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 Read more [...]


A chronic and recurrent disease characterized by dry, well-circumscribed, silvery, scaling papules and plaques of various sizes. (The Merck Manual) This is a common skin disease of unknown cause that affects up to 3 % of the American population. Onset usually occurs before age 20, but all age groups may be affected. The severity of this condition can vary from the presence of one or two cosmetically annoying lesions to a physically disabling and disfiguring affliction of the entire body surface. The condition is not contagious in any way, and general health usually is not affected. However, it is no exaggeration to say that in extreme cases, psoriasis be ruinous to the individual’s physical, emotional, and economic well-being. In addition, some cases are associated with a severe form of arthritis, called psoriatic arthritis, that affects general health in much the same way as rheumatoid arthritis does. Psoriasis usually develops slowly, following a typical course of remission and recurrence. The characteristic psoriatic plaques, or lesions, are sharply demarcated, red and raised, covered with silvery scales, and bleed easily. These plaques do not usually itch, and will heal without leaving scar tissue or affecting Read more [...]

Herpes Simplex Virus

Herpes simplex virus (HSV) is a member of the human herpes virus group that includes, for example, herpes simplex virus-1, herpes simplex virus-2, and Epstein-Barr virus (EBV). Herpes simplex virus is a recurrent viral infection that remains dormant in the nervous system with periods of reactivation characterized by individual or multiple clusters of fluid-filled vesicles at specifically affected sites. Herpes simplex virus-1 and -2 are the main types of herpes virus seen in general clinical practice. Herpes simplex virus-1 typically manifests above the waist and is referred to as Herpes labialis because of it primarily appearing on the lips in the form of “cold sores.” Herpes simplex virus-2, Herpes genitalis, typically appears on the genitals, although it also produces skin lesions. The vesicles rupture, leaving small, sometimes painful ulcers, which generally heal without scarring, although recurrent lesions at the same site may cause scarring. Coinfection with herpes simplex virus-1 and -2 increases the frequency of herpes simplex virus-2 outbreaks. Orogenital sex can lead to cross-contamination of these sites, with oral herpes being more likely transmitted to the genitals than the other way around. The incubation Read more [...]

Diseases of the Musculoskeletal System

Herbs For Diseases Of The Musculoskeletal System Disorders of the musculoskeletal system — including arthritis, hip and elbow dysplasia, ligament conditions such as anterior cruciate / luxating patellas, and spinal arthritis / spondylosis — generally present as altered gait or lameness caused by pain. These conditions benefit from physical therapies including acupuncture, chiropractics, physiotherapy, and massage, as well as weight reduction where appropriate. Chondroprotective agents should always be considered and conventional antiinflammatory agents should be considered for acute injuries. Alternatives to nonsteroidal antiinflammatories are often sought because of concerns over side effects of medications including continued degeneration of joints and gastrointestinal, hepatic, or renal effects. Musculoskeletal conditions affect the whole body. Pain in one area leads to biomechanical changes elsewhere due to shifts in weight bearing and movement. The whole body must be evaluated, not just the affected limb or back. Frequently, muscle spasm, trigger points, myofascial pain, and joint pain are detected elsewhere in the body. Similarly, herbalists take a systemic approach to treating musculoskeletal disorders. Read more [...]

Anti-Inflammatory Herbs

Withania (Withania somnifera) Withania is a useful component of any musculoskeletal formula as both an adaptogen and an herb. It was traditionally recognized in Ayurvedic medicine for musculoskeletal disorders. Although the mechanism of action is not fully understood, it appears that Withania may involve cyclooxygenase inhibition and a direct musculotropic action that accounts for the antispasmodic effects of Withania. Devil’s claw (Harpagophyturn procumbens) Devil’s claw is a threatened plant species used in traditional African medicine for arthritis. In humans it has been investigated for the treatment of nonspecific lower back pain, arthritis, and rheumatism, and has been shown to be effective for pain relief when the extract provides more than 50 mg of harpagoside daily. However, the effects of Devil’s claw are not just due to the constituent harpagoside. In one in vitro study it was shown to suppress prostaglandin (PG)E2 synthesis and nitric oxide production by inhibiting lipopolysaccharide-stimulated enhancement of cox2 and inducible nitric oxide synthase mRNA expression. It has been included in a formula with Black currant (Ribes nigrum), Horsetail (Equisetum arvense), and White willow (Salix alba) and compared Read more [...]


IMMUNOSUPPRESSANTS are agents that inhibit the body’s reaction to infection or foreign bodies. In this capacity, drugs with this property may be used to prevent tissue rejection following donor grafting or transplant surgery (though there is then the risk of unopposed infection). Also, immunosuppressants are used to treat autoimmune diseases (where the immune system is triggered into acting against systems in the body), including disorders such as rheumatoid arthritis or lupus erythematosus, and also to treat collagen disorders. These agents include cyclosporin, rapamycin and tacrolimus, cytotoxic agents such as azathioprine and cyclophosphamide. and the glucocorticoids. These will be discussed in turn. Cyclosporin is technically an antibiotic, which was discovered serendipitously during a search for antifungal agents and is unique in having a selective action on lymphocytes. It is a cyclic peptide of 11 residues – some previously unknown. It is particularly important as an immunosuppressant in limiting tissue rejection during and following organ transplant surgery. It can also be used to treat severe active rheumatoid arthritis and some skin conditions, such as severe resistant atopic dermatitis and (under supervision) Read more [...]

