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Name four herbs used for BPH
- saw palmetto
- pygeum
- pumpkin
- stinging nettle
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Serenoa repens
saw palmetto
-
saw palmetto MOA
Inhibits 5-alpha reductase types 1 and 2
-
saw palmetto dosage
- 320 mg QD or 160 mg BID
- takes 4-6 weeks to work
-
saw palmetto safety/adverse effects
case report of bleeding; avoid in pregnancy; GI
-
saw palmetto drug interactions
- androgenic drugs
- anti-androgenic drugs
-
saw palmetto active compound
beta-sitosterol
-
saw palmetto part of plant used
berry
-
-
pygeum MOA
might inhibit growth factors
-
pygeum dosage
- 75-200 mg/day; may be taken QD or BID
- takes a few months to work
-
pygeum safety/adverse effects
-
pygeum drug interactions
NA
-
pygeum active compound
- 14% triterpenes
- 0.5% docosanol
-
pygeum part of plant used
bark
-
Cucurbita pepo
Cucurbita moschata
pumpkin
-
pumpkin dosage
480 mg/day in 3 divided doses taken with saw palmetto
-
pumpkin safety/adverse effects
electrolyte imbalance
-
pumpkin drug interactions
diuretics
-
pumpkin part of plant used
seed
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Urtica dioica
stinging nettle
-
-
stinging nettle dosage
- 300 mg capsule BID for 6-9 weeks
- 80mg extract/day with saw palmetto
-
stinging nettle safety/adverse effects
potential with diuretics and/or hypertensive agents
-
stinging nettle active compounds
"nothing really special" (chlorogenic acid and kaempferol, also found in apples)
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stinging nettle parts of plant used
- roots --> used for BPH
- leaves
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Name two herbs used for UTI
-
Vaccinium marcrocarpon
cranberry
-
cranberry MOA
- urine acidification
- e.coli adhesion
-
cranberry dosage
- 8-16 oz of pure juice/day for prevention of UTI
- not as good evidence for treatment
-
cranberry safety/adverse effects
good, but could be risky for those who form kidney stones easily
-
cranberry drug interactions
possibly warfarin
-
cranberry active compound
anthocyanins (antioxidant, anti-inflam.)
-
cranberry part of plant used
berry
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Arctostaphylos uva-ursi
bearberry
-
bearberry MOA
antibacterial, urinary antiseptic for uncomplicated cystitis
-
bearberry dosage
3 g/day of dried leaf = 400-800mg arbutin/day until disappearance of symptoms (maximum of 12 weeks)
-
bearberry safety/adverse effects
Nausea/vomiting (due to high tannin content)
-
bearberry drug interactions
corticosteroids, diuretics, NSAIDs
-
bearberry active compound
arbutin - sugar breaks down in alkaline urine to hydroquinone (anti-microbial)
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bearberry part of plant used
leaves
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Name 6 herbs with gynecological indications
- chasteberry
- black cohosh
- soy
- red clover
- dong quai
- wild yam
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Vitex agnus castus
chasteberry
-
chasteberry indications
- menstrual irregularities
- menopause/PMS symptoms
- female infertility
-
chasteberry MOA
acts at dopamine receptors to prevent prolactin formation
-
chasteberry dosage
- 30-40 mg/d extract
- 500mg TID powdered berries
- single dose each morning before breakfast throughout the cycle
-
chasteberry safety/adverse effects
- well-tolerated
- allergic reactions
- headaches
- increase in menstrual flow
-
chasteberry drug interactions
- AVOID with dopamine agonists/antagonists
- AVOID during pregnancy and lactation
-
chasteberry active compound
agnuside - not active compound but marker compound (quality measure)
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chasteberry part of plant used
dried, ripe berries
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Cimifuga racemosa
black cohosh
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black cohosh indications
symptoms of menopause (hot flashes, mood swings, fatigue)
-
black cohosh MOA
SERM effects (can be estrogenic or anti-estrogenic in tissues)
-
black cohosh dosage
- ethanol extract: 40 mg of dried rhozome/root/day
- remifenin: standardized extract = each 20 mg tablet contains 1mg active compound = 40 mg/day
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black cohosh safety/adverse effects
- no GRAS status (“undefined” safety)
- GI upset due to high tannins
- may cause liver disease
- may cause hypotension
-
black cohosh drug interactions
- contraindicated in pregnancy
- use for no more than 6 months due to lack of long-term data
- use cautiously in breast cancer, uterine cancer
- allergy to aspirin
- contraindicated in patients with known estrogen sensitive condition
- atorvastatin
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black cohosh active compound
deoxyactein
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black cohosh part of plant used
rhizome
-
-
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soy dosage
- soy protein: 20-60 g
- concentrated soy isoflavone extracts: providing 35-120mg isoflavones daily
-
The beneficial components of soy
fatty acids
-
What should the ratio of omega-6 to omega-3 be?
