February 20, 2000 - Herbal medicine refers to the use of whole plant remedies for healing and promoting good health. Over time it has waxed and waned, with tremendous popularity in the 16th and 17th centuries followed by a steady decline until the early 20th century. Today, there is a wave of new interest in herbal medicine, with more than 500 licensed products being widely advertised as harmless remedies for constipation, fatigue, obesity, and skin conditions such as acne and psoriasis. As use of herbal remedies has increased, side effects have been reported, some of them dangerous.
On this page, I will concentrate on herbal medicines as they relate to heart disease, specifically, congestive heart failure. However, I will include warnings about dangerous products as I run across them. I will also include items of general interest, especially if they catch my fancy. <g> If you know of any good herbal sites, please let me know and I will consider adding them to my links here. Jon.
The following drugs have some degree of diuretic action. Taking a product containing one of these substances while also taking a diuretic drug raises your risk for dehydration and electrolyte imbalance.
Ginseng and licorice can potentially worsen your heart failure and edema, by causing fluid retention. Aconite has varying effects on the heart that could lead to heart failure.
December, 2000 - From the jounal Clinical Pharmacology (2000):
Source: Clinical Pharmacology 2000
December 16, 1999 - Intermittent claudication is a painful condition caused by blockages in leg arteries. When arteries in a person's legs become obstructed, severe pain will occur with exercise and can cause even walking to be too much.
A new study published in this month's issue of the German journal Arzneimittel Forschung (Drug Research) suggests that a higher than usual dose of ginkgo biloba can increase walking distance more than the normal dose in those with claudication. This double-blind study enrolled 74 people with fairly severe intermittent claudication. Half were given ginkgo at a dose of 240mg a day, and the other half received 120mg a day (the more typical ginkgo dose).
At the beginning of the study, the average distance participants could walk without pain was about 100 meters. After 6 months, people taking the higher dose of ginkgo could walk more than twice as far as they could before they started treatment. In contrast, the lower ginkgo dose only provided about 60% improvement. Ginkgo is thought to work by improving circulation and has been shown in previous trials to be more effective than placebo for claudication.
From Reuters Health
March 1, 2000 - Gingko biloba herbal extract is more effective than placebo for treating intermittent claudication, researchers report in the American Journal of Medicine. Drs. Max Pittler and Edzard Ernst analyzed 8 randomized, placebo-controlled, double-blind studies investigating the use of Gingko biloba for intermittent claudication resulting from peripheral artery disease.
While non-randomized studies have shown Ginkgo biloba to be effective, those studies "may have substantially overestimated the effect," the authors note. The researchers found that pain-free walking distance was 34 meters (about 100 feet) greater for those taking the herb compared to control subjects. However, they caution that "the overall effect seems modest."
While regular walking is effective to relieve symptoms long-term, patient compliance is often poor, so drug treatment is common. "In the few studies that have been done comparing the herb with conventional drugs, Gingko biloba has been as effective as the drugs with fewer side effects," Dr. Ernst said.
In an editorial, Drs. Bradly Jacobs and Warren Browner, comment that even though the herb "was well tolerated and less expensive than the 2 FDA-approved drugs, doctors will probably be reluctant to recommend this herbal product to their patients." This is due to the lack of FDA regulation of herbal products. "Herbal products should be regulated for safety and product quality so doctors can prescribe them without fear of harming patients," they conclude.
Source: Am J Med 2000;108:276-281,341-342
October 15, 1999 - Some popular herbal remedies, including gingko biloba, ginseng and St. John's wort, may be dangerous if taken before surgery. You shold tell your surgeon about all herbal products you use, along with prescriptions and over the counter products, to avoid dangerous interactions, said Dr. Charles McLeskey, an anesthesiologist at Scott & White Memorial Hospital. At a conference of the American Society of Anesthesiologists, he presented results of a survey of 979 pre-surgical patients, and 17% said they take one or more herbal products.
Recent findings disclose that 7 out of 10 herb users never tell their doctors about the herbal products they take. Most believe that since the products are "natural," they must be safe. ASA president John Neeld Jr cautions, "Just because a medicine is called 'natural' or 'herbal' does not mean it is harmless." Many of these products can be dangerous, especially if the patient's anesthesiologist or surgeon does not know that the patient is taking them, he said.
