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DIETARY

SUPPLEMENTS AND HERBAL MEDICATIONS


Dr. Aben

Objectives:
By the end of the lecture, learner should be able to:

Contrast the regulations of botanicals and nutritional


supplements with those of therapeutic drugs

List several of the most widely used botanical


products, and describe their intended medical uses,
adverse effects, and potential for drug interactions.

Describe the intended medical uses and adverse


effects of several purified nutritional supplements.

Describe the process of herbal medicine development


in the Philippines.

List several herbal medicines being used in the


Philippines.

HISTORY OF PHARMACOLOGY
Prehistory
Egypt, China, India recognition of beneficial and toxic effects
from plant and animal material; most were worthless and harmful

th
End of 17 Century
Reliance on observation and experimentation
Development of materia medica - science of drug preparation and
the medical use of drugs
Limitation: lack of
Methods of purifying active agents
Methods of testing hypothesis on MOA

th

th

Late 18 and 19 Century


Francois Magendie and Claude Bernard development of
methods for experimental pharmacology and physiology

1940s and 50s
Introduction of rational therapeutics and controlled clinical trial
accurate evaluation of therapeutic claims

Last 30 - 50 years
Increased information on receptor pharmacology (identification
and drug development), molecular mechanisms of action, orphan
receptors, pharmacogenomics (relationship of genetics and drug
response)


2 Basic Principles
1. All substances can, under certain circumstances
be toxic (including chemicals in botanicals)
(as to dose or intrinsic chemical activity)
2. all dietary supplements and all therapies
promoted as health-enhancing should meet the
same standards of efficacy and safety as
conventional drugs and medical therapies
Good Evidence Good Medicine


Examples of Modern Medicines Derived from Plant Sources
Medicine
Common name Scientific name Indication
of plant
of plant
Aspirin

Bark of the
white willow

Salix alba

Treatment of fever, pain, inflammatory conditions and


Kawasaki disease; prevention of thromboembolism

Oseltamivir
Atropine

Star anise
Belladonna

Tiotropium
bromide

Belladonna

Illicium verum
Atropa
belladona
Atropa
belladona

Treatment and prevention of Influenza A and B


Antidote for overdose of cholinergic drugs and
organophosphate pesticides; treatment of bradycardia
Maintenance treatment of bronchospasm associated with
chronic obstructive pulmonary disease

Digoxin

Purple foxglove

Digitalis
purpurea

Treatment of heart failure; slows ventricular rate in atrial


fibrillation

Drug Development and Evaluation



it is after phase 3 that a drug is sold to the market
and is given a generic name, brand name, and a
chemical name

Mechanism of action
Decreases production of prostaglandins and TXA2 due to
its irreversible inactivation of the cyclooxygenase
enzyme
Inhibits neuraminidase
Inhibits muscarinic actions of acetylcholine on structures
innervated by postganglionic cholinergic nerves
Inhibits muscarinic actions of acetylcholine on structures
innervated by postganglionic cholinergic nerves
Inhibits Na+/K+ pump in cardiac myocytes

Medicine

Common name of
plant

Scientific name
of plant

Indication

Mechanism of action

Warfarin

Sweet clover silage

Melilotus

Prevention of deep vein thrombosis and


pulmonary embolism

Inhibits vitamin K epoxide reductase component 1 of vitamin K to its


active form

Artemisinin

Qinghaosu

Inhibition of a parasite Ca+ dependent ATPase

Paclitaxel

Pacific yew

Artemisia
Treatment of chloroquine-resistant
annua
falciparum malaria
Taxus brevifolia Treatment of breast cancer

Vincristine

Periwinkle

Vinca rosea

Treatment of numerous types of cancer

Binds with tubulin and inhibits its polymerization into microtubules,


causing arrest at metaphase

Quinine

Cinchona bark

Cinchona
officinalis

Alternative treatment of severe malaria in Inhibits hemozoin biocrystallization in heme detoxification pathway,
combination with other antimalarials
which facilitates the aggregation of cytotoxic heme

