Dietary Supplements Guide Spring 2022 by ckohknox

Dietary Supplements Guide Spring 2022

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Created by the students in PHPR 48900 Complementary and Alternative Medicine, Purdue University and PHCG 329 Herbal Dietary Supplements & Alternative Therapies, University of Mississippi This assignment for both courses is comprised of individual topic monographs, peer review of monographs, and submission of final draft after receiving feedback from peers. Compiled by Cynthia P. Koh-Knox, PharmD, RPh Clinical Associate Professor, Pharmacy Practice, Purdue University David Colby, PharmD, PhD Associate Professor, Medicinal Chemistry, University of Mississippi

First day of class ABCs (PHPR 48900)

Last day of class ABCs (PHPR 48900)

Topic (Author, University)

Dietary supplements guide

Page

Alfalfa (Chadwick Cabanero , University of Mississippi School of Pharmacy) .................................................... 5 Aloe vera (Connor Dowling , University of Mississippi School of Pharmacy) ..................................................... 7 Apple cider vinegar (Gabriela Gmyrek, Purdue College of Pharmacy/BSPS) ...................................................... 9 Ashwagandha (Alaina Albrecht, Purdue College of Pharmacy) ........................................................................ 11 Asian ginseng (Alina Arzumanian, Purdue Health and Human Sciences – Nursing) ......................................... 13 Bitter melon (Madison Everhart , University of Mississippi School of Pharmacy) ............................................ 15 Bitter orange (Olivia Fairley , University of Mississippi School of Pharmacy/BSPS) ......................................... 17 Black cohosh (Claudia Chiang, Purdue College of Pharmacy) ........................................................................... 19 Bladderwrack (Julie Doan, Purdue College of Pharmacy) ................................................................................. 21 Blessed thistle (Boyang Dong, Purdue College of Pharmacy) ........................................................................... 23 Blueberry (Pearl Feng, Purdue College of Pharmacy) ....................................................................................... 25 Boron (Abigail Gick, Purdue College of Pharmacy) ........................................................................................... 27 Boswelia (Taylor Gannon , University of Mississippi School of Pharmacy)....................................................... 29 Calcium (Jacob Paulaskas, Purdue College of Pharmacy) ................................................................................. 31 Carnitine (Sean Graham , University of Mississippi School of Pharmacy) ........................................................ 33 Chamomile (Brianna Haas, Purdue Health and Human Sciences - Psychology/Pre-physician assistant) ......... 35 Chasteberry (Catera Hamilton, Purdue College of Pharmacy).......................................................................... 37 Chondroitin (Andrew Hess, Purdue College of Pharmacy) ............................................................................... 39 Cinnamon (Katrina Hoang, Purdue College of Pharmacy) ................................................................................ 41 Collagen (Avery Claire Jones , University of Mississippi School of Pharmacy).................................................. 43 Cranberry (Anne Hummer, Purdue College of Pharmacy) ................................................................................ 45 Curcumin (Megan Jurek, Purdue College of Science - Chemistry) .................................................................... 47 Dandelion (Michael Kelley, University of Mississippi School of Pharmacy) ...................................................... 49 Devil’s claw (Cecelia Kaiser, Purdue College of Pharmacy) ............................................................................... 51 Dong quai (Christie Kang, Purdue College of Pharmacy, BSPS candidate) ....................................................... 53 Elderberry (Garnett Meggs , University of Mississippi School of Pharmacy).................................................... 55 Evening primrose (Annie Lin, Purdue College of Pharmacy)............................................................................. 57 Fenugreek (Will Moffett , University of Mississippi School of Pharmacy) ........................................................ 59 Feverfew (Elizabeth Loper, Purdue College of Science – Chemistry/Pre-medicine) ........................................ 61 Flaxseed (Lam Nguyen , University of Mississippi School of Pharmacy) ........................................................... 63 Gamma-linolenic acid (Radhika Patel , University of Mississippi School of Pharmacy) .................................... 65 Garcinia cambogia (Kaitlyn Margraf, Purdue College of Pharmacy) ................................................................. 67 Garlic (Julianna Massa, Purdue College of Health and Human Sciences/Pre-physician assistant) ................... 69 Ginger biloba (Lauren Mikell, Purdue College of Pharmacy) ............................................................................ 71 Ginkgo biloba (Hunter Smith , University of Mississippi School of Pharmacy) ................................................. 73

Ginseng Lexi Nash, Purdue College of Pharmacy)............................................................................................. 75 Glucosamine (Macy Nemeth, Purdue College of Pharmacy) ............................................................................ 77 Goldenseal (Yi Wen Ni, Purdue College of Pharmacy) ...................................................................................... 79 Green tea (Hoa Tran , University of Mississippi School of Pharmacy) .............................................................. 81 Hawthorn (Aleksandar Pejnovic, Purdue College of Pharmacy) ....................................................................... 83 Kava kava (Mikiyala Wells , University of Mississippi School of Pharmacy) ..................................................... 85 Kelp (Kathryn Cavitt , University of Mississippi School of Pharmacy) ............................................................... 87 Krill oil(Kalin Hewett , University of Mississippi School of Pharmacy) .............................................................. 89 Lavender (Jenny Liu , University of Mississippi School of Pharmacy) ............................................................... 91 Licorice (Hien Hoang , University of Mississippi School of Pharmacy).............................................................. 93 Maca (Joy Lovell , University of Mississippi School of Pharmacy) .................................................................... 95 Magnesium (Dalton Huffman, Purdue College of Pharmacy) ........................................................................... 97 Mangosteen (Amanda Lowery , University of Mississippi School of Pharmacy) .............................................. 99 Milk thistle (Luke Nguyen , University of Mississippi School of Pharmacy) .................................................... 101 Noni (Garrett Ozborn , University of Mississippi Coll School ege of Pharmacy) ............................................. 103 Pomegranate (Hunter Swindle , University of Mississippi School of Pharmacy) ............................................ 105 Soy (Sara Green , University of Mississippi School of Pharmacy) ................................................................... 107 St. John’s wort (Emily Wood, Purdue College of Pharmacy) .......................................................................... 109 Tea tree Oil (Bao Van , University of Mississippi School of Pharmacy) ........................................................... 111 Turmeric (Hannah Berry , University of Mississippi School of Pharmacy) ...................................................... 113 Valerian (Frank Zahariadis, Purdue College of Pharmacy) .............................................................................. 115 Vitamin D (Li Xiang Yu, Purdue College of Science – Computer Graphics Technology) .................................. 117 Xocai (Blake Burnett , University of Mississippi School of Pharmacy) ............................................................ 119 Yohimbe (Leedell Tripp , University of Mississippi School of Pharmacy)........................................................ 121

Alfalfa (Medicago

sativa)

Chadwick Cabanero, Student pharmacist Spring 2022

Pharmacology/MOA ❖ Prevents cholesterol absorption in the stomach ❖ Slows the absorption of glucose into the intestines

Dosage Forms ❖ ❖ ❖ ❖ ❖ ❖

History Writings describing alfalfa was ﬁrst discovered in Southwestern Asia in what is now known as modern day Turkey in 1300 BC, however, 6000 year-old remains of the plant was discovered in Iran. Eventually, it was domesticated throughout the region to primarily provide forage and grains to cattle.

Common Uses Alfalfa is a great source of nutrition and ﬁber. It provides essential elements such as calcium, potassium, iron and vitamins A, C, E, and K. It is an herbal supplement that may beneﬁt in treating diabetes and high cholesterol.

Fresh sprouts Dried herbs Seeds Tea Powder Tablets/Capsules/Chews

Typical Dosing ❖ 5 mg-10 mg of dried herb ❖ 40 mg (hyperlipidemia)

Also Known As… ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖

Feuille de Luzerne Grand Trèfle Herbe aux Bisons Herbe à Vaches Lucerne Phyoestrogen Purple Medick Sanfoin

Effectiveness

Professional Opinion

Alfalfa has shown benefit primarily for hyperlipidemia patients by increasing HDL-C and reducing TC, TG, LDL-C, and VLDL. Some benefits in glucose, ALT, and AST were observed.

Alfalfa has been used for over 6,000 years with trusted properties. It also has an excellent safety profile with little to no harmful adverse effects. It has also shown significant benefit when used in conjunction with medications targeting hyperlipidemia and diabetes. Therefore, I believe this would be beneficial for overall nutrition and concurrent treatment. ~ C. Cabanero

Safety Unless the patient is allergic to alfalfa, this herb is generally safe to use.

Adverse Effects/Toxicities Warfarin & Anticoagulants Decreases effectiveness of these medications and is associated with an increased risk of blood clots due to significant amounts of vitamin K. Estrogen derivatives Worsen the adverse effects of certain birth control medications. NSAIDs Associated with increased bleeding when taken together. Other adverse effects: hypoglycemia

References ❖ ❖ ❖

https://medlineplus.gov/druginfo/natural/1 9.html Westgate, J. M. (1908). Alfalfa (PDF). Washington: U. S. Department of Agriculture. p. 5. Retrieved 28 July 2013. Farsani MK, Amraie E, Kavian P, Keshvari M. Effects of aqueous extract of alfalfa on hyperglycemia and dyslipidemia in alloxan-induced diabetic Wistar rats. Interv Med Appl Sci. 2016 Sep;8(3):103-108. doi: 10.1556/1646.8.2016.3.5. PMID: 28203391; PMCID: PMC5283756.

Page 1 Graphics 1. https://www.gardeningknowhow.com/edible /vegetables/alfalfa/growing-alfalfa.htm 2. https://heatherreseck.com/how-to-grow-sp routs/ 3. https://www.alfalfaspain.es/bales-of-dehydr ated-alfalfa/?lang=en Page 2 Graphics 1. https://www.hobbyfarms.com/all-hay-is-not -equal-choose-your-livestocks-carefully/ 2. https://www.coweniga.com/shop/pantry/be verages/tea/alvita_tea_bags_alfalfa_leaf_c affeine_free/p/2493106 3. https://www.herbalhills.in/ayurvedic/produ cts/green-food-supplement/alfalfa-powder -tablets-green-food-supplement/ 6

Connor Dowling, Student pharmacist Spring 2022

Aloe Vera

canva.com

Scientific name: Aloe barbadensis miller Common names: aloe, true aloe Background Aloe vera is a perennial succulent that has been used as a medication for thousands of years by many different cultures. From serving as a funerary gift to pharoahs as the "Plant of Immortality" to being cited by Greek physicians as a treatment for wounds, balding, hemorrhoids, and Step 2 ulcers. Common Uses

Dermatologic: acne, burns, wounds, radiation trauma Gastrointestinal: weight loss, diabetes, hepatits, IBD, constipation Cosmetics: shampoos, sunscreens, moisturizers Pharmacology and MOA GI effects are associated with the aloe vera latex that is rich in cathartic anthraquinones, normally known as aloin, that act as colonic-specific stimulant laxatives that induce gut motility, transit, and inhibition of water and electrolyte secretion. Dermatologic antimicrobial activity likely stems from its polysaccharide content whereas its anti-inflammatory features come from salicylates, breakdown of bradykinin via carboxypeptidases, and inhibition of histamine release. Emollient features stem from the polysaccharide glucomannan.

Dosage Forms

Juices, capsules, softgels, ointments, creams, lotions, and more!

Dosing As a laxative: once daily before bed with a max oral dose of 0.05 to 0.2 grams/day. Metabolic Syndrome: 500 mg BID x eight weeks Burns: topically every three days (gels) or twice daily for fresh aloe mucilage - https://www.puritan.com - https://www.naturessunshine.com/product/aloe-vera-leaf-juice - https://www.naturecity.com/ -https://www.walmart.com/ip/Spring-Valley-Concentrated-Aloe-Vera-Gel-Dietary-Supplement-50-count/10316845? wmlspartner=wlpa&selectedSellerId=0&wl13=6807&adid=2222222227710316845_117755028669_12420145346&wmlspartner=wmtlabs&wl0= &wl1=g&wl2=c&wl3=501107745824&wl4=pla293946777986&wl5=1026069&wl6=&wl7=&wl8=&wl9=pla&wl10=8175035&wl11=local&wl12=10316845&wl13=6807&veh=sem_LIA&gclid=CjwK CAjwopWSBhB6EiwAjxmqDfYDcQ-gWOJ8Y1JeviqoCVzK98VOp0EhAnnaNSsDpgLTMq6-h2nHQhoCWYcQAvD_BwE&gclsrc=aw.ds

Effectiveness Due to the variety of different aloe vera species, there is a difference in the effectiveness between strands; thus, some aloe vera formulations may not be as effective as an emollient but could be a potent anti-inflammatory. Also, while aloe can act as a potent laxative, it’s stimulating mechanism of action can also lead to severe gut irritation leading to abdominal pains, cramps, and bloody stool.

Safety Topical: Generally well-tolerated and safe! Laxatives: Not to be used under the age of 12, with an allergy to it, with an ileus of any kind, or with any undiagnosed abdominal pains. Reported abortificant, so avoid in pregnancies. Toxicities Step 2 Excessive laxative use can lead to severe dehydration and electrolyte imbalances, especially in prolonged use. Most common AE's include nausea, vomiting, diarrhea, abdominal cramps, and palpitations. Severe events include kidney damage, heart issues, GI hemorrhage, and fluid depletion. Bone deterioration and toxic hepatitis have also been reported. Interactions Potential hypokalemia from electrolyte imbalances could lead to digoxin toxicities. Significantly reduced blood glucose when used with Glyburide that could lead to hypoglycemia. Potentially raises risk of perioperative bleeding post-op if the anesthetic sevoflurane is used.

Professional Opinion

Topically, aloe vera is able to safely and effectively offer a myriad of benefits from burn and wound healing to cosmetic purposes. However, I would strongly discourage patients from routinely consuming aloe vera orally due to the side effects one may potentially incur. Other OTC laxatives would work just as if not more effectively without nearly the amount of side effects. ~ C. Dowling References 1. Surjushe A, Vasani R, Saple DG. Aloe vera: a short review. Indian J Dermatol. 2008;53(4):163-166. doi:10.4103/0019-5154.44785 2. Aloe Vera. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/aloe-vera. Published August 2020. Accessed March 3, 2022. 3. Aloe. Natural Products Database. Hudson, OH: Lexicomp. http://online.lexi.com/. Updated November 30, 2020. Accessed March 3, 2022. 4. Plants-Aloe. Micromedex Solutions. Greenwood Village, CO: Truven Health Analytics. http://micromedex.com/. Updated August 21, 2017. Accessed March 4, 2022. 5. Aloe uses, benefits & dosage - drugs.com herbal database. Drugs.com. https://www.drugs.com/npp/aloe.html. Published December 2021. Accessed March 4, 2022. 6. Aloe. Micromedex Solutions. Greenwood Village, CO: Truven Health Analytics. http://micromedex.com/. Updated March 2008. Accessed March 4, 2022.

DIETARY SUPPLEMENT REVIEW

Apple Cider Vinegar Gabriella Gmyrek Purdue University College of Pharmacy Student Spring 2022 Toxicity There is limited information on the toxicity of apple cider vinegar. For that reason it is important to use ACV in moderation and while monitoring potassium levels should they drop Scientific Name of Supplement too low. Malus Pumila Mill

GENERAL INFORAMTION

Common Name of Supplement Apple Cider Vinegar (ACV)

Typical Serving 1-2 tbs when liquid or up to 1000mg

Safety Concerns Skin and Throat Burns Lowered Potassium Levels

Side Effects When Taken in Large Doses:

Nausea/indigestion Tooth decay Increased gastroparesis

Available Forms Liquid

Tablet Gummies Capsules Dehydrated Powder

Interactions Apple cider vinegar, in conjunction with digoxin or insulin-stimulating medications, ACV can cause decreased potassium levels in the body. Those taking diuretics that cause potassium excretion should limit ACV uses

Purported Uses 1. Blood Pressure Stabilizer 2. Blood Sugar Control 3. Lowered Cholesterol 4. Cold/Flu Aid 5. Increased Weight Loss 6. Anti-Inflammatory Benefits 7. Improved Digestion 9 Perri O. Blumberg September 1 2021. The best apple cider vinegar supplements, according to Dietitians. Eat This Not That. https://www.eatthis.com/best-apple-cider-vinegar-supplements/. Published September 1, 2021. Accessed April 13, 2022.

HISTORY Apple cider vinegar is made in a similar fashion to regular vinegar. It is produced during the fermentation of apple cores and peels in sugar water. While the history of vinegar dates back to the Babylonians in 5000 BC, the oldest known documentation of apple

cider vinegar is with Hippocrates in 400 BC. It has been used as a traditional “cure-all” remedy in Asia, Africa, and Europe.

PHARMACOLOGY

The complete mechanism of action for apple cider vinegar is unknown. It is believed that ACV can improve digestion and act antilipidemic due to the increased acidity allowing the easier breakdown of foods and lipolysis, By delaying gastric emptying and inhibiting enzyme activity, ACV is believed to help boost digestion and decrease glucose levels. Finally, acidity is thought to create an antibacterial environment in the throat and GI tract.

EFFECTIVENESS According to research, the use of apple cider vinegar can be beneficial in reducing blood sugar spikes after meals, increasing weight loss, and acting as an inflammatory measure. There have been no results supporting blood pressure aid in humans (the research on rats found the benefits negligible). The use of ACV during cold and flu is theoretically plausible due to its antiinflammatory and antibacterial properties but has not been adequately studied. There have been no definitive reports of ACV lowering cholesterol in humans (but positive results from animal research were present). In large amounts, ACV can actually slow digestion but in standard amounts improve it.

RESULTS OF OXIDATIVE STRESS/OBESITY STUDY In 2018, a study was conducted by the University of Tunis El Manar on male Wistar rats. These rats were fed a high-fat diet and, after six weeks, were started on doses of ACV. By nine weeks, the rats showed a decrease in obesity and a decreased triglyceride, LDL, and total cholesterol levels. Moreover, the oxidative stress that developed after six weeks on the high-fat diet decreased with doses of ACV. An additional finding was that ACV increases the production of antioxidants in the body which causes a positive metabolic change.

RESOURCES

1. Hoover, Andi. “Apple Cider Vinegar Myths & Facts.” WVU Community Education Outreach Service, https://extension.wvu.edu/foodhealth/cooking/apple-cider-vinegar-myths-facts. 2.“Health Benefits of Apple Cider Vinegar and Other Common Vinegars: A Review.” Relias Media Continuing Medical Education Publishing, https://www.reliasmedia.com/articles/140790-health-benefits-of-applecider-vinegar-and-other-common-vinegars-a-review. 3. Edwin McDonald IV, MD. “Debunking the Health Benefits of Apple Cider Vinegar.” UChicago Medicine, UChicago Medicine, 23 Aug. 2018,https://www.uchicagomedicine.org/forefront/health-and-wellnessarticles/debunking-the-health-benefits-of-apple-cider-vinegar. 4. Halima BH;Sonia G;Sarra K;Houda BJ;Fethi BS;Abdallah A; “Apple Cider Vinegar Attenuates Oxidative Stress and Reduces the Risk of Obesity in High-Fat-Fed Male Wistar Rats.” Journal of Medicinal Food, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/29091513/#affiliation-1.

PROFESSIONAL OPINION When used in moderate amounts not exceeding a safe dose, Apple Cider Vinegar can benefit its purported uses. However, the results appear more minimal, and the use of ACV does not replace proper medication, diet, and exercise. ~G. Gmyrek 10

Ashwagandha Alaina Albrecht, Student pharmacist Spring 2022

Scientific Name of Supplement Withania Somnifera (L.) Dunal

Common Names of Supplement • • • • • • • • • •

Amangura Amukkirag Asgand Asundha Indian ginseng Kanaje Hindi Kuthmithi Samm al ferakh Winter Cherry Withania

Typical Dose

https://health.clevelandclinic.org/what-is-ashwagandha

Available Forms • • • • • •

Capsules Elixirs Paste Powders Tablets Root extract (dried)

Common Uses • • • •

https://strictlymedicinalseeds.com

For stress: 240mg of standardized ashwagandha once daily. Can be titrated up to 500mg twice daily for 10-12 weeks. For insomnia: 300mg twice daily of root extract for 10-12 weeks.

Stress Insomnia Memory loss Sexual balance

Pharmacology The steroidal lactones in ashwagandha have adaptogenic and immunomodulating effects. Anticonvulsant effects can occur via a GABA-ergic mechanism and can occur by decreased glycosaminoglycan content. Antibiotic effects have also been reported.

Background/ History Ashwagandha is one of the most important herbs of Ayurveda (traditional Indian medicine). It is a shrub that grows to about 1.5M in height, has long tuberous roots, and has yellowish flowers that can grow in clusters or by themselves. The fruit of this plant is orange, smooth, round, and fleshy, with many seeds. Its use can be traced back to 6000 BC when it was used as a Rasayana, when herbals promote a youthful state, mental and physical health, and expand overall happiness. The root smells like a horse (‘ashwa’), where its name comes from. It has been used for emaciation in children, rheumatism, insomnia, stress, constipation, debility from old age, etc. It is commonly available as a churna, a fine powder that can be mixed with water or honey. 11

Ashwagandha https://www.maryruthorganics.com

Alaina Albrecht, Student pharmacist Spring 2022

Interactions

Effectiveness

Moderate interactions for the following: • Anti-diabetes drugs (could increase risk of hypoglycemia) • Antihypertensive drugs (could increase risk of hypertension) • Benzodiazepines (sedative effect) • CNS depressants (sedative effect) • Immunosuppressants (could decrease the effects of immunosuppressants) • Thyroid hormone drugs (increases adverse effects of thyroid hormone)

Effective for both stress and insomnia.

Adverse Effects At large doses: • Liver injury • Diarrhea https://en.wikipedia.org • GI upset and Vomiting • Decreased body temperature • CNS and respiratory depression

Safety Concerns Do not use while pregnant or breast feeding as it is likely unsafe and possibly an abortifacient. Do not use when autoimmune diseases are present such as lupus, MS or RA because it could flare up those conditions.