A number of anesthesiologists have reported significant changes in heart rate or blood pressure in some patients who have been taking herbal medications. These herbal products include:
The ASA suggests that patients stop taking herbal products at least 2 weeks before elective surgery and keep their doctors informed. This should be enough time for the herbs to be cleared from the body. If there is not enough time to stop your herbal medication before your surgery, bring the product to the hospital in its original container. This allows the anesthesiologist to see exactly what you are taking and what its ingredients are, so he can make any necessary adjustments in your surgical drugs to keep you safe.
Title: Researchers Warn of Potential Herbal-Anesthesia Interactions
Author: Charles McLesky
Source: See the Web page of the American Society of Anesthesiologists
September, 1999 - The Ginkgo biloba tree is found as an ornamental plant in many countries, including the USA. Flavinoids from the fan-shaped leaves of the female ginkgo (or maidenhair) tree were identified in the 1930s. In the mid 1970s, an extract of the leaves was developed in Europe.
Ingredients Ginkgo biloba preparation is an extract that should contain 24% flavone glycosides (primarily quercetin, kaempferol, and isorhamnetin) and 6% terpene lactones (equal parts of bilobalide and ginkgolides A, B, and C). Many other ingredients have been identified.
Action Ginkgo biloba's main action seems to be inhibiting platelet activating factor or PAF (see reference 5). Ginkgolide B is considered responsible for this PAF antagonism (see reference 6). The extract may also affect norepinephrine, serotonin, monoamine oxidase, acetylcholine, and nitric oxide (reference 7). Ginkgolides A and B may inhibit corticosteroid synthesis (reference 6). Note that some heart failure drugs also affect norepinephrine, so interaction is possible.
Uses The Chinese use Ginkgo biloba seeds to treat asthma, productive chest cough, and urinary incontinence (reference 2). Preparations from the leaf have been used as an asthma remedy (reference 3). In France and Germany, the leaf extract is prescribed for intermittent claudication and "cerebral insufficiency" - a syndrome associated with impaired circulation (reference 5). In one clinical study, patients with dementia improved 25% in cognitive function after 4-6 weeks of ginkgo biloba therapy (reference 8).
In other trials, the EGb 761 extract was shown to improve walking distances in patients with intermittent claudication (reference 9). French researchers have linked ginkgo biloba to improved vision in patients with macular degeneration (reference 6).
Clinical trials do not yet support using Ginkgo biloba for asthma, inflammatory conditions, myocardial ischemia, shock, graft rejection, or kidney disease. However, some evidence suggests that ginkgo biloba enhances blood vessel relaxation (reference 13). Unproven uses include treatment of cardiac arrhythmia, varicosities, hemorrhoids, and leg ulcers, phlebitis, diabetic vascular disease, depression, and Raynaud's syndrome (reference 15).
Cautions Ginkgo biloba may prolong bleeding time and should not be used in people with hemophilia or other bleeding disorders (reference 15), or in patients taking anticoagulants or daily aspirin. No specific drug interactions has been documented (reference 5) but it is advisable to avoid using ginkgo biloba with anything that has a similar action, like warfarin (Coumadin) or aspirin (reference 16). Drinking alcohol may also prolong bleeding time (reference 17).
Side Effects Most side effects are mild, such as upset stomach, headache, allergic skin reactions (reference 18), irritability and restlessness (reference 15); and peripheral visual shimmering (reference 6). In placebo controlled clinical studies, the number of side effects with ginkgo biloba was similar to that with placebo (reference 8). Reactions may be more common when using Ginkgo biloba seeds. Contact with the fruit pulp causes skin irritation called dermatitis (references 2 and 15).
Long-term use has been linked with spontaneous subdural bruising (bruising between the brain and skull), intracerebral or intraocular bleeding, and prolonged bleeding time (references 16, 17 and 19). Ginkgo biloba extracts are not known to be poisonous, even in above average doses (reference 3). No major adverse effects like liver or kidney failure have been seen with long-term use (reference 3).
Dose The average dose of standardized extract is 40mg 3 times a day. People over age 50 may choose to use use 60mg. Patients with cerebral insufficiency and dementia have reportedly benefited from taking 120-160mg daily in 3 divided doses (reference 18). One study reported good results with 240mg daily of ginkgo biloba or 40mg of tacrine (reference 20). Best dose and length of treatment are unknown. While some people report benefits within 3 weeks of daily use, most require months before significant effects are felt. Some sources advise taking ginkgo indefinitely. Its effectiveness increases and lasts longer with time (reference 14).