Metformin

French lilac

Galega
officinalis

Treatment of type 2 diabetes mellitus and Reduction of hepatic glucose production and renal glucogenesis
polycystic ovary syndrome



Introduction
Dietary supplements - include botanical and herbal medications; available without
prescription; considered as nutritional supplements
-marketed without premarketing review of efficacy or safety and little
government oversight of purity, variations in potency, or adverse effects

Purified nonherbal nutritional supplements ex. dehydroepiandrosterone (DHEA)
and melatonin; used widely as alternative medicine
*Evidence from controlled clinical studies for their medical effectiveness is incomplete or
nonexistent.
Pharmaceuticals versus Dietary Supplements
Pharmaceuticals
Dietary Supplements
Chemical can be natural or synthetically
Chemical is derived from foods or animal
derived
tissues
FDA regulates as drugs
Generally, natural chemicals
Requires regulatory (FDA) pre- market
FDA regulates as foods (not drugs)
assessment of risk, efficacy
Pre-market assessment of risk (by FDA) is
Post-marketing surveillance (for
limited
adverse reactions)
No assessment of efficacy
System is not perfect
System is not perfect
Some risks not identified until after
Some risks not identified until after
marketing
marketing
Some risks differ from
pharmaceuticals

Binds with tubulin and inhibits its polymerization into microtubules,


causing arrest at metaphase


Common Intended Uses of Some Botanical or Nutritional Supplements

Botanical or Nutritional
Common Intended Use
Supplement
Echinacea
Decrease duration and intensity of cold symptoms
Ephedra (ma huang)
Treatment of respiratory ailments such as bronchitis
and asthma, and as a CNS stimulant
Garlic
For cholesterol lowering and atherosclerosis
Ginkgo
Treatment of intermittent claudication, and cerebral
insufficiency and dementia
Ginseng
Improvement of physical and mental performance
Milk thistle
Limitation of hepatic injury and as an antidote to
Amanita mushroom poisoning
Saw palmetto
Improvement in symptoms of benign prostatic
hyperplasia
St. Johns wort
Treatment of mild to moderate depression
Coenzyme Q10
Improvement of ischemic heart disease and for
Parkinsons disease
Glucosamine
Reduction of pain associated with osteoarthritis
Melatonin
Decrease jet lag symptoms and as a sleep aid


BOTANICAL SUBSTANCES
Synergism in Herbal Medicines
Herbal medicines composed of several molecules -> value comes from
synergy
Ex. Artemisia annua fresh extracts were 6 to 18 times more
efficacious against the plasmodium parasite than the same
amount of pure, synthesized artemisinin; 5 flavonoids:
-Artemetin, casticin, chrysoplenetin, cirsilineol,
chrysoplenol D

Mechanisms of synergy
Natural enzymes which promote transport of the active
substances across barriers
Inhibition of oxidative and reductive enzymes decreasing
metabolism
Naturally occurring multi-drug resistant proteins

BOTANICAL SUBSTANCES
Echinacea

flavonoids,
polyacetylenes
caffeoyl
conjugates

(+) cytokine activation and antiinflammatory properties

Ephedra
(Ma Huang)

major chemical
constituents -
ephedrine and
pseudoephedrine

Garlic
(Allium
sativum)

organic
thiosulfinates that
form allicin
(responsible for the
characteristic odor)

Ginkgo
(Ginkgo
biloba)

