Taxonomic Class

Solanaceae

Common Trade Names

None known.

Common Forms

Available as an extract of the corkwood tree (leaves and stems) in liquid and tablets.

Source

The active ingredients are extracted from the leaves, stems, and root bark of Duboisia myoporoides, which is native to Australia.

Chemical Components

The corkwood tree is a rich source of alkaloids and has been used as a commercial source of scopolamine. The major alkaloids found in young leaves and stems are scopolamine and valtropine; other alkaloids­hyoscyamine, trigloyl tropine, and valeroidine-occur in lesser quantities. Alkaloids extracted from older leaves and stems include acetyl tropine, apohyoscine, butropine, hyoscyamine, isoporoidine, noratropine, poroidine, scopolamine, tropine, valeroidine, and valtropine. The young root and bark of the tree yield apohyoscine, atropine, hyoscyamine, scopolamine, tropine, valeroidine, and valtropine. Similar alkaloids are found in old root and bark samples. Nicotine and nornicotine have also been reported in the leaves .

Actions

Scopolamine and the other alkaloids found in corkwood are antimuscarinics or muscarinic-cholinergic blockers and exhibit a wide range of pharmacologic effects. When taken in therapeutic doses, scopolamine may cause drowsiness and a dreamlike state. Larger doses can result in excitement or restlessness and hallucinations. These antimuscarinics may also affect heart rate, reduce gastric and salivary secretions and GI motility, and cause mydriasis and blurred vision because of cycloplegia.

Reported Uses

The corkwood tree was principally used as a main source of scopolamine and atropine before the availability of other commercial sources.

Scopolamine is commonly used to prevent motion-induced nausea and vomiting, and atropine has limited use in treating GI motility disturbances. It has been reported that corkwood leaves are cured, rolled into a quid, and chewed by native Australians for their stimulant effects and used in hunting to stun animals. Extracts of the leaves have been used medicinally as a substitute for atropine. Quids are chewed to ward off hunger, pain, and tiredness. Alkaloids from the plant are used as a therapeutic substitute for atropine.

Dosage

No consensus exists.

Adverse Reactions

CNS: disorientation, drowsiness, euphoria, excitation (in high doses), fatigue, hallucinations (in high doses).

CV: alterations in heart rate.

EENT: blurred vision, cycloplegia, dry mouth.

GI: constipation.

GU: urine retention.

Skin: dry skin.

Interactions

Amantadine, beta blockers, digoxin, tricyclic antidepressants and other drugs with anticholinergic or anticholinergic-like effects: Increased anticholinergic-like effects. Avoid administration with corkwood.

Contraindications And Precautions

Corkwood and its products are contraindicated in patients who are hypersensitive to antimuscarinics; in those with CY disease, glaucoma, myasthenia gravis, obstructive GI conditions, obstructive uropathy or renal disease, or other conditions that may be exacerbated by antimuscarinics; and in pregnant or breast-feeding patients.

Special Considerations

Adverse reactions from corkwood alkaloids are related to their antimuscarinic action.

Consider exposure to corkwood if the patient manifests pupillary, vision, or behavioral changes.

Advise the patient who is already receiving anticholinergic-like drugs to avoid taking corkwood because of the risk of increased anticholinergic effects.

Caution the patient who may be at risk for disease exacerbation or adverse effects from anticholinergic drugs against using corkwood.

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

Commentary

Although corkwood leaves and stems have been used for medicinal purposes, primarily as an atropine substitute, no clinical studies of the plant have been undertaken. Antimuscarinic toxicity has been reported after occupational or accidental exposure, with absorption through the mucous membranes and upper respiratory tract. Medicinal use of the plant is not recommended.

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Taxonomic class

Liliaceae

Common Trade Names

None known.

Common Forms

Available as extracts.

Source

Active components are derived from leaves, roots, and flowers of Conval/aria majalis, a low-growing perennial herb that is native to Europe and naturalized throughout North America.

Chemical components

The entire plant contains cardiac glycosides (convallatoxol, convallotoxin, convallarin, convallamarin, locundjosid, and convallosid-which transforms into convallatoxin when dried), volatile oil, saponins, asparagin, resin, rutin, chelidonic acid, calcium oxalate, choline, carotene, and wax.

Actions

Tea made from this herb is claimed to have diuretic, emetic, pyrogenic, and sedative actions. Cardiac effects stem from plant glycosides thought to be less toxic than those offoxglove . The plant was also believed to exert hypoglycemic effects, but studies in diabetic mice have shown this to be false .

