Dietary supplements guide Spring 2021

Dietary Supplements Guide Spring 2021

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PHRM 48600 Complementary and Alternative Medicines Student monographs compiled by Cynthia Koh-Knox Sharp, PharmD, RPh

Dietary supplement

Author (major)

Page

Acai .....................................................Amadio, Riley (Pharmacy) ................................................ 4 Arnica .................................................Baker, Rebecca (Pharmacy) ............................................. 6 Ashwaganda .......................................Bammidi, Megana (Pre-Physician Assistant) ................... 8 Black cohosh ......................................Bracken, Erin (Environmental Health Sciences) ............. 10 Cannabidiol ........................................Chen, Jason (Pharmaceutical Sciences) ......................... 12 Chamomile .........................................Dunn, Sarah (Web Programming and Design) ............... 14 Chondroitin ........................................Evans, Breanna (Biology/Pre-Veterinary) ...................... 16 Cinnamon ...........................................Fernandez, Travis (Pharmacy)........................................ 18 Coenzyme Q10 ...................................Gertz, Cheney (Pharmacy) ............................................. 20 Cranberry ...........................................Han, Jenny (Pharmacy) .................................................. 22 Creatine ..............................................Harycki, Maggie (Pharmacy) .......................................... 24 Echinacea ...........................................Hoang, Ben (Pharmacy) ................................................. 26 Evening primrose ...............................Ingle, Kalyn (Pharmacy) ................................................. 28 Feverfew ............................................Nguyen, Tiffany (Pharmacy)........................................... 30 Garcinia cambogia..............................Padgett, Jasmine (Nursing) ........................................... 32 Garlic ..................................................Pensyl, Sarah (Pharmacy) .............................................. 34 Ginger .................................................Porter, Gabriel (Visual Effects) ....................................... 36 Ginkgo ................................................Swanson, Hannah (Nursing)........................................... 38 Ginseng ..............................................Pourian, Pasha(Pharmacy) ............................................. 40 Glucosamine ......................................Roach, Elizabeth (Pre-Physician Assistant) .................... 42 Goldenseal .........................................Caplis, Matthew (Health Sciences) ................................ 44 Hawthorn ...........................................Siwy, Samuel (Pharmacy) ............................................... 46 Horse chestnut ...................................Smith, Kiara (Pre-Med) .................................................. 48 Melatonin ...........................................Stolte, Aubrey (Pharmacy) ............................................. 50 Omega-3 fatty acids ...........................Tchachito, Bill (Pharmacy) ............................................. 52 Probiotics ...........................................Wagner, Sarah (Pharmacy) ............................................ 54 SAMe ..................................................Tucker, Sarah (Pharmacy) .............................................. 56 Saw palmetto .....................................Walton, Nolan (Pharmacy)............................................. 58 St. John’s wort ....................................Whitnah, Audrey (Pharmacy) ........................................ 60 Turmeric .............................................Zambrano, Hannah (Pharmacy) ..................................... 62 Valerian ..............................................Zhao, Lin (Pharmacy) ..................................................... 64

First day of class ABCs

Last day of class ABCs

Acai

Riley Amadio Student Pharmacist

Acai palm, cabbage palm, palma manaca

Spring 2021

Euterpe oleracea

Acai is a small berry that grows on

claims of the berry’s benefits. These

the acai palm tree in the rainforests of South

experiments include studies on anticancer,

America. Acai berries are often referred to

antidiabetic, and antioxidant properties, and

as superfruits that are claimed to have a

hypertensive and lipid effects. All the above

number of positive health impacts like

tests showed positive results in the animal

promoting weight loss, clear skin, and

and in vitro experiments, however the

decreasing cholesterol levels. The uses of

conclusions from clinical studies were not

acai to improve health were originally

clear for most of them.

discovered by tribes in the Amazon that frequently consumed the fruit to help their immune systems and keep themselves healthy. Eventually,

It is suggested that when taking an acai supplement, one should take a minimum dose of 700 mg, with the average dosage being between 1000 mg and 4000 mg daily.

acai was introduced to America in the late 1990s and has since been developed into

Acai berries contain many chemical

various forms like wines, smoothies, ice

antioxidants that protect cells in the body

cream, and supplement pills.

from the harmful effects of oxidation.

There has been extensive research on

There are very few clinical studies to

the legitimacy of acai as a dietary

prove the effectiveness of acai berries in

supplement and though many of the claims

terms of their health claims. The only claim

do not have enough research behind them to

that has significant research backing is the

prove them true or false, it has been proven

positive effect of antioxidants in the fruit.

that acai is a strong antioxidant and has

The other health benefit claims previously

many health benefits from that. The berries

mentioned have positive results from animal

have also been proven to have antiinflammatory effects. Many animal and in vitro studies have been done to test the

Acai Acai palm, cabbage palm, palma manaca Euterpe oleracea

and in vitro studies, however the clinical

same experiment was inconclusive in human

studies were either not extensive enough to

subjects.

justify the claims, or the results of the studies were inconclusive. People have different reactions to the fruit; some experience positive results while others do not see results at all.

It is recommended that pregnant

In my opinion, acai is a healthy fruit that will not cause any harm if included in one’s diet. Many people have found it helps clear up acne and boosts the immune system. Although acai does not have much clinical evidence supporting the many claims associated with it, consuming the fruit or a derivative of it is not harmful and

women do not take acai supplements

may benefit the consumer. Everyone

because there is not evidence that acai is

experiences different benefits from acai, and

safe for the fetus. There are reportedly no

it wouldn’t hurt

toxicities, adverse events, or side effects

to try it for a

associated with acai. However, it is

while to see

recommended to avoid the use of acai if you

what the

are allergic to acai berries, acai palm, or its

possible

components. There are also no food or drug

benefits might

interactions associated with acai.

be. ~RAPDGLR

An animal study was done on rats to prove the antihypertensive effect of acai.

Hypertensive rats were given a dose 200 mg/kg of acai pulp daily for 40 days. The results of this experiment showed a significant decrease in the rats’ hypertension, concluding that acai has some antihypertensive properties. However, this

References “12 Amazing Health Benefits of Acai Berry TeaRivert.” www.rivertea.com, https://www.ecosia.org/images?q=acai#id=837F81FF70828531EF2C8AB43 4768707E3544D33.

“Acai.” Lexicomp, online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3749995?cesid=atRPR oXY0JK. “Acai Berry: Health Benefits, Nutrition Facts & Recip.”

Www.foodsforbetterhealth.com, www.ecosia.org/images?q=acai%20berry#id=417E1C0AC5545B19F474D8 CDCEB593C765C196A6.

“Acai juice powder – NutraWiki.” Nutrawiki.org, https://www.ecosia.org/images?q=acai%20powder#id=2DC322F6700BC8E A3818B4B26173C0AA261B2B39.

Acaiberry.org. 2021. Acai Berry Benefits and Facts. [online] Available at: <http://www.acaiberry.org/> [Accessed 24 February 2021].

Zeratsky, K., 2021. Acai berries: The new superfood?. [online] Mayo Clinic.

Available at: <https://www.mayoclinic.org/healthy-lifestyle/nutrition-andhealthy-eating/expert-answers/acai/faq-20057794> [Accessed 23 February 2021].

Rebecca Baker Student Pharmacist Spring 2021

ARNICA Scientific Name: Arnica montana Common Names: Mountain tobacco; Leopard’s bane; Wolf’s bane; Mountain arnica

Purported Uses: Relieve pain associated with…

-

Bruising Inflammation Sprains Muscle pain Infections Osteoarthritis

Dosage Forms: -

Tincture Homeopathic ointment Cream Salve Pill

Dose: https://www.organicauthority.com/health/what-is-arnica-8-ways-to-usesunflower-like-plant-to-your-everyday-advantage

Background: Arnica is a flower belonging in the sunflower family that commonly grows in East Asia, Europe, Canada, and northern United States. The use of its yellow flowers dates back to the 1500’s to treat an array of medical conditions.

Mechanism of Action: Arnica is known to have antiinflammatory properties by inhibiting the binding of transcription factors and NF-kappa-B to DNA. It has also been found to suppress collagenase-1 and collagenase-13 mRNA levels – two enzymes thought to play a role in joint destruction and inflammation commonly seen in osteoarthritis and rheumatoid arthritis.

Ointments and tinctures: Rub arnica onto injured, unbroken skin.

Compress: Mix 1 tablespoon of arnica tincture in 1 pint of purified water. Dip gauze in the mixture and apply it to bruise or arthritic joint.

Pills: Place 4 pills into bottle cap and toss them into mouth (don’t handle homeopathic pills in order to preserve energetic qualities). Can be taken every two hours for the first 24 hours after the injury – not within half an hour of eating.

Child dosage: Half of the adult dose

https://www.puritan.com/arnica-579/pparnica-cream4-ozliq-054927

Effectiveness:

Food/Drug Interactions:

Arnica has been found to have beneficial effects in the treatment of diabetic retinopathy and gonarthrosis. It hasn’t been proven to prevent or treat muscle soreness.

Although it was found inferior to diclofenac for postoperative pain, it was equivalent in controlling swelling.

Arnica inhibits platelet aggregation in vitro: - Anticoagulants (Warfarin) - Antiplatelet agents - Low molecular weight heparins - Thrombolytic agents

Safety: In the United States, Arnica has been approved for use as a flavoring agent in alcoholic beverages. It is listed as Class 3 in the Botanical Safety Handbook and should be used only under the supervision of a qualified expert. It is for external use only and should not be used on broken skin or during pregnancy.

Adverse/Side Effects: -

Itching and inflammation at site of application Eczema Formation of vesicles and necrosis on skin in high doses Diarrhea Vomiting Stomach pain

Toxicities: Homeopathic arnica should be diluted 10-30 times. Undiluted Arnica can cause adverse effects such as tachycardia, hypertension, dyspnea, damage to the heart and other organs, increased bleeding, coma, or even death. Arnica use is not safe in women who are pregnant or breastfeeding.

Summary of Study: A 1996 study found that intraarticular injections containing Arnica were found to effectively treat osteoarthritis in the knee.

Personal Opinion: I believe Arnica may be useful in some patients with moderate pain or inflammation who would prefer a more natural remedy. Although, I would recommend anyone who wants to take it should first consult with their physician to see if Arnica is indicated for the symptoms they are experiencing. ~R. Baker

References: Arnica. Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/integrativemedicine/herbs/arnica. Published February 17, 2020.

Accessed March 2, 2021.

Arnica. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed March 02, 2021. http://micromedexsolutions.com Liu L. Caution When Using Arnica Products. Get Poison Control Help Online or Call 1-800-222-1222. https://www.poison.org/articles/caution-when-usingarnica-products-193. Published November 2, 2020.

Accessed March 1, 2021.

Weil A. Arnica: Uses & Benefits: Herbal Remedies: Andrew Weil, M.D. DrWeil.com. https://www.drweil.com/vitaminssupplements-herbs/herbs/arnica/. Published October 11, 2019. Accessed March 1, 2021.

Ashwagandha Megana Bammidi Pre-PA Student Spring 2021 Scientific Name: Withania somnifera Common Name: Indian ginseng or poison gooseberry Traditional Names: Ajagandha, Asundha, Asgand

Background and History: this supplement is an Ayurvedic which is a form of a medicinal branch known as Ayurveda. This is a traditional system of medicine that is practiced in India. This started way back during the 6000 BC. Ever since then, the root of Ashwagandha has been regarded as a tonic, narcotic, diuretic, aphrodisiac, anthelmintic, astringent, stimulant and thermogenic. This supplement is a shrub part of the evergreen family that is grown in India, the Middle East and certain parts of Africa. The parts specifically used are the roots and the orange-red fruit of this plant for medicinal purposes.

Purported Uses: This has many health benefits; it was first traditionally used in various formulas to treat a variety of ailments such as anxiety, fatigue, pain, skin problems, diabetes and rheumatoid arthritis. It is also used in certain parts to help fight depression and boost fertility as well as testosterone in men. This supplement can be an easy and effective way to improve the quality of life.

Pharmacology: The way this is improved in the body for the reproductive system is to maintain balance and enhance the body’s resilience to stress. This is done by improving the cellmediated immunity. Ashwagandha is an adaptogen which can help our body manage stress while benefiting the body as well as the brain. This can be seen by boosting brain function and through lowering blood sugar and cortisol levels. This can be done by increasing acetylcholine levels in the brain, this helps improve memory and brain function.

Dosage: The information on dosing is very limited but W. Somnifera root powder has generally been used at a daily dosage of 120mg to 2g in combination with various other preparations. The dosage depends on your needs with a standard of 250-500mg per day for at least one month to be effective. The recommended dosage for improvement in sperm quality is to take ¼-½ teaspoon of Ashwagandha root powder with sugar and honey, twice a day for a month.

Or you can mix ¼-½ teaspoon of Ashwagandha root powder in a glass of warm milk at bedtime for improvement in brain functions.

https://netchanting.com/ashwagandha-benefits-side-effects-at-a-glance/

Article: The article, “An overview on Ashwagandha: A rasayana (rejuvenator) of Ayurveda”, focuses on experiments that showed the this supplement helps with prevention of stress induced gastric ulcers. It also had cognition promoting effects for children and older adults that helped with memory deficit and memory loss.

Side Effects, Toxicities and Drug Interactions: The side effects are only seen when there are large doses consumed such as diarrhea, vomiting and stomach pain. Other than that, Ashwagandha is possibly safe when taken up to 3 months.

When it comes to toxicities, ashwagandha is generally safe and has no major adverse effects.

The clinical trials had no reports of any serum enzyme elevations nor hepatotoxicity. The interactions it could have would be with sedatives, blood thinners, thyroid supplements, immunosuppressants, medications for anxiety, high blood pressure and diabetes. Ashwagandha does have any serious interactions with any drugs.

Safety: Ashwagandha is considered safe but women who are pregnant or breastfeeding as well as people who suffer from hyperthyroidism should avoid this. This supplement can interact with sedatives as well as with medications that deal with diabetes, high/low blood pressure, stomach ulcers, autoimmune disease or thyroid disorders.

Effectiveness: The effects can be seen as early as two weeks in conjunction with a healthy lifestyle. But the main determinant of the supplement is the quality of it. The highconcentration, full-spectrum extract is the best kind required to make the biggest impact on your body. Research has shown that it can improve body composition and healthy men who took 750-1250mg of pulverized ashwagandha root per day ended up gaining muscle strength after 30 days.

Final Thoughts: My thoughts on Ashwagandha is that I feel like it can be effective for certain general health benefits such as overall immunity.

But again, I think this is effective if used over a long period of time and in accordance with other supplements and a healthy lifestyle. Having more information about the specifics that this supplement targets such memory and ulcer prevention is harder to believe as there is no evidence that it happened just through this dietary supplement - Mbammidi

References: Singh N, Bhalla M, de Jager P, Gilca M. An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda. African journal of traditional, complementary, and alternative medicines: AJTCAM. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252722/. Published 2011. Accessed March 8, 2021.

Ashwagandha: Health benefits, side effects, and how to use. Medical News Today. https://www.medicalnewstoday.com/articles/318407#summary. Accessed March 8, 2021.

Parch LA, Rapaport L, Migala J, et al. Ashwagandha Benefits: Everyday Health. EverydayHealth.com. https://www.everydayhealth.com/diet-nutrition/the-benefits-of-ashwagandha/. Accessed March 8, 2021.

Erin Bracken Environmental Health Science Student Spring 2021

BLACK COHOSH

Background/History: Black Cohosh is a member of the buttercup family. The herb’s rhizobium and root have been used for medicinal purposes dating back to the Native Americans who used the herb to treat a plethora of conditions such as musculoskeletal pain, fever, cough, pneumonia, sluggish labor, and menstrual irregularities. Today, the most common use of black cohosh is for menstrual and menopausal symptoms. Menopausal women are more likely to benefit from using this product as it helps with hot flashes, heart palpitations, vertigo, sleep disturbances, and other menopausal related symptoms

Pharmacology: The mechanism black cohosh uses to relieve menstrual symptoms is not fully understood. It has been suggested that black cohosh acts as a selective estrogen receptor modulator because of its ability to alleviate menstrual symptoms. It has also been proposed that black cohosh can act through serotonergic pathways, as an antioxidant, or on inflammatory pathways. Black cohosh’s ability to relieve many menopausal symptoms such as hot flashes, mood swings, anxiety, and insomnia, are all mediated through the central nervous system. 23-epi-26-deoxyactein is the main triterpene that is found in black cohosh, it acts by suppressing cytokine-induced nitric oxide production in the brain’s microglial cells, while whole black cohosh is found to be an enhancer of this pathway.

