Asteraceae: Drug Interactions, Contraindications, And Precautions

Patient survey data from Canada, the U.S., and Australia show that one in five patients use prescription drugs concurrently with CAM. The inherent polypharmaceutical nature of complementary and alternative medicine increases the risk of adverse events if these complementary and alternative medicine either have pharmacological activity or interfere with drug metabolism. Since confirmed interactions are sporadic and based largely on case reports, advice to avoid certain drug-CAM combinations is based on known pharmacological and in vitro properties. Known Hypersensitivity to Asteraceae Cross-reactive sesquiterpene lactones are present in many, if not all, Asteraceae. Patients with known CAD from one plant may develop similar type IV reactions following contact with others. Affected patients are often advised to avoid contact with all Asteraceae, yet this advice is based on limited knowledge of cross-reactivity between relatively few members of this large family. Some authorities recommend avoiding Asteraceae-derived complementary and alternative medicine if, for example, the patient is known to have IgE-mediated inhalant allergy to ragweed. While a reasonable approach, this ignores a number of important facts: (1) Read more […]

Herbal Stimulants

Occasionally it may be necessary to temporarily boost the energy of someone who is feeling depressed. The German Commission E has approved the use of Cola nitida (kola nut) as an adjunct therapy in depression, and Camellia sinensis (tea), Coffea arabica (coffee), and Ilex paraguayensis (yerba mate) may be useful stimulants due to their caffeine content. However, this is rarely an effective long-term therapy, and entirely fails to address the underlying causes of depression. Certainly, botanical stimulants should not be part of a standard regimen for depression, and it is in fact often recommended that the nearly ubiquitous stimulant caffeine be removed from the diet to stop masking symptoms and allow the person to deal with the real issues of depression. Instead, we recommend using adaptogens to provide stimulation. These do not contain caffeine and do not appear to have the suppressive effect of the caffeine alkaloid. Instead, they tend to stimulate the entire nervous system. On rare occasions, this may manifest as insomnia, agitation, or mild anxiety but usually adaptogens increase the person’s sense of well-being and energy without negatively affecting mood. That said, there is a case report of a woman, taking Read more […]

Diseases of the Urogenital System

Herbs For Diseases Of The Urogenital System Prescription For Nephritis Strategy Treat conventionally until the patient is stable in acute conditions. Treat the underlying etiology if known  (infectious, immune complexes, etc.). Consider ACE inhibitors and conventional renal support, appropriate diet therapy, and thromboxane and PAF inhibitors. Use alcohol or glycetract tinctures for best results; alternatively, use teas. Astragalus: Immune enhancing, cardiotonic, diuretic, hypotensive; 1 part. Dong guai: Blood tonic, circulatory stimulant, vasodilator; 1 part. Siberian ginseng: Immune modulating, adaptogen; 1 part. Hawthorn: Hypotensive, vasodilator, antioxidant, cardiotonic; 1 part. Ginkgo: Inhibits platelet activating factor, antioxidant, circulatory stimulant; 1 part. For tinctures, give 1 ml per 10 pounds twice daily in food. For teas, give one-fourth cup per 10 pounds twice daily in food. Consider using Cordyceps as well: Dried herb, 25 to 100 mg / kg divided daily if extracted and dried; triple or quadruple dose for unprocessed herb; tincture, 1:2 to 1:3: 0.5 to 2 mL per 10 kg (20 pounds) divided daily and diluted or combined with other herbs. Chinese herbal formulas including Rehmannia Read more […]