Reported Uses

The plant was traditionally used as an antidote to poison gas and as a cardiotonic agent for treating valvular heart disease. Russian herbalists have also reported its use as an antiepileptic. The roots have been used in an ointment to help heal burn wounds and prevent them from scarring. In Germany, the flowers are mixed with raisins and made into wille.

Dosage

No consensus exists.

Adverse Reactions

CNS: coma, dizziness, hallucinations, headache, paralysis.

CV: arrhythmias, heart failure.

EENT: burning pain in the mouth and throat, mydriasis, increased salivation.

GI: abdominal cramps and pain, diarrhea, nausea, vomiting.

GU: urinary urgencyMetabolic: hyperkalemia.

Skin: cold, clammy skin; dermatitis (contact with leaves) .

Other: death.

Interactions

Beta blockers, calcium channel blockers: Increased risk of heart block or bradycardia. Avoid administration with lily-of-the-valley.

Digoxin: May have additive effects. Avoid administration with lily-of­the- valley.

Contraindications and precautions

All parts of the plant are contraindicated.

Special considerations

Lily-of-the-valley has been used in folk medicine as a digitalis substitute. However, it should not be used for any cardiac condition because of its potential for toxicity and lack of accurate dosage information.

Alert The entire plant is toxic, causing digitalis-like symptoms. The water in which the cut flowers have been placed can also be toxic. Treatment includes emesis and gastric lavage followed by administration of activated charcoal and sorbitol cathartic as well as supportive care. Perform cardiac monitoring and restore normal sinus rhythm, if necessary, with atropine. Additional effects of plant ingestion may include other rhythm disturbances and hyperkalemia. Treatment is similar to that for digitalis toxicity.

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.

Keep lily-of-the-valley out of the reach of children and pets.

Points of Interest

The FDA considers lily-of-the-valley an unsafe and poisonous plant.

The essential oils of the highly aromatic flowers have been used in perfumes and cosmetics.

Commentary

Digoxin and digitalis preparations are available for treating heart failure and other cardiac conditions. There is little use for a highly toxic, insufficiently studied herbal product that might have a similar therapeutic action.

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Taxonomic Class

Araliaceae

Common Trade Names

Multi-ingredient preparations: Activex 40 Plus, Elton, Gincosan (with gingko biloba), Ginkovit, Ginseng Complex, Leuzea, Leveton, Minadex Mix Ginseng, Panax Complex, Siberian Ginseng, Taiga Wurzel, Vigoran

Common Forms

Available as capsules, oils, powders, tablets, teas, and tinctures. Source The drug is extracted from the root and root bark of Eleutherococcus senticosus, which belongs to the same family as panax or chinese ginseng.

Chemical Components

Constituents of the root include saponins (termed eleutherosides), which appear to be the active drug and are found in equal concentrations in above-ground parts and roots. The eleutherosides are subgrouped A to G. Other components include essential oil, resin, starch, and vitamin A.

Actions

The saponin portion of Siberian ginseng appears to have affinity for progestin, mineralocorticoid, and glucocorticoid receptors, although not to the extent of panax ginseng. Unlike panax ginseng, Siberian ginseng binds to estrogen receptors.

When the extract was injected into the peritoneal cavity of mice, a marked hypoglycemic effect was observed . Orally administered Eleutherococcus was found to decrease blood glucose levels in rats but had no effect on plasma lactic acid, glucagon, insulin, or liver glycogen levels . It is not known if this effect occurs in humans.

Despite the claim that Siberian ginseng enhances the ability to tolerate stress, ingestion of Eleutherococcus was not found to significantly affect the survival of mice under major environmental stress, but a more aggressive behavior was noted .

Reported Uses

Siberian ginseng is described as a pungent, bittersweet, warming herb with the purported ability to stimulate the immune and circulatory systems, regulate blood pressure, reduce inflammation, treat insomnia caused by prolonged anxiety, and increase stamina and the ability to cope with stress. Preliminary Russian studies have attempted to verify adaptogenic effects of ginseng in studies of both healthy and nonhealthy patients. These trial results are at best inconsistent but suggest some favorable effects in certain parameters associated with the patients’ ability to withstand stressful conditions. An abstract of a trial published in a Russian journal describes a trial that supposedly documented an increase in working capacity and rehabilitation of trained athletes after a 20-day ingestion of new dosage formulations of Eleutherococcus . Also, the apparent increase in blood coagulability seen with highly trained athletes was in part abrogated by the Eleutherococcus treatments. Another trial out of Poland concluded that an Eleutherococcus preparation, when given to 10 healthy men for 30 days, revealed a higher oxygen plateau, as measured by ergospirometry, and demonstrated beneficial effects on the lipid profile compared with echinacea . Some questions exist in regard to the study’s design.