Common Uses: • • • • •

Hot Flashes Heart Palpitations Vertigo Sleep Disturbances Other menopausal related symptoms

Available Dosage Forms: • • • •

Capsules Tablets Liquid Tinctures Extracts

Typical Serving: • Capsules/Tablets: 20 to 80 mg per day, or two capsules/ tablets.

• Liquid Tincture: 2 to 4 ml, or 1 to 3 times per day in water or another beverage.

• Tea Method: 20 grams of dried root in 34 ounces of water. Recommended 3 times per day to achieve menopausal symptom relief *NOT RECOMMENDED FOR CHILDREN

https://www.nccih.nih.gov/health/black-cohosh

Scientific Name: Actaea ra cemos e Common Names: Snakeroot; Black Bugbane; Rattleweed; Macrotys; Rheumatism weed

Currently, there is no conclusive scientific evidence of Black Cohosh’s effectiveness.

Although, menopausal women reportedly experienced a 26% reduction in night sweats and hot flashes. Most studies do not show positive benefits exceeding 6 months to 1 year.

Toxicity: The most severe and studied toxicity is of the liver, which can possibly lead to liver failure.

Because black cohosh is not regulated under the FDA, it is possible that products could contain other ingredients that are not listed, potentially causing harm.

Adverse Effects:

https://www.graphicsprings.com/logographics /pharmacy-symbol-snakes

Effectiveness/Safety:

https://www.amazon.com/Natures-Bounty-Supplement-MenopausalCapsules/dp/B000GG874Y

BLACK COHOSH Most common reported side effects include; abnormal/increased vaginal discharge; vaginal bleeding; abnormal heartbeat/altered blood pressure; headache; irritability; moodiness; depression. Black cohosh can also act as a blood thinner.

Food/Drug Interactions: Many classes of medications can increase risk of complications used alongside black cohosh including; liver; osteoporosis/arthritis; depression/mood; anti-seizure; antihistamines; cancer; cholesterol medications.

References: Black cohosh. Mount Sinai Health System. https://www.mountsinai.org/health-library/herb/black-cohosh.

Huizen J. Black cohosh for menopause: Uses and side effects. Medical News Today. https://www.medicalnewstoday.com/articles/317530. Published May 20, 2017.

Office of Dietary Supplements - Black Cohosh. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/BlackCohoshHealthProfessional/#:~:text=Black cohosh (Actaea racemosa or,weed [1,2].

Ruhlen RL, Sun GY, Sauter ER. Black Cohosh: Insights into its Mechanism(s) of Action. Integrative medicine insights. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046019/#:~:text=Although the mechanism by which,or 4) on inflammatory pathways. Published 2008.

Personal Opinion: Initially black cohosh seemed to be a great natural alternative to managing menstrual and menopausal symptoms. After performing this assignment, I would no longer recommend this product due to the risk of developing liver toxicity as well as developing worse symptoms after prolonged use.

Additionally, it does not appear that the product would be effective with treating and managing menopausal symptoms. This is due to the fact menopausal symptoms typically last longer than the intended use of up to 1 year. ~EBracken

Jason Chen BSPS Student Spring 2021

Cannabidiol (CBD) C21H30O2

Cannabidiol (CBD) NON-PSYCHOACTIVE

Tetrahydrocannabinol (THC) PSYCHOACTIVE

History & Background

Cannabidiol (CBD) was extracted and studied in 1940 from cannabis plants, specifically the Minnesota wild hemp. As its commercial and therapeutic markets developed, some US growers managed to selectively breed this cannabis plant by alternating the ratio of its CBD-to-THC content, since some customers preferred a higher proportion of THC which is psychoactive, or “mind-blowing”.

Medical Uses & Effects

Seizure Disorders / Epilepsy: - With the trade name as Epidiolex, cannabidiol is the first prescribed natural product approved by the regulatory bodies in the US and Europe.

- Suitable for patients aged two years and older, Epidiolex has a neurological calming effect targeting Dravet syndrome (DS) or Lennox Gastaut syndrome (LGS), with minor adverse effects.

Mechanism of Action

The exact mechanism of its anticonvulsant action is unknown; However, cannabidiol (CBD) has little to no connection to cannabinoid receptors, thus cannabidiol (CBD) has a lower potential for abuse compared to THC, which shows a psychoactive effect when bound to the cannabinoid receptors.

Dosage Forms

Cannabidiol branded as Epidiolex is typically an oral solution, which has a low bioavailability of ~15%, and a short half-life (elimination) of ~30-50 hours.

& Pharmacokinetic

Dosing

With poor absorption discussed right above and minor adverse effects, daily Epidiolex intake should still not exceed 20 mg/kg. In order to observe a therapeutic effect, 5 mg/kg should be administered.

Jason Chen BSPS Student Spring 2021

Cannabidiol (CBD)

Efficacy & Safety

In treating seizures associated with DS or LGS, efficacy and safety regarding the non-psychoactive cannabidiol (CBD) are established not only in adults but also in pediatric patients over 2 years of age.

Toxicities

CBD is considered as the safe “medical marijuana”, which distinguishes it from the intoxicating THC - see the structure differences on top of the first page.

Adverse Effects

CBD is generally safe, but when the dose is too high (20mg/kg + ), incidences of adverse effects are observed, which include nausea and diarrhea, insomnia, and reduced appetite. Chronic high dosing results in unhealthy weight loss and severe anemia.

Article Review,

Cannabidiol & Cytochrome P450 - Cannabidiol at clinically relevant concentrations may inhibit CYP2C8, CYP2C9, and CYP2C19. These cytochrome P450 enzymes (CYPs) are responsible for oxidation of xenobiotics in our body. When CYPs are inhibited, chances of cell damages (cancer) may increase.

- CYPs also help to metabolize and clear out drugs in the body, meaning that when a patient is taking other medications at the same time, cannabidiol excess intake would result in harmful metabolites yielded by other medications not being cleared away from the body in an efficient manner.

and Potential Drug Interactions

Professional opinion: As the “medical marijuana”, cannabidiol is providing great efficacy but lower risks compared to the abusive tetrahydrocannabinol. This natural product is one of the best discoveries of human intelligence in history, which has helped countless individuals suffering from seizures. ~ J.Chen References 1.

2.

3.

4.

Anderson, Leigh Ann. 2021. Cannabidiol Monograph for Professionals. [online] Available at: <https://www.drugs.com/monograph/cannabidiol.html> [Accessed 10 March 2021].

Chen, J., Borgelt, L. and Blackmer, A., 2021. Cannabidiol: A New Hope for Patients With Dravet or LennoxGastaut Syndromes. [online] PubMed.gov. Available at: <https://pubmed.ncbi.nlm.nih.gov/30616356/> [Accessed 10 March 2021].

En.wikipedia.org. 2021. Cannabinol. [online] Available at: <https://en.wikipedia.org/wiki/Cannabinol> [Accessed 10 March 2021].

Peter Grinspoon, M., 2021. Cannabidiol (CBD) — what we know and what we don’t - Harvard Health Blog. [online] Harvard Health Blog. Available at: <https://www.health.harvard.edu/blog/cannabidiol-cbd-what-weknow-and-what-we-dont-2018082414476> [Accessed 10 March 2021].

Sarah Dunn Web Programming and Design

Chamomile

Spring 2021

Scientific name: Matricaria chamomilla Common names: Chamomile, Roman Chamomile

Common Uses: O o o o o o o

Reducing inflammation and muscle spasms To alleviate hemorrhoids Help with stomach aches Help with anxiety Intestinal gas Diarrhea Eczema

Dosage Forms:

https://stillpointaromatics.com/blog/roman-chamomile-essential-oil-benefits-uses/

Background Chamomile is natively found in Europe, North Africa, and in some parts of Asia, where it was prescribed as a cold remedy and used to induce sleepiness and to help with stomach aches. Even though there is not much medical evidence, many people still find chamomile to be helpful with certain ailments.

o o o o

Leaves (tea) Oil Topical cream Gel

Typical Dosage: o

1.1 – 15 grams per day

Pharmacology Chamomile contains an antioxidant called apigenin, and when it binds to the GABA benzodiazepine receptors in the brain, it can increase drowsiness and reduce anxiety.

References: Chamomile - side effects, dosage, interactions - drugs - everyday health. (2014, October 09). Retrieved March 11, 2021, from https://www.everydayhealth.com/drugs/chamomile Chamomile uses, benefits &amp; dosage - drugs.com herbal database. (n.d.). Retrieved March 11, 2021, from https://www.drugs.com/npp/chamomile.html Roman chamomile essential oil: Physical &amp; emotional benefits &amp; uses. (2020, July 27). Retrieved March 11, 2021, from https://stillpointaromatics.com/blog/roman-chamomile-essential-oil-benefits-uses/ Srivastava, J., Shankar, E., &amp; Gupta, S. (2010, November 1). Chamomile: A herbal medicine of the past with bright future. Retrieved March 11, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995283/

Effectiveness and Safety There is little data proving how effective chamomile is in treating reported ailments. There has been some research into how it works, finding that the antioxidant it contains does reduce anxiety and induce sleepiness.

Chamomile is considered extremely safe to people who don’t have any allergies to related plants such as daisies, chrysanthemums, marigolds, and ragweed.

Side effects: o Possible allergic reactions (rash, itching, scaling) o Nausea o Dizziness o May make birth control less effective

Toxicities: o Non-toxic to humans unless more than the recommended dosage is taken o Toxic to dogs, cats, and horses

My Professional Opinion In my opinion, I think that chamomile is a pretty effective remedy in helping minor issues, such as trouble falling asleep, anxiety, and treating eczema for those who prefer a natural remedy that is easily accessible to most people. For other issues, I think people should do some research and see how chamomile has worked for others Dunn before using it as a treatment plan. ~ ~S. S. Dunn

Food and Drug Interactions o Avoid ragweed, asters, and other members of the Asteraceae family

NOTE: it is recommended that those who are pregnant; have breast, ovary, or uterus cancer: or a history of endometriosis or uterine fibroids stay away from chamomile

Article Summary Chamomile is a plant that has been used since ancient times to treat minor problems such as trouble with sleep, anxiety, and colds. It is usually taken orally as a tea, but sometimes can be turned into a topical treatment for skin issues. Chamomile is not typically harmful unless the person taking it has allergies. It is best to tell the doctor if using chamomile as a treatment for anything serious or if taken often.

References: Chamomile - side effects, dosage, interactions - drugs - everyday health. (2014, October 09). Retrieved March 11, 2021, from https://www.everydayhealth.com/drugs/chamomile Chamomile uses, benefits &amp; dosage - drugs.com herbal database. (n.d.). Retrieved March 11, 2021, from https://www.drugs.com/npp/chamomile.html Roman chamomile essential oil: Physical &amp; emotional benefits &amp; uses. (2020, July 27). Retrieved March 11, 2021, from https://stillpointaromatics.com/blog/roman-chamomile-essential-oil-benefits-uses/ Srivastava, J., Shankar, E., &amp; Gupta, S. (2010, November 1). Chamomile: A herbal medicine of the past with bright future. Retrieved March 11, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995283/

Breanna Evans Biology Student / Pre-Vet Student Spring 2021

Chondroitin ___

Scientific Name:​ ​Chondroitin Sulfate

Common Names: ​Chondroitin sulfate sodium, Chondroitin 4-sulphate sodium, Dermatansulfat natrium, Sodium chondroitin sulfate, Chondroitin natrii sulfas

Background Information: Chondroitin sulfate is a chemical that is found in cartilage around joints in the body. It is typically manufactured from shark and cow cartilage but can also be made in the lab.

Purported Uses: Used to treat osteoarthritis and can possibly be used to help in protecting the eye during cataract surgery.

Mechanism of Action: Osteoarthritis causes the cartilage in the joints to breakdown, but it is believed that taking chondroitin sulfate, one of the building blocks of cartilage, can slow this breakdown. In cataract surgery (when coupled with sodium hyaluronate), chondroitin sulfate is thought to help protect the eye by decreasing the pressure in the eye during and after cataract surgery as well as improving overall eye health after the cataract has been removed.

Available Dosage Forms: Chondroitin sulfate can be taken orally, given by a shot or applied directly to the skin.

Typical dosing / Serving For osteoarthritis, the typical dose is 800-2000 mg taken orally as a single dose or in two to three divided doses for up to three years. When applied to the skin for osteoarthritis, a cream containing 50 mg/gram of chondroitin sulfate, 30 mg/gram of glucosamine sulfate, 140 mg/gram of shark cartilage, and 32 mg/gram of camphor has been used as needed for sore joints for up to eight weeks. When injected into the muscle for osteoarthritis, chondroitin sulfate has been injected daily or twice weekly for up to six months. When applied to the eye for cataracts, eye drops containing chondroitin sulfate and sodium hyaluronate are placed into the eye during cataract surgery.

Effectiveness: Studies have shown that chondroitin might be effective for protecting the eye during cataract surgery and in treating osteoarthritis. When it comes to protecting the eyes during cataract surgery, chondroitin sulfate is added to sodium hyaluronate. Many products that contain chondroitin sulfate and sodium hyaluronate have been reviewed by the FDA for use during cataract surgery, but it is not clear if the addition of

chondroitin sulfate to sodium hyaluronate solution actually helps reduce the pressure that is present within the eye after cataract surgery. Early studies suggested that an eye solution containing chondroitin sulfate and sodium hyaluronate decreased the pressure in the eyes and improved the overall eye health after the cataract was removed but these drops did not appear to work better than drops that contained sodium hyaluronate alone. The effect of solutions only containing chondroitin sulfate during cataract surgery has not been studied which leads to the overall effectiveness of chondroitin sulfate in cataract surgery being unknown.

Chondroitin sulfate is most commonly used to treat osteoarthritis where it improves pain and function in some people when used for up to six months. Studies have shown that it works best in people who have severe pain and when a pharmaceutical-grade preparation is used. In these cases, pain relief is said to be small at best. In a study that was conducted over the course of two years, it was determined that chondroitin sulfate might be able to slow the progression of osteoarthritis.

Adverse / Side Effects: Side effects include but are not limited to: stomach pain, nausea, bloating, diarrhea, constipation, headache, swollen eyelids, leg swelling, hair loss, skin rash, and irregular heartbeat.

Food / Drug Interactions: It has been found that chondroitin sulfate interacts with warfarin. Warfarin is a medication used to slow blood clotting and when it is taken with chondroitin sulfate its effects are increased which can lead to bruising and bleeding that can be serious. There are currently no known interactions between chondroitin sulfate and herbs, supplements, or foods.

Professional Opinion: Chondroitin sulfate can be used to improve pain in people who have osteoarthritis. I believe that its

Safety / Toxicities:

use in people who have severe pain for a duration

Chondroitin sulfate is likely safe when used as an eye solution during cataract surgery and when taken orally. Chondroitin sulfate is possibly safe when injected into the muscle as a shot if used short-term. The safety concern is due to the fact that it comes from animal sources so unsafe manufacturing practices could lead to contamination. You should not use this product if you are pregnant, breast-feeding, have asthma, have blood clotting disorders, or have prostate cancer.

assuming that the person does not have other

of no longer than six months could be beneficial health issues. When paired with sodium hyaluronate it can be useful in reducing pressure in the eye during cataract surgery. The use of this product could have small beneficial effects but each person should weigh their options carefully for what medication will produce the best results for their particular case (“~BEvans”)

References: 1.

2.

3.

4.

Chondroitin sulfate. Chondroitin sulfate CAS#: 9007-28-7. https://www.chemicalbook.com/ProductChemicalPropertiesCB1249888_EN.htm#General%20Description​.

Accessed March 3, 2021.

Chondroitin Sulfate: MedlinePlus Supplements. MedlinePlus. ​https://medlineplus.gov/druginfo/natural/744.html​.

Accessed March 2, 2021.

CHONDROITIN SULFATE: OVERVIEW, Uses, side Effects, precautions, Interactions, dosing and reviews. https://www.webmd.com/vitamins/ai/ingredientmono-744/chondroitin-sulfate​. Accessed March 2, 2021.

Henrotin Y, Mathy M, Sanchez C, Lambert C. Chondroitin sulfate in the treatment of osteoarthritis: from in vitro studies to clinical recommendations. Therapeutic advances in musculoskeletal disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383492/​. Published December 2010. Accessed March 2, 2021.

