Title: Herbal Remedies:
1Herbal Remedies
- Facts For Advanced Practice Nurses
2Objectives
- Explain the dramatic rise in the use of herbal
products - Discuss the current laws dealing with herbal
products - Discuss some of the most popular herbs used in
the U.S. - Explain how an Advanced Practice Nurse should
deal with patients considering the use of herbs
3Reasons For Increased Use of Herbal Products
- Disillusionment with modern medicine
- Superior because theyre natural
- Emphasis on disease prevention
- Multimillion-dollar ad campaigns
- Health conscious American public
4The Dietary Supplement Health and Education Act
(DSHE)
- Went into effect on October 25, 1994
- Includes vitamins, minerals, amino acids and
herbs - FDA does not regulate quality control
- Category II or III OTC drugs
- Must prove substantial and reasonable risk to
ban the sale of a product
5Advertisement of Herbal Products
- Regulated by DSHE
- Effect on physiological structure and function
- Cant be labeled for treatment of a disease
- Must include disclaimer
- Names of products not regulated by FDA
6Advanced Practice Nurses and Herbal Products
- Economic opportunities
- Lack of good scientific data
- Little emphasis in colleges of pharmacy
- Numerous CE courses available
- Research manufacturers
- Assume that patients may be taking herbal products
7Aloe Vera
- Tropical
- Light Green Leaves that contain gel
8Aloe Vera
- History
- 1500 BC
- Ramses the 2nd and Jesus Christ
9Aloe Vera
- Various uses
- External use - Skin application
- Internal use - Aloe vera drinks
10Aloe Vera
- 96 water
- The remaining constituents - Known as aloin
made up of complex carbs, enzymes, vitamins, and
minerals.
11Aloe Vera
- Sold OTC
- Is available in many different preparations.
12Aloe Vera
- Conflicting reports and data
- External vs. Internal use
- Advanced Practice Nurse involvement
13Arnica
- Latin name is Arnica Montana
- AKA Leopards Bane
- Used for pain and inflammation
14Arnica
- Sesquiterpene lactones
- Used externally
- Toxic internally
- Sold in lotions and creams
15Bilberry
- Vaccinium myrtillus aka Huckleberry
- Low growing shrub
- Fruit and leaves used since 16th century
16Bilberry
- Uses
- Vascular and blood disorders
- Visual uses
- Gastro-intestinal
17Bilberry
- Diabetes 7-methyl delphinidin or
other active substance.
18Bilberry
- Many uses
- Need more proof
- Bilberry is available now in various products
19Cats Claw (Uncaria tomentosa)
- Many different species
- Tropical vine
20Cats Claw
- History
- South America
- Ashanica Indians
21Cats Claw
- Immune system booster
- Antihypertensive
- Stroke and heart attack
- Cholesterol
- Crohns disease
- Gastric ulcers
- Diabetes
- Contraceptive
22Cats Claw
- No supporting clinical studies
- Diarrhea reported
23Dong quai (Angelica sinensis)
- Extract from Angelica sinensis
- All-purpose womens tonic herb
- No supporting clinical studies
- Discourage use
24Dong quai
- Claims
- Menstrual cramps
- Menopausal symptoms
- Strengthens heart, liver, spleen, kidneys
25Echinacea (Echinacea purpurea)
- Most studied and used
- Parthenium integrifolium L.
