskeletal rheumatism. Twenty patients were treated with a PA-free ointment and the remainder received placebo for 4 weeks. Significant improvement was reported with the ointment compared with placebo in patients with epicondylitis and tendovaginitis, but no difference was found in patients with periarthritis .

Dosage

The oil from the leaves and roots can be incorporated in creams and ointments or used in a compress. Ointments and other external preparations are typically made with 5% to 20% comfrey. Comfrey should be applied topically on unbroken skin for less than 10 days or a maximum of 6 weeks per year in amounts at or below a daily dosage of 100 mcg of the unsaturated PAs.

Although comfrey has been used as a tea or taken in capsule form, it is not recommended for internal use because of its toxicity.

Adverse Reactions

CNS: chills, fever.

GI: abdominal pain, diarrhea, hematemesis, poor appetite, vomiting.

Hepatic: hepatotoxicity. exfoliative dermatitis, jaundice.

Other: weight loss, cancer (several animal studies report hepatocellular adenomas and urinary bladder tumors caused by PAs in comfrey death.

Interactions

Eucalyptus: May increase the risk of PA toxicity because of enzyme induction by eucalyptus. Avoid administration with comfrey.

Other PA-containing herbs: May increase risk of toxicity. Herbs that contain PAs include agrimony, alkanna, alpine ragwort, borage, colt’s foot, dusty miller, golden ragwort, goundsel, gravel root, ground’s tongue, hemp, petasties, and tansy ragwort. Avoid administration with comfrey.

Contraindications And Precautions

Internal use of comfrey is contraindicated because of hepatotoxicity. Because PAs are teratogenic and excreted in breast milk of animals, comfrey is contraindicated in pregnant or breast-feeding patients and in young children. It is also contraindicated in patients who are hypersensitive to comfrey and in those with a history of hepatic disease.

Special Considerations

Caution the patient not to use the root for medicinal purposes.

Instruct the patient to apply the mature leaves externally on intact skin for only a limited period; caution him not to use the leaves on open wounds.

Monitor wound appearance and size if the patient is taking comfrey to promote healing.

Assess for signs and symptoms of hepatotoxicity.

Comfrey either alone or in combination has been reported to cause abdominal pain, chills, death, diarrhea, exfoliative dermatitis, fever, hematemesis, jaundice, poor appetite, vomiting, and weight loss .

Alert Several studies report on hepatic veno-occlusive disease caused by PAs in the plant .

Caution the patient against consuming comfrey.

Advise the patient to try commercially available antiseptic ointments and creams before attempting to use comfrey to promote wound healing.

Advise women to avoid using comfrey during pregnancy or when breast-feeding.

Points of Interest

Comfrey has been used since the time of the ancient Greeks and Romans. In the Middle Ages, it was commonly applied as a poultice for treating broken bones, giving rise to the common names of boneset, knitback, and knitbone.

The botanical genus name, Symphytum, originates from the Greek physician Disocorides some 2,000 years ago and is derived from the Greek word sympho, meaning to unite. The common name, comfrey, is derived from the Latin confirmare, which means to heal or unite.

Commentary

Although comfrey has a long history of therapeutic claims for several ailments, it is potentially hepatotoxic and thus should not be consumed. Anecdotal reports and animal studies suggest medicinal benefit for wound healing. Commercially available topical antiseptic agents are probably safer and more effective.

Bitter Melon Drug Information - Precautions to be kept in mind while using Bitter Melon

Taxonomic Class

Cucurbitaceae

Common Trade Names

None known.

Common Forms

Available in a decoction or tincture and as juice or a whole fruit.

Source

Bitter melon is derived from the tropical tree Momordica charantia, which is native to Asia, East Africa, South America, and parts of the Caribbean. Seeds, vines, and leaves are used medicinally, but the fruit of the tree is most commonly used and generally thought to be the safest.

Chemical Components

Bitter melon contains the proteins alpha- and beta-momorcharin, along with serine protease inhibitors BGIA (bitter gourd inhibitor against amino acid-specific proteins) and BGTI (bitter gourd trypsin inhibitor). Also present is the plant protein MAP30; charantin, which is a mixture of steroidal saponins; and insulin-like peptides and alkaloids.

Actions

Recombinant MAP30 has been shown to inhibit HIV-1 and to have antitumorigenic effects with no untoward effects on normal human cells. MAP30 also may enhance the activity of dexamethasone and indomethacin as weak HIV antagonists by causing inactivation of viral DNA and specific cleavage of 28 S ribosomal RNA .

A crude extract of bitter melon was reported to be both cytostatic and cytotoxic to human leukemic lymphocytes and yet had no harmful effect on normal human lymphocytes in vitro . These effects were observed within 2 hours, and the researchers theorize that the effect may result from quick entrance of the factor into the cells.

A later study in mice led to the conclusion that the antileukemic properties exhibited by bitter melon may be caused, at least in part, by the activation of natural killer cells in the host .

Reported Uses

Bitter melon has been used as a food substance and to treat cancer, diabetes, and some types of infections. Beer, soups, and teas have been made from both the leaves and the fruit. Wax produced by the berries has been used in candlemaking.

A 1981 study measured the effect of a fruit extract of bitter melon on nine patients with type 2 diabetes. The extract was given and followed by a glucose tolerance test, which revealed an improvement in glucose tolerance that was small but possibly clinically significant. No increase in serum insulin levels was noted in these patients.

Dosage

The typical dose is one small unripe melon, the equivalent of about

50 ml of juice in divided doses b.i.d. or t.i.d. Up to 100 ml of the decoction or 5 ml of the tincture may be consumed daily, also in divided doses. No dosing information for patients with renal or hepatic impairment is available.

Adverse Reactions

GI: diarrhea, stomach pain (overdose).

Interactions

Antidiabetics: May cause additive effects, resulting in excessive hypoglycemia. Monitor blood glucose levels and patient closely.

Contraindications And Precautions

Bitter melon is contraindicated in patients with hypoglycemia because it may exacerbate this condition, causing dangerously low blood glucose levels. It is also contraindicated in young children, who may be overly sensitive to the hypoglycemic effect. Avoid using bitter melon in women who are pregnant because alpha- and beta-momorcharin have abortifacient properties . Data regarding the use of bitter melon in women who are breast-feeding are lacking.

Special Considerations

No dosage form can effectively mask the extremely bitter taste of bitter melon and its preparations.

Monitor the patient for adverse GI reactions because they may be signs of overdose.

Monitor the patient’s blood glucose levels if he is taking bitter melon for its hypoglycemic effect.

Commentary

The best-substantiated use for bitter melon is as an antidiabetic agent. Without clinical data on effective dosing and predictability of response, bitter melon should be used with care and probably not with other antidiabetic drugs until more is known about its potency. Bitter melon may show some value as adjunctive therapy for HIV-infected or leukemic patients in the future, but additional studies are needed to fully evaluate its efficacy and clinical relevance. Use of bitter melon as an anti-infective remains unsubstantiated.