Studies with animals have indicated no effect on stamina or stress tolerance. In a study involving highly trained distance runners, the herb had no effect on improving exercise tolerance . As with other ginseng plants, Siberian ginseng claims to have immunomodulatory actions; it is thought to stimulate macrophages, promote antibody formation, activate complement, and increase T-Iymphocyte proliferation. An increase in the T-Iymphocyte count and in the activation state ofT cells were shown in human patients neither the extent of the proliferation nor the duration of these effects can be determined from this study alone.

Extensive human studies are needed to verity claims of radioprotective or chemotherapeutic effects of Siberian ginseng.

Dosage

No guidelines exist. The most common regimen is 500 to 2,000 mg/day P.O. Use cautiously because of the lack of uniform content of capsules and the substitution of less expensive plants.

Adverse Reactions

CNS: agitation, decreased concentration, dizziness, euphoria, insomnia, nervousness.

CV: hypertension.

GI: diarrhea.

GU: estrogenic effects, vaginal bleeding.

Hematologic: reduced coagulation potential (unknown mechanism).

Skin: rash.

Interactions

Digoxin: Elevated serum digoxin levels. Monitor digoxin use closely.

Hexobarbital: Inhibited hexobarbital metabolism. Avoid administration with Siberian ginseng.

Vitamins B1, B2 and C: Siberian ginseng may increase excretion of these vitamins. Avoid administration with Siberian ginseng.

Contraindications And Precautions

Siberian ginseng use is contraindicated in children and in patients who are hypersensitive to ginseng, Siberian ginseng, or ingredients in the preparation.

Special Considerations

Advise the patient not to use Siberian ginseng for longer than 3 weeks.

Siberian ginseng is not uniform in content when packaged, and less expensive plant products are commonly substituted for this herb.

Siberian ginseng may be sold as a combination product with panax ginseng. Monitor for adverse reactions also associated with panax or Chinese ginseng.

Urge the patient to report agitation, diarrhea, euphoria, insomnia, menstrual irregularities, nervousness, and rash.

Caution the diabetic patient to closely monitor blood glucose levels and to watch for increased effects of antidiabetic drugs because of the herb’s hypoglycemic effect in animals.

Commentary

The most prevalent claim for Siberian ginseng is its ability to improve energy, exercise performance, and stamina. This claim has proved to be untrue. Also, the adaptogenic response, which claims increased resistance to stress, has also been found to be false.

The immunomodulating and radioprotective effects have been studied mostly in animal and foreign trials. Although the data thus far ap pear promising, particularly for a radioprotective action, larger controlled studies are needed in humans to determine whether the herb not only increases the T-lymphocyte count and response but also clinically prevents or hastens recovery from infections.

There are no data to substantiate other claims for Siberian ginseng. There are also no long-term studies, and thus its effects over time are not known. Consequently, the use of Siberian ginseng beyond 3 weeks is not recommended.

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Taxonomic class

Monascaceae

Common Trade Names

Cholestin

Common Forms

Available as a 600-mg capsule in the United States. In China, dried red yeast rice is either powdered (ZhiTai) or extracted with alcohol (XueZhiKang) .

Source

Red yeast rice is a traditional Chinese substance made by fermenting a particular strain of yeast, called Monascus purpureus, over rice. The red yeast rice is produced in China and imported by Pharmanex, Inc., for packaging into gelatin capsules in the United States.

Chemical Components

Red yeast rice contains 0.4% naturally occurring HMG-CoA reductase inhibitors. The most abundant HMG-CoA reductase inhibitor is mevinolin, or lovastatin. It also contains unsaturated fatty acids, including monounsaturated fatty acids, diene-, triene-, tetraene-, and pentaenefatty acids. Other components include amino acids, protein, saccharides, beta-sitosterol, campesterol, stignasterol, isoflavone, saponin, and other trace elements.

Actions

Red yeast rice has cholesterol-reducing properties. It contains lovastatin and related mevinic acid compounds that competitively inhibit 3­hydroA)-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase. This blocks the synthesis of cholesterol in the liver and results in decreased LDL, VLDL, and triglyceride levels. It also increases HDL levels.

Reported Uses

Red yeast rice has been used to maintain desirable cholesterol levels in healthy people and to reduce cholesterol levels in people with hypercholesterolemia. Chinese medicine uses this product for diarrhea and indigestion, for improving blood circulation, and for spleen and stomach health.

Animal and human studies to evaluate the effectiveness of red yeast rice in hypercholesterolemia have been performed primarily in China. Studies in rabbits and quail have demonstrated cholesterol lowering and decreased lipid accumulation in the liver with XueZhiKang . Clinical studies performed with several formulations of M. purpurpeus have also shown cholesterol-lowering effects. Studies conducted in the United States included appropriate diet instructions or surveys for the patients.