Professional Opinion I feel that this product is safe and would be effective for both insomnia and stress management. After reading through many different database monographs and articles, I feel that the minor adverse effects that can occur from taking Ashwagandha do not outweigh the benefits that have been seen for thousands of years. ~A. Albrecht

Summary of Study According to “An overview on ashwagandha: A Rasayana (rejuvenator) of Ayurveda” withania somnifera (WS) is an herb of the Indian Ayurveda system and is used for several diseases as a nervine tonic. In experimental models, WS increased stamina in rats and prevented adrenal gland changes of ascorbic acid. WS showed significant protection against stress-induced gastric changes. WS was useful in children with memory deficits and in older people with memory loss. It has GABA mimetic effect and was shown to promote the formation of dendrites. It is an anti-inflammatory and anti-arthritic agent useful in RA and OA clinical cases. Ashwagandha. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 20, 2022. http://online.lexi.com. Ashwagandha. IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed February 20, 2022. http://www.micromedexsolutions.com. Ashwagandha: Overview, uses, side effects, precautions, interactions, dosing, and reviews. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono953/ashwagandha. Accessed February 23, 2022. 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 February 23, 2022.

Asian Ginseng Alina Arzumanian, Nursing Student, Spring 2022 Background Scientific Name: Panax Ginseng; Araliaceae (Araliaceae, 2021)

(Asian Ginseng, 2020)

Common Name: Asian ginseng (Araliaceae, 2021)

Effectiveness o Water-soluble components make absorption quick and immediate after ingestion o Effects may be seen in a few days (Learn About Ginseng in 5 Minutes, 2020) o Not all studies of Asian ginseng are not high quality so the evidence there is of effectiveness is limited (Asian Ginseng, 2020) Safety (Asian Ginseng, 2022) o Likely safe—short-term use and oral use o Short term use: up to six months o Potentially not safe when used long-term (over six months) o Can be used safely in infants o Caution with use in pregnancy—contact HCP o Contact HCP before using if you take other medications o Other toxicities o Manic episodes, uterine bleeding, gynecomastia, long QT syndrome, atrial fibrillation, and hypertensive crisis (Ratan et al., 2021)

Asian ginseng is one of the most widely recognized plants used in traditional medicine. It has been used for over 2,000 years for a variety of different uses. It is classified into white (dried after peeling), fresh, and red (steamed and dried). While there are many uses, today it is most used for apoptogenic or stress protective effect (Ginseng, 2021). Purported/Common Uses Ginseng root is used for several different pathologies. It has been known for its apoptogenic, immunomodulatory, antineoplastic, cardiovascular, CNS, endocrine, and ergogenic effects (Ginseng, 2021). Mechanism of Action Studies have shown that much of Asian ginseng’s pharmacological effects come from ginsenosides. This includes the inhibitory and excitatory effects on the nervous system, antineoplastic effects, immunomodulatory effects, and nitric oxide release (Park et al., 2018). Dosage Forms: - Crude root powder in a capsule - Extract in liquid form Typical Dosage: - Crude root: 0.5-3 g/day - Extract: 100-800 mg (Ginseng, 2021)

Interactions (Asian Ginseng, 2022) All of the following drugs have moderate interactions and may either be enhanced or decreased with use of Asian ginseng and vice versa: anticoagulants/antiplatelets, antidiabetic drugs, caffeine, cytochrome P450 1A1 (minor), 2D6, 3A4, estrogens, fexofenadine—minor, furosemide, Imatinib, Immunosuppressants, Insulin, lopinavir/ritonavir—minor, midazolam, monoamine oxidase inhibitors, nifedipine, QT Interval-prolonging drugs, raltegravir, selegiline, stimulant drugs, warfarin 13

(Asian Ginseng, 2022) General Side Effects • Generally well tolerated when used for up to 6 months Cardiovascular Side Effects • High BP • Low BP • Edema Dermatologic Side Effects • Oral--itching/hypersensitivity Endocrine Side Effects • May be potential estrogenic effects GI Side Effects • Decreased appetite • Diarrhea • Abdominal pain • Nausea GU Side Effects • Amenorrhea Hepatic Side Effects

• Uncommon: cholestatic hepatitis Immunologic Side Effects • Anaphylaxis--hypotension and rash Neurologic/CNS Side Effects • Insomnia: most common side effect Based off my research, I believe that the pharmacological properties of Asian ginseng have been proven to have contributed to positive patient outcomes in the healthcare field. The clinical trials done have shown its benefits and have also shown its risks. These risks need to be taken into account when considering Asian ginseng in your medication regimen. It is important to contact your primary provider before taking this supplement due to its long list of drug interactions. Despite these interactions and side effects, I believe that ginsenosides, one of the more significant components of Asian ginseng, have demonstrated to be effective and safe for conditions involving the cardiovascular, endocrine, and neurologic system. ~A. Arzumanian

Research: (Ratan et al., 2021) Ginseng has been used for disease treatment in East Asian countries for many years. Certain compounds in this herbal supplement have been found to have a therapeutic effect in hypertensive disorders, stress, and neurological disorders. A variety of bioactive components of this herbal supplement have contributed to its positive outcomes on disease processes. A research article explained that a double-blind randomized controlled clinical trial found that ginseng administration played a role in the significant decrease in the level of serum ROS and methane dicarboxylic aldehyde activity which are associated with certain types of cancers, asthma, atherosclerosis, diabetes, inflammatory joint diseases, dementia, and certain eye diseases. Additionally, another study within this article described that those who took ginseng after curative surgery found that they had a 35% higher chance of diseasefree living for 5 years and up to a 38% higher survival rate than those who did not. In terms of cardiovascular disease outcomes, ginseng has been shown to help maintain proper blood circulation and decrease blood pressure—contributing to a lower rate of heart failure and hypertensive conditions. Japan, Korea, and China have used Ginseng in treatment for diabetes mellitus and evidence has shown that it reduces fasting blood glucose as well as stimulating insulin secretion. This article concluded that ginseng has “great pharmaceutical potential to prevent and treat different diseases.”

Lexicomp. 2021. Ginseng. [online] Available at: <http://online.lexi.com.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/fc_rnp2/3750164?cesid=1gfcZqY29wd&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dginseng%26t%3Dname%26va%3Dginseng> [Accessed 23 February 2022]. Park, S., Park, J., Kim, H., Lee, C., Lee, H., Kang, K. and Kim, C., 2018. Systems-level mechanisms of action of Panax ginseng: a network pharmacological approach. Journal of Ginseng Research, [online] 42(1), pp.98-106. Available at: <https://www.sciencedirect.com/science/article/pii/S1226845317302634?via%3Dihub> [Accessed 23 February 2022]. Natural Medicines. 2022. Asian Ginseng. [online] Available at: <https://naturalmedicines-therapeuticresearch-com.ezproxy.lib.purdue.edu/databases/commercial-products/commercial-product.aspx?cpid=63237> [Accessed 23 February 2022]. National Center for Complementary and Integrative Health. 2020. Asian Ginseng. [online] Available at: <https://www.nccih.nih.gov/health/asian-ginseng> [Accessed 23 February 2022]. Feel. 2020. Learn About Ginseng in 5 Minutes. [online] Available at: <https://wearefeel.com/blogs/learn/what-is-ginseng> [Accessed 23 February 2022]. Ratan, Z., Haidere, M., Hong, Y., Park, S., Lee, J., Lee, J. and Cho, J., 2021. Pharmacological potential of ginseng and its major component ginsenosides. Journal of Ginseng Research, [online] 45(2), pp.199-210. Available at: <https://www.sciencedirect.com/science/article/pii/S1226845320300592> [Accessed 23 February 2022]. Araliaceae. 2021. [online] Available at: <https://en.wikipedia.org/wiki/Araliaceae> [Accessed 24 February 2022].

Madison Everhart, Student Pharmacist

Spring 2022

Momordica charantia — Bitter melon Common Names: Bitter cucumber, Bitter squash, Bitter gourd

Common uses

History

Momordica charantia is a tropical, tendril-bearing vine of the family cucurbitaceae. Commonly grown in Africa, Asia, and the Caribbean, this plant varies in shape and bitterness. In Turkey, this melon was used for stomach ailments, and in some Asian countries, it is used in stir-fried dishes and as an antiemetic.

Bitter melon is often used as an antidiabetic. In certain countries, it is also used as a laxative, emetic, and as an antioxidant.

Pharmacology/MOA

Antimicrobial / Antiviral — Momordica charantia has demonstrated inhibition of HIV integrase and has been shown to work synergistically with aminoglycosides in treating MRSA Antioxidant — due to phenolic content, free-radical scavenging activity has been shown Antidiabetic — M. charantia enhances insulin secretion by islets of Langerhans. This reduces glycogenesis and enhances peripheral glucose utilization

Dosage forms & Typical dosing Dried Fruit — 5 g of dried fruit given 3 times daily Juice — 50 to 100 mL of juice Encapsulated powder — 3 to 15 g daily Encapsulated extract — 100 to 200 mg 3 times daily

Safety & Efficacy

Bitter melon is not safe to use in pregnant or breastfeeding populations. Use with caution in patients who have impaired hepatic function. Components of the M. charantia have a similar structural makeup in compared to animal insulin. Additional trials are needed to assess the safety and efficacy of bitter melon before it can be routinely recommended

Adverse Reactions

Gastrointestinal — abdominal pain, diarrhea CNS — Headaches

Interactions

hypoglycemic eﬀect demonstrated if used with other anti diabetic agents like metformin and glibenclamide

Toxicities

Some toxicities reported when too high of a dose is ingested includes dizziness or depression. Bitter melon may also be toxic to children. It has been reported that hypoglycemic coma, convulsions, and death have occurred in children who ingest it.

Professional Opinion

After researching Momordica charantia, I would not recommend using it. Since it is not widely studied, toxic in children, and toxic in excess, it would be risky in trying to treat disease states that are not studied with this ~ M. Everhart herbal product. References - Jia S, Shen M, Zhang F, Xie J. Recent Advances in Momordica charantia: Functional Components and Biological Activities. Int J Mol Sci. 2017 Nov 28;18(12):2555. doi: 10.3390/ijms18122555. PMID: 29182587; PMCID: PMC5751158. - Basch E, Gabardi S, Ulbricht C. Bitter melon (Momordica charantia): a review of efficacy and safety. Am J Health Syst Pharm. 2003 Feb 15;60(4):356-9. doi: 10.1093/ajhp/60.4.356. PMID: 12625217. - Mohammadmoradi S, Howatt DA, Lu HS, Daugherty A, Saha SP. Bitter Melon (Momordica charantia L.) Supplementation Has No Effect on Hypercholesterolemia and Atherosclerosis in Mice. Curr Dev Nutr. 2020 Sep 14;4(10):nzaa148. doi: 10.1093/cdn/nzaa148. PMID: 33103042; PMCID: PMC7568838. Images: - https://www.bebeautiful.in/all-things-lifestyle/health-and-wellness/bittergourd-benefits-that-you-should-know-about - Momordica_charantia#:~:text=Momordica%20charantia%20(colloquially %3A%20bitter%20melon,Caribbean%20for%20its%20edible%20fruit.

Bitter Orange (Citrus aurantium) Active Ingredient: Synephrine

Mechanism of Action: Synephrine exerts its effects on α-, β-1, and β-2 adrenergic receptors to increase vasoconstriction, cardiovascular constriction, and heart rate.

Common Names: Bitter Orange, Seville Orange, Sour Orange, Zhi Shi

Common Uses: Weight Loss and Appetite Suppression Appetite Stimulation Enhanced Athletic Performance Topical Pain, Bruises, and Fungal Infections

History: Native to Eastern Africa, the Arabian Peninsula, Syria, and Souteast Asia First brought to the Americas by the Spanish and Portugese in the 1500s Used in Traditional Chinese Medicine for nausea, indigestion, and constipation. Dried bitter orange is also used to treat uterine and anal ptosis, abdominal distention, and blood in feces. Used in Europe as a sedative and prophylaxis for GI issues, sore throat, gout, and nervous conditions Banned by the National Collegiate Athletic Association (NCAA) for its role as a stimulant Typical Dosing: Pure Synephrine -- 5 mg Bitter Orange -- 100 mg

Dosage Form: Capsules (Isolated Synephrine and Bitter Orange Extract)

Spring 2022 Olivia Fairley, BSPS student 17

Professional Opinion: There is evidence that suggests that bitter orange is an effective weight loss medication at certain doses. However, due to activity on adrenergic receptors, it is highly susceptible to additive effects when combined with other supplements. For patients with hypertension or any sort of cardiovascular disease, I would advise patients to avoid use of bitter orangecontaining supplements. As it is a CYP inhibitor, I also would recommend that patient's medication history is reviewed prior to starting a supplement. ~O. Fairley

Adverse Events: Photosensitization Increased risk of cardiotoxicity (in animal studies) Rapid increase in blood pressure Tachycardia Nausea, Vomiting, and Irritability

Efficacy: No significant clinical evidence of efficacy. Some patients do experience weight loss; however use caution in patients with CVD and HTN.

Safety: Generally Regarded as Safe (GRAS) by the FDA

Interactions: CYP3A4 Inhibitor and P-Glycoprotein Inhibitor Decreases serum concentrations of many antivirals Increases serum concentrations and adverse effects of amiodarone, calcium channel blockers, and antidepressants.

Citations: Bauer BA. Bitter orange weight-loss supplement: Skip it. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/weight-loss/expertanswers/bitter-orange/faq-20058283. Published March 7, 2020. Accessed March 4, 2022. Bent S, Padula A, Neuhaus J. Safety and efficacy of citrus aurantium for weight loss. The American journal of cardiology. 2004;94:1359-1361. Bitter orange. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/bitter-orange. Accessed March 4, 2022. Bitter Orange (Natural Products Database). Lexicomp. https://online.lexi.com. Accessed March 4, 2022. Bitter orange uses, benefits & dosage - drugs.com herbal database. Drugs.com. https://www.drugs.com/npp/bitter-orange.html. Accessed March 4, 2022. Stohs SJ. Safety, Efficacy, and Mechanistic Studies Regarding Citrus aurantium (Bitter Orange) Extract and p-Synephrine. Phytother Res. 2017;31(10):1463-1474. doi:10.1002/ptr.5879 18

https://www.emedicinehealth.com/what _does_black_cohosh_do_for_your_body/ article_em.htm

BLACK COHOSH CLAUDIA CHIANG, STUDENT PHARMACIST SPRING 2022

SCIENTIFIC AND COMMON NAMES Actaea racemosa, Cimicifuga racemosa Black snakeroot, macrotys, bugbane, bugwort, rattleroot, rattleweed

BACKGROUND Black cohosh is a plant, grown in North America, in which Native Americans have introduced to European colonists. It was originally used to treat musculoskeletal pain, fever, cough, pneumonia, labor, and menstrual irregularities. In traditional Chinese medicine, it was known for antiinflammatory, analgesic, and antipyretic uses. The root and rhizome of the plant are what is used in herbal preparations.

COMMON USES Menopausal symptoms Hot flashes, night sweats, vaginal dryness, heart palpitations, tinnitus, vertigo, sleep disturbances, nervousness, irritability Arthritis Osteoporosis Breast cancer-related hot flashes Insect repellant

PHARMACOLOGY The active ingredients of black cohosh include phytosterin, organic acids, sugars, tannins, long-chain fatty acids, and triterpene glycosides. There is not enough evidence to conclude a certain mechanism of action, but there are several hypotheses. Some properties that black cohosh is suspected to have are antihistamine, antiinflammatory, antilipemic, antineoplastic, antioxidant, antiviral, bone metabolism, estrogenic, and GI effects. It is said to have selective estrogen receptor modulating (SERM) effects, thus, having both estrogenic and antiestrogenic effects.

DOSAGE FORMS Capsules Tablets Liquid extracts Dried root for tea

TYPICAL DOSING/SERVING Recommended dose ranges from 20 to 80 mg/day Tea: 20g of dried root in 34 oz water; one cup 3 times/day

SUMMARY OF STUDY

EFFECTIVENESS Based on clinically used commercial products, therapeutic effects usually begin after two weeks of treatment with maximum effects usually occurring within eight weeks Depending on formulations, results show variability in effectiveness

SAFETY AND TOXICITY Possibly safe when taken orally and appropriately Concerns of possibility of causing liver damage/toxicity in patients Several case reports linking it, but evidence is inconclusive Avoid use during pregnancy May increase risk of miscarriage (theoretically) Avoid use when breast-feeding due to hormonal effects Theoretically may adversely affect a nursing child

ADVERSE EFFECTS Common: Breast tenderness, dizziness, upset stomach, headache, irritability, rash, tiredness, weight gain Rare: Endometrial hyperplasia, hepatotoxicity

FOOD/DRUG INTERACTIONS Atorvastatin, cisplatin, cytochrome P450 2D6 substrates, hepatotoxic drugs/herbs, organic aniontransporting polypeptide substrates (OATP)

https://www.gnc. com/blackcohosh/197012.h tml

A double-blind, randomized, placebo-controlled crossover trial was performed to study the efficacy of black cohosh for the treatment of hot flashes in women. This trial occurred over two 4-week periods, and one 20mg capsule was taken by mouth twice daily. The toxicity effects were found to be minimal, and the average number of hot flashes decreased by 17% with black cohosh and 26% with the placebo. The study concluded that it failed to show any evidence of black cohosh reducing hot flashes more than the placebo.

PERSONAL OPINION Based on my opinion and research, I would not recommend or use this product. This is due to the lack of support and evidence of its use and effectiveness. In addition, black cohosh being linked to possible liver damage leads me to believe that taking it would not be worth the risk when there are other alternative medications or supplements available. ~ C. Chiang

REFERENCES

1. National Center for Complementary and Integrative Health. Black Cohosh. Accessed February 19, 2022. https://www.nccih.nih.gov/health/black-cohosh 2. National Institutes of Health. Black Cohosh. Accessed February 19, 2022. https://ods.od.nih.gov/factsheets/BlackCohoshHealthProfessional/ 3. Black Cohosh. Professional Monograph. Natural Medicines. Accessed February 19, 2022. https://naturalmedicinestherapeuticresearch-com.ezproxy.lib.purdue.edu/ 4. Black Cohosh. Natural products database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 19, 2022. http://online.lexi.com 5. Mount Sinai. Black Cohosh. Accessed February 19, 2022. https://www.mountsinai.org/health-library/herb/blackcohosh 6. Pockaj BA, Gallagher JG, Loprinzi CL, et al. Phase III Double-Blind, Randomized, Placebo-Controlled Crossover Trial of Black Cohosh in the Management of Hot Flashes. 2016; 24(18). doi: 10.1200/JCO.2005.05.4296 20

Jolie Doan Student Pharmacist Spring 2022

BLADDERWRACK Scientific Name: Fucus Vesiculosus

Mechanism of Action

Common Names: Bladderwrack, Black Tang,

Through the metabolism of bladderwrack, one metabolite belongs to the class of phlorotannins, a class of phenolic compounds that are found exclusively in marine organisms. The subclasses of phlorotannins related to bladderwrack is called fucols and fucophlorethols. These phenolic compounds produce antioxidant, antiinflammatory, antimicrobial, and antidiabetic properties.

Rockweed, “Sea Grapes,” Bladder Fucus, Sea Oak, Cut Weed, Dyers Fucus, Red Fucus, Rock Wrack

Background and History Bladderwrack is a brown seaweed that is grown in high salinity waters, such as the Baltic Sea. This seaweed belongs to a class of plants called Fucus Vesiculosus. In East Asia, this plant is harvested and used as a nutritional source of food for centuries. It is unknown as to when the use of bladderwrack began. Currently, it is also being used in fertilizers, animal nutrition, and pest control.

Purported Uses Most Commonly Used For: • Inflammation • Hypothyroidism • Indigestion Other Uses: • Diabetes • Skin conditions • Cancers • Diarrhea • Constipation • Gastritis • Gastroesophageal Reflux Disease (GERD) • Heartburn • Wound Healing • Low Stomach Acidity • Weight Loss https://www.google.com/url?sa=i&url=https%3A%2F%2Fdra xe.com%2Fnutrition%2Fbladderwrack%2F&psig=AOvVaw2m G6pGwW9A66v8A1Or7lf&ust=1645843014831000&source=imag es&cd=vfe&ved=0CAsQjRxqFwoTCOiOoK3pmfYCFQAAAAAd AAAAABAD

It also contains high levels of iodine. Iodine produces thyroid hormones (T3 and T4) to help regulate metabolism and hypothyroidism. A lack of thyroid hormones causes the body to secrete thyroid stimulating hormone.

Doses and Dosage Forms There is not much information regarding dosing of bladderwrack, so information that is found is through drug facts from store-bought bottles. Bladderwrack can be found in a few dosage forms: powdered, dried, capsules, or as a tea. Capsules: It is commonly seen throughout stores that bladderwrack is dosed at one capsule (580 MG) daily. Tea: Steep one bag for 4-5 minutes in eight ounces of hot water or add one teaspoon of dried bladderwrack to boiling water and allow it to simmer for 10-15 minutes.

Bladderwrack. 21

Effectiveness

Article/Study

There is currently not enough information to determine if bladderwrack is effective. There is one acute study in rodents that found no evidence of toxic effects after using bladderwrack for four weeks.

In the scientific article, “Fucaceae: A Source of Bioactive Phlorotannins,” it studies the class of fucus vesiculosus seaweeds and the health benefits that they provide. Phlorotannins are abundant in green seaweeds, like bladderwrack and produce the metabolite called phlorotannin. This study focused on the antioxidant effects, anti-diabetic effects, anti-tumor, and antiinflammatory effects. The phenolic compounds showed positive results for antioxidant activity through its scavenging activity and could inhibit xanthine oxidase. Phlorotannins also show to be effective inhibitors of αglycosidase and α-amylase, which work by preventing hydrolysis of carbohydrates in the body and prevent the blood sugar from rising. For its anti-inflammatory activity, it is shown to downregulate the LPS-induced inflammatory molecules, like IL-6 and IL-8. Through its anti-inflammatory properties and antioxidant activity, it is associated with anti-tumor properties by decreasing inflammation and oxidative elements in the body.

