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 […]

Echinacea (E. angustifolia, E. purpurea, and E. pallida)

Echinacea: Medical Uses Echinacea is used for the common cold, infections, and low immune status. It is given with antibiotics and chemotherapy and acts as an anti-inflammatory. Historical Uses Native Americans and Eclectic physicians used echinacea as a natural anti-infective for colds and flu. Native Americans first introduced echinacea to the colonists. Growth There are nine species of echinacea. This perennial will grow in most herb gardens in the northeast. The beautiful flower of E. purpurea, commonly called “purple cone-flower,” may grow up to 6 feet tall. E. angustifolia has narrow leaves and is much shorter, at about 2 feet. It has pink flowers. E. pallida grows to about 3 feet and is much paler. All three species have been cultivated in the U.S. and Europe. E. angustifolia is listed as an at-risk endangered herb. Parts Used • Aerial (above-ground) parts • Whole plant and root Major Chemical Compounds • Alkylamides • Caffeic acid derivatives • Cichoric acid • Polysaccharides • Glycoproteins Not all active chemical compounds are found in each species of echinacea. Mechanism of Action Alkylamides, which cause a tingling sensation on the tongue, produce anti-inflammatory Read more […]

Vulvovaginal Candidiasis

Vulvovaginal candidiasis (VVC), commonly referred to as yeast infection, is the second most common cause of vaginitis in the United States. Approximately 75% of all women will experience an episode of VVC in their lifetime, with recurrent vulvovaginal candidiasis occurring in 5% of women. It is most commonly caused by the fungus Candida albicans; however, other Candida species, such as C. tropicalis and C. glabrata are becoming increasingly common, possibly because of increased use of OTC anti-fungals, and they are also typically more resistant to antifungal treatments. OTC antifungal treatments are among the top 10 selling OTC medications in the United States with an estimated $250 in annual sales. Establishing Candida as a cause of vaginitis can be difficult, because 50% of all women have Candida organisms as part of their normal vaginal flora. Candida is not considered a sexually transmitted disease, and conventional medical practice does not include treatment of male partners unless uncircumcised or presenting with inflammation of the glans penis. recurrent vulvovaginal candidiasis is defined as four or more episodes annually. Recurrence may be a result of associated factors, intestinal microorganism reservoir, Read more […]

Sex Herbs

The following herbs are used to improve sexual function: • Anise imitates the female hormone estrogen, increasing sexual intensity and satisfaction • Epimedium, a Chinese herb, has a testosterone-like substance and enhances a woman’s sexual desire • Fenugreek augments breast size and is used to elevate sex drive • Fennel prolongs orgasm, allowing men to enjoy sex for a longer period of time • Guarana seed tea has aphrodisiac effect • Quebracho (in South America) and Sheng Jing (in China) are used in male infertility and erectile dysfunction (impotence) Erectile dysfunction (ED) is a condition defined by the inability to attain or maintain penile erection sufficient for satisfactory sexual intercourse. In 1995, it was estimated that approximately 152 million men worldwide suffered from erectile dysfunction, with projections for 2025 growing to a prevalence of 322 million affected men. In the past, erectile dysfunction was believed to be caused by nonspecific psychological causes; however, in the past two decades, the majority of cases have been attributed to an organic etiology. Although erectile dysfunction patients can have a number of medical conditions, organic erectile dysfunction Read more […]

Herb-Drug Interactions: German Chamomile

Matricaria recutita L. (Asteraceae) Synonym(s) and related species ChamomiUa, Hungarian chamomile, Matricaria flower, Scented mayweed, Single chamomile, Sweet false chamomile, Wild chamomile. ChamomiUa recutita (L.) Rauschert, ChamomiUa vulgaris SF Gray, Matricaria chamomilla L. Pharmacopoeias Chamomile (The United States Ph 32). Constituents The flowerheads of German chamomile contain essential oil composed mainly of (-)-alpha-bisabolol. Sesquiterpenes and proazulenes (e.g. matricarin and matricin) are also present. Chamazulene (1 to 15%), another volatile oil found in chamomile, is formed from matricin during steam distillation of the oil. Other constituents present in chamomile include flavonoids (apigenin, luteolin, quercetin, rutin), and the natural coumarins umbelliferone and its methyl ether, heniarin. Use and indications German chamomile is used for dyspepsia, flatulence and travel sickness, especially when the gastrointestinal disturbance is associated with nervous disorders. It is also used for nasal catarrh and restlessness. German chamomile is widely used in babies and children as a mild sedative, and to treat colic and teething pain. It has been used topically for haemorrhoids, mastitis and Read more […]