Warning In some people, even small doses of ginkgo biloba may not be tolerated (reference 15). Children taking ginkgo biloba - and adults taking medicinal sized doses - should only do so under the care of a doctor (reference 15). Ginkgo biloba should not be used by those with risk factors for stroke. This includes people on anticoagulant therapy (blood thinners or aspirin), high blood pressure, alcohol intake, or amphetamines or cocaine use. Smoking may increase risk of hemorrhage (reference 17). Patients with diabetes mellitus should use ginkgo biloba with caution. Although diabetes may be a risk factor for stroke, the vasodilating qualities of ginkgo biloba might be beneficial to diabetics.
Title: Ginko Biloba
Author: Janet H. Cuccinelli
Source: Clinician Reviews 9(8):93-94, 97, 1999
March 9, 1999 - Investigators from New England Medical Center in Boston have found that people taking the herb ma huang, a natural source of the stimulant ephedrine, may be at risk for heart attacks, sudden death and strokes.
They looked at a database containing 926 reports of problems from ephedrine use. Fifty of these were heart-related, including 14 sudden deaths, 13 strokes, 2 mini-strokes and 9 heart attacks. Thirty-eight of the subjects had no history of heart disease. He said that sudden death can occur after taking this substance, even if a person doesn't have heart disease.
The researchers reported their findings at the annual meeting of the American College of Cardiology. Ma huang has been used for 500 years in Chinese herbal remedies to treat asthma. In this country, it is used largely for weight loss, energy enhancement and body building. In the study, 27 people had used the supplement for weight loss, and 15 had used it to boost their energy. Women were more likely to suffer serious consequences after taking ma huang. Last year, the FDA issued a warning about the dangers of taking supplements containing ephedrine.
Source: The New York Times
December, 1999 - Herbal preparations are marketed as natural and safe alternatives to conventional medicines. However, consumers may not be fully aware of their potential side effects. We report 2 cases of acute hepatitis (severe inflammation of the liver) after herb use. One of the mixtures included chaparral and bee pollen; the other was pure bee pollen. We reviewed the literature and will discuss herbs with the potential to poison the liver, with acute hepatitis and venoocclusive disease (blockage of the veins) as two of the more serious toxicities.
Case one was a 33 year old woman who had been taking two tablespoons of pure bee pollen per day for several months. She had sharp stomach pains as well as some chest pain. The patient had no nausea, vomiting, or diarrhea. Medications included aspirin and caffeine for headaches, as well as regular use of erythromycin for chronic acne. Herbal medication was discontinued while the other medications were not. This resulted in complete relief from symptoms, and laboratory test results returned to normal after 6 weeks.
Case 2 was a 69 year old man who had been taking 14 tablets per day of a mixed herb preparation for 6 weeks. He had severe itching and nausea. These symptoms became more intense and were followed by loss of appetite, weight loss, and jaundice. His only medication was Lopressor for high blood pressure. Herbal medications were discontinued and the patient's symptoms, as well as liver function problems, progressively improved. He was without symptoms 8 weeks later, and results of laboratory tests were normal.
Discussion Venoocclusive disease, a blockage of small veins in the liver by connective tissue, has been extensively reported as occurring after exposure to contaminated grains in Asia and in herbal teas. The toxic compound is made of pyrrolizidine alkaloids, which were major components in these herbs. Recently, acute hepatitis has also been associated with the use of herbs.
Symptoms We found several reports of acute hepatitis after use of herbal preparations like chaparral, germander, Chinese herbs such as Jin bu huan, mahuang, skullcap, mistletoe, senna, and valerian root. However, we found no reported cases of acute hepatitis associated with use of bee pollen. In all of the acute hepatitis cases, symptoms started from 2 weeks to 6 months after the patient started taking herbal preparations. Jaundice was the most common initial symptom. Additional symptoms included nausea, stomach pain, and enlarged liver. One report described ascites (accumulation of fluid in the spaces between tissues and organs in the abdominal area) and encephalopathy (degenerative brain disease). Liver function abnormalities included certain test results being as much as 100 times normal.
Results In most of the cases, stopping use of the herbal preparations led to relief and normal liver function within 1 to 10 months. However, there were 2 reports of liver failure and death.
Bee Pollen Bee pollen is a fine powder-like material, which is produced by the anthers of flowering plants and then gathered by bees. It is recovered from bee hives and then sold in a liquid form by itself or mixed with honey. It is marketed for fatigue, depression, colon disorders, and as an antimicrobial agent. This substance has been known to cause allergic reactions, but no cases of acute hepatitis have been linked to bee pollen.