Warnings and Toxicity It is found that bladderwrack interacts with amiodarone, ACE inhibitors, cytochrome P450 enzyme substrates, lamotrigine, Vitamin K anticoagulants (i.e., warfarin), non-steroidal anti-inflammatory products with antiplatelet and/or anticoagulant properties, and thrombolytic agents with antiplatelet and/or anticoagulant properties. Bladderwrack increases the risk of bleeding. Information is limited towards the toxicity of bladderwrack. It could potentially be toxic due to heavy metal absorption of iodine.

Side Effects There are currently not enough clinical studies to show the side effects of bladderwrack. One possible side effect may be a minor gastric adverse event, which includes soft feces and feelings of fullness. https://www.google.com/u rl?sa=i&url=https%3A%2F% 2Fwww.vitaminshoppe.co m%2Fp%2Fsolaraybladderwrack-580mg-100capsules%2Fso7144&psig=AOvVaw1sw_0 oORRAjmnteAXPFvP4&ust= 1645842682104000&sourc e=images&cd=vfe&ved=0C AcQjRxqFwoTCNDSwPXnmf YCFQAAAAAdAAAAABAQ

Personal Opinion There is currently not enough evidence to prove the effectiveness of bladderwrack. In my professional opinion, I would not suggest people to take this product when there are other products that could help with the same issues. In addition to this, there are also many drug interactions with bladderwrack, where it increases the risk of bleeding. If there are people who are interested in trying the product, they should reach out to their physician before starting bladderwrack to make sure that they don’t face any side effects through this natural product. - J DOAN

References 1. 2. 3. 4.

Catarino M, Silva A, Cardoso S. Fucaceae: A source of bioactive phlorotannins. International Journal of Molecular Sciences. 2017;18(6):1327. doi:10.3390/ijms18061327 BLADDERWRACK: Overview, uses, side effects, precautions, interactions, dosing and reviews. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-726/bladderwrack. Accessed February 25, 2022. Bladderwrack. Drug Facts and Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 25, 2022. http://online.factsandcomparisons.com Davidson K. Bladderwrack: Benefits, uses, and side effects. Healthline. https://www.healthline.com/nutrition/bladderwrack-benefits#forms-dosage. Published July 8, 2020. Accessed February 25, 2022. Tennant L. Iodine &amp; Thyroid Health: Are You Getting Enough?: Imaware™. imaware. https://www.imaware.health/blog/iodine-and-thyroidhealth#:~:text=Iodine%20is%20important%20for%20healthy,neck%20caused%20by%20elevated%20TSH. Published June 4, 2021. Accessed February 25, 2022. 22

Blessed Thistle Boyang Dong (Pharmacy Student) Spring 2022 Scientific Name: Cnicus benedictus L., Carduus benedictus Steud., Carbenia benedicta Adans Common Names: Holy thistle, St.-Benedict's-thistle, our Lady's thistle, bitter thistle, spotted thistle, cursed thistle, blessed cardus

Common use: Background/History:

diarrhea cough swelling indigestion infections wounds other conditions with no scientific

Native to the Mediterranean, Blessed thistle was a medieval panacea and was known everywhere in Europe by the Latin name Carduus benedictus. "Blessed" is thought to derived from the thistle's reputation as an aid in many diseases, especially as People use it for many other a plague cure. conditions, but there is no scientific evidence to support these uses.

Mechanism of Action:

The bitterness of cnicin within blessed thistle stimulates the activity of the digestive system and increases the flow of saliva as well as the secretion of gastric juice, which therefore improves the appetite and digestion of people. Moreover, some pharmacological evidence suggests that blessed thistle may have antiinflammatory properties.

Dosage Forms: tea or liquid extract capsules topicals

Typical Dosing: 1/2 teaspoon of dried herb with 250ml of boiling water to make a tea and drink three cups daily No detail found for topical dosing Two capsules 3three times daily

Citations: Health topics A-Z. PeaceHealth. Accessed February 26, 2022. Blessed thistle. Drugs and Lactation Database (LactMed) [Internet]. Published July 19, 2021. Accessed February 26, 2022. Blessed thistle: Medlineplus supplements. MedlinePlus. 23 Accessed February 26, 2022. Blessed Thistle. Blog.metmuseum.org. Accessed February 26, 2022.

Effectiveness:

Safety/Warnings:

I could not find any information on reliable sources.

Adverse/side effects: allergic reactions (high doses) stomach cramps, nausea, and vomiting (women in breastfeeding) elevated liver enzymes

Interactions: No known interactions with foods, herbs, and supplements. Blessed thistle can increase the stomach acid, so it might decrease the effects of antacids, H2blockers, and/or proton pump inhibitors.

Personal Opinion: Blessed thistle seems to be used by people in many ways, especially for breastfeeding women. However, in my opinion, I would not recommend people to use it because there is lack of scientific evidence on its effectiveness as well as its safety for use! ~ B. Dong

Do not use during pregnancy Avoid use blessed thistle during breastfeeding due to lack of reliable information Do not take blessed thistle if you have intestinal problems, such as infections, Crohn's disease, and other inflammatory conditions because it might irritate the stomach and intestines. Blessed thistle may cause an allergic reaction in people who are sensitive to the Asteraceae/Compositae family (include ragweed, chrysanthemums, marigolds, daisies, and many others).

Summary of One Study: Blessed Thistle A double-blind randomized study showed no differences between the control group (the group with lemon verbena tea) and the experiment group (the group with blessed thistle herb in their tea) in terms of infant digestive, respiratory, dermatological, and other adverse events as well as growth of the breastfed infants. 24

Student Pharmacist Pearl Feng Spring 2022 Blueberry (Cyanococcus vaccinium) Background: The blueberries were first cultivated in the United States by Native Americans due to its long shelf life when dried. The dried form would be used medicinally as tea, to act as muscle relaxant for women going through childbirth. It was also used for coughs that resulted from tuberculosis (9). In the 20th century though, the blueberry was successfully developed for the first time for a commercial cultivation. Then around the 1990s to early 2000s, various research papers were released discussing the health benefits of the fruit (1). This has been continuing, and now has even led up to blueberries being certified as heart-health by the American Heart Association in 2019 (2).

Ref. 14

Common Uses: Blueberries have a wide variety of benefits, including memory, blood sugar and heart health improvement (3,4,5) and even cancer prevention (6). The most common use out of these would likely be heart health improvement, due to its certification by the American Heart Association. Some other claims of the benefits of blueberries include preventing blindness, osteoporosis (the breakdown of the bones), and cancer (8). Pharmacology: The main ingredients in a blueberry that are said to have benefits are anthocyanins and polyphenols. Both are antioxidants, which prevent the formation of damaging molecules in the body called free radicals. Without free radicals present, the destruction of the eye, liver, heart, brain, and lungs are decreased, as well as the presence of inflammation. The anti-cancer trait of blueberries are also due to the anthocyanins, which work by controlling cell proliferation and signal transduction in cancerous cells. Polyphenols prevent obesity by downregulating the expression of a particular gene that is associated with a “high-fat diet group” (8). They also control inflammation by regulating the creation of an inflammatory molecule called interleukins. Dosing: Ranges anywhere from 100 mg to 8000 mg of blueberry extract, usually in capsule or tablet form. There are also blueberry extract powders and solutions (7). The most common doses found in local supermarkets would be 8000 mg in capsule form, taken once a day with a meal (10). Efficacy: The efficacy of blueberries is quite unclear. There are many papers citing it as being efficacious, and others that state that there is not enough evidence. In general, there are many papers that cannot prove the efficacy of blueberry extract. Ref. 13

Warnings: Since these are supplements, there is no testing regulation imposed on the formulation companies. Supplements can also contain higher levels of the active ingredient than would be found in blueberries, which may lead to a higher risk of pro-oxidative damage (11). Adverse Effects: Could cause rash, headache, and nausea due to the salicylates. An overconsumption of the supplement may also lead to iron deficiency due to the interaction of polyphenols and iron (11). Interactions with other drugs: I could not find any information about blueberry interacting with other drugs.

Ref. 15

One article summary: “Anthocyanin analyses of Vaccinium fruit dietary supplements” by Jungmin Lee goes over the process of evaluating supplements for the presence of the actual fruit, as well as the concentration of anthocyanins. The conclusion of the paper was that the beneficial molecule of blueberries was not present in high enough concentrations for it to be beneficial, and that a whole fruit may be safer due to the unknown ingredients in the supplements (12). Opinion: While I do think blueberries hold essential vitamins and minerals for human function, supplements for such fruit should not be necessary for daily living. Besides in blueberries, there are many other foods that contain the beneficial molecules of blueberries. While a capsule and tablet may be easier to consume, there are more benefits from eating the fruit itself—such as the fiber that the blueberry contains. ~P Feng References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Pankau, Ryan. Illinois Extension. The history of blueberries: From Native American staple to domesticated superfood. Accessed February 12, 2022. https://extension.illinois.edu/blogs/garden-scoop/2019-01-19-history-blueberries-native-american-staple-domesticated-superfood History of blueberries. Blueberry.org. Published August 4, 2021. Accessed February 12, 2022. https://blueberry.org/about-blueberries/history-ofblueberries/. Krikorian R, Shidler MD, Nash TA, et al. Blueberry supplementation improves memory in older adults. Journal of Agricultural and Food Chemistry. 2010;58(7):3996-4000. doi:10.1021/jf9029332 Miraghajani M, Momenyan S, Arab A, Hasanpour Dehkordi A, Symonds ME. Blueberry and cardiovascular disease risk factors: A systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Medicine. 2020;53:102389. doi:10.1016/j.ctim.2020.102389 Martineau LC, Couture A, Spoor D, et al. Anti-diabetic properties of the Canadian lowbush blueberry vaccinium angustifolium AIT. Phytomedicine. 2006;13(9-10):612-623. doi:10.1016/j.phymed.2006.08.005 Davidson, K.T., Zhu, Z., Balabanov, D. et al. Beyond Conventional Medicine - a Look at Blueberry, a Cancer-Fighting Superfruit. Pathol. Oncol. Res. 24, 733–738 (2018). doi:10.1007/s12253-017-0376-2 Google shopping. Accessed February 20, 2022. https://www.google.com/search?q=blueberry%2Bpill&client=firefox-b-1-d&sxsrf=APqWBuUuXYTpEjV2wehLI8RRrqSeU5_UQ%3A1645379470914&source=lnms&tbm=shop&sa=X&ved=2ahUKEwjLtImX7I72AhUwlYkEHVn2BUQ_AUoAXoECAEQAw&biw=1280&bih=567&dpr=1.5. Ma L, Sun Z, Zeng Y, Luo M, Yang J. Molecular mechanism and health role of functional ingredients in blueberry for chronic disease in human beings. International Journal of Molecular Sciences. 2018;19(9):2785. doi:10.3390/ijms19092785 Murphy H. Foods indigenous to the Western Hemisphere. American Indian Health - Health. Accessed February 20, 2022. https://aihd.ku.edu/foods/blueberry.html. Blueberry extract 8000mg: 150 capsules. Horbäach. https://horbaach.com/products/blueberry-extract-8000mg-150-capsules. Accessed February 20, 2022. Martin KR. Polyphenols as dietary supplements: A double-edged sword. Nutrition and Dietary Supplements. February 2009:1. doi:10.2147/nds.s6422 Lee J. Anthocyanin analyses of Vaccinium fruit dietary supplements. Food Science &amp; Nutrition. 2016;4(5):742-752. doi:10.1002/fsn3.339 Nutricost Blueberry Extract Capsules. Nutricost, Accessed March 30, 2022. https://nutricost.com/products/nutricost-blueberry-extract. blueberry isolated on white background. iStock. Accessed March 30, 2022. https://www.istockphoto.com/photo/blueberry-isolated-on-white-backgroundgm853493518-140246543 Fresh Sweet Blueberry Fruit Leaf Mint Stock Photo (Edit Now) 337738601. Shutterstock. Accessed March 30, 2022. https://www.shutterstock.com/imagephoto/fresh-sweet-blueberry-fruit-leaf-mint-337738601

Abigail Gick, Student Pharmacist

BORON SUPPLEMENT

Spring 2022

Is also known as elemental boron and borate. Other forms include boric acid, boron oxide, and borates1. Chemical formula and structure of main forms used in supplement: Boron2: B

Boric Acid3: B(OH)3

HISTORY

Boron is an element with the atomic number 5 in group 13 of the periodic table. It was discovered in 1808 by Louis-Josef Gay-Lussac and Louis-Jacques Thenard in Paris, France and, separately, by Humphry Davy in London, England4. It was extracted from borax, a mineral found in many hot springs that goldsmiths used as a flux and that the Ancient Chinese used in glazes4-5. The borax was heated with potassium metal to produce the impure boron. This process was later perfected by American Ezekiel Weintraub who created a mixture of boron chloride, BCl3 vapor, and hydrogen to produce the pure element of boron in 19094-5. Boron can also be found in various foods and plants6. USES

Common uses of boron as a supplement include menstrual cramps, osteoarthritis, osteoporosis, wound healing, increased hormone levels, and athletic performance. Another form of boron, boric acid, is commonly used for yeast infections1. MECHANISM OF ACTION

There is no conclusive mechanism of action showing how boron works in the body. However, it could have some antioxidant properties and could regulate gene and hormone expression that stimulates osteoblast mineralization, which could help with bone growth and wound healing1,3. DOSAGE FORMS

Tablets and Capsules DOSING 7

Adult:

Child: 1-20 mg/day

Max: 20mg/day

1-3 years: 3mg/day

8-12 years: 11mg/day

3-8 years: 6mg/day

13-18 years: 17mg/day

EFFECTIVENESS

The efficacy of boron has not been concluded by any health organization. However, there is research that states that boron may work to increase testosterone levels within a week and may also be useful in the treatment of osteoarthritis5. 27

SAFETY/WARNINGS/TOXICITIES

The FDA has not established how safe boron is as a supplement. It appears safe below the maximum limit of 20mg/day for the average healthy adult. There are mixed reviews about whether or not boric acid is recommended to be used vaginally as it may cause birth defects and vaginal burning1,8. It also appears safe for pregnant women. Signs of toxic overdose include headache, diarrhea, vomiting, tremors, weakness, and irritability1. ADVERSE/SIDE EFFECT (SE)

Common side effects include blue/green feces, diarrhea, nausea, vomiting, and abdominal pain8. INTERACTIONS (FOOD/DRUG)

There are no known drug or food interactions with boron. However, when taking boron with magnesium, estrogens, or testosterones, it can increase the amount of boron that remains in the body which could have negative side effects1,8. SUMMARY OF ONE ARTICLE/STUDY 2

Nothing Boring About Boron by Lara Pizzorno discusses the importance of boron in bone growth, wound healing, hormone levels, magnesium absorption, inflammatory markers, antioxidants, cognitive activity, the influence of biomolecules, and chemotherapeutic effects. She claims there may benefits to consuming boron for people with a poor diet of fruit and vegetables and who are at risk for osteopenia, osteoporosis, osteoarthritis, breast, prostate, or lung cancer. She does also recommend a minimum dose of 3mg/dL to achieve some results. PERSONAL/PROFESSIONAL OPINION

While there are studies that show the possible benefits of boron in certain situations, there is not much conclusive evidence or research that would make me choose boron as a supplement or treatment over a proven medication. In addition, the possible clinical benefits of boron do not include the relief of menstrual cramps, which is what boron is mainly used for. Lastly, the benefits do not outweigh the side effects. I would not recommend boron for a patient, nor would I take it myself. ~ A. Gick REFERENCES 1. Natural Medicines Comprehensive Database Consumer Version. Boron: MedlinePlus supplements. MedlinePlus. https://medlineplus.gov/druginfo/natural/894.html. Accessed February 24, 2022. 2. Boron Lewis Dot Structure. Borates Today. https://borates.today/boron-lewis-dot-structure/. Published December 15, 2021. Accessed February 24, 2022. 3. Pizzorno L. Nothing Boring About Boron. Integr Med (Encinitas). 2015;14(4):35-48. https://www.ncbi.nlm.nih.gov/pmc/articles /PMC4712861/ 4. Boron. Royal Society of Chemistry. https://www.rsc.org/periodic-table/element/5/boron. Accessed February 24, 2022. 5. Wikipedia contributors. Boron. Wikipedia, The Free Encyclopedia. February 20, 2022, 07:53 UTC. Available at: https://en.wikipedia.org/w/index.php?title=Boron&oldid=1072950712. Accessed February 24, 2022. 6. Boron - Fact Sheet for Health Professionals . NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/BoronHealthProfessional/. Accessed February 24, 2022. 7. Boron. Drugs.com. https://www.drugs.com/npp/boron.html. Accessed February 24, 2022. 8. John CP, ed. Boron. RxList. https://www.rxlist.com/consumer_boron/drugs-condition.htm. Published August 20, 2021. Accessed February 24, 2022. 9. David, L J, Louis, et al. Boron complex 3 mg - 100 capsules. PureFormulas. https://www.pureformulas.com/boron-chelate-3-mg100-capsules-by-natures-way.html. Published April 13, 2019. Accessed April 12, 2022.

Boswellia serrata Roxb. Indian Frankincense, Dhup, Salai Guggal Taylor Gannon, Student Pharmacist, Spring 2022

History Boswellia is thought to be related to the tree from the Bible that provided the frankincense gift given to baby Jesus by the wise men. It can be used within hair, clothes, or rooms as a perfume. Historically, the plant was burned to produce psychoactive effects in religious and spiritual ceremonies. In India, the plant can be used in Ayurvedic medicine for the treatment of multiple ailments. In Egypt, it can be used within the mummification process as an embalming fluid ingredient.1 http://blogs.reading.ac.uk/crg/files/2014/12/5Boswellia_sacraCC2.jpg

Common Uses

FAST FACTS

Oleoresin Gum – anti-inflammatory effects • Asthma • Osteoarthritis • Rheumatoid Arthritis • Colitis • Irritable Bowel Syndrome (IBS) Boswellic Acids – immunomodulatory and antimicrobial effects

Dosage Forms1, 3 The most commonly available formulation is a tablet. The herb can also be formulated into a capsule or tincture. Many combination products exist with other herbal products.

Typical Dosing1

Mechanism of Action2 Most Likely – Inhibition of 5-lipoxygenase (5-LOX), which provides an antiinflammatory effect • 5-LOX is part of the arachidonic acid pathway and results in the production of leukotrienes that cause inflammation • Too many leukotrienes can result in excessive inflammation, which can be seen with many inflammatory disorders, such as rheumatoid arthritis or irritable bowel syndrome Other potential targets include cytokines, such as interleukins and TNF-alpha

Inflammatory Conditions: 300 to 400 mg three times daily of extract or gum resin tablets/capsules 29

Professional Opinion Effectiveness1 While B. serrata has been used in many conditions for its touted antiinflammatory properties, clinical trials have not been promising. There is currently no scientific evidence that confirms the efficacy of this natural product.

A literature review regarding the safety and efficacy of B. serrata reveals few studies. Published studies are typically low quality and are conducted in small patient populations. The studies are also predominantly conducted in countries outside of the United States, such as India, Armenia, and Iran. While trials do show some evidence that B. serrata is significant for improving pain over placebo treatment, no head-to-head studies against NSAIDs or other drug classes have been conducted. The low quality of the studies also elicits questions regarding both internal and external validity. No issues with safety were identified, however.4 Based on these factors, I would not recommend utilizing Boswellia serrata for antiinflammatory, immunomodulatory, or antimicrobial effects, as I feel that scientific evidence for safe and effective usage is lacking. ~ T. Gannon

Safety1 B. serrata is considered to be relatively safe and mostly well tolerated. While a study in mice did report hepatotoxic effects, no such effects have been reported in humans. Patients that should avoid this herb include those with a hypersensitivity to B. serrata and females that are pregnant or lactating, as adequate safety data is lacking.

https://healthjade.com/boswellia/ https://www.organicveda.com/boswellia-serrata-capsules/

Adverse Effects, Toxicities, and Interactions1,3 Common adverse effects include nausea, anorexia, stomach pain, diarrhea, and dermatitis. No data has been reported for toxicology in humans. In rats, doses over 2 g/kg were determined to be the median lethal dose (LD50). B. serrata is an inhibitor of many CYP450 enzymes and P-gp. A couple of case reports have also reported increased INR levels when taken with warfarin.

References 1.

2. 3.

Frankincense, Indian. Lexicomp. https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750151 ?cesid=5bnMlPVEuhx&searchUrl=%2Flco%2Faction%2Fsearch%3Fq% 3DBoswellia%26t%3Dname%26va%3DBoswellia#. Published October 20, 2020. Accessed February 4, 2022. Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006;72(12):1100-1116. Doi:10.1055/s-2006-947227 Boswellia . Micromedex . https://www.micromedexsolutions.com/micromedex2/librarian/CS/B3 5BF8/ND_PR/evidencexpert/ND_P/evidencexpert/DUPLICATIONSHIEL DSYNC/4C2E23/ND_PG/evidencexpert/ND_B/evidencexpert/ND_AppPr oduct/evidencexpert/ND_T/evidencexpert/PFActionId/evidencexpert.D oIntegratedSearch?SearchTerm=Boswellia&UserSearchTerm=Boswellia &SearchFilter=filterNone&navitem=searchALL#. Published 2022. Accessed February 4, 2022. Bannuru RR, Osani MC, Al-Eid F, Wang C. Efficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and metaanalysis. Semin Arthritis Rheum. 2018;48(3):416-429. doi:10.1016/j.semarthrit.2018.03.001 30

CALCIUM CARBONATE Jacob Paulaskas, Student Pharmacist, Spring 2022

CALCIUM CARBONATE & IT’S HISTORY Calcium carbonate is a common supplement, and most people know it as the brand Tums. Calcium supplements were invented in the 19th century. WHAT IS IT USED FOR? § Calcium can be used for either GI issues or to supplement the natural amount of calcium we are

supposed to consume from our diets. § GI: Sold under the common brand name Tums, calcium has FDA approved uses for relief of acid

indigestion, heart burn, upset stomach and other stomach issues. § Supplement: This can be used in those with low calcium levels, and those with conditions such as

osteoporosis, osteomalacia, hypocalcemia rickets. HOW DOES IT WORK? In the GI tract, calcium quickly neutralizes excess acid making it a popular supplement for upset stomach. As a supplement, the calcium is absorbed into the body and slows the decay of bone, especially in those with osteoporosis. DOSAGE FORMS AND DOSING § Calcium supplements are available in tablet form. For each gram of calcium carbonate, it has 400mg

of elemental calcium. § GI: dosing for stomach related issues is up to 8g of calcium carbonate per day for up to two weeks. § Supplementation: The dosage range varies from 500mg-4g of calcium carbonate per day, in 1-3 doses.

