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 […]


HAEMOSTATIC AGENTS enhance the process of haemostasis, which is the arrest of blood loss from damaged blood vessels, and is essential to life. It involves three key components and their processes: platelets, blood vessels (the vascular endothelium and smooth muscle of the wall), and the blood-borne coagulation cascade system. To an extent, these components can be separated, but proper formation of the haemostatic plug in vivo requires interaction of all. For instance, blood coagulation in vitro is rapid and efficiently forms a clot as such, but it is not the same entity as the thrombus of platelets enmeshed in fibrin that constitutes the functional haemostatic plug which is required in haemostasis to prevent haemorrhage. Similarly, in vivo, in a patient with a deficiency of platelets, there may be spontaneous bleeding giving a purple coloration in the skin (thrombocytopenic purpurea); though the clotting time of the blood is unchanged, the bleeding time is prolonged. The processes involved in formation of fibrin are described in more detail at ANTITHROMBINS and ANTICOAGULANTS. Briefly, some agents are direct-acting thrombin antagonists, binding avidly to this enzyme and thus preventing the key stage in blood coagulation Read more […]

Hypericum perforatum

St John’s wort (Hypericum perforatum) is a native flowering plant of Europe and Asia which produces attractive yellow flowers. According to Kiple and Ornelas (2000) its lemon-scented leaves have been used for thousands of years as human food and have also been used to make a form of tea. Extracts of the flowers and leaves of this plant are now widely taken in the belief that they are mood enhancing and have beneficial effects in the treatment of clinical depression. In Germany hypericum extracts are widely prescribed by physicians for the treatment of clinical depression and it is the best selling antidepressant there. What is depression? Clinical depression is a common, painful and disabling condition which is more severe than the normal downward fluctuations in mood that we all regularly experience. The American Psychiatric Association lists the following symptoms for depression: • Depressed mood • Loss of interest in and lack of pleasure derived from activities that the patient usually finds pleasurable • Disturbed sleep patterns • Abnormal activity patterns, either agitation or being uncharacteristically inactive • Loss of drive and energy, loss of sex drive and reduced appetite To Read more […]

Panax ginseng

(Ginseng) Several plants of the Panax genus are commonly referred to as ginseng. Ginseng (Panax ginseng) was used by the Chinese as an aphrodisiac because its forked roots resemble the lower part of the human body. Native Americans brewed a type of tea from one species, Panax quinquefolius, and they ate the roots of the dwarf ginseng, Panax trifolius. Some plants referred to as Siberian, Manchurian and Brazilian ginseng do not belong to the Panax genus and so may not contain the agents in Panax ginseng to which its effects are attributed. The term ginseng usually refers to Panax ginseng also called Chinese or Korean ginseng and this is the most commonly used and tested variety of ginseng. It has been suggested that as many as six million Americans may use ginseng preparations. The name of the genus Panax is derived from the Greek word for panacea meaning ‘all healing’ and it is suggested that ginseng preparations have a number of diverse effects that promote general well-being. The active principles of ginseng are believed to be substances called ginsenosides which are saponins consisting of a steroidal triterpene and a sugar residue (triterpene glucuronides). Around a dozen of these ginsenosides have been identified Read more […]

Cerebrovascular Insufficiency And Depression

Atherosclerosis of the vasculature feeding the brain can lead to a condition known as cerebrovascular insufficiency. This chronic low-grade ischemia can impair memory or otherwise mimic dementia. It can also produce a syndrome resembling depression. This syndrome is surprisingly little discussed in the United States but is much more widely recognized in Europe. The treatment is obviously the same as for atherosclerosis anywhere in the body — elimination of the underlying dietary and lifestyle causes (especially sedentariness) and addition of supportive nutrients and practices (like meditation). Ginkgo biloba (ginkgo) leaf extracts have been very rigorously shown to help alleviate cerebrovascular insufficiency symptoms. This is almost certainly due to ginkgo’s ability to reduce the underlying atherosclerosis and improve neuron function despite ischemia. It also seems to stimulate blood flow to the brain, perhaps by acting on blood vessels. The usual dose of ginkgo standardized extract is 80-160 mg two or three times per day. It should be used attentively in patients taking anticoagulants as the combination occasionally but rarely may have a synergistic effect and cause bleeding. Gingko has also been shown to Read more […]

