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 […]

Garlic: Contraindications. Practice Points. FAQ

Contraindications and Precautions Patients with bleeding abnormalities should avoid therapeutic doses of garlic. Although usual dietary intakes are likely to be safe prior to major surgery, suspend the use of high-dose garlic supplements 1 week before, as garlic may increase bleeding risk. If being used as part of a topical application, a test patch is advised before more widespread application. Pregnancy Use Garlic is not recommended at doses greater than usual dietary intakes. Practice Points / Patient Counselling • Garlic is both a food and a therapeutic medicine capable of significant and varied pharmacological activity. • It has antioxidant, antimicrobial, antiplatelet, antithrombotic, antihypertensive, lipid-lowering, anti-atherosclerotic and vasoprotective activity. • It also enhances microcirculation and may have hypoglycaemic, anti-inflammatory and immunostimulant activity. • Garlic is used as a treatment for many common infections, to reduce the incidence of colds, improve peripheral circulation and manage hyperlipidaemia and hypertension. • Increased consumption of garlic has been associated with a decreased risk of stomach and colorectal cancer, according to a review of the Read more […]

Garlic: Dosage. Adverse Reactions. Interactions.

Dosage Range GENERAL GUIDE • Fresh garlic: 2-5 g/day (ensure it is bruised, crushed or chewed). • Dried powder: 0.4-1.2 g/day. • Aged-garlic extracts have been studied in amounts ranging from 2.4 to 7.2 g/day. • Oil: 2-5 mg/day. • Garlic preparations that will provide 4-12 mg alliin daily. • Fluid extract (1:1): 0.5-2 mL three times daily. ACCORDING TO CLINICAL STUDIES • Hypertension: 600-900 mg/day in divided doses (delivering approximately 5000-6000 µg allicin potential). • Hyperlipidaemia: 600-9000 mg/day. • Fungal infection: topical 0.4-0.6% ajoene cream applied twice daily. • Occlusive arterial disease: 600-800 mg/day. It is important to be aware of the thiosulfinate content, in particular allicin-releasing ability, of any commercial product to ensure efficacy. Adverse Reactions INTERNAL USE Breath and body odour, allergic reactions, nausea, heartburn, flatulence, abdominal discomfort and diarrhea have been reported. Headache, myalgia and fatigue were reported in one study using a dose of 900 mg garlic powder (standardised to 1.3% alliin). TOPICAL USE An ajoene 0.6% gel produces a transient burning sensation after application, according to one study. Contact Read more […]

Garlic: Uses

Clinical Use Most studies have used a non-enteric coated dehydrated garlic powder preparation standardised to 1.3% alliin content (Kwai, Lichtwer Pharma) or an aged garlic extract (Kyolic, Wakunaga of America). CARDIOVASCULAR DISEASE Epidemiologic studies show an inverse correlation between garlic consumption and progression of CVD in general. This review will consider the evidence for garlic in the management of specific risk factors such as hypertension and hyperlipidaemia. Additionally, investigation into the effects of garlic directly on the atherosclerotic and arteriosclerotic processes is presented. Hypertension A meta-analysis of seven clinical trials using a garlic preparation, produced commercially as Kwai, found that three showed a significant reduction in SBP and four in DBP. Kwai was used in these studies in the dosage of 600-900 mg daily. Garlic treatment resulted in a mean reduction in SBP of 7.7 mmHg and 5.0 mmHg in DBP compared with placebo. In 2000, the Agency for Health Care Research and Quality analysed results from 27 randomised, placebo-controlled trials and reported that results were mixed. When significant reductions in blood pressure were observed, these were small. Several newer Read more […]