2:1
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active compound of both soy and red clover
isoflavone
-
Effects of phytoestrogens in human health
- Cancer preventive
- Post-menopausal supplement
- Prevention of osteoporosis
- Cardiovascular health
-
Trifolium pratense
red clover
-
red clover part of plant used
flowering tops
-
red clover (isoflavones) dosage
- hormone replacement: 40-80mg/day
- hypercholesterolemia: 28.5mg, 57mg, 85.5mg/day
- osteoporosis: 40mg/day
- menopausal symptoms: 40mg, 80mg, or 160mg/day
-
Two therapies for hot flashes that do not work very well, if at all
-
Angelica sinensis
dong quai
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What are some traditional uses of dong quai (but probably don't work well, if at all)?
- dysmenorrhea
- premenstrual syndrome (PMS)
- menopausal symptoms
- (doesn't work because dong quai doesn't contain any phytoestrogens)
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What does dong quai contain that increases bleeding risk?
Coumarin derivatives
-
dong quai dosage
4.5g of powdered dong quai root
-
dong quai safety/advers effects
- well tolerated
- risk of photodermatitis (psoralen derivatives)
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Disocorea species
wild yam
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Uses for wild yam
- menopausal complaints
- osteoporosis
- precursor for commercial chemical synthesis of human steroidal hormones
- (however wild yam is not good for any of these because diosgenin does not convert into progesterone in the body)
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Wild yam applied topically is no better than placebo. True or false?
True
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Name 7 natural products with CV indications
- garlic
- red yeast rice
- oat bran
- artichoke
- hawthorn
- fish oil
- horse chestnut
-
-
garlic indication
atherosclerosis
-
garlic MOA
- regular garlic inhibits HMG-CoA (cholesterol lowering effect)
- aged garlic scavenges reactive oxygen species (ROS)/free radicals (antioxidant effect)
- aged garlic stimulates immune system
-
garlic dosage
- 600-900mg tabs or caps daily
- odorless formulations other than EC tabs may be less effective
- must be taken for 6 wk-2 mo for maximal effect
- dried garlic leaves require enteric coating
-
garlic safety/adverse effects
- GRAS status
- GI upset and odor
-
garlic drug interactions
- can enhance effects of warfarin
- Norvir (GI toxicity)
- Saquinavir (decreased effectiveness)
-
garlic active compound
allicin (gives garlic odor- odiferous)
-
garlic part of plant used
root
-
Monascus purpureus
red yeast rice
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red yeast rice indication
high cholesterol
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red yeast rice MOA
HMG-CoA reductase inhibition
-
red yeast rice dosage
- Traditional dosage: 6-9g/day
- Recommend dose (extract): 1.2g/day
- Cholestin capsule contains 600 mg of red yeast rice (off the market)
- (NOTE: Dr. Butterweck does not recommend red yeast rice. Suggest garlic or prescription statin instead.)
-
red yeast rice safety/adverse effects
mild: heartburn, flatulence, dizziness
-
red yeast rice drug interactions
- additive effect with statins and grapefruit juice
- not recommended in pregnancy
-
red yeast rice active ingredient
Monacolin K or mevinolin
-
-
oat part of plant used
- oat brain (mostly)
- seeds
- straw
-
oat indications (orally)
- hypercholesterolemia
- diabetes
- lowering uric acid levels (may prevent gout)
-
oat indications (topically)
- seborrhea
- dry and itchy skin
-
oat active compound
- beta-glucan (oat gum)
- builds a 3-dimensional network that will form a gel
- a water-soluble polysaccharide
-
oat MOA (due to beta-glucan)
- binds with bile acids
- decreases cholesterol absorption
- increases the viscosity of foods (delay absorption of food)
-
oat dosage
hypercholesterinaemia: 56-150g of whole oat products
-
Under what conditions can the health claim for an oat products to claim it reduces the risk of heart disease?
