The effectiveness and safety of ginger for

pregnancy-induced nausea and vomiting: A

systematic review
Mingshuang Ding

Matthew Leach

Helen Bradley

Received 13 April 2012; received in revised form 30 July 2012; accepted 4 August 2012.
published online 30 August 2012. Corrected Proof

Article Outline
Abstract

1. Introduction

2. Background

3. Methods

4. Results

5. Discussion

6. Dosage

7. Pharmacological interaction

8. Conclusion

References

Copyright

1
Abstract
Background

Ginger has been used throughout the world as a therapeutic agent for centuries. The
herb is increasingly used in Western society also, with one of the most common indications
being pregnancy-induced nausea and vomiting (PNV).

Objectives

To examine the evidence for the safety and effectiveness of ginger for PNV.

Methods

Randomised controlled trials (RCTs) of ginger and PNV were sourced from CINAHL,
the Cochrane library, MEDLINE and TRIP. The methodological quality of RCTs was
assessed using the Critical Appraisal Skills Programme (CASP) tool

Results

Four RCTs met the inclusion criteria. All trials found orally administered ginger to be
significantly more effective than placebo in reducing the frequency of vomiting and intensity
of nausea. Adverse events were generally mild and infrequent.

Conclusion

The best available evidence suggests that ginger is a safe and effective treatment for
PNV. However, there remains uncertainty regarding the maximum safe dosage of ginger,
appropriate duration of treatment, consequences of over-dosage, and potential drugherb
interactions; all of which are important areas for future research.

Keywords: Ginger, Herbal medicine, Pregnancy, Nausea, Vomiting, Systematic review

1. Introduction
2
 One of the most common and unpleasant complications of pregnancy is pregnancy-
induced nausea and vomiting (PNV). These symptoms are frequently experienced by women
in the first trimester of pregnancy; affecting between fifty and eighty percent of pregnant
women.1

A number of complementary and mainstream medicines have been recommended or

prescribed for women suffering from PNV. Ginger is one such example. 2 Although many
alternative therapists advocate the use of ginger for PNV, it is unclear if there is sufficient
clinical evidence to support its use in this condition. 3, 4 On the surface, it would seem that
ginger is a safe, non-invasive therapy. However, there is a need to critically review the
evidence of effectiveness for ginger and PNV in order to justify its application in clinical
practice.

2. Background
The etiology of nausea and vomiting is complex, involving both neural pathways and
motor responses. Each of these pathways may occur independently, but essentially involve
the same central nervous system reaction; prompted by the neural pathway to and from the
chemoreceptor trigger zone in the brain stem. This reaction results in a series of
gastrointestinal responses, including hyposecretion, decreased small intestine motility,
hypotonicity, hypoperistalsis, and subsequent ejection of the contents of the stomach and
small intestine. This is thought to be mediated through increased serotoninergic and
cholinergic activity.5

Pregnancy-induced nausea and vomiting (PNV) generally begins at four to six weeks
gestation, but may occur as early as two to three weeks after the onset of the last menstrual
period. The symptoms typically peak at eight to twelve weeks, and usually resolve by three to
four months. However, symptoms can persist for fourteen weeks in forty percent of women,
sixteen weeks in less than twenty percent, and twenty weeks in less than ten percent. Few
women (less than ten percent) experience symptoms to full term.6

The use of some pharmacological agents to relieve the symptoms of PNV during the
period of embryonic organogenesis is contraindicated.5 Two notable cases confirm the risks
associated with conventional pharmaceutical medications: Thalidomide, for instance, is
associated with the development of severe limb defects in utero, Bendectin a combination
of pyridoxine and an antihistamine is believed to cause congenital malformations, and
whilst a causal relationship has never been documented, the drug has been the subject of
several lawsuits and has subsequently been withdrawn from the market.6, 7 Vitamin B6
(pyridoxine hydrochloride) is one of the treatments recently recommended by health
professionals to reduce the symptoms of PNV. However, more research needs to be done in
order to determine its safety or efficacy in treating PNV.6, 7

In light of the above-mentioned concerns, many researchers have turned to the field of
complementary and alternative medicine to seek out alternative solutions to the management
of PNV.8, 9, 10, 11 The rhizome of ginger (Zingiber officinale) has a long history of use as a
culinary spice, but also as a herbal medicine11; specifically, as a digestive aid and antiemetic.10
Ginger is attributed to an increase in gastric tone and peristalsis via anticholinergic and
antiserotonergic pathways.12 An earlier review has indicated that ginger may be effective for
the treatment of PNV and vomiting13; however, this review is dated and may not represent the

3
best available evidence on this subject. There is also uncertainty about the safety of ginger in
PNV.14, 15, 16, 17 Hence, a systematic review of the literature was conducted to examine the
evidence of the safety and effectiveness of ginger for pregnancy-induced nausea and
vomiting.

3. Methods
A systematic search of the literature was conducted using CINAHL, the Cochrane
library, MEDLINE and TRIP databases. Keywords included: antiemetic, ginger, hyperemesis,
nausea, pregnancy, vomiting and Z. officinale. The search was limited to randomised
controlled trials investigating the clinical effectiveness or safety of oral monopreparations of
ginger for PNV. The search was restricted to full-text articles published in English between
2000 and 2009. The methodological quality of eligible RCTs was evaluated using the Critical
Appraisal Skills Programme (CASP) tool for RCTs, (UK National Health Service Public
Health Research Unit).18 Essentially, the tool contains ten questions relating to the quality of
the study design and results, and whether the information is useful to local practice.

4. Results
The search identified nineteen potentially relevant studies. Of these, fifteen were
rejected as they were not RCTs. This resulted in four prospective, parallel-design, randomised
controlled trials, of which all but one were double-blind (Fig. 1). Three trials were placebo-
controlled and one was compared to vitamin B6. All trials used mono preparations of ginger,
with daily doses ranging between 500 mg and 1050 mg. Sample size ranged from 26 to 291,
with a mean of 126 and a pooled size of 504. All participants were pregnant women of less
than twenty weeks gestation. Trial duration varied between four days and three weeks, with a
mean duration of 1.5 weeks.

Fig. 1.
Flow chart of study selection.

The quality of included trials was generally high, with three out of four trials
obtaining a CASP score above 6/10.