Iron Deficiency: Botanical Treatment

The use of various forms of elemental iron have been a part of both folk and Western medical herbal tradition for at least the past few hundred years, whether in the form of iron nails stuck in apples to infuse the apples with iron for consumption by pioneer women, or the use of ferrum supplements by the Eclectic physicians. As stated earlier, side effects from iron supplements are common. For pregnant women who may be experiencing GI symptoms due to the pregnancy itself, such as nausea, vomiting, or constipation, regular elemental iron supplements may be intolerable. Although there is almost no evidence in the literature evaluating the efficacy or safety of herbs used as “iron tonics,” their use is popular amongst herbalists, midwives, and pregnant women (Table Botanical Treatment Strategies for Iron Deficiency Anemia). Clinical observation has demonstrated a high level of efficacy and minimal side effects (see Case History) with a limited number of botanical supplements. The herbs in this section are those most commonly used in contemporary midwifery and herbal practice. Botanical Treatment Strategies for Iron Deficiency Anemia Therapeutic Goal Therapeutic Activity Botanical Name Common Name Provide Read more […]

Zingiber officinale

Roscoe (Zingiberaceae) Common Ginger Description Zingiber officinale Roscoe is an herbaceous plant that grows up to 1.2 m high and with an underground rhizome. The stem grows above ground and leaves are narrow, long, lanceolate, with distinct venation pattern and pointed apex. Flowers are white or yellowish-green, streaked with purple and fragrant. Origin Originate from tropical Asia, widely cultivated in the tropics. Phytoconstituents Gingerol, zingiberene, farnesene, camphene, neral, nerol, 1,8-cineole, geranial, geraniol, geranyl acetate and others. Traditional Medicinal Uses Ginger is the folk remedy for anaemia, nephritis, tuberculosis, and antidote to Arisaema and Pinellia. Sialogogue when chewed, causes sneezing when inhaled and rubefacient when applied externally. Antidotal to mushroom poisoning, ginger peel is used for opacity of the cornea. The juice is used as a digestive stimulant and local application in ecchymoses. Underground stem is used to treat stomach upset, nausea, vomiting, nose bleeds, rheumatism, coughs, blood in stools, to improve digestion, expel intestinal gas, and stimulate appetite. The rhizomes are used to treat bleeding, chest congestion, cholera, cold, diarrhoea, dropsy, dysmenorrhoea, 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: 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: Chitosan

Types, sources and related compounds Poliglusam. Pharmacopoeias Chitosan Hydrochloride (British Ph 2009, European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4). Constituents Chitosan is a polysaccharide composed of polymers of glucosamine and N-acetylglucosamine. It is obtained from the partial deacetylation of chitin obtained from the shells of crustaceans such as shrimps and crabs. It is available in different molecular weights, viscosity grades and degrees of deacetylation. Use and indications Chitosan is used as a dietary supplement for obesity and hypercholesterolaemia. Pharmaceutically, chitosan and various derivatives are used, or being investigated, as excipients in drug formulations including oral or nasal dosage forms and gene carrier systems. Pharmacokinetics Chitosan is an absorption enhancer and increases the permeability of peptide drugs across intestinal and mucosal epithelia, which has implications for drug delivery systems. A thiolated chitosan derivative is also reported to inhibit the activity of P-glycoprotein, which has possible applications for improving the bioavailability of P-glycoprotein substrates, but note that this derivative does not appear to be used as a dietary supplement. Interactions Read more […]