Herbals Uses Flashcards
Acai (Uses)
Weight loss + Anti Aging
Acai (Efficacy)
insufficient evidence
Acai (Adverse Effects)
Generally well tolerated
Changas disease (Parasitic protozoan) from contaminated raw fruit and juice
Acai (Important Considerations)
Avoid if having MRI, may affect results
Bitter orange (Uses)
Weight loss
Bitter orange (Adverse Effects)
Prolong QT interval
Caution anyone with Hypertension or Heart Disease
Bitter orange (Important Considerations)
Related to ephedrine, banned by many sports
Black cohosh (Uses)
?able: may reduce hot flash freq compared to baseline but not placebo
Black cohosh (Efficacy)
Effectiveness can depend on formulation
Not effective for hot flashes related to breast cancer treatment
Black cohosh (Adverse Effects)
Similar to SSRI
Rash, GI, Tender Boobs, Headache, Weight Gain
Black cohosh (Important Considerations)
Contraindicated pregnancy due to uterine contractions
MOA more like SSRIs than phytoestrogens
Caffeine (Uses)
Used in weight loss
Caffeine (Efficacy)
None really
can give mental acuity but there’s a sweet spot
Caffeine (Adverse Effects)
increased HR,BP and diuretic effects
Caffeine (Important Considerations)
High doses increase anxiety and decrease mental acuity
Cranberry (Uses)
Urinary Tract infections
Cranberry (Efficacy)
Treatment = not effective Prevention = maybe 1/3 reduce risk
Cranberry (Adverse Effects)
Stomach upset and Diarrhea in high doses
Cranberry MOA
prevents bacterial adhesion to urinary tract walls and not due to acidification of urine
Echinacea (Uses)
Common Cold and Upper respiratory infections
Echinacea (Efficacy)
may have limited benefit for prevention
does not shorten the length of cold
Echinacea (Adverse Effects)
GI
Rash (Children)
Allergic reactions
Echinacea (Important Considerations)
Avoid in patient with autoimmune disorders
Avoid in patients with ragweed allergy, history of asthma,atopy or allergic rhinitis.
Interacts with some CYP but not clinically significant
Fish oil (Uses)
Hyperlipidemia (High doses are RX)
CVD (reduce BP)
HF (Dietary oil will reduce risk of CHF by 15%)
Mental development in infants (doesn’t do anything to prevent stuff such as dementia)
Fish oil (Efficacy)
Hyperlipidemia: Decreases
TG—high doses, Rx
Reduces BP modestly
(2-5 SBP/1-3 DBP)
DIETARY fish oil reduces
risk of CHF by 15%
Mental development
(infants)
Fish oil (Adverse Effects)
Fishy Burp Bad Breath (Use EC) Heartburn Loose Stools ** Slightly increased LDL**
Fish oil (Important Considerations)
Take with meals, freeze caps, use enteric coated to
minimize AE
May inhibit platelet aggregation (>3g/day)
AHA recommends 2 servings/week, non-fried fish in
place of other proteins
Flaxseed (Uses)
Hot Flashes
Flaxseed (Efficacy)
Questionable, need 40Gram/Day and take 1-2 month potentially to work
Flaxseed (Adverse Effects)
Bloating
Diarrhea
Flatulence
Abdominal Pain
Flaxseed (Important Considerations)
1-2 months to see benefit, amount required is a lot (40Gram). Questionable efficacy
Garcinia (Uses)
Weight Loss
Garcinia (Efficacy)
Review of 11 studies found no sig effect on weight loss
Garcinia (Adverse Effects)
Mild GI
Liver toxicity requiring transplant
No warfarin interactions
Garcinia (Important Considerations)
Active ingredient is HCA (Hydroxycitric acid)
Garlic (Uses)
Not significant Cholesterol
Hypertension
Garlic (Efficacy)
HTN: Limited (decreases
SBP 7-8%)
Lipids: None (recent
studies)
Garlic (Adverse Effects)
Heartburn
Flatulence
Nausea/Vomiting
Contact Dermatitis
Garlic (Important Considerations)
Must take daily for >2 months to see clinical benefit
odorless garlic won’t work too well
Ginkgo (Uses)
Dementia
Peripheral Arterial Disease (Blood clot risk)
Ginkgo (Efficacy)
May improve cognitive symptoms in patients with dementia
No benefit in slowing or preventing dementia
Ginkgo (Adverse Effects)
Allergic reactions (Poison oak, ivy and mango tin)
Bleeding
Ginkgo (Important Considerations)
Decreases Blood viscosity = bleeding risk
Need 2-3 weeks for initial effect
Ginseng (Uses)
general wellbeing
Immune Stimulant
Sexual Dysfunction
Ginseng (Efficacy)
Minimal; depends on
indication
Ginseng (Adverse Effects)
Insomnia (Take in AM)
Headache
Estrogenic effects (Rare, high dose)
Ginseng (Important Considerations)
We focus on Panax Ginseng
Increased risk of bleeding (Antiplatelet agents = Anticoagulants) Hypoglycemia w/ Diabetes medications
Glucosamine (Uses)
Osteoarthritis but not Rheumatoid Arthritis
Glucosamine (Efficacy)
Sulfate: Improves pain and functionality for osteoarthritis of the knee when used for >4 Weeks
No improvement in osteoarthritis of the hip
Dependent on formulation
Glucosamine (Adverse Effects)
Mild GI complains
Glucosamine (Important Considerations)
Warfarin: increased INR
Shellfish allergy….Naturally derived = bad but synthetic would most likely be Safe
Melatonin (Uses)
Jetlag and Insomnia
Melatonin (Efficacy)
Best evidence for improving insomnia in elderly
Melatonin (Adverse Effects)
