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 […]

Ailanthus altissima

Ailanthus species (Simaroubaceae) have a history of use in traditional medicine, particularly for the treatment of dysentery, A. altissima is particularly noted as an antibacterial, anthelmintic, amoebicide and insecticide (); A. excelsa () is noted as a specific for respiratory problems and A. malabarica is noted for the treatment of dyspepsia, bronchitis, opthalmia and snake bite. Ailanthus altissima: Distribution and Importance A. altissima Mill. Swingle. (Syn. A. glandulosa Desf.) originated in China, where it has been used in traditional medicine for enteritic infections of various origins (American Herbal Pharmacology Delegation 1975). Throughout the Far East, various parts of A. altissima are considered to be medicinal, with the use of either the fruits or bark of either root or stem for dysentery and various other gastric and intestinal upsets. Trees harvested for medicinal purposes are usually felled in the spring or autumn, and the bark is removed and dried in the sun. It is normally used to make aqueous extracts which are bitter, astringent and cooling. Bark extract has also been used to treat anaemia and as a taeniafuge, but does not have vermifuge properties. Leaves are toxic to domestic animals, causing Read more […]

Bacterial Vaginosis

Bacterial vaginosis (BV) is a common form of infectious vaginitis caused by the polymicrobial proliferation of Gardnerella vaginalis, Mycoplasma hominis, and other anaerobes. It is associated with loss of normal lactobacilli. bacterial vaginosis accounts for at least 10% and as many as 50% of all cases of infectious vaginitis in women of childbearing age. Determining the presence of bacterial vaginosis can be difficult, however, because as many as 75% of women are asymptomatic. Symptoms Some or all of these symptoms may be present in women with bacterial vaginosis. • Milky, homogenous discharge • Possible vaginal irritation • Malodorous vaginal discharge (characteristic “fishy” odor) bacterial vaginosis is also commonly asymptomatic. Diagnosis Diagnosis is based on the Amstel criteria, which is considered 90% accurate with three or four of the following findings: the presence of milky, homogenous discharge, vaginal pH greater than 4.5 positive whiff test (“fishy” odor to the vaginal discharge), and the presence of clue cells on light microscopy of vaginal fluid. Odor is a symptom that is frequently associated with bacterial vaginosis, due to amines produced from the breakdown products of amino acids Read more […]


Trichomoniasis vaginalis is a motile, flagellate protozoan. It is the third most common cause of vaginitis. Every year, approximately 180 million women worldwide are diagnosed with this infection annually, accounting for 10% to 25% of all vaginal infections. Current belief is that T. vaginalis is almost exclusively acquired through sexual contact. Male sexual partners are infected in 30% to 80% of cases. Symptoms Symptomatic infection causes a characteristic frothy green malodorous discharge with a high pH (can be as high as 6.0).s Additionally, there may be soreness and irritation in and around the vulva and vagina, dysuria, dyspareunia, bleeding upon intercourse, inability to tolerate speculum insertion because of pain, or a superficial rash on the upper thighs with a scalded appearance. The cervix may have a characteristic appearance, called petechial strawberry cervix, in up to 25% of cases. Chronic asymptomatic infection can exist for decades in women; an infection also may present atypically. In men, infection is mostly asymptomatic, or there may be a thin white or yellow purulent discharge with dysuria (nongonococcal urethritis). Diagnosis Trichomoniasis can be diagnosed on the basis of simple microscopy, Read more […]


ANTIULCEROGENIC AGENTS (or ulcer-healing drugs) are used to promote healing of ulceration of gastric and duodenal peptic ulcers. A number of classes of drugs may be used. See also gastric secretion inhibitors. First, the HISTAMINE H2-ANTAGONISTS are very effective and have considerable usage, e.g. cimetidine. famotidine, nizatidine and ranitidine. These agents decrease gastric acid secretion and promote healing and may be used to treat dyspepsia and oesophagitis of a number of etiologies. Acid production is also very effectively reduced by the newer agents, the proton pump inhibitors, e.g. omeprazole (see GASTRIC PROTON PUMP INHIBITORS). Anticholinergic drugs are only really suitable in the case of agents that show some gastric-selectivity, e.g. pirenzepine and telenzepine (see muscarinic cholinoceptor ANTAGONISTS). They work by reducing the secretion of peptic acid by the stomach mucosa. Some prostaglandin analogues are effective in protecting the mucosa, and are incorporated into some preparations of NSAIDs to offer concurrent protection (though they may cause unacceptable stimulation of the ileum), e.g. misoprostol. (see prostanoid receptor agonists) . Bismuth-containing antacid preparations have been Read more […]

