Drug Interactions

A probable interaction between warfarin and apanax ginseng product has been reported (13). A 47-year-old man with a St. Jude-type mechanical aortic valve had been controlled on warfarin with an international normalized ratio (INR) of 3.1 (goal 2.5-3.5). He experienced a subtherapeutic INR of 1.5 following 2 weeks of ginseng administration (Ginsana three times daily). Other medications included 30 mg of diltiazem three times daily, nitroglycerin as needed, and 500 mg of salsalate three times...

Cardiovascular Diseases

Ephedrine and pseudoephedrine share properties with cocaine and with the amphetamines because they (1) stimulate p-receptors directly, and (2) also cause the increased release of norepinephrine. Chronic exposure to abnormally high levels of circulating catecholamines can damage the heart. This is certainly the case with cocaine and methamphetamine (116,117), but ephe-drine-related cardiomyopathy is an extremely rare occurrence, occurring only in individuals who take massive amounts of drug for...

Cardiovascular Effects

EGb 761 at a dose of 200 mg administered to 60 patients intravenously for 4 days improved skin perfusion and decreased blood viscosity without affecting plasma viscosity (19). Another GB extract, LI 1730, increased blood flow in nailfold capillaries and decreased erythrocyte aggregation compared to placebo in 10 volunteers at a dose of 112.5 mg (26). Blood pressure, heart rate, packed cell volume, and plasma viscosity were unchanged. A study in subjects with type 2 diabetes mellitus complicated...

Methamphetamine Manufacture

Either (-)-ephedrine or (+)-pseudoephedrine can be used to make meth-amphetamine by reductive dehalogenation using red phosphorus as a catalyst. If (-)-ephedrine is used as the starting material, the process will generate (+)-methamphetamine. If psuedoephedrine is used, the result will be dextromethamphetamine (136). As this synthetic route has become nearly universal, both state and federal governments have enacted laws limiting the amount of pure ephedrine or pseudoephedrine that can be...

Pharmacological Effects

Studies have shown that resultant effects are similar, regardless of whether pure synthetic ephedrine or naturally occurring ephedra is ingested (24,25). There are, however, significant enantioselective differences between the enantomers in both pharmacokinetic and pharmacodynamic effects. All of the ephedra alkaloids have important effects on the cardiovascular and respiratory systems, but not to the same degree. Ephedrine, the predominant alkaloid in ephedra, is both an a and p stimulant. It...

Sources and Chemical Composition

Korean ginseng, Asian ginseng, Oriental ginseng, Chinese ginseng (7), Japanese ginseng, American ginseng (8). Note that the term ginseng can refer to the species of the genus Panax, as well as to Eleutherococcus senticosus (Siberian or Russian ginseng) (8). Unless otherwise noted, the information in this monograph refers specifically to species of the genus Panax. Depending on the particular botanical reference, there are three to six different species of Panax ginseng, and three with purported...

Products Available

Two commercial forms of the herb are available. White ginseng consists of the dried root and red ginseng is prepared by steaming the fresh, unpeeled root before drying (9). Many different formulations of the herb are available including capsules, gelcaps, powders, tinctures, teas, slices to eat in salads, and whole root to chew. There are also a wide variety of products that claim to contain ginseng such as ginseng cigarettes, toothpaste, cosmetics, soaps, beverages (including beer), candy,...

Nervous System Effects

The pharmacological basis of the effects of GBE on brain function has been addressed in a number of studies. One study (6) showed that dietary GBE 761 (prepared by the Henri Baeufour Institute) protected striatal dopaminergic neurons of male Sprague-Dawley rats from damage caused by (MPTP). MPTP, which has caused Parkinsonism in young drug abusers, is thought to damage these neurons through formation of free radicals. The mechanism of GBE's protective effect was attributed to an antioxidant...

Antimicrobial Activity

Garlic has in vitro activity against many Gram-negative and Gram-positive bacteria, including species of Escherichia, Salmonella, Staphylococcus, Streptococcus, Klebsiella, Proteus, Bacillus, Clostridium, and Mycobacterium tuberculosis. Even some bacteria resistant to antibiotics, including methicil-lin-resistant Staphylococcus aureus, multidrug-resistant strains of Escherichia coli, Enterococcus spp., and Shigella spp. were sensitive to garlic (40). Activity against H. pylori is discussed in...