CALCIUM EFFECTIVENESS The effects can be suggestive. It can help those with low calcium and acid reflux, but to others it may not be beneficial. It works quickly to reduce stomach acid, but slowly to help with other issues. SAFETY, WARNINGS, AND SIDE EFFECTS § May cause hypercalcemia if blood calcium levels are not monitored § Higher doses of calcium may cause blood clots. § Side effects: constipation, gas, bloating

INTERACTIONS § Do not take calcium with tetracycline antibiotics.

SUMMARY ARTICLE According to an article by John Hopkins medicine, the best calcium supplement is from food and a balanced diet opposed to getting it from a supplement. Additionally, it is stated that any amount of calcium over 500mg is considered dangerous and can lead to adverse side effects such as blood clots. The article mentions that other ways to improve bone strength is to exercise. PROFESSIONAL OPINION In my professional opinion, this product is only effective in patients with calcium deficiencies and acid reflux. Calcium has been proven to help reduce stomach acid and therefore it is a safe use for it. I think it is beneficial for those who are under the care of a physician and lab tests have shown hypocalcemia. It is crucial that they discuss with physicians before starting calcium or any supplement. ~J Paulaskas REFERENCES Calcium Carbonate. In: Specific Lexicomp Online Database [database on the Internet]. Hudson (OH): Lexicomp Inc.: publication year [updated 02 Feb. 2022; cited 25 Feb. 2022]. Available from: http://online.lexi.com. Subscription required to view. Calcium supplement 600 mg 60 tablets each (1 or 3 pack) by rugby. Hargraves Online Healthcare. (n.d.). Retrieved February 26, 2022, from https://hargravesotc.com/products/calcium-supplement-600-mg-60-tablets-each-1-or-3-pack-by-rugby Calcium supplements: Should you take them? Johns Hopkins Medicine. (n.d.). Retrieved February 26, 2022, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/calcium-supplements-should-you-take-them

Spring 2022

Sage Graham, Student Pharmacist

Carnitine

Common names: (L-carnitine, Acetyl-L-carnitine, Bicarnesine, and Carnitor) Scientific name: (L-3-hydroxytrimethylaminobutanoate)

History L-carnitine is a naturally occurring, nonprotein amino acid that is biosynthesized in the liver and kidneys from the essential amino acids lysine and methionine. The generic term "carnitine" originates from the Latin carnus (flesh), as the compound was originally isolated from meat, and refers to the group of carnitine derivatives: L-carnitine, acetyl-L-carnitine, and propionyl-Lcarnitine. Dextro- forms also exist; however, only the levo-isomers are biologically active in humans. In 1989, the US Food and Nutrition Board of the Institute of Medicine determined that carnitine was not an essential nutrient and has not established a recommended dietary allowance for the compound.1

MOA

Uses

L-carnitine facilitates beta-oxidation of long-chain fatty acids by transporting them into the mitochondria to be oxidized, which produces energy. It also exports short- and medium-chain fatty acids as well as toxic compounds from the mitochondria that accumulate as a result of normal and abnormal metabolism.1

The US Food and Drug Administration (FDA) has approved oral and intravenous (IV) Lcarnitine for the treatment of primary and secondary carnitine deficiency because of inborn errors of metabolism. IV L-carnitine is also approved for the treatment of carnitine deficiency resulting from dialysis in patients with end-stage renal disease.2

Dosage forms and typical dosing

Comes in intravenous and oral dosage forms. Most commonly dosage 3-4 grams per day for most of its indications.1

Safety and effectiveness Adverse events and toxicities Nausea, vomiting, abdominal cramps, diarrhea, and a "fishy" body odor can occur with doses of about 3 g/day. Less common adverse effects have included pruritic rash, muscle weakness in uremic patients, and seizures in patients with seizure disorders. The IV median lethal dose (LD50) of levo carnitine in rats is 5.4 g/kg, and the oral LD 50 of levocarnitine in mice is 19.2 g/kg.1

There have been no reports of a levocarnitine overdosage; however, large doses may cause diarrhea. Carnitine has been commercially advertised to improve exercise performance, enhance a sense of wellbeing, and to aid weight loss; however, clinical trials have not consistently supported these uses. Limited clinical data support Lcarnitine as an effective therapy for improving sperm quality for men with oligoasthenozoospermia.1

Professional opinion

Interactions Carbamazepine, phenobarbital, phenytoin, and valproic acid may decrease blood concentrations of carnitine in children treated for convulsions. Pivampicillin and other pivalate-conjugated antibiotics may decrease blood concentrations of carnitine and limit fatty acid oxidation.1

As a naturally occurring amino acid, carnitine is a safe supplement and the depletion of which can have a negative impact on health. The function of carnitine is mostly facilitating long chain fatty acids and humans can run low on this amino acid especially in patients with CRD needing dialysis. If it’s the unadulterated version of L-carnitine, supplementation can be helpful to patients with only minor GI upset adverse effects. ~ S. Graham

References 1.Login. Online.lexi.com. https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/6032226?cesid=0RDA4L7mASe &searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dcarnitine%26t%3Dname%26va%3Dcarniti ne. Published 2022. Accessed March 4, 2022. 2. Micromedex Products: Please Login. Micromedexsolutions.com. https://www.micromedexsolutions.com/micromedex2/librarian/PFDefaultActionId/evidence xpert.DoIntegratedSearch?navitem=topHome&isToolPage=true#. Published 2022. Accessed March 4, 2022. 3. Gnoni A, Longo S, Gnoni G, Giudetti A. Carnitine in Human Muscle Bioenergetics: Can Carnitine Supplementation Improve Physical Exercise? Pictures:

https://www.amazon.com/Natures-Bounty%C2%AE-L-Carnitine-500-Tablets/dp/B000KOOARU 34

Briana Haas, Pre-Physician Assistant student, Spring 2022

CHAMOMILE Source: Canva

Scientific Name: Matricaria Chamomilla Common Name: Chamomile

History Ancient Egyptians used chamomile as an offering to their Gods to help cure a fever. Romans used chamomile as a healing beverage. In the middle ages, chamomile was used as an ingredient in making beer.

Uses Reduce anxiety, aid sleep Relieve digestive issues Anti-inflammatory effects Improve symptoms of a common cold Treatment of eczema

Source: Canva

Pharmacology

Forms

Volatile oils penetrate the skin for an anti-inflammatory effect Flavonoid, apigenin binds to benzodiazepine receptors in the brain to induce sleep

Dosage

Capsules Liquid extract Teas Topical cream

Tea: 1 cup orally three times daily to four times daily Liquid extract: 1-4 ml orally three times daily; 1:1 in 45% alcohol Cream: Apply 3-10% ointment/gel as needed Capsules: 900-1200 mg daily 35

Briana Haas, Pre-Physician Assistant student, Spring 2022

CHAMOMILE Personal opinion: Chamomile is a great natural alternative to certain medicines and can be effective depending on its use. ~B. Haas

Effectiveness:

Summary of Study:

Safely improves sleep quality Doesn't significantly effect insomnia Moderately effective in treatment of eczema (60% as effective as hydrocortisone cream) 45 minutes to kick in

Do not take if

Chamomile Treatment for Generalized Anxiety Disorder (GAD) Long term chamomile use for relief of symptom relapse in GAD Phase 1: 500mg three times daily for 12 weeks Phase 2: 26 weeks of therapy or placebo

Past or present breast or ovarian cancers Endometriosis

Reduced moderate to severe GAD symptoms

Pollen allergies

Did not reduce rate of relapse

Possible side effects: Severe allergic reaction (anaphylaxis) Contact dermatitis/skin reactions Eye irritation Vomiting (when taken in large amounts)

References

Interactions: Ginko biloba Garlic St. Johns Wort Valerian Saw palmetto

Griffin RM. Chamomile plant, tea, and oils: Health benefits and uses. WebMD. https://www.webmd.com/diet/supplement-guide-chamomile. Accessed February 24, 2022. Link R. The 6 best bedtime teas that help you sleep. Healthline. https://www.healthline.com/nutrition/teas-that-help-you-sleep. Published December 14, 2021. Accessed February 24, 2022. Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria Chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine. 2016;23(14):1735-1742. doi:10.1016/j.phymed.2016.10.012 Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Molecular medicine reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995283/. Published November 1, 2010. Accessed February 24, 2022. What is chamomile? Teatulia. https://www.teatulia.com/tea-varieties/what-is-chamomile.htm. Accessed February 24, 2022.

CHASTEBERRY Catera Hamilton | Student Pharmacist | Chasteberry Monograph | Spring 2022

Common Names Also known as: Agnus Cactus, Chaste Trees Gattilier, Indian Spice, Lilac Chaste Tree, Monkey tree hemp, Vitex, Wild Pepper

Common Uses Common uses include treatment of menstrual cycle disorders and premenstrual syndrome

Available Forms

The typical serving depends on the condition treated • For menstrual cycle

disorders: 1 g up to three times daily orally • For premenstrual

syndrome: 20 mg daily orally

https://www.shutterstock.com/search/chasteberry

History Chasteberry, which is the most well-known name, belongs to the scientific family of vernbenaceae. It is native to Mediterranean region and Asia. It is a dried, ripe fruit used in traditional medicine. The earliest known uses were described in the In Homer’s epic The Iliad. It was described as a symbol of chastity. Early physicians suggested use in controlling hemorrhages and expelling the placenta after birth. Monks used to chew it to decrease sexual desire.

Effectiveness Chasteberry is may be effective for menstrual cycle disorders, mastalgia, progesterone deficiency, menstrual irregularities and shrinking fibroids. It is not proven to be effective for female infertility. The data is inconclusive for acne.

Pharmacology and Mechanism of Action Pharmacology date is limited. Exact mechanism of action for chasteberry is not known.

https://hormonesbalance.com/recipes/ chasteberry-tea-pms-menopause/

Recommendations

Facts and comparisons®: Drug Referential Resource. Chaste Tree (Natural Products Database). httpswww.wolterskluwer.co m/en/solutions/lexicomp/ facts-and-comparisons. Accessed February 25, 2022. IBM Micromedex. Vitex Agnus Castus. https:// www.micromedexsolutions. com. Accessed February 25, 2022. Rafieian-Kopaei M, Movahedi M. Systematic Review of Premenstrual, Postmenstrual

https://www.nccih.nih.gov/health/chasteberry

Andrew Hess

Student Pharmacist

Scientific Name Chondroitin (3R,4R)-2-{[(2R,3S,4R,5R,6R)-3-acetamido2,5-dihydroxy-6-(hydroxymethyl)oxan-4yl]oxy}-3,4-dihydroxy-3,4-dihydro-2H pyran-6-carboxylic acid

Common Names Chondroitin sulfate Chondroitin sulfuric acid Chonsurid Structum

History Chondroitin sulfate was first isolated and studied in the late 19th century. Its efficacy has been researched throughout the 20th century, primarily in regard to its use in the treatment of osteoarthritis. Many of these have been disregarded due to poor experimental design. In 2007, there were two large scale analyses of prior studies done on the clinical effects of chondroitin. One concluded that chondroitin provided little to no benefit and discouraged its recommendation in clinical practice. The other concluded that there was compelling evidence to suggest it may affect the progression of osteoarthritis.

Common Uses Arthritis Anticoagulation Cancer Cystitis Dry eyes Kidney Stones

How it works Chondroitin stimulates the activity of chondrocytes, which are cells responsible for making cartilage, by supplying them with the building blocks needed to do so.

Dosing Chondroitin is available as 400mg, 500mg, and 600mg capsules Recomended daily dosage is 1200mg (400mg three times daily or 600mg twice daily) https:/ /i5.walmartimages.com/ asr/ead81182-6a00-446c-a8f3f29a0d3df03c_l.190917007177 d87ald03lc08db5clbc5.jpeg? odnHeight=612&odnWidth= 612&odnBg=FFFFFF

Chondroitin What to expect

Interactions

Safety

Real World Study

For preventative care, may notice improvement in joint health within a few weeks. If taking to repair existing joint damage, may need to take chondroitin for two to thre e months before any notice of improvement. As of yet, evidence supporting the efficacy of chondroitin is mixed. More high quality studies are needed for a reliable conclusion.

Most reports conclude that chondroitin is safe when compared to other arthritis therapies such as NSAIDS, however, information is limited.

Side Effects May cause mild stomach pain, nausea, bloating, diarrhea, and constipation.

For patients taking warfarin, chondroitin may increase INR levels when taken at doses of 2400mg daily. No notable changes in INR were documented when taking chondroitin at doses of 800mg daily. This data was collected during co-administration of glucosamine and chondroitin. The effects of each individual product on INR in patients taking Warfarin have not been studied.

The largest double-blind study involving chondroitin was the Glucosamine and Chondroitin Arthritis Intervention Trial published in 2006. Its focus was on patients suffering from osteoarthritis of the knee. Researchers concluded that the supplement provided no additional improvement of symptoms when compared to both placebo and a positive control treatment with an anti-inflammatory medication.

Professional Conclusion Chondroitin is not an appropriate medication for anyone in need of acute treatment. It is likely best served as a preventative treatment and may have benefits in several areas of the body other than joints, but until more sound research is done it is difficult to reccomend for any indication with confidence. Since it is considered safe, however, I wouldn't discourage anyone interested in investing the time necessary from trying it for themselves. Just remember to talk to your doctor before starting any new medications. ~ A Hess

References

1. Chondroitin. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. http://online.lexi.com. Accessed February 23, 2022. 2. Chondroitin Sulfate. Professional Supplement Center. https://www.professionalsupplementcenter.com/ Aisle7.aspx?%2Fassets%2Fnutritional-supplement%2Fchondroitin-sulfate%2Fhow-it-works. Accessed February 23, 2022. 3. Morrison LM, Emick N. Coronary heart disease: reduction of death rate by chondroitin sulfate A. Angiology. 1973;24(5):269-287. doi:10.1177/000331977302400503. Accessed February 24, 2022. 4. Sawitzke AD, Shi H, Finco MF, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis Rheum. 2008;58(10):3183-3191. doi:10.1002/art.23973. Accessed February 24, 2022.

Cinnamon

Katrina Hoang Student Pharmacist Spring 2022

History of Cinnamon Not only is cinnamon a common household spice, it has been prized for its medicinal properties for thousands of years in various parts of the world, including Egypt, Sri Lanka, and southeastern Asia. The four main types of cinnamon are Ceylon cinnamon (Cinnamomum zeylanicum), Indonesian cinnamon (Cinnamomum burmanni), Vietnamese cinnamon (Cinnamomum loureiroi), and Cassia cinnamon (Cinnamomum aromaticum). Ceylon cinnamon differs from other varieties, as it has a milder flavor and lower levels of coumarin, a hepatotoxin, thereby giving it the name “true cinnamon.” Dating back to 2800 BC, varying parts of the cinnamon tree, including its leaves and bark, are used to treat digestive ailments, respiratory disorders, and even bacterial infections. Additionally, the Romans have been noted to use cinnamon to disguise the odor of a dead body, and Egyptians incorporate the spice into the embalming process.

https://www.easthawaiioutdoorcircle.o rg/2020--2021-tree-giveaway-specieslist-and-information/cinnamon

Diabetic Use There are numerous small trials that allude to the cinnamon’s ability to lower the body’s sugar levels and play a positive role in regulating diabetes. Cinnamon is believed to be able to eliminate insulin resistance associated with diabetes by activating signaling proteins and glucose transporters to decrease diabetic insulin resistance. However, due to the number of studies with insufficient or contradictory data that does not support cinnamon’s role in diabetes treatment, more research is required.

Blood Pressure Regulation In order to manage hypotension, patients are recommended to eat a healthy diet, exercise regularly, refrain from smoking, and limit sodium intake. Some studies have also demonstrated that cinnamon shows some promise in reducing high blood pressure. Research to support this claim is limited, and the mechanism for this action is unknown.

Antioxidant Effects Amongst other health benefits, cinnamon contains polyphenol antioxidants, which protect against free radical mechanisms that can induce tissue damage, heart disease, and even cancer. Antioxidants neutralize highly reactive free radicals by donating electrons to the unstable unpaired electrons. Antioxidants also work by preventing free radical formation, thereby preventing tissue damage. Cinnamon is proven to contain high levels of antioxidants necessary to combat free radicals; however, additional research is necessary to prove its role in heart disease and cancer treatment.

Dosage Forms and Serving Size Cinnamon supplements are available in capsule form and as an oil. The single dose of the cinnamon supplement capsules should fall between 1 - 4 grams daily. However, cinnamon oil is far more concentrated than the ground cinnamon bark found in capsules. As such, if using the oil, 0.05 grams – 0.2 grams should be diluted in a carrier liquid prior to use or consumption

Side Effects Cassia cinnamon contains high levels of a compound known as coumarin, which is a known hepatotoxin. 1 teaspoon of cassia cinnamon contains approximately 7 – 18 mg of coumarin. It is not recommended to ingest more than 0.1 mg of coumarin per kg of body weight within a day, as this will increase the risk for liver damage or toxicity. Other side effects of cinnamon supplements may include mouth sores, low blood sugar, and breathing problems. https://www.easthawaiioutdoorcircle.org/2020--2021-treegiveaway-species-list-and-information/cinnamon

Interactions with Cinnamon There are no significant findings regarding food or drug interactions.

Summary of Cinnamon: Update of Potential Health Benefits Cinnamon has anti-inflammatory properties that could possibly be used to alleviate symptoms of PCOS and dysmenorrhea; however, there is limited data about the use of cinnamon in alleviating inflammation. Five trials were performed with a small sample size between six and 42 participants. These studies tested the efficacy of cinnamon on conditions such as hyperglycemia, dyslipidemia, polycystic ovary syndrome, and other inflammatory conditions; however, the variability presented in the results does not give definitive proof of a cure or of a viable treatment option.

Personal opinion Due to the inconsistencies amongst varying studies about the possible role cinnamon may play in alleviating symptoms or characteristics of different disease states, patients should not incorporate cinnamon into their health regimen before consulting their physician. Although there are no significant interactions between cinnamon and other medications or foods, patients should be aware of the possible side effects of overconsumption and use of the supplement. ~ K Hoang

References Anne, M.. SFGate. Daily Requirements for Cinnamon Supplements. Accessed April 13, 2022. https://healthyeating.sfgate.com/daily-requirements cinnamon-supplements-10613.html Castro, R.. Mayo Clinic. Diabetes treatment: Can cinnamon lower blood sugar?. Accessed April 13, 2022. https://www.mayoclinic.org/diseasesconditions/diabetes/expert-answers/diabetes/faq-20058472 Kawatra, P., & Rajagopalan, R.. National Library of Medicine. Cinnamon: Mystic powers of a minute ingredient. Accessed April 13, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466762/#:~:text=HISTORY%20OF%20CINNAMON&text=The%20Romans%20used%20it%20fo r,its%20fragrance%20and%20flavoring%20properties. National Center for Complementary and Integrative Health. Cinnamon. Accessed April 13, 2022. https://www.nccih.nih.gov/health/cinnamon Raman, R.. Healthline. 6 Side Effects of Too Much Cinnamon. Accessed April 13, 2022. https://www.healthline.com/nutrition/side-effects-ofcinnamon#5.-May-Cause-Breathing-Problems Singletary, K. Cinnamon: Update of Potential Health Benefits, Nutrition Today. Vol 54 (1):42-52. https://journals.lww.com/nutritiontodayonline/fulltext/2019/01000/cinnamon__update_of_potential_health_benefits.8.aspx Wilson, D. R.. Healthline. Cinnamon Oil Benefits and Uses. Accessed April 13, 2022. https://www.healthline.com/health/cinnamon-oil#how-to-use

Collagen The name collagen comes from the Greek κόλλα (kólla), meaning "glue", and suffix γέν, -gen, denoting "producing" Common Names: Collagen Peptides, Hydroxylated Collagen Avery Claire Jones, Student Pharmacist, Spring 2022 Background/History: Collagen makes up approximately 30% of the proteins in the body and is the most abundant protein in the body. It plays a vital role in the health of skin, bones, and connective tissues. It helps to keep joints strong, make skin elastic, and protect organs. Our bodies continuously synthesize collagen; however, after the age of 25 our bodies start to lose collagen. In Traditional Chinese Medicine, Ejiao (made from donkey-hide gelatin) has been used since ancient times. Scientific efforts to obtain biologically active collagen peptide were pioneered in the 1960s by Paul Börnstein, who developed an extraction-based method of obtaining collagen. However, it was found to not be active collagen. In the 1980s, Polish scientists extracted collagen from fish skin. Methods of collagen production were devised which managed to preserve its unique spatial conformation the triple helix made up of amino acid chains.

Common Uses: • • • • •

Improve skin health (aging skin) Relieve joint pain (osteoarthritis) Prevent bone loss Boost muscle mass Promote heart health

GNC® | Vitamins, Supplements, Protein Powder & Health Products. Gnc.com. https://www.gnc.com/. Published 2022. Accessed March 3, 2022.