In terms of outcome measures, two trials used the Rhodes index of nausea and
vomiting (RINV; a tool measuring vomiting episodes per day; severity of vomiting; extent
and duration of nausea and retching, as well as distress) 19 and two measured the intensity of
nausea and frequency of vomiting by questionnaire. In the two studies using the RINV, ginger
was found to be as effective as vitamin B6in reducing nausea and vomiting, 20 and

4
significantly more effective than placebo in PVN, but not vomiting. 21 In the two studies
examining the effectiveness of ginger using self-reported questionnaires, both found ginger to
be superior to placebo in improving the intensity of nausea and frequency of vomiting. 2, 22, 20,
21
A synopsis of these studies is presented in Table 1.

Table 1. Randomised controlled trials investigating the effectiveness and safety of ginger for pregnancy-
induced nausea and vomiting.

Authors Year Country Design Participants Treatment Control Duration Outcomes Main Findings
Greater reductions in nausea and
Double Ginger syrup 1 vomiting were evident in the
Intensity of
blind, 26 women, 7 tbsp (equiv to Placebo ginger group when compared to
Keating United nausea;
2002 parallel 11 weeks 250 mg ginger syrup 1 2 weeks the placebo group. No foetal
and Chez2 States frequency of
group gestation root extract) tbsp QID abnormalities were detected
vomiting
RCT QID following maternal treatment with
ginger.
Ginger was significantly more
Single
Placebo Intensity of effective than placebo in reducing
blind, 67 women, Ginger
Ozgoli et (lactose) 1 nausea; the frequency of vomiting and
2009 Iran parallel <20 weeks Capsule 250 4 days
al22 capsule frequency of intensity of nausea (p < 0.05).
group gestation mg QID
QID vomiting Both treatments were without
RCT
side effects.
Ginger was as effective as
Double Rhodes index vitamin B6 in reducing
blind, 291 women, Vitamin of nausea and pregnancy-induced nausea,
Smith et Ginger 350 mg
2004 Australia parallel <16 weeks B6 25 mg 3 weeks vomiting; retching and vomiting. The side
al20 TDS
group gestation TDS change in effect most frequently reported by
RCT health status women was difficulty swallowing
capsules.
Ginger was significantly more
effective than placebo in reducing
Double Ginger extract Placebo pregnancy-induced nausea and
blind, 120 women, (equivalent to (soya bean Rhodes index retching, but not vomiting.
Willetts
2003 Australia parallel <20 weeks 1.5 g dried oil) 1 4 days of nausea and Mothers who were exposed to
et al21
group gestation ginger) 125 capsule vomiting ginger did not have an increased
RCT mg QID QID risk of foetal abnormalities, low
birthweight, or antenatal or post-
partum haemorrhage.

In no study was the safety of ginger consumption during pregnancy explicitly

addressed, nor was any study powered well enough to provide statistically significant results
concerning safety. Studies were also time limited.

Three studies assessed for adverse events. Ozgoli et al. 22 found both ginger and
placebo treatments were without side effects. The main adverse events reported by Smith et
al.20 were burning sensations (ginger 2% vs. vitamin B6 2%) and belching (ginger 9% vs.
vitamin B6 0%). Dry retching after swallowing (ginger 52% vs. vitamin B6 56%) and
vomiting after ingestion (ginger 2% vs. vitamin B6 1%) were also reported, but these effects
were mostly likely attributed to PNV rather than the intervention. Willetts et al. 21 found
exposure to ginger during pregnancy did not appear to increase the risk of foetal
abnormalities, low birth weight, or antenatal or postpartum haemorrhage. No foetal
complications or abnormalities were reported among women treated with ginger in the
Keating and Chez2 study.

5
 Studies were heterogeneous in terms of comparison interventions used, outcome
measures, trial duration and ginger formulation, and thus, were deemed unsuitable for
pooling of data.

5. Discussion
Ginger has long been used in Western herbal medicine, traditional Chinese medicine
and Ayurvedic medicine as an antiemetic. 5, 8, 9, 10, 11, 16 This review set out to examine the
evidence of effectiveness for ginger and pregnancy-induced nausea and vomiting. Four
parallel-group, randomized controlled trials were located. All studies found orally
administered ginger, in various forms, to be a safe and effective treatment for PNV when
compared to placebo and vitamin B6.

It is important that the interpretation of these findings takes into account the
limitations of the included studies; in particular, study duration and population. Firstly,
studies were time limited, with no trials delivering treatment beyond three weeks. This does
not allow any conclusions to be made about the long-term safety or effectiveness of ginger in
PNV; future long-term studies of ginger may shed some light on these concerns. Secondly,
most studies recruited women who were beyond the third trimester of pregnancy (two studies
recruited women who were up to twenty weeks gestation). This may not represent the typical
population with PNV as PNV usually resolves by three to four months (in 40% of women),
with less than 20% continuing to sixteen weeks, and less than ten percent to twenty weeks.6

Several other issues emerge in the wider literature, which are also worthy of
discussion in this review; these relate to the areas of dosage and pharmacological interaction.

6. Dosage
The recommended daily dose of ginger for the treatment of PNV is 1000 mg.16, 23, 24 It
is difficult to know whether the four studies administered ginger at a dose close to that
recommended given the lack of details on the method of extraction, solvent used, dose of the
extract and the dried herb equivalent. The only study reporting the dried herb equivalent was
Willetts et al.21 who administered ginger at a dose equivalent to 4.5 g of dried ginger daily.
This exceeds the maximum recommended daily dose for pregnancy of 4 g.25 This is a cause
for some concern as ginger doses of more than 4 g per day may produce uterine stimulating
effects,26 which could adversely affect the pregnancy. High doses of ginger may also
aggravate pre-existing conditions, such as cholelithiasis,27 or contribute to cardiac arrhythmia,
CNS depression and heartburn.15, 28 Notwithstanding, such adverse events were not identified
by Willetts et al.21 Table 2 illustrates how the consumption of ginger from a variety of sources
can result in a woman exceeding the maximum recommended daily dose of ginger for
pregnancy.

Table 2. Dosage of various forms of ginger.22

The following forms of ginger are reported to be equivalent to a 1000 mg dose of a

standardised ginger extract:
1 teaspoon (5 g) of freshly grated ginger rhizome.
2 ml of ginger liquid extract.
2 teaspoons (10 ml) of ginger syrup.

6
 4 cups (237 ml each) of prepackaged ginger tea.
4 cups (237 ml each) of fresh ginger tea (prepared by infusing teaspoon of freshly grated
ginger in hot water for 510 min).
1 cup (237 ml) of ginger ale (made with real ginger).
2 pieces of crystallized ginger, each 1 inch square, inch thick.