Dosage

Capsules: Two 600-mg capsules P.O. b.i.d.

Extract: 0.6 g P.O. b.i.d.

Each gram of Cholestin contains 4 mg of HMG-CoA reductase inhibitors: 2 mg as lovastatin, 1 mg as lovastatin acid, and 1 mg as a mixture of seven other statins. Therefore, the recommended dose of 1,200 mg b.i.d. would provide 7.2 mg oflovastatin and 2.4 mg of other statins . The product is standardized to contain 0.4% (9.6 mg) HMG-CoA reductase inhibitors and greater than or equal to ISO mg of unsaturated fatty acids per daily dosage.

Adverse Reactions

CNS: dizziness.

GI: bloating, flatulence, heartburn.

Other: anaphylaxis .

Interactions

Cytochrome P-450 inhibiting drugs: Increased serum lovastatin level and risk of adverse effects. Avoid administration with red yeast rice.

Food: Increased bioavailability of lovastatin. Red yeast rice may be taken with food.

Grapefruit juice: 15-fold increase in serum lovastatin levels; increased risk of adverse effects. Do not administer red yeast rice with grapefruit juice.

Levothyroxine: Concomitant use with lovastatin can cause thyroid function abnormalities. Avoid using together.

Other cholesterol-lowering drugs: Increased risk of adverse effects and

toxicity. Avoid administration with red yeast rice.

Contraindications and Precautions

Red yeast rice should be avoided in patients who are at risk for or who have active hepatic disease and in those with a history of hepatic disease. It is also contraindicated in people who consume more than two alcoholic beverages daily; in patients with a serious infection, disease, or physical disorder or who have had an organ transplant; and in anyone younger than age 20. Avoid use in female patients who are breast­feeding, pregnant, or planning to become pregnant.

Special Considerations

• Red yeast rice may be taken with food to minimize adverse GI effects.

Alert Anaphylaxis to red yeast rice has been reported.

• Natural constituents in red yeast rice (HMG-CoA reductase inhibitors) in much higher doses have been associated with some rare but serious adverse effects, including hepatic and skeletal muscle disease.

Elevated liver enzyme and creatine kinase levels can occur.

Points of Interest

• Cholestin is considered a dietary supplement.
• Red yeast rice has been used in China since A.D. 800 to make red rice wine, to preserve and enhance food, and as a medicinal substance.
• Written records from the Ming dynasty show that red yeast rice was believed to improve blood circulation and reduce clotting.

Commentary

Red yeast rice appears to be well tolerated and effective in lowering cholesterollevels. It is sold in the United States as a dietary supplement.

Until more clinical studies are performed, red yeast rice should be treated as an HMG-CoA reductase inhibitor. This includes potential adverse effects, drug interactions, and precautions associated with this drug class. Studies to evaluate the long-term safety and efficacy of this supplement in larger populations are needed.

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Taxonomic Class

Rutaceae

Common Trade Names

Citricidal, GSE, Traveler’s Friend

Common Forms

Liquid extract

Source

Grapefruit seed extract is synthesized from the pulp, seed, and inner rind of the fruit of Citrus paradisi.

Chemical Components

The liquid concentrate contains 67% vegetable glycerin (derived from palm and coconut) and 33% CitricidaI. Traveler’s Friend is made up of 67% deionized water and 33% Citricidal.

Grapefruit juice contains naringin and naringenin, which inhibit the production of CYP3A4, leading to increased rates of absorption of certain drugs. Grapefruit seed extract contains about 0.1 % of these compounds.

Actions

Grapefruit seed extract is part of the quaternary compound, and its structure is similar to that of benzylkonium chloride. The extract is reported to exhibit antibacterial, antifungal, and, potentially, antiviral activity. One study of the antimicrobial efficacy of six grapefruit seed extract products found that the preservative agents in the products, including benzethonium chloride, triclosan, and methyl parabens, were responsible for their activity.

Reported Uses

Grapefruit seed extract has been used topically as an antiseptic wound cleaner and to treat skin infections and internally as supportive treatment for various ailments, including Candida infections, GI upset, and sore throat. Grapefruit seed extract has also been used by campers and travelers to foreign countries to purity drinking water.

Dosage

One product reports a dosage of 10 to 15 gtt P.O. in water or juice b.i.d. or t.i.d.

Adverse Reactions

GI: indigestion.