Mechanism of Action: In the dermis, collagen has a dual mechanism of action: 1) free amino acids provide building blocks for the formation of collagen and elastin fibers; 2) collagen oligopeptides act as ligands, binding to receptors present on the fibroblasts’ membrane and stimulate the production of new collagen, elastin, and hyaluronic acid Dosage Forms: 1. Tablets 2. Powders

3. Liquids 4. Capsules

Dosing: Collagen peptides have most often been used by adults in doses of 2.5 -10 grams daily for up to six months.

Effectiveness: Numerous clinical trials have been performed showing the efficacy and benefits of collagen peptides on skin properties, such as hydration, elasticity and reduction of wrinkles. Béguin completed a study demonstrating that collagen may be effective to protec t the skin and support its repair process. Choi et al.'s study showed that daily collagen peptide supplementation improved skin hydration and elasticity. Bolke’s study stated that objective dermatological measurements, such as cutometry and corneometry, have proven that oral collagen peptides together with other dermo nutrients significantly improve skin hydration, elasticity, roughness, and density after three months of intake. Taking collagen peptides by mouth might slightly relieve pain and improve joint function in people with knee osteoarthritis. But it might take about 3-5 months of daily treatment before it helps. The results of a meta-analysis completed by Garcia-Coronado and colleagues showed that collagen is effective in improving OA symptoms by the decrease of both total WOMAC index and VAS score. Safety/Adverse & Toxic Effects: When taken by mouth, side effects are rare. Collagen peptides are deemed possibly safe and have safely been used in doses up to 10 grams daily for up to five months. There is not enough information to determine if collagen peptides are safe in pregnancy and breastfeeding. Side effects consist of mild digestive symptoms and a bad taste in the mouth. Stimulating collagen production can increase oxidative stress which can lead to cell and tissue damage. Since collagen is not FDA regulated, it can sometimes contain heavy metals and/or toxins which can cause toxic effects. Too much collagen can cause thicken and harden skin. It could potentially damage internal organs as well. No known interactions with medications, herbals/supplements, or foods. Professional Opinion: After reading the clinical trials on collagen’s safety and effectiveness, I would recommend this supplement to patients with instructions to talk to their healthcare provider before initiating. Studies have shown potential benefits of collagen on aging skin and osteoarthritis with mild but rare side effects. However, collagen is not regulated by the FDA and could be contaminated or adulterated. ~ AC Jones

PDB101: Molecule of the Month: Collagen. RCSB: PDB-101. https://pdb101.rcsb.org/motm/4. Published 2022. Accessed March 30, 2022

References: 1.Bolke L, Schlippe G, Gerß J, Voss W. A Collagen Supplement Improves Skin Hydration, Elasticity, Roughness, and Density: Results of a Randomized, Placebo-Controlled, Blind Study. Nutrients. 2019;11(10):2494. Published 2019 Oct 17. doi:10.3390/nu11102494 2. García-Coronado JM, Martínez-Olvera L, Elizondo-Omaña RE, et al. Effect of collagen supplementation on osteoarthritis symptoms: a metaanalysis of randomized placebo-controlled trials. Int Orthop. 3. Health Benefits of Collagen: Pros, Cons, and More. Healthline. https://www.healthline.com/nutrition/collagen-benefits#side-effects. Published 2022. Accessed March 3, 2022. 2019;43(3):531-538. doi:10.1007/s00264-018-4211-5 4. Sibilla, S., Godfrey, M., Brewer, S., Budh-Raja, A. and Genovese, L., 2015. An Overview of the Beneficial Effects of Hydrolysed Collagen as a Nutraceutical on Skin Properties: Scientific Background and Clinical Studies. The Open Nutraceuticals Journal, 8(1), pp.29-42. 5. The Amazing History of Collagen. The Red Tree. https://theredtree.co.uk/articles/the-amazing-history-of-collagen/. Published 2022. Accessed March 3, 2022. 6. What Are Collagen Supplements?. Verywell Health. https://www.verywellhealth.com/collagen-supplements-for-skin-89940. Published 2022. Accessed March 3, 2022.

CRANBERRY

Spring 2022

VACCINIUM OXYCOCCOS By Anne Hummer - Student Pharmacist Background and History Cranberries are a type of fruit grown on a bush that are native to Northeastern America. Their history in traditional medicines began when Native Americans used them to treat bladder and kidney ailments. Eastern European folklore suggested that the berries had anticancer and antifever properties. Even sailors used cranberries to prevent scurvy.

COMMON USES Urinary Tract Infection (UTI) The most common use with clinical evidence, is in the prevention of urinary tract infections. Cardiovascular Disease (CVD) More research on the link between cranberries and CVD needs to be conducted. Some reviews suggest that it can help with CVD. Cancer

Pixabay."Cranberries."PublicDomainPictures

MECHANISMS OF ACTION Cranberries are useful primarily for their antibacterial and antiinflammatory properties. What makes them useful is they decrease the bacteria's ability to adhere to surfaces and form biofilms. This in turn helps to reduce inflammation where the bacteria are attacking.

DOSAGE FORMS AND DOSING Cranberry Juice 120 mL - 1000 mL per day cranberry Extract Capsules 600 mg - 1200 mg per day Dried cranberry powder 250 mg - 1500 mg per day

Recent studies suggest that cranberry extract inhibits the growth of multiple types of cancers including oral, colon, and prostate.

"Flat Textured Rustic Autumn Harvest Cranberries." Trendify

EFFECTIVENESS

SIDE EFFECTS

In general, consumption of cranberry When it comes to the prevention of UTIs, products is well tolerated and has few side studies have shown that cranberries can effects. be helpful. One analysis concluded that Diarrhea the use of cranberry products in healthy Gastrointestinal discomfort females decreased their risk of having a recurring UTI of 26%. MY PROFESSIONAL OPINION For cardiovascular disease, the There are mixed reviews when it comes to effectiveness of cranberries seems to be cranberries and their potential benefits. In unlikely. A study showed that there was my opinion, if you are a healthy female that no clinical significance in the effects of will have no drug or conditional interactions cranberry on diastolic blood pressure, with cranberries, then it is worth trying. glycemic control, and lipid levels. Cranberries are a good source of vitamins The link between cancer prevention and outside of their antibacterial properties and cranberries has vague effectiveness. they are relatively easy to incorporate into Some sources say that in invitro studies it one's diet. The cost of cranberry products is has shown effectiveness while others say relatively not expensive when compared to more work needs to be done. other supplemental products. ~ A. Hummer

DRUG INTERACTIONS

RESEARCH ARTICLE

Moderate drug interactions ATORVASTATIN (Lipitor) CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES NIFEDIPINE (Procardia) WARFARIN (Coumadin) Minor drug interactions CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES DICLOFENAC (Voltaren, others) Conditional Interactions Aspirin Allergy Diabetes Kidney Stones

A 2017 study investigated the link between cranberries and the prevention of UTIs. They had nearly 1500 participants separated into seven randomized control groups. From there, some groups consumed cranberry products while the others none to compare the results between the two. The results were that cranberries seemed to reduce the risk of healthy women contracting a UTI by 27%.

SAFETY Cranberries are safe for human consumption at the proper dosing as described in the dosage forms section. There are no toxic effects.

REFERENCES Naturalmedicines.therapeuticresearch.com. 2022. Cranberry. [online] Available at: <https://naturalmedicines.therapeuticresearch.com/databases.aspx> [Accessed 24 February 2022]. Online.lexi.com.ezproxy.lib.purdue.edu. 2022. Cranberry. [online] Available at: <http://online.lexi.com.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/fc_rnp2/3750115? cesid=9idvlaf0cIW&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dcranberry%26t%3Dname%26va%3Dcranberry Cranberry> [Accessed 24 February 2022]. Zhuxuan Fu, DeAnn Liska, David Talan, Mei Chung, Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women: A Systematic Review and Meta-Analysis, The Journal of Nutrition, Volume 147, Issue 12, December 2017, Pages 2282–2288, https://doi.org/10.3945/jn.117.254961

SPRING 2022

CURCUMIN

Megan Jurek, Chemistry Student Common Uses Scientific Name Curcuma longa

Common names

Analgesic, anti-inflammatory and antioxidant. Used in food and is a primary component of curry powders and some mustards. Also found in cosmetics.

Turmeric, Curcuma, Haldi, Indian saffron

Pharmacology

History in Ayuervic Medicine To treat respiratory conditions, liver disorders, anorexia, rheumatism, diabetic wounds, cough & sinusitis.

History in Chinese Medicine To treat conditions that cause abdominal pain

Dosage Forms Available in powder or capsule form. Taken orally.

Modulates transcription factors, cytokines, growth factors, kinases, and other enzymes.

Typical Dosing 200 miligrams a day to 6 grams a day for treatment up to eight months

Effectiveness Can take up to eight months to be effective depending on the dosage. Efficacy also depends on the aim for treatment

The Author's Opinion When using in moderation, I believe that curcumin could be used to effectively reduce inflammation in many diseases and conditions. However, there are likely to be better treatments based on Western medicine and the use of curcumin as an added supplement in a medication regime should be advised by a doctor to avoid interactions with other medications. ~M. Jurek

Safety & Warnings

Avoid during pregnancy and lactation because of the effects of stimulating menstrual flow. Patients with gallstones, bile ducts, or passage obstructions should avoid. Should be also be avoided by heavy drinkers and those with liver disease.

Side Effects Dyspepsia and pruritus possible. As well as rare cases of contact dermatitis and anaphylaxis. Chronic use can cause liver toxicity.

Interactions CYP2D6 & CYP3A substrates, anti platelet anticoagulants agents, cladribine, nonsterodial antiinflammatory agents, salicylates, and thrombotic agents.

Research Curcumin has a potential role in the prevention and treatment of Alzheimer’s disease. Neurologically, Alzheimer patients experience neuronal loss in the temporoparietal and frontal cortex and inflammation due to amyloid plaques and neurofibrillary tangles. Curcumin has been used in Ayurveda medicine as mainly as an antiinflammatory and anti-oxidant. One study has shown that the binding of curcumin to the Egr-1 protein, which has a role in amyloid plaque production, has reduced the presence of inflammation. Curcuminoids, the active molecule in curcumin, have also been linked to inhibiting the formation of free radicals, thus reducing oxidative stress on neurons. (3)

References

(1) Van Wyk, & Wink, M. Phytomedicines, herbal drugs, and poisons. The University of Chicago Press; 2014. (2) Curcumin. Natural Products. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 8, 2022. http://online.lexi.com (3) Mishra, S., & Palanivelu, K. The effect of curcumin (turmeric) on Alzheimer's disease: An overview. Ann Indian Acad Neurol. 2008; 11(1): 13-19. Accessed Apr 11, 2022. doi: 10.4103/0972-2327.40220 48

Michael Kelley, Student Pharmacist Spring 2022

Dandelion Scientific Name: Taraxacum officinale https://www.gardeningknowhow.com/edible/herbs/dandelion/growingdandelion.htm

Common Names: Taraxacum, Lion’s Tooth, Pissenlit, Puffball

Background / History Dandelion is a perennial herb native to Europe and Asia, but has since been naturalized in North America. It has been used as a medicinal herb for centuries in places such as China and the Middle East. It has also been widely grown through the years as a food crop, however it has fallen out of favor over time and is most often recognized now as a persistent weed. It is thought that by blowing all the seeds of the seed head away in one breath a wish will be granted, however studies are currently inconclusive on this theory.

COMMON USES Dandelion is often used for its nutritional value. All parts of the plant are edible, with the leaves being used as salad greens or cooked, the root being eaten in salad, or the flowers being used to make a sweet wine or tea. Dandelion has also been traditionally used to treat hyperglycemia, liver disorders, digestion issues, and as a diuretic. However, there is limited clinical research to support these claims.

Pharmacology / Mechanism of Action Dandelion contains many compounds that are beneficial to the body. The leaves are a rich source of the antioxidant beta-carotene, which is used to make vitamin A. It is also a great source of fiber, potassium, calcium, magnesium, phosphorus, thiamine, and riboflavin. Some compounds found in the roots include taraxol, inulin, and linoleic acid. Bioactive compounds that have shown anti-diabetic potential include chicoric acid, taraxasterol, and chlorogenic acid.

DOSAGE FORMS Dandelion is available as a fresh herb as well as a dietary supplement. The herb can be eaten raw or cooked, as well as being brewed into a tea. Tinctures and oral dosage forms are also available.

TYPICAL DOSING Doses should not be higher than those seen in food. The German Commission E Monographs recommends the following doses: • •

3-4 g of dandelion root or 10-15 drops of root tincture twice daily 4-10 g of dandelion leaves or 2-5 mL of leaf tincture three times daily 49

Safety The FDA considers dandelion GRAS as a food; however, no safety data is available for quantities larger than normally found in food.

Interactions Dandelion contains vitamin K, so patients on Warfarin could experience decreased INR levels with increased intake of the herb. Case studies exist that also show interactions with drugs used for diabetes and diuresis.

Adverse Events / Toxicity Dandelion has a low acute toxicity. It can cause allergies in some individuals. Mild GI effects have also been reported. Dandelion should not be foraged from places where pesticides or other chemicals have been sprayed, as these may affect the purity of the herb and cause adverse events.

https://www.pbs.org/wgbh/nov a/article/dandelion-seed-flight/

Effectiveness Dandelion has been used throughout history for the treatment of liver diseases, digestive problems, and as a diuretic. It was also used in home remedies to treat a wide range of conditions, ranging from toothaches and fevers to baldness and depression. Hypoglycemic activity, GI and choleretic activity, hypolipidemic activity, antimicrobial, and anticancer effects have been tested in animal models, but human clinical trials have not been performed.

PROFESSIONAL OPINION “I believe there is sufficient evidence to support consuming dandelion for its nutritional benefits. However, I believe there is insufficient data in human trials to support using dandelion for the treatment of medical conditions.” ~ M. Kelley

REFERENCES Rothfeld A. The dandelion – circulating now from NLM. U.S. National Library of Medicine. https://circulatingnow.nlm.nih.gov/2016/06/07/the-dandelion/. Published June 7, 2016. Accessed March 4, 2022. Link R. Dandelion: Health benefits and side effects. Healthline. https://www.healthline.com/nutrition/dandelion-benefits#TOC_TITLE_HDR_11. Published January 4, 2022. Accessed March 4, 2022. Lexicomp. Dandelion (Natural Products Database). Facts and comparisons®: Drug Referential Resource. https://www.wolterskluwer.com/en/solutions/lexicomp/facts-and-comparisons. Published August 23, 2019. Accessed March 4, 2022. Wirngo FE, Lambert MN, Jeppesen PB. The Physiological Effects of Dandelion (Taraxacum Officinale) in Type 2 Diabetes. Rev Diabet Stud. 2016;13(23):113-131. doi:10.1900/RDS.2016.13.113 50

https://www.walmart.com/ip/Nature-s-Way-DandelionRoot-525-mg-100-Capsules/26965397

Devil’s Claw

Cecelia Kaiser, Student Pharmacist, Spring of 2022

Scientific Name: Harpagophytum procumbens, Grapple Plant, Wood Spider 1 What is it? Devil’s Claw is a leafy perennial native to southern Africa, consisting of fruits covered in small hooks (where the common name is derived from), and branchlike roots and See Reference 8 off-shoots. The plant has secondary roots known as tubers, and these are used with the roots themselves to create medicine.1 This plant has been highly valued by Namibian natives, who have used it to treat a variety of conditions.3

What is it used for? Devil’s Claw is commonly purported to be a treatment for osteoarthritis and back or neck pain. Some herbalists claim that it can also be used to treat loss of appetite and upset stomach, in addition to headache and fever.1 One source claimed that Devil’s Claw could be used to treat or otherwise relieve all of the following: arteriosclerosis, arthritis, rheumatoid arthritis, bladder weakness, blood impurities, cholesterol, diabetes, gall bladder, gall stones, gout, headaches, inflammation, and many other disorders.3

How does it work? Devil’s Claw is known to contain iridoid glycosides, naturally occurring compounds known for their ability to reduce inflammation, among other things. The specific moieties identified within this plant species include harpagoside, harpagide, 8-coumaroyl-harpagide, and pagoside. The mechanism of these species is believed to be the “inhibition of cysteinyl-leukotrienes and TBX2, suppression [of] PGE2 synthesis and NO production by inhibiting LPSstimulated enhancement of the COXe-2 and iNOS mRNAs expressions.” See Reference 9

How should I take it? Devil’s Claw can be obtained as tablets, capsules, teas, topical ointments, liquid extracts, or as fresh or dried roots to be added to home remedies or recipes for the previously mentioned forms1. No formal research exists indicating safety or common dosages, however a brief search across the internet found several different brands available for purchase See Reference 5 that had dosing shown on them 4,5,6. Brand Nature’s Way Devil’s Claw (see Reference 4) Herb Pharm Devil’s Claw (see Reference 5) Earthborn Elements Devil’s Claw (see Reference 6)

Daily Dosing Two capsules twice daily (2 x 960 mg) twice daily = 3.84 g/day

Dosage Form and Ingredient Capsule; Devil’s Claw (tuber)

One full squeeze of the dropper bulb (0.7 mL) in 2 oz. of water or juice 2-4 times daily, preferably between meals Four servings (623 mg/serving = 2.492 g/day)

Liquid Extract; Devil’s Claw secondary tuber extract

Two capsules 1-3 times daily, preferably with meals and with at least 8 oz of water. Two capsules (800 mg) three times daily = 4.8g/day

Capsule; Devil’s Claw

Devil’s Claw How well does it work? Current research has produced limited conclusions, and a satisfactory answer to “Is it safe? Is it effective?” has yet to be found. Further research is warranted.2 However, a small study of 122 people found that over

See Reference 4

the course of 8 to 12 weeks, Devil’s Claw was found to provide “as much relief [as a leading European medication used in relieving pain] …[with] fewer side effects and [needing] fewer pain relievers throughout the study.”1 There is some evidence of efficacy, though it is limited.

What should I be concerned about? Due to possible gastrointestinal side effects, those with duodenal or stomach ulcers, or gallstones, should avoid using Devil’s Claw.1 Women who are pregnant or breastfeeding should avoid this supplement as sufficient research assuring its safety is not available.1 Devil’s Claw may interact with blood thinning medications, diabetes medications, antacids, and possibly other medications that See Reference 6 are broken down by the liver.1 More research will be necessary to understand how this drug affects other medications.

{Anti-Inflammatory Iridoids of Botanical Origin, Viljoen A, Mncwangi N, Vermaak I.} Many plants contain chemical compounds originating from the iridoid family and are known for their use in herbal medicine. This chemical family is well known for its effect on the complex process of inflammation. Many subspecies and moieties exist within the plant kingdom, allowing for many mechanisms and effective routes of administration, as well as differing efficacy from one plant to the next. This article summarizes the chemical species found in the most common plants used in herbal medicine, and their mechanisms. To summarize, Devil’s Claw is a relatively uncommon supplement, and therefore limited research exists. However, some evidence of efficacy has been found, and patients with few or low-risk comorbidities may find that non-excessive maintenance doses, or as needed doses, may provide them with adequate relief of their joint-related pain. If patients are interested in trying this supplement and no immediate contraindications are present, they should do so after informing their primary care physician or pharmacist. ~C Kaiser References: 1. 2.

Mount Sinai. Devil’s claw. Accessed February 22, 2022. https://www.mountsinai.org/health-library/herb/devils-claw Brien S, Lewith GT, McGregor G. Devil's Claw (Harpagophytum procumbens) as a Treatment for Osteoarthritis: A Review of Efficacy and Safety. J Altern Complement Med. 2006;12(10):981-93.

3. Ritchason J, eds. The Little Herb Encyclopedia: The Handbook od Natural Remedies for a Healthier Life. 3rd Edition. Woodland Publishing; 1995 4. Product image of Nature’s Way branded Devil’s Claw Supplement. Amazon. https://www.amazon.com/Natures-Way-Devils-Claw-

Capsules/dp/B000I48PIC/ref=sr_1_4?crid=3LA555UKHJ9XB&keywords=devil%27s+claw&qid=1645582730&sprefix=devil%27s+claw%2Cstripboo ks%2C84&sr=8-4. Accessed 2/22/2022

Product Image of Herb Pharm branded Devil’s Claw supplement. Amazon. https://www.amazon.com/Herb-Pharm-Extract-MusculoskeletalSupport/dp/B0006O2KL2/ref=sxin_14_cpf_saw-CPFPecos-dsk-lmlkasin?crid=3LA555UKHJ9XB&cv_ct_cx=devil%27s+claw&keywords=devil%27s+claw&pd_rd_i=B0006O2KL2&pd_rd_r=7e42cbe3-6a03-403f87d3-ffafe303c953&pd_rd_w=qiT0i&pd_rd_wg=ICeH6&pf_rd_p=3171e255-0ecb-47e8-9210cfa1596239ed&pf_rd_r=AVGPD6NXS00GX6Y8PBTS&qid=1645582730&rdc=1&sprefix=devil%27s+claw%2Cstripbooks%2C84&sr=1-2-88bb4e7bfb79-43dc-9dec-6da196f88672. Accessed 2/22/2022

6. Product Image of Earthborn Elements branded Devil’s Claw supplement. Amazon. https://www.amazon.com/Extract-Capsules-Strength-Non-GMO-

Serving/dp/B08R5L7LMT/ref=sr_1_22_sspa?crid=3LA555UKHJ9XB&keywords=devil%27s+claw&qid=1645582730&sprefix=devil%27s+claw%2Cs tripbooks%2C84&sr=8-22spons&psc=1&spLa=ZW5jcnlwdGVkUXVhbGlmaWVyPUEzRTJGUUQ2V1Q3UUFIJmVuY3J5cHRlZElkPUEwNTE4ODc5MTZZWFIwTzZCSVRCQyZl bmNyeXB0ZWRBZElkPUEwMzM0MzM2MURXUUNKWDBPVFo5OCZ3aWRnZXROYW1lPXNwX2J0ZiZhY3Rpb249Y2xpY2tSZWRpcmVjdCZkb05 vdExvZ0NsaWNrPXRydWU=. Accessed on 2/22/2022

Viljoen A, Mncwangi N, Vermaak I. Anti-inflammatory iridoids of botanical origin. Curr Med Chem. 2012;19(14):2104-2127. doi:10.2174/092986712800229005

8. Product Image of Harpagophytum procumbens/Devil’s Claw herb. Intelezi. https://www.inteleziherbs.co.za/product/harpagophytum-procumbensdevils-claw/

9. Product Image of Devil’s Claw Tea. Tea Life. https://www.tealife.com.au/products/devils-claw-tea 52

Dong Quai Christie J Kang BSPS Candidate Spring 2022

Background Dong Quai, also known as Angelica sinensis, is a female ginseng root that is grown in high altitude mountains in China, Japan, an Korea and has been medicinally used for to trreat irregular

Common uses Menopause Menstrual cramps Irregular periods Migraines Premature Ejaculation Blood circulation

menstrual cycles, menopause, or other hormonal related disorders.