- Traditional medicine by Native Americans
26Echinacea
- Claims
- Immunostimulant
- Wound healing
27Echinacea
- Pharmacological effects
- Phagocytosis stimulation
- Increased cellular respiratory activity
- Increased WBC motility
28Echinacea
- Contraindications
- Autoimmune disorders
- Immunosuppressive therapy
29Echinacea
New evidence
30Evening Primrose OilCommon uses
- Atopic eczema
- Mastalgia
- Diabetic neuropathy
- Rheumatiod arthritis
- Menopausal flushing
31Evening Primrose OilPharmacologic Properties
- Linoleic acid
- Gamma-linoleic acid
- essential fatty acids
- precursors to prostaglandin
- heart protective effect
32FeverFewCommon uses
- Headache
- Menstrual irregularities
- Stomachache
- Arthritis
- Insect bites
- Migraine headaches
33FeverFewPharmacologic Properties
- Sesquiterpene lactones
- Inhibit prostaglandin synthesis
- Decrease platelet aggregation
- Inhibit histamine release
- Seratonin antagonist
- Parthenolide
34GarlicCommon uses
- Antibiotic
- Antiviral
- Atherosclerosis
- Reducing Blood Pressure
- Reducing Cholesterol
- Regulating circulatory system
35GarlicPharmacologic properties
- Allicin
- antibiotic
- antiplatelet
- antihyperlipidemic
- Ajoenes
- antithrombotic
36Ginger rootCommon uses
- Ease congestion
- Promote perspiration
- Stimulates the circulatory system
- Blocks muscle intestinal spasms
- Provides stress relief
- Indigestion, upset stomach
- Motion morning sickness
37GingerPharmacologic properties
- Ginerols
- Shogoals
- Inhibit enzymes that produce
- Prostaglandins
- Leukotrienes
- Clinical trials
- /-
38Ginkgo biloba
39Ginkgo biloba
- Background
- Ginkgo tree
- 2 lobed fan-shaped leaves
- Seeds originally used
40Ginkgo biloba
- Active Constituents
- Ginkgolides A, B, C, J, and M
- Inhibit platelet activating factor (PAF)
- PAF causes
- Platelet aggregation
- Bronchoconstriction
- Peripheral vasodilation
- Release of inflammatory mediators
41Ginkgo biloba
- Proposed Uses
- Alzheimers dementia
- Peripheral vascular disease
- improves perfusion
- Vertigo
- Tinnitus
- Short-term memory enhancement
42Ginkgo biloba
- Side Effects
- Rare
- Headache
- Dizziness
- GI upset
- Standardization
- 24 flavonoids
- 6 terpenoids
43Ginseng
- Korean ginseng
- (Panax ginseng)
44Ginseng
- Background
- Human-shaped root
- Different types of ginseng
- Korean ginseng
- American ginseng
- Siberian ginseng
45Ginseng
- Active Constituents
- triterpene saponins
- structure related to steroids
- no steroid effect
46Ginseng
- Proposed Uses
- Adaptogen
- Aphrodisiac
- Improve athletic performance
47Ginseng
- Side Effects
- Nervousness and excitation
- Decrease with continued use or decreased dose
- Hypoglycemia
- Inverse relationship between dietary intake and
stomach cancer
48Ginseng
- Standardization
- Wide range in quantity of ginseng between ginseng
products
49Hawthorne
- Derived from bright red berries grown on small
bush - Very common in European medicine
- Three dozen preparations marketed in
- Germany
50HawthorneUses
- Increases blood flow to heart tissue
- relieves angina
- prevents arrhythmias
- improves heart tone
- Peripheral vasodilator
- lowers blood pressure
51HawthorneLimitations
- Side effects at high doses
- sedation
- hypotension
- arrhythmias
- Safety and efficacy yet to be evaluated
52Hawthorne
- Appropriate Use
- in healthy patients seeking a lifestyle
supplemented with herbal therapies -
- Inappropriate Use
- in patients with severe cardiovascular disease
53Horse Chestnut
- Aesculus hippocastanum
- Derived from the dried seed extract
- Related to American horse-chestnut and Ohio
buckeye
54Horse ChestnutUses
- Increases overall venous tone
- in turn improves return blood flow to heart
- reduces edema caused by venous insufficiency
- studies compared to compression stockings
- Anti-inflammatory properties
- treat phlebitis, varicosity, and hemorrhoids
55Horse ChestnutLimitations
- Relatively safe in recommended doses
- Isolated cases of renal and hepatotoxicity
56Horse Chestnut
- Appropriate Use
- in healthy patients
- mild edema
- Inappropriate Use
- in patients with severe edema
57Kava-kava
- Member of the pepper family
- Grows as a bush in the South Pacific
- Derived from the extracts of the rhizomes
58Kava-kavaUses
- Anxiolytic
- clinical studies showed reduction from 25.3 to
12.6 on the Hamilton Anxiety Scale - Anesthetic
- Anti-inflammatory
- Antispasmodic
59Kava-kavaLimitations
- Mildly narcotic
- euphoric changes such as elevated mood
- Side effects at high doses
- muscle weakness, visual impairment, dizziness,