Travis Fernandez Student Pharmacist Spring 2021

Cinnamon

Scientific Names: Cinnamomum cassia or Cinnamomum verum Common Names: cinnamon, cinnamon bark, Ceylon cinnamon, cassia cinnamon History: Cinnamon has long been used as a spice and aromatic. It comes from the inner bark of the cinnamon tree. The bark is dried into scroll-like sticks, and ground into the powder used as a spice. Oil extracts from the bark are also manufactured for use in flavorings and aromatic applications.3 Medicinal Uses: Cinnamon bark and oil have both been used for a variety of medicinal applications including: diarrhea, GI problems, and dysmenorrhea. Cinnamon has also been suggested as a treatment for diabetes. Some research has investigated the antimicrobial, antioxidant, and anti-inflammatory properties of cinnamon.1

Fernandez T. Ground and Stick Cinnamon. 2021.

Mechanism of Action: Cinnamaldehyde is the primary ingredient in cinnamon oil.

Cinnamaldehyde inhibits nitrous oxide production and may inhibit COX-2 activity. This is a possible explanation for the anti-inflammatory and analgesic activity of cinnamon. Though an exact mechanism has not been described, cinnamon oil has been shown to inhibit microbial growth in vitro. Ethanol extracts of cinnamon seem to have antioxidant properties.1 Dosage Forms: Ground cinnamon powder is the most widely available form, found in most grocery stores. The oil extract is also readily available, as are compressed tablets found in dietary supplement aisles.

Dosing: Ground cinnamon is typically dosed at 1-3 grams daily. The ethanol extract has been studies at 80 mg daily for antimicrobial use.1

Effectiveness: Studies to determine the efficacy of cinnamon in various medical applications have provided inconclusive results. Cinnamon has not been shown to be an effective treatment for diabetes despite some evidence that it may lower blood sugar levels.2 Despite theoretically possible methods of action, studies do not support the use of cinnamon to treat health conditions in people.3 Safety: Cinnamon is Generally Recognized As Safe (GRAS) by the FDA. In doses up to 6 grams per day no harm has been reported.1 Adverse Effects: In large doses or topical uses, irritation of the skin may occur. Some people may experience allergic reaction to cinnamon products.1 Toxicity: There has been insufficient research into toxicity of cinnamon. Theoretically a compound in Cinnamomum cassia could be harmful to the liver in doses well above those found in food.3 Drug Interactions: There has not been much documentation of cinnamon interacting with medications. It is possible it may interact with hepatically metabolized drugs, but evidence of interactions is scarce.1 Cinnamon in the Research Literature: There was a recent research analysis of 18 different cinnamon related studies exploring its use to treat diabetes. The overall conclusion of this 2019 study was that cinnamon does reduce blood glucose levels. However, most trials analyzed by this researcher had significant errors of varying types, so no strong consensus could be determined.2 Professional Opinion: Evidence of efficacy as a health product is lacking for cinnamon. Apart from those people with a cinnamon allergy, it is safe in doses typically found in food. High doses of cinnamon supplements should probably be avoided by patients with compromised liver function. Cinnamon should be enjoyed as a spice and aromatic but should not be used in place of necessary medicinal therapy. ~T Fernandez References: 1. Cinnamon. Natural Products Database. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 8, 2021. http://online.factsandcomparisons.com 2. Namazi N, Khodamoradi K, Khamechi SP, Heshmati J, Ayati MH, Larijani B. The impact of cinnamon on anthropometric indices and glycemic status in patients with type 2 diabetes: A systematic review and meta-analysis of clinical trials. Complement Ther Med. 2019;43:92-101. doi:10.1016/j.ctim.2019.01.002 3. National Center for Complementary and Informative Health. Cinnamon. Accessed March 7, 2021. https://www.nccih.nih.gov/health/cinnamon

Coenzyme Q10 CHENEY GERTZ, STUDENT PHARMACIST SPRING 2021

COMMON NAMES Adelir, CoQ10, Ubiquinone, Heartcin, Inokiton, Neuquinone, Taidecanone, Udekinon, Bio-Quinone Q10, Myoquinon

PURPORTED USE A variety of uses in heart conditions including: angina, congestive heart failure, high blood pressure, doxorubicin-induced cardiotoxicity, and cardiomyopathy. Other conditions thought to have some effective treatment using are diabetes mellitus, HIV/AIDS immunostimulant, mitochondrial cytopathies, muscular dystrophies, migraine headaches, end-stage renal failure, and Parkinson’s, among other conditions. More recently coenzyme Q10 has also been appearing in energy drinks and pre-workout supplements.

PHARMACOLOGY In organs with a high metabolism (heart, kidney, liver) coenzyme Q10 functions as an energy transfer molecule. It is a cofactor in the electron-transport chain for a series of redox reactions ultimately resulting in the production of ATP.

DOSAGE FORMS

Mainly tablets, chewable tablets, powderfilled capsules, gel-filled capsules, liquid syrups, wafers, & solubilized formulations.

Coenzyme Q10 can also be found in facial serums, eye cream, toner, and energy drinks.

Coenzyme Q10. Target. Accessed March 2, 2021. http://target.com

Coenzyme Q10. Isosciences. Accessed March 2, 2021. http://isosciences.com

BACKGROUND Coenzyme Q10 was first identified in 1940 and isolated in 1957. It was not until 1978 that work to figure out exactly how Coenzyme Q10 worked in the body was recognized for a Nobel Prize. Coenzyme Q10 has been found to be a vitamin-like compound that is naturally occurring and prevents energy drops during the day. It provides cells with the ability to make energy through adenosine triphosphate (ATP) molecule production. Coenzyme Q10 is produced in the body, but people can have deficiencies in the enzyme leading to health hazards later in life. In more recent studies it was found that Coenzyme Q10 can have beneficial outcomes for patients with heart failure.

TYPICAL DOSING

Dosing is dependent on the specific disease state the product is being used for. Most studies suggest splitting the dose into a twice-daily dose rather than a singular dose per day. In cardiovascular and neurological trials, the standard dosing was 300 mg/day.

In end-stage renal failure and Parkinson’s, a dose of 1,200 mg/day was used. Studies have shown ranges from 50 mg to 1,200 mg in single and split dosing, but the typical daily dosing was determined to be around 100 mg to 200 mg.

CoQ10 Powder . Nootropics.

Accessed March 2, 2021. http://nootropicsdepot.com

Coenzyme Q10 EFFECTIVENESS For the treatment of congestive heart failure, there is no strong consensus of effectiveness. Studies on neurological disorder treatment are also inconclusive.

Very limited clinical testing has been done to determine the effectiveness of Coenzyme Q10 on a variety of disease states.

SAFETY No serious side effects have been reported and only mild side effects have been seen.

Do not take if on medications with interactions associated with Coenzyme Q10, take as directed, and consult your physician. Coenzyme Q10 is possibly safe in pregnant/nursing women and kids but no extensive testing has proved this.

ADVERSE EFFECTS Severe gastrointestinal bleeding associated with angiodysplasia is a possible adverse effect associated with Coenzyme Q10.

Clinical trials at high doses found mild GI effects (loose stool, nausea, and vomiting), abdominal discomfort, headache, fatigue, and urine discoloration.

TOXICITIES Through animal experiments and clinical trials, the acceptable intake has been estimated at 12 mg/kg. Other observed studies have shown there is no blockage of biosynthesis pathways at 1200 mg/day.

FOOD & DRUG INTERACTIONS Drug Interactions: Vitamin K Antagonists, Warfarin, antihypertensive medications like losartan, and some cancer treatments.

Food Interactions: none determined by studies.

SUMMARY Due to its antioxidant properties and believed ability to support the proper functioning of the mitochondria, CoQ10 was examined in a clinical trial in 2014 for its ability to reduce dopamine receptor loss in Parkinson's disease.

A placebo-controlled, double-blinded study was conducted with 600 patients receiving 1200 mg/day of CoQ10, 2400 mg/day of CoQ10, or a placebo. Patients were set to be observed for 16 months unless having to be removed and given dopaminergic treatment.

268 participants made it through the allotted time trial with similar baseline effects. The treatment groups had slight adverse effects compared to the placebo. Statistically, there was no evidence CoQ10 had a clinical benefit.

REFERENCES Coenzyme Q10. National Center for Complementary and Integrative Health. Accessed February 26, 2021. http//:nccih.nih.gov/health Parkinson Study Group QE3 Investigators, Beal MF, Oakes D, et al. A randomized clinical trial of highdosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. JAMA Neurol. 2014;71(5):543552. doi:10.1001/jamaneurol.2014.131 Ubiquinone. Natural Products Database. Lexicomp.

Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 24, 2021. http://online.lexi.com

PERSONAL OPINION Coenzyme Q10 is an easily accessible dietary supplement that comes in an extensive amount of forms. The efficacy of the drug is highly debatable for a wide variety of disease states and as an energy supplement. While Coenzyme Q10 may not cause many adverse effects, it can not be proven whether it is actually effective at all.

Enhanced results may be based on their own beliefs of the supplements effects. - C Gertz

Scientific Name Vaccinium subg. Oxycoccus

Common uses: Urinary tract infection Type 2 Diabetes mellitus

Common name cranberry

CRANBERRY

Background / History Cranberry grows wild from the mountains of Georgia to Canadian Maritimes, and Minnesota. Cranberry plant is described as a lowgrowing, woody perennial with small, oval leaves borne on fine, vine-like shoots. Cranberries are processed into products such as jam, sauce and juice to consumers.

Chronic fatigue syndrome Cancer treatment

Available dosage forms Capsule Juice Topical

Pharmacology

Jenny Han Student Pharmacist Spring 2021 https://www.freshfruitportal.com/news/2019/12/18/naturipe-debunks-five-mythsabout-cranberries/

Cranberry contains high content of flavonoids and phenolic acids giving it an antioxidant properties which contribute to its disease fighting ability. It is a potential cancer treatment agent due to its action in inhibiting oxidative stress and other pathways. Cranberry extract is conveyed to have the ability to inhibit ornithine decarboxylase expression and induce the xenobiotic detoxification enzyme quinone reductase in vitro and inhibits proliferation of MCF-7 and MDA-MB-435 cells in breast cancer.

Typical Serving: Capsule: one tablet (300 to 400mg) twice daily. (1500mg max dose) Juice: 8 oz three times daily

Effectiveness and Safety Cranberry supplements are shown to have effect in urinary tract infection (UTI), Type 2 diabetes, chronic fatigue syndrome, anticonvulsant, antipyretic and prevention of cancer. It is conveyed that people with aspirin allergy to avoid taking large quantities of cranberry juice due to significant amount of salicylic acid contained in it and may cause inflammation of the stomach lining and cause low stomach acid.

Adverse Effect It is shown to be generally safe if taken by mouth for most adults. However, drinking too much cranberry juice may cause mild stomach upset and diarrhea in some people. There is a potential risk of building kidney stones if drinking more than one liter a day for a long period of time.

Toxicities There have been no reported toxicities on cranberry itself or its supplements.

Food/Drug interactions It is shown to have moderate interaction between cranberry and warfarin and minor interaction between cranberry and medications that is changed by the liver (CYP2C9 substrates).

Cranberry might increase half life of the warfarin in the body and increase chances of bruising and bleeding.

Cranberry might decrease the metabolism of certain drugs that is metabolized by the liver leads to increase in chance of side effects.

Use in caution if you are taking amitriptyline, diazepam, zileuton, celecoxib, diclofenac, glipizide, tamoxifen, torsemide, warfarin and others.

https://www.ideal-uroshield.com/blogs/does-cranberry-juicestop-utis/

Article Review Cranberries have been tested for their clinical relevance in the treatment of UTIs, however, they were found ineffective. Although, there have been some evidence of cranberry juice in decreasing the number of symptomatic UTIs for women with recurrent UTIs.

https://www.puritan.com/cranberrysupplements-022/one-a-day-cranberry-500-mg073226

Personal opinion In my personal opinion, cranberry supplement is a beneficial supplemental remedy for prevention or treatment of Urinary tract infections as it helps in reducing or removing bacteria in urinary tract.

However, I recommend using of synthetic medication as it is more effective than only relying on the cranberry supplement. It is relatively safe to use and readily available with low cost, so it recommend the use of it as a supplemental remedy. ~J. Han References Neto CC. Cranberry. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. https://www.ncbi.nlm.nih.gov/books/NBK92762/. Published January 1, 1970.

CRANBERRY: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews.

WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-958/cranberry. Cranberry: Side Effects, Dosages, Treatment, Interactions, Warnings. RxList. https://www.rxlist.com/consumer_cranberry/drugs-condition.htm. Published September 6, 2017.

Creatine Scientific Name: 2-[Carbamimidoyl(methyl)amino]acetic acid Maggie Harycki Student Pharmacist Spring 2021

Common Names: creatine monohydrate, creatine anhydrous, creatine citrate Background/History: Michel Eugene Chevreul discovered creatine in 1832. Creatine is a part of human tissue, so he extracted creatine from meat. The name creatine came from the word κρέας, the Greek word for meat. A German chemist named Justus von Liebig then continued the studies and found that wild animals had more creatine, which with correlated the amount of activity and the amount of creatine made. In 1923, the concept of nitrogen retention from oral creatine was introduced. It was found that when creatine was ingested it caused weight gain due to the extra protein in the muscle. In 1950, creatine was synthesized in the lab. In the late 1900’s, it was confirmed that creatine could increase muscle size and prevent muscles from losing their strength.

Purported Uses: Creatine is used to increase muscle endurance, size, and strength. It can also be used to help with neurological diseases.

Pharmacology: Creatine is made from the amino acids arginine and glycine. Most of the creatine is kept in the muscles as phosphocreatine. After creatine is ingested, the amount of phosphocreatine in the body increases. Phosphocreatine, a form of ATP, allows the body to exert more energy during exercise. Phosphocreatine is also stored in the brain and is beneficial in patients with neurological diseases.

Available Dosage Forms: The main dosage form of creatine is a powder, as seen in the picture on the bottom right. It’s normally mixed with water to take before a workout.

Typical Dosing: Creatine is taken in two different doses normally. There is creatine loading dose and then a maintenance dose. The loading dose is normally 20-25 grams. The loading dose is the split into 4 and taken throughout the day for around 6 days. Then about 4 grams is taken each day. The other way creatine is taken is with a maintenance dose. Around 4 grams is taken each day with the maintenance dosing.

https://www.sigmaaldrich.com/catalog/product/sigma/c0780?lang=en&region=US

Effectiveness: Creatine has been seen to be effective for use during performances that require muscle activity. It has also been useful for people who have issues producing and transporting creatine in their body. It’s been helpful in older patients experiencing

sarcopenia, or muscle loss associated with age. Creatine is known for its high effectiveness when used for muscle building.

Safety: There isn’t a ton of information known on the safety of creatine. When used in adults and children by mouth it’s most likely safe. It is unknown if it’s safe in pregnancy.

Creatine isn’t safe in people with Parkinson’s disease that also consume caffeine. Manic episodes have been reported in bipolar disorder patients using creatine. Creatine also might worsen kidney disease.

Side Effects: Not much is known about the side effects of creatine, but there have been

studies on the effects of the supplement on renal function. It has been shown to create toxic metabolites such as formaldehyde and methylamine that might not be safe for patients with pre-existing kidney disease. Weight gain has also been reported as a side effect of creatine.

Toxicities: There are no known toxicities of creatine.

Food/Drug Interactions: There are no known drug interactions with creatine.

Carbohydrates taken with creatine can increase the amount of creatine in the body.

Personal Opinion: My opinion of creatine is that it’s alright to use, in moderation. There are too many risks and unknowns to use it all of the time.

Summary of One Article: Myopathy, a disease that causes muscle weakness, can be caused by patients who take statins, drugs taken to reduce cholesterol levels. Studies have shown that taking creatine can help with statin-induced myopathy. Statin-induced myopathy causes patients to have weakness, fatigue, and cramping.

When patients take statins, the amount of creatine in their body decreases due to their inhibition of an enzyme that creates creatine, called guanidinoacetate methyl transferase (GAMT). Taking creatine can help restore the creatine in the body which helps reduce the effects of statin induced myopathy.

References:

1https://www.sigmaaldrich.com/catalog/product/sigma/c0780?lang=en&region=US

“Creatine: MedlinePlus Supplements.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/druginfo/natural/873.html#Effectiveness.

E;, Balestrino M;Adriano. “Creatine as a Candidate to Prevent Statin Myopathy.” Biomolecules, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/31533334/.

Gavin Van De Walle. “Can You Take Too Much Creatine?” Healthline, www.healthline.com/nutrition/too-much-creatine#dosage.