7. Pharmacological interaction
In addition to concerns about dosage, ginger also has the potential to interact with
other medications. It is recommended that ginger not be combined with medications such as
dimenhydrinate (Dramamine) since the possible interactions are currently unknown. Ginger
should also be avoided in patients prescribed oral hypoglycaemic agents or insulin, as some
of the constituents of ginger could theoretically potentiate the hypoglycaemic effect of these
medications.29

Abebe24 has indicated that ginger should not be used concurrently with other plants or
herbal products that may interfere with normal blood clotting, such as garlic, ginseng or
Ginkgo biloba. Patients being treated with anti-arrhythmic drugs or central nervous system
depressants should also observe caution when using ginger preparations. 29, 30 Ginger also may
increase the absorption of other orally administered drugs, 20 and may antagonise the activity
of proton pump inhibitors and H2 blockers by increasing the production of gastric acid.22

There are also suggestions that ginger should not be administered with drugs that
interfere with blood clotting, such as aspirin, heparin or warfarin. 22, 20 However, in a
randomised crossover study of twelve healthy subjects, three ginger capsules (each
containing an extract equivalent to 400 mg of ginger rhizome powder) taken three times daily
for two weeks had no effect on the pharmacokinetics or pharmacodynamics of a single 25 mg
dose of warfarin taken on day seven. Moreover, ginger alone did not affect the International
Normalised Ratio (INR) or platelet aggregation.31

A case report does describe a rise in INR to greater than 10 with accompanying
epistaxis in a woman consuming dietary ginger. The woman ate ginger regularly in the form
of dried ginger pieces and tea from ginger powder several weeks after her INR had been
stabilised on phenprocoumon. This combination was possibly the cause of the high INR.
Once the woman stopped consuming ginger, her INR restabilised on the original dose of
phenprocoumon.31 A similar case resulting in bleeding has been reported in a woman on
warfarin.32

Likewise, in a prospective longitudinal study of patients taking warfarin and

herbal/dietary supplements, there was a statistically significant increase in bleeding events in
patients taking warfarin and ginger (7 bleeds in 25 weeks), none of which were major (odds
ratio 3.2).33 None of the patients using the combination demonstrated an elevated INR. The
ginger products used in this study were not mentioned, but it is important to note that some
patients were taking more than one potentially interacting supplement.

8. Conclusion
7
 This review investigated the safety and effectiveness of oral mono preparations of
ginger in women with pregnancy-induced nausea and vomiting. The review found modest
research in the area, with four RCTs identified. All four studies found ginger to be more
effective than placebo and as effective as vitamin B6 in improving PNV. The studies suggest
also that the use of ginger in women with PNV is safe. However, the authors highlight that
the use of ginger in this population is not without risk; noting that there may be adverse
consequences associated with overdose, and use alongside other medication. Disappointingly,
all four studies were time-limited; despite the fact that PNV often persists for weeks, even
months. Future research needs to investigate the long-term safety and effectiveness of ginger
for PNV, including the effect of dosage on these parameters.

References
1. Fisher-Rasmussen W, Kjaer SK, Dahl C. Ginger treatment of hyperemesis
gravidarum. European Journal of Obstetrics, Gynecology, and Reproductive Biology.
1991;42:163164

2. Keating A, Chez R. Ginger syrup as an antiemetic in early pregnancy. Alternative

Therapies in Health and Medicine. 2002;8:8991

3. Chrubasik S, Pittler MH, Roufogalis BD, Zingiberisrhizoma: . A comprehensive review

on the ginger effect and efficacy profiles. Phytomedicine. 2005;12(9):684701

4. Matthews A, Dowswell T, Haas David M, Doyle M,

OMathn&TDREFS;aDn&TDREFS;al P. Interventions for nausea and vomiting in
early pregnancy. Cochrane database of systematic reviews. John Wiley & Sons, Ltd.;
2010;

5. Blumenthal M. Expanded commission E monographs. Boston: Integrative Medicine

Publications; 2000;

6. Lacroix R, Eason E, Melzack R. Nausea and vomiting during pregnancy: a

prospective study of its frequency, intensity and pattern of change. American Journal
of Obstetrics and Gynecology. 2000;182:931937

7. Frye A. Care during pregnancy. Holistic midwifery. Portland: Labrys Press; 1998;I

8. Al-Achi A. A current look at ginger use. US Pharmacist. 2000;(September):4046

9. Bruneton J. Pharmacognosy: phytochemistry, medical plants. 3rd ed.. Paris: Intercept-

Lavoisier; 2000;

10. Chevallier A. Encyclopedia of herbal medicine. London: Dorling-Kindersly; 2000;

11. Castleman M. The new healing herbs. 2nd ed.. Emmaus, Pennsylvania: Rodale Press;
2001;

8
12. Wilkinson J. What do we know about herbal morning sickness treatments? A
literature survey. Midwifery. 2000;16:224228

13. Ali A, Gilani AH. Medicinal value of ginger with focus on its use in nausea and
vomiting of pregnancy. International Journal of Food Properties. 2007;10:269278

14. Chandra K, Einarson A, Koren G. Taking ginger for nausea and vomiting during
pregnancy. Canadian Family Physician. 2002;48:14411442

15. Barrett M. Handbook of clinically tested herbal remedies. New York: Haworth Herbal
Press; 2004;

16. Wichtl M. Herbal drugs and phytopharmaceuticals. 3rd ed.. Boca Raton, Florida: CRC
Press; 2004;

17. Bryer E. A literature review of the effectiveness of ginger n alleviating mild-to-

moderate nausea and vomiting of pregnancy. Journal of Midwifery and Women's
Health. 2005;50:13

18. Guyatt GH, Sackett DL, Cook DJ. Users guides to the medical literature. II. How to
use an article about therapy or prevention. A. Are the results of the study valid?
Evidence-Based Medicine Working Group. Journal of the American Medical
Association. 1993;270:25982601

19. HER Foundation. Rhodes index assessment tool; 2010. Available at

http://www.helpher.org/health-professionals/diagnosis-assessment/rhodes-index.php
&LPAR;accessed 15.08.11&RPAR;.