Chaparral Six cases of acute hepatitis associated with chaparral use have been reported. This herb comes from the leaves of the creosote bush, an evergreen desert shrub. The leaves are ground and used for tea or made into tablets and capsules. Chaparral has been used as an antioxidant to slow aging, and it has been suggested as a remedy for colds, diarrhea, aches, lacerations, withdrawal from booze, and for skin conditions such as acne, dandruff, and psoriasis. Its active ingredient is nordihydroguaiaretic acid (NDGA). In rats, this has been shown to cause kidney cysts.
Germander is another herb that has been reported to cause hepatitis. It has been used as tea, made into capsules, or mixed with other herbs and has been used as remedy for obesity. The components of germander include polyphenol derivatives, diterpenes, and flavonoids, but the toxicity of these compounds is unknown.
Chinese herbal medicines are mixtures of several plant products that are being used increasingly in the United States. Jin bu huan is used as a sleeping aid and pain reliever. Mahuang is used as an aid to weight loss. Others are used for skin disorders such as eczema and psoriasis. In the last 5 years, Chinese herbal medicines have become the leading cause of liver toxicity from herbs. Furthermore, one of the reported 7 cases of hepatic necrosis and death was due to Chinese herbs. These mixtures often contain 8 or more varieties of root, root bark, and insect fragments, which are boiled together. Therefore, it is often difficult to pinpoint the specific component responsible for the damage.
Conclusions Herbal medications are widely advertised as harmless remedies for a variety of ailments. Many people are turning toward the Internet for information about their illnesses and are discovering the potential uses of herbal mixtures. It is often difficult to identify the exact toxic component in herbal preparations, since they contain multiple ingredients. Individual components may not be pure substances, and not all components are listed on the lables. The true number of herb-induced liver toxicities is unknown because many of the side effects are nonspecific, and patients may not seek medical care but stop taking the herbs on their own.
Title: Acute Hepatitis After Ingestion of Herbs
Authors: Javaid A. Shad, Colin G. Chinn, Oscar S. Brann
Source: South Med J 92(11), 1999
February 16, 2000 - Swiss researchers have reported 2 cases of acute heart transplant rejection due to an interaction between St. John's wort and cyclosporin.
Dr. Georg Noll reports a 61 year old patient who had a heart transplant 11 months before to being admitted for a heart biopsy. The patient had been on 125mg cyclosporin twice a day, 100mg azathioprine daily and 7.5mg prednisone daily. The patient started treating himself for depression with 300mg St. John's wort 3 times a day, about 3 weeks before being admitted.
Upon admission, Dr. Noll noticed decreased cyclosporin blood levels. The biopsy revealed acute organ rejection, and the doctors suspended the St. John's wort due to suspicion of an interaction with cyclosporin. Dr. Noll's group tried mildly increasing the man's meds but another heart biopsy showed that the acute rejection persisted. At this point, they took serious drug action, which stopped the rejection episode.
One week later, a 63 year old patient was admitted to the hospital, also for heart biopsy. This patient had undergone heart transplant 20 months earlier and had been maintained on the same three anti-rejection drugs as the previous patient. Three weeks before admission, a psychiatrist started the patient on 300mg St. John's wort 3 times a day because of anxiety and depression. This patient also had a low cyclosporin level and his biopsy showed acute organ rejection.
Dr. Noll halted the St. John's wort, and cyclosporin levels increased to the proper level. The researchers believe that St. John's wort was the cause of the drop in blood levels of cyclosporin. They point out that St. John's wort extracts contain naphtodiantrons, which alter the way a human body metabolizes cyclosporin. "In addition," Dr. Noll's group writes, "St John's wort extracts have been suggested to induce intestinal P-glycoprotein drug transporter, which could also decrease bioavailability of cyclosporin."
Source: Lancet 2000;355:548-549
May 17, 2000 - The use of St. John's wort, an herbal remedy sold over the counter as a treatment for depression, has taken off among consumers in recent years. The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) recently stated that the herb may be effective against mild depression, at least in the short term but a new study warns that it is no better than placebo for treating major depression.
Researchers from Vanderbilt University presented their study, one of the first large government-funded projects studying St. John wort's effectiveness, at the annual meeting of the American Psychiatric Association. The team, led by Dr. Richard Shelton, did a placebo-controlled study of 200 patients with major depression that was at least moderately severe. In the end, the researchers concluded that St. John's wort was no more effective than placebo in these patients with major depression.
