Cannabis and Cannabinoids in Pain Relief

Cannabis is a term that describes products derived from the Indian hemp, Cannabis sativa. It has its origins probably in India but now grows all over the world. The chemical compounds responsible for intoxication and medicinal effects are found mainly in a sticky golden resin exuded from the flowers of the female plants and surrounding leaves. Cannabis sativa contains a wide range of different chemicals including a family of compounds called “cannabinoids”. Of the cannabinoids delta-9 tetrahydrocannabinol (THC) is probably the main compound responsible for the psychotropic activities. Cannabis has been used as a medicine for thousands of years and is mentioned in a Chinese herbal dating back to 2700 BC. There are records of ’its medicinal use in Egyptian papyri of the sixteenth century BC. Much later, the plant is mentioned in Assyrian texts and in Greek and Roman sources as a medicinal agent. Early Experiences in the 19th Century Cannabis Tincture was used in the nineteenth century as an analgesic, as well as numerous other conditions and was considered milder and less dangerous than opium. W.B.O’Shaughnessy was the first of the western physicians to take an interest in cannabis as a medicine on account Read more […]

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 […]

Plantago major

Plantago major L. (Plantaginaceae) Common Plantain, Whiteman’s Foot, Daun Sejumbok Plantago major L. is a small perennial herb. Leaves are nearly all basal, exstipulate, lanceolate to ovate, 5-20 cm long and rosette. Flowers are small, white, in dense spike-like inflorescence. Sepals are broadly elliptic, oblong to rounded obtuse or subacute and corolla are greenish or yellowish, with four lobed and imbricate. Seeds are dull black and endospermous. Origin It is found in Europe, Northern and Central Asia, and introduced all over the world. Phytoconstituents Aucubin, catalpol, scutellarein, nepetin, chloro genie acid, neochlorogenic acid, hispidulin, homoplantaginin, nepitrin, ursolic acid and others. Traditional Medicinal Uses The Greeks and Romans used it as an astringent, to heal wounds, asthma, fever and eye disorders. In Brazil, it has been used to treat skin ulceration (cutaneous leishmaniasis) caused by Leishmania braziliensis.l] P. major has been used in Turkey in the treatment of ulcers by taking the powdered dried leaves together with honey daily before breakfast. Infusion of the leaf has been taken for diarrhoea, ulcers, bloody urine, digestive disorders, and excess mucous discharge. The American Indian Read more […]

Herb-Drug Interactions: Cinnamon

Cinnamomum cassia Blume and Cinnamomum verum J. Presl. and its varieties (Lauraceae) Synonym(s) and related species Cinnamomum cassia: Cassia, Chinese cinnamon, False cinnamon, Cassia lignea, Cinnamomum aromaticum Nees, Cinnamomum pseudomelastoma auct. non Liao. Cinnamomum verum: Canela, Ceylon cinnamon, Cinnamomum burmannii (Nees & T. Nees) Bl. (known as Batavian cinnamon or Panang cinnamon), Cinnamomum loureiroi Nees, Cinnamomum zeylanicum Nees., Cinnamomum zeylanicum Blume. Pharmacopoeias Cassia Oil (British Ph 2009, European Ph 2008); Ceylon Cinnamon Bark Oil (British Ph 2009, European Ph 2008); Ceylon Cinnamon Leaf Oil (British Ph 2009, European Ph 2008); Cinnamon (British Ph 2009, European Ph 2008); Cinnamon Tincture (British Ph 2009, European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4). Constituents The bark of Cinnamomum cassia and Cinnamomum verum contains volatile oil mainly composed of trans-cinnamaldehyde, with cinnamylacetate, phenylpropylacetate, salicylaldehyde and methyleugenol. Diterpenes including cinncassiols, and tannins such as cinnamtannins, are also present. Use and indications Both varieties of cinnamon are mainly used for digestive disorders such as diarrhoea, Read more […]

CNS DEPRESSANTS

CNS DEPRESSANTS depress the CNS. In practice, very diverse agents can be grouped under this heading and it does not describe any specific type of drug action. Most of the agents that depress neuronal activity in the brain or spinal cord are dealt with under specific headings. The properties of some of these classes will be summarized here. GENERAL ANAESTHETICS are either inhaled or injected agents and produce insensibility, mostly to alleviate pain during surgical procedures (e.g. halothane, thiopentone sodium). HYPNOTICS induce sleep and a wide range of chemical types may be used. The older agents, such as the barbiturates, were often SEDATIVE agents used at a higher dose, but they readily produced dangerous respiratory depression and are now much less commonly used (e.g. amylobarbitone, chloral hydrate, chlormethiazole, triclofos). Increasingly, the drugs of choice are anxiolytic/minor tranquillizers at a somewhat higher dosage (vide infra). Tranquillizers depress the CNS. The need for the term came with the introduction of drugs having rather more subtle effects on mood and behaviour than the barbiturates. However, it soon became necessary to divide the category into minor tranquillizers and major tranquillizers. Read more […]

