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
What is soy used to treat?
menopausal symptoms *conflicting data on efficacy for hot flashes
metabolite INC estrogen activity
What groups should avoid soy?
Pt estrogen receptor positive breast cancer
What is saw palmetto used to treat?
BPH Grade A!
-antiandrogenic, antiproliferative, anti-inflammatory properties -significantly improves many BPH symptoms –> frequent urination, painful urination, hesitancy, urgency
Side effects of saw palmetto
- well tolerated w/ few side effects
- dizziness and GI
- less impotence than finasteride
- does not decrease PSA levels
- INR w/warfarin
What are the grades of evidence for garlic and what it’s able to treat?
Grade A = hyperlipidemia, HTN Grade B = decrease CVD risks
antimicrobial, antiviral, immune-enhancing, antispasmodic, antihypertensive, cholesterol lowering
What are drug interactions of garlic?
- reduces saquinavir by ~50%
- advise pts on protease inhibitors not to start or stop
- INC bleeding time and INR w/warfarin
ADE of garlic
- may inhibit platelet aggregation
- postop bleeding and spinal epidural hematoma
What are the claims of ginkgo biloba?
memory enhancement, cognitive improvement, and antiplatelet activity.
Grade A = claudication (PVD),
dementia Grade B = cerebral insufficiency
Drug interactions of ginkgo
- potent inhibitors of platelet-activating factor
- may also CYP450 enzymes
- DI warfarin, aspirin, ibuprofen
- serotonergic effects
- don’t take w/ MAOIs and SSRIs!
- NOT recommended if using w/ antiplatelet agents
ADE of ginkgo
- intracerebral hemorrhage, spontaneous bleeding in the eye, postop bleeding
- variable insulin levels DM caution
What are the claims of ginseng?
'mental performance' and 'increase energy' - immune function, antioxidant activity, analgesic effects, improved *glucose homeostasis, reduces cancer risk
What is the grade of evidence for ginseng and what it’s able to treat?
Grade B = CV conditions, hyperglycemia in healthy individuals, immune system enhancement, DM2
ADE of ginseng
insomenia, nervousness, HTN
What supplements should be avoided with warfarin?
3 G’s! Gingko, garlic, ginseng*
What is echinacea indicated for?
‘immune modulating’ agent - increases production of interleukins and NK cell activity, demonstrated weak antibiotic/antiviral/antifungal effects
Grade B for URTI prevention/treatment-marketed to reduce duration of cold if started within 24hrs
ADE for echinacea
flu-like symptoms, unpleasant taste, GI discomfort
What is melatonin?
a serotonin derivative produced by pineal gland helps regulate sleep/wake cycles - release coincides w/ darkness and is suppressed by daylight
What are the grades of evidence for melatonin and what it’s able to treat?
Grade A - jet lag Grade B - delayed sleep phase syndrome, insomnia in elderly, sleep disorders, sleep enhancement in healthy people
How to give melatonin for insomnia and jet lag?
At sunset!
insomnia - QD HS
jet lag- first dose at departure, 1-3 nights after arrival
ADE of melatonin
Rare
next day drowsiness, vivid dreams, HA
Does vitamin B3/Niacin prevent cancer!?
nonmelanoma skin cancer- Niacinamide 500mg BID Continue topical sunscreen
What supplements should never ever use!?
Comfrey- inflammatory ADE- liver failure irreversible; deaths reported
Kava-GAD; ADE-liver liver failure -death reported
Yohimbe- impotence; ADE-*changes in BP, arrhythmias, respiratory depression, heart attack