Leaves

flavone glycosides
and terpenoids

indirect-acting sympathomimetics ephedrine for nasal decongestion


Ephedrine:
Contraindications - anxiety
that release norepinephrine from
and as a pressor agent
-dizziness, insomnia,
states, bulimia, cardiac
sympathetic nerve ending
(common) respiratory dysfunction
anorexia, flushing,
arrhythmias, diabetes,
(bronchitis and asthma) and as mild
palpitations,
heart failure,
CNS stimulant
tachycardia, and
hypertension, glaucoma,
Chinese medicine for cold and flu
urinary retention;
hyperthyroidism,
symptoms, diuresis, and bone or
high doses -
pregnancy
joint pain
marked increase in renal elimination - facilitated
BP, arrhythmias,
by urinary acidification
Dietary supplements w/
toxic psychosis

ephedrine alkaloids - weight loss

and enhancement of athletic
performance
allicin -inhibits hepatic
(CS)more effective than placebo

Toxicity - nausea, hypotension, and allergic


hydroxymethylglutaryl coenzyme
at lowering total cholesterol; in
reactions; possible antiplatelet - caution in patients
A (HMG-CoA) reductase and
adults with moderately elevated
receiving anticoagulants or antiplatelet
angiotensin-converting enzyme
LDL no lowering effect; in
(ACE), blocks platelet aggregation,
advanced coronary artery disease
increases nitric oxide (NO), is
(+) reduction in plaque
fibrinolytic, has antimicrobial
accumulation but death, stroke,
activity, and reduces carcinogen
myocardial infarction were not
activation
studied
antioxidant and radical (AS)reduced blood viscosity and changes in CNS

Toxicity GI effects,
scavenging effects and
neurotransmitters
anxiety, insomnia, headache;
increases nitric oxide formation
possible antiplatelet action
(CS)useful in intermittent claudication;
(caution if given with
pretreatment may reduce markers of oxidative stress
anticoagulants or
associated with CABG; mild benefit of ginkgo in patients
antiplatelets); may be
with cognitive impairment and dementia, but effects are
epileptogenic
unpredictable and unlikely to be significant.

Leaves and roots

early treatment of COLDS (aerial


parts)

Toxicity
unpleasant taste
GI effects, dizziness or
headache

Some preparations have


high alcohol content
no reported drug
interactions

Ginseng

genus Panax

contain multiple triterpenoid saponin glycosides


(ginsenosides); absent in Siberian or Brazilian ginseng

purported to improve mental and physical performance,


but evidence is limited; some evidence - cold prevention
and lowering postprandial glucose
Ginseng

Milk Thistle

flavonolignans
(silymarin)

(AS) protects against liver injury caused by alcohol,


acetaminophen, and Amanita mushrooms

(CS)no significant reduction in all-cause mortality, liver
histopathology, or complications of liver disease in
patients with alcoholic liver disease or viral hepatitis
SILYBIN (isomer of silymarin) - an antidote to Amanita
phalloides mushroom poisoning


Silybum
marianum

Fruit & seeds

reduces lipid peroxidation,


scavenges free radicals,
enhances superoxide
dismutase, inhibits formation of
leukotrienes, and increases
hepatocyte RNA polymerase
activity

oxicity - Estrogenic
effects (mastalgia, vaginal
bleeding); insomnia,
nervousness, hypertension;
use with caution in patients
receiving anticoagulant,
antihypertensive,
hypoglycemic, or psychiatric
medications
Toxicity loose stools; no
known drug interactions

Inhibition of RNA Polymerase


Nonedible mushrooms most cause GI distress; most are not life-threatening
Amanita phalloides ("death cap") - most deaths are due to liver damage;
A. ocreata death angel; equally dangerous
TWO TOXIC CHEMICALS:
Phalloidin
cyclic heptapeptide; combines with actin in muscle cells to interfere with muscle function contributes to diarrhea
(develops 10 to 12 h after ingestion)
Amatoxins
readily absorbed, bicyclic peptides
alpha-amanitin most toxic; has a strong affinity for hepatocytes binds to RNA polymerase II inhibit protein synthesis
rd
3 day of ingestion: serious clinical signs manifest
liver transplant - treatment in severe cases
renal proximal tubular lesions seen in severe poisoning

