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Herbal Products
- A plant that has a fleshy stem and without a permanent woody tissue as distinguished from shrubs and trees
- May include a plant part/extract or mixture of these used to prevent, alleviate, or cure disease
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Case Against Herbal Medicine
- Lack of FDA Regulation and Oversight
- Lack of dosage standardization
- Potential for adulteration
- Potential for toxicity and drug interactions: natural is not always safer
- More effective therapy may be delayed
- Many herbs are not superior to prescription medicines
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Dosage Forms
- Fresh or dried product
- Water extractions (teas or infusions)
- Decoction – involves crushing herb first (stronger liquid)
- Solvent Extractions
- Tinctures
- Liquid or solid extracts
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Asian or American Ginseng
- Protect against common cold *, ↑ activity of flu vaccine
- Lower blood glucose
- Improve sexual function
- Improve mental performance
- MOA - immunostimulant, decrease insulin resistance, stimulate insulin release
- Adverse effects - hypoglycemia, in vivo antiplatelet, insomnia
- Interactions - ↓warfarin, ↑ hypoglycemics
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Black Cohosh
- Used for menstrual irregularities, premenstrual syndrome, and to induce labor
- Study results still mixed on effectiveness
- USP suggests that women with liver damage should not use Black Cohosh
- Safety for women with hormone sensitive conditions unknown
- SE’s – stomach discomfort, HA, rash
- Risk of interactions minimal
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Dong Quai Root
- Effectiveness unknown
- Relieve symptoms of menopausal symptoms
- Heart disease – used in combination with Asian ginseng and astralagus
- SE - photosensitivity
- Essential oil contains cancer causing substances
- Contraindicated for those with hormone sensitive conditions
- Interactions – may ↑ effects of warfarin & other herbs
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Echinacea
- Used to treat or prevent colds - may slightly reduce symptom severity or duration if taken when symptoms first noticed and continued for 7 – 10 days
- Recurrent vaginal candidiasis prevention – likely effective
- Ragweed cross-hypersensitivity
- MOA - immunostimulant, antifungal, antiinflammatory
- Adverse effects – allergic reactions
- Interactions – may ↓ effectiveness of medications that suppress immune system
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Feverfew
- Migraine headaches, arthritis, fever
- Parthenolide – may relieve smooth muscle spasms, prevent vasoconstriction of vessels in brain, inhibit actions of compounds that cause inflammation and cancer growth
- SE – GI symptoms, bleeding (inhibit platelet activity)
- Contraindicated in pregnancy, breastfeeding and children < 2
- Withdrawal symptoms if abruptly stopped
- Interactions - warfarin
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Flaxseed
- Seeds and oil contain alpha-linoleic acid (omega-3 fatty acid), lignans – phytoestrogens that may protect body from cancer
- ↑ cholesterol, heart disease, menopausal symptoms, colon cancer, prostate cancer, skin cancer
- Laxative effect (fiber and mucilage content)
- May ↓ rate of absorption of other medications if taken at the same time
- Interactions – may ↑ effects of warfarin, aspirin; insulin/oral diabetic agents, may alter effects of HRT & oral contraceptives
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Garlic
- Prevention of atherosclerosis, high cholesterol, hypertension, improve immune function, and may protect against cancer
- May ↓ homocysteine and C-reactive protein
- Rich in antioxidants (destroy free radicals)
- Prevent and treat common cold
- Reduce side effects of chemotherapy
- Low toxicity – can ↑ risk of bleeding
- SE – GI symptoms, HA, fatigue, vertigo, allergies
- Interactions – antiplatelet, anticoagulants, protease inhibitors
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Ginger
- Active components – phenol compounds (gingerols)
- Short term use – relief of N/V during pregnancy
- Studies mixed about effectiveness for N/V in motion sickness, chemotherapy, or following surgery
- Unclear about effectiveness in treating RA, OA or joint/muscle pain, CAD
- Ongoing research into effects of ginger on inflammation
- Minimal SE if taken in small doses; gas, bloating, heartburn
- Interactions – anticoagulants
- Contraindications – persons with gall stones
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Gingko Biloba
- Mixed results for treating dementia – may enhance memory in older adults, intermittent claudication – dilates blood vessels & ↓ platelet aggregation (walking as effective)
- Use in glaucoma and macular degeneration – some evidence to slow down these
- Improvement in functional measures in MS; relief of tinnitus
- Leaves contain potent antioxidants (flavenoids)
- Minimal SE – HA, GI upset, dizziness, allergic rxn’s, ↑risk of bleeding
- Contraindicated during pregnancy & breastfeeding
- Interactions – anticonvulsants (↓ seizure threshold), SSRI’s (serotonin syndrome), MAOI’s, CCB’s (↓ BP), anticoagulants, NSAID’s, ↑ insulin levels, thiazides, trazadone, cyclosporine
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Goldenseal
- Few studies published on goldenseal – little evidence
- Contains berberine – kills bacteria, fungi, parasites, activates WBC’s, often used with echinacea
- Used in URI’s, minor wounds (antiseptic), eye, mucous membrane and infectious conditions, sore throats, canker sores
- Used in tablet or tincture form
- Not to be used in pregnancy or breastfeeding
- Interactions – tetracycline, anticoagulants
- May affect metabolism of certain drugs – antivirals used in HIV
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Saw Palmetto
- Primarily used for BPH – may affect testosterone and ↓ an enzyme responsible for growth of prostate cells
- Studies mixed on effectiveness over that of finasteride (Proscar)