This is cause for concern because a second study showed that more and more patients are turning to herbs for depression relief. "They're fearful," Dr. Cornelia Lange said. "They'll try anything they can to avoid coming to a psychiatrist."
Lange discussed the survey done at her clinic that showed high rates of herbal therapy being used by psychiatric patients. Herbs may have harmful interactions with conventional antidepressants and other psychiatric drugs, Lange warned. She advised psychiatrists to be sure to ask their patients - in a non-judgmental way - whether they are using any herbs. It is important to ask the question because herbs like St. John's wort reduce the effectiveness of antidepressants.
The survey of 80 psychiatric patients found that 69% were using herbs such as St. John's wort, ginseng, ginko biloba, and chamomile. Hispanic and non-Hispanic patients reported using herbs at the same rate. Most of the patients said they hesitated to tell their psychiatrist about taking herbs. Lange counseled her fellow psychiatrists to have an open mind so that patients will feel comfortable sharing about alternative therapies. She also called for more research into interactions between herbs and conventional drugs.
Source: Reuters Health
March 16, 2000 - At least 50 species are known, but this article applies only to Urtica dioica, a perennial herb. Touching the hairs on the leaves and stems of this plant causes a temporary painful sting, thus the name stinging nettle. The leaves, roots, and seeds of the plant have all been used as herbal medicine. The root of the plant contains several compounds including scopoletin, sitosterol, oleanolic acid, isolectins, polysaccharrides, and various lignans. The root seems to have different effects from the the leaves. The leaves may cause a mild diuretic effect; why is unknown.
Stinging nettle may benefit patients with BPH (benign prostatic hypertrophy), where cell growth in the prostate gland obstructs urination by constricting the urethra. A protein called UDA is also found in the root. This compound can stimulate production of immune system components, and has anti-viral actions. The herb can have a diuretic effect and can lower systolic blood pressure.
German doctors say the root is good for treating urinary difficulties associated with BPH and several clinical studies support the plant's effectiveness. The leaves can be used as a mild diuretic. At least one double-blind trial supports the effectiveness of freeze-dried nettle in treating patients with allergic rhinitis. Drug interactions are unknown. Nettle appears to be completely non-toxic but as with any herb, allergic reactions are possible.
Dose Since the active ingredients seem to be water soluble, the root may be used to make a tea. The usual dose is 4-6 grams per day. The dried leaves have also been used to prepare a tea, with a typical dose of leaves being 3-4 teaspoonfuls per 150ml boiling water. One cup of this tea can be consumed 3-4 times a day. Note: Potency for herbal products can vary a lot from manufacturer to manufacturer.
Sources: Tyler VE. Herbs of Choice 1994:84-5
Yarnell E. Alt & Comp Ther 1998;4:180-6
Galelli A, et al. J Immunol 1993;151:1821-31
Krzeski T et al. Clin Ther 1993;15:1011-20
Mittman P. Planta Medica 1990;56:44-7
April 9, 2000 - Researchers at St. Michael's Hospital and the University of Toronto say that taking American ginseng before a meal reduces blood sugar in people with and without diabetes. The study appears in the April 9 issue of the Archives of Internal Medicine. Dr. Vladimir Vuksan, lead investigator for the study, says, "Although preliminary, these findings indicate that American ginseng's potential role in diabetes should be taken seriously. Controlling after-meal blood sugar levels is very important in managing diabetes. It may also be important in the prevention of diabetes."
Patients were both diabetic (Type 2) and non-diabetic. They took capsules containing 3 grams of ground Ontario-grown American ginseng either 40 minutes before, or during, a glucose test meal. Among Type 2 diabetics, those who took the ginseng capsules had a 20% reduction in blood sugar levels compared to when they took placebo capsules. Among non-diabetics, similar reductions were only seen when the ginseng capsules were taken before - not together - with the test meal. Thus, the timing of taking ginseng may be important. The trial did not compare diabetics to non-diabetics.
Although the results are encouraging, Vuksan cautions that people should not use these findings as a reason to start taking ginseng. "This is a short-term study that only shows a need for more research. We don't know what the effects of long-term ginseng consumption will be. Because of poor standardization in the herbal industry, we also don't know if these findings will hold true for all American ginseng products. Nor do we know whether taking different species of ginseng such as Chinese or Japanese will have the same outcome."