Interactions

Anticonvulsants, benzodiazepines, calcium channel blockers, certain antibiotics and antivirals, cyclosporine, nonsedating antihistamines, oral contraceptives, quinidine: Grapefruit extract may increase the bioavailability of these classes of drugs by inhibiting the cytochrome P-450 isoenzyme in the liver and gut wall . Monitor the patient closely.

Contraindications And Precautions

Avoid using grapefruit seed extract in pregnant or breast-feeding patients; effects are unknown. Do not use in the eyes. Do not use the extract with a mechanized toothbrush or tooth polisher because the acidic nature of the extract and abrasive actions of these instruments could cause tooth damage, including enamel erosion.

Special Considerations

Grapefruit seed extract concentrate has a pH of 2.2 and should be diluted before use.

The extract is extremely bitter.

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

The U.S. Department of Agriculture (USDA) confirmed that Citricidal was effective in inhibiting viral strains in cattle and hogs in the early 1980s and approved it for use in the USDA’s Evian Influenza Eradication Program in 1984.

Commentary

Although grapefruit seed extract has been thought to be effective as an antimicrobial, limited studies have not supported this claim. Further investigation is needed into whether grapefruit seed extract alone possesses antimicrobial activity or if it lies with the product’s preservative.

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Taxonomic class

Adiantoideae

Common Trade Names

None known.

Common Forms

Available in decoctions, infusions, syrups, and teas.

Source

Maidenhair fern, Adiantum capillis-veneris (A. pedatum), is a member of the Adiantoideae family of ferns. It is native to eastern Asia and North America but has been naturalized throughout Europe as well. Related species may be found throughout the world. The fern typically grows about I’ high. The stems are darkly colored with 6″ fronds composed of alternate, triangular, and oblong (or fan-shaped) notched pinnae. The aerial portions of the fern are used to make decoctions, infusions, syrups, and teas.

Chemical components

Maidenhair fern’s numerous constituents, including volatile oils, sugars, tannins, mucilages, and bitters, have been poorly characterized. Triterpenoids, beta-sitosterol, stigmasterol, and capesterol have also been isolated from the fern .

Actions

There are no clinical or laboratory data describing known actions of maidenhair fern or its constituents. All purported actions are anecdotal.

Reported Uses

Historically, maidenhair fern has been used to treat various pulmonary cattarhs (asthma, cough, pleurisy) and renal disorders (gravel) and as a hair-darkener and restorer. Modern recommendations for its use include alopecia, bronchitis, dysmenorrhea, and whooping cough and as an expectorant and a refrigerant drink for erysipelas and fever. Numerous other uses are mentioned in the lay literature. There is no evidence to support its use in any disease state.

Dosage

Decoction and infusion: 1 to 4 fl oz P.O.

Syrup: 1 or 2 tbsp P.O.

Tea: 1.5 gin 150 ml of water P.O.

Adverse Reactions

GI: vomiting.

Other: allergic reaction.

Interactions

None reported.

Contraindications and precautions Maidenhair fern is contraindicated in pregnant patients.

Special Considerations

Caution the patient not to self-treat symptoms of respiratory illness before seeking appropriate medical evaluation because this may delay diagnosis of a serious medical condition.

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.

Urge the patient to notify the prescriber and pharmacist of any herbal or dietary supplement he is taking when filling a new prescription.

Points of Interest

About 9,500 species of ferns exist. The genus Adiantum has more than 200 species of ferns. The American Fern Society, which is more than 100 years old, provides information and specimens (spores) to those who are interested in cultivating ferns.

Commentary

The use of maidenhair fern is regulated in the United States, and it is permitted to be used only as a flavoring agent in alcoholic beverages . Some sources indicate that if maidenhair fern is taken in small quantities, there is no reason to expect adverse drug, herb, or food interactions . Because laboratory and clinical data on potential mechanisms of action, pharmacodynamic effects, therapeutic benefits, toxicity profiles, and interactions are lacking, there is no basis for recommending maidenhair fern for any reason.

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In modern times where the standard of living is increasing the concerns over health is also coming to forefront. With different types of food habits and environmental changes taking place, individuals are getting more and more susceptible to health-centric problems and as a result health care have become a bare necessity. People are talking about health maintenance, health insurance and so on to secure their health.

One of the most common forms of health care that people take up now-a-days are the health insurance plans and associated schemes to help them in times of need. It is always good to take long-term health insurance plans because they offer lots of benefits then short term insurance plans. One of the best ways to get affordable health insurance quotes is to visit a free insurance quote website. Such websites give reasonable quotes from different health insurance providers so that an individual can compare the interest rates, prices and facilities. Once the quotes are available, it is important to look extensively at the policies and schemes and then decide which one suits the best according to the needs.