Heffernan, Conor, et al. “Creatine: A Short History.” Physical Culture Study, 16 May 2017, physicalculturestudy.com/2015/02/26/creatine-a-short-history/.

MM;, Davani-Davari D;Karimzadeh I;Ezzatzadegan-Jahromi S;Sagheb. “Potential Adverse Effects of Creatine Supplement on the Kidney in Athletes and Bodybuilders.” Iranian Journal of Kidney Diseases, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/30367015/.

“Product No. C0780: Sigma-Aldrich.” Sigma, www.sigmaaldrich.com/catalog/search?term=C0780&interface=Product+No.&N=0.

Echinacea Ben Hoang - Student Pharmacist Spring 2021

Scientific- Echinacea purpurea Common Name- Purple Cone Flower

Background The plant was used by Native Indian Americans back in the 1800s as traditional medicine. Echinacea was used in many treatments such as wound healing, rattlesnake bite, and dizziness. In the early 20th century, it was used as an anti-infective until it was replaced by antibiotics later on.

Uses Echinacea supplements are currently used to build immune health and help prevent infection related diseases such as strep throat

Mechanism of Action https://www.medicalnewstoday.com/articles/252684

Dosage Forms + Servings ●

Capsules (Variety of Servings, most

Echinacea is shown to increase lymphocytes leading to a better cell-mediated response. It also was tested in a serial dilution against bacterial microorganism and was shown to have bactericidal activity that is equivalent to Vancomycin.

commonly 400mg) ●

Herbal Tea (5-6 cups day 1, then decrease 1/day over 5 days, no use greater than 8 weeks)

●

Dry Powder Extract (150-300mg/day)

●

Root Extract (300mg TID)

https://www.swansonvitamins.com/

Effectiveness

+Safety

A study on the effectiveness and safety of Echinacea use showed that Echinacea had therapeutic effectiveness when taken over the course of 4 weeks and no safety issue as compared to the placebo.

OpinionsI think that Echinacea would be great for people who are immunocompromised seeing as how it shows promising results of helping the body’s immune system. -BH

Side Effects ● ● ● ● ●

Dizziness Fevers Chills Hypersensitivity Reactions Nausea

Toxicities Echinacea was not found to have any toxic effects.

Interactions (Food/Drugs) Avoid taking Echinacea with corticosteroids because it decreases the corticosteroids’ ability to provide immunosuppressant effects, which can be life threatening.

Echinacea also interacts with Caffeine by increasing caffeine serum level and reducing caffeine clearance so it is best to avoid any food or drinks that contains caffeine while taking Echinacea.

https://topictea.com/blogs/tea-blog/what-is-echinace a-tea-and-can-it-help-a-cold/

References Echinacea. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com.

Accessed February 26, 2021.

Cunha, J., Echinacea: Side Effects, Dosages, Treatment, Interactions, Warnings. [online] RxList. Available at: <https://www.rxlist.com/consumer_echinacea/drugs-condition.htm> Accessed 26 February 2021.

Drugs.com. 2020. Echinacea Uses, Benefits & Dosage - Drugs.com Herbal Database. [online] Available at: <https://www.drugs.com/npp/echinacea.html> Accessed 2 March 2021.

Jawad, M., Schoop, R., Suter, A., Klein, P. and Eccles, R., 2012.

Safety and Efficacy Profile ofEchinacea purpureato Prevent Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial. [online] NCBI. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3457740/> Accessed 2 March 2021.

EVENING PRIMROSE Oenothera biennis

BACKGROUND & USAGE Once introduced in Europe in the 17th century it was used for many different medical conditions including whooping cough, rheumatoid arthritis, mastalgia, and many others. Today, evening primrose is used to help treat atopic dermatitis or eczema, diabetic neuropathy, cardiovascular disease, premenstrual syndrome, and much more.

It is also still currently undergoing trials to treat mastalgia and it is frequently marketed for Women’s Health.

DOSAGE FORM & MECHANISM It is sold as a capsule and a liquid and currently there is no evidence to provide the exact mechanism of action this supplement has in the body. It is believed that it may be able to be converted to a prostaglandin precursor and may also be beneficial to individuals who are unable to metabolize cislinoleic acid to GLA. It is also theorized to help those with a low diet in cislinoleic.

RECOMMENDED INTAKE According to Facts and Comparison’s , there is no set dose for this supplement. In clinical trials it was given orally to adults in doses of 6-8 grams/day and to children orally in 2-4 grams/day. However, when searched on the internet you can buy it in 1000 mg and 500 mg capsules and depending on the brand, they recommend 1 capsule as a serving size, but the milligrams differ.

PERSONAL OPINION aIn my personal opinion based on the research I have done I believe that evening primrose is nothing more than a placebo. There is evidence suggesting that it has little to no effect in patients with its indicated uses. -KI .

Effectiveness The oil of this plant is effective at helping reduce the signs and symptoms of eczema but as far as other indications go it is fairly similar to that of a placebo.

There is no significant data saying that it can actually help other conditions.

Drug Interactions This supplement does have some significant drug interactions with CYP 3A4 substrates (like statin drugs). Using it with anticoagulants and anti-platelet drugs can also increase the risk of bleeding.

Adverse Effects Some common side effects include upset stomach, nausea, diarrhea, headache, and you may bruise easier than normal.

Safety Evening Primrose is safe for most people as long as they are not consuming it in large quantities. There is no data about it being safe for pregnant and breastfeeding women so you should avoid it if you fall into either of those categories.

Toxicity Evening primrose is toxic to cats, dogs, and

References Harvesting History. 2021. Evening Primrose - Harvesting History. [online] Available at: <https://harvestinghistory.com/evening-primrose/> [Accessed 10 March 2021].

Verywell Health. 2021. Health Benefits of Evening Primrose Oil. [online] Available at: <https://www.verywellhealth.com/the-benefits-of-evening-primrose-oil-89561> [Accessed 10 March 2021].

Fco-factsandcomparisons-com.ezproxy.lib.purdue.edu. 2021. Purdue Web Authentication. [online] Available at: <https://fco-factsandcomparisons.com.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/fc_rnp2/3750140? cesid=0RDRpUJv5DO&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Devening%252520primrose%26t%3Dname%2 6va%3Devening%252520primrose%26nq%3Dtrue> [Accessed 10 March 2021].

TIFFANY NGUYEN STUDENT PHARMACIST SPRING 2021

https://www.healthline.com/nutrition/feverfew

FEVERFEW (Tanacetum Parthenium L.) Common names

Common Uses

Feverfew is a medicinal flower plant in the daisy family (Asteraceae). It can be found in brand names: Altamisa, bachelor button, camomille grande, Chrysanthemum parthenium, featherfew (feather life leaves), feather foil, flirtwort midsummer daisy, midsummer daisy, Santa Maria, Tanacetum parthenium.

This plant has been traditionally used for fever treatment, migraine headaches, rheumatoid arthritis, stomachaches, toothaches, insect bite, infertility, and menstruation and labor during childbirth-related issues.

Background

This medication is found to have a variety of pharmacologic properties (no single mechanism) by inhibiting inflammatory response, histamine release, platelets release, growth of gram-positive bacteria, yeast and fungi, and anticancer activity. More of the inhibitor of prostaglandin synthesis acts as an antiinflammatory response is found in the ground portions compared to the leaf extracts. Feverfew was also found to inhibit 5-HT secretion which inhibits platelets to release. Inhibition of histamine release was also taken note however the exact mechanism is not determined.

Feverfew is suggested to have a cytotoxic effect (and some mechanisms are irreversible) because feverfew has highly reactive lactone (parthenolide) rings that interrupt DNA replication.

This medicine originated among Greek and early European herbalists. The ancient Greeks called this herb “Parthenium” for its medicinal use. The Latin word febrifugia meaning fever reducer is where the name feverfew got its origin. Feverfew is considered as the aspirin of the 18th century and used to treat fever, aches, inflammatory conditions, insect bites, labor, menstrual disorders, vertigo, worms, and more. Both the blossoms and leaves can be used.

Sometimes, feverfew was planted to purify the air and as an insect repellent.

Pharmacology

Adverse Side Effects Some side effects could include increased heart rate, mouth ulceration, inflammation (mouth, tongue, lips), loss of taste, and dermatitis. There are patients who have feverfew withdrawal and experienced nervous system related effects such as headache, insomnia, joint pain nervousness, poor sleep patterns, muscle and joint stiffness, tension, and tiredness. https://www.amazon.com/Solaray-Organic-Feverfew-SupplementCount/dp/B00028PJ2E

Toxicities

There are not enough studies to determine how toxic feverfew is for long-term use. Women who are pregnant should not use feverfew because it could affect the menstrual flow and it's not recommended for breastfeeding mothers or children.

Drug Interactions Feverfew could react with agents, herbs, NSAIDS, salicylates – all of which have either anticoagulant or antiplatelet properties or both. This drug will enhance the drugs with those properties and may increase bleeding.

Available Dosage Forms Feverfew can be taken as fresh freeze-dried or dried leaves and come in capsule, tablet, or liquid extract dosage forms.

Typical Dosing Migraine Treatment: 50 to 50 milligrams of dried leaves, 2.5 fresh leaves, or 5 to 20 drops dissolved in a 1:5 ratio in ethanol. For supplements, take 6.25 mg up to 3 times daily, up to 16 weeks.

Migraine prevention: 0.2 to 0.6 milligrams a day of parthenolide (the active ingredient in feverfew) Inflammation (ex. arthritis): 60 to 120 drops dissolved in a 1:5 ratio in ethanol

Effectiveness There were a few clinical studies with results that do not have a significant difference; some actually had negative results. A study of 72 patients who had migraines (half took a capsule of dried feverfew leaves, and half took a placebo) resulted in less average in the severity of attacks every two months. Vomiting and duration of the individual attacks did not change, and there were no serious side effects. There are also other studies where such as the one in the UK that did not find any difference between placebo-controlled and feverfew groups. There are a few people who already have been taking feverfew for a long time and once they stopped and took a placebo their headaches increased by a factor of 3.

Personal Opinion Multiple studies have shown no significant, statistical evidence that this drug works, and for those patients that claim that feverfew does work for them are very few in numbers.

Based on the available clinical study about feverfew, there is not enough evidence for me to recommend taking feverfew over other medications that are indicated for migraines.

I do think it's possible to consider feverfew for migraines (other conditions are unlikely) but I would consider taking feverfew as my last option. https://www.food4less.com/p/herb-pharm-organic-feverfewnervous-system-herbal-supplement/0009070000055

References

Feverfew Natural Products. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed August 10, 2021. http://online.lexi.com Murphy JJ, Heptinstall S, and Mitchell JRA. RANDOMISED DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL OF FEVERFEW IN MIGRAINE PREVENTION. The Lancet. 1988;322(8604):189-192. doi:10.1016/S01406736(88)92289-1 Pareek A, Suthar M, Rathore GS, Bansal V. Feverfew (Tanacetum parthenium L.): A systematic review.

Pharmacogn Rev. 2011;5(9):103-110. doi:10.4103/09737847.79105

Jasmine Padgett Nursing Student Spring 2021 Common Names: Brindle berry, Malabar tamarind, Hydroxycitric acid, Gambooge

Background •

Native to India and Southeast Asia

•

Fruit pulp is often used as a preservative and condiment in Asia

•

Hydroxycitric acid (HCA) is found in the rind and has been studied for how it affects appetite

Uses •

Weight loss

•

Relief of joint pain

•

Relief of digestive symptoms

•

Improvement of athletic performance

Available Dosage Forms Supplements are available in many forms, including tablets, capsules, extracts, and more. This supplement is most often seen in capsule form.

https://images.search.yahoo.com/search/ images;_ylt=AwrJ7JgEnUlgKjEACz1XNyoA;_ylu=Y29sbwNiZjEEcG9zAzEEdnRpZAMEc2VjA3BpdnM-?p=garcinia+cambogia&fr2=pivweb&fr=mcafee#id=0&iurl=http%3A%2F%2Fwww.dietspotlight.com%2Fwp-content%2Fuploads%2Fgarcinia-cambogia-fruit-productimage.jpg&action=click

Mechanism of Action Garcinia Cambogia has an effect on how fats are metabolized. It does so by accelerating the oxidation of fats which is believed to speed up the process of lipolysis (destruction of fat cells) which would accelerate weight loss. The HCA in garcinia cambogia is believed to inhibit alpha-amylase and alpha-glucosidase which blocks the breakdown of carbohydrates. It is also determined that garcinia cambogia suppresses appetite, but it is not well understood how this happens.

Typical Dosing/Serving There are various recommendations on dosing.

However, the most common dosing seen is 300 to 500 mg three times a day 30 minutes before meals.

Effectiveness It is unclear at present time if garcinia cambogia has any affect on weight loss as there have been varying results from studies that have been done and not enough large-scale studies to really determine its effectiveness.

Adverse/Side Effects •

Flatulence

•

Diarrhea

•

Abdominal pain

Serotonin Syndrome: •

Stuttering

•

Anxiety

•

Agitation

•

Loss of coordination

•

Upset stomach

•

Dizziness

•

Hallucinations

•

Dry mouth

•

Increased heart rate

•

Increased blood pressure

Safety The safety of garcinia cambogia has been questioned as it has been found that some reports of liver failure have been linked to taking high doses of the supplement. It has also been found that this supplement increases serotonin levels in the body and, when used with antidepressants, can lead to serotonin syndrome.

Drug Interactions As previously mentioned, when this supplement is taken in combination with antidepressants, it can lead to serotonin syndrome. When it is taken in combination with medications for asthma, allergies, and diabetes, it can lower their effectiveness. It can also have an adverse effect on anticoagulants, pain killers, and statins for lowering cholesterol.

Personal Opinion In my personal opinion, I don’t believe that garcinia cambogia is worth trying based on the lack of sufficient research on its efficacy and the risk of liver toxicity if taken incorrectly. I’m sure that people will still try this as a lot of people out there seem to try anything to help them with their weight loss. If people are going to choose to use this supplement, I would recommend that they do some research and ask their primary care physician before including it into their daily regimen. J Padgett References Sturluson, T. Herbal Supplement Resource. Garcinia Cambogia—Health Benefits and Side Effects. Accessed March 10, 2021. https://www.herbal-supplementresource.com/garcinia-cambogia.html National Center for Complimentary and Integrative Health. Garcinia Cambogia. Accessed March 10, 2021. https://www.nccih.nih.gov/health/garciniacambogia#:~:text=Background%20Garcinia%20cambogia%20is%20native%20to%20India%20and,has%20been%20studied%20for%20its%20effect%20on% 20appetite.

RxMed: Diseases and Preparations' Description. Garcinia Cambogia. Accessed March 10, 2021. https://www.rxmed.com/herbal/garcinia-

Scientific Name: Allium sativum L. Image 2 Image 1 Sarah Pensyl, Student Pharmacist, Spring 2021 Reference for Image 1 and Image 2 BBC Good Food. Accessed March 6, 2021. https://www.bbcgoodfood.com/glossary/garlic-glossary Walmart. Accessed March 6, 2021. https://www.walmart.com/ip/Spring-Valley-Odorless-GarlicSoftgels-1000mg-100-Count-2-Pack/10316867

Common Names: Allium; Camphor of the poor; Da-suan; Garlic; La-suan; Nectar of the gods, stinking rose Background and History: The genus Allium comes from the Celtic word for “burning” or “smarting.” In the past, garlic was used in the early Olympics in Greece to improve the stamina of athletes and Hippocrates treated chest and stomach pains with it. During the 1800’s, physicians prescribed garlic inhalation to treat tuberculosis. American Indians used garlic as a treatment for earache, flatulence, and scurvy. In WWII garlic was used to disinfect wounds. Naturopaths today use garlic as a poultice to treat inflammation.

Purported Uses: 1. Anti-Inflammatory Effects 2. Antimicrobial Activity 3. Antioxidant Effects 4. Antiplatelet Effects 5. Diabetes 6. Dyslipidemia 7. Hypertension 8. Ischemic Heart Disease and Heart Failure 9. Peripheral Vascular Disease

Mechanism of Action: Atherosclerosis: Diallyl sulfide, diallyl disulfide and allicin are active compounds within garlic that have an anti-atherosclerotic effect through antioxidation, lipoprotein modification, inhibition of LDL uptake, reduction of lipid content in arterial walls, and prevention of intracellular lipid accumulation. A lipid lowering effect is seen through reducing intestinal MTP (microsomal triglyceride transfer protein) gene expression, thus suppressing the assembly/secretion of chylomicrons.