Herb-Drug Interactions: St John’s wort

Hypericum perforatum L. (Clusiaceae) Synonym(s) and related species Hypericum, Millepertuis. Hypericum noeanum Boiss., Hypericum veronense Schrank. Pharmacopoeias St John’s Wort (British Ph 2009, European Ph 2008, US Ph 32); St John’s Wort Dry Extract, Quantified (British Ph 2009, European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4). Constituents The main groups of active constituents of St John’s wort are thought to be the anthraquinones, including hypericin, isohypericin, pseudohypericin, protohypericin, protopseudohypericin and cyclopseudohypericin, and the prenylated phloroglucinols, including hyperforin and adhyperforin. Flavonoids, which include kaempferol, quercetin, luteolin, hyperoside, isoquercitrin, quercitrin and rutin; biflavonoids, which include biapigenin and amentoflavone, and catechins are also present. Other polyphenolic constituents include caffeic and chlorogenic acids, and a volatile oil containing methyl-2-octane. Most St John’s wort products are standardised at least for their hypericin content (British Pharmacopoeia 2009), even though hyperforin is known to be a more relevant therapeutic constituent, and some preparations are now standardised for both (The United Read more […]

ANTIDEPRESSANTS

ANTIDEPRESSANTS are used to relieve the symptoms of depressive illness, an affective disorder. There are three main groups of drugs used for the purpose. All interfere with the function of monoamine neurotransmitters, and the considerable delay before antidepressants become effective is taken as evidence of a down-regulation of noradrenergic or serotonergic systems (rather than the opposite, as advanced in Schildkraut’s original amine theory of depression). Tricyclic antidepressants are the oldest group (named after the chemical structure of the original members) .e.g. imipramine. They act principally as CNS monoamine (re-) UPTAKE INHIBITORS. Although far from ideal, this is still the most-used antidepressant group. Chemically, they have gone through transformations from the dibenzazepines (e.g. imipramine, desipramine), to dibenzcycloheptenes (e.g. amitriptyline, nortryptyline), dibenzoxepines (e.g. doxepin) and some recent members are not strictly tricyclics. They are effective in alleviating a number of depressive symptoms, though they have troublesome anticholinergic and other side-effects. Most drugs of this class also have sedative properties, which is more pronounced in some, especially amitriptyline, which Read more […]

St John’s wort: Significant Interactions

St John’s wort is one of the few herbal medicines that has been subjected to controlled studies in order to determine the significance of its interaction with numerous drugs. Although this can be reassuring, the clinical significance of many interactions is still unpredictable because of the variable chemical composition of products. It is important to note that interactions due to CYPand P-gp induction do not appear significant with low hyperforin extracts (ZE 117). Clinical note— Mechanisms responsible for reported interactions Based on the herb’s pharmacology, there are several mechanisms by which it may interact with drugs. Considering St John’s wort has significant serotonin reuptake inhibitor activity and significantly upregulates both 5-HT1A and 5-HT2A receptors, concomitant use of drugs that elevate serotonin levels, such as tricyclic antidepressants or SSRIs, may result in additive or synergistic effects and increase the risk of serotonergic syndrome. As the constituent hyperforin has a significant and selective induction effect on CYP3A4 and 2C19 activity and induces the drug transporter P-glycoprotein, a number of pharmacokinetic interactions are possible with those drugs that are substrates for Read more […]

St Mary’s thistle: Background. Actions

Common Name St Mary’s thistle Other Names Carduus marianus, cardo bianco, cardo de burro, chandon marie, holy thistle, lady’s milk, lady’s thistle, Mariendistel, Marian thistle, Mary thistle, milk thistle, silybum, true thistle Botanical Name / Family Silybum marianum (family [Compositae] Asteraceae) Plant Part Used Ripe seed Chemical Components The major active constituents are the flavolignans, collectively named ‘silymarin’. The principal components of silymarin are silybin, isosilybin, silychristin and silydianin. Silybin makes up approximately 50% of silymarin and is regarded as one of the most biologically active constituents. There is also a fixed oil comprising linoleic, oleic and palmitic acids, tocopherol and sterols, including cholesterol, campesterol, stigmasterol and sitosterol. Historical Note St Mary’s thistle has a long history of traditional use since ancient times. Over the centuries, it has been touted as a remedy for snake bite, melancholy, liver conditions and promoting lactation. The name ‘milk thistle‘ derives from its characteristic spiked leaves with white veins, which according to legend, were believed to carry the milk of the Virgin Mary. St Mary’s thistle:  Main Actions Most Read more […]