Pharmacology Dong Quai is known to stimulate uterus activity by increasing the contractive rhythm of the smooth muscle of uterus. The movement of the uterus changes from fast, irregular, and weak to slow, regular, and stronger. It also increases DNA synthesis and glucose utilization of the uterus, which indicates the increase of uterus activity.

Dosage forms Dried Herb Tablets/capsules 500-600 mg of powdered herb (six times daily) Tincture (70% alcohol) 40-80 drops (2-4 mL taken three times daily)

https://www.gardeningknowhow.com/edible/herbs/angelica/gr owing-chinese-angelica-plants.htm

Article summary Dong Quai is a nontoxic herbal supplement that does rarely causes side effects even in large amounts.Unlike what most people believe, Dong Quai does not contain natural estrogen so it does not stimulate any estrogenic activity yet it has been reported that it does cause growth of breast cancer cells, so women with breast cancer are recommended to not take this supplement.

Effectiveness It takes around four weeks for benefits to kick in, but takes two months for the effect to become noticeable. Females have reported to have more regular menstrual cycles and relieved menstrual symptoms after two months.

Interactions

Dong Quai can increase the potency of Warfarin and other blood-thinning drugs which can increase the risk of severe bleeding and bruising.

Safety/warnings Consumption of Dong Quai during pregnancy can increase the risk of birth defects Can slow blood clotting and increase chance of bruising on people with bleeding disorders or patients recovering from surgery

Side effects Burping Gas Fever High blood pressure Upset stomach Increased risk of bleeding

Professional opinion There is not much study done on Dong Quai, but I believe that it is a great alternative to females who do not want to take birth control because it achieves the same effects with less severe also a more accessible drug since one does not need a prescription and it can be purchased more easily. ~ C. Kang

References 1. DONG QUAI: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews (2022). Webmdcom. Available: https://www.webmd.com/vitamins/ai/ingredientmono-936/dong-quai. Accessed 21 February 2022. 2. (2022). Available: https://www.drugs.com/npp/dong-quai.html. Accessed 21 February 2022. 3. Dong Quai: uses, dosage & background (2022). Sagacouk. Available: https://www.saga.co.uk/magazine/healthwellbeing/treatments/herbal-remedies/dong-quai. Accessed 21 February 2022. 4. Dong Quai - Cancer Care of Western New York (2022). Cancercarewnycom. Available: https://www.cancercarewny.com/content.aspx? chunkiid=21668. Accessed 21 February 2022. 54

Spring 2022

Garrett Meggs; Student Pharmacist

Elderberry

[3]

Scientific name: Sambucus nigra Background/history: Elderberry is a berry from the black elder tree found in Europe, North

America, North Africa, and Asia during warmer weather. It is dark purple in color. Historically, the elder tree was thought to protect against evil spirits, witches, and death.

Common uses: used to treat colds, flu, and general upper respiratory infections. Also used for cardiovascular benefit.

Pharmacology/mechanism of action: there are numerous proposed mechanisms of action. Multiple active ingredients are present including numerous ribosome inactivating proteins and flavonoids. Quercitin is present in noticeable amounts. Elderberry modulates IL-1 and TNF-alpha in vitro; increases IL-4, IL-13, and histamine; and modulates many other inflammatory pathways to lower inflammation. The flavonoid component provides antioxidant activity. Laboratory research shows inhibition of influenza and herpes simplex virus replication. Dosage forms: liquid extracts, dry powder capsules, elderberry juice, lozenges, and creams.

Spring 2022

Garrett Meggs; Student Pharmacist

Typical dosing: reported doses for influenza were 175mg of elderberry extract four

times a day for two days or 15mL of syrup four times a day for five days. General use has been reported as 3-5 grams of dried flowers placed in one cup of boiling water for 10-15 minutes. The resulting product is take three times daily. Cardiovascular use was reported as two capsules of 500 mg.

Effectivness: S. Nigra has shown inhibition of influenza

type A and B viruses along with herpes simplex virus 1. Symptoms of upper respiratory infections also saw improvement and included headache, cough, sore throat, fever, and fatigue from two studies albeit with design flaws. A long-term RCT from Curtis et. al. showed a lack of cardiovascular benefit. [2]

Safety: Cooked berries or flowers are likely safe if cyanide

levels are below 25 ppm according to the systematic review by Ulbricht et. al. [2]

[4]

Adverse effects: Cyanide poisoning, tachycardia due to cyanide poisoning,

application site reactions for topicals, GI distress, dysmenorrhea, CNS/respiratory depression, diuretic effect, and increased coughing have all been reported in various human studies. [2]

Toxicities: the root, bark, and leaves of elderberry contain cyanide in low levels.

Interactions: synergistic effect with doxycycline, may increase effects/adverse effects of alkylating cancer agents, may affect caffeine levels from quercetin, additive effect with diuretics, and add to VEGF inhibitor effects. [2]

Professional opinion: Elderberry has the most amount of evidence supporting its use in reducing symptoms or duration of upper respiratory infections, specifically influenza type A and B. It is generally regarded as safe especially if bought from pharmacies in the supplement form. I recommend 15mL of Sambucol® 4 times a day starting within two days of flu symptoms. ~ G Meggs

References 1. European Elder. NCCIH. https://www.nccih.nih.gov/health/elderberry 2. Ulbricht C, Basch E, Cheung L, et al. An evidence-based systematic review of elderberry and elderflower (Sambucus nigra) by the Natural Standard Research Collaboration. J Diet Suppl. 2014;11(1):80-120. doi:10.3109/19390211.2013.859852 3. Elderberry: Store bought vs Natural. Mountain Meadow Herbs. Published August 5, 2020. Accessed March 4, 2022. https://www.mmherbs.com/blog/mountain-meadowherbs-blog-3/post/elderberry-store-bought-vs-natural-93 4. https://marronspharmacy.ie/product/sambucol-extra-defence-liquid-120ml/

Evening Primose Annie Lin Student Pharmacist Spring 2022

Name/Background/History Evening primose, known scientifically as Oenothera biennis L., is a plant native to North and South America that also grows throughout Europe and parts of Asia. It has yellow flowers that open at sunset and close during the day. Native Americans made poultices from evening primose for bruises and wounds while using its stem and leaf juices as topical remedies for skin inflammations. Leaves were ingested orally for gastrointestinal complaints and sore throats.

Common Uses Premenstrual syndrome (PMS) Atopic dermatitis Menopause symptoms Mastalgia in women Pre-eclampsia in women High cholesterol

Dosage Forms/Servings Evening primose oil is available in either a capsule or liquid form. An individual typically takes 2-6 grams by mouth daily for 3-12 months.

Pharmacology The seeds of evening primose oil (EPO) are tpically used because they are rich in omega-6 essential fatty acids, including linoleic acid and gammalinolenic acid. The therapeutics effects are caused by the direct action of its fatty acids on immune cells as well as their indirect effect on the synthesis of eicosanoids. 57

Effectiveness

It may take six weeks to notice any difference, but most people report changes in 1-2 weeks. Research shows that evening primrose has an effect on increasing the level of prostaglandins in your body, regulating hormones that are linked to inflammatory response, and helping relieve symptoms of PMS.

Adverse/Side Effects Abdominal pain Nausea Increased bowel movements Diarrhea Headaches

Warnings/Toxicities People with epilepsy or schizophrenia should also not use evening primose, and avoid use while on phenothiazine neuroleptics or anticonvulsants.

My Opinion

Interactions Evening primose should not be used while taking antihypertensive agents, anticoagulants, NSAIDS, and cytochrome P450 substrates.

Based on research I have done, I think that evening primose could help in terms of PMS and should be taken for a short time interval (at most 6 months since we are unsure of all its side effects). - A Lin

Summary of Research Article Evening Primrose (oenothera biennis) Oil in Management of Female Ailments The research article was over evaluating the efficacy of evening primose oil in the management of female ailments, and so they split people up and gave one group placebos while the other group actual EPO. They found that EPO is effective in treating women who have mastalgia, gestational diabetes, pre-eclampsia, and cervical ripening and dilatation.

Citations Plant database. Lady Bird Johnson Wildflower Center - The University of Texas at Austin. Accessed February 25, 2022. Evening primrose oil. National Center for Complementary and Integrative Health. Accessed February 25, 2022. Evening primrose oil: Overview, uses, side effects, precautions, interactions, dosing and reviews. WebMD. Accessed February 25, 2022. Oenothera biennis (common evening primrose). Gardenia.net. Accessed February 25, 2022. Evening primrose oil: Uses, dosage & background. Saga. Accessed February 25, 2022. Evening primrose. Mayo Clinic. Published November 13, 2020. Accessed February 25, 2022. Evening primrose. Grand Prismatic Seed. Accessed February 25, 2022. Mahboubi M. Evening primrose (oenothera biennis) oil in management of female ailments. Journal of menopausal medicine. Published August 2019. Accessed February 25, 2022.

Fenugreek

Will Moffett, Student Pharmacist Spring 2022

Scientific Name Trigonella foenum-graecum L.

Common Name(s) Faenum graecum; Fenugreek; Huluba; Methi; Semen Trigonellae

History Fenugreek herb has been used for centuries as a cooking spice in Europe and remains a popular ingredient in pickles, curry powders, and spice mixtures in India and other parts of Asia. In folk medicine, fenugreek has been used to treat boils, cellulitis, and tuberculosis. It was a key ingredient in a 19th century patent medicine Lydia Pinkham's Vegetable Compound, which was used for dysmenorrhea and postmenopausal symptoms. It has also has been recommended for the promotion of lactation. Fenugreek seeds have been used as an oral insulin substitute, and seed extracts have been reported to lower blood glucose levels. The maple aroma and flavor of fenugreek has led to its use in imitation maple syrup. The seeds are rich in protein, and the plant is grown as animal forage.

Uses Limited clinical trial data suggest fenugreek extracts may have a role in the therapy of dyslipidemia, diabetes, and Parkinson disease; however, studies were limited and provided inconsistent dosing information, making it difficult to provide recommendations.

Dosing Wide-ranging dosages and differing preparations have been used in clinical studies. A standardized hydroalcoholic extract of fenugreek seeds is available, and a trial evaluated its use in patients with Parkinson disease at 300 mg twice daily for a period of 6 months. Studies in patients with type 2 diabetes and hypercholesterolemia have used from 1 g/day of a hydroalcoholic extract of fenugreek up to 100 g/day of germinated fenugreek seeds, whereas seed powder 1.8 to 2.7 g taken three times daily for the first three days of menstruation was used in primary dysmenorrhea (total daily dose, 5.4 to 8.1 g); 500 mg twice daily of a standardized extract was studied for management of postmenopausal symptoms.

Pharmacology

Polysaccharides such as galactose and mannose are found in fenugreek seeds, which are associated with anticholesterolemic and antidiabetic properties. A small clinical

study evaluated the effect of adjuvant standardized hydroalcoholic extract of fenugreek seeds in patients with Parkinson disease. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS), and Hoehm and Yahr (H & Y) staging measured at baseline and at 6 months. Fenugreek showed greater efficacy than placebo

Interactions

Interactions with anticoagulant and hypoglycemic agents are possible.

Adverse Reactions Mild and transient GI effects are most commonly reported; hypoglycemia, micturition, dizziness have also been documented within a range of doses and variety of preparations. When ingested in culinary quantities, fenugreek is usually devoid of adverse reactions. Allergy to fenugreek is recognized, including severe responses such as asthma, anaphylaxis, and toxic epidermal necrosis. Cross-reactivity to legumes is possible; consider allergy potential with chickpea, peanuts, soybeans, lentils, lupin, green peas, or coriander.

Safety Fenugreek is believed to be safe in the amounts commonly found in food. Its safety in larger quantities is uncertain. It should not be used by children. Fenugreek is not safe for use during pregnancy in amounts greater than those in food; its use has been linked to increased risks of birth defects in both animals and people. Little is known about whether it’s safe to use fenugreek in amounts greater than those in food while breastfeeding.

Toxicology Doses for humans should not exceed 350 mg/kg.

Professional Opinion I believe fenugreek can be a viable option for patients with dyslipidemia, diabetes, and Parkinson disease when prescription options fail. ~ W. Moffett

References 1. Trigonella L. USDA, NRCS. 3013. The PLANTS Database (http://plants.usda.gov, 21 November 2013). National Plant Data Team, Greensboro, NC 27401-4901 USA. Accessed February 24, 2014. 2. Ulbricht C, Basch E, Burke D, et al. Fenugreek (Trigonella foenum-graecum L. Leguminosae): an evidence-based systematic review by the natural standard research collaboration. J Herb Pharmacother. 2007;7(3-4):143-177.[PubMed 18928139] 3. Elujoba AA, Hardman R. Saponin-hydrolyzing enzymes from fenugreek seed. Fitoterapia. 1987;58:197-199 4. Chandel HS, Pathak AK, Tailang M. Standardization of some herbal antidiabetic drugs in polyherbal formulation. Pharmacognosy Res. 2011;3(1):49-56.[PubMed 21731396] 5. Fenugreek. Lexi.com. Published 2019. https://online.lexi.com

Feverfew

Elizabeth Loper, Pre-med student Spring 2022

Scientific Name: Tanacetum parthenium Common Names: Wild quinine, featherfew, altamisa, bachelor’s button, wild chamomile, nosebleed, flirtroot Name comes from the Latin word febrifugia which means “fever reducer”

Background/history: • • • • • • • •

Used by Greek and European herbalists From Balkan peninsula Aspirin of the 18th century Used as an antipyretic Often mistaken for chamomile Found in upland prairie areas and glades in North America Some Native American tribes used it for a poultice Grows in clusters Available forms: Leaves, fresh or dried Fluid extracts

Typical dosing: Daily dose of 50-150 mg of dried leaves OR

Tea

Five to 20 drops fluid extract

Pharmacology:

• The parts of feverfew that have medicinal effects are sesquiterpene lactones, and the parthenolide compounds found in the leaf glands. • Polar flavonoids block prostaglandin synthesis. • There is also cytotoxic action that interrupts DNA replication which may result in anticancer activity.

Common Uses:

Feverfew can be used for fevers, migraines, rheumatoid arthritis, stomach aches, toothaches, insect bites, infertility, problems with menstruation and labor during childbirth, psoriasis, allergies, asthma, tinnitus, dizziness, nausea, and vomiting. However, the most common uses are for migraines and anti-inflammatory purposes, such as arthritis.

Safety/warnings: It is not safe for pregnant women due to potentially stimulating menstrual flow. It is not recommended for lactating mothers or for use in children.

Food/Drug Interactions: Feverfew can interact with blood-thinning medications such as aspirin and warfarin) because feverfew can inhibit the activity of platelets.

Summary of one article/study:

Effectiveness: Studies have mixed results on whether Feverfew helps with migraines and others indicate it is only slightly more helpful than placebos. However, it does seem to be effective against inflammation.

J.J Murphy, S Heptinstall, J.R.A Mitchell, Randomised Double-Blind Placebo-Controlled Trial of Feverfew in Migraine Prevention, The Lancet, Volume 332, Issue 8604, 1988, Pages 189-192, https://doi.org/10.1016/S0140-6736(88)92289-1.

• •

Side effects: 1. “Post-feverfew” syndrome which can happen to long-term feverfew users and cause fatigue, anxiety, headaches 2. Mouth ulceration: widespread inflammation that includes lip swelling and loss of taste My personal/professional opinion: Feverfew is a very versatile herb and has been shown to help a lot of people with inflammatory medical conditions and migraines, so I believe it is a safe and effective supplement to take as long as it is used correctly by adults. ~ E. Loper

• •

76 participants that suffered from migraines were in the study First, there was one month of placebo then participants were randomly selected for four months of feverfew or continuing placebo Some participants withdrew from the study either because there was no improvement or that they experienced side-effects The study concluded that there was a reduction in migraine frequency and associated vomiting References:

Pareek A, Suthar M, Rathore GS, Bansal V. Feverfew (tanacetum parthenium L.): A systematic review. Pharmacognosy reviews. https://pubmed.ncbi.nlm.nih.gov/22096324/. Published January 2011. Accessed February 26, 2022. Pictures References: Feverfew herbal medicine by Jeremy Burgess/science photo library. Pixels. https://pixels.com/featured/feverfew-herbalmedicine-jeremy-burgessscience-photo-library.html. Accessed February 26, 2022. Wong C. What is feverfew and what does it do? Verywell Health. https://www.verywellhealth.com/the-health-benefitsof-feverfew-89562. Published June 6, 2020. Accessed February 26, 2022. Raman R. What is Feverfew, and Does it Work for Migraines?. Healthline. https://www.healthline.com/nutrition/feverfew. Published January 25, 2019. Accessed February 26, 2022.

FLAXSEED “Linum Usitatissimum L.” Common Name(s): Flax, Flaxseed, Linseed, Lint bells, Linum

Background/History Flax seed originated in the Mediterranean region into India. It was introduced to the US by the colonists. This has been used for 120 centuries as a source of fiber for linen and was one of the earliest plants used for

Dosage form/ Dosing

purposes other than food. The term usitatissimum means

seed, oil, powder, gel, oral, rectal, and topical

very useful in Latin. The fiber that they used comes

whole or ground 5-50g/day or 4-60mL of oil daily. Children at doses equivalent to 400mg of ALA daily in divided doses. 8g of seed or 2.5g of oil = 1.1g of ALA for women and 1.6g for men

from the stem and the oil comes from the seed. Flax oil is also used in paints and varnishes as waterproofing agent. Flaxseed cake leftover from extracting the oil is used as cattle feed. Moistened seed is also used to remove foreign material from the eye. It was first pharmacology used as demulcent, emollient, and laxative for certain animals. Other uses are also coughs, cold, constipation, and UTI.

Effectiveness Flaxseed oil is one of the best natural sources of ALA (omega 3-fatty acid), linoleic acid ( omega 6-fatty acid), and lignans. Flaxseed oil appears beneficial in certain aspects of the metabolic syndrome, consisting of overweight, dyslipidemia, insulin resistance, and/or hypertension

Safety Pregnancy/ Lactation: not recommended Safety to ingest > 50g/ day has not established

Toxicity FDA has not granted GRAS. Agency allows up to 12% flaxseed in food by weight. Flaxseed and flaxseed oil are safe in doses up to 50g/day. Anecdotally may result in weakness, unstable gait, paralysis, or seizures.

LAM NGUYEN , student pharmacist SPRING 2022

Clinical Uses Antioxidant effect

Pharmacology / Mechanism of Actions

Antiplatelet effect

• Laxative effects from increased volume and consequent initiation of intestinal peristalsis from stimulation of stretch receptors. Mucilage protects the mucosa and facilitates movement of intestine. • Metabolites of ALA and linoleic acid act as substrates for the formation of the anti-inflammatory eicosanoids, comprising prostaglandins, thromboxane, and leukotrienes. • Omega fatty acids suppress the production of

Attention deficit hyperactivity disorder Bipolar disorder Constipation Dermatology Dyslipidemia

interleukin, tumor necrosis factor, and leukotriene B4 from monocytes and polymorphonuclear leukocyte

DM Gout HTN Lupus nephritis Menopausal symptoms

Interactions v Flaxseed itself contains mucilage absorption that coadminister with other drugs may be affected. Oral

Adverse Effects Usually well tolerated with few reactions reported related

drugs should be taken one hour before or two hours after consuming flaxseed to prevent absorption of the drug decreasing. Flaxseed also induce the

to flaxseed allergy such as palmar pruritus, generalized

enhancement effect of laxatives. Flaxseed oil

urticaria, nausea/vomiting, intestinal/abdominal pain,

enhance antiplatelet effect of ibrutinib.

diarrhea, sneezing, nasal obstruction, and intense general malaise. Flaxseed, not the oil, can cause digestive symptoms like dietary fibers such as bloating, flatulence, abdominal pain, diarrhea, dyspepsia, and nausea.

References: Flax. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at:

Professional Opinions After researching on flaxseed, I would not recommend patient taking this as medication for treatment. There is not enough clinical evidence that this is more helpful than harm. I would recommend if they requested to take this on the side under 50g/day but not as a treatment. ~ L. Nguyen

https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750147?cesid=3oF48qMk Qc3&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dflaxseed%26t%3Dname%26va%3Dfl axseed#monograph-tab-content. Accessed February 11, 2022. Flax. Micromedex Products: https://www.micromedexsolutions.com/micromedex2/librarian/CS/A40D78/ND_PR/eviden cexpert/ND_P/evidencexpert/DUPLICATIONSHIELDSYNC/E66888/ND_PG/evidencexpe rt/ND_B/evidencexpert/ND_AppProduct/evidencexpert/ND_T/evidencexpert/PFActionId /evidencexpert.DoIntegratedSearch?SearchTerm=flax&UserSearchTerm=flax&SearchFilt er=filterNone&navitem=searchALL#. Published June 2001. Accessed February 20, 2022 Goyal, Ankit et al. “Flax and flaxseed oil: an ancient medicine & modern functional food.” Journal of food science and technologyvol. 51,9 (2014): 1633-53. doi:10.1007/s13197013-1247-9

Radhika Patel, Student Pharmacist

Spring 2022

Gamma-linolenic acid Jaeger G. The Health Benefits of GLA. Nordic Naturals. https://www.nordic.com/ healthy-science/health-benefits-of-gla. Published June 23, 2021. Accessed March 29, 2022.