One of the most effective health care is to undergo natural remedies because these techniques help in treating different health related ailments with precision and accuracy as well as keeping the patient free from any worries related to side effects and other health complications. Since natural remedies do not contain any harmful antibiotics they can easily be incorporated by patients of any age. Natural remedies work faster and more efficiently if a patient follows certain guidelines keeping his or her lifestyle in check. Some natural remedies can be implemented very easily with a little bit of initiative to keep the body healthy and free from any diseases. The first and foremost is to stop consuming junk foods. Drink lots of water to keep the body hydrated and at the same time eat nutritious food. Good quality of sleep every night is almost an implied necessity and exercising regularly is important.

Herbal remedies are the most effective health care techniques that an individual can employ to stay healthy all the time. Different herbal remedies are available for the treatment of different diseases like depression, constipation, various acne problems and so on. They are best suited as like natural remedies they do not pose threat of side-effects or any types of allergic reactions on the body.

All the aforementioned health care tips and techniques if implemented according to circumstances can definitely lead to a healthy and quality life with energy and enthusiasm.

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Taxonomic Class

Piperaceae

Common Trade Names

Aigin, Antares, Ardeydystin, Cetkava, Kava Kava Liquid, Kava Kava Root, Kavarouse, Kavasedon, Kavasporal, Kava Stress, Kavatino, Kavatrol, laitan, Mosaro, Nervonocton N, Potter’s Antigian Tablets, Super 5HT with Kava, Viocava

Common Forms

Prepared as capsules, a drink from pulverized roots, an extract, or tablets. Source

Kava comes from the dried rhizome and root of Piper methysticum, a member of the black pepper family (Piperaceae). Kava, a large shrub with broad, heart-shaped leaves, is native to many South Pacific islands.

Chemical Components

Pharmacologic activity is attributed to the kavapyrones that occur in the root. Biologically active components are obtained from chemical substitution of the basic pyrone structure. Alpha-pyrone components include yangonin, desmethoxyyangonin, 5,6-dehydromethysticin, ll-methoxyyangonin, and] 1-methoxy-nor-yangonin. Methysticin, kawain, dihydromethysticin, and dihydrokawain are active components from the 5,6-dyhydro-alpha-pyrone structure. Pipermethystine is an alkaloid isolated from the plant leaves of kava.

Actions

More than one mode of action is involved. An unquantified synergism exists among kava components. Components of the root may produce local anesthetic activity similar to that of cocaine but lasting longer than that of benzocaine. Kava induced mephenesin-like muscle relaxation in animals but was found to lack curare-like activity. The limbic system is inhibited by kavapyrones, an effect associated with suppression of emotional excitability and mood enhancement. Kava also inhibited haloperidol-induced catalepsy in rats .

In human studies, kava produced mild euphoria with no effects on thought and memory. The neuropharmacologic effects of kava include analgesia, hyporeflexia, and sedation. Kava can impair gait and cause pupil dilation. Some pyrones show fungistatic properties against several fungi, including some that are pathogenic to humans.

Reported Uses

Kava has been useful in attenuating spinal seizures and has antipsychotic properties. Therapeutic trials have shown a degree of seizure control in epileptic patients, suggesting involvement of gamma-aminobutyric acid receptors.

Kava extract has also been studied for treating anxiety disorders. In one study, 101 patients with anxiety of nonpsychotic origin showed improved scores on the Hamilton Anxiety Scale after being given a lipophilic extract of kava standardized to 70 mg of kavalactones three times a day . Both placebo and kava showed benefit as per the scale after 8 weeks, but kava fared significantly better than placebo at 16 weeks (P<.0001). No improvement was seen as measured on the Clinical Global Impression Scale. A meta-analysis of seven double­blind, randomized, placebo-controlled trials found some superiority of kava over placebo for treating anxiety in all trials but statistically significant superiority in only three trials .

Other claims for kava include treatment of asthma, depression, insomnia, muscle spasms, pain, rheumatism, and sexually transmitted disease and promotion of wound healing.

Dosage

Dosage is usually based on the kavapyrone content, which varies with preparation. Most studies in humans used 70 to 240 mg of kavapyrone P.O. daily. One study used 90 to 110 mg of dried kava extract P.O. t.i.d. for the treatment of anxiety . Doses of freshly prepared kava beverages average 400 to 900 g P.O. weekly.

Adverse Reactions

CNS: changes in motor reflexes and judgment, headache, dizziness.

EENT: vision changes.

Long-term, heavy use

CV: hypertension.

GI: diarrhea.

Hematologic: decreased platelet and lymphocyte counts.