Garlic: Background. Actions

Historical Note Garlic has been used as both a food and a medicine since antiquity. Legend has it that garlic was used in ancient Egypt to increase workers’ resistance to infection and later used externallyto prevent wound infection. Other ancient civilizations have also used it medicinally. Sanskrit records document the use of garlic approximately 5000 years ago and the Chinese have been using it for over 3000 years. One of the uses of garlic was as a treatment for tumours, a use which extends back to the Egyptian Codex Ebers of 1550 BC. Louis Pasteur was one of the first scientists to confirm that garlic had antimicrobial properties. Garlic was used to prevent gangrene and treat infection in both world wars. Traditionally, garlic has been used as a warming and blood cleansing herb to prevent and treat colds and flu, coughs, menstrual pain and expel worms and other parasites. Common Name Garlic Other Names Ail, ajo, allium, camphor of the poor, da-suan, knoblauch, la-juan, poor man’s treacle, rustic treacle, stinking rose Botanical Name / Family Allium sativum (family Liliaceae) Plant Part Used Bulb, and oil from the bulb Chemical Components Garlic bulbs contain organosulfur compounds, protein (mainly alliinase), Read more […]

Ginger: Practice Points – Patient Counselling. FAQ

Pregnancy Use Although Commission E suggests that ginger is contraindicated in pregnancy, more recent research suggests that ginger is not contraindicated in pregnancy — doses up to 2 g/day of dried ginger root have been used safely. No adverse effects on pregnancy were observed in multiple studies of ginger or nausea and vomiting. Practice Points / Patient Counselling • Ginger is most often used for its anti-emetic, anti-inflammatory and gastrointestinal effects. • There is clinical support for the use of ginger in the treatment of nausea and vomiting associated with motion sickness, the postoperative period, pregnancy and chemotherapy. • Ginger is traditionally used for gastrointestinal disorders including dyspepsia, poor appetite, flatulence, colic, vomiting, diarrhea and spasms, as well as a diaphoretic in the treatment of the common cold and influenza. • Ginger is also used as an anti-inflammatory agent for arthritis, although large controlled studies have yet to produce strong support for this use. • Although antiplatelet effects have been reported, this requires very large doses and is not likely to be significant in normal therapeutic doses or dietary intake levels. Answers to Read more […]

Ginger: Dosage. Interactions. Contraindications.

Dosage Range The recommended dose ranges widely from 500 mg to 9 g/day dried root or equivalent; however, as there are wide variations in the gingerol concentrations in commercial ginger supplements the effective dosage will depend on the preparation and the indication for use. • Liquid extract (1:2): 0.7-2.0 mL/day. • Dried root: 1-3 g daily in divided doses or 1-2 g taken as a single dose for nausea and vomiting. • Infusion: 4-6 slices of fresh ginger steeped in boiling water for 30 minutes. Adverse Reactions Gastric irritation, heartburn and bloating have been reported in clinical trials. Contact dermatitis of the fingertips has also been reported with topical use. Significant Interactions Controlled studies are not available for many interactions; therefore they are based on evidence of activity and are largely theoretical and speculative. WARFARIN Due to the herb’s antiplatelet effects there is a theoretical risk of increased bleeding at high doses (> 10 g) although this is not evident clinically. There is no evidence of an interaction with warfarin at the usual dietary and therapeutic intakes, and ginger has been shown not to alter prothrombin times in pooled human plasma collected from Read more […]

Ginger: Uses

Clinical Use Although ginger is used in many forms, including fresh ginger used in cooking or chai (Indian spicy tea), pickled or glazed ginger, ethanol extracts and concentrated powdered extracts, preparations made with the root are used medicinally. Depending on the specific solvent used, the resultant preparation will contain different concentrations of the active constituents and may differ markedly from crude ginger. Although the great majority of research refers specifically to the species Zingiber officinale, there is the potential for confusion with other species or even with other genera. Furthermore, there are reported to be wide variations in the quality of commercial ginger supplements with concentrations of gingerols ranging from 0.0 to 9.43 mg/g. As such, the results of specific research can not necessarily be extrapolated to different preparations. PREVENTION OF NAUSEA AND VOMITING Many clinical studies have investigated the effects of ginger in the prevention and treatment of nausea and vomiting associated with different circumstances, including pregnancy, the postoperative period, motion sickness and chemotherapy. A recent systematic review of 24 RCTs covering 1073 patients suggest that results Read more […]