dry skin - Long term use
- hypertension, reduced protein levels, liver
damage, blood cell abnormalities
60Kava-kava
- Appropriate Use
- in healthy patients
- mild anxiety
- Inappropriate Use
- contraindicated for endogenous depression
- sever anxiety
- alcohol consumption
61Milk Thistle (Silybum marianum)
- Tonic for liver function
- regenerates liver tissue
- protects liver cells
62Milk Thistle
- Silybin
- Hepatoprotectant
- Classified as flavonolignans
63Milk Thistle
- Treatment of cirrhosis and hepatitis
- Increased survival of cirrhosis
- APAP and mushroom poisoning
64Milk Thistle
- Adverse reactions
- Laxative effect
65St. Johns Wort (Hypericum perforatum)
- Versus SSRIs and placebo
- Components
- Hypericin-MAO inhibitor
- Other components
66St. Johns Wort
- Uses
- Depression
- Anxiety
- Inflammation
- AIDS
67St. Johns Wort
- RPh shouldnt recommend dietary supplements for
treatment of depression or AIDS
68St. Johns Wort
- Drug Interactions
- Potentiate MAO inhibitors
- MAO inhibitor-like reactions
- tyramine-containing foods
- dextromethorphan
- SSRIs
- sympathomimetics
- TCAs
69St. Johns Wort
- Adverse Reactions
- Phototoxicity
70Saw palmetto (Serenoa repens, Serenoa serrulata)
- American dwarf palm
- Native to southern U.S. Atlantic coast
- Officially used for many ailments before WWII
- French extract Permixon used
71Saw palmettoUses
- Anti-androgenic, anti-inflammatory, and
anti-estrogenic activity - Benefits shown in the treatment of BPH
- Has yet to undergo FDA safety and efficacy testing
72Saw palmettoStudies
- Proposed mechanisms of action
- inhibition of 5-alpha-reductase
- inhibition of androgen-receptor binding
- Results of study versus finasteride
- greater reduction in IPS score
- greater increase in urinary peak flow
73Saw palmettoLimitations
- Studies criticized for lack of placebo
- Little or no bioequivalence data among products
available - Limited toxicity data
- SEs headache, nausea, and abdominal pain
74Saw palmettoOverview
- Inexpensive
- Decreased side effects compared to other drugs
- No effect on PSA level
- Look for fatty acid or lipophilic extract
- Maintain regular physician visits
75Valerian (Valeriana officinalis)
- Commonly used sedative in Europe
- Alternative to anxiolytic medications
- Previously used to relieve menstrual and stomach
cramps
76Valerian
- Popular herb all over the world
- Major ingredient valerian acid
- Available as tea, tincture, or capsule
- Effects seen within one hour of administration
- Hangover not associated with use
77ValerianStudies
- Used in patients suffering from sleep dysfunction
- Results of study using extract
- improved sleep quality
- decreased sleep latency
- Most benefit seen in smokers and poor sleepers
78ValerianLimitations
- Evidence subjective
- SEs headache, excitability, and insomnia
- Tea and tincture have foul odor
- Depression possible after prolonged use
79ValerianOverview
- FDA generally regards as safe
- Kava-kava and St. Johns Wort effective
alternatives without the odor - May be most beneficial in smokers and poor
sleepers
80Requirements for Dietary Supplement Labels
- Statement of identity (ex. Ginko biloba)
- Net quantity of contents (ex. 50 capsules)
- Directions for use (ex. 1 cap tid)
- Constituent panel (ex. serving size, amt.,
active ingredient) - Other ingredients (in descending order)
- Name, place, address of manufacturer
- Structure-function claim and statement
81Advice for the Patients on the Use of Herbal
Products
- Fraudulent Products/Claims
- Quality Products
- Caution With Use
- RPhs Role in Patient Care
82Fraudulent Products
- Avoid break through, miracle cure, etc
- Careful with detoxify, purify, energize
- Claims for wide ranges of diseases
- Backed by scientific studies
- Benefits WITHOUT side effects
- Notions about the medical community hiding
information
83Quality Products
- Consider the manufacturer
- Single agent products
- Part of the plant used (ex. Saw Palmetto berries
vs. the roots) - Stick with the same product
84Caution ! ! !
- Do Not Use if
- Pregnant or Breast Feeding
- Chronically Ill
- Elderly
- Under 18 y.o.
- Taking Rx and OTC Medications
- Discontinue STAT if Adverse Reaction!
85Advanced Practice Nurses Role
- Recognize a potential benefit
- Do not criticize
- Encourage to inform health care providers about
product use - Inquire about successful outcomes
- FDA Med-Watch Reporting
86Conclusions
- Herbals Drugs ????
- Regulation and GMP
- RPh Recommendations
- Be There For The Patient