CARDIAC DEPRESSANTS

CARDIAC DEPRESSANTS are little used in medicine, however, some are used to slow the heartbeat in tachycardias and a number of these are often analogues or derivatives of other drugs with optimized activity for this purpose in the heart (e.g. procainamide, quinidine) — these are dealt with under antiarrhythmic agents. In addition to drugs in these classes, many drugs have the adverse effect of cardiac depression as a side-effect. This is particularly so with LOCAL ANAESTHETICS (e.g. lignocaine, procaine), which is a major reason why they are only used by local application. A number of other drugs, particularly chemotherapeutic agents that have strong reasons for their selection, may be cardiac depressants in some patients at high doses (e.g. doxorubicin, quinine). Many drugs with depressant actions on the CNS are also cardiac depressant in higher doses (e.g. carbamazepine. chlorpromazine, pentobarbitone). Drugs with actions on the autonomic system may have cardiac depressant actions (e.g. bretylium, reserpine) Also, β-adrenoceptor antagonists, whose actions are generally beneficial, can in some conditions and in overdose cause heart block or even cardiac arrest. Cholin-oceptor muscarinic agonists, by definition, 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 […]

Herb-Drug Interactions: Melatonin

N-(2-(5-Methoxyindol-3-yl)ethyl)acetamide Types, sources and related compounds N- Acetyl-5-methoxytryptamine. Use and indications Melatonin is a hormone that is produced in the pineal gland of the brain and influences the circadian rhythm. Supplements are therefore principally used for treating sleep disturbances and disorders such as jet lag, insomnia, sleep walking, and shift-work sleep disorder. It is also believed to have anticancer and antihypertensive properties, and has been used to treat cluster headaches. Melatonin has also been detected in a large number of plant species, including those used as foods. Concentrations detected have been very variable, the reasons for which are currently uncertain. In addition, the importance of dietary melatonin is unclear. Pharmacokinetics When an oral melatonin supplement 3mg was given to 17 healthy subjects the AUC and maximum serum levels of melatonin were about 18-fold and 100-fold greater, respectively, than overnight endogenous melatonin secretion, although there was a wide variation between individuals.The oral bioavailability was approximately 15% after oral doses of 2 or 4mg, possibly due to significant first-pass metabolism. The half-life has been found Read more […]

Herb-Drug Interactions: Liquorice

Qycyrrhiza glabra L. (Fabaceae) Synonym(s) and related species Licorice. Spanish and Italian liquorice is Glycyrrhiza glabra var typica Reg. et Herd. Persian or Turkish liquorice is Glycyrrhiza glabra L var violacea Boiss. Russian liquorice is Glycyrrhiza glabra L var glanduli-fera. Chinese liquorice is the closely related Glycyrrhiza uralensis Fisch., also known as Gancao. Pharmacopoeias Licorice (US Ph 32); Liquorice (British Ph 2009); Liquorice Dry Extract for Flavouring Purposes (British Ph 2009); Liquorice Liquid Extract (British Ph 2009); Liquorice Root (European Ph 2008); Liquorice Root for use in THM (British Ph 2009); Powdered Licorice (US Ph 32); Powdered Licorice Extract (US Ph 32); Processed Liquorice Root for use in THMP (British Ph 2009); Standardised Liquorice Ethanolic Liquid Extract (British Ph 2009, European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4). Constituents Liquorice has a great number of active compounds of different classes that act in different ways. The most important constituents are usually considered to be the oleanane-type triterpenes, mainly glycyrrhizin (glycyrrhizic or glycyrrhizinic acid), to which it is usually standardised, and its aglycone glycyrrhetinic Read more […]

Herb-Drug Interactions: Grapefruit

Citrus paradisi Macfad. (Rutaceae) Synonym(s) and related species Citrus paradisi Macfad. Grapefruit is a hybrid of the Pummelo or Pomelo (Citrus maxima (Burm.) Merr) with the sweet orange (Citrus sinensis (L.) Osbeck). Constituents Grapefruit contains furanocoumarins including bergamottin, 6′,7′-dihydroxybergamottin, bergapten, bergaptol, geranyl-coumarin and paradisin A, flavonoid glycosides such as naringin and flavonoid aglycones galangin, kaempferol, morin, naringenin, quercetin and others. The peel contains a volatile oil, mostly composed of limonene. Note that some grapefruit seed extracts have been found to contain preservatives such as benzethonium chloride, triclosan and methyl-p-hydroxybenzoate, which might be present because of the methods of production. Use and indications Grapefruit is used as a source of flavonoids (citrus bioflavonoids), which are widely used for their supposed antioxidant effects, and are covered under flavonoids. Grapefruit seed extracts are used for their antimicrobial properties, but there is some controversy that this might be due to preservative content rather than natural constituents. Grapefruit and grapefruit juice are commonly ingested as part of the diet, Read more […]