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 […]

Bromelain (Ananas Comosus)

Medical Uses Bromelain is used to decrease swelling after oral surgery and episiotomy. It is also used as an anti-inflammatory, an antibiotic, a treatment for cancer and sports injuries, an aid to wound healing, and a treatment for mild ulcerative colitis. Historical Uses In folk medicine, bromelian fruit latex was used to treat wounds, burns, and cancer. It was also used as an aid to digestion. Growth Commercial bromelain is derived from pineapple stems. The major producers of bromelain are Japan, Taiwan, and Hawaii. Bromelain: Part Used • Pineapple plant stem Major Chemical Compounds • Sulfur-containing proteolytic enzymes () • Glycoproteins • Vitamins that contain enzymes Bromelain: Clinical Uses This herb has been used to help resolve hematoma after oral surgery and episiotomy. It has also been used as an anti-inflammatory, an antibiotic, a treatment for cancer and sports injuries, an aid to wound healing (Natural Medicines, 2000), and a treatment for mild ulcerative colitis. It is approved by the German Commission E for “acute post-op and post-traumatic conditions of swelling, especially of the nasal and paranasal sinuses”. Mechanism of Action This proteolytic enzyme has fibrinolytic Read more […]

Conventional Treatment Approaches

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention (CDC) published guidelines in 1996 recommending a risk-based (screening) approach, to determine when to recommend intravenous (IV) antibiotic prophylaxis during labor. It was determined that women with the following risk factors should be offered (IV) antibiotics during labor and delivery, not before labor: • fever during labor • rupture of membranes 18 hours or more before delivery • labor or rupture of membranes before 37 weeks As of 2002, the CDC revised the 1996 guidelines, recommending routine screening for all pregnant women between 35 and 37 weeks gestation, and universal treatment for women who test positive for group B Streptococcus during pregnancy (Box CDC 2002 group B Streptococcus Treatment Guidelines). CDC 2002 group B Streptococcus Treatment Guidelines • All pregnant women should be screened at 35 to 37 week gestation for vaginal and rectal group B Streptococcus colonization. At the time of labor or rupture of membranes, intrapartum chemoprophylaxis should be given to all pregnant women identified as group B Streptococcus carriers. Colonization Read more […]

Herb-Drug Interactions: Resveratrol

Types, sources and related compounds Resveratrol is a polyphenol present in most grape and wine products and is the compound largely credited with providing the health benefits of red wine. However, the concentration is very variable between foods and supplements, so it is difficult to evaluate the clinical relevance of the available information. Use and indications Resveratrol is used for its reputed anti-ageing effects. It is said to have antioxidant properties and antiplatelet effects, and is therefore promoted as having benefits in a variety of cardiovascular diseases, including atherosclerosis. It also has some oestrogenic and anti-inflammatory activity, and is under investigation in the prevention and treatment of cancer, because it appears to reduce cell proliferation. Pharmacokinetics An in vitro study reported that resveratrol inhibited the cytochrome P450 isoenzyme CYP3A4, but was much less potent than erythromycin, a known, clinically relevant, moderate CYP3A4 inhibitor. Similar results were found in other studies. Interestingly, red wine also inhibited CYP3A4, but this effect did not correlate with the resveratrol content. In other studies resveratrol had only very weak inhibitory effects on CYP1A2, Read more […]

Herb-Drug Interactions: Pepper

Piper nigrum L. (Piperaceae) Synonym(s) and related species Black and white pepper are derived from the fruits of the same species, Piper nigrum L. Black pepper is the unripe fruit which has been immersed in hot water and dried in the sun, during which the outer pericarp shrinks and darkens into a thin, wrinkled black layer. White pepper consists of the seed only, prepared by soaking the fully ripe berries, removing the pericarp and drying the naked seed. Long pepper, Piper longum L., is a closely related species where the fruits are smaller and occur embedded in flower ‘spikes’, which form the seed heads. Constituents Alkaloids and alkylamides, the most important being piperine, with piperanine, piperettine, piperlongumine, pipernonaline, lignans and minor constituents such as the piperoleins, have been isolated from the fruits of both species of pepper. Black pepper and long pepper also contain a volatile oil which may differ in constitution, but is composed of bisabolene, sabinene and many others; white pepper contains very little. The pungent taste of pepper is principally due to piperine, which acts at the vanilloid receptor. Use and indications Pepper is one of the most popular spices in the world, 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 […]


