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 […]

Black Cohosh (Cimicifuga Racemosa)

Medical Uses Black cohosh is helpful in relieving menopausal symptoms, including mood swings, hot flashes, profuse sweating, and sleep disturbances. It has been the largest-selling herbal dietary supplement for menopause in the United States. Historical Uses In China, black cohosh root has been used for centuries for menopausal symptoms and women’s health in general. Native Americans and Eclectic physicians used black cohosh for rheumatism, menstrual difficulties, and sore throats. Native American women have used it for menopausal symptoms such as hot flashes, anxiety, and depression. Do not confuse it with blue cohosh. Growth Black cohosh is a member of the buttercup family. It is native to the northeastern U. S. and grows in sunny areas in temperate zones. An at-risk endangered herb, black cohosh can be grown in herb gardens. The roots maybe harvested after 2 years. Black Cohosh: Part Used • Root Major Chemical Compounds • Triterpene • Glycosides Black Cohosh: Clinical Uses Studies show that black cohosh is safe and helpful in relieving menopausal symptoms, particularly mood swings, hot flashes, profuse sweating, and sleep disturbances. It is “a safe, effective alternative to estrogen replacement Read more […]

Burdock: Modern Uses And Essiac

When we turn to modern sources, we may imagine that the internal use of burdock for boils echoes the old topical use. However, an antimicrobial action would be desirable to support this action, and this has been linked to poly-acetylenes found in fresh burdock root, whereas the classical authors wanted the leaves to be applied topically. Weiss considers the root the most important part of the plant for medicinal use but does not consider its action to be very great and recommends its use only in combination with other herbs. This could include cystitis, as listed by other authors. An oil made from the root can be used, says Weiss, to stimulate hair growth in alopecia and for dry seborrhoea. Mills and Bone also discuss only the root. Wood and Menzies-Trull include the seeds as well, perhaps following the recommendation by Priest & Priest of the seeds, especially in skin conditions. Pelikan highlights the fact that it is only the flower heads of burdock, and its fruit or seed, which display the thistle aspect of the plant. The leaves and root, on the other hand, are rich in mucilage, which he regards as evidence of their ‘struggle against spiny hardness’. Here we have an image to link with the several recommendations Read more […]

Herb-Drug Interactions: Chinese angelica

Angelica sinensis (Oliv.) Diels (Apiaceae) Synonym(s) and related species Dang Gui (Chinese), Danggui, Dong quai. Angelica polymorpha van sinensis. Other species used in oriental medicine include Angelica dahurica. Not to be confused with Angelica, which is Angelica archangelica L. Pharmacopoeias Angelica Sinensis Root for use in THM (British Ph 2009); Processed Angelica Sinensis Root for use in THMP (British Pharmacopoeia 2009). Constituents The major constituents include natural coumarins (angelicin, archangelicin, bergapten, osthole, psoralen and xanthotoxin) and volatile oils. Other constituents include caffeic and chlorogenic acids, and ferulic acid. Angelica sinensis also contains a series of phthalides (n-butylidenephthalide, ligustilide, n-butylphthalide). Use and indications One of the most common uses of Chinese angelica root is for the treatment of menopausal symptoms and menstrual disorders. It has also been used for rheumatism, ulcers, anaemia, constipation, psoriasis, the management of hypertension and to relieve allergic conditions. Pharmacokinetics Evidence is limited to experimental studies, which suggest that the effects of Angelica dahurica and Angelica sinensis may not be equivalent. Read more […]

Herb-Drug Interactions: Soya

Glycine max (L.Merr.) (Fabaceae) Synonym(s) and related species Soy. Glycine soja Siebold and Zucc. Pharmacopoeias Hydrogenated Soya Oil (British Ph 2009); Hydrogenated Soybean Oil (European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4, The United States Ph 32); Powdered Soy Isoflavones Extract (US Ph 32); Refined Soya Oil (British Ph 2009); Soybean Oil (US Ph 32); Soybean Oil, Refined (European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4). Constituents The isoflavones in soya beans consist mainly of genistein and daidzein, with smaller amounts of isoformononetin, ononin, glycetein, desmethyltexasin and others. They are present mainly as glycosides, and the amount varies between the different soya products. Soya beans also contain coumestans (mainly in the sprouts) and phytosterols. The fixed oil from soya beans contains linoleic and linolenic acids. Fermented soya products contain variable amounts of tyramine. Use and indications Soya is a widely used food, particularly in Japanese and Chinese cuisine. Flour and protein from the beans are used as tofu and as a substitute for meat. Fermented products include soy sauce, natto and miso, and these can contain high concentrations Read more […]

Herb-Drug Interactions: Shatavari

Asparagus racemosus Willd. (Asparagaceae) Synonym(s) and related species Wild asparagus. Not to be confused with asparagus, which is Asparagus officinalis, the species used as a food. Constituents The root and rhizome of shatavari contain a series of steroidal saponins, the shatavarins and others, based on sarsapogenin, diosgenin and arasapogenin. The polycyclic alkaloid asparagamine A, benzofurans such as racemofuran and racemosol, and the isoflavone 8-methoxy-5,6,4′-trihydroxyisoflavone 7-O-beta-D-glucopyranoside are also present. Use and indications Shatavari is widely used in Ayurvedic medicine for dealing with problems related to women’s fertility, loss of libido, threatened miscarriage and menopausal problems, and to increase the flow of breast milk. It is also reported to be antispasmodic, aphrodisiac, demulcent, diuretic, anti-diar-rhoeal, antirheumatic and antidiabetic. Some of these indications are supported by pharmacological (but little clinical) evidence. Pharmacokinetics No relevant pharmacokinetic data found. Interactions overview Shatavari may have additive effects with conventional antidiabetic drugs, and may alter the absorption of a number of drugs by delaying gastric emptying. Shatavari Read more […]