"This study is an important step in evaluating herbals," says Vuksan. "A major criticism of the herbal research has been the lack of scientific, placebo-controlled trials in humans. Our study applied clinical trial standards to researching an alternative herbal product." Ginseng is one of the most widely-used herbs worldwide. There are several types, including American, Chinese, Japanese and Siberian. Only recently have tests of ginseng begun using scientific techniques.
Title: American ginseng reduces blood sugar; Implications for diabetes and herbal research
Author: Nicole Ireland
Contact: U of T Public Affairs (416) 978-5949; firstname.lastname@example.org
June 29, 2000 - The leaves of feverfew (Tanacetum parthenium) contain parthenolide, (a sesquiterpene lactone). Other similar substances in feverfew contribute to its action. These lactones inhibit the release of serotonin from blood cells. This makes feverfew useful for relieving migraine headache and the associated nausea and vomiting. Several clinical studies have documented this use of feverfew.
Interactions There may be interactions with other drugs that affect serotonin. In theory, feverfew may interact with drugs like dexfenfluramine, fenfluramine and SSRIs such as Prozac, Paxil and Zoloft. However, this is unproven.
Cautions Chewing the leaves has been associated with oral ulcers in 12% of subjects. Irritation of the tongue and swelling of the lips has been reported in 7%.
Dose Feverfew is commonly used by chewing the leaves of the plant but this is not recommended. Tablets and capsules are available commercially, which contain 300mg of the herb. Manufacturers recommend two to six 300mg doses per day but this is a much larger dose than is necessary for migraine headache. Doses of 0.25mg of parthenolide is adequate. For preparations that contain 0.2% parthenolide, only 0.125mg of the herb would be necessary. A sublingual spray is also commercially available but proper dose of that is unknown at this time.
Canadian authorities suggest that quality feverfew should contain not less than 0.2% parthenolide. British feverfew preparations vary a lot in active ingredient. American preparations are even less reliable - no parthenolide could be detected in 2 of 3 preparations purchased in Louisiana health food stores (Tyler 1994).
June 29, 2000 - Huperzia serrata (Huperzine A) is a club moss that is used in Chinese medicine. It contains an alkaloid known as huperzine A or HupA. HupA has been reported to treat memory loss associated with Alzheimer's and other forms of dementia. In China, huperzine A is known as "Qian Ceng Ta." In the USA, Huperzine A is marketed in combination with vitamin E as Cerebra ®. Other Huperzine A products are also available.
The alkaloid HupA binds very tightly to and inhibits acetylcholinesterase (AChE), thereby controlling acetylcholine. Binding of HupA to the enzyme is reversible. In experiments on rats' brains, levels of acetylcholine, dopamine, and norepinephrine all increased after giving HupA. Drugs approved for treating Alzheimer's dementia (donepezil, tacrine) also inhibit AChE.
The FDA gave permission to Nutrapharm Inc., to market Cerebra as a nutritional supplement to adults in their 50s, 60s, and 70s who are experiencing memory loss. Some investigators have tested the drug for treating patients exposed to nerve gas.
Cautions This herb should not be used during pregnancy or in patients with high blood pressure. Nausea, digestive discomfort, and dizziness have been reported in limited clinical trials. Consumers should not confuse the raw product (the moss) with the alkaloid. Other compounds in the moss could be toxic. Some products may contain standardized or purified HupA extracts.
Interactions Since this herb potentiates acetylcholine, you probably should not use drugs with central anticholinergic properties at the same time (benztropine, trihexyphenidyl). Also, use with other acetylcholinesterase inhibitors (tacrine, donepezil) is not recommended.
Dose Unclear at this time. Limited trials in various demetias have used an starting dose of 50 micrograms orally twice a day, with final dose in the range of 200µg - 400µg orally per day, given in divided doses.
March 20, 2000 - Anti-digoxin Fab fragments can safely treat heart arrhythmias caused by eating yellow oleander seeds, a common cause of poisoning worldwide. Ingesting the seeds - which contain cardiac glycosides (digoxin is a cardiac glycoside) - can cause a state similar to digoxin poisoning. Self-poisoning recently became a big problem in rural Sri Lanka, causing hundreds of deaths each year, according to a team led by Dr. Michael Eddleston.
The most severely affected patients often have to be transferred to a coronary care unit in the capital city for cardiac pacing (as in pacemaker) and many do not survive the trip, say the researchers in the March 18th issue of The Lancet.