St. Johns Wort



Hypericum perforatum

Dried flowers

Hypericin
hyperforin

(IV)decreased activity
of serotonergic
reuptake systems

(AS)downregulation of
adrenoceptors and
upregulation of 5-HT
receptors

efficacy is greater than placebo, and similar to


antidepressants for mild or moderate depression

Hypericin - may have antiviral and anticancer effects (needs
photoactivation)

Toxicity mild GI side effects,


photosensitization; avoided in
patients using SSRIs or MAOIs
and those with bipolar or
psychotic disorder; induce
CYP450 isoforms and Pglycoprotein drug
transporters decreases
efficacy of OCPs, cyclosporine,
digoxin, HIV protease
inhibitors, and warfarin

Saw Palmetto
Serenoa repens or
Sabal serrulata

berries

phytosterols,
aliphatic
alcohols,
polyprenes, and
flavonoids

inhibits 5-reductase
and antagonizes
androgen receptors

mixed results in BPH (outcome: urologic function


and urinary flow)

abdominal pain, GI
distress, decreased libido,
headache, hypertension; no
effect on PSA


ADVERSE EFFECTS OF PLANT FOOD SUPPLEMENTS AND BOTANICAL
products and does not report their use if they are admitted to hospital or
PREPARATIONS: A systematic Review with Critical Evaluation of causality
emergency service;
CONCLUSIONS
as they use PFS (plant food supplements) at their own discretion,
14 plants were the most frequently cited; 2 were responsible for 32% of the adverse
consumers could avoid informing the family doctor, fearing a
effects reported
reprimand;
Glycine max (soybean) - considered in 95 papers; allergic reactions and
Data collected by poison centres are published only in a relatively few
hormone-like activity well known
cases.
Included in the list of major food allergens
Despite apparent reassuring ndings, it is important be aware of rare but severe
Hormonal activity is the reason that it is used in menopause
adverse effects from botanical preparations or ingredients of food supplements
Glycyrrhiza glabra (liquorice)
or traditional medicines; EXAMPLE:
Causes hypokalemia and hypertension due to glycyrrhetic acid
Camellia sinensis (green tea)

Severe hepatotoxixity was unknown before the product Exolise,
Cases of adverse effects of botanicals are numerous, in term of citations by
containing a hydroalcoholic extract responsible for a number
scientic literature or phytovigilance centres, but an assessment according to
of cases of acute hepatitis in France and Belgium
the WHO criteria indicates that the number of those with adequate evidence
Although very rare, the severity of these reactions needs
for a causal relationship is signicantly less.
information and vigilance.
Given the long period of time considered and the number of plants included in the
EXAMPLE:
review, the occurrence of adverse effects of botanical ingredients is relatively
Citrus aurantium (bitter orange)
low.
Contains adrenergic amines
The number of severe clinical reactions is very limited, but some fatal cases have
must be considered a potential risk both for athletes and for the
been described.
general population
It is important to recognize that an underestimation is also possible, for the
possible abuse as a substitute for the products containing
following reasons:
Ephedra
the consumer usually considers botanicals as safe


PURIFIED NUTRITIONAL SUBSTANCES


Coenzyme Q10
Ubiquinone
; cofactor in the mitochondrial
antioxidant; predominant form after
Toxicity well tolerated; GI disturbances -

electron transport chain; reduced
ingestion
most common adverse effect; Rare
form (ubiquinol)
small degree of efficacy in reducing BP
effects - include rash, thrombocytopenia,
and treating CAD and chronic stable
irritability, dizziness, and headache;
angina; not useful as adjunct in HF (?);
structural similarity to vitamin K
some efficacy in statin- related
decreases effects of warfarin
myopathy

Glucosamine

amino sugar

precursor of nitrogen-containing
sugars (glycosaminoglycans)
major constituent of connective
tissue (cartilage in joints)