Anti-Inflammatory Effects: Garlic Oil shows anti-inflammatory activity by inhibiting the assembly-disassembly processes of the cytoskeleton. Garlic intake also decreases CRP (C reactive protein) concentrations which is a marker of inflammation.

Diagram 1: The structures of the active components of garlic including Allicin, Diallyl Sulfide and Diallyl Disulfide mentioned in the mechanism of action.

Typical Adult Dosing: 4 g (1 or 2 cloves) of raw garlic per day; one 300 mg dried garlic powder tablet (0.6 and 1.3% allicin yield) 2-3 times per day, or 7.2 g of aged garlic extract per day

Available Dosage Forms: Garlic Supplements: 1. Capsules (made with enteric coating to prevent garlic breath) 2. Tablets (made with dried garlic powder) 3. Softgels 4. Cloves (food product either consumed raw or cooked) 5. Garlic Extract 6. Garlic Oil Reference for Diagram 1: Viswanathan V, Phadatare AG, Mukne A. Antimycobacterial and antibacterial activity OF Allium SATIVUM BULBS. Accessed March 6, 2021. https://www.ijpsonline.com/articles/antimycobacterial-andantibacterial-activity-of-iallium-sativumibulbs.html?view=mobile.

Opinion: I recommend garlic because it’s a safe product, easy to incorporate in a diet, doesn’t have many adverse effects, and can treat chronic disease. -S Pensyl Effectiveness: Studies suggest that garlic is effective in reduction of serum cholesterol and low-density lipoprotein cholesterol in subjects with elevated cholesterol. Similarly, taking a garlic powder supplement twice daily for 24-months can reduce the progression of the hardening of the arteries. Garlic extracts can reduce insulin resistance in diabetes mellitus. Recently, garlic was found effective as an antibiotic to grampositive, gram-negative, and acid-fast bacteria. Clinical studies have shown consumption of garlic tablets reduces systolic blood pressure and diastolic blood pressure in participants with high blood pressure.

Safety: If pregnant or breast feeding ask a health professional before use. Little is known about the safety of garlic supplements during pregnancy or lactation. Garlic supplement consumption may increase risk of bleeding. Before taking an anticoagulant or undergoing surgery make sure to consult your physician. Garlic supplements should be used with caution in individuals at risk of hypotension and hypoglycemia.

Toxicities: In studies based on rats, garlic toxicity decreased testosterone secretion and spermatogenesis. Garlic has the potential to be toxic to dogs and cats causing anemia and hypertension resulting from toxic erythrocyte hemolysis.

Food/Drug Interactions: Garlic’s can contribute to interactions through its use of the CYP-450 System, specifically CYP1A2, 2D6, and 3A4 and through its impact on the P-glycoprotein.

Consider therapy modification if taken with: 1. Agents with antiplatelet properties 2. Anticoagulants 3. Antidiabetic Drugs 4. Herbs 5. Hypoglycemia associated agents 6. Nonsteroidal Anti-Inflammatory Drugs 7. Protease Inhibitors 8. Salicylates 9. Thrombolytic Agents

Adverse Effects: Although garlic is used frequently for culinary purposes, little is known about the longterm effects of garlic supplements. Side effects observed along with consumption of garlic-coated tablets include: 1. Mild GI adverse reactions (including nausea, bloating, and flatulence) 2. Body odor or malodorous breath 3. Increased bleeding risks when combined with anticoagulants 4. Anaphylaxis Single Case Reports of: 1. obstruction of the small intestine 2. dysphagia 3. esophageal pain Topical Garlic Paste 1. skin burns Article Summary: Overall, garlic has anti-cancer, cardioprotective, antihyperglycemic, antimicrobial, antihypertensive, antiplatelet, anti-inflammatory and antioxidant effects which can contribute to therapeutic effects in the treatment of many chronic diseases. Once in the body, garlic is rapidly metabolized and generally has poor bioavailability which contributes to garlic’s low therapeutic effect and low incidence of toxic effects. In the future, scientists are looking to better harness the therapeutic effects of garlic by concentrating the sulfur compounds found in garlic.

Ansary J, Forbes-Hernandez TY, Gil E, Cianciosi D, Zhang J, Elexpuru-Zabaleta M, Simal-Gandara J, Giampieri F, Battino M. Potential Health Benefit of Garlic Based on Human Intervention Studies: A Brief Overview. NCBI. 2020; 9(7): 619. doi: 10.3390/antiox9070619.

Garlic. Natural Product Database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 6, 2021. http://online.lexi.com Mikaili P, Maadirad S, Moloudizargari M, Aghajanshakeri S, and Sarahroodi S. Therapeutic Uses and Pharmacological Properties of Garlic, Shallot, and Their Biologically Active Compounds. NCBI. 2013; 16(10): 1031-1048

Ginger

Gabriel Porter Visual Effects student Spring 2021

Other names: Zingiber Officinale (scientific), Ginger Root

History and Background Ginger is commonly known as a food additive, added into consumables such as gingerbread and ginger ale, but Ginger’s use as a spice, food, and medicine dates back at least 5000 years in ancient India and China. It spread through trade and became well known in England by the 11th century. It is often refered to it as “Ginger root,” but what is actually consumed is the rhizome of the plant. The plant is commonly grown in Asia and tropical areas.

Purported Uses • Reducing nausea and vomitting, especially for pregnancy and after surgery • Stimulating apetite • Easing arthritis • Easing digestive issues

• • • •

Alleviating menstrual issues Managing diabetes Cancer prevention Treating asthma and other allergic reactions

How it works in the body Ginger’s mechanisms are underresearched. As far as its ability to ease digestive issues, it appears that Ginger affects the gastrointestinal system both locally and through the central nervous system.

Ginger also has an exceptionally high degree of antioxidants which may have anticancer effects, has shown an anti-inflammatory response which may ease arthritis, has anticoagulant properties, and has demonstrated suppression of allergic reactions.

Forms Ginger is very versatile and can be ingested through many forms. It can be served fresh, dried, pickled, powdered, and as an essential oil. Additionally, it can be added to consumables, most commonly bread, tea, soft drinks, sauces, and capsules.

Typical Serving

Unprocessed Ginger rhizome https://commons.wikimedia.org/wiki/File:Ginger_Root_Display.JPG

While there is no recommended serving, research with Ginger typically uses between 250mg to 1g taken one to four times daily.

Effectiveness In clinical research, Ginger has been shown to be effective in reducing nausea in certain contexts, being as good as and possibly better than vitamin B6. However, the effectiveness in Ginger at treating other ailments is dubious, as either the research has produced conflicting results, or there is too little research to make a secure claim.

Safety There are no known toxic effects of Ginger and it appears very safe to consume, even for pregnant women. However, this area has little research. Those on anticoagulant medication or expecting to soon undergo a surgical procedure might exercise caution in consuming Ginger because of its anticoagulant properties, although research on the legitimacy of pontential danger is inconclusive.

Side Effects Although uncommon, Ginger may cause mild cases of heartburn, diarrhea, and mouth irritation. It is also possible to have a Ginger allergy, so allergy symptoms like difficulty breathing, swelling, and rash should be noted.

Toxicity There is no known toxicity in Ginger, even at high doses.

Food/Drug Interaction There is no known food/drug interaction with Ginger, but there has been little research in this area.

As noted above, one might be cautious in consuming Ginger while taking an anticoagulant medication because of Ginger’s anticoagulant properties.

Article Summary A study published in 2007 found that Ginger used on cultured ovarian cancer cells significantly inhibited the cancer cells’ growth. The study concluded that the use of Ginger could be potentially effective in treating and preventing ovarian cancer.

My Takeaway Although many aspects of Ginger are underresearched, its consumption appears very safe and its use virtually harmless. Ginger seems like a great avenue for research, especially for it’s inconclusive beneficial properties and effects, such as the treatment and prevention of cancer.

References 1. Alavinia A, Asili J, Golmakani E, et al. Effect of ginger (zingiber officinale) on heavy menstrual bleeding. Phytotherapy Research. 2015: 29(1): 114-119. https://onlinelibrary.wiley.com/ doi/full/10.1002/ptr.5235. Accessed March 11, 2021.

2. Bode AM, Dong Z. The amazing and mighty ginger. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/ Taylor & Francis; 2011. Chapter 7. https://www.ncbi.nlm.nih.gov/books/NBK92775. Accessed March 11, 2021.

3. Daily, JM, Kim DS, Park S, et al. Efficacy of ginger for treating Type 2 diabetes: A systematic review and meta-analysis of randomized clinical trials. Journal of Ethnic Foods. 2015; 2(1): 36-43. https://doi.org/10.1016/j.jef.2015.02.007. Accessed March 11, 2021.

4. Forgoros S, Rhode J, Zick S, et al. Ginger inhibits cell growth and modulates angiogenic factors in ovarian cancer cells. BMC Complement Altern Med. 2007; 7: 44. https://doi. org/10.1186/1472-6882-7-44. Accessed March 11, 2021.

5. ginger (Ginger Root). eMedicineHealth. https://www.emedicinehealth.com/drug-ginger/article_em.htm. Accessed March 11, 2021.

6. Ginger. Britannica. https://www.britannica.com/plant/ginger. Accessed March 11, 2021.

7. White B. Ginger: an overview. Am Fam Physician. 2007 Jun 1; 75(11):1689-1691. https://www.aafp.org/afp/2007/0601/p1689.html. Access March 11, 2021.

Hannah Swanson Student Nurse, Spring 2021

Ginkgo Biloba

Common name: maidenhair tree Background: Fossil leaves show that Ginkgo has been around as far back as the Jurassic Period in Mongolia, Europe, and western North America. Ginkgo was frequently planted in Chinese and Japanese Temple Gardens. Gingko has been used in traditional Chinese medicine, for its memory-enhancing characteristics.

Ginkgo biloba was recommended for asthma, swelling of the hands and feet, coughs, vascular disorders, aging, and for the brain. Since 1965, Ginkgo biloba has been used in Europe for the treatment of cerebral insufficiency and peripheral vascular disease. (Image:healthline.com)

Uses -

Contains powerful antioxidants Improves circulation and heart health Reduces symptoms of dementia Treat depression Treat migraines and headaches Reduces PMS symptoms

- Can help fight inflammation - Improves brain function & well-being - Reduce anxiety - Can support vision and eye health - Improve asthma and COPD symptoms - Treats sexual dysfunction

Pathophysiology: While the exact physiology of Ginkgo Biloba leaf extract is unknown, it is believed to inhibit monoamine oxidase A and B, as well as inhibiting catechol-O-methyl transferase. Lastly, it is thought to increase the number of alpha-adrenoreceptors in the brain. Other proposed mechanisms of action include possible effects on the benzodiazepine receptors, a possible decrease in glucocorticoid biosynthesis, and a possible increase in pancreatic beta-cell function in response to glucose loading.

Dosing: A safe dose for an adult would be between 120-240mg a day, not exceeding 600mg per day. Ginkgo is commonly available as an oral tablet, extract, capsule, or tea.

Effectiveness: According to MayoClinic, “While some evidence suggests that Ginkgo extract might modestly improve memory in healthy adults, most studies indicate that Ginkgo doesn’t improve memory, attention, or brain function.” Further research is necessary to find out the effectiveness and claims of the Ginkgo extract. (Image: forbes.com)

2

Adverse Effects: Ginkgo can cause:

Safety: When Ginkgo is used

Headache Dizziness Heart palpitations Upset stomach Constipation Allergic skin reactions

in moderate amounts, it appears to be safe for most healthy adults. Do not eat raw or roasted ginkgo seeds, which can be poisonous. Do not take if you are epileptic or prone to seizures. If you are older, have a bleeding disorder or are pregnant, Ginkgo is not recommended.

Possible Interactions include: ● ● ● ● ● ● ● ●

Alprazolam (Xanax) Anticoagulants and anti-platelet drugs Herbs, and supplements Anticonvulsants and seizure threshold lowering drugs, herbs, and supplements Antidepressants Certain statins Diabetes drugs- Ibuprogen (Advil, Motrin IB)

Article Review: Ginkgo Biloba has not been proven to improve cognitive function. In fact, a 2014 research study took two groups of Alzheimer’s patients. One group was the control, only taking their traditional medications. The test group was given Ginkgo Biloba in conjunction with their normal pharmaceutical treatments. The two groups had no significant differences in their outcomes. As of now, there is no statistically significant data to support the use of Gingko Biloba with Alzheimer’s patients. (Image: espacepourlaive.com) Professional opinion: More research needs to be done on the effects of Ginkgo Biloba.

Patients should consult with their doctor before purchasing this supplement, as it may affect their current treatment modalities and may not produce any measurable differences in brain function or any of the other claims. I would not feel comfortable recommending this to a patient given the lack of evidence-based research supporting the claimed benefits of this supplement. ~HS~

References Canevelli M, Adali N, Kelaiditi E, Cantet C, Ousset P-J, Cesari M. Effects of Gingko biloba supplementation in Alzheimer’s disease patients receiving cholinesterase inhibitors: Data from the ICTUS study. Phytomedicine. 2014;21(6):888-892. doi:10.1016/j.phymed.2014.01.003 Ginkgo. Britannica.com. https://www.britannica.com/plant/ginkgo-tree. Updated January 29, 2021. Accessed March 7, 2021.

Ginkgo. Mayoclinic.org. https://www.mayoclinic.org/drugs-supplements-ginkgo/art-20362032. Accessed March 7, 2021.

Ginkgo Biloba and Memory. Clevelandclinicmeded.com. Pharmacotherapy Update - Ginkgo Biloba and Memory. Accessed March 7, 2021.

Ansley Hill. 12 Benefits of Ginkgo Biloba (Plus Side Effects & Dosage). Healthline.com. 12 Benefits of Ginkgo Biloba (Plus Side Effects & Dosage). Published May 29, 2018. Accessed March 7, 2021. https://www.forbes.com/sites/stevensalzberg/2019/05/28/ginkgo-biloba-doesnt-work-for-anything-its-just-a-tree/?sh=2c4e45ce45ac https://m.espacepourlavie.ca/en/growing-ginkgo-seed

Pasha Pourian, student pharmacist Spring 2021

Ginseng Scientific name: Panax ginseng, Panax quinquefolius, Panax repens Common names: American/Chinese/Korean ginseng, man-root, Schinsent Background/History1,2,3 Ginseng is a very popular drug that has been used in Asia for many years as part of Traditional Chinese medicine. The drug is boasted to have many physiological properties, from improving the immune system to treating health conditions like respiratory or cardiovascular diseases. Ginseng has many compounds within it, but the main compound are ginsenosides.

Ginsenoside. (2020, December 05).

Purported Uses1,2,4 Retrieved April 22, 2021, from ▪ Improved stamina and wellbeing https://en.wikipedia.org/wiki/Ginsen ▪ Increased activity of immune system oside#/media/File:Ginsenoside_Rg1. png ▪ Dietary supplement ▪ Treatment of health conditions like epilepsy, depression, diabetes, erectile dysfunction, and Alzheimer’s disease

Pharmacology/Mechanism of Action5,6 Ginseng works by promoting vascular endothelial cell-derived nitric oxide secretion, and by acting on the BDNF system in the hippocampus. It also activates and promotes many other genes such as PI3K, Akt, and ERK, which help neuroprotection and cognition.

Dosage Forms & Dosing4 Dosing varies from 100-200mg to 1-3g daily, taken from 3-8 weeks Dosage forms include gummies, tea, powder, capsules, and comes in many other forms Toxicities7 Toxicities from consuming too much ginseng are not only rare, and there were not many sources confirming any toxicities from ginseng.

Safety3 There are little to no adverse effects reported when taking ginseng. However, it should be avoided during pregnancy as it can lead to birth defects. It can also minorly affect other medication such as anti-depressants.

Effectiveness5, Ginseng is an effective drug for treatment of depression, neuronal damage, Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. This is because ginseng acts on intracellular signaling molecules like neurotransmitters and receptors.

Adverse/side effects4,7 Although ginseng has little to no adverse effects, it should not be taken at night due to it causing insomnia or sleeping problems. In rare cases, side effects like nervousness, insomnia, changes in blood pressure, breast pain, vaginal bleeding, vomiting, diarrhea, and mania can be observed.

3

Food/drug interactions2 Ginseng should not be taken with warfarin (coumadin) and should be cautiously taken with anti-depressants, immunosuppressants, or diabetic medication. There are also no known food interactions with ginseng.

