Supplement&Herbs Flashcards
What is feverfew used for?
migraine prophylaxis;-reduce migraine frequency
-less severe symptoms,
Grade A - possibly effective 3/5 trials found efficacy, but well designed trial found no difference than placebo
MOA theories for feverfew
inhibits platelet aggregation,
serotonin release,
leukotrienes,
prostaglandin synthesis
Cautions for feverfew
- safe for up to 4 months (length of study)
- does not work for acute attacks
- taper dose to prevent withdrawal
- do not use if allergic to ragweed or related plants
- caution in pts taking warfarin
- *do NOT use during pregnancy/lactations
What is coenzyme Q10 used for?
migraine prophylaxis-reduces migraine attack frequency, headache-days, days w/ nausea! can also be used for Co-Q10 deficiency, CHF, angina.
Grade A - more effective than placebo
MOA for coenzyme Q10 and migraine prophylaxis
-might improve mitochondrial oxidative phosphorylation
well tolerated!
What is riboflavin (Vitamin B2) used for?
migraine prophylaxis:may affect mitochondrial dysfunction Grade A
What are the claims for riboflavin in regards to migraine prophylaxis?
high dose may reduce the frequency of migraines
does not reduce severity or duration,
must be used 3 months to see improvement
ADE for migraine prophylaxis w/ riboflavin?
-higher dose may cause diarrhea and polyuria -yellow-orange discoloration of urine
What is the MOA of Mg for migraine prophylaxis?
low Mg levels may induce cerebral arterial vasoconstriction –> increase platelet aggregation –> promote serotonin release *more likely to benefit pts with low Mg levels
Grade A -
ADE for magnesium?
diarrhea
What is St. John’s Wort indicated for?
depression - mild-to-moderate
Grade A -
What is the major active constituent of St. John’s Wort?
hyperforin
inhibits reuptake of serotonin, norepinephrine, dopamine
ADE of St. John’s Wort
- incidence similar to placebo and less than conventional antidepressants
- sexual dysfunction less than SSRIs
- serotonin syndrome
- hypertensive crisis reported with tyramine-containing foods
- can induce abortion –> do not use during pregnancy!!
Drug interactions of St. John’s Wort*
Potent inducer of CYP450 3A4
Reduce levels of
- Amitriptyline and nortriptyline
- Midazolam and alprazolam
- cyclosporine and tacrolimus
- indinavir and nevirapine
- imatinib and irinotecan
- digoxin, fexofenadine, methadone, omeprazole, oral contraceptives, simvastatin, theophylline, verapamil, warfarin
Very important drug interactions to remember with St. John’s Wort!
- FDA -protease inhibitors and non-nucleoside reverse transcriptase inhibitors
- additive effects with antidepressants
- allow 14 day washout period after treatment with an MAOI before starting St. John’s Wort
What is S-adenosylmethionine (SAMe) indicated for?
- depression Grade C
- osteoarthritis-Grade B
What is the MOA for SAMe for treatment of depression?
increase dopamine & norepinephrine levels
**may be effective as TCAs for depression
ADE for SAMe
additive effect on drugs that increase serotonin levels –> * not to combine SAMe with other antidepressants
What is glucosamine/chondroitin indicated for?
osteoarthritis- alone alleviate symptoms and slow joint deterioration in osteoarthritis
G - chitin (building block of exoskeletons of crustaceans) and stimulates the manufacturing of substances essential for proper joint function and joint repair stimulation; analgesic effects
C - bovine or shark cartilage, and acts as chondroprotective
What are the grades of evidence for both glucosamine/chondroitin?
G: Grade A - mild-moderate knee OA Grade B - general OA
C: Grade A - OA of knee and other joints Grade B - urinary incontinence/detrusor instability
ADE of glucosamine/chondroitin
-GI (nausea, indigestion, vomiting)
-headache
asthma exacerbations with chondroitin
AVOID-allergy to shellfish
What is methylsulfonylmethane (MSM) indicated for?
osteoarthritis-Grade C = conflicting data
What is black cohosh indicated for?
menopausal symptoms-Grade C
- may relieve hot flashes
- NO affect estrogen receptors
- NO affect endometrial or breast tissue
What groups should avoid black cohosh?
women w/ hx or family h/o breast CA