Metabolic: reduced plasma protein, urea, and bilirubin levels; weight loss.

Musculoskeletal: increased patellar reflexes.

Respiratory: shortness of breath.

Skin: hypersensitivity reaction .

Other: dopamine antagonism (potential for galactorrhea and breast engorgement), reddened eyes and dry, flaking, discolored skin.

Interactions

Alcohol: Increased kava toxicity. Avoid administration with kava.

Alprazolam: May cause coma . Avoid administration with kava.

Benzodiazepines, other CNS depressants: Additive sedative effects. Avoid administration with kava.

Levodopa: Increased parkinsonian symptoms. Avoid administration with kava.

Pentobarbital: May have additive effects. Avoid administration with kava.

Contraindications And Precautions

Avoid using kava in pregnant or breast-feeding patients and in children under age 12; effects are unknown. Use cautiously in patients with neutropenia, renal disease, or thrombocytopenia. Avoid administration with psychotropic drugs.

Special Considerations

Inform the patient that significant adverse reactions may occur with long-term use of kava.

Caution the patient to avoid alcohol and other CNS depressants because they enhance kava’s sedative and toxic effects.

Inform the patient that absorption of kava may be enhanced if it is taken with food.

Advise women to avoid taking kava during pregnancy or when breast­feeding.

Points of Interest

Kava, although a depressant, is non fermented, nonalcoholic, nonopioid, and nonhallucinogenic and does not appear to cause physiologic dependence, but the risk of psychological dependence exists.

Kava is commonly used in the South Pacific as a ceremonial beverage.

Commentary

Kava has been used or studied most commonly for the treatment of ahxiety, restlessness, and stress. These uses are supported by limited evidence from a few small clinical trials. In studies of kava as an anxiolytic, adverse reactions were minimal, but significant adverse reactions are re­ported with chronic, heavy use. Other therapeutic claims are poorly documented. Additional trials are needed to establish dosing regimens, drug interactions, therapeutic benefits, and adverse effects.

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Taxonomic Class

Juglandaceae

Common Trade Names

None known.

Common Forms

Available as a decoction, an extract, and a tincture and used externally as a bath additive and a compress.

Source

The leaves of the deciduous tree (Juglans regia), the bark, the hull of the nut, and the nut itself have been used for various preparations.

Chemical Components

The leaves contain about 10% tannins of the ellagitannin type; naphthalene derivatives, especially the monoglucosides of juglone (=5- hydroxy-1,4-naphtholquinone) and hydrojuglone; more than 3% flavonoids (such as quercetin, quercitrin, hyperoside, and kaempferol derivatives); 0.8% to 1% ascorbic acid, plant acids, including gallic, caffeic, and neochlorogenic acids; and 0.001 % to 0.03% volatile oil, mainly germacrene D. The main active components are the tannins and juglone.

Actions

J. regia is mainly used externally as an astringent, based on its tannin content (10%). Juglone and the essential oils may have in vitro antifungal activity and, possibly, antitumorigenic effects in mice. The actual nut has been studied as a substitute (replacing 20% to 35% of monounsaturated fat foods) in cholesterol-lowering diets with success in further reducing total cholesterol and LDL levels in human subjects .

Reported Uses

Walnut preparations have been used externally for acne, eczema, eyelid inflammation, excessive perspiration of the hands and feet, pyodermia, tuberculosis, and various skin ulcers. It has been used internally for catarrhs of the GI tract and as an anthelmintic and a blood-purifying agent.

Dosage

Dosing is highly dependent on various factors. Because no standard production exists, dosage ranges must be viewed as relative guidelines.

External: 3 to 6 g/day; 100 g per full bath.

Extracts: 2 to 3 g P.O. once to several times a day.

Tincture: 1 to 3 ml P.O. once to several times a day.

Adverse Reactions

Hepatic: hepatotoxicity (caused by tannin content).

Other: carcinogenic effects (potential with long-term use of J. regia as an external preparation).

Interactions

None reported.

Contraindications and Precautions

Excessive oral ingestion and topical application of walnuts should be avoided in pregnant or breast-feeding patients.

Special Considerations

• Caution the patient who is at risk for heptatotoxicity about ingesting considerable quantities of walnut because the tannin content may increase the risk of hepatic injury.
• Advise the patient who is looking for a natural agent to reduce serum cholesterol levels to pursue more stringently studied and proven alternatives.
• Inform the patient that walnut preparations that contain juglone compounds can discolor the skin or mucous membranes yellowish brown.
• Caution the patient that daily topical application of walnut preparations may increase the risk of tongue cancer and leukoplakia of the lips.