Scientific Name all-cis-6,9,12-octadecatrienoic acid Common Names: Gamma-linolenic acid, Gamolenic acid, GLA Background/History Gamma-linolenic acid is an omega-6, 18 carbon polyunsaturated fatty acid which is found in the human milk and several botanical seed oils, and it is typically used as a dietary supplement. Omega-6 fatty acids are essential fatty acids. They are essential fatty acids, but the human body cannot make them, so we have to consume them as a dietary supplement. Gamolenic acid is produced minimally in the body as the delta 6desaturase metabolite of linolenic acid. Then it is converted to dihomo-gamma-linolenic acid, which is a biosynthetic precursor of monoenoic prostaglandins such as PGE1. Gamolenic acid is also found in some fungal and it is naturally present in the form of triglyceride. Common uses Gamma-linolenic acid is used for following conditions and could also be used for rheumatoid arthritis, allergies, breast cancer, acne, mastalgia and premenstrual syndrome. ● Diabetic neuropathy: some studies show that taking GLA for six months can reduce nerve pain symptoms and people who have good control over blood sugar may find GLA more effective. ● Osteoporosis: studies suggest that people who do not take GLA supplements are more likely to have bone loss than those with normal levels of GLA. ● Menopausal symptoms: treats hot flashes and night sweats ● Breast cancer: study found that women who took tamoxifen and GLA had a better response vs the women who only took tamoxifen. ● ADHD: clinical study suggests that children with ADHD have lower levels of this fatty acid and this fatty acid is needed for the development of the brain, so taking this supplement helps reduce the symptoms of ADHD. Pharmacology/mechanism of action: When gamma-linolenic acid is absorbed in the body it gets converted into dihomo-gamolenic acid. Then they are further converted into several lipid mediators with predominantly anti-inflammatory properties such as prostaglandin-E1 and 15-HETrE. PGE1 and 15- HETrE have been known to suppress inflammation, decrease blood pressure, promote vasodilation, inhibit platelet aggregation, and exert anti-neoplastic activities. GLA also increases calcium absorption, decreases excretion and increases calcium deposition in bone. It may also stop the growth of tumor in vivo by increasing the expression of E-cadherin. This molecule acts as a suppressor of metastasis.

Dosage forms: Dosage forms usually vary based on the conditions. GLA supplements are made from EPO, black currant seed and borage seed oil. Most supplements are capsules containing oil. Typical dosing: Dosage usually varies based on the conditions. Should not take GLA greater than 3000 mg per day. Higher levels could cause inflammation. Infants can get enough essential fatty acids in the breast milk if the mother is eating a balanced diet, so supplements should not be given to infants unless prescribed by the physicians. Route of elimination: it is eliminated via renal excretion. Effectiveness: GLA and GLA/n-3 PUFA supplements help treat inflammation. Safety: supplements of GLA have been safely administered in clinical trials at an oral dose of 2.8 grams per day or maybe less for a year and GLA rich oils have also been used in the USA for some time now and there have been no reports of serious adverse effects. Adverse effects and toxicities: some adverse effects include soft stool, belching, and abdominal bloating. Interactions: if you are taking any of the following medications, then you should talk to your doctor first about taking this supplement. ● ● ● ● ●

Blood thinning medications like aspirin, Plavix and warfarin Chemotherapy Ceftazidime Cyclosporine phenothiazines

Precautions: Because of the side effects and interactions with other medications, you should always talk to your doctor first and take them under healthcare supervision. If you have a seizure disorder, then you should not take omega-6 fatty acids. Pregnant women should not take borage seed oil, and other sources of GLA, because they could harm the fetus and induce early labor. Professional opinion: in my opinion I would recommend taking this supplement because it is essential and our body cannot make it, so we need it, but at the same time I recommend talking to your doctor first before you start taking this medication. ~ R. Patel References ● Tasset-Cuevas I, Fernández-Bedmar Z, Lozano-Baena MD, et al. Protective effect of borage seed oil and gamma linolenic acid on DNA: in vivo and in vitro studies. PLoS One. 2013;8(2):e56986. doi:10.1371/ journal.pone.0056986 ● Sergeant S, Rahbar E, Chilton FH. Gamma-linolenic acid, Dihomo-gamma linolenic, Eicosanoids and Inflammatory Processes. Eur J Pharmacol. 2016;785:77-86. doi:10.1016/j.ejphar.2016.04.020 ● https://www.sciencebasedhealth.com/GLA-A-Safe-Effective-Anti-Inflammatory-Omega6-Fatty-Acid-W57.aspx

Kaitlyn Margraf Student Pharmacist Spring 2022

Garcinia Cambogia COMMON NAMES: Garcinia, Malabar Tamarind, Brindle Berry SCIENTIFIC NAME: Garcinia Gummi-Gutta HISTORY: native to India and Southeast Asia; used as condiment and preservative in Asian countries

Figure 1. Garcinia Cambogia plant. www.peninsuladailynews.com

PURPORTED USE: weight loss – rind contains hydroxycitric acid (HCA) which may affect appetite; also promoted for relief of join pain, digestive symptoms, improve athletic performance Available dosage forms: capsules and tablets Typical dosing/serving: 1500-3000mg daily. Divide into two or three doses PHARMACOLOGY: Suggested mechanism is to inhibit lipogenesis, increase lipid oxidation, and reduce food intake. HCA inhibits the first step of fatty acid synthesis by inhibiting ATPcitrate lyase. This blocks the conversion of citrate to acetyl-CoA. Other possible pathways are displayed in the graphic below.

Figure 2 (Above). Garcinia cambogia capsules. Source: How Safe is Garcinia cambogia and other weight loss supplements? Piedmont.org Figure 3 (Left). Possible pathways of action of Garcinia cambogia. Source: A Comprehensive Scientific Overview of Garcinia Cambogia, Semwal et. al. 67

EFFECTIVENESS: Results from studies are conflicting so it is difficult to determine whether this supplement is effective for weight loss. SAFETY AND TOXICITY: Not well known, but pure substance does not appear to have significant safety concerns. Side effects may include headache, nausea, diarrhea, and other gastrointestinal symptoms. Some cases of severe liver damage have been associated with both garcinia combination products and products labeled to contain only garcinia cambogia. INTERACTIONS: No human data available

STUDY SUMMARY: EFFECTS OF GARCINIA CAMBOGIA (HYDROXYCITRIC ACID) ON VISCERAL FAT ACCUMULATION Hayamizu K, Ishii Y, Kaneko I, et. al.

In a double-blind, randomized, placebo-controlled, parallel-group study 18 participants were given Garcinia cambogia (1000mg HCA/day) and 21 were given placebo. Participants were put on a diet monitored by a registered dietitian with limited calorie intakes of 2250kkcal/day for men and 1800 kkcal/day for women. Determination of fat was measured by CT scans and body indices such as body weight and height. After 16 weeks, the Garcinia cambogia group has significantly reduced visceral, subcutaneous, and total fat areas. No rebound effect was observed when both groups were given placebo for four weeks after the study.

PERSONAL/PROFESSIONAL OPINION: Studies on the effectiveness of Garcinia cambogia are conflicting. It does not appear to have harmful effects, however the manufactured product may contain other ingredients or harmful components. Personally, I would not purchase this product as it is not a magic weight-loss solution. It may be effective when combined with diet and exercise, although that effect may be due to the lifestyle changes and not the Garcinia cambogia. -K Margraf References Garcinia Cambogia. IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed February 25, 2022. http://www.micromedexsolutions.com Hayamizu K, Ishii Y, Kaneko I, Shen M, Okuhara Y, Shigematsu N, Tomi H, Furuse M, Yoshino G, Shimasaki H. Effects of garcinia cambogia (Hydroxycitric Acid) on visceral fat accumulation: a double blind, randomized, placebo-controlled trial. Current Therapeutic Research 2003. doi:10.1016/S0011393X(03)00152-8 0011-393X/03 NCCIH. Garcinia Cambogia. Accessed February 24, 2022. https://www.nccih.nih.gov/health/garciniacambogia Semwal RB, Semwal DK, Vermaak I, Viljoen A. A comprehensive scientific overview of Garcinia cambogia. Elsevier 2015. doi:10.1016/j.fitote.2015.02.012 Vitamin Shoppe. Accessed February 24, 2022. ://www.vitaminshoppe.com/search?search=garcinia% 20cambogia 68

Spring 2022

GARLIC ( A L L I U M S A T I V U M L. FAM. LILIACEAE) JULIANNA MASSA - PRE-PA STUDENT

HISTORY OF USE

Garlic has a long history of being used for its medicinal properties. It has gone by many names including Russian penicillin, rank rose, and snake grass. It is native to Middle Asia where it was used to treat depression. In Ancient India, it was a remedy used to cure a lack of appetite, general weakness, cough, and skin disease. The Egyptians fed their slaves garlic to provide them with vitamins and stifle their appetite to make them capable of doing more work. Hippocrates lists garlic as a remedy for intestinal parasites. In World War I, it was used as a natural antibiotic in place of penicillin for the Russian Army. In fact, garlic’s antiseptic properties have been used to stop cholera and typhoid fever in the early 1900s in Beirut (Petrovska BB, Cekovska S.).

Image A

AVAILABLE FORMS AND DOSAGES

MECHANISM OF ACTION

Garlic supplements can be taken using fresh, aged, or boiled garlic as well as garlic oil. The best way to take it to retain the allicin is either crushed or sliced raw garlic. Grilling or roasting it will not damage the allicin. The recommended daily dosage range is 600-1,200mg divided into small portions and eaten with meals. The minimum effective dose is one clove (Petrovska BB, Cekovska S.).

Various compounds in garlic such as ajoene and allicin lead to many of its effects. Ajoene produces antithrombotic effects by inhibiting lipoxygenases, increasing fibrinolysis, and decreasing thrombocyte production. Garlic also decreases the concentration of triglycerides, serum lipids, and cholesterol in blood. It also prevents the generation of dangerous free radicals (Petrovska BB, Cekovska S.).

COMMON USES There are different uses for garlic around the world. Some of the most popular include treating stomach aches, the common cold, atherosclerosis, high blood pressure, high cholesterol, dandruff, hair loss, and depression. It has also been used to fight many infectious diseases such as typhoid fever and influenza. It is also said to have antiaging and anti-cancer properties (Petrovska BB, Cekovska S.).

Image B 69

EFFECTIVENESS Effects of garlic supplementation tend to take at least two weeks to be observable. Taking 600mg of garlic powder daily reduced LDL cholesterol in participants in a study after two weeks. It also reduced total cholesterol and blood pressure in persons with hypertension. The frequency of developing the common cold was 60 to 70 percent lower in people who took garlic daily than those who did not (Patel K).

MY OPINION I believe that garlic is beneficial for those who have high blood pressure, high cholesterol, and unflavored food. It is a great supplement because it is easy to find at your local grocery store and relatively easy to incorporate into one's daily routine. I already use garlic in my cooking for flavor, but it's nice to know that it is packed with nutrients that are helping my body. ~ J. Massa

TOXICITY, SIDE EFFECTS, AND INTERACTIONS There are some side effects and warnings about garlic. The main effect that those who consume fresh garlic may notice is the unpleasant odor it may give to one's breath. Garlic oil has a “potentially high level of toxicity” when compared to fresh garlic. Also, at high doses it has been seen to have bloodthinning properties and toxicities. Supplementation should never go beyond 5 percent of the diet, which means about 17 grams for a 150 pound person. Very high doses may interact with Warfarin, an anticoagulant, as well as isoniazid, NNRTIs, and saquinavir (Patel K).

SUMMARY OF SCIENTIFIC ARTICLE In an article published in the Journal of Primary Health Care in 2014 by Martini, they evaluated the effects of 12 week garlic supplementation. They found that there was a significant reduction in common cold frequency. It also resulted in a reduction of the severity and duration of symptoms when compared to a placebo group. They also found that there was a “reduction in mean supine systolic and diastolic blood pressure” (Martini N).

SOURCES Image A: Garlic [Photograph] Wallpapers High Quality. http://yesofcorsa.com/garlic/ Image B: [Photograph] TreeHugger. https://www.treehugger.com/planting-garlic-in-the-fall4865530 Petrovska BB, Cekovska S. Extracts from the history and medical properties of garlic. Pharmacogn Rev. 2010;4(7):106-110. doi:10.4103/0973-7847.65321 Patel K. Examine. Garlic. Accessed February 24, 2022. https://examine.com/supplements/garlic/ Martini N. Potion or poison? garlic. Journal of Primary Healthcare 2014; 6, 337-338. doi:10.1071/HC14337

GINGER LAUREN MIKELL | STUDENT PHARMACIST|SPRING 2022

SCIENTIFIC NAME Zingiber officinale

PURPOSE/COMMON USES It is said that ginger has analgesic and antiinflammatory effects in nausea, vomiting, dizziness, and headaches/ brain.

TYPICAL DOSING/ SERVING Doses of ginger can range from 250mg to 2g per day given in three divided doses.

BACKGROUND/HISTORY OF GINGER Ginger is a part of a plant family that also includes turmeric. However, it does not grow in the wild and some of its origins are uncertain. Ginger was produced by the Indians and Chinese as a tonic root to treat many ailments with India being the largest producer. It was an article of trade and much of it was exported from India to nations at the time including the Roman Empire many years ago. Ginger of course became highly valued for its medicinal properties. It was put in bread to be used as a digestive aid; it was also used as treatment for nausea and vomiting. Although early in its time it was recognized as a flavoring agent in foods, later in its use it was very popular to be used in sweets hence the creation of gingerbread and many other desserts.

PHARMACOLOGY MECHANISM OF ACTION The exact mechanism is not understood completely as of now, but the compounds found in the ginger have antioxidants, anti-inflammatory, anti-analgesic, and anti-tumor properties. These compounds target nausea, vomiting, and digestive issues.

AVAILABLE DOSAGE FORMS Tablets, capsules, syrups, teas, essential oils, dried powder, ointments, topical gels, liquid extracts 71

GINGER Lauren Mikell|Student Pharmacist|Spring 2022

SUMMARY OF ARTICLE/STUDY EFFECTIVENESS The time it takes for ginger to work depends on the person and what is being treated. There are clinical, lab, and animal studies that provide evidence that ginger might be effective.

FOOD/DRUG INTERACTIONS Check with a doctor before taking ginger if taking other medications. Ginger might interact with blood thinners and medications to treat diabetes and high blood pressure.

REFERENCES Griffin, R. M. (n.d.). Ginger: Health benefits & side-effects. WebMD. Retrieved February 26, 2022, from https://www.webmd.com/vitamins-andsupplements/ginger-uses-and-risks Bode, A. M. (1970, January 1). The amazing and mighty ginger. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Retrieved February 26, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK92775/ Modi, M. (2021, December 4). Ginger root. StatPearls [Internet]. Retrieved February 26, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK56588 6/

This article was written by R. Morgan Griffin; he discusses health benefits, side effects, interactions, nutrition, origin, and risks of ginger. There was also a supplemented video that voiced some of this information in a minute-long clip. In his article he says that there is evidence that studies have proven that ginger can theoretically lessen swelling, lower blood sugar, lower bad cholesterol levels, prevent blood clotting, and even protect against Alzheimer’s Disease while clinical evidence just shows that ginger may help with blood pressure and blood sugar. Ginger also has evidence that indicates that it aids in many conditions such as joint pain, nausea, periods, and more. Overall, the article gave ginger big props. At the end the author also stated that with ginger being a dietary supplement, the makers of these products don’t have to prove as well that the products are safe or effective for the patient/consumer.

SAFETY, WARNINGS, TOXICITIES, & SIDE EFFECTS In low doses, ginger is likely very safe. In higher doses, however, it can cause mild side effects including diarrhea, heartburn, stomach discomfort, gas, and mouth irritation. Ginger can potentially be unsafe for people with bleeding disorders. Consult a doctor before starting ginger.

PROFESSIONAL/PERSONAL OPINION As a professional, I do believe that ginger can aid with the severity of many conditions. I do not however, believe it can completely cure these conditions, but I don’t say this to devalue its quality. In terms of my personal opinion, I feel that more studies should be done to really find out the truth of the effects of ginger. I would also really like to know the specific mechanism and pharmacokinetics because it would explain how ginger has its many effects. ~ L. Mikell 72

Hunter Smith, Student Pharmacist Spring 2022

Scientific Name: Ginkgo biloba Common Names: Ginkgo, Kew Tree, Maidenhair Tree

Background: Ginkgo biloba is a large dioecious tree, part of the Ginkgoaceae family. Ginkgo trees nearly went extinct during the last ice age with only a few tertiary relict trees surviving in China. Ginkgo has been used medically for over a thousand years. The leaves have traditionally been used for asthma, and the seeds were used as a digestive aid and prevent drunkenness. Medical use of ginkgo in western medicine began in the 1960s to inhibit platelet activating factors and as free radical scavengers. Dosing: Ginkgo is commonly dosed at daily doses of 120 – 240 mg.

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Common Uses: • Cardiovascular protection • Chemopreventative • Dementia • Schizophrenia • Stroke • Cognitive function • Sexual dysfunction • Tinnitus

Dosage Forms: • Tea • Liquids • Colas • Capsules • Extracts • Tablets • Sprays • Bars

Pharmacology: Ginkgo biloba has many mechanisms of action from its two main active ingredients, terpene lactones and ginkgo flavone glycosides. 1. Ginkgo biloba acts as an antioxidant by acting as a free radical scavenger. 2. Triggers the release of endothelium-derived relaxing factor and prostacyclin 3. Moderate nitric oxide production for vasodilation with inflammatory conditions 4. Antagonize platelet-activating factor. 5. In animal studies ginkgo extract reversibly inhibits the uptake of serotonin and dopamine as well as inhibit anticholinesterase. 73

Safety: Ginkgo biloba is considered a safe supplement. There are no contraindications and adverse effects are rare. There could be weak interactions with CYP3A4 inducers if doses are taken higher than the recommended doses.

Effectiveness: Several studies have been conducted to determine the efficacy of Ginkgo biloba, but there is not enough evidence to support ginkgo for any indication.

Interactions: No interactions are expected at recommended doses. Weak interactions with CYP3A4 inducers, such as warfarin, omeprazole, and grape fruit juice, at higher doses.

Adverse Effects and Toxicities: Adverse effects are rare but they include: • Headache • Dizziness • Heart palpitations • GI reactions • Dermatologic reactions Toxicities are also rare but are possible. • Possible carcinogen • Toxic syndrome

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https://healthjade.net/ginkgo-biloba-reviews/

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Professional Opinion: In my opinion, ginkgo biloba could have many positive effects for human health. With no drug or food interactions and rare adverse effects ginkgo biloba could be an adjunctive therapy for many health issues. Although I do think ginkgo biloba can have positive effects, I would not recommend this product to patients do to lack of evidence for indications. ~ H. Smith

References Hohmann N, Wolf EM, Rigault P, et al. Ginkgo biloba's footprint of dynamic Pleistocene history dates back only 390,000 years ago. BMC genomics. 2018;19:299-299. Kluwer W. Ginkgo biloba. Shibboleth authentication request. https://online-lexicom.umiss.idm.oclc.org/lco/action/doc/retrieve/docid/fc_rnp2/3750163?cesid=8ZBfp2cLUFN&search Url=%2Flco%2Faction%2Fsearch%3Fq%3DGinkgo%252520biloba%26t%3Dname%26va%3DGinkgo%22 520biloba#dis. Published 2022. Accessed March 4, 2022. Nguyen T. Ginkgo biloba. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK541024/. 74 Published July 9, 2021. Accessed March 4, 2022.