if dose too high it can cause insomnia so lower dose should you tried
Dose: 2-3mg QHS, can go up to 10
Melatonin (Important Considerations)
Mechanism: It regulates circadian rhythm’s and is a natural hormone secreted from pineal gland
Don’t use natural, only synthetic derived
Red clover (Uses)
Hot flashes
Red clover (Efficacy)
mixed evidence shows no benefit over placebo
Red clover (Adverse Effects)
Nausea, Vomiting, Vag Spotting
Red clover (Important Considerations)
Avoid if taking tamoxifen
Avoid in women with estrogen-dependent cancers
May increase risk of bleeding with anti-platelet agents or anticoagulants
SAMe (Uses)
increases Serotonin, NE and Dopamine levels
SAMe (Efficacy)
Insufficient evidence
SAMe (Adverse Effects)
Headache
Dry mouth
Insomnia
Nausea,vomiting, diarrhea
SAMe (Important Considerations)
Concerns: Product quality and Cost
Saw palmetto (Uses)
BPH
Saw palmetto (Efficacy)
Likely ineffective for BPH
5a-reductase inhibitors = similar in relieving BPH symptoms
A1-blockers= Palmetto less effective for Urinary symptoms and reducing prostate volume
Saw palmetto (Adverse Effects)
Dizziness Headache Decreased Libido GI Complaints Bleeding
Saw palmetto (Important Considerations)
Prolonged Bleeding time
Soy (Uses)
Hot flashes
Takes up to 2 months
Always choose Protein (Food) over Soy supplement
** Protein can reduce LDL by 10% and BP **
Soy (Efficacy)
Soy PROTEIN may modestly decrease severity/freq of hot flashes
take up to 2 months to work
Soy (Adverse Effects)
Generally well tolerated
** Avoid Supplements**
Soy (Important Considerations)
PROTEIN»_space; Supplements
Takes 2 months to work
St. John’s Wort (Uses)
Effective for mild-moderate depression
St. John’s Wort (Efficacy)
effective, high placebo effect
St. John’s Wort (Adverse Effects)
** Shit Load**
** Photosensitivity (5-10mg Hypericin) Dry mouth Fatigue Restlessness Vivid dreams Dizziness Insomnia
St. John’s Wort (Important Considerations)
Potent inducer of CYP3A4, P-gp….will decrease effectiveness of drugs related to those
Midl inducer: 1A2, 2C9, 2C19
Valerian (Uses)
Insomnia
Valerian (Dosing)
May take a few days to weeks for full effect
Taper when discontinuing
Valerian (Adverse Effects)
Headache
Nervousness
Excitability
Hepatotoxicity (Rare)
Valerian (Important Considerations)
Not as fast as benzo, shouldn’t be used with them because similar MOA
Reasons to re-evaluate herbal use? (Counseling points)
Plan on becoming pregnant Breastfeeding Need surgery/invasive procedures (Due to bleeding) Have cancer or starting chemo Change in medical condition Starting or stoping medications
Drugs used for menopause?
Soy
Black cohosh
Red clover
Flaxseed
What makes Menopause herbals “work”
Phytoestrogens “plant estrogens” = what make them work
Isoflavones = most potent of these/ most studied
Is soy effective for women who have hot flashes related to breast cancer?
No
Who should avoid Soy supplements?
if taking tamoxifen
Women with estrogen-dependent cancers
** In general Soy protein is the better choice, answer is never Soy Supplements **
Black Cohosh MOA?
thought to be similar to SSRIs
Black Cohosh Contraindications
Pregnancy: increased risk of miscarriage
How often should you get LFTs on Black Cohosh?
every 6 mo - 1yr
Why is Caffeine given combo with Ephedrine?
Caffeine decreases breakdown of NE in synaptic cleft
Ephedrine increase release of NE
Combo gives sustained effect
Ephedra Adverse effects
Heart Attack Arrhythmia Stroke Psychosis Death Seizures
Is ephedrine and derivates allowed to be used by athletes?
No, banned by every organization
Who should avoid immunostimulants?
Those with allergies, autoimmune disorders and those on immunosuppressive therapies
Fish Oil interactions?
Over 3g can inhibit platelet aggregation
Garlic Interactions
Antiplatelet agens and anticoagulants
induces P-gp efflux pump (decrease serum conc of P-GP substrates)
Soy Health Claim
Consuming 25 grams of soy protein per day reduces the risk of heart disease
St. John’s Wort Dosing
May take 3-4 weeks to see maximal effects
Taper when discontinuing to avoid withdrawal effects
St. Johns Wort MOA
Inhibits reuptake of serotonin, NE and Dopamine
Gaba effects
Ginkgo Interactions
Antiplatelet agents or anticoagulants (Stop 2 week before surgery)
Induce CYP2C19 (moderate) Medications that can lower seizure threshold
Ginkgo toxin from seeds can cause…
seizures
Valerian MOA
May increase GABA activity in CNS by inhibiting enzyme that metabolizes GABA
Benzo like effects
What is Glucosamine derived from?
Exoskeletons of shrimp, lobster, and crabs or made synthetically
Saw Palmetto MOA
Antiandrogenic
Antiproliferative
Anti-inflammatory
5-Alpha reductase activity
Cranberry Interactions
Warfarin: increases INR
May inhibit CYP3A4
What does Fish oil contain, and differences between Plant based Fatty Acid and ones from fish.
Contains EPA and DHA…… plant based Fatty Acid are not as effective because the ALA gets converted to EPA/DHA in small amounts