Commentary

Little, if any, evidence exists other than in vitro studies to support most of the claims for the use of walnut. Larger human trials are needed to demonstrate its effectiveness in hypercholesterolemic men and Women. More research is needed before definitive recommendations can be put forward.

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Taxonomic class

Smilacaceae

Common Trade Names

Multi-ingredient preparations: Sarsaparilla, Sarsaparilla Root Extract

Common Forms

Available as capsules (425 mg, 520 mg), dried root powder, liquid (30 ml), solid root extract, tablets, and teas.

Source

The dried roots and rhizomes of various Smilax species (S. aristochiifolia, S. regelii, S. febrifuga, S. ornata) are used in commercial products. Smilax species are cultivated in Mexico, Jamaica, and South America.

Chemical Components

Saponins constitute] % to 3% of the chemical components of sarsaparilla, with the three main saponins being sarsaponin (parillin), smilasaponin (smilacin), and sarsaparilloside. Other saponins include sarsapogenin (parigenin), smilagenin, diosgenin, tigogenin, aspergenin, and laxogenin. Phytosterols, such as beta-sitosterol, may contribute to an anti-inflammatory effect. Resins, starch, trace volatile oils, and cetyl alcohol constitute the remainder of the compound.

Actions

Sarsaparilla’s pharmacologic effects have been attributed to the saponins, which are claimed to be blood purifiers or tonics that supposedly remove unwanted toxins from the body. This idea might have arisen from sarsaparilla’s supposed diaphoretic and diuretic effects. Other purported effects of saponins include an ability to bind serum cholesterol in the GI tract and a hemolytic effect if administered IV These pharmacologic effects are not well documented.

Sarsaparilla has shown in vitro activity against common dermatophytes . Significant anti-inflammatory activity and prevention of chemically induced hepatocellular damage have been noted in rodents . Sarsaparilla was found not to have any beneficial effects for improving the healing of bone fractures in rats.

Reported Uses

Sarsaparilla root is claimed to be useful for treating renal disease, rheumatism, and skin diseases such as psoriasis and eczema. Older research attempts to substantiate sarsaparilla for use in psoriatic disease.

The most notable trial involved patients with psoriasis vulgaris who received sarsaponin (a major component of sarsaparilla) or placebo . Although the study showed favorable results in terms of improved symptoms, duration of benefit, and reduced disease exacerbations, problems with study design led to questions regarding the final conclusions reached.

Because of its steroidal components, sarsaparilla has also been touted as an athletic performance-enhancing agent. These steroids have not been proven to be anabolic, and therefore, this claim remains unsubstantiated. Sarsaparilla has been promoted as an appetite and digestion aid and as a diuretic. Its extract has been evaluated as adjunctive therapy in leprosy .

The 1992 German Commission E monograph advocates the use of sarsaparilla in treating psoriasis, renal disease, and rheumatic complaints and for diaphoresis and diuresis.

Sarsaparilla is accepted by the FDA as a flavoring agent.

Dosage

For psoriasis, 1 to 4 g of dried root, 8 to 30 ml of concentrated sarsaparilla compound decoction, or 8 to 15 ml of liquid extract P.O. t.i.d. has been suggested.

Adverse Reactions

CV: hypotension.

GI: diarrhea, GI irritation.

GU: renal dysfunction.

Hematologic: hemolysis (I.V. use).

Metabolic: electrolyte imbalances.

Respiratory: asthma (inhalation of root dust).

Interactions

Bismuth: May increase absorption or elimination or both. Avoid administration with sarsaparilla.

Certain hypnotic drugs: Increased elimination. Monitor for lack of effectiveness.

Digitalis: Increased absorption. Do not use together.

Oral drugs: Saponins may affect absorption of other drugs. Other drugs should be taken 2 hours before or after taking sarsaparilla.

Contraindications and Precautions

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

Special Considerations

• Inform the patient that therapeutic claims for sarsaparilla are weakly substantiated.
• Advise the patient with asthma to avoid inhaling sarsaparilla root dust or root particles.
• Caution the patient who is already taking a diuretic about excessive diuretic effects, fluid and electrolyte imbalances, and hypotension.

Points of Interest

• Since the] 6th century, sarsaparilla was thought to be an effective treatment for syphilis. It gained popularity in the Old West of the United States and was the drink of choice for cowboys. It was even listed for such uses in the USP from 1820 to 1910. Activity against syphilis has not been pharmacologically substantiated.

Commentary

The use of sarsaparilla for any condition needs further research. Mechanisms and properties are not clearly documented or adequately researched. The most notable clinical trial evaluated the herb’s use in study design and the presence of confounding variables placed the conclusions in question.

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