20. Smith C, Crowther C, Willson K, Hotham N, McMilliam V. A randomized controlled

trial of ginger to treat nausea and vomiting in pregnancy. Obstetrics and Gynecology.
2004;103:639645

21. Willetts K, Ekangaki A, Eden J. Effect of a ginger extract on pregnancy-induced

nausea: a randomised controlled trial. Australian & New Zealand Journal of Obstretics
& Gynaecology. 2003;43:139144

22. Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea, and
vomiting. Journal of Alternative and Complementary Medicine. 2009;15:243246

23. Bryer E. A literature review of the effectiveness of ginger in alleviating mild-to-

moderate nausea and vomiting of pregnancy. Journal of Midwifery and Women's
Health. 2005;50:13

24. Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs.
Journal of Clinical Pharmacology. 2002;27:391401

25. Schulick P. Ginger: common spice and wonder drug. 3rd ed.. Prescott, Arizona: Hohm
Press; 1996;

9
26. Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA. Effectiveness and safety of
ginger in the treatment of pregnancy-induced nausea and vomiting. Obstetrics and
Gynecology. 2006;105:849856

27. Hardy M, Udani J. Does ginger help with symptoms of nausea in early pregnancy?.
Alternative Therapies in Women's Health. 2004;6:2529

28. Westfall R. Use of antiemetic herbs in pregnancy: women's choices, and the question
of safety and efficacy. Complementary Therapies in Nursing and Midwifery.
2004;10:3036

29. Cassileth B, Lucarelli C. Herb-drug interactions in oncology. London: BC Decker;

2003;

30. Skidmore-Roth L. Handbook of herbs and natural supplements. St. Louis: Mosby;
2003;

31. Jiang X, Williams KM, Liauw WS, Ammit AJ, Roufogalis BD, Duke CC, et al. Effect of
ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy
subjects. British Journal of Clinical Pharmacology. 2005;59:425432

32. Lesho EP, Saullo L, Udvari-Nagy S. A 76-year-old woman with erratic

anticoagulation. Cleveland Clinic Journal of Medicine. 2004;71:651656

33. Shalansky S, Lynd L, Richardson K, Ingaszewski A, Kerr C. Risk of warfarin-related

bleeding events and supratherapeutic international normalized ratios associated
with complementary and alternative medicine: a longitudinal analysis.
Pharmacotherapy. 2007;27:12371247

References
34. Fisher-Rasmussen W, Kjaer SK, Dahl C. Ginger treatment of hyperemesis
gravidarum. European Journal of Obstetrics, Gynecology, and Reproductive Biology.
1991;42:163164

10
 o View In Article

35. Keating A, Chez R. Ginger syrup as an antiemetic in early pregnancy. Alternative

Therapies in Health and Medicine. 2002;8:8991

o View In Article

o MEDLINE

36. Chrubasik S, Pittler MH, Roufogalis BD, Zingiberisrhizoma: . A comprehensive review

on the ginger effect and efficacy profiles. Phytomedicine. 2005;12(9):684701

o View In Article

o Abstract

o Full Text

o Full-Text PDF (346 KB)

o CrossRef

37. Matthews A, Dowswell T, Haas David M, Doyle M,

OMathn&TDREFS;aDn&TDREFS;al P. Interventions for nausea and vomiting in
early pregnancy. Cochrane database of systematic reviews. John Wiley & Sons, Ltd.;
2010;

o View In Article

38. Blumenthal M. Expanded commission E monographs. Boston: Integrative Medicine

Publications; 2000;

o View In Article

39. Lacroix R, Eason E, Melzack R. Nausea and vomiting during pregnancy: a

prospective study of its frequency, intensity and pattern of change. American Journal
of Obstetrics and Gynecology. 2000;182:931937

o View In Article

o Abstract

o Full Text

o Full-Text PDF (75 KB)

o CrossRef

40. Frye A. Care during pregnancy. Holistic midwifery. Portland: Labrys Press; 1998;I

11
 o View In Article

41. Al-Achi A. A current look at ginger use. US Pharmacist. 2000;(September):4046

o View In Article

42. Bruneton J. Pharmacognosy: phytochemistry, medical plants. 3rd ed.. Paris: Intercept-
Lavoisier; 2000;

o View In Article

43. Chevallier A. Encyclopedia of herbal medicine. London: Dorling-Kindersly; 2000;

o View In Article

44. Castleman M. The new healing herbs. 2nd ed.. Emmaus, Pennsylvania: Rodale Press;
2001;

o View In Article

45. Wilkinson J. What do we know about herbal morning sickness treatments? A

literature survey. Midwifery. 2000;16:224228

o View In Article

o Abstract

o Full-Text PDF (113 KB)

o CrossRef

46. Ali A, Gilani AH. Medicinal value of ginger with focus on its use in nausea and
vomiting of pregnancy. International Journal of Food Properties. 2007;10:269278

o View In Article

47. Chandra K, Einarson A, Koren G. Taking ginger for nausea and vomiting during
pregnancy. Canadian Family Physician. 2002;48:14411442

o View In Article

48. Barrett M. Handbook of clinically tested herbal remedies. New York: Haworth Herbal
Press; 2004;

o View In Article

49. Wichtl M. Herbal drugs and phytopharmaceuticals. 3rd ed.. Boca Raton, Florida: CRC
Press; 2004;

12
 o View In Article

50. Bryer E. A literature review of the effectiveness of ginger n alleviating mild-to-

moderate nausea and vomiting of pregnancy. Journal of Midwifery and Women's
Health. 2005;50:13

o View In Article

51. Guyatt GH, Sackett DL, Cook DJ. Users guides to the medical literature. II. How to
use an article about therapy or prevention. A. Are the results of the study valid?
Evidence-Based Medicine Working Group. Journal of the American Medical
Association. 1993;270:25982601

o View In Article

52. HER Foundation. Rhodes index assessment tool; 2010. Available at

http://www.helpher.org/health-professionals/diagnosis-assessment/rhodes-index.php
&LPAR;accessed 15.08.11&RPAR;.

o View In Article

53. Smith C, Crowther C, Willson K, Hotham N, McMilliam V. A randomized controlled

trial of ginger to treat nausea and vomiting in pregnancy. Obstetrics and Gynecology.
2004;103:639645

o View In Article

o MEDLINE

o CrossRef

54. Willetts K, Ekangaki A, Eden J. Effect of a ginger extract on pregnancy-induced

nausea: a randomised controlled trial. Australian & New Zealand Journal of Obstretics
& Gynaecology. 2003;43:139144

o View In Article

55. Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea, and
vomiting. Journal of Alternative and Complementary Medicine. 2009;15:243246

o View In Article

56. Bryer E. A literature review of the effectiveness of ginger in alleviating mild-to-

moderate nausea and vomiting of pregnancy. Journal of Midwifery and Women's
Health. 2005;50:13

o View In Article

13
57. Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs.
Journal of Clinical Pharmacology. 2002;27:391401

o View In Article

58. Schulick P. Ginger: common spice and wonder drug. 3rd ed.. Prescott, Arizona: Hohm
Press; 1996;

o View In Article

59. Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA. Effectiveness and safety of
ginger in the treatment of pregnancy-induced nausea and vomiting. Obstetrics and
Gynecology. 2006;105:849856