Current Promoted Uses

Physicians routinely used intravenous ephedrine for the prophylaxis and treatment of hypotension caused by spinal anesthesia particularly during cae-sarean section (9). In the past, ephedrine was used to treat Stokes-Adams attacks (complete heart block), and was also recommended as a treatment for narcolepsy. Over the years, ephedrine has been replaced by other, more effective agents (10), and the advent of highly selective -agonists has mostly eliminated the need to use ephedrine in treating...

Pharmacological Toxicological Effects 51 Endocrine Effects

P. ginseng may exert hypoglycemic effects possibly by accelerating hepatic lipogenesis and increasing glycogen storage (16-18). In a study of 36 newly diagnosed patients with type II diabetes, ginseng at a dose of 200 mg daily exerted a statistically significant benefit on glycosylated hemoglobin (HbA1c) compared to 100 mg of ginseng daily or placebo after 8 weeks of therapy, and patients receiving 100 mg of ginseng had smaller mean fasting blood glucose levels than patients taking 200 mg of...

Pharmacological Toxicological Effects 51 Immunological Effects

The majority of literature published about Echinacea focuses on its activity as an immunostimulant. Many of the studies focus on the activity of macrophages and Echinacea's ability to activate and stimulate immune function. One constituent of Echinacea, the polysaccharide arabinogalactan, has been identified as a macrophage activator in vitro, causing macrophages to attack tumor cells and microorganisms. When injected into mice intraperito-neally, arabinogalactan was able to activate...

Pharmacological Toxicological Effects 51 Neurological Effects

The neurological effects of kava are attributed to a group of substituted dihydropyrones called kava lactones (1). The main bioactive constituents include yangonin, desmethoxyyangonin, 11-methoxyyangonin, kavain (kawain), dihydrokavain, methysticin, dihydromethysticin, and 5,6-dehydromethysticin (8). It is believed that the components present in the lipid-soluble kava extract, or kava resin, are responsible for the central nervous system (CNS) activities of kava including sedation, hypnosis,...

Regulatory Status

OEP is regulated as a dietary supplement in the United States. It is approved in Canada as an over-the-counter product for use in EFA-deficiency conditions and as a dietary supplement to increase EFA intake. In the United Kingdom, it is on the General Sales List. In Germany, OEP is approved for use as food and is approved there in the treatment and symptomatic relief of atopic eczema. In Sweden, OEP is classified as a natural product. OEP has a Class 1 Safety Rating with the American Herbal...

Adverse Effects and Toxicity 71 Reproductive System

There has been a theoretical concern with regard to pregnant women taking valerian because of possible effects on uterine contractions (1), but no problems were noted in three cases of intentional overdose with 2-5 g of valerian during weeks 3-10 of pregnancy (33). A mentally retarded child was born to a woman who overdosed on valerian 3 g, phenobarbital, glutethamide, amobarbital, and promethazine at 20 weeks of gestation, but this same woman delivered a mentally retarded child 2 years later...

Pharmacological Toxicological Effects 51 Dermatological Effects

Clinical evidence of nutritional supplementation with OEP to correct dermal conditions is mixed. One theory for the mixed results is that in some persons, once sensitized, immunological factors may override what help OEP can offer. Very high doses of OEP or linoleic acid, or modest doses of y-linolenic acid, with corresponding correction of plasma EFA levels, produce some clinical improvement (8). A defect in the capability of the enzyme 8-6-desaturase to convert linoleic acid to y-linolenic...

Pharmacological Toxicological Effects 51 Insomnia

Several studies have examined the effects of valerian on sleep (10-15). Donath and colleagues performed a randomized, double-blind, placebo-controlled, cross-over study assessing the short-term (single dose) and long-term (14-day multiple dosage) effects of valerian extract on sleep structure and sleep quality. There were significant differences between valerian and placebo for parameters describing slow-wave sleep (SWS) and shorter sleep latency, with very low adverse events. Leathwood and...

History

Ephedra, and other medicinal plants have been identified at European neanderthal burial sites dating from 60,000 BCE (1). Thousands of years later, Pliny accurately described the medicinal uses of ephedra. But thousands of years before Pliny, traditional Chinese healers used ephedra extracts. Chinese texts from the 15 th century recommended ephedra as an antipyretic and antitussive. In Russia, around the same time, extracts of ephedra were used to treat joint pain and though recent laboratory...

