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 […]

Ginger: Background. Actions

Historical Note Ginger has been used as both a food and a medicine since ancient times. Confucius wrote about it in his Analects, the Greek physician, Dioscorides, listed ginger as an antidote to poisoning, as a digestive, and as being warming to the stomach in De Materia Medica, and the Koran, the Talmud and the Bible all mention ginger. Records suggest that ginger was highly valued as an article of trade and in 13th and 14th century England, one pound of ginger was worth the same as a sheep. Ginger is still extremely popular in the practice of phytotherapy, particularly in TCM, which distinguishes between the dried and fresh root. It is widely used to stimulate circulation, treat various gastrointestinal disorders and as a stimulant heating agent. Other Names African ginger, Indian ginger, Jamaica ginger, common ginger, rhizoma zingiberis, shokyo (Japanese) Botanical Name / Family Zingiber officinale Roscoe (family Zingiberaceae) Plant Part Used Rhizome Chemical Components The ginger rhizome contains an essential oil and resin known collectively as oleoresin. The composition of the essential oil varies according to the geographical origin, but the chief constituents, sesquiterpene hydrocarbons, which are Read more […]

Ginkgo biloba: Contraindications. Practice Points. FAQ

Contraindications and Precautions If unusual bleeding or bruising occurs, stop use immediately. Although new clinical evidence suggests that Ginkgo biloba does not affect clotting times, it may be prudent to suspend use for 1 week prior to major surgery. CEREBRAL HAEMORRHAGE AND EPILEPSY Recent, rare case reports have suggested that ginkgo should be used with caution in people with known risk factors for cerebral haemorrhage and epilepsy until further investigation can clarify its safety. Pregnancy Use Not recommended in pregnancy as insufficient reliable evidence is available to determine safety. Practice Points / Patient Counselling • Ginkgo biloba is a complex herb that contains many different active constituents and works by means of multiple mechanisms. Therefore, it has applications in many varied conditions. • It is an effective treatment in conditions of acquired cognitive impairment, including dementia of any degree of severity and intermittent claudication, according to evidence from meta-analyses. • Positive evidence also exists for premenstrual syndrome, sudden deafness, Raynaud’s syndrome and depression when associated with cognitive decline. • Largely based on the herb’s physiological Read more […]

Ginkgo biloba: Significant Interactions

PLATELET INHIBITOR DRUGS Due to its platelet-activating factor antagonist activity, Ginkgo biloba may theoretically enhance the effects of these drugs and increase risk of bruising or bleeding; however, three clinical trials have cast doubt on the clinical significance of this activity — observe patients taking this combination. WARFARIN Theoretically, ginkgo may increase bleeding risk when used together with warfarin; however, two randomised double-blind studies have found that Ginkgo biloba does not affect the pharmacokinetics, pharmacodynamics, INR or clinical effects of warfarin, and two clinical trials have not found evidence of significant effects on bleeding. Due to the potential seriousness of such an interaction, caution is still advised. CHOUNERGIC DRUGS Cholinergic activity has been identified for ginkgo; therefore, combined use may theoretically increase drug activity — observe patients using this combination, although the effects may be beneficial when used under supervision. DOXORUBICIN In vivo research suggests that ginkgo can prevent doxorubicin-induced cardiotoxicity suggesting a potentially beneficial interaction, although no human studies are available to confirm clinical significance. ANTIDEPRESSANT Read more […]

Ginkgo biloba: Uses. Dosage. Adverse Reactions

Other Uses Ginkgo biloba is used for many other indications, including improving connective tissue conditions such as haemorrhoids, common allergies, reducing the effects of exposure to radiation and to prevent some of the complications associated with diabetes. In the UK and other European countries, the cardioprotective effects of EGb 751 in myocardial ischaemia and reperfusion are currently being investigated in preclinical studies. ADJUNCT IN CANCER TREATMENT As a herb with significant antioxidant activity, ginkgo has been used to reduce the toxic side-effects of some chemotherapeutic drugs. Evidence from in vivo studies demonstrate protective effects against nephrotoxicity induced by cisplatin and cardiotoxicity induced by doxorubicin. Clinical trials are not yet available to determine its effectiveness in practice. CANCER PREVENTION A 2005 review puts forward the case that Ginkgo biloba should be more widely used as a safe, preventative agent for reducing cancer incidence. This recommendation is based on results from numerous in vitro and experimental studies showing that ginkgo affects many factors associated with the incidence and mortality of cancer. Dosage Range The recommended dose varies depending Read more […]