- if they contain at least 750mg of soluble fiber per serving
- approximately 3g of soluble fiber taken daily
-
Cynara scolymus
artichoke
-
artichoke part of plant used
leaves from the stems
-
artichoke indications
mild to moderate hyperlipidemia (lipid lowering effects)
-
artichoke MOA
HMG-CoA reductase inhibition
-
artichoke dosage
artichoke leaf extract: 320-640mg PO TID
-
artichoke safety/adverse effects
- mild GI disturbances
- allergic reactions
- allergic contact dermatitis
-
artichoke drug interactions
- no interactions with other medications reported
- no toxic effects reported due to overdose
- no restriction on duration of treatment
- GRAS
-
Crataegus species
hawthorn
-
hawthorn part of the plant used
leaves and flowers (high in flavonoids)
-
Two species of hawthorn
- Crataegus monogyna
- Crataegus laevigata
-
hawthorn standardization
flavonoids: 0.6-1.5% (calculated as hyperoside)
-
hawthorn active compound
proanthocyanidins (OPCs)
-
hawthorn indications
- hydroalcoholic extracts: declining cardiac performance (NYHA Class II)
- herbal teas: nervous heart complains, support of cardiac and circulatory function
-
hawthorn safety/adverse effects
- in general, very well tolerated
- mild GI complaints (due to high tannin content)
- mild vertigo
- mild headache
- mild sleeplessness
- safe, when used short-term (e.g., 6 months)
- avoid use during pregnancy and lactation
- no toxic effects reported during overdose
-
hawthorn drug interactions
- conventional cardiovascular drug therapy
- no reported
-
Hawthorn can be safely used with diuretics and laxatives. True or false?
True.
-
hawthorn MOA
- increases force of contraction and lengthens refractory period
- increases coronary blood flow and cardiac output and reduces oxygen consumption
- increases membrane permeability for calcium and phosphodiesterase inhibition
- increases cAMP (vasodilation and positive isotropic effects)
-
hawthorn dosage
- 160-900 hawthorn extract per day in 2-3 divided doses
- use 4 to 8 weeks to determine benefit
- Note: Dr. Butterweck recommends 900mg/day
-
benefits of omega-3 EPA/DHA in fish oil
- heart health
- brain development
- brain function
- asthma
- visual acuity
- immune function
- arthritis
- skin & hair health
-
fish oil dosage
- two 4 oz. serving of fatty fish per week
- 496mg of EPA+DHA [er dau
- total EPA+DHA consumption of 56-100mg/day
-
horse chestnut active compound
- terpenoid compounds (escin, aka aescin)
- coumarin derivative (e.g., aesculin from the bark, leaves twigs)
-
horse chest nut standardization
16-20% triterpene glyycosides calculated as escin (aescin)
-
horse chestnut indication
vericose veins (chronic venous insufficiency)
-
horse chestnut dosage
300 to 900mg of a 16% extract
-
horse chestnut safety/adverse effects
- FDA status: unsafe herb
- Toxicity: attributed to the glycoside Aesculin, a warfarin-like structure (dilation of pupils, diarrhea, vomiting, paralysis)
-
horse chestnut drug interactions
- anticoagulants (theoretically)
- no interaction reported
- not to be used in pregnancy and lactation (applies to most every plant)
-
Aesculus hippocastanum
horse chestnut
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Latin name and English name: Cort.
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Latin name and English name: Fol.
- folium, folia
- leave, leaves
-
Latin name and English name: Frct.
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Latin name and English name: Pericarp.
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Latin name and English name: Rad.
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Latin name and English name: Rhiz.
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Latin name and English name: Sem.
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Latin name and English name: Flor.
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Chemically defined constitutuents of herbal drugs of interest for control purpoces only.
- marker substances
- (may be independent of whether they have any therapeutic activity or not)
-
Defined as all measures during manufacturing process and quality control to yield reproducibility.
standardization
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Parameters influencing extract composition (i.e., extract quality) related to HERB MATERIAL
- extractive concentration
- water content
- drug particle size
- powder fraction
-
Parameters influencing extract composition (i.e., extract quality) related to SOLVENT EFFECTS
- solvent type(s)
- modifier concentration
- solvent amount
- flow-through rate
-
Parameters influencing extract composition (i.e., extract quality) related to MANUFACTURING PLANT
- filling amount
- filling height (density)
- static pressure
-
Parameters influencing extract composition (i.e., extract quality) related to MANUFACTURING PROCEDURE
- extraction mode
- extraction time
- extraction pressure
- batch size
-
Extracts prepared from the same (plant) material are similiar. True or false?
False. Not necessarily.
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Describe 5 ramifications of the Dietary Substance Health Education Act
- Food Safety Division of the FDA regulates herb products, not the Drug Division
- No safety or efficacy tests required, but manufacturer is responsible for safety
- No adverse event report to FDA necessary
- No TREATMENT claim, but "structure-function" claims are acceptable
- To halt sale or distribution, the FDA must prove that the product is "unsafe" (i.e., the manufacturer does not)
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Herbal medications may be produced ___________ the assurance of compliance standards for Good Manufacturing Practice.
without
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Herbal medications may be marketed ____________ prior approval of EFFICACY and SAFETY from the Food and Drug Administration (FDA).
without
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Name two reputable resources regarding herbal medicines.
- Germany's Commission E
- ESCOP Monographs
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