Herb-Drug Interactions: Cola

Cola acuminata Schott & Endl. or Cola nitida Schott & Endl. (Sterculiaceae) Synonym(s) and related species Guru nut, Kola. Garcinia kola Heckel, Sterculia acuminata Beauv. Pharmacopoeias Cola (British Ph 2009, European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4). Constituents Cola seed contains xanthine derivatives, mainly caffeine (1.5 to 3%) to which it may be standardised, with traces of theobromine and theophylline. Other constituents include flavonoids from the flavanol group (such as catechin and epicatechin), amines, an anthocyanin pigment (kola red) and betaine. Use and indications The main use of cola seed is as a stimulant for depression, tiredness and poor appetite, and as a diuretic. Both uses can be attributed to the caffeine content. Cola is also used as flavouring agent in the manufacture of soft drinks. Pharmacokinetics For the pharmacokinetics of caffeine, see caffeine. For information on the pharmacokinetics of individual flavonoids present in cola, see under flavonoids. Interactions overview Cola contains significant amounts of caffeine, therefore the interactions of caffeine, should be applied to cola, unless the product is specified as decaffeinated. By Read more […]

Herb-Drug Interactions: Schisandra

Schisandra chinensis K.Koch (Schisandraceae) Synonym(s) and related species Gomishi (Japanese), Magnolia vine, Wu-Wei-Zi (Chinese). Kadsura chinensis Turcz. Schisandra sphenanthera Rehder & EH Wilson is often used with, or substituted for, Schisandra chinensis. Other species of Schisandra are also used medicinally in China. Constituents The major active components of the fruits of Schisandra chinensis are dibenzocyclooctene lignans. The identity and nomenclature are confusing, because, when originally isolated by different researchers, the same compounds were given different names. The main groups of compounds are the schisandrins (schizandrins) and the gomisins (some of which were originally called wuweizu esters) and their derivatives. Schisandrin is also referred to in the literature as schisandrol A, gomisin A as schisandrol B, deoxyschisandrin as schisandrin A or wuweizu A, and schisantherin B as gomisin B or wuweizu B, for example. An essential oil contains borneol, 1,8-cineole, citral, sesquicarene and other monoterpenes. Extracts of Schisandra sphenanthera are reported to have a fairly similar chemical composition. Use and indications Schisandra is a very important herb in Chinese medicine. Read more […]

Herb-Drug Interactions: Natural coumarins

Natural coumarins are widespread in herbal medicines and vegetables. There is a misconception that if a plant contains natural coumarins it will have anticoagulant properties, but very specific structural requirements are necessary for this – namely there must be a non-polar carbon substituent at the 3-position of 4-hydroxycoumarin. Moreover, at present, there are no established interactions between warfarin and herbal medicines that have been attributed to the natural coumarin content of the herb. Even in the classic case of haemorrhagic death of livestock that led to the discovery of dicoumarol, it was the action of the mould on the natural coumarin in the sweet clover (melilot) that led to the production of the anticoagulant, so consumption of a spoiled product would seem to be necessary for this specific interaction to occur. This suggests that the occurrence of natural coumarins in dietary supplements or herbal medicines should not trigger immediate concern as regards interactions with anticoagulants. The information in this family monograph relates to the individual natural coumarins, and the reader is referred back to the herb (and vice versa) where appropriate. Note that, to avoid confusion with the synthetic Read more […]


ANTIFUNGAL AGENTS are antimicrobial drugs used to treat infections caused by fungal microorganisms. They may be antibiotics produced naturally, or purely synthetic. Fungal infections are not usually a major problem in healthy, well-nourished individuals. But, superficial, localized infections, such as thrush (caused by Candida albicans), and athlete’s foot and ringworm (caused by Tinea fungi of the dermatomycoses group), are common. These can readily be treated with topical application of antifungals. Severe infections occur most frequently where the host’s immunity is low, e.g. following immunosuppression for transplant surgery or in AIDS. Unfortunately, the most potent antifungal drugs taken systemically tend to be toxic. Amphotericin is a complex amphoteric polyene ANTIBIOTIC that binds to cell membranes and forms a pore through which ions can pass, with consequences that include loss of potassium ions from within the cell. Since the antibiotic binds more readily to fungal cell membranes than mammalian, its action is relatively selective. It can potentiate the action of certain other antifungals, and it may be used with flucytosine. Also, it confers antifungal activity on rifampicin (normally antibacterial). As Read more […]