Herb-Drug Interactions: Milk thistle

Silybum mahanum (L.) Gaertn. (Asteraceae) Synonym(s) and related species Lady’s thistle, Marian thistle, Mediterranean milk thistle, St Mary’s thistle. Carduus marianus, Mariana lactea Hill. Pharmacopoeias Milk Thistle (US Ph 32); Milk Thistle Capsules (US Ph 32); Milk Thistle Fruit (British Ph 2009, European Ph 2008); Milk Thistle Tablets (US Ph 32); Powdered Milk Thistle (US Ph 32); Powdered Milk Thistle Extract (US Ph 32); Refined and Standardised Milk Thistle Dry Extract (British Ph 2009, European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4). Constituents The mature fruit (seed) of milk thistle contains silymarin, which is a mixture of the flavonolignans silibinin (silybin), silicristin (silychristin), silidianin (silydianin), isosilibinin and others. It may be standardised to contain not less than 1.5% (European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4), or not less than 2% (The United States Ph 32) of silymarin, expressed as silibinin (dried drug). Standardised extracts, containing high levels of silymarin, are often used. Milk thistle fruit also contains various other flavonoids, such as quercetin, and various sterols. Note that milk thistle leaves do not contain silymarin, 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 […]

Goldenseal: Uses. Dosage

Clinical Use Goldenseal has not been significantly investigated under clinical trial conditions, so evidence is derived from traditional, in vitro and animal studies. Many of these have been conducted on the primary alkaloids. All results are for the isolated compound berberine, and although this compound appears to havevarious demonstrable therapeutic effects, extrapolation of these results to crude extracts of goldenseal is premature. It should also be noted that equivalent doses of the whole extract of goldenseal are exceptionally high. DIARRHOEA A double-blind, placebo-controlled, randomised trial examined the effect of berberine alone (100 mg four times daily) and in combination with tetracycline for acute watery diarrhea in 400 patients. Patients were divided into four groups and given tetracycline, tetracycline plus berberine, berberine or placebo; 185 patients tested positive for cholera and those in the tetracycline and tetracycline plus berberine groups achieved a significant reduction in diarrhea after 16 hours and up to 24 hours. The group given berberine alone showed a significant reduction in diarrhea volume (1 L) and a 77% reduction in cAMP in stools. Noticeably fewer patients in the tetracycline and Read more […]


ANTICOLITIS AGENTS are used to treat inflammation of the colon. This inflammation can be due to many things, and is usually characterized by pain in the lower bowel, diarrhoea, sometimes with mucus and blood in the faeces. The treatment depends on diagnosis and severity. Aminosalicylates contain a 5-aminosalicylic acid component and these drugs are used primarily to treat active Crohn’s disease, and to induce and maintain remission of the symptoms of ulcerative colitis. Drugs in this group include mesalazine (which is 5-aminosalicylicacid itself), olsalazine sodium (which links two molecules of 5-aminosalicylic acid), balsalazide (a prodrug of mesalazine) and sulfasalazine (which chemically combines 5-aminosalicylic acid with the antibacterial sulphonamide sulfapyridine). Antiinflammatory CORTICOSTEROIDS, especially prednisolone, are also effective in the treatment of ulcerative colitis, inflammatory bowel disease, Crohn’s disease, rectal or anal inflammation and haemorrhoids. Azathioprine is a powerful cytotoxic agent, an IMMUNO-SUPPRESSANT used to treat ulcerative colitis and other autoimmune diseases. Administration is oral or by injection. Colitis may result from various gut infections, especially amoebic Read more […]


AMOEBICIDAL AGENTS (antiamoebic agents; amoebicides) are used to treat or prevent infections caused by amoebic microorganisms, which are small unicellular organisms that prefer damp environments. Although now classified as part of the kingdom Protista, phylum Rhizopoda, amoebae were originally classified as Protozoa. Consequently, the term antiamoebic agent tends to be used as synonymous with ANTIPROTOZOAL AGENT, and a number of agents are effective against both. One genus of amoebae responsible for a number of diseases are the Entamoeba, found particularly in the gastrointestinal tract of humans. E. histolytica invades and destroys the tissues of the gut wall causing amoebic dysentery and ulceration of the gut wall. Infection of the liver by this species causes amoebic hepatitis. E. gingivalis, found within the spaces between the teeth, is associated with periodontal disease and gingivitis. In practice, treatment of amoebiasis can be divided into treatment of bowel lumen amoebiasis, and tissue-invading amoebiasis. The bowel lumen infection, which is usually asymptomatic, may be in trophozoites form (non-infective) or in cysts form (infective); and treatment is directed at eradicating cysts with a luminal amoebicide Read more […]