Echinacea: Adverse Reactions. Interactions. Pregnancy Use. Practice Points

Dosage Range GENERAL GUIDE • Dried herb: 3 g/day of either Echinacea angustifolia or Echinacea purpurea. • Liquid extract (1:2): 3-6 mL/day of either Echinacea angustifolia or Echinacea purpurea. This dose may be increased to 10-20 mL/day in acute conditions. Treatment is usually started at the first sign of URTI and continued for 7-14 days. SPECIFIC GUIDE • Echinacea angustifolia dried root: 1-3 g/day. • Echinacea purpurea dried root: 1.5-4.5 g/day. • Echinacea purpurea dried aerial parts: 2.5-6.0 g/day. • Echinacea purpurea expressed juice of fresh plant: 6-9 mL/day. • Echinacea pallida ethanolic extract of root: 2-4 mL/day. Although controversy still exists over which part of the plant and which particular plant has the strongest pharmacological activity, it appears that the cold-pressed juice of Echinacea purpurea is the most studied preparation for URTIs. Adverse Reactions Oral dose forms and topical preparations tend to be well tolerated, although allergic reactions are possible in rare cases (mainly to the aerial parts, in contact dermatitis). One study using Echinacea purpurea in children found that rash occurred in 7.1% of children using echinacea compared with 2.7% with Read more […]

Echinacea: Uses

Clinical Use Clinical trials using echinacea have used various preparations, such as topical applications, homeopathic preparations, injectable forms and oral dose forms, characteristics that should be noted when reviewing the data available. Overall, the majority of clinical studies performed in Europe have involved a commercial product known as Echinacin (Madaus, Germany), which contains the fresh-pressed leaf juice of Echinacea purpurea stabilised in ethanol. UPPER RESPIRATORY TRACT INFECTIONS Overall, clinical studies support the use of echinacea in URTIs, such as bacterial sinusitis, common cold, influenza-like viral infections and streptococcal throat. Evidence is strongest for use of echinacea in adults as an acute treatment; however, results in children have been disappointing. A 1999 review of 13 clinical trials consisting of 9 treatment studies and 4 prevention studies concluded that 8 of 9 treatment trials produced positive results whereas 3 of 4 prevention trials suggested modest effects. In other words, current evidence is stronger for supporting the use of echinacea as acute treatment in URTIs than as prophylactic treatment. In 2000, a Cochrane review was published that had assessed the evidence Read more […]

Echinacea: Background. Actions

Historical Note Echinacea was first used by Native American Sioux Indians centuries ago as a treatment for snakebite, colic, infection and external wounds, among other things. It was introduced into standard medical practice in the USA during the 1 800s as a popular anti-infective medication, which was prescribed by eclectic and traditional doctors until the 20th century. Remaining on the national list of official plant drugs in the USA until the 1940s, it was produced by pharmaceutical companies during this period. With the arrival of antibiotics, echinacea fell out of favour and was no longer considered a ‘real’ medicine for infection. Its use has re-emerged, probably because we are now in a better position to understand the limitations of antibiotic therapy and because there is growing public interest in self-care. The dozens of clinical trials conducted overseas have also played a role in its renaissance. Common Name Echinacea Other Names Echinacea angustifolia — American coneflower, black sampson, black susans, coneflower, echinaceawurzel, Indian head, kansas snakeroot, purple coneflower, purpursonnenhutkraut, racine d’echinacea, Rudbeckia angustifolia L, scurvy root, snakeroot Echinacea purpurea — Read more […]

Goldenrod: Adverse Reactions. Pregnancy Use. Practice Points

Adverse Reactions Handling the plant has been associated with allergic reactions ranging from allergic rhinoconjunctivitis and asthma to urticaria. There is one study of a cohort predominantly comprising florists who had presented with complaints relating to the handling of plants found that extensive cross-sensitisation to pollen of several members of the Compositae family (e.g. Matricaria, Chrysanthemum and Solidago) and to pollen of the Amaryllidaceae family (Alstroemena and Narcissus). Significant Interactions None known Contraindications and Precautions Commission E cautions against use as irrigation therapy when heart or kidney disease is also present. People with known allergy to goldenrod or who are allergic to the Compositae (Asteraceae) family of plants should avoid this herb. Pregnancy Use From limited use in pregnant women, it appears that no increase in frequency of malformation or other harmful effects have been reported although animal studies are lacking. Practice Points / Patient Counselling • Goldenrod has a long history of use but has not been tested in humans to any significant extent. • Traditionally it has been used internally to reduce upper respiratory catarrh, arthritis, menorrhagia, Read more […]

Goldenrod: Uses. Dosage

Clinical Use Goldenrod has not been significantly investigated under controlled study conditions, so most evidence is derived from traditional use, in vitro and animal studies. CYSTITIS The most common use of goldenrod is in the treatment of bladder infections. Both the Commission E and ESCOP (2003) have approved its use for irrigation of the urinary tract, with ESCOP also indicating usefulness as adjunctive treatment for bacterial UTIs. ARTHRITIS The product Phytodolor contains alcoholic extracts of Populus tremula, Fraximus excelsior and Solidago virgaurea and is standardised to 0.14 mg/mL of isofraxidine, 1 mg/mL salicine, and 0.07 mg/mL of total flavonoids. As part of this combination, goldenrod has been investigated in patients with RA, osteoarthritis and back pain. Pain was significantly reduced by treatment with Phytodolor in a placebo-controlled study of 47 patients. Symptom relief was equally effective amongst patients receiving half strength, normal (60 drops three times daily) or double-strength treatment. A shorter placebo-controlled study of 2 weeks duration found that Phytodolor reduced the need for conventional drug doses in subjects with ‘at least one rheumatological diagnosis’. Similarly, Phytodolor Read more […]