Herb-Drug Interactions: Cannabis

Cannabis sativa L. (Cannabaceae) Synonym(s) and related species Bhang, Dagga, Ganja, Hashish, Indian hemp, Marihuana, Marijuana. Cannabis indica Lam. Constituents Cannabis herb contains a wide range of cannabinoids, which are the major active compounds. The main psychoactive constituent is delta9-tetrahydrocannabinol (THC; dronabinol), and it is the cause of many of the pharmacological effects elicited by the consumption of cannabis. However, other cannabinoids, which do not possess psychoactive properties, such as cannabidiol, cannabinol (a decomposition product of delta9-tetrahydrocannabinol), cannabigerol and cannabichromene, are increasingly being investigated for their pharmacological and therapeutic properties. Cannabinoids are often found in the plant as their acid metabolites, e.g. ll-nor-9-carboxy-delta9-tetrahydrocannabinol, cannabidiol acid and others, especially if the plant has been grown in a cooler climate. These decarboxylate to the parent cannabinoid at high temperatures, such as during smoking. Most medicinal cannabis products have been heat treated to ensure that the cannabinoids are present only in the non-acid form. Use and indications Cannabis has no current established use in herbal Read more [...]

Anti-Inflammatory Activity

Some reports have indicated that the use of anti-inflammatory compounds may modify the progression of Alzheimer’s disease, since inflammatory processes have been linked with Alzheimer’s disease pathology. Some studies have indicated that non-steroidal anti-inflammatory drugs (NSAIDs), which inhibit cyclo-oxygenase activity, may reduce the risk of developing Alzheimer’s disease, and patients with rheumatoid arthritis, who often use NSAIDs, are suggested to have a lower incidence of Alzheimer’s disease. In addition to inhibition of cyclo-oxygenase, it has also been suggested that NSAIDs may act via other mechanisms such as anti-amyloidogenic effects. In view of the adverse effects commonly associated with cyclo-oxygenase inhibitors currently in clinical use, new anti-inflammatory compounds may be developed, including those which are naturally derived, which may have potential in modifying the progression of cognitive disorders such as Alzheimer’s disease with fewer adverse effects. There are numerous examples of plant extracts and their constituents which display anti-inflammatory effects. Consequently, there is some potential for novel anti-inflammatory agents to be identified from plant sources, although Read more [...]


CORTICOTROPHIN-RELEASING FACTOR RECEPTOR ANTAGONISTS inhibit the actions of agents related to corticotrophin-releasing factor (CRF). Two subtypes of receptor, CRF, and CRF2, have recently been identified and cloned, and there is interest in these as therapeutic targets. See CORTICOTROPHIN-RELEASING FACTOR RECEPTOR AGONISTS. Some peptide antagonists that have some affinity for both CRF, and CRF2 receptors have been developed by making modifications of the CRF sequence, and these include; a-helicalCRE9-41,DPhe-CRF12-41 and the peptide astressm. Recently, some related non-peptides that act selectively at CRF, receptors have been developed including CP 154526, NB 127914 and antalarmin. A number of other agents are currently the subject of patent applications. Some possibly clinical applications of CRF receptor ligands are discussed in relation to evidence about the role of CFG; see corticotrophin-releasing factor receptor agonists. It might be hypothesized that corticotrophin-releasing factor antagonists could be used clinically to treat panic and generalized anxiety disorders, and possibly also to treat clinical depression and anorexia. Similarly, there is some evidence suggesting that stroke might be treatable with Read more [...]

Herb-Drug Interactions: St John’s wort

Hypericum perforatum L. (Clusiaceae) Synonym(s) and related species Hypericum, Millepertuis. Hypericum noeanum Boiss., Hypericum veronense Schrank. Pharmacopoeias St John’s Wort (British Ph 2009, European Ph 2008, US Ph 32); St John’s Wort Dry Extract, Quantified (British Ph 2009, European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4). Constituents The main groups of active constituents of St John’s wort are thought to be the anthraquinones, including hypericin, isohypericin, pseudohypericin, protohypericin, protopseudohypericin and cyclopseudohypericin, and the prenylated phloroglucinols, including hyperforin and adhyperforin. Flavonoids, which include kaempferol, quercetin, luteolin, hyperoside, isoquercitrin, quercitrin and rutin; biflavonoids, which include biapigenin and amentoflavone, and catechins are also present. Other polyphenolic constituents include caffeic and chlorogenic acids, and a volatile oil containing methyl-2-octane. Most St John’s wort products are standardised at least for their hypericin content (British Pharmacopoeia 2009), even though hyperforin is known to be a more relevant therapeutic constituent, and some preparations are now standardised for both (The United Read more [...]