Melatonin

serotonin
derivative

produced mainly in the pineal


gland; regulate sleepwake
cycles; release coincides with
darkness (9 PM to 4 AM)

primarily used for pain associated with


OA; clinical trials have produced
mixed results; recent trials failed to
find a benefit

Other purported activities -
contraception, prevention of aging,
protection against oxidative stress,
treatment of cancer, major
depression, and HIV
jet lag subjective improvements in
mood, more rapid recovery times, and
reductions in daytime fatigue

insomnia - improves sleep onset,
duration, and quality when given to
patients with sleep disorders

Ramelteon - melatonin receptor
agonist; FDA- approved for insomnia

Toxicity diarrhea and nausea; well


tolerated; commercially prepared from
crustaceans concern about cross-allergenicity
in people with shellfish allergy
ToxicitySedation, next-day drowsiness,
headache; can suppress the midcycle LH
surge CI in pregnancy or in women
attempting to conceive; can decrease
prolactin levels CI in nursing mothers;
chronic use decreases sperm quality

DRUG-HERB
INTERACTIONS

Ginkgo biloba
- inhibits platelet
aggregation
Echinacea
- contain alkaloids that
may deplete hepatic
glutathione stores
St. John's wort




Drug safety and efficacy may be altered by co-exposure


with various non-pharmaceuticals
wide use of unregulated herbal products among the
public should lead clinicians to inquire about patient
use
NSAIDs
may increase the risk of bleeding

syndrome
may increase affects of
antidepressants
decrease effectiveness of

Garlic and gingko


acetaminophen

SSRIs -

increased risk of Acetaminophen


toxicity

Kava

cause a mild serotonergic

Ma-huang and
ephedra

cyclosporine,
idinavir, oral
contraceptives,
and warfarin
anticoagulant or
increase risk of bleeding
antiplatelet drugs
sedative-hypnotics additive CNS depression
(including alcohol
sympathomimetics additive

HERBAL MEDICINE DRUG DEVELOPMENT IN THE PHILIPPINES


Common name Scientific name
Most frequent use Parts
by traditional
used
healers
Damong maria Artemisia vulgaris L.
Stomach ache
Leaves
Lagerstroemia speciose L.

Banaba
Kidney
Sambong
Bayabas
Tubang bakod

Blumea balsamifera (L.) DC

Cogon

Imperata cylindrical (L.) P


Beauv
Senna alata L.

Akapulco
Malunggay
Herba buena
Luyang dilaw
Oregano
Kataka-taka
Lubigan
Makabuhay
Ampalaya
Mayana
Tanglad
Abutra
Kalamansi
Dita












Psidium quajava L.
Jatropha curcas L.

Moringa oleifera Lam


Mentha cordifolia Opiz
Zingiber officinale Rosc
Coleus aromatic Benth
Kalanchoe pinnata (Lam.)
Pers.
Acorus calamus L.
Tinospora rumphii Boerl
Momordica charantia L.
Cloeus blumei Benth
Cymbopogon citratus (DC)
Stapf.
Arcangelisia flava (L.)
Merr.
Citrofortunella microcarpa

Cough
Diarrhea
Fractures, sprains
and dislocated
joints
Kidney trouble

Preparati
on
Decoction
Decoction
Decoction
Decoction
Poultice

Roots

Decoction

Skin diseases
Wounds
Stomach ache
Stomach ache
Cough
Boils, swelling

Leaves

Poultice
Poultice
Decoction
Poultice
Juice drink
Poultice

Stomach ache
Malaria
Cough, colds
Boils
High BP

Rhizomes
Vines
Leaves

Rhizomes
Leaves

Roots

Irregular mens

Cough, colds
Alstonia scholaris (L.) R. Br. Malaria

Decoction
Decoction
Decoction
Decoction
Decoction
Decoction

Fruits
Bark

Juice
Decoction

Akapulko
(Cassia alata)
Ampalaya
(Momordica
charantia)
Bawang (Allium
sativum)

TEN MEDICINAL PLANTS PHILIPPINE DOH


"bayabastreatment of ringworms and
bayabasan" and
skin fungal infections
"ringworm bush";
"bitter gourd" or
DM II
"bitter melon";
"garlic";

Bayabas (Psidium
guajava)

guava";

Lagundi (Vitex
negundo)
Niyog-niyogan
(Quisqualis indica L.)