Since there is a need for an effective therapy that can be given in small rural hospitals, the researchers tested the effects of anti-digoxin Fab fragments, which are used to treat cardiac glycoside poisoning. After doing a small study to find the proper dose, Dr. Eddleston randomized 66 patients with serious cardiac arrhythmia to receive anti-digoxin Fab fragments or placebo.
Two hours after treatment, the arrhythmia was completely gone in 15 of the 34 patients in the treatment group and in 2 of the 32 in the placebo group. At 8 hours, heart rates had reverted to normal (sinus) rhythm in 24 patients in the treatment group and 5 patients in the placebo group. Adverse reactions to the antibody treatment occurred in 23% of patients, although there were no deaths in either group.
"The challenge now is to make the antibodies affordable and available in rural clinics where most of the patients die," Dr. Eddleston said.
Source: Lancet 2000;355:967-972
July 6, 2000 - Two Chinese herbs have been chosen for research funding worth one million dollars US in Hong Kong. Danshen (Radix salviae miliorrhizae) may be effective treating heart diseases, including angina. Sanqi (Radix notoginseng) may prevent inflammation and pain, and improve circulation.
Research will focus on quality control. The Hong Kong Institute of Biotechnology, University of Science and Technology, and Baptist University will use the funds to improve growing practices and develop production lines within 2 years.
Hong Kong's Commissioner for Innovation and Technology, Francis Ho Suen-wai, says government encourages collaboration between private companies and institutions. "This research sponsored by the government and the New World China BioSciences Company is important to development of the Chinese medicine industry in Hong Kong," Mr. Ho said.
The Hong Kong government also secured 64 million dollars US from the Hong Kong Jockey Club to establish an Institute of Chinese Medicine. Hong Kong plans to become a major world center for Chinese medicine by 2009.
Source: Reuters Health
November 30, 1999 - Dong quai, prepared from the root of Angelica sinensis, is also known by the names tang-kuei, dang gui, and Chinese angelica. It is used in China for the heart and lungs, and to treat a wide variety of illnesses, mainly menstrual and menopause symptoms. It has been used to treat high blood pressure and ischemic stroke (stroke cause by shortage of blood to the heart).
Several active chemical components of dong quai have been specifically isolated and show the following activities:
One randomized, double-blind, placebo controlled trial in 71 post-menopausal women found that dong quai was no better than placebo for relieving menopause symptoms.
A 25% IV solution of dong quai root extract, given at 200ml per day was reported to improve neurologic symptoms, increase PT time (INR), and lower fibrinogen blood levels in 50 ischemic stroke patients after 10 days of therapy.
Cautions Psoralen and bergapten cause photosensitivity. Psoralen and safrole, an essential oil in the dong quai root, can cause cancer if taken in large amounts. There has been no testing of safety in children or in women with uterine bleeding. Dong quai is often an ingredient in combination products with other herbs.
Warnings Do not use dong quai while also taking blood thinners! Also dangerous for those who have leukemia or hemophilia. Dong quai causes photosensitivity, a reaction that may be severe. Avoid excessive sunlight exposure and avoid tanning booths.
Interactions Dong quai causes anti-blood clotting activity that may strongly add to the blood thinning effect of prescription drugs like Coumadin (warfarin). Dong quai increases INR (PT time) - human cases have been documented.
Dosage Chinese medical references list a range from 3 to 15 grams a day of raw herb steeped into tea or broth. The dose used in clinical trials has been 1.5 grams 3 times per day.
June 16, 2000 - Cancer patients may reduce the side effects of chemotherapy by taking an herbal formula called Amrit. "It makes chemo more bearable for patients without interfering in the cancer treatment," said Dr. Hari Sharma of Ohio State University.
He recently completed a study on Amrit in which Amrit patients reported improved overall well-being during chemotherapy, with less nausea, vomiting, diarrhea, insomnia, and anorexia. They also reported higher energy levels.
Several similar drugs are available that - unlike Amrit - have gone through controlled clinical trials and have been approved by the FDA, according to American Cancer Society spokeswoman Joann Schellenbach. "This may prove helpful but with any new substance, we just don't know this early on," she said.
While Amrit has been used widely in India against aging, little research exists on its medicinal qualities. Sharma acknowledged that the formula has only been tested in controlled fashion a few times over the years. Amrit is a combination of 44 herbs and minerals, including large amounts of vitamins C and E, as well as beta carotene. Taken together, Sharma claims that the the herbs increase a chemical in the liver responsible for cleansing toxins from the body.
