Hops: Interactions. Practice Points. FAQ

Adverse Reactions Drowsiness is theoretically possible at excessive doses. Contact with the herb or oil has resulted in reports of systemic urticaria, allergic dermatitis, respiratory allergy and anaphylaxis. Significant Interactions Interactions reported here are theoretical and have yet to be tested clinically for significance. PHARMACEUTICAL SEDATIVES Additive effects are theoretically possible — observe the patient (this interaction may be beneficial). DRUGS METABOLISED CHIEFLY WITH CYP2B OR CYP3A Altered drug effect — CYP induction and inhibition has been demonstrated. However, it is unknown if these effects are clinically significant — observe the patient for signs of altered drug effectiveness. ANTI-OESTROGENIC DRUGS Hops may alter the efficacy of these medicines; use with caution in patients taking anti-oestrogenic drugs. Contraindications and Precautions According to one source, hops should be used with caution in depression. Due to the herb’s oestrogenic activity, disruption to the menstrual cycle is considered possible. Use is contraindicated in patients with oestrogen-dependent tumours. Pregnancy Use Caution in pregnancy because of possible hormonal effects. Practice Points / Patient Read more […]

Hops: Uses. Dosage.

Clinical Use In practice, the herb is prescribed in combination with other herbal medicines, such as valerian and passionflower. As is representative of clinical practice, most studies have investigated the effects of hops in combination with other herbs. RESTLESSNESS AND ANXIETY Based on the herb’s sedative activity, it is likely to have some effect in the treatment of restlessness and anxiety, but careful dosing would be required to avoid sedation. This indication has been approved by Commission E and ESCOP. SLEEP DISTURBANCES Although there have been no clinical studies to support hops as a stand-alone sedative agent, several studies have demonstrated formulas combining hops with other sedative herbs are effective for insomnia. Two randomised double-blind studies have investigated the effects of an oral preparation of hops and valerian in sleep disorders. One study observed equivalent efficacy and tolerability of a hops-valerian preparation comparable to benzodiazepine treatment, with withdrawal symptoms only reported for benzodiazepine use. Improvement in subjective perceptions of sleep quality was confirmed in another study, which also reported that a hops-valerian combination was well tolerated compared Read more […]

Hops: Background. Actions

Historical Note Although hops are most famous for producing the bitter flavour in beer, this plant has been used since ancient times to treat digestive complaints and for its slight narcotic and sedative actions. The climbing nature of the herb influenced its common name, as this is derived from the Anglo-Saxon hoppan, which means ‘to climb’. Common Name Hops Other Names Common hops, European hops, hop strobile, hopfen, houblon, humulus, lupulus, lupulin Botanical Name / Family Humulus lupulus (family Cannabinaceae) Plant Part Used Dried strobiles Chemical Components Resinous bitter principles (mostly alpha-bitter and beta-bitter acids) and their oxidative degradation products, polyphenolic condensed tannins, volatile oil, polysaccharides, mainly monoterpenes and sesquiterpenes, flavonoids (xanthohumol, isoxantholumol, kaempferol, quercetin and rutin), phenolic acids, and amino acids. Main Actions Traditionally, hops are viewed as a bitter tonic with antispasmodic, relaxant and sedative actions. SEDATIVE A long history of use within well-established systems of traditional medicine, together with scientific testing, have suggested that hops have significant sedative activity. A recent in vivo study found Read more […]

Kava Kava: Contraindications and Precautions. FAQ

Endogenous depression — according to Commission E. Although clinical studies indicate no adverse effects on vigilance, the herb’s CNS effects may slow some individuals’ reaction times, thereby affecting ability to drive a car or operate heavy machinery. Additionally, it should not be used by people with pre-existing liver disease and long-term continuous use should be avoided unless under medical supervision. It should be used with caution in the elderly and in those with Parkinson’s disease. Pregnancy Use Not recommended for use in pregnancy. Practice Points / Patient Counselling Kava kava is a scientifically proven treatment for the symptoms of anxiety and stress states. Its anxiety-reducing effects are similar to those of 15 mg oxazepam or 9 mg bromazepam, yet physical tolerance and reduced vigilance have not been observed. It also reduces symptoms of anxiety related to menopause when used together with HRT, and reduces withdrawal symptoms associated with benzodiazepine discontinuation. It has anxiolytic, sedative, antispasmodic, analgesic and local anaesthetic activity. Although the herb is considered to have a low incidence of adverse effects, long-term use should be carefully supervised because Read more […]

Kava Kava: Significant Interactions

ALCOHOL Potentiation of CNS sedative effects has been reported in an animal study; however, one double-blind placebo-controlled study found no additive effects on CNS depression or safety related performance. Alternatively, a study of 10 subjects found that when alcohol and kava were combined, kava potentiated both the perceived and measured impairment compared to alcohol alone. Caution. BARBITURATES Additive effects are theoretically possible. Use with caution and monitor drug dosage. However, interaction may be beneficial under professional supervision. BENZODIAZEPINES Additive effects are theoretically possible. Use with caution and monitor drug dosage. However, interaction may be beneficial under professional supervision. The combination has been used successfully to ease symptoms of benzodiazepine withdrawal. L-DOPA MEDICATION Antagonistic effects are theoretically possible, thereby reducing the effectiveness of L-dopa. Avoid concurrent use unless under professional supervision. METHADONE AND MORPHINE Additive effects with increased CNS depression are theoretically possible, so use with caution, although interactions may be beneficial under professional supervision. SUBSTRATES FOR CYP3A4 Although Read more […]