"5-leaved chaste
tree"
"Chinese honey
suckle";

Sambong (Blumea
balsamifera)-
Tsaang Gubat
(Ehretia microphylla
Lam.)
Ulasimang
Bato/Pansit-Pansitan
(Peperomia
pellucida)
Yerba Buena
(Clinopodium
douglasii)

Blumea camphora

reduces cholesterol in the


blood and hence, helps
control blood pressure
antiseptic; mouthwash to
treat tooth decay and gum
infection
relief of coughs and asthma

for intestinal worms (Ascaris


and Trichina); dried matured
seeds are used
diuretic; helps in excretion of
urinary stones; for edema
for intestinal motility; used as
a mouthwash (leaves have a
high fluoride content)
for arthritis and gout

Peppermint

used as an analgesic

Local name

Scientific
name

Other names

Sambong

Blumea
balsamifera (L)
DC
Vitex negundo
(L)

Bukadkad
Subsob
Blumea Camphor
Five leaf chaste tree
Chinese chaste tree

Lagundi

Akapulco

REGISTERED HERBAL MEDICINES IN THE PHILIPPINES


Approved indication
Parts used/
Pharmaceutical
preparation
Edema
Leaf/tablet
Kidney stones
Cough of non-bacterial origin
Leaf/tablet and
Mild to moderate asthma (controller and reliever syrup
of asthma)

Senna alata (L)

Pharmacologic
Action
Diuresis
Chemolysis of urinary tract stones
Bronchial smooth muscle
relaxation
Antihistamine
Anti-leukotriene
Anti-inflammatory
Fungicide

Sonting
Antifungal
Leaf/lotion
Kasitas
Candlebush
Ringworm bush
NOTE: Herbal medicines are composed not only of a single compound but of several molecules. The value of medicines from plant compounds come from the synergy of
several compounds into one herbal drug product


SUMMARY
Dietary Supplements: Observations and Challenges
Botanicals and Nutritional Supplements
Components of dietary supplements can have pharmacological,
Concepts
toxicological effects on healthy individuals
Botanicals and nutritional supplements are marketed without FDA
What about individuals with disease?
review of efficacy
Role of chemical interactions?
Must follow GMP and be registered
Dietary supplements with pharmaceutical drugs
Must show studies that it is safe
Does the regulatory risk assessment process for dietary
In many cases, evidence for medical effectiveness is incomplete or
supplements take these factors in consideration?
non-existent


POSSIBLE CLINICAL USES AND COMMON TOXICITIES
Agent
Echinacea

Clinical/Intended Uses
Common cold

Toxicities
GIT distress, dizziness, headache

Ephedra

As for ephedrine

CNS and cardiovascular stimulation; arrhythmias, stroke, and seizures at high doses

Feverfew

Migraine

GIT distress, mouth ulcers, antiplatelet actions

Garlic

Cholesterol lowering and


atherosclerosis
Intermittent claudication
Improvement of physical and mental
performance

GIT distress, possible antiplatelet actions

Chronic anxiety

GIT distress, sedation, ataxia, hepatotoxicity, phototoxicity, dermatotoxicity

Gingko
Ginseng
Kava

GIT distress, anxiety, insomnia, headache, antiplatelet actions


Estrogenic effects (mastalgia, vaginal bleeding), insomnia and nervousness; use with caution in patients
taking anticoagulants, antihypertensives, hypoglycemic, or antipsychotics