Article Summary5 After reviewing the Hou article, I realized that ginseng consists of many mechanisms that activate/regulate receptors which can help neurological disorders. Due to its few little adverse effects and the fact that ginseng is still being studied, it can be used in conjunction with other medication, but not as a substitute.

7

Personal opinion Personally, in my professional opinion, I don’t think of ginseng as a life-altering drug.

Having tried it multiple times myself in different forms such as gel or capsules, I believe that ginseng only mildly improves your overall health, just as taking vitamins do. ~P References Asian Ginseng. https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=hn-2098004. Accessed April 22, 2021.

American Ginseng: MedlinePlus Supplements. MedlinePlus. https://medlineplus.gov/druginfo/natural/967.html. Published October 23, 2020. Accessed April 22, 2021.

Asian Ginseng. National Center for Complementary and Integrative Health. Published August 2020. Accessed April 22, 2021.

Ginseng. Ginseng - Health Encyclopedia - University of Rochester Medical Center. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=19&contentid=Ginseng. Accessed April 22, 2021.

Hou W, Wang Y, Zheng P, Cui R. Effects of Ginseng on Neurological Disorders. Frontiers. https://www.frontiersin.org/articles/10.3389/fncel.2020.00055/full. Published February 27, 2020. Accessed April 22, 2021.

Park S-Y, Park J-H, Kim H-S, et al. Systems-level mechanisms of action of Panax ginseng: a network pharmacological approach.

Journal of ginseng research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766701/#:~:text=It%20is%20known%20that%20P,63%5D%2C%20%5B64%5D. Published October 16, 2017. Accessed April 22, 2021.

Side Effects of Ginseng Supplements. Side Effects of Ginseng. Accessed April 22, 2021.

Spring 2021- Complementary and Alternative Medicine

Glucosamine Elizabeth Roach, Pre-Physician Assistant Student

Common Names: Glucosamine, chondroitin, methylsulfonylmethane Figure 1: chemspider.com Scientific Names: 2-Amino-2-deoxy-glucose, (3R,4R,5S)-3-Amino-6-(hydroxymethyl)oxane2,4,5-triol Brand Names: Genicin, Optiflex-G, Osteo Bi-Flex Advanced

Background/History: Glucosamine was first utilized in veterinary medicine as an injectable in the 1970s and was originally unstable, meaning that it could be not used as an oral capsule. In the 1990’s, a large Italian pharmaceutical company by the name of Rottapharm received a U.S. patent for the supplement. After the introduction of glucosamine in 1994, many other “knock-offs” were introduced in order to get around the patent originally reserved by Rottapharm.

Purported Uses: Glucosamine is most used in order to relieve patients of pain caused by osteoarthritis and/or rheumatoid arthritis. Usually, patients turn to glucosamine when they are not able to take NSAIDs. Glucosamine is an amino sugar and also a precursor of glycosylated proteins and lipids, which are major components of joint cartilages. Main use is to potentially build up cartilage and relieve symptoms of osteoarthritis.

Pharmacology/Mechanism of Action: Oral glucosamine is an amino sugar made from glucose and glutamine. It is also a precursor of glycosylated proteins and lipids which create an ester as an intermediate that incorporates into a large proportion of articular cartilage. The mechanism of action includes taking supplemental glucosamine, which is often combined with HCL and chondroitin sulfate.

Glucosamine can also stimulate synthesis of synovial fluid, hold off degradation and improve healing of cartilage, all of which hopefully make the symptoms of osteoarthritis subside.

Figure 2: Image From Bicycling.com

Available Dosage Forms and Typical Dosing: Tablet—ranging from 200 mg- 1500 mg Intramuscular Injection – 400 mg/2mL

2

Effectiveness: The efficacy of glucosamine is still in question, but early research studies suggest positive outcomes.

Safety: According to multiple sources, since glucosamine is a supplement that is not FDA approved or monitored, the safety of the drug is the responsibility of the manufacturer and consumer.

Adverse/Side Effects/Toxicity: Side Effects: Itching, diarrhea, heartburn, nausea, vomiting, constipation, drowsiness, headache. May worsen asthma and raise eye pressure.

Toxicity: Glucosamine in high levels can cause hepatotoxicity Figure 3: www.printablesigns.net

Food/Drug Interactions: Since some glucosamine products are

Summary:

manufactured from the shells of shellfish,

Glucosamine is the second most common

people with shellfish allergies should stay away

supplement in the United States and is most

from glucosamine. Possible drug interactions

commonly used to promote joint health. It

include Acetaminophen, such as Tylenol,

was first used in veterinary medicine and

Excedrin, Midol, etc. and Warfarin. When

became available as an OTC supplement in

taken at the same time, the effects of Warfarin

1994. There are still research studies and

may increase causing a higher risk of bleeding.

experiments being conducted due to the lack of evidence that glucosamine works in

Personal/Professional Opinion:

treating osteoarthritis.

My personal view on glucosamine includes getting multiple doctors’ opinions and checking the dosage with a medical professional prior to supplementing. I believe that in theory, this supplement could work in helping those with osteoarthritis, but the research studies do not yet suggest great efficacy. E.Roach

References: A history of Glucosamine: The Good, the Bad and the Ugly. Dcpracticeinsights.com. Published July 1, 2012. Accessed March 3, 2021. http://www.dcpracticeinsights.com/mpacms/dc/pi/article.php?id=56005 Glucosamine. Accessed March 8, 2021. https://go.drugbank.com/drugs/DB01296 Glucosamine - brand name list from Drugs.com. Drugs.com. Accessed March 9, 2021. https://www.drugs.com/ingredient/glucosamine.html Glucosamine. Mayoclinic.org. Published November 12, 2020. Accessed March 8, 2021. https://www.mayoclinic.org/drugs-supplements-glucosamine/art-20362874

Matthew Caplis Health Sciences Student Scientific Name: Hydrastis canadnesis

Spring 2021

BACKGROUND Hydrastis canadensis, known as Goldenseal, is a North American perennial grown and harvested for the medicinal properties of its root. Originally, Goldenseal was used as a medicine and a dye by Native American tribes such as the Cherokee, leading to names such as Jaundice Root, Orange Root, and Yellow Root. Goldenseal was adopted by European culture around the 19th century after their colonization of North America.

COMMON USES Traditional herbal remedy for the following: •

Common Cold

•

Digestive Disorders

•

Respiratory Infections

•

Irritation

DOSAGE FORMS ORAL: Ingesting the dried root, a liquid extract, or a tincture.

TOPICAL: Mouthwash made up of 6 g of

TYPICAL DOSE Dried root: 0.5-1.0g, 3x/day Liquid extract: 0.3-1.0 mL, 3x/day Tincture: 2-4 mL, 3x/day Mouthwash: Rinse 3-4x/day

dried herb and 150 mL of water.

MECHANISM OF ACTION Goldenseal naturally contains numerous alkaloid compounds

Berberdine. https://en.wikipedia.org/wi ki/Berberine

such as berberine and canadine. These alkaloids act as antibacterial and anti-inflammatory compounds. As an isoquinoline alkaloid, berberine has an antimicrobial function against bacteria by destroying cellular proteins and hindering DNA synthesis.

1.“Goldenseal.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, www.nccih.nih.gov/health/goldenseal.

2. Peng, Lianci et al. “Antibacterial activity and mechanism of berberine against Streptococcus agalactiae.” International journal of clinical and experimental pathology vol. 8,5 5217-23. 1 May. 2015 3. Pregnancy and Alternative Therapies. Cleveland Clinic. (n.d.). https://my.clevelandclinic.org/health/drugs/9595-pregnancy-usingalternative-therapies.

SAFETY

EFFECTIVENESS According to the National Center for

Goldenseal is generally safe for short term intake

Complementary and Integrative Health

by most adults but should not be given to infants

(NCCIH), there are no scientific studies

and should be avoided by women who are

containing the evidence to viably support

pregnant or breastfeeding. There is not a

the use of Goldenseal as a treatment

significant amount of research regarding long term

method.

use to determine its safety.

SIDE EFFECTS/ TOXICITIES

INTERACTIONS

•

Excitability

Since Goldenseal contains

Metformin is an anti-diabetic medication used

•

Indigestion

alkaloid compounds, alkaloid

to regulate glucose levels for people with type

•

Hallucinations

poisoning may be possible.

2 diabetes. Goldenseal has been seen to

•

Delirium

However, due to the low

decrease levels of metformin by approximately

•

Skin or orifice

absorption of the alkaloids

25% in healthy adults, and thus may interfere

irritation

present in Goldenseal, this

with glucose regulation in type 2 diabetics.

•

Sunlight sensitivity illness is unlikely.

STUDY SUMMARY One study explored the carcinogenic activity of Goldenseal in mice and rats by incorporating increasing concentrations of Goldenseal to different group’s diets for a period two years. This study’s results suggest carcinogenic activity in the form of hepatocellular adenomas. However, this study was not conducted on a large enough sample to be considered definitive evidence.

PERSONAL OPINION

Goldenseal flower. https://woodlandessence. com/products/goldenseal-hydrastis-canadensis

The main benefit of Goldenseal comes from the alkaloids present in the root (mainly berberine). However, the absorption of berberine from Goldenseal is very low when ingested orally. In my opinion, taking supplements of berberine would provide a better means to achieve the intended results of Goldenseal, due to the absorbed concentration being more significant.

1.“Goldenseal.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, www.nccih.nih.gov/health/goldenseal.

2. Peng, Lianci et al. “Antibacterial activity and mechanism of berberine against Streptococcus agalactiae.” International journal of clinical and experimental pathology vol. 8,5 5217-23. 1 May. 2015 3. Pregnancy and Alternative Therapies. Cleveland Clinic. (n.d.). https://my.clevelandclinic.org/health/drugs/9595-pregnancy-usingalternative-therapies.

Samuel Siwy, Student Pharmacist Spring 2021

https://bit.ly/3ultjtK

Hawthorn Common names: Crataegus monogyna, Crataegus laevigata

USED FOR Heart Failure Lowering Cholesterol Lowering Blood Pressure Digestive Problems Kidney Problems

HOW IT WORKS IN THE BODY The leaves, berries, and flowers of Hawthorn are used to make medicine because they contain flavonoids, oligomeric proanthocyanins, tyramine, and tannins. The flavonoids and oligomeric proanthocyanins are the most pharmacological active compounds. However, there is no scientific explanation on how this dietary supplement works in the human body. Overall, Hawthorn has many different effects to help treat the body, and it requires the plant to be eaten to have an effect.

AVAILABLE DOSAGE FORMS Oral

TYPICAL DOSING Heart Failure: 160mg-1800mg divided and taken by mouth 2-3 times daily.

ADVERSE EFFECTS being Side effects are rare and if they do occur, they usually are mild.

They can include: Mild/Moderate Dizziness Headache Rash Palpitations Nausea GI Symptoms

DRUG INTERACTIONS Hawthorn has major interactions with Digoxin, any medications that increase blood flow to the heart (Nitrates), any medications for high blood pressure (ie. Beta- Blockers, Calcium Channel Blockers), and any medications for male sexual dysfunction (ie.

Phosphodiesterase-5 inhibitors, Viagra, Cialis, & etc.). However, the adverse effects from these drug interactions is not that life threatening. There is a increased chance of dizziness and decrease in effects of the drugs Hawthorn interacts with.

Might be effective in treating heart Problems, lowering cholesterol, and lowering Blood Pressure.

Generally safe. However, may interact with some heart medications.

*Little is known about safety for use during Pregnancy or Breastfeeding*

SUMMARY OF AN ARTICLE ON HAWTHORN Hawthorn has a variety of benefits and is a great dietary supplement. However, dosing and being cautious with the drug interactions need to be monitored to prevent adverse effects.

Hawthorn is recommended to try as a natural treatment for cardiovascular disease.

MY PROFESSIONAL OPINION In my opinion, Hawthorn is worth trying if the consumer is wanting to treat cardiovascular disease by a natural supplement.

This supplement is cheap and is very easy to find. The use of this supplement should still be cautioned and advised to be looked over by a doctor or pharmacist to look at the drug interactions for any adverse effects. Overall, Hawthorn is a relatively safe supplement. - SS

Reported toxic at high doses.

Hawthorn (2020, November 24).

Retrieved February 27, 2021 from https://www.drugs.com/npp/hawthor n.htmlHawthorn Supplement: Uses, Side Effects, Precautions, Interactions, Dosing (2020, September 18).

Retrieved from https://www.webmd.com/vitamins/ai /ingredientmono-527/hawthorn Hawthorn (Crataegus spp.) in treatment of cardiovascular disease (2010, Jan-Jun). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/ar ticles/PMC3249900/

Horse Chestnut (Aesculus hippocastanum) Use The seed, bark, flowers, and leaves of a horse chestnut tree have been used for centuries to treat a variety of conditions including joint pain, GI disturbances, and muscle cramps. Although they were originally used in Turkey, the began to be used mecially in the UK in the late 1500s and spread to the rest of the Western world in the next two cen-

turies. All horse chestnut products are poisonous if eaten raw, but prepared medications from horse chestnut are useful as a blood thinner. The approved uses of horse chestnut today include the treatment of varicose veins and other circulatory conditions that result in

Nccih.nih.gov

Dosing

edema.

Mechanism of Action A chemical called aescin in horse chestnut promotes the contraction of venous smooth muscle, reducing the porosity that typically leads to edema. It also reduces the release of inflammatory mediators, which re-

duces the inflammation typical of varicose veins.

The typical recommended dose of horse chestnut is 300 mg daily, which works out to about 50 mg of the active ingredient, aescin.

Horse chestnut seed extract can be taken as a pill or a suppository. Other preparations, such as tea, are unsafe due to the toxic substance esculin present in raw horse chestnut.

Kiara Smith, pre –med student, Spring 2021

Effectiveness Studies have shown that horse chestnut is effective in treating in-

flammation and venous insufficiency. It’s use in treating varicose veins is particularly well-documented. It is often used for other conditions including infertility, IBS, and joint pain, but it’s usefulness in these conditions is not known.

Article Review In a clinical trial whose results were published in The Lancet, it was found that in the treatment of varicose veins, horse chestnut was as effective as the current recommended treatment of compression stockings1 Safety, Interactions & Side Effects Horse chestnut should never be ingested raw, as all raw parts of the plant contain the poison esculin. Effects of esculin poisoning include stomach and kidney disturbances, weakness, paral-

ysis, and death.

Other possible side effects include allergic reactions to eiAmazon.com

ther horse chestnut itself or to pollen found on the flowers used to

References

prepare horse chestnut products. Rarely horse chestnut use can cause headaches, nausea, or muscle spasms. The effects of horse

1.

chestnut in pregnant women are not known, so it should be avoided in those populations.

Horse chestnut lowers blood sugar and decreases blood clotting, so it is not recommended for patients taking medication for diabe-

2.

tes or for patients taking anticoagulants or anticipating surgery Professional Opinion

3.

Horse chestnut, when safely prepared, is an effective treatment for chronic venous insufficiency. Some evidence suggests that it may be useful in treating male infertility2, but more research is needed to support this use. (K Smith)

4.

Diehm, C et al. Comparison of leg compression stocking and oral horsechestnut seed extract therapy in patients with chronic venous insufficiency. The Lancet,. 3 February 1996; Volume 347, Issue 8997.

Fang Y, Zhao L, Yan F, Xia X, Xu D, Cui X. Escin improves sperm quality in male patients with varicoceleassociated infertility. Phytomedicine.

2010;17(3-4):192-196. doi:10.1016/j.phymed.2009.07.014 “Horse Chestnut”. National Center for Complementary and Alternative Health..

May 2006.

Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2012;11(11):CD003230. Published 2012 Nov 14.

DOSAGE FORMS

USES Melatonin is mainly used to treat sleeping disorders such as insomnia, but also has shown positive outcomes regarding sleep-onset latency for autism spectrum disorder, shift workers and jet lag.

There is less evidence supporting the use of melatonin for a wide variety of other health issues such as atopic dermatitis, bone density, cardiovascular conditions, IBS, infections, multiple sclerosis, various reproductive problems, tardive dyskinesia and tinnitus.

HOW

it WORKS

Melatonin levels have found to be decreased in those with insomnia. Therefore, supplemental melatonin has been throughly studied because of its link to circadian rhythm. Taking it at a certain time of day can produce different effects. For instance, taking it in the morning can delay the circadian rhythm and the onset of evening fatigue whereas taking it in the evening does the opposite- it induces the circadian rhythm and onset of sleep.

Oral (tablets, capsules, gummies, liquid drops)

DOSING Insomnia: 3-5 mg daily in the evening for 4 weeks.