o View In Article

o MEDLINE

o CrossRef

60. Hardy M, Udani J. Does ginger help with symptoms of nausea in early pregnancy?.
Alternative Therapies in Women's Health. 2004;6:2529

o View In Article

61. Westfall R. Use of antiemetic herbs in pregnancy: women's choices, and the question
of safety and efficacy. Complementary Therapies in Nursing and Midwifery.
2004;10:3036

o View In Article

62. Cassileth B, Lucarelli C. Herb-drug interactions in oncology. London: BC Decker;

2003;

o View In Article

63. Skidmore-Roth L. Handbook of herbs and natural supplements. St. Louis: Mosby;
2003;

o View In Article

64. Jiang X, Williams KM, Liauw WS, Ammit AJ, Roufogalis BD, Duke CC, et al. Effect of
ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy
subjects. British Journal of Clinical Pharmacology. 2005;59:425432

o View In Article

o MEDLINE

14
 o CrossRef

65. Lesho EP, Saullo L, Udvari-Nagy S. A 76-year-old woman with erratic

anticoagulation. Cleveland Clinic Journal of Medicine. 2004;71:651656

o View In Article

o MEDLINE

o CrossRef

66. Shalansky S, Lynd L, Richardson K, Ingaszewski A, Kerr C. Risk of warfarin-related

bleeding events and supratherapeutic international normalized ratios associated
with complementary and alternative medicine: a longitudinal analysis.
Pharmacotherapy. 2007;27:12371247

o View In Article

o CrossRef

PII: S1871-5192(12)00045-5

doi:10.1016/j.wombi.2012.08.001

2012 Australian College of Midwives. Published by Elsevier Inc. All rights reserved.

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THE EFFECTIVENESS AND SAFETY OF GINGER

FOR PREGNANCY-INDUCED NAUSEA AND
VOMITING: A SYSTEMATIC REVIEW
Dibuat untuk memenuhi tugas mata kuliah asuhan kebidanan

16
Penelitian pendahuluan menyarankan bahwa jahe aman dan efektif untuk mual
dan muntah pada kehamilan jika digunakan dengan dosis yang
direkomendasikan dalam waktu kurang dari 5 hari (www.drug and
medicine.com). Jahe memproduksi aksi antimual dan antimabuk karena efek
antihistamin dan anticholinergic pada peripheral dan pusat. Zat pedas dari jahe
melepaskan zat P dari serat sensori. Zat P yang dilepaskan menstimulasi
cholinergic dan histaminicneurin untuk melepaskan Ach dan histamin sendiri-
sendiri atau memproduksi kontraksi otot langsung dengan mengaktifkan
reseptor M dan H1 secara korespondensi. Ini bertujuan agar setelah M tereksitasi
oleh zat P, reseptor M dan H1 inaktif untuk sementara dan tidak dapat dieksitasi

17
oleh agonis. Karena itu jahe menghambat aksi anticholinergic dan antihistaminic
(Qian, D. S, dan Liu, Z. S, 1992)

Jahe di pasaran dikemas dalam bentuk kapsul yang mengandung 500 mg serbuk
jahe atau dalam bentuk Kristal jahe. Di Asia, jahe diolah dalam bentuk minuman
seduh atau kembang gula. Sedangkan di Indonesia jahe dapat ditemukan dalam
bentuk minuman seduh dan salah satu komponen jamu. Beberapa hasil
pengolahan jahe lain yang terdapat di pasaran, yaitu:
Jahesegar
Jahekering
Awetanjahe
Jahebubuk
Minyakjahe
Oleoresin jahe

Gingerol dapat mereduksi nausea yang dikarenakan mabuk atau kehamilan dan
juga dapat mengurangi migraine.

Meskipun tidak ada bukti ilmiah atau lainnya untuk mendukung bahwa jahe dalam bentuk
apapun menyebabkan kerusakan pada wanita hamil, janin atau bayi menyusui, dianjurkan
oleh banyak dokter untuk tidak mengambil jahe selama lebih dari empat hari berturut-turut
saat menyusui atau hamil, dan tidak lebih dari 3 sampai 5 gram per hari penggunaan.

Efektivitas dan keamanan jahe untuk kehamilan-induced mual dan muntah:

Sebuah review sistematis

Mingshuang Dingemail alamat

,
Matthew Leachemail alamat
,
Helen Bradleyemail alamat

18
Diterima 13 April 2012, yang diterima dalam bentuk direvisi 30 Juli 2012,
diterima 4 Agustus 2012. diterbitkan online 30 Agustus 2012.
Dikoreksi Bukti

Abstrak
Full Text
PDF
Gambar
Referensi

Pasal Outline

Abstrak
1. Pengantar
2. Latar belakang
3. Metode
4. Hasil
5. Diskusi
6. Dosis
7. Farmakologi interaksi
8. Kesimpulan
Referensi
Hak cipta

Abstrak
Latar belakang

Jahe telah digunakan di seluruh dunia sebagai agen terapi selama berabad-abad.
Ramuan ini semakin banyak digunakan di masyarakat Barat juga, dengan salah
satu indikasi yang paling umum adalah kehamilan-induced mual dan muntah
(PNV).
Tujuan

Untuk memeriksa bukti untuk keamanan dan efektivitas jahe untuk PNV.
Metode

Percobaan terkontrol acak (RCT) jahe dan PNV yang bersumber dari CINAHL,
perpustakaan Cochrane, MEDLINE dan TRIP. Kualitas metodologi RCT dinilai
menggunakan Appraisal Program Keterampilan Kritis (CASP) alat.
Hasil

Empat RCT memenuhi kriteria inklusi. Semua percobaan ditemukan jahe oral
secara signifikan lebih efektif daripada plasebo dalam mengurangi frekuensi dan
intensitas muntah mual. Efek samping umumnya ringan dan jarang.
Kesimpulan

Bukti terbaik yang tersedia menunjukkan bahwa jahe merupakan pengobatan

yang aman dan efektif untuk PNV. Namun, masih ada ketidakpastian mengenai
dosis aman maksimum jahe, durasi yang tepat pengobatan, konsekuensi dari
over-dosis, dan potensi obat-ramuan interaksi, yang semuanya merupakan
daerah penting bagi penelitian di masa depan.