- Most effective in capsule form
- Side effects - include nausea, diarrhea, headache impotence
- Cautions - include false negative PSA
- May interfere with iron absorption
- Interactions – finasteride, antiplatelet and anticoagulants
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St. John’s Wort
- Some evidence that it may be useful in treatment of mild to moderate depression – SAD (seasonal affective disorder)
- Also some evidence for use in PMS, menopause
- SE – photosensitivity, dry mouth, dizziness, anxiety, GI symptoms, fatigue, HA, sexual dysfunction
- Interactions – antidepressants (SSRI’s & TCA’s), oral contraceptives, cyclosporine, digoxin, drugs used to treat HIV, anticonvulsants, anticoagulants, antihistamines, dextromethorphan, barbiturates, benzodiazepines, sleep agents, alcohol, Triptans (used for migraines), antifungals, statins, and some CCB’s
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Valerian
- Used for sleep disorders and anxiety; also used for HA, depression, irregular heartbeat, and trembling
- May increase GABA
- Mixed results on studies which confirm effectiveness
- For insomnia – may need to use for one month before effects are seen
- Generally regarded as safe
- Mild SE – HA, dizziness, GI upset, and some fatigue after use
- Interactions – can ↑ sedating effects of some drugs – anticonvulsants, barbiturates, benzodiazepines, other drugs to treat sleep disorders, TCA’s and alcohol, anesthetic agents
- Metabolized by liver enzymes which also help break down antihistamines, statins and antifungals
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Kava Kava
- Reported to have effects similar to alcohol – produces a feeling of relaxation, mood elevation and may be useful in treatment of anxiety and insomnia
- Serious concerns about liver damage – reports of hepatitis, cirrhosis, & liver failure after limited use
- Some countries have taken it off the market
- Still available in US, but FDA issued a consumer alert in 2002
- Many interactions – anticonvulsants, alcohol, anti-anxiety agents, diuretics, phenothiazines, levodopa
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Ma Huang (Ephedra)
- Ingredient in dietary supplements until 2004 – FDA banned US sales
- Used for weight loss, energy, and improved athletic performance
- Increased risk of cardiac, psychiatric, GI problems, seizures, ↑ BP, & stroke (reason for ban)
- Products regulated as drugs that contain chemically synthesized ephedrine are not dietary supplements - not covered by this rule
- These include drugs used for the short-term treatment of asthma, bronchitis, and allergic reactions
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Coenzyme Q10 (Ubiquinone)
- CHF, HTN, cardiac reperfusion, 2nd MI prevention – may be beneficial
- “Statin” induced myopathies – need more studies
- MOA - naturally occurring substance used by cells in the production of ATP, which is used in cell growth and maintenance processes, antioxidant, membrane stabilizer, ↓ TC, & LDL, ↑HDL & Vitamin E levels
- Adverse reactions of concern – none noted
- Interactions – anticoagulants (similar to Vitamin K), antihypertensives (additive effect), chemotherapeutic agents (may ↓ effctiveness)
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Creatine
- Enhanced muscle mass or strength - may ↑ anaerobic capacity; may be useful for high-intensity, short-duration exercise, but it has not proven to be effective in endurance sports
- MOA - increases stores of naturally occurring substance phosphocreatine, precursor to ATP molecule
- Adverse effects - dehydration, heat intolerance, electrolyte imbalance, seizures, muscle tears, kidney or liver dysfunction
- Interactions
- Contraindicated with diuretics
- Electrolyte imbalance & dehydration
- Nephrotoxic with drugs with similar effects
- Ephedra, caffeine - ↑ risk of stroke
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Glucosamine
- Used in osteoarthritis – likely effective
- As effective as 1200mg ibuprofen/day
- Onset of action delayed compared to ibuprofen
- DJD – may be beneficial
- MOA
- Supplementation provides more endogenous “building blocks” required for production of substances within joint and cartilage, may inhibit pancreatic beta cells, may impair glucose uptake and metabolism
- Adverse reactions – hyperglycemia
- Interactions – antidiabetic agents, anticoagulants if used with chondroitin (structurally similar to heparin
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Omega-3 Fatty Acids
- ↓triglycerides levels, ↑ or no change to LDL cholesterol - effective
- ↓ incidence of CV disease and events (MI, stroke), slows the progression of atherosclerosis – likely effective
- HTN – likely effective
- MOA - anti-inflammatory, decreases platelet aggregation & vasoconstriction, decrease VLDL synthesis
- Adverse effects - fishy aftertaste (take with meals to help tolerate), 3 gm or more/day may increase risk of bleeding, suppress immune system
- Drug interactions of concern - anticoagulants, anti-hypertensives
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Zinc
- ↓ duration of common cold – inconclusive
- Zinc gluconate - ingest w/in 24 hours of onset
- Adverse effects of concern
- Long term use may increase risk of prostate cancer, chronic toxicity possible (copper deficiency, depressed immune function, HA, nausea, fatigue), taste disturbances
- Drug interactions of concern
- Fluoroquinolones, tetracycline - decrease bioavailability, administer 2 hours before or 4 hours after
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Patient Education
- Natural does not equal safe
- Herbs used for medicinal purposes are drugs
- Risk/benefits often unknown
- Ingredient quality or quantity not monitored
- Always inform health care provider of use of supplements, herbals, and OTC’s
- As nurses – we need to ask about the use of these substances directly
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Avoid Use In
- Infants
- Children
- Pregnancy/lactation
- Patients with plant allergies
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