Goldenrod: Background. Actions

Historical Note Goldenrod has been used therapeutically for centuries for bladder conditions and wound healing. The name, Solidago, is from the Latin verb ‘to make whole’. In 1934, reports from the US Department of Agriculture suggested that goldenrod was considered as a potential future source of commercially prepared rubber, although it was noted that domestication of the plant would be difficult as it is vulnerable to fungal infection and insect attack. Common Name Goldenrod Other Names Aaron’s rod, blue mountain tea, sweet goldenrod, woundwort Botanical Name / Family Solidago canadensis (Canadian goldenrod), Solidago virgaurea (European goldenrod) (family Asteraceae [Compositae]). There are numerous species of goldenrod. Plant Parts Used Dried aerial parts — flowers and leaves Chemical Components Flavonoids, including rutin, catechol tannins, triterpene saponins, phenol glycosides, phenolic acids, one essential oil, diterpene lactones, and polysaccharides. Main Actions The pharmacology of goldenrod has not been significantly investigated; therefore, evidence of activity derives from traditional, in vitro and animal studies. DIURETIC Goldenrod is considered an aquaretic medicine, as it promotes fluid Read more […]

Goldenseal: Practice Points – Patient Counselling. FAQ

Pregnancy Use Contraindicated in pregnancy and lactation. In addition to the preceding concerns about bilirubin, berberine has caused uterine contractions in pregnant and non-pregnant experimental models. A recent in vivo study using 65-fold the average human oral dose of goldenseal investigated effects on gestation and birth and found no increase in implantation loss or malformation. The authors conclude that the low bioavailability of goldenseal from the gastrointestinal tract was likely to explain the differences between in vitro and in vivo effects in pregnancy. Hydrastine (0.5 g) has also been found to induce labour in pregnant women. Until more pharmacokinetic studies are done, goldenseal is best avoided in pregnancy. Practice Points / Patient Counselling • Goldenseal has been used traditionally as an antidiarrheal agent and digestive stimulant. • It has been used topically as a wash for sore or infected eyes and as a mouth rinse. • Goldenseal is a bitter digestive stimulant that improves bile flow and improves liver function. • Most clinical evidence has been conducted using the chemical constituent berberine. This data has shown effectiveness against diarrhea, congestive heart failure, Read more […]

Goldenseal: Adverse Reactions. Interactions

Clinical note — Berberine absorption Berberine is poorly absorbed, with up to 5% bioavailability. In vitro data has clearly demonstrated that berberine is a potent antibacterial; however, in vivo data has established low bioavailability. Berberine has been shown to upregulate the expression and function of the drug transporter P-glycoprotein (Pgp). Pgp belongs to the super family of ATP-binding cassette transporters that are responsible for the removal of unwanted toxins and metabolites from the cell. It appears that Pgp in normal intestinal epithelia greatly reduces the absorption of berberine in the gut. In vivo and in vitro methods have been used to determine the role of Pgp in berberine absorption by using the known Pgp inhibitor cyclosporin A. Co-administration increased berberine absorption six-fold and clearly demonstrated the role of Pgp in absorption. Increased expression of Pgp can lead to cells displaying multi-drug resistance. As previously reported a certain flavonolignan in many Berberis spp. has the ability to inhibit the expression of multi-drug resistant efflux pumps allowing berberine and certain antibiotics to be more effective. Adverse Reactions Goldenseal is generally regarded as safe Read more […]

Goldenseal: Uses. Dosage

Clinical Use Goldenseal has not been significantly investigated under clinical trial conditions, so evidence is derived from traditional, in vitro and animal studies. Many of these have been conducted on the primary alkaloids. All results are for the isolated compound berberine, and although this compound appears to havevarious demonstrable therapeutic effects, extrapolation of these results to crude extracts of goldenseal is premature. It should also be noted that equivalent doses of the whole extract of goldenseal are exceptionally high. DIARRHOEA A double-blind, placebo-controlled, randomised trial examined the effect of berberine alone (100 mg four times daily) and in combination with tetracycline for acute watery diarrhea in 400 patients. Patients were divided into four groups and given tetracycline, tetracycline plus berberine, berberine or placebo; 185 patients tested positive for cholera and those in the tetracycline and tetracycline plus berberine groups achieved a significant reduction in diarrhea after 16 hours and up to 24 hours. The group given berberine alone showed a significant reduction in diarrhea volume (1 L) and a 77% reduction in cAMP in stools. Noticeably fewer patients in the tetracycline and Read more […]

Goldenseal: Background. Actions

Historical Note Goldenseal is indigenous to North America and was traditionally used by the Cherokees and then by early American pioneers. Preparations of the root and rhizome were used for gastritis, diarrhea, vaginitis, dropsy, menstrual abnormalities, eye and mouth inflammation, and general ulceration. In addition to this, the plant was used for dyeing fabric and weapons. Practitioners of the eclectic school created a high demand for goldenseal around 1847. This ensured the herb’s ongoing popularity in Western herbal medicine, but unfortunately led to it being named a threatened species in 1997. Today, most high-quality goldenseal is from cultivated sources. Common Name Goldenseal Other Names Eye root, jaundice root, orange root, yellow root Botanical Name / Family Hydrastis canadensis (family Ranunculaceae) Plant Parts Used Root and rhizome Chemical Components Isoquinoline alkaloids, including hydrastine (1.5-5%), berberine (0.5-6%) and canadine (tetrahydroberberine, 0.5-1.0%). Other related alkaloids include canadaline, hydrastidine, corypalmineand isohydrastidine. Clinical note — Isoquinoline alkaloids Isoquinoline alkaloids are derived from phenylalanine or tyrosine and are most frequently found Read more […]