Kata kunci: Jahe, Obat Herbal, Kehamilan, Mual, Muntah, tinjauan sistematik

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Kembali ke Garis Pasal
1. Pengantar

Salah satu komplikasi yang paling umum dan tidak menyenangkan dari
kehamilan adalah kehamilan-induced mual dan muntah (PNV). Gejala ini sering
dialami wanita pada trimester pertama kehamilan, yang mempengaruhi antara
lima puluh dan delapan puluh persen dari perempuan.1 hamil

Sejumlah obat komplementer dan mainstream telah direkomendasikan atau

diresepkan untuk wanita yang menderita PNV. Jahe merupakan salah satu
example.2 seperti terapis Meskipun banyak alternatif menganjurkan penggunaan
jahe untuk PNV, tidak jelas apakah ada bukti klinis yang cukup untuk mendukung
penggunaannya dalam condition.3, 4 Di permukaan, akan terlihat bahwa jahe
adalah aman, non-invasif terapi. Namun, ada kebutuhan untuk secara kritis
meninjau bukti efektivitas jahe dan PNV untuk membenarkan penerapannya
dalam praktek klinis.

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2. Latar belakang

Etiologi mual dan muntah adalah kompleks, yang melibatkan kedua jalur saraf
motorik dan tanggapan. Masing-masing jalur dapat terjadi secara independen,
tetapi pada dasarnya melibatkan reaksi sistem saraf pusat yang sama, diminta
oleh jalur saraf ke dan dari zona pemicu kemoreseptor di batang otak. Hasil
reaksi ini dalam serangkaian respon gastrointestinal, termasuk hyposecretion,
penurunan motilitas usus kecil, hypotonicity, hypoperistalsis, dan pengusiran
selanjutnya dari isi lambung dan usus kecil. Hal ini dianggap dimediasi melalui
serotoninergic meningkat dan kolinergik activity.5

Kehamilan-induced mual dan muntah (PNV) biasanya dimulai pada empat hingga
enam minggu kehamilan, tetapi dapat terjadi sedini dua sampai tiga minggu
setelah onset periode menstruasi terakhir. Gejala biasanya puncak pada delapan
sampai dua belas minggu, dan biasanya menyelesaikan tiga sampai empat
bulan. Namun, gejala dapat bertahan selama empat belas minggu dalam empat
puluh persen wanita, enam belas minggu dalam waktu kurang dari dua puluh
persen, dan dua puluh minggu dalam waktu kurang dari sepuluh persen.
Beberapa perempuan mengalami gejala (kurang dari sepuluh persen) menjadi
term.6 penuh

Penggunaan beberapa agen farmakologis untuk meringankan gejala PNV selama

periode organogenesis embrio adalah contraindicated.5 Dua kasus menonjol
mengkonfirmasi risiko yang terkait dengan obat farmasi konvensional:
Thalidomide, misalnya, dikaitkan dengan perkembangan anggota tubuh cacat
parah pada rahim , Bendectin - kombinasi dari pyridoxine dan antihistamin -
diyakini menyebabkan cacat bawaan, dan sementara hubungan kausal belum
pernah didokumentasikan, obat telah menjadi subyek dari beberapa tuntutan
hukum dan kemudian telah ditarik dari market.6, 7 Vitamin B6 (pyridoxine
hydrochloride) adalah salah satu perawatan baru yang direkomendasikan oleh
para profesional kesehatan untuk mengurangi gejala PNV. Namun, penelitian
lebih lanjut perlu dilakukan untuk menentukan keamanan atau keberhasilan
dalam mengobati PNV.6, 7

Dalam terang yang disebutkan di atas keprihatinan, banyak peneliti telah

20
berpaling ke bidang pengobatan komplementer dan alternatif untuk mencari
solusi alternatif untuk pengelolaan PNV.8,, 9 10, 11 The rimpang jahe (Zingiber
officinale) memiliki panjang riwayat penggunaan sebagai bumbu kuliner, tetapi
juga sebagai medicine11 herbal, khusus, sebagai alat bantu pencernaan dan
antiemetic.10 Jahe dikaitkan dengan peningkatan nada lambung dan peristaltik
melalui antikolinergik dan antiserotonergic pathways.12 Review yang
sebelumnya telah menunjukkan bahwa jahe mungkin efektif untuk pengobatan
PNV dan vomiting13, namun, ulasan ini tanggal dan tidak dapat mewakili bukti
terbaik yang tersedia tentang hal ini. Ada juga ketidakpastian tentang keamanan
jahe dalam PNV.14,, 15 16, 17 Oleh karena itu, tinjauan sistematis literatur
dilakukan untuk mengkaji bukti-bukti keamanan dan efektivitas jahe untuk
kehamilan-induced mual dan muntah.

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3. Metode

Sebuah pencarian sistematis literatur dilakukan dengan menggunakan CINAHL,

perpustakaan Cochrane, MEDLINE dan database TRIP. Kata kunci meliputi:
antiemetik, jahe, hiperemesis, mual, kehamilan, muntah dan Z. officinale.
Pencarian terbatas pada uji coba terkontrol secara acak menyelidiki efektivitas
klinis atau keamanan monopreparations oral jahe untuk PNV. Pencarian dibatasi
untuk teks lengkap artikel yang dipublikasikan dalam bahasa Inggris antara
tahun 2000 dan 2009. Kualitas metodologi RCT memenuhi syarat dievaluasi
menggunakan Appraisal Program Keterampilan Kritis (CASP) alat untuk RCT, (UK
National Health Service Unit Kesehatan Penelitian Masyarakat) .18 Pada
dasarnya, alat berisi sepuluh pertanyaan yang berkaitan dengan kualitas desain
penelitian dan hasil , dan apakah informasi yang berguna untuk praktek lokal.

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4. Hasil

Pencarian mengidentifikasi studi sembilan belas berpotensi relevan. Dari jumlah

tersebut, lima belas ditolak karena mereka tidak RCT. Hal ini mengakibatkan
empat calon, desain paralel, uji coba terkontrol secara acak, yang semua kecuali
satu adalah double-blind (Gambar 1). Tiga uji coba yang terkontrol plasebo dan
satu dibandingkan dengan vitamin B6. Semua percobaan yang digunakan
persiapan mono jahe, dengan dosis harian berkisar antara 500mg dan 1050mg.
Ukuran sampel berkisar 26-291, dengan rata-rata 126 dan ukuran dikumpulkan
dari 504. Semua peserta adalah wanita hamil kurang dari dua puluh minggu
kehamilan. Durasi percobaan bervariasi antara empat hari dan tiga minggu,
dengan durasi rata-rata 1,5 minggu.

Lihat ukuran penuh gambar.

Lihat Gambar Besar
Download ke PowerPoint
Gambar. 1.

Diagram alur pemilihan studi.

Kualitas pengadilan termasuk adalah umumnya tinggi, dengan tiga dari empat
percobaan memperoleh skor di atas CASP 6/10.