Herb-Drug Interactions: Red clover

Trifolium pratense L. (Fabaceae) Synonym(s) and related species Cow clover, Meadow clover, Purple clover, Trefoil. Trifolium borysthenicum Gruner, Trifolium bracteatum Schousb., Trifolium lenkoranicum (Grossh.) Rosk., Trifolium ukrainicum Opp. Not to be confused with melilot, which is known as sweet clover. Pharmacopoeias Powdered Red Clover (US Ph 32); Powdered Red Clover extract (US Ph 32); Red Clover (US Ph 32); Red Clover Tablets (The United States Ph 32). Constituents Red clover flowers contain isoflavones, to which they may be standardised. The major isoflavones are biochanin A and formononetin, with small amounts of genistein and daidzein and others, and their glycoside conjugates. Other constituents include clovamides, coumestrol, and the natural coumarins medicagol and coumarin. Use and indications Red clover was traditionally used for skin conditions, such as eczema and psoriasis. However, the isoflavone fraction is now more commonly used as a form of HRT in women to reduce the symptoms of the menopause, although randomised controlled studies show only a slight benefit at best. It is also used for mastalgia, premenstrual syndrome and cancer prevention. Pharmacokinetics In an in vitro study, Read more […]

Herb-Drug Interactions: Kudzu

Pueraria montana (Lour.) Merr. (Fabaceae) Synonym(s) and related species Ge Gen. Pueraria hirsuta (Thunb.) C. Schneider, Pueraria lobata (Willd.) Ohwi, Pueraria lobata (Willd.) Ohwi var. thomsonii (Benth.) Maesen, Pueraria thunbergiana (Sieb. & Zucc.) Benth., Dolichos lobatus Willd. Other species used include Pueraria mirifica Airy Shaw & Suvatabandhu (Thai kudzu, Kwao Kreu Kao) and Pueraria phaseoloides (Roxb.) Benth. (Puero, Tropical kudzu). Constituents The major isoflavone constituent of the root of Pueraria lobata is puerarin, which is the 8-C-glucoside of daidzein, but there are many others, such as puerarin hydroxy- and methoxy- derivatives and their glycosides, daidzein and its O-glycoside daidzin, biochanin A, genistein and formononetin derivatives. Pterocarpans are also present, including medicarpin glycinol and tuberosin. The flowers contain the phytoestrogens kakkalide and tectoridin. Pueraria mirifica root contains similar constituents to Pueraria lobata, the major difference being lower amounts of daidzein. Much of the research carried out on kudzu has been on the effects of isolated puerarin. Use and indications Kudzu contains isoflavones and is used as a phytoestrogen for Read more […]

Herb-Drug Interactions: Isoflavones

Isoflavonoids This is a large group of related compounds with similar structures and biological properties in common, which are widely available as additives in dietary supplements as well as the herbs or foods that they were originally derived from. Isoflavones are the subject of intensive investigations and new information is constantly being published. You may have come to this monograph via a herb that contains isoflavones. The information in this monograph relates to the individual isoflavones, and the reader is referred back to the herb (and vice versa) where appropriate. It is very difficult to confidently predict whether a herb that contains one of the isoflavones mentioned will interact in the same way. The levels of the isoflavone in the particular herb can vary a great deal between specimens, related species, extracts and brands, and it is important to take this into account when viewing the interactions described below. Types, sources and related compounds Isoflavones are plant-derived polyphenolic compounds that are a distinct group of flavonoids. They can exert oestrogen-like effects, and therefore belong to the family of ‘phytoestrogens’. Most occur as simple isoflavones, but there are other derivatives Read more […]

Herb-Drug Interactions: Hops

Humulus lupulus L. (Cannabaceae) Synonym(s) and related species Humulus, Lupulus. Pharmacopoeias Hop Strobile (British Ph 2009, Eur Ph 6.4). Constituents The flowers (strobiles) of hops contain a volatile oil composed mainly of humulene (alpha-caryophyllene), with beta-caryophyllene, myrcene, famesene and others. There is also an oleo-resin fraction composed of bitter acids. Flavonoids present include glycosides of kaempferol and quercetin, and a series of prenylated flavonoids (including 6-prenylnaringenin) and prenylated chalcones. A number of hop proanthocyanidins, based on gallocatechin, afzelechin and epicatechin derivatives, and the trans isomer of the stilbenoid resveratrol and its glucoside, piceid, have also been isolated. Note that a large variety of hops genotypes exist, and the relative content of these constituents may vary between genotype. Use and indications Hops are used mainly as a sedative, anxiolytic, hypnotic and tranquilliser. These properties have been demonstrated pharmacologically but there is little clinical evidence to date. Hops also contain a number of compounds with oestrogenic activity such as 6-prenylnaringenin. Many products include hops as one of several ingredients rather Read more […]