COMPLEMENTARY THERAPY Herbal Medicines and St John’s wort Flashcards
what do herbalists believe?
– health is when the natural state of the body is achieved.
– Ill health arises when there is an imbalance.
– in a holistic approach to healthcare
– Their remedies:
• Stimulate the bodies defences
• Normalise processes
• Eliminate toxins
what are herbal medicines?
– Use whole plants, whole plant parts or whole plant extracts
• The wide range of compounds act together to produce a single therapeutic effect
what are the legal considerations with herbal medicines?
• Herbals remedies that make therapeutic claims need to be registered as:
– Medicines
Or
– Under Traditional herbal registration scheme (THR)
• All registered products are given a registration number (THR) similar to a MA number
what are traditional herbal medicinal products?
• Must have been in use for 30 years • Must demonstrate: – Quality – Safety • Must provide patient information on: – Contraindications – Side effects – Use in pregnancy, children • No requirements to show benefit, no need for clinical trials. As long as it is safe it can be sold
what are the restrictions on pharmacists selling herbal remedies?>
can sell from registered premises any herbal remedies
– Containing substances in Parts I & II
– Anything sold by a herbal practitioner or a shopkeeper
what are restrictions of herbal practitioners selling herbal remedies?
– Containing substances in Part II
– GSL herbal medicines
– Any remedy which can be sold by a shopkeeper
what are the restrictions on shopkeepers selling herbal remedies?
– GSL herbal medicines (MA, PL)
– Registered Traditional Herbal Medicinal Products (THR
what are the traditional uses of st johns worts?
- Hang plant in the house on St John’s day (24th June) over a religious icon to ward off evil! (Wiki)
- Relief of slightly low mood and mild anxiety (PIL)
what is the mode of action on st john worts?
• Depression – exact mechanism is not certain
• A number of compounds have been identified in the extracts:
• Main active ingredient hyperforin:
– Inhibit the reuptake of monamines
• inhibits the reuptake of serotonin (5-HT)
• Upregulate serotonin receptors
• An active hypericin:
– Blue-black planar solid.
– Can readily form free radicals-linked to photosensitivity side effects.
how is st john worts prepared from extract?
- Extraction solvent: Ethanol 60% (v/v)
* Each tablet contains 250mg of extract (as a dry extract) from St John’s aerial parts (3.5-6:1)
what is the dosage of st johns worts?
• Adults & the elderly: Take 1 tablet daily. Swallow the tablets whole with some water or other liquid. Do not chew the tablets. Do not exceed the stated dose
what are the available formulations of st johns worts?
- Tablets
- Capsules
- Teabags
- Tinctures
what are the interactions with st johns worts?
• St John’s wort induces the cytochrome P450 isoenzymes CYP3A4 and CYP2C10.
– Drugs which are metabolised by these isoenzymes will therefore be at a lower concentrations & decreased clinical efficacy.
• St John’s wort induces the P-glycoprotein (P-gp) efflux transporter.
– Drugs which are substrates for this transporter show an increased clearance, leading to lower concentrations & decreased clinical efficacy.
when should you NOT take St johns worts?
- You are under 18
- You are pregnant or breastfeeding
- You are allergic to any of the ingredients
- You are lactose intolerant
- Your skin is exceptionally sensitive to sunlight
- You are having light treatment for any condition
- You are suffering from depression
what should you do whilst taking the product?
• Avoid excessive sunbathing or the use of sunbeds/solariums
• Stop using it at least 10 days prior to undergoing any surgery: it will induce enzymes and will cause the anaesthetics to wear of more quickly
• Avoid with anaesthetics/pre-operative medicines:
– Fentanyl, propofol, sevoflurane, midazolam