Dalam hal ukuran hasil, dua percobaan menggunakan indeks Rhodes mual dan
muntah (RINV, sebuah alat ukur episode muntah per hari, keparahan muntah,

21
tingkat dan durasi mual dan muntah-muntah, serta distress) 19 dan dua
mengukur intensitas mual dan frekuensi muntah dengan kuesioner. Dalam dua
studi menggunakan RINV, jahe ditemukan seefektif vitamin B6in mengurangi
mual dan muntah, 20 dan secara signifikan lebih efektif daripada plasebo dalam
PVN, tetapi tidak vomiting.21 Dalam dua penelitian yang meneliti efektivitas jahe
menggunakan self- kuesioner yang dilaporkan, baik jahe ditemukan lebih unggul
dengan plasebo dalam meningkatkan intensitas mual dan frekuensi vomiting.2,,
22 20, 21 Sinopsis studi ini disajikan pada Tabel 1.
Tabel 1. Acak terkontrol menyelidiki efektivitas dan keamanan jahe untuk
kehamilan-induced mual dan muntah.
Penulis Tahun Peserta Desain Negara Pengobatan Kontrol Durasi Hasil Temuan
Utama
Keating dan Chez2 2.002 Amerika Serikat ganda buta, paralel kelompok RCT 26
wanita, 7-11 minggu kehamilan Jahe sirup 1 sdm (equiv untuk 250mg ekstrak
akar jahe) qid Placebo sirup 1 sdm qid 2 minggu Intensitas mual, muntah
pengurangan frekuensi Greater mual dan muntah yang nyata dalam kelompok
jahe jika dibandingkan dengan kelompok plasebo. Tidak ada kelainan janin yang
terdeteksi setelah pengobatan ibu dengan jahe.
Ozgoli et al22 2009 Iran Tunggal buta, paralel kelompok RCT 67 wanita, <20
minggu kehamilan Jahe Kapsul 250mg qid Placebo (laktosa) 1 kapsul qid 4 hari
Intensitas mual, muntah Jahe frekuensi secara signifikan lebih efektif daripada
plasebo dalam mengurangi frekuensi muntah dan intensitas mual (p <0,05).
Kedua perlakuan tanpa efek samping.
Smith et al20 2004 Australia ganda buta, paralel kelompok RCT wanita 291, <16
minggu kehamilan Ginger 350mg TDS Vitamin B6 25mg TDS 3 minggu indeks
Rhodes mual dan muntah, perubahan status kesehatan jahe sama efektifnya
dengan vitamin B6 dalam mengurangi kehamilan-induced mual, muntah-muntah
dan muntah. Efek samping yang paling sering dilaporkan oleh perempuan adalah
kesulitan menelan kapsul.
Willetts et al21 2003 Australia ganda buta, paralel kelompok RCT 120 wanita,
<20 minggu kehamilan Ginger ekstrak (setara dengan jahe kering 1.5g) qid
Placebo 125mg (minyak kacang kedelai) 1 qid kapsul 4 hari indeks Rhodes mual
dan muntah Jahe secara signifikan lebih efektif daripada plasebo dalam
mengurangi kehamilan-induced mual dan muntah-muntah, tapi tidak muntah.
Ibu yang terkena jahe tidak memiliki peningkatan risiko kelainan janin, berat lahir
rendah, atau perdarahan kehamilan atau pasca melahirkan.

Dalam penelitian tidak ada keamanan konsumsi jahe selama kehamilan eksplisit
ditangani, juga tidak ada studi didukung cukup baik untuk memberikan hasil
yang signifikan secara statistik mengenai keselamatan. Studi juga waktu yang
terbatas.

Tiga penelitian dinilai untuk efek samping. Ozgoli et al.22 menemukan kedua
perawatan jahe dan plasebo tanpa efek samping. Efek samping utama yang
dilaporkan oleh Smith et al.20 terbakar sensasi (jahe 2% vs% vitamin B6 2) dan
sendawa (jahe 9% vs% vitamin B6 0). Muntah kering setelah menelan (jahe 52%
vs% vitamin B6 56) dan muntah setelah menelan (jahe 2% vs 1% vitamin B6)
juga dilaporkan, namun efek ini sebagian besar kemungkinan disebabkan PNV
bukan intervensi. Willetts et al.21 menemukan paparan jahe selama kehamilan
tampaknya tidak meningkatkan risiko kelainan janin, berat badan lahir rendah,
atau perdarahan antenatal atau postpartum. Tidak ada komplikasi janin atau
kelainan yang dilaporkan di kalangan wanita yang diobati dengan jahe dalam
Keating dan studi Chez2.

22
Studi yang heterogen dalam hal intervensi perbandingan yang digunakan, hasil
tindakan, durasi percobaan dan formulasi jahe, dan dengan demikian, dianggap
tidak cocok untuk pengumpulan data.

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5. Diskusi

Jahe telah lama digunakan dalam pengobatan herbal Barat, pengobatan

tradisional Cina dan pengobatan Ayurvedic sebagai antiemetic.5,, 8 9, 10, 11, 16
ini set ulasan dari untuk memeriksa bukti efektivitas untuk mual jahe dan
kehamilan-induced dan muntah . Empat kelompok paralel, uji coba terkontrol
secara acak berada. Semua studi menemukan jahe oral, dalam berbagai bentuk,
untuk menjadi pengobatan yang aman dan efektif untuk PNV bila dibandingkan
dengan plasebo dan vitamin B6.

Adalah penting bahwa penafsiran temuan memperhitungkan keterbatasan studi

termasuk, khususnya, studi durasi dan populasi. Pertama, penelitian itu waktu
yang terbatas, tanpa percobaan memberikan pengobatan lebih dari tiga minggu.
Ini tidak memungkinkan kesimpulan yang akan dibuat tentang keamanan jangka
panjang atau efektivitas jahe di PNV, masa studi jangka panjang jahe dapat titik
terang pada masalah ini. Kedua, kebanyakan studi merekrut perempuan yang
berada di luar trimester ketiga kehamilan (dua studi merekrut perempuan yang
sampai dua puluh minggu kehamilan). Hal ini mungkin tidak mewakili populasi
khas dengan PNV sebagai PNV biasanya sembuh oleh tiga sampai empat bulan
(pada 40% wanita), dengan kurang dari 20% terus enam belas minggu, dan
kurang dari sepuluh persen menjadi dua puluh weeks.6

Beberapa isu lainnya muncul dalam literatur yang lebih luas, yang juga layak
diskusi dalam tinjauan ini, ini berhubungan dengan bidang dosis dan interaksi
farmakologis.