Jet Lag: 0.5-2 mg daily before flight or 5 mg after flight for up to 4 days.

Aubrey Stolte, Student Pharmacist Spring 2021

Melatonin M E L A T O N I N

Scientific Names: Circadin, MEL, MLT

HISTORY Melatonin was first isolated from beef pineal glands by Aaron B. Lerner in 1958 and early animal studies demonstrated its role in mammalian functions.

Studies also began to show that melatonin production is controlled by changes in the day-night cycle via the pineal gland. In the 1990s, research was done to prove its use for easing insomnia, combating jet lag, preventing pregnancy, serving as an antioxidant, boosting the immune system, preventing cancer and ultimately extending life.

Pictured below: Common melatonin products

EVIDENCE Current pharmaceutical treatments can be used to treat sleep disorders but come with a wide variety of adverse effects. Therefore, supplemental melatonin is being studied because of its limited side effects and low potential for dependence. It has been shown to be effective in improving insomnia, sleep breathing disorders, excessive daytime sleepiness, circadian rhythm sleep-wake disorders and parasomnias without causing addiction or significant adverse effects.

More large-scale research is needed to support long-term use.

professional

OPINION

Among all remedies for sleep disorders, supplemental melatonin appears to be a promising solution, at least short-term. There is little to no harm in trying it as its benefits are likely to outweigh its risks. Although more evidence is needed for true recommendation, it is worth trying for a short duration. Seek other treatment if further intervention is needed.

A. Stolte

Information I N F O R M A T I O N

TOXICITY

SAFETY & EFFECTIVENESS

At typical and high doses, no studies have proven any major toxicities with supplemental melatonin.

There is not enough strong evidence to recommend the use of supplemental melatonin for chronic insomnia. Shortterm use of melatonin appears to be safe for the majority of people, but more research needs to be done to prove the long-term safety of its supplementation.

FOOD/DRUG INTERACTIONS

There are many interactions including alcohol, tobacco, and a variety of medications. Contact your pharmacist for further details.

ADVERSE EFFECTS

Minor adverse effects have been reported such as headache, short-term depression, involuntary urination, dizziness, nausea, stomach cramps, irritability, insomnia, nightmares, hypothermia and daytime sleepiness.

REFERENCES Melatonin. Natural Products Database. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 28, 2021. http://online.factsandcomparisons.com National Center for Complementary and Integrative Health. Melatonin: What You Need To Know. Accessed February 14, 2021. https://www.nccih.nih.gov/health/melatoninwhatyou-need-to-know.

Xie Z, Chen F, Li WA, et al. A review of sleep disorders and melatonin. Neurol Res. 2017;39(6):559-565. doi:10.1080/01616412.2017.1315864

Bill Steve Tchachito, Student pharmacist Spring 2021 https://www.medicinenet.com/omega-3_fatty_acids/article.htm

Omega 3 fatty acids, docosahexaenoic acid (DHA), Eicosatetraenoic acid (EPA) Common names of omega 3 Dialyvite Omega-3 Concentrate [OTC]; Fish Oil Concentrate [OTC]; Lovaza; Maximum Red Krill [OTC]; Ocean Blue MiniCaps Omega-3 [OTC]; Odorless Coated Fish Oil [OTC]; Omega Power [OTC]; Omega-3 2100 [OTC]; Omega-3 Fish Oil Ex St [OTC]; Omega-3 IQ [OTC] [DSC]; Pro Nutrients Omega 3 [OTC]; Salmon Oil-1000 [OTC] [DSC]; Sam-E.P.A. [OTC]; Sea-Omega [OTC]; Triklo [DSC Background/history The advent of essential fatty acids can be credited to George and Mildred Burr during their work on the attic plant. Their research paper published lead to the discovery of the omega 6 use for the skin, but the exact mechanism was still unknown.

Several decades later many other researchers tried to figure out the different application of those essentials amino acids, but it was until 1980 that omega 3 were known to be used for neurocognitive health and cardiovascular health.

Purported uses The labeled use of omega 3 are: A dietary supplement that is recommended by the American heart association for everyone whether you are documented with coronary heart disease or not.

It also uses as an adjunct to reduce triglyceride in an adult with severe Hypertriglyceridemia some off-label use of omega 3 can be associated with the treatment of IgA nephropathy by slowing the progression of renal loss.

Pharmacology and mechanism of action Omega 3 play multiple roles within the body.

Anti-inflammatory These essential fatty acids promote the anti-inflammatory response in many different aspects of the cell whether is by promoting the production of resolvins and protectins using the COX and LOX pathways. The production of those molecules prevents the infiltration of neutrophils to the site of inflammation. Some variety of resolvins (D1) inhibit the production of IL-1b and protectins inhibit the production of TNF-a and IL-1b which are essentials cytokine for the inflammatory response.

Also, omega 3 inhibits the endotoxins stimulating proteins of IL-6,8, inhibit the production of prostaglandins which is an inflammatory mediator.

Help in the cardiovascular regulation It can be used to reduce, hypertriglyceridemia and to prevent cardiovascular events. Omega 3 decreases the production of the bad cholesterol LDL and at the same time by decreasing the production of arachidonic acid, they reduce the production of thromboxane A. TXA2 promotes the production of aggregation factors leading to a blood clot. By decreasing the production of TXA2 they reduce the risk of cardiovascular events.

Available dosage form Capsules: available over the counter in the dietary part of pharmacy or marketplace.

We can also have it our diet: from product such as fish mackerel, salmon or from nuts such as chia seed, walnuts, soybeans.

Typical serving: is one to three capsule of 1000 mg a day with a maximum amount of 4000 mg a day https://www.jacc.org/doi/abs/10.1016/j.jacc.2020.11.060

Effectiveness: many studies have suggested that the increasing consumption of seed, fish like the one cited earlier was more beneficial for main men which are more prone to a heart attack. Omega 3 plays another important role in the humans body besides inflammation and cardiovascular disease. Other studies suggested that omega 3 plays an important role in

stabilizing membrane cells by decreasing cholesterol oxidation. So consuming a specific amount of omega 3 could be beneficial for us in multiple ways.

Adverse effects: These adverse effects can be observed with omega 3 Cardiovascular: Atrial fibrillation, atrial flutter Gastrointestinal: Dysgeusia (4%), dyspepsia (3%), eructation (4%) Dermatologic: Pruritus, skin rash Endocrine & metabolic: Increased LDL cholesterol Gastrointestinal: Constipation, vomiting Hepatic: Increased serum alanine aminotransferase, increased serum aspartate aminotransferase

Food/drug interactions: Taking omega 3 supplement and antiplatelet such agents such as P2Y12 inhibitors, NSAIDs, SSRIs May enhance the activity of those antiplatelet. In the same way taking omega 3 with anticoagulant could be bad because of the property of omega 3 as inhibitor of platelet formation. Some of those antiplatelet are: • Aspirin • Cilostazole • Clopidogrel • Vorapaxar

Dermatologic: Urticaria Hematologic & oncologic: Bleeding tendency disorder Hypersensitivity: Anaphylaxis Safety: Although many drugs have side effects, studies showed that omega 3 is safe to use by everyone even for pregnant women.

On the other hand, people differ in multiple ways if you experience any of the following symptoms rash, stomach upset, itching, or any other signs of allergy, you need to contact your doctor.

Toxicity: Bleeding, allergy or sensitivity to fish or shellfish Summary Polyunsaturated fatty acids play an important role in the human diet. People with no history of ASCD can have up to 2 recommended fatty fish a week to have enough amount of omega 3. Some other people can compensate that amount with a fish oil capsule. The use of those omega 3 is for the treatment of hypertriglyceridemia and the prevention of cardiovascular events.

Professional opinion: Since the level of adverse reaction with omega 3 is low, I will recommend either increasing the consumption of seed or fish or taking the capsule omega 3 to have enough of those essential fatty acids. My best suggestion is not to abuse and stay within the recommended daily dose which is 4g. also avoid combining any anticoagulant with fish oil omega 3. “~ B. Tchachito Reference 26, T. (2019, December 26). The omegas: A long, scaly tale, still growing. Retrieved March 07, 2021, from https://www.naturalproductsinsider.com/lipids/omegas-long-scaly-talestill-growing Calder, P. (2012, January 25). Mechanisms of action of (n-3) fatty acids. Retrieved March 07, 2021, from https://academic.oup.com/jn/article/142/3/592S/4630968 Calder, P. (2013, March). Omega-3 polyunsaturated fatty acids and inflammatory processes: Nutrition or pharmacology? Retrieved March 07, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575932/ Weinberg, R., Brook, R., Rubenfire, M., & Eagle, K. (2021, February 01). Cardiovascular impact of nutritional supplementation with omega-3 fatty Acids: JACC FOCUS SEMINAR. Retrieved March 07, 2021, from

https://www.sciencedirect.com/science/article/abs/pii/S0735109720380037

Probiotics/Prebiotics Sarah Wagner; Student Pharmacist; Spring 2021 Dietary Supplement

Common OTC Product Names of Probiotics: with Active Ingredient 2,3,8

(1)

Background/History: Elie Metchnikoff noticed that farmers who consumed fermented dairy products regularly, were living longer. He thought the lactobacilli were protecting them from the GI metabolism that contributes to aging. E. Metchnikoff thought that bacteria could improve health. Hence, here we are today!1,5

(2)

Photograph obtained from Reference #9

(3) 1. Florajen: Lactobacillus Acidophilus, Bifidobacterium lactis 3 2. Culturelle: Lactobacillus Rhamnoses 2 3. Nature’s Bounty Probiotic: Lactobacillus Acidophilus 8

Dosage forms: • Tablet 4 •

Capsule 4

•

Powder 4

Typical Dosing: 1 (one) capsule by mouth with or without food (according to Florajen, Culturelle and Nature’s Bounty Websites). 2,3,8

Purported Uses: The indicated use of Probiotics is to promote normal bacterial flora of the intestinal tract.

Also used while taking antibiotics to help restore normal gut flora. 4

Off-Label Uses: According to Facts and Comparisons, some off-label uses that are not directly indicated for Probiotics are for the following conditions: GI issues and urogenital infections. 4

Pharmacology/Mechanism of Action: According to Facts and Comparisons, the mechanism of action of Lactobacillus is to subdue the development of pathogenic microorganisms by producing lactic acid which helps to reform the normal intestinal flora (usually acidic in GI). 4

Effectiveness: According to the article, “A Meta-Analysis of Probiotic Efficacy for Gastrointestinal Disease” The efficacy of probiotics varies within individual’s disease states and which strain the patient needs most. Overall, probiotics are generally effective at treating symptoms/ prevention of gastrointestinal diseases. 6

Analysis of “Safety Assessment of Probiotics for Human Use.”: The safety assessment of probiotics for human use is promising. Probiotics are relatively safe. When multiple types of toxicity tests are performed, none of them indicate any severe toxicity in humans. My conclusion for this is that it proves to me that a patient would have to take a very, very large dose in order to get severe, adverse, life threatening effects.

Safety concern of probiotics?

The FDA does not strictly regulate probiotics since it is a dietary supplement.

Having said this, there are not many safety concerns about probiotics. There are very few, if any contraindications (the only one for lactobacillus: don’t use if have milk protein sensitivity). Use in caution with children, pregnant people, and immunocompromised patients. 4

Article Review: I believe that probiotics are beneficial when taking antibiotics to help restore the normal gut flora. I would recommend this use for any person taking antibiotics. Having said this, I feel as though there is not enough research for long term use. While I don’t think that long term use would harm the patient, I believe that it will be hard to discontinue taking probiotics. ~SWagner

Adverse/Side effects: According to Facts and Comparisons: Constipation, flatulence, GI bloating, and increased thirst are the most common adverse effects. 4

Toxicities: According “Safety Assessment of Probiotic for Human Use,” “It has proved difficult to establish infection after oral administration of probiotic bacteria, even when tested at doses 10,000 times higher than those normally consumed by humans” 7

Interactions: For Lactobacillus there are no known drug or food interactions according to Facts and Comparisons. 4

References:

1.

A;, Gasbarrini G;Bonvicini F;Gramenzi. “Probiotics History.” Journal of Clinical Gastroenterology, U.S. National Library of Medicine, Nov. 2016, pubmed.ncbi.nlm.nih.gov/27741152/.

2.

“Culturelle® Digestive Daily Probiotic Capsules.” Digestive Health Daily Probiotic Capsule | Culturelle®, www.culturelle.com/products/adult/digestive-healthprobiotic-capsules.

“Florajen Digestion Probiotics for Adults: Florajen Probiotics.” Florajen High Potency Probiotics, 27 Aug. 2020, www.florajen.com/products/florajendigestion.

3.

4.

Mackowiak, Philip A. “Recycling Metchnikoff: Probiotics, the Intestinal Microbiome and the Quest for Long Life.” Frontiers in Public Health, Frontiers Media S.A., 13 Nov. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3859987/.

5.

Probiotics. Drug Facts and Comparisons eAnswers. Accessed March 1,2021 https://fco-factsandcomparisonscom.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/fc_dfc/5548349?cesid= a3ay3HO0L40&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dprobiotics% 26t%3Dname%26va%3Dprobiotics%26nq%3Dtrue

6.

Ritchie, Marina L, and Tamara N Romanuk. “A Meta-Analysis of Probiotic Efficacy for Gastrointestinal Diseases.” PloS One, Public Library of Science, 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3329544/.

7.

Sanders, Mary Ellen, et al. “Safety Assessment of Probiotics for Human Use.” Gut Microbes, Landes Bioscience, 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC3023597/.

8.

Speranza, et al. “Acidophilus Probiotic.” Nature's Bounty, 8 Oct. 2017, www.naturesbounty.com/our-products/specialty/dietsupplements/acidophilus-probiotic-100-tablets/.

9.

Mary Ellen Sanders Mary Ellen Sanders is a consultant in the area of probiotic microbiology. “Scientists Re-Classify the Lactobacillus Genus into 25 Genera.”

Gut Microbiota for Health, 4 May 2020, www.gutmicrobiotaforhealth.com/scientists-re-classify-the-lactobacillus-genusinto-25-genera-including-groups-of-closely-related-species/.

Sarah Tucker - Student Pharmacist Spring 2021

SAMe S-adenosylmethionine Common names: SAM, ademetionine, AdoMet

https://images.app.goo.gl/owPRWRagCR3kuyqr5

https://images.app.goo.gl/3R7DdczyMTpXJcRS9

Background and History SAMe (S-adenosylmethionine) is a naturally occurring molecule present in all cells in your body.

People with depression have been found to have lower levels of SAMe than people without depression. Decreased levels of SAMe have also been documented in people with chronic joint pain and liver disease. Formulations of SAMe have been prescribed to people in Europe since the 1970’s.

Available dosage forms Tablets Capsules Liquid

Typical dosage ranges Depression: 200-1200mg/day (sometimes 400mg QID) Pain Control: 200-400mg two-three times daily

Common Uses SAMe is thought to be helpful in depression, chronic pain disorders like osteoarthritis and fibromyalgia, liver disease, among other indications. The indication with the most clinical data supporting its benefit is in depression. SAMe is available as a prescription drug used to treat depression and arthritis in Europe, though it is still only considered a dietary supplement in the United States.

Pharmacology The effect of SAMe is thought to come from increase the natural levels of the molecule in the body. This is why it has been studied in diseases that are found to typically exhibit lower levels of SAMe. Endogenously, more than 85% of SAMe is produced in the liver, which is why it is thought that SAMe may help with some of the symptoms of liver dysfunction.

Safety and Side effects Reported side effects of SAMe are minor. They include • • • • •

Nausea Dizziness Mild insomnia Diarrhea Constipation

Long term use of SAMe has not been studied, but a 2 year study in patients with liver disease did not report any major side effects.

Non-toxic SAM-e has not been found to have any toxic effects even at high doses.

Contraindications The only contraindication to SAMe is as monotherapy in bipolar disorder, as it can promote a switch to mania.