Kava Kava: Adverse Reactions

In RCT, the incidence of adverse effects to kava kava has been found to be similar to placebo. Two post-marketing surveillance studies involving more than 6000 patients found adverse effects in 2.3% and 1.5% of patients taking 120-240 mg standardised extract. The most common side-effects appear to be gastrointestinal upset and headaches. HEPATOTOXICITY A systematic review assessing the safety of kava which included a total of 7078 patients taking kava extract equivalent to 10 mg to 240 mg kavalactones per day for 5-7 weeks identified no cases of hepatotoxicity. Considering that case reports of hepatotoxicity exist, they should be considered a very rare event based on the evidence. LONG-TERM USE Most adverse effects, such as yellow discolouration of the skin, hair and nails, have been associated with excessive long-term use. This temporary condition is known as ‘kava dermopathy’ and reverses once kava use is discontinued. A 2003 report found no evidence of brain dysfunction in heavy and long-term kava users. Clinical note Commercial kava products and links to hepatotoxicity Conflicting reports abound. On 15 August 2002, the TGA initiated a voluntary recall of all products containing kava kava. The response was Read more […]

Kava Kava: Clinical Use. Dosage

Kava extracts are popular in Europe and have been investigated in numerous clinical trials, primarily in European countries. As a result, many research papers have been published in languages other than English. In order to provide a more complete description of the evidence available, secondary sources have been used where necessary. NERVOUS ANXIETY A 2000 Cochrane review of the scientific literature assessed the results from seven, double-blind, randomised placebo-controlled trials and concluded that kava extract has significant anxiolytic activity and is superior to placebo for the symptomatic treatment of anxiety. An update of this review was published in 2003 and analysed results from 12 clinical studies involving 700 subjects. The results of 7 studies that used the Hamilton Anxiety Scale (HAM-A) score were pooled and a significant reduction in anxiety was observed for kava treatment compared with placebo. The results of the five studies that were not submitted to meta-analysis largely support these findings. The extract most commonly tested was WS 1490 at a dose of up to 300 mg daily. Preliminary evidence suggests it may be equivalent to benzodiazepines for non-psychotic anxiety. Safety According to the authors Read more […]

Kava Kava: Background. Actions

Common Name Kava kava Other Names Kawa, awa, intoxicating pepper, rauschpfeffer, sakau, tonga, yagona Botanical Name / Family Piper methysticum (family Piperaceae) Plant Parts Used Root and rhizome Chemical Components The most important constituents responsible for the pharmacological activity of kava rhizome are the fat-soluble kava lactones (kavapyrones), mainly methysticin, dihydromethisticin, kavain, dihydrokavain and desmethoxyangonin and flavonoids (flavokavains). Historical Note For many centuries, Pacific Islanders have used the kava kava root to prepare a beverage used in welcoming ceremonies for important visitors. Drinking kava is not only done to induce pleasant mental states but also to reduce anxiety and promote socialising. It is believed that the first report about kava came to the West from Captain James Cook during his voyages through the Pacific region. Kava Kava: Main Actions CNS EFFECTS The kava lactones reach a large number of targets that influence CNS activity. They interact with dopaminergic, serotonergic, GABA-ergic and glutamatergic neurotransmission, seem to inhibit monoamine oxidase B and exert multiple effects on ion channels, according to in vitro and in vivo research. Read more […]

Lavender: Practice Points – Patient Counselling. FAQ

• The active part of lavender is the volatile oil, which has relaxing, sedative, antispasmodic and antiseptic activity. • Lavender can be taken as a tincture or tea, or the oil can be applied topically, used in baths or inhaled from a diffuser. • It is advised that topical preparations be tested on a small area of skin before widespread application. • Lavender has traditionally been used for sleep disorders, anxiety and nervous stomach, as well as to treat minor cuts, burns, bruises and insect bites and is commonly found in cosmetics and toiletries. • Lavender contains substances that are currently being studied for cancer prevention. Answers to Patients’ Frequently Asked Questions What will this herb do for me? Lavender oil is used to assist in relaxation, digestive problems and as first aid for minor skin conditions. When will it start to work? As a relaxant, effects may be felt on the first day of use, but this will depend on the dose and form used. Are there any safety issues? Although lavender has not been scientifically studied as extensively as some other herbal medicines, historical use suggests it is generally safe. Read more […]

Lavender: Significant Interactions. Pregnancy Use

Toxicity Although there are no specific reports of toxicity, it is suggested that no more than two (2) drops be taken internally. There is the potential for irritant or allergenic skin reactions with the topical use of lavender oil as it has been found to be cytotoxic to human skin cells in vitro (endothelial cells and fibroblasts) at a concentration of 0.25% (v/v), possibly due to membrane damage. The activity of linalool was found to reflect the cytotoxicity of the whole oil, whereas the cytotoxicity of linalyl acetate was found to be higher than that of the oil, suggesting suppression of its activity by an unknown factor in the oil. Significant Interactions Controlled studies are not available; therefore, interactions are based on evidence of activity and are largely theoretical and speculative. PHARMACEUTICAL SEDATIVES Theoretically, lavender can potentiate the effects of sedatives, so observe patients taking this combination closely — beneficial interaction possible under professional supervision. ANTIDEPRESSANTS Lavender tincture may have additive effects when used with these medicines — beneficial interaction possible. Pregnancy Use No restrictions known for external use. Safety of internal use Read more […]