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6. Dosis

Dosis harian yang direkomendasikan jahe untuk pengobatan PNV adalah

1000mg.16, 23, 24 Sulit untuk mengetahui apakah empat studi diberikan jahe
pada dosis dekat dengan yang dianjurkan mengingat kurangnya rincian tentang
metode ekstraksi, pelarut yang digunakan , dosis ekstrak dan setara herbal
kering. Penelitian hanya melaporkan setara herbal kering adalah Willetts et al.21
yang diberikan jahe pada dosis setara dengan 4.5g jahe kering setiap hari. Ini
melebihi dosis maksimum harian yang direkomendasikan untuk kehamilan 4g.25
Ini adalah penyebab keprihatinan beberapa jahe sebagai dosis lebih dari 4g per
hari dapat menghasilkan efek stimulasi rahim, 26 yang dapat mempengaruhi
kehamilan. Dosis tinggi dari jahe juga dapat memperburuk kondisi yang sudah
ada, seperti cholelithiasis, 27 atau berkontribusi terhadap aritmia jantung,
depresi dan SSP heartburn.15, 28 Meskipun, efek samping seperti itu tidak
diidentifikasi oleh Willetts al.21 Tabel et 2 menggambarkan bagaimana Konsumsi
jahe dari berbagai sumber dapat mengakibatkan seorang wanita melebihi dosis
harian maksimum yang disarankan jahe untuk kehamilan.
Tabel 2. Dosis berbagai bentuk ginger.22
Bentuk mengikuti jahe dilaporkan menjadi setara dengan dosis 1000mg dari
ekstrak jahe standar:
1 sendok teh (5g) rimpang jahe segar parut.
2 ml ekstrak jahe cair.

23
2 sendok teh (10ml) sirup jahe.
4 cangkir (237ml masing-masing) dari teh jahe dikemas.
4 cangkir (237ml masing-masing) teh jahe segar (disiapkan oleh menanamkan
sendok teh jahe parut dalam air panas selama 5-10min).
1 cup (237ml) ginger ale (dibuat dengan jahe yang nyata).
2 buah jahe mengkristal, masing-masing persegi 1inch, inci tebal.

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7. Farmakologi interaksi

Selain kekhawatiran tentang dosis, jahe juga memiliki potensi untuk berinteraksi
dengan obat lain. Disarankan bahwa jahe tidak dikombinasikan dengan obat-
obatan seperti dimenhydrinate (Dramamine) karena interaksi yang mungkin saat
ini tidak diketahui. Jahe juga harus dihindari pada pasien diresepkan obat
hipoglikemik oral atau insulin, seperti beberapa konstituen jahe secara teoritis
bisa mempotensiasi efek hipoglikemik dari medications.29

Abebe24 telah menunjukkan bahwa jahe tidak boleh digunakan bersamaan

dengan tanaman lain atau produk herbal yang dapat mengganggu pembekuan
darah normal, seperti bawang putih, ginseng atau Ginkgo biloba. Pasien yang
diobati dengan anti-arrhythmic obat atau pusat depresan sistem saraf juga harus
memperhatikan hati saat menggunakan jahe preparations.29, 30 Jahe juga dapat
meningkatkan penyerapan obat oral lain yang dikelola, 20 dan mungkin
menentang aktivitas inhibitor pompa proton dan H2 blocker dengan
meningkatkan produksi acid.22 lambung

Ada juga saran bahwa jahe tidak boleh diberikan dengan obat yang mengganggu
pembekuan darah, seperti aspirin, heparin, atau warfarin.22 20 Namun, dalam
sebuah studi crossover acak dari dua belas subyek sehat, kapsul jahe tiga
(masing-masing berisi setara ekstrak menjadi 400mg bubuk rimpang jahe)
diminum tiga kali sehari selama dua minggu tidak berpengaruh terhadap
farmakokinetika atau farmakodinamika dosis 25mg tunggal warfarin diambil
pada hari ketujuh. Selain itu, jahe saja tidak mempengaruhi Normalised Ratio
Internasional (INR) atau trombosit aggregation.31

Sebuah laporan kasus tidak menggambarkan kenaikan INR lebih dari 10 dengan
epistaksis menyertainya dalam jahe wanita mengkonsumsi makanan. Wanita itu
makan jahe secara teratur dalam bentuk potongan jahe kering dan teh bubuk
jahe dari minggu setelah beberapa INR nya telah stabil pada phenprocoumon.
Kombinasi ini adalah kemungkinan penyebab INR tinggi. Setelah wanita itu
berhenti mengkonsumsi jahe, INR nya restabilised pada dosis asli
phenprocoumon.31 Kasus serupa mengakibatkan perdarahan telah dilaporkan
pada seorang wanita pada warfarin.32

Demikian juga, dalam studi longitudinal prospektif pasien yang memakai

warfarin dan suplemen herbal / makanan, ada peningkatan signifikan secara
statistik dalam peristiwa pendarahan pada pasien yang memakai warfarin dan
jahe (7 berdarah dalam 25 minggu), tidak ada yang besar (rasio odds 3.2) .33
Tak satu pun dari pasien yang menggunakan kombinasi menunjukkan sebuah
INR ditinggikan. Produk jahe digunakan dalam penelitian ini tidak disebutkan,
tetapi penting untuk dicatat bahwa beberapa pasien memakai lebih dari satu
berpotensi berinteraksi suplemen.

Kembali ke Garis Pasal

24
8. Kesimpulan

Ulasan ini meneliti keamanan dan efektivitas persiapan mono oral jahe pada
wanita dengan kehamilan-induced mual dan muntah. Kajian ini menemukan
penelitian sederhana di daerah, dengan empat RCT diidentifikasi. Keempat studi
menemukan jahe lebih efektif daripada plasebo dan seefektif vitamin B6 dalam
meningkatkan PNV. Penelitian menunjukkan juga bahwa penggunaan jahe pada
wanita dengan PNV aman. Namun, penulis menyoroti bahwa penggunaan jahe
pada populasi ini bukan tanpa resiko, mencatat bahwa mungkin ada konsekuensi
buruk yang terkait dengan overdosis, dan penggunaan bersama obat-obatan
lainnya. Mengecewakan, semua empat studi yang waktu terbatas, meskipun
fakta bahwa PNV sering berlangsung selama berminggu-minggu, bahkan
berbulan-bulan. Penelitian di masa depan perlu menyelidiki keamanan jangka
panjang dan efektivitas jahe untuk PNV, termasuk efek dosis pada parameter ini.

25