ANTIBIOTICS are, strictly speaking, natural products secreted by microorganisms into their environment, where they inhibit the growth of competing microorganisms of different species. In common usage, the term is generally applied to a wide range of chemicals, whether directly isolated from mould ferments, their semisynthetic derivatives, or synthetic chemicals showing some structural similarities. Also, in everyday language the term is used to denote drugs with a selectively toxic action on bacteria or similar non-nucleated single-celled microorganisms (including chlamydia, rickettsia and mycoplasma), though such drugs have no effect on viruses. In this loose parlance even the sulphonamides may, incorrectly, be referred to as antibiotics because they are antimicrobial. More confusing is the fact that a number of antibiotics are used as cytotoxic agents in cancer chemotherapy (e.g. bleomycin): see ANTICANCER AGENTS. Further, partly because of the recent development of high-throughput screens for lead chemicals, a number of new drug chemical classes have arisen from antibiotic leads (e.g. the CCK antagonist asperlicin and derivatives, from Aspergillus spp.). The antimicrobial antibiotics have a selectively toxic Read more […]

Zinc: Practice Points – Patient Counselling. FAQ

Zinc is involved in many chemical reactions that are important for normal body functioning and it is essential for health and wellbeing. • Although zinc supplements are traditionally used to treat deficiency, they are also used to prevent deficiency in conditions associated with low zinc status or deficiency, such as acrodermatitis enteropathica, anorexia nervosa, malabsorption syndromes, conditions associated with chronic diarrhea, alcoholism, diabetes, HIV and AIDS, recurrent infections, severe burns, Wilson’s disease and sickle cell anaemia. • Zinc supplements are also popular among athletes in order to counteract zinc loss that occurs through perspiration. • Zinc lozenges have been used to prevent and treat the symptoms of the common cold and oral supplements have been used to treat acnevulgaris, improve wound healing and chronic leg ulcers, resolve intestinal permeability problems and reduce recurrences in Crohn’s disease, treat recalcitrant warts, reduce symptoms of tinnitus and improve ADHD. • Topical applications of zinc have been used to treat acnevulgaris (in combination with erythromycin), herpes simplexand to promotewound healing. • Numerous interactions exist between other minerals, Read more […]

Zinc: Clinical Use

Many of the clinical uses of zinc supplements are for conditions thought to arise from a marginal zinc deficiency, but some indications are based on the concept that high-dose zinc supplements act as a therapeutic agent. DEFICIENCY Traditionally, zinc supplementation has been used to treat deficiency or prevent deficiency in conditions such as acrodermatitis enteropathica, anorexia nervosa, malabsorption syndromes, conditions associated with chronic diarrhea, alcoholism, diabetes, HIV and AIDS, recurrent infections, severe burns, Wilson’s disease and sickle cell anaemia. Zinc supplements are also popular among athletes in order to counteract the zinc loss that occurs through perspiration. COMMON COLD Oral zinc supplements, lozenges and nasal sprays and gels have been investigated in the treatment of the common cold. It has been demonstrated that a transient increase in zinc concentrations in and around the nasal cavity prevents rhinovirus binding to cells and disrupts infection and/or modulates inflammatory cytokines that may exacerbate cold symptoms. Nasal preparations A randomised, double-blind placebo-controlled trial with 160 people tested the effects of a nasal spray of 0.12% zinc sulfate and found that it Read more […]

St Mary’s thistle: Practice Points – Patient Counselling. FAQ

St Mary’s thistle has hepatoprotective activity and has been shown to reduce the hepatotoxic effects of a variety of environmental toxins and medicines, such as paracetamol, erythromycin, carbon tetrachloride and death cap mushrooms. • It has direct and indirect antioxidant activity, accelerates the regeneration of hepatocytes after liver damage, has significant gastroprotective and nephroprotective activity, anti-inflammatory and antihistamine activity according to in vitro and animal studies. • Numerous clinical studies have investigated its effects in a variety of liver diseases. However, a recent review concluded that current data are still insufficient to recommend the herb in chronic liver diseases. • In clinical practice, it is used to treat dyspepsia, toxic liver damage, as supportive therapy in chronic liver diseases and hypercholesterolaemia. • Preliminary evidence suggests a possible role as adjunctive therapy with cisplatin and as a skin cancer preventative agent when applied topically. Answers to Patients’ Frequently Asked Questions What will this herb do for me? St Mary’s thistle may improve digestion, particularly of fatty foods, and afford protection against the toxic effects Read more […]