Source: The Associated Press
March 26, 2002 - People who have liver problems or take drugs that can weaken the liver should not take the herbal supplement kava. The FDA said kava may be linked to serious liver injury. "This kind of liver damage appears to be extremely rare," said FDA supplement chief Dr. Christine Taylor, "But because it is severe liver damage, we thought consumers needed to be aware of it."
The FDA began investigating the herb after a previously healthy 45 year old woman used kava and suddenly required a liver transplant. European health officials have reported 25 similar cases, 4 requiring transplants. Canada is urging consumers not to take kava until the safety question is settled. Sales were halted in Switzerland and France, and suspended in Britain. Germany is acting to make kava a prescription drug.
Kava users should talk to a doctor if they experience yellowing of the skin or eyes; brown urine; nausea or vomiting; light-colored stools; unusual tiredness or weakness; stomach pain; or loss of appetite. Kava is sold under many names including ava, awa, intoxicating pepper, kava root, kava pepper, kawa, kew, Piper methysticum, rauschpfeffer, sakau, tonga, wurzelstock and yangona.
Kava is promoted to relieve anxiety, stress, and insomnia. A member of the pepper family, it has long been used as a ceremonial drink in the South Pacific. It's possible that kava may only be dangerous to certain people. Some of the European patients already had some liver damage before using kava.
Under federal law, no one has to prove that a dietary supplement is safe or effective before selling it. The FDA must prove a supplement is dangerous before it can halt sales. As of last month the FDA was examining 38 cases of harm from kava.
Source: Associated Press
October, 2004 - The HERB-CHF trial showed no benefit to taking Hawthorne for heart failure patients already on standard CHF meds. The small hawthorn tree (crataegus monogyna) is often considered an herb useful as medicine.
Hawthorne includes 2 kinds of active compounds: flavonoids and OPCs. WS 1442 was used in HERB-CHF. It is an extract of hawthorn leaves with flowers standardized to contain 18.75% OPCs.
Clinical trials with hawthorn extract in more than 1500 CHFers have reported improved exercise ability, increased EF, and pretty good results. However, these trials have included mostly class 2 patients, often with relatively high EF, and not often taking all the standard CHF meds.
HERB-CHF was a randomized, double-blind, placebo-controlled, parallel-group trial. It studied using 450mg of WS1442 twice a day versus placebo. One hundred twenty patients were included. All were class 2 to class 4 and had an EF less than 41%. All patients were taking standard meds, including an ACE inhibitor, beta-blocker, diuretic, and digoxin if possible.
Testing included 6-minute walk tests twice over one to 4 weeks, quality of life questionnaires, EF by MUGA, peak Vo2, norepinephrine and C-reactive protein levels, and TNF level.
57 placebo and 54 hawthorne patients completed 6 months of follow-up. There were 3 deaths in the placebo group and 6 in the hawthorn group, none related to hawthorne use. Hawthorn did not affect 6-minute walk distance.
|Outcome||At Study Start||At 6 Months|
|6-minute walk distance||374 m||358 m||379 m||371 m|
|How Patients Felt|
Hawthorne raised EF very slightly. It also slightly reduced blood pressures but it increased heart rate a bit. This trial shows hawthorne not much use to class 2 or class 3 heart failure patients already on standard meds - at least not at this dose (450mg twice a day of WS 1442 extract).
There is a big European trial of hawthorne for heart failure in progress. It is called SPICE (Survival and Prognosis Investigation of Crataegus Extract). This is a randomized, placebo-controlled, double-blind trial studying whether hawthorne reduces risk of death in CHFers. SPICE should study about 2500 class 2 to class 3 CHFers with low EF. Treatment will be the same as in HERB-CHF, and all patients will be on standard CHF meds as well. Results are expected in 2005.
Title: HERB-CHF: Hawthorne Extract Randomized Blinded Chronic Heart Failure Trial
Presenter: Dr. Keith Aaronson.
Reference : Aaronson K. HERB-CHF (Hawthorn Extract Randomized Blinded Chronic HF Study). Late-Breaking and Recent Clinical Trials. Presented at the 8th Annual Scientific Meeting of the Heart Failure Society of America; September 12-15, 2004.
Reference: Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med. 2003;114:665-674.
Reference: Holubarsch CJ, Colucci WS, Meinertz T. Survival and prognosis: investigation of Crataegus extract WS 1442 in congestive heart failure (SPICE) - rationale, study design and study protocol. Eur J Heart Fail. 2000;2:431-437.
All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006 Jon C.