Agent
Milk thistle
Saw palmetto
St. Johns wort
Coenzyme Q10

Clinical/Intended Uses
Viral hepatitis
Benign prostatic hyperplasia
Mild-moderate depression
Ischemic heart disease and Parkinsons
disease

Toxicities
Loose stools
GIT distress, decreased libido, hypertension
GIT distress, phototoxicity, serotonin syndrome with SSRIs; induces cytochrome P450 enzymes
GIT distress, can decrease effects of warfarin (structurally similar to vitamin K

Glucosamine
Dehydroepiandrosterone

Osteoarthritis
Symptomatic improvement in females
with SLE or AIDS

GIT distress, possible cross-allergenicity in people with shellfish allergy


Androgenization (premenopausal women), estrogenic effects (post menopausal), feminizarion (young men)

Melatonin
Jet lag, insomnia
Sedation, suppresses mid-cycle LH, hypoprolactinemia

Chaparral
Anti-infective, antioxidant
Ephedra


Extracts from the genus Ephedra (ma-huang) contain ephedrine and
Coltsfoot
Anti-infective
pseudoephedrine
Prior to FDA regulations, ephedra products were commonly used for asthma
Germander Dietary and digestive aid
and bronchitis, as nasal congestants, and as aids to weight reduction
Agent
Intended Uses
Chinese medicine - relieve cold and flu symptoms, for diuresis, and for bone
Jimsonweed Respiratory tract diseases
and joint pain
CARDIOTOXICITY major problem in overdose
Pennyroyal Abortifacient, induces
Contraindications: same as for ephedrine anxiety states, cardiac arrhythmias,
menses, digestive aid
diabetes, heart failure, hyperthyroidism, pregnancy

Pokeweed
Root extracts for emesis
CLAIMED USES AND IMPORTANT TOXICITIES OF SELECTED BOTANICALS
and rheumatism

Royal jelly
Immune potentiation,
Agent
Intended Uses
Toxicities
tonic, hyperlipidemias
Aconite
Analgesic (topical and
Cardiac and CNS toxicity with oral
Sassafras
Anticoagulant, urinary
oral)
use
tract disorders; oil used
Borage
Anti-inflammatory,
GIT distress and hepatic dysfunction
as antiseptic
diuretic
with oral use
REVIEW QUESTIONS

Does the United States Food and Drug Administration (FDA)
regulate herbal medications? No

Are herbal medications considered drugs by FDA standards?
No, considered nutritional supplements

What herbal medication is used for migraine and fever?
Feverfew

What herbal medication is used for jet lag?
Melatonin

What herbal medication is used for depression?
St. Johns wort


What herbal medication is used for benign prostate hyperplasia
(BPH)? Saw palmetto

What herbal medication is used for anxiety? Kava kava

What herbal medication is used for Alzheimer disease?
Gingko biloba

What herbal medication is used for hypercholesterolemia? Garlic

What herbal medication is used for the common cold?
Echinacea

What herbal medication is used for hepatitis? Milk thistle

Hepatic and renal dysfunction



Allergies, phototoxicity, hepatic
dysfunction
Hepatitis and complete liver failure
Toxicities
Atropine-like CNS and peripheral
toxicities
CNS dysfunction, hematemesis, liver
and renal dysfunction, disseminated
intravascular coagulation
Bloody diarrhea, hypotension,
respiratory failure, coma, blindness
Allergic reaction, including
anaphylaxis
Diaphoresis and hot flushes with
use of bark; ingestion of oil may
cause CV and respiratory collapse


What herbal medication is used to treat hot flushes in
menopause? Black cohosh

Is St. Johns wort a metabolic enzyme inducer or inhibitor?
Inducer

What herbal supplements should one use with caution when
using warfarin concomitantly?
The G4 supplements: garlic, ginger, gingko, and ginseng. These
substances may interact with warfarin, and some, especially
gingko which has antiplatelet effects, may increase bleeding
risk. Ginseng may decrease warfarins effects.

diane