Personal Recommendation SAMe appears to be safe to use and has shown some benefit in trials evaluating its use in depression. While its use for chronic pain and liver health are uncertain, it does not appear to have any negative effects. It is not known to interact with many foods or prescription medications. Patients with more serious depression should seek help from a medical professional to get their symptoms under control. This medication can be considered for patients who are looking for a complementary approachǤ ̵ Ǥ References: SAMe. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. http://online.lexi.comǤ S-Adenosylmethionine. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.comǤ National Institutes of Health. S-Adenosyl-L-Methionine (SAMe). https://www.nccih.nih.gov/health/sadenosyllmethionine-same-indepthǤ

Saw Palmetto (Serenoa repens)

https://www.google.com/url?sa=i&url=https%3A%2F%2Fobserver .com%2F2016%2F09%2Fis-saw-palmetto-an-alternativetreatment-for-enlargedprostate%2F&psig=AOvVaw1AyaT4OvZKBNiF9gQVO5qa&ust=161 4976361455000&source=images&cd=vfe&ved=0CAIQjRxqFwoTC OCrv4K-l-8CFQAAAAAdAAAAABAD

Purported Uses: Traditionally, Saw palmetto was supposedly used as a diuretic, sedative, sleep aid, expectorant, cough suppressant, to prevent baldness, and as an aid to lactation/fertility/indigestion/urin ary issues. Now, it is most commonly used for treatment of Benign Prostatic Hyperplasia (BPH). Less common uses include chronic pelvic pain, migraine, and hair loss.

Nolan Walton Student Pharmacist Spring 2021

dihydrotestosterone (a stronger androgen). This mechanism has been proven in-vivo, but has yet to be proven in human studies.

Dosage Forms: Saw palmetto is available as tablets, capsules, liquid extracts, or even as a herbal tea.

Also known as: cabbage palm, American Dwarf palm, scrub palm History: Saw palmetto is derived from the fruit of the saw palmetto tree (Serenoa repens). The fruit is very sweet smelling and dark brown to black in color. The fruit has commonly been used as a source of food for Native American tribes, as well as animals like deer and bears. The fruit was also used as a natural remedy by tribal healers.

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.resear chgate.net%2Ffigure%2FStructure-and-mechanism-of-action-offinasteride-a-5-alpha-reductase-inhibitorreduces_fig1_333823673&psig=AOvVaw1AdsSJPitf4m3rRHCi7VrW&us t=1614997746659000&source=images&cd=vfe&ved=0CAIQjRxqFwoT CLj418qNmO8CFQAAAAAdAAAAABAD

Mechanism: The mechanism of action is not fully understood. It is theorized that the active components of saw palmetto act to inhibit 5a-reductase, which will prevent the conversion from testosterone to 5-

https://www.iherb.com/pr/Nature-s-Answer-Saw-Palmetto-ExtractAlcohol-Free-1-200-mg-1-fl-oz-30ml/5209?gclid=CjwKCAiAp4KCBhB6EiwAxRxbpEAVYsgtAJDMNvzkpP7Z5mzCxVkzlF20R_YTIgKXxwmttZTQM5TgBoCdBQQAvD_BwE&gcl src=aw.ds

Dosing: Usually dosed at 320 mg of saw palmetto extract once a day.

Nolan Walton Student Pharmacist Spring 2021

Effectiveness: Saw palmetto’s use for treatment of BPH has not been unanimously determined. The majority of studies have claimed that saw palmetto is not very effective for the treatment of BPH and is no more effective than a placebo, including two high quality studies funded by the National Institute of Health (NIH). However, a handful of studies have claimed that saw palmetto “provided significant improvements in peak urinary flow and prostate symptoms”. There is very little evidence for effectiveness of saw palmetto outside of BPH. Overall, this compound is not proven to be effective.

Safety: Not much research has gone into the safety of saw palmetto. It is known to be fairly well tolerated and has very few interactions. However, saw palmetto may be unsafe for use during pregnancy or lactation.

Adverse Effects: Saw palmetto is well tolerated in most patients. Common side effects are mild, and may include headache, dizziness, nausea, vomiting, constipation, and diarrhea.

Toxicities: Information about toxicities is very limited. It seems that saw palmetto can, in very rare cases, cause acute pancreatitis and cause hepatotoxicity from prolonged use or overuse.

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.istockph oto.com%2Fillustrations%2Fliverdisease&psig=AOvVaw1R2cddMYG9M0JeYQgpyWP&ust=1614995827761000&source=images&cd=vfe&ved=0CAIQjRxqFwo TCLji_bmGmO8CFQAAAAAdAAAAABAD

Food/Drug Interactions: Saw palmetto does not induce/inhibit the CYP450 system, and doesn’t interact with many drugs or herbal products.

However, saw palmetto also has anticoagulant activity, so should not be used alongside anticoagulants (like warfarin) or in patients with heart failure. Administration is also not recommended in

pregnant/lactating women or in pediatric patients.

Article Summary: The majority of studies seem to show that saw palmetto is ineffective. However, one study done in China found that saw palmetto caused significant improvements in urinary flow and prostate symptoms through a randomized, double-blind placebocontrolled trial. In the study, a standard dose of 320 mg/day was used, and found that benefits were seen in as little as 2 weeks.

Professional Opinion: Personally, I would not recommend the use of saw palmetto due to the poor evidence of effectiveness. However, I believe that there are not too many negatives to taking the product, since there are only a few interactions and very mild side effects. ---N Walton.

References:

LiverTox: Clinical and Research Information on DrugInduced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Saw Palmetto. [Updated 2020 Apr 2]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548378 / Saw palmetto. Drug Facts and Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 2, 2021. http://online.factsandcomparisons.com “Saw Palmetto.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, www.nccih.nih.gov/health/saw-palmetto.

Audrey Whitnah Pharmacy Student Spring 2021

St. John’s Wort: Hypericum Perforatum Introduction St. John’s wort, also known as hypericum, Klamath weed, or goat weed, is a wild plant with yellow flowers that has been used for centuries dating back to ancient Greece. Its extract is said to have been used to heal wounds including those of the Knights Hospitaller, the Order of St. John.

Widely prescribed in Europe, it blooms in the summer around the time of Saint John’s Feast natively in Europe, Asia, and North Africa. It is an invasive species to North America.

Its most popular purported uses were in treating mild to moderate depression, insomnia, and kidney and lung ailments.

Today, St. John’s Wort is still used to treat depression along with menopause symptoms, attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and somatic symptom disorder.

https://bit.ly/3xcwTyn

Pharmacology St. John’s Wort has been thought to work in similar ways to prescribed antidepressants. Its mechanism of action is still not entirely understood; however, it has been observed to inhibit the synaptic uptake of serotonin, dopamine, and norepinephrine, increasing their availability. When given to rats, there appeared to be a downregulation of beta-adrenergic receptors with an upregulation of serotonin 5-HT receptor. https://bit.ly/3vcvVA6

Dosing This plant is available in capsules, tablets, lotions, tinctures, and dried herb that can be made into a tea.

The typical dosing of St. John’s Wort is between 300mg to 1200mg a day. This is often divided to be taken in multiple doses throughout the day. The effects of the herb may not be felt for 3-6 weeks.

Effectiveness A number of studies from the NCCIH (National Center for Complementary and Integrative Health) and NIMH (National Institute of Mental Health) have found St. John’s wort to be minimally effective. One in 2011 compared it to citalopram, a standard antidepressant, and placebo in patients with minor depression and found it was unable to perform better at decreasing symptoms.

A similar sentiment was shared with a study in 2002. Patients with major depression found St. John’s wort and a placebo to be equally effective. https://bit.ly/3x8owE1

Safety This herb is known to have dangerous interactions with a number of medications and conditions, so it is important to speak with your doctor before use. St. John’s wort is able to weaken other antidepressants, oral birth control, cyclosporine, Warfarin, some cancer, heart, statins, and HIV medications, and more. Do not take this product with others that increase serotonin in the body. St. John’s wort appears to be safe and effective when taken properly but should not be used to treat severe depression.

Adverse Effects • Mild upset stomach • Hives/rash • Fatigue • Headache • Dizziness • Sun-sensitivity This herb has no significant interactions with food but avoid alcohol while using. https://bit.ly/3n7Dq8R

Conclusion After research and seeing the results of a number of studies, I believe that St. John’s wort is minimally effective. Multiple studies found the herb to be slightly better if not just as effective as a placebo at treating depression ranging from mild to moderate. Although it has been used for centuries since ancient times for a multitude of ailments, there is little to no understanding of how the herb works or evidence that it has much of an impact on the mind and body except in effecting other medications one may be taking. In my opinion, mild to moderate treatment of depression should not be left to St. John’s wort, especially if a patient is taking other medications. ~A Whitnah References Butterweck V. Mechanism of action of St John's wort in depression: what is known? PubMed. Accessed March 8, 2021.

St. John's Wort, Hypericum perforatum oral dosage forms. Cleveland Clinic. Accessed March 6, 2021.

St. John’s Wort. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 6, 2021.

St. John's wort. Mount Sinai Health System. Accessed March 7, 2021.

St. John's Wort. National Center for Complementary and Integrative Health. Accessed March 7, 2021.

Turmeric Scientific name: Curcuma longa Common Names: Turmeric, Curcumin

2018

History: Curcuma longa is a perennial herb. It is a plant that grows extensively in India, China, and other Asian countries with a tropical climate. The rhizome is the portion of the plant used medicinally. When it is boiled, cleaned, and dried, it yields a yellow powder. This is the source of the spice turmeric, which gives curry powder it’s yellow color. It has a long history in the Chinese and Ayurvedic systems of medicine being used as an anti-inflammatory agent to treat flatulence, jaundice, menstrual difficulties, and hematuria. It can also be applied topically to relive pain and inflammation. Current research has focused on turmeric’s antioxidant, hepatoprotective, antiinflammatory, anti-carcinogenic, antimicrobial, and antidepressant properties.

Uses: antioxidant, anti-inflammatory, antidepressant, and antithrombotic agent to treat cancer, arthritis, and atherosclerosis

https://health.clevelandclinic.org/7tips-for-taking-turmeric-infographic/

Mechanism of Action: Curcumin, the active ingredient in turmeric inhibits the NF-KB, MAPK, and JAK pathways. These pathways all induce transcription of proinflammatory agents like the COX-2 gene.

Dosage Forms: capsule, fluid extract, infusion, powder, tea Usual Doses: Capsule: 0.5-1 gram twice daily Fluid extract: 10-30 mL three time daily Infusion: 15 mL daily of 15 g in 500 mL water Powder: 1.5-3 grams daily Tea: 4.5-9 grams daily

SPRING 2021 Hannah Zambrano Student Pharmacist

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Safety: Turmeric should not be used in pregnancy or lactation because safety has not been studied. It also should not be used in patients with gall bladder obstructions, gall stones, hyperacidity, obstruction of bile passages, or stomach ulcers

Case Study: In a randomized, placebo controlled study, researchers found that 500-1000 mg/day of curcumin as adjunct therapy significantly improved depression symptoms in patients with major depressive disorder.

“My professional opinion is that turmeric can be used safely to treat many diseases and symptoms, but patients should notify their health care professionals if they decide to use turmeric because it has possible side effects and several drug interactions.” –H Zambrano

Effectiveness: Few placebo randomized, controlled trials have studied the efficacy of curcumin in treatment of inflammatory conditions. However, there is some evidence demonstrating that curcumin is more effective than placebo in treating conditions such as depression, rheumatoid arthritis, ulcerative colitis, and premenstrual syndrome.

Toxicities: At high doses, curcumin can cause diarrhea, headache, rash, and yellow stool. One person reported an abnormal heart rhythm following a high dose of turmeric.

Interactions: Food: There are no known food interactions Drug: • Anticoagulants • Antiplatelets • Heparins • Antithrombotics • Drugs metabolized by CYP 3A4

Side Effects: • skin sensitization problems • bitter taste • gallbladder contractions

http://cdn.shopify.com/s/files/1/0148/3636/7424/products/TURM_Bo ttleMockup_With_Ingredients_1200x630.jpg?v=1601576249

References: Jane Higdon, Victoria Drake, Barbara Delage, and Lynne Howells. Curcumin.

Oregon State University. https://lpi.oregonstate.edu/mic/dietaryfactors/phytochemicals/curcumin Kanchanatawan B, Tangwongchai S, Sughondhabhirom A, et al. Add on Treatment with Curcumin Has Antidepressive Effects in Thai Patients with Major Depression. Neurotox Res. 2018:33(3)621-633.

Turmeric. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://micromedexsolutions.com. Accessed March 10, 2021.

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PHRM 489000 / SPRING2021 Student Pharmacist LIN ZHAO

VALERIAN Scientific Name: Valeriana officinalis

Common Name: Cat’s love/valerian, garden heliotrope/valerian, Kesso root, St. George’s root

BACKGROUND Valerian is a perennial plant native to Europe and Asian, but naturalized in North America. There are 250 species of this plant with Valeriana officinalis being the most used species in Europe and the US. Historically, the plant was used as a medicinal herb by ancient Greek and Rome – even described by Hippocrates!

PURPORTED USES/MOA During the 2nd century, Valerian was prescribed for insomnia, and in the 16th century was used for nervousness, trembling, headaches, heart palpitations, and as a perfume.

DOSAGE FORMS Oral extracts or oils, oral infusions (tea), oral tinctures, oral tablets, root powder capsules

Left: https://theherbalacademy.com/getting-toknow-the-valerian-plant/ https://www.siskiyouseeds.com/products/valerian

It was then seen as a stimulant during the 19th century, and further used to relieve stress from air raids during WWII. Though there isn’t sufficient scientific evidence, Valerian has been also used for GI spasms/distress, epileptic seizures, and ADHD. Today, it’s being used for insomnia.

Valerian works by increasing or potentiating the binding of GABA to GABA-A receptors. Receptor activation then leads to an influx of chloride – resulting in hyperpolarization and is now less responsive to excitatory postsynaptic potentials.

Typical dosing for insomnia: 400 – 600 mg of valerian extract taken 1 hour before bedtime for 2 – 4 weeks* *in clinical trials evaluating Valerian in insomnia - Lexicomp

VALERIAN

SAFETY/SIDE EFFECTS Generally, clinical studies have found that valerian has a wide margin of safety, and is devoid of adverse effects – at least it is associated with fewer adverse reactions than positive control drugs such as diazepam. It has also been associated with headaches, diarrhea, pruritus and dizziness, but hangovers were seldom reported in clinical trials. https://bareorganics.com/valerianliquid-drops

TOXICITY/EFFECTIVITY One concern stemmed from valepotriates or valerian extract being mutageninc in an assay. However, valepotriates exhibit poor bioavailability, which in turn contributes little to its toxicity and efficacy. It’s also been found that baldrinal compounds, metabolites of valepotriates, are higher in vivo than in vitro from being readily absorbed.

These same metabolites have been found in commerical preparations.

No teratogenicity or overt toxicity for baldrinal compounds have been found in 2 different studies with rodents. On the other hand, mice experienced ataxia, muscle relaxation, and hypothermia from doses more than 1 g/kg by oral and intraperitoneal routes.

No evidence of hepatitis was observed with oral valerian at average doses of 2.5 g/day for 4 years. Because dosages varied in studies, it’s not clear what dose is most effective or for how long for a particular dose.

REFERENCES 1)

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Bent S, Padula A, Moore D, Patterson M, Mehling W. Valerian for sleep: a systematic review and meta-analysis.

Am J Med. 2006; 119(12): 1005-1012. doi:10.1016/j.amjmed.2006.02.026 Block KI, Gyllenhaal C, Mead MN. Safety and efficacy of herbal sedatives in cancer care. Integr Cancer Ther.

2004 Jun; 3(2): 128-148. doi: 10.1177/1534735404265003 Leathwood PD, Chauffard F, Heck E, Munoz-Box R. Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man.

Pharmacol Biochem Behav. 1982; 17(1): 65-71. doi:10.1016/00913057(82)90264-7

FOOD/DRUG INTERACTIONS For the most part, valerian may interact with substances or medications involved as CNS depressants. For example, valerian may enhance CNS depressant effects in alcohol, cannabis, opioid analgesics or zolpidem.

A patient experienced mild symptoms that resolved within 24 hours after overdosing 20 times the recommended dose. Farmers growing the herb were also evaluated for adverse reactions, but few notable effects were observed.

Notably, hepatotoxity associated with valerian was first reported in 1989 of which six cases have been reported in women that all improved or normalized over 1 to 19 months after valerian discontinuation.

IN CANCER CARE One study looked into the safety and efficacy of herbal sedatives in cancer among various herbal options. This is because insomnia poses as a multifactorial health concern that affects around 1/3 cancer patients with many sufferers not consulting pharmaceutical options for relief.

It was found that valerian shown moderate evidence for safe use in cancer patients. More importantly, the herb was evidenced to also be moderately effective in treating insomnia.2

PERSONAL OPINION Valerian is a good option for those preferring natural remedies or exhibit conditions where many side effects may not be tolerated given its relatively safe profile. – LZ (Lin Zhao)