Herbal Medicines

  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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)
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. Avoid Use In
    • Infants
    • Children
    • Pregnancy/lactation
    • Patients with plant allergies
Card Set
Herbal Medicines
Herbal Medicines