References

Herbal research review vitex agnus castus. Clinical monograph. Q Rev Nat Med 1994 2 111-121. 2. Hobbs C. The chaste tree Vitex agnus castus. Pharm Hist 1991 33 19-24. 3. Foster S. A Field Guide to Western Medicinal Plants and Herbs. Boston Houghton Mifflin Co., 2002. 4. Du Mee C. Medicinal plant review vitex agnus castus. Aust J Med Herbalism 1993 5 63-65. 5. Jellin JM, Gregory, P, eds. Natural medicines comprehensive database. Stockton Therapeutic Research Faculty, 2003....

Pharmacological Toxicological Effects

John's wort is not known. It is composed of many different compounds. The concentrations of these chemicals vary from brand to brand and batch to batch. Hyperforin, hypericin, and pseudohypericin are considered by most to be the major active ingredients. Hypericin, pseudohypericin, isohypericin, protohypericin, protopseudohypericin, and cyclopseudohypericin are all anthraquinone derivatives (naphthodianthrones) (1-5). Hyperforin and adhyperforin are both prenylated...

Garlic Allergy

Allergic reactions to garlic have also been reported in the literature. Garlic allergy can manifest as occupational asthma, contact dermatitis, urticaria, angioedema, rhinitis, and diarrhea. A 35-year-old woman experienced several episodes of urticaria and angioedema associated with ingestion of raw or cooked garlic, as well as urticaria from touching garlic. Two garlic extracts as well as fresh garlic produced a 4+ reaction on skin prick tests (SPTs) in this patient, but no other food...

Pharmacological Toxicological Effects 51 Cardiovascular Effects

Hawthorn extracts purportedly dilate coronary blood vessels, decrease blood pressure, increase myocardial contractility, and lower serum cholesterol (9). Benefits have been demonstrated in patients with heart failure (10). In patients with stage II New York Heart Association (NYHA) heart failure, doses of 160-900 mg day of the aqueous-alcoholic extract for up to 56 days showed an increase in exercise tolerance, decrease in rate pressure product, and increased ejection fraction (11). Degenring...

Toxicoloqy and Clinical Pharmacoloqy

Kingston, PharmD Herbal Products Toxicologyand Clinical Pharmacology, Second Edition, edited by Timothy S. Tracy and Richard L. Kingston, 2007 Criminal Poisoning Investigational Guidefor Law Enforcement, Toxicologists, Forensic Scientists, and Attorneys, Second Edition, by John H. Trestrail, III, 2007 Forensic Pathology of Trauma Common Problems for the Pathologist, by Michael J. Shkrum and David A. Ramsay, 2007 Marijuana and the Cannabinoids, edited by Mahmoud...

Dean Filandrinos Thomas R Yentsch and Katie L Meyers

John's wort has demonstrated clinical efficacy for mild to moderate depression and compares favorably to other more potent or toxic antidepressants. Low side effects and potential benefits warrant its use as a first-line agent for select patients with mild to moderate depression or anxiety-related conditions. Benefits related to other reported uses such as an antimicrobial, agent to treat neuropathic pain, antiinflammatory, treatment alternative for atopic dermatitis, and antioxidant are...

Case Reports of Toxicity Caused By Commercial Kava Products

Kava dermatopathy in association with traditional use of kava is well described in the literature 3 . In addition, two cases of dermopathy have recently been associated with commercially available kava products 26 . A 70-year-old man who had been using kava as an antidepressant for 2-3 weeks experienced itching, and later erythematous, infiltrated plaques on his chest, back, and face after several hours of sun exposure. Skin biopsy revealed CD8 lymphocytic infiltration with destruction of the...

Interactions

John's wort has been shown to have many interactions with other drugs. Although one study found that St. John's wort has no effect on the cytochrome P450 CYP enzyme system 62 , most studies have shown it is a potent inducer of CYP3A4, and some studies have shown it induces CYP1A2 and CYP2C9 3,63-67 . Other studies have not supported the induction of CYP1A2 and CYP2C9 by St. John's wort 68 . Induction of CYP3A4 is of the greatest concern because it is an important enzyme involved with the...