GINSENG SCIENTIFIC NAME Panax ginseng, Panax quinquefolius L 2

SPRING 2022 Lexi Nash; Student Pharmacist

COMMON NAMES American ginseng, Asian ginseng, Canadian ginseng, Chinese ginseng, Korean ginseng, Oriental ginseng, Radix ginseng2 COMMON USES Ginseng root has been used in the treatment of asthenia (abnormal physical weakness or lack of energy), atherosclerosis (thickening/hardening of the arteries caused by plaque buildup), blood and bleeding disorders, erectile dysfunction, hypertension (high blood pressure), liver dysfunction, and colitis (inflammation of the inner lining of the colon). The root can also be used to relieve the effects of aging, cancer, postmenopausal disorder, and senility. 2 Ginseng root also has a strengthening effect that can be used to raise mental and physical capacity. 2

Figure 1: Ginseng Root 1

The root also has protectant effects against stress, diabetes, neurosis, radiation sickness, and some cancers. 2 DOSAGE FORMS Ginseng root can be chewed, taken as a capsule, powder, liquid extract, decoction/tea, or infusion. 2,4 DOSE Dried root powder: take 500 milligrams to 2 grams daily up to 3 months Solid extract: take 200-600 milligrams daily Tea: drink one cup 1 to 3 times daily for 3 to 4 weeks 4 PHARMACOLOGY Ginseng root contains triterpene saponins, polyacetylenes, sesquiterpenes, polysaccharides, peptidoglycans, nitrogen-containing compounds, fatty acidic, carbohydrates, and phenolic compounds. The triterpene saponins have a stress-protective effect and are the most active compounds in the root. The saponins are metabolized by the gut microflora and its metabolite products are pharmacologically active. However, differences in a person’s gut flora may lead to differing pharmacological responses to the ginseng root. 2 BACKGROUND/HISTORY Ginseng has been used medicinally for over 2,000 years. It is the most widely recognized plant used in traditional medicine and the herbal health care market. There are three classifications of ginseng: fresh, white (dried after peeling), and red (steamed and dried). Ginseng root has a man-shaped figure, which made ancient European herbalists believe it had the properties to heal or strengthen any part of the body. Additionally, the word Panax found in its scientific name is derived from the Greek word “all-healing”. 2

GINSENG

SPRING 2022 Lexi Nash; Student Pharmacist

EFFECTIVENESS Ginseng has a range of effects that have been determined through a clinical trial or lack thereof. Ginseng has been determined possibly effective for cognitive function, diabetes, erectile dysfunction, immunostimulation, male infertility, quality of life, and reduction of blood alcohol concentrations. It has been deemed ineffective for exercise performance and human immunodeficiency virus. There is inconclusive data for its effectiveness in cancer, cardiovascular disease, hyperlipidemia, and menopause. 4 SAFETY/WARNINGS/TOXICITIES Ginseng root could cause hypersensitivity reactions. Caution should be taken in patients with diabetes for ginseng may lower blood sugar levels and in hyperactive patients who are taking stimulants such as caffeine. The root may also increase blood pressure and alter control in patients with hypertension. Additionally, ginseng may interfere with blood coagulation, so it should be discontinued 1-2 weeks before surgery. 4 ADVERSE/SIDE EFFECTS Ginseng can cause the following adverse effects: edema, headache, nausea, vomiting, chest tightness, ginseng abuse syndrome, gastrointestinal upset, hypertension, hypotension, euphoria, nervousness, insomnia, mania, skin eruptions, estrogenic effects, vaginal bleeding, hypoglycemia. 4 INTERACTIONS Drug-Drug: albendazole, anticoagulants, antidiabetic agents, estrogen, imatinib, loop diuretics, monoamine oxidase inhibitors, nifedipine, opioid analgesics Drug-Food: ethanol 4 SUMMARY OF ONE ARTICLE/STUDY A randomized, double-blind, placebo-controlled trial was performed to determine the antifatigue effects of Panax ginseng. In the study, 90 participants (21 men, 69 women) with chronic fatigue took either 1-2 grams of ginseng extract or the placebo for 4 weeks. Fatigue was then monitored using a self-rating numeric scale (NRS), a visual analog scale (VAS), and the patient’s serum levels were measured. After 4 weeks, participants who took 2 grams of ginseng extract showed a significantly higher mental NRS score, reduced VAS score, and reduced reactive oxidative species in serum than those who took the placebo. This indicates that Panax ginseng has antifatigue effects. 3 PROFESSIONAL/PERSONAL OPINION I think it is reasonable for a patient to try ginseng for any of its common uses. However, before using ginseng supplements, the patient should talk to their doctor and ask for recommendations on what brand/where to buy them. This would ensure the authenticity and efficacy of the product. ~L Nash REFERENCES (1) Ginlac. Korean Ginseng. Accessed February 21, 2022. https://www.ginlac.eu/en/korean-ginseng/ (2) Ginseng, Natural Products Database. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 19, 2022. http://online.factsandcomparisons.com (3) Kim HG, Cho JH, Yoo SR, et al. Antifatigue effects of Panax ginseng C.A. Meyer: a randomised, double-blind, placebocontrolled trial. PLoS One. 2013;8(4):e61271. Published 2013 Apr 17. doi:10.1371/journal.pone.0061271 (4) Panax Ginseng. IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed February 19, 2022. http://www.micromedexsolutions.com

GLUCOSAMINE MACY NEMETH, PHARMACY STUDENT SPRING 2022

BACKGROUND/HISTORY 5. Dona Crystalline Glucosamine Sulfate

SCIENTIFIC NAME 3-Amino-6-(Hydroxymethyl) Oxane-2,4,5-Triol Sulfate

COMMON NAME Glucosamine Three types of glucosamine are common dietary supplements: glucosamine sulfate, glucosamine hydrochloride, and N-acetyl glucosamine.

COMMON USES Glucosamine is most commonly used to treat osteoarthritis especially in the knee. This use of glucosamine was listed as the most effective. There is not enough research in these areas yet, but it may also help with inflammatory bowel disease, leg pain when it is injected, rehabilitation after an acute knee injury, and rheumatoid arthritis.

In 1969, glucosamine was first reported to be used to treat osteoarthritis by German physicians. Glucosamine is an amino sugar used to make cartilage proteoglycans. It is necessary to make some carbohydrate-containing compounds that are found in cartilage, tendons, ligaments, synovial fluid, and other places in the body. Glucosamine sulfate in particular is thought to be helpful in strengthening the cartilage and increasing glycosaminoglycan synthesis. Glucosamine is often taken with chondroitin.

PHARMACOLOGY/MECHANISM OF ACTION Glucosamine is absorbed from the small intestine and exhibits first-pass metabolism in the liver. In arthritis, glucosamine helps decrease collagen degradation and increases collagen synthesis. Glucosamine sulfate and hydrochloride may also lower the amount of certain matrix metalloproteinases that are associated with arthritis disease progression. Glucosamine sulfate is likely the most effective because sulfate is necessary for articular cartilage glycosaminoglycan synthesis and some believe that the glucosamine just helps absorb the sulfate.

AVAILABLE DOSAGE FORMS The oral form is available in the United States, but in some other countries there are intravenous, intramuscular, and intra-articular forms as well. Glucosamine is available in tablets and capsules, in most studies the participants take 500 mg tablets or capsules three times a day for 30-90 days.

TYPICAL DOSE/SERVING The usual dose of glucosamine sulfate or glucosamine hydrochloride is 1.5 g per day for up to three years though this can be taken at once or in divided doses. It can also be taken with 200-400 mg of chondroitin sulfate two-three times a day. Research is limited and no dosing information was found for N-acetyl glucosamine or any other dosage forms. 77

EFFECTIVENESS

Glucosamine sulfate seems to be effective at reducing pain and improving function in knee osteoarthritis if taken for a minimum of four weeks. Glucosamine hydrochloride, on the other hand, has only seemed to work when it is taken in combination with chondroitin and other ingredients. In a 3 year study, glucosamine seemed to help prevent joint space narrowing.

SIDE EFFECTS

Some of the more common adverse effects are diarrhea, heartburn, and nausea though taking it with food may help these symptoms. Other common effects are bloating, constipation, cramps, heartburn, and headaches. Though rare, some more serious adverse effects are hepatotoxicity and severe allergic reaction.

REFERENCES 1. Glucosamine Professional Monograph. Natural Medicines. January 2022. https://naturalmedicines.therapeuticresea rch.com. Accessed February 25, 2022. 2. Glucosamine. Natural Products Database. http://online.lexi.com. Published April 13, 2020. Accessed February 25, 2022. 3. Natural Standard. Glucosamine: Bottom Line Monograph, Assessing the Research on this Popular Supplement. Natural Medicine Journal. 2011;3(5). https://www.naturalmedicinejournal. com. Accessed February 25, 2022. 4. Glucosamine. Mayo Clinic. https://www.mayoclinic.org/drugssupplements-glucosamine/art-20362874. Published November 12, 2020. Accessed February 25, 2022. 5. Dona Crystalline Glucosamine Sulfate. WynnPharm Inc. https://www.wynnpharm. com/dona-crystalline-glucosaminesulfate. Accessed February 25, 2022.

INTERACTIONS Glucosamine may interact with anticoagulants and might increase their anti-platelet activity. It has a major interaction with warfarin and should not be taken with it. There is a moderate interaction with topoisomerase II inhibitors and could cause resistance to them. There are minor interactions between acetaminophen and glucosamine sulfate, specifically with the sulfate part. There might be a minor interaction with antidiabetes drugs though it is unlikely. Taking chondroitin sulfate might decrease the absorption of glucosamine hydrochloride though it is unclear what effect that may have.

SAFETY/WARNINGS/TOXICITIES Though glucosamine can be made synthetically, it can also be obtained from the exoskeleton of certain marine creatures like shrimp, crab or other shellfish. This means that people with a shellfish allergy should be very careful about using glucosamine. People with diabetes or hypoglycemia should also be careful because glucosamine may increase insulin resistance when it is injected. When taken orally, it does not seem to have an effect on blood glucose. Pregnant women are advised to not take glucosamine due to a lack of information.

ARTICLE SUMMARY The Mayo Clinic published an article about glucosamine, though mostly about glucosamine sulfate. Their perspective is that glucosamine is a generally safe option that may be helpful to relieve pain in patients with osteoarthritis. It could be especially useful for those who are unable to NSAIDs. It goes on to describe many of the same side effects and drug interactions mentioned in the monograph.

OPINION In my opinion, glucosamine seems to be a good alternative to prescription medication to treat osteoarthritis especially in the knees. However, results are varied and it may take some time for it to function. You also need to be careful about which salt form and brand of glucosamine you buy because many brands do not contain the amount they advertise. Most of the studies have looked at glucosamine sulfate and used the Dona ~M Nemeth Rottapharmaceuticals brand.

Goldenseal Yi Wen Ni Student pharmacist Spring 2022 Scientific name: Hydrastis canadensis Common names: goldenseal, yellow root, orange root, yellow puccoon, ground raspberry, eye balm, eye root, jaundice root, and Indian turmeric Medical Uses for Goldenseal Today Today goldenseal is normally found as “goldenseal” in the supplement sections of different drug and/or grocery stores. It is used to treat a variety of conditions, including indigestion, symptoms of flu/cold, mild eye irritation, ulcers, and eye and/or ear infections.

Background/History Originally goldenseal was not only for medical use. The Native Indians also used this plant as a dye. By using the root, yellow dye can be made. The root itself is typically one to three inches long and has many bright yellow filaments. Sometimes a red berry (looks like a raspberry) will also sprout in July, hence the name “ground raspberry”. Some medical conditions the Native used Goldenseal to treat were inflammation and eye infections. Lastly, it is also used as an insect repellent. Mechanism of Action There is no information on exactly how it affects the body to treat the different conditions. However, it is just known that goldenseal is made of alkaloids, but isn’t very effectively absorbed when taken orally.

Suggested Dosing Lexicomp recommends 250mg to 1gram, three times daily. But some labels may even suggest higher dosing. Women who are pregnant or lactating should not take this supplement.

Effectiveness Based on clinical trials, there is no solid evidence that goldenseal may be effective in any treatments. For example, it is said that the Berberine in goldenseal plants supposedly helps treat Type 2 diabetes, but there is not enough information on how it works, either via CYP450 or other mechanisms.

THE PICTURE ON THE LEFT SHOWS THE PLANT “GOLDENSEAL”. IT DISPLAYS THE YELLOW ROOTS COMMONLY USED.

Available Dosing Forms ⚘ Capsules ⚘ Teabags ⚘ Lotions ⚘ Eyewashes ⚘ Sprays

Safety/ Warning/ Toxicities After long term use ( >two years) of the root of Goldenseal, there is a chance of DNA damage, particularly non-neoplastic hepatic lesions due to what is believed by inhibiting topoisomerase. Pregnant women should not take Goldenseal.

Article/Study

A study was done to see if different conditions can speed up the degradation process of Hydrastis Canadensis. The root of this plant is usually what is used for medical purposes. When the root is degraded, it goes from its normal healthy yellow color to a darker brownish color. In this study, the biomarkers selected are metabolites from the root. The three chosen were berberine, hydrastine, and canadine. Then tests were done by putting them in different temperatures and in different lightings. In the end, when comparing the results to the control group after 6 months, it shows that there is no significant effect from light or temperature that can speed up the degradation.

Interactions

Adverse/Side Effects

Interacts with many CYP3A4 inhibitors and certain blood pressure lowing agents.

There is not enough research to know all adverse effects. However, if taking Goldenseal in the suggested dose, adverse effects are rare. When taken in high doses, though rare, it may induce nausea, anxiety, depressions or possibly paralysis. It is also suggested to be careful taking this if you have cardiovascular disease due to possible effects on blood pressure.

CYP3A4 inhibitors e.g.: aripiprazole, cyclosporine, dofetilide, flibanserin, midazolam, and nimodipine Other common drugs: metformin, oseltamivir and losartan. MY OPINION:

DUE TO THE VERY LOW AMOUNT OF RESEARCH AND CLINICAL TRIALS DONE ON GOLDENSEAL, I BELIEVE IT’S NOT SAFE TO TAKE IT RIGHT AWAY WITHOUT CONSULTING A PHYSICIAN. THERE IS QUITE A LONG LIST OF COMMON DRUGS THAT HAVE DRUG INTERACTIONS WITH GOLDENSEAL. I RECOMMEND LOOKING INTO OTHER OTC MEDICATIONS INSTEAD OF THIS SUPPLEMENT. ESPECIALLY IF IT IS FOR A COMMON COLD OR INDIGESTION ~YW Ni

REFERANCES Goldenseal. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 20, 2021. http://online.lexi.com Goldenseal. Interactions. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed August 24, 2016. http://online.lexi.com Khin M, Cech NB, Kellogg JJ, Caesar LK. Chemical Evaluation of the Effects of Storage Conditions on the Botanical Goldenseal using Marker-based and Metabolomics Approaches. Yale J Biol Med. 2020;93(2):265-275. Published 2020 Jun 29. Lloyd JU . Goldenseal (Hydrastis canadensis). HerbRally. Published June 18, 2020 Accessed February 24,2021. https://www.herbrally.com/monographs/goldenseal Petre A. Goldenseal: Benefits, Dosage, Side Effects, and More. Healthline. Published June 18, 2020 Accessed February 24,2021. https://www.healthline.com/health/goldenseal-cure-for-everything

Green Tea Hoa Tran, Student pharmacist Spring 2022 Scientific Name: Camellia Sinenesis Scientific Family: Theaceae Common names: Green tea; Green tea extract; Tea

Common Use Use: Green tea has beneficial effects on some heart disease risk factors, including blood pressure and cholesterol. It also plays a role in metabolic syndrome because it could impact body weight, glucose homeostasis, and other cardiovascular risk factors. Some studies show green tea can prevent cancer, stroke, and chronic obstructive pulmonary disease (COPD). Topical as well as oral formulations could protect skin from ultraviolet (UV) damage.1,2

Dosing Daily intake of three to five cups/day (720 to 1,200 mL) of green tea will produce at least 180 mg of catechins and at least 60 mg of theanine. Should not take green tea extract on an empty stomach due to hepatotoxicity from excessive levels of epigallocatechin gallate (EGCG).

Effectiveness FDA Approved Indications: approved sinecatechins (Veregen) topical ointment that includes extracted components of green tea leaves and is used for the treatment of genital warts.1

Background history The origin of green tea began in China. Chinese Emperor Shennong accidently drank water with dead tea leaf and found that the flavor refreshing.

Mechanism of Action The anti-tumor mechanism of green tea appears to include the induction of apoptosis by EGCG through production of H2O2, inhibition of cell-cycle progression, inhibition of nuclear factor kappa B (NF-kB), activation of the mitogen0activated protein kinase cascade, and binding to a 67 kDa laminin receptor.

Safety concerns/warnings:

Side Effects

Contraindications: Use caution for hepatic failure patients.1

There are no reports of clinical toxicity from daily tea consumption. The most common adverse event associated with green tea extract includes headaches, dizziness, and GI symptoms.

Hypersensitivity and Allergic Reactions: Hepatic Impairment: People with liver disease should talk to their provider before taking green tea extract products. Discontinue use and consult a health care provider if you develop symptoms of liver trouble such as dark urine, abdominal pain, or jaundice.2

Toxicity

High amount can link with liver injury.

Interaction

At high doses, it has been shown to reduce blood levels and effectiveness of the drug nadolol, a beta-blocker used for high blood pressure and heart problems.

Pregnancy: take up to 6 cups per day (no more than about 300 mg of caffeine). Drinking more than 6 cups a day may be unsafe and increase the risk of negative effects. It could also be associated with folic acid deficiency, which will increase the risk of birth defects. Caffeine can also affect a breastfeeding infant when caffeine passes into breast milk. The FDA advises those who are or may become pregnant to avoid caffeine.2 Geriatric Use: green tea has shown the significance of a lower prevalence of depressive symptoms, independent of other risk factors.4

Professional Opinion: Green tea has been used in Asian countries for medicinal purposes for thousands of years. Much research has been shown that green tea shows many benefits, including impact on body weight, glucose homeostasis, other cardiovascular risk factors, preventing cancer, stroke, and chronic obstructive pulmonary disease. Green tea also interacts with many medications, which reduces the medication’s effects. Therefore, the FDA recommends talking to a healthcare provider before taking green tea. Especially, pregnant women should avoid green tea due to birth defects. Do not use it in high amount and too often. ~ H. Tran Reference 1.Lexicomp, 03 Mar. 2022, https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750176?cesid=8ygHUs1WRs0&searchUrl=%2Flco%2Faction% 2Fsearch%3Fq%3Dgreen%252520tea%26t%3Dname%26va%3Dgreen%252520tea. Green tea. Accessed 3 Mar. 2022. 2.National Center for Complementary and Integrative Health, 3 Mar. 2022, https://www.nccih.nih.gov/health/green-tea. Accessed 3 Mar. 2022. 3.Kajita, Naoki et al. “Green tea-induced anaphylaxis: The first pediatric case report.” Allergology international: official journal of the Japanese Society of Allergology vol. 70,4 (2021): 507-508. doi:10.1016/j.alit.2021.05.007 Graphic Reference 4. Healthline. https://www.healthline.com/nutrition/matcha-green-tea. April 20, 2019. Accessed March 29, 2022. 5. WallpaperAccess. https://wallpaperaccess.com/green-tea. January 6. 2020. Accessed March 29, 2022

HAWTHORN Aleksandar Pejnovic Student Pharmacist Spring 2022

Scientific Name •

Crataegus monogyna Jacquin

HISTORY Hawthorn has been used going all the way back to 40- 90 AD. There are over 280 confirmed species of hawthorn. The flowers, leaves, and fruits of

Common names Cardiplant Crateaegisan English hawthorn Maybush

the plants are used in hawthorn products. COMMON USES Normally used for kidney and bladder disorders. Hawthorn is used to treat stomach aches and to stimulate appetite. Hawthorn has been used to improve circulation in the cardiovascular system. According to Micromedex there is evidence that Hawthorn is effective for congestive heart failure. There have been large scale trials that show hawthorn is effective in prevention and treatment of cardiovascular diseases especially for chronic CHF. 83

MECHANISM OF ACTION- While there is limited data on the exact pharmacology of hawthorn, we do know that the flavonoids and proanthocyanins are the chemical compounds most likely to be active in hawthorn preparations. DOSING AND PHARMACOLOGY- About 160 to 2,500 mg per day in most trials and the doses are divided over a period of 3-24 weeks. For CHF the minimum effective dose is suggested to be around 300 mg daily and the maximum benefit is usually seen at 6-8 weeks of therapy. ADVERSE EFFECTS AND TOXICOLOGY-No contraindication except for allergies to plants that are members of the Rosaceae family. Hawthorn is toxic in high doses and may cause increased heart palpitations. There is some evidence that it interacts with digoxin ARTICLE REVIEW- The article was about the health effects of hawthorn and the result from the study is that there is no evidence that hawthorn reduces the mortality of heart failure even through other studies have shown that patients do experience an improvement in symptoms. The study recommends that conventional therapies are more effective than hawthorn. In my opinion Hawthorn can be used for people with high blood pressure if they feel like they will get some benefit out of it. There aren't too many adverse effects reported for most people so I would say that it is relatively safe even if it isn’t the most effective therapy available.-A Pejnovic Hawthorn. Lexicomp. http://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750183?cesid=9YLz1tyYHCl&searchUrl=%2Fl co%2Faction%2Fsearch%3Fq%3Dhawthorn%26t%3Dname%26va%3Dhawthorn#history-nested. Accessed April 13, 2022. Hawthorn facts and comparisons. Micromedex. https://fco.factsandcomparisons.com/lco/action/doc/retrieve/docid/fc_rnp2/3750183?cesid=11aha90nPkU&se archUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dhawthorn%26t%3Dname%26va%3Dhawthorn%26nq%3Dt rue#inter-nested. Accessed April 13, 2022. Dahmer, S., & Scott, E. (2010). Health effects of hawthorn. American Family Physician, 81(4), 465-468.

Background/History

KAVA KAVA Mikiyala Wells, Student pharmacist Spring 2022

(Piper Methysticum) Name is so nice, you say it twice. Common Names: Kava, Kawa, ‘Ava (Somoa), ‘Awa (Hawaiian), Waka, Lawena, Sakau, Yaqona

For many centuries, kava has been an important part of Pacific Island cultures. The rituals consisted of consuming kava as a beverage composed of the plant’s roots. It is prepared by pulverizing or chewing the roots then steeping them into water or coconut milk. The kava beverage was used in the ceremony to induce relaxation and symbolized respect and hospitality. In the early 1900’s, the use of kava was researched. Kava was used for anxiety, sleep disorders, and nervous disorders. It was one of the top herbals used in the US and Europe until the Food and Drug Administration issued a warning for the potential for liver injury.

Common Uses ● ● ● ● ● ● ● ●

Anticonvulsant Anti-inflammatory Local anesthetic Anxiolytic Cognition Sleeping aid / Sedative Antithrombotic Spasmolytic

Pharmacology/MOA https://erowid.org/plants/kava/kava.shtml

The proposed mechanisms of action for kava are increased levels of dopamine and serotonin by inhibiting monoamine uptake, decreased levels of glutamate, increased excitatory neurotransmitters, and GABA receptor interactions.

Dosage Forms Kavalactone tablets/capsules 125 mg with the maximum daily dose of 250 mg

Typical Dosing Kavalactones 50 to 70 mg three times daily or dried kava root 2 to 4 grams boiled as a decoction three times daily.

https://www.nccih.nih.gov/health/kava#hed2

Adverse Effects

Effectiveness Meta-analysis and systematic reviews suggest that kava is an effective anxiolytic compared with a placebo. Studies also suggest that kava has effective anti-inflammatory and anti-cancer effects.

Safety

Dry scaly skin Heart problems Eye irritation

https://www.verywellmind.com/kava-kava-what-you-need-to-know-89703

Toxicity FDA published a notice for hepatotoxicity

Although there are well-documented benefits to kava use, there is reported hepatotoxicity in several reports in Europe and the United States. Kava should be used with caution in patients with renal or liver disease, Parkinson's disease, blood disorders, or depression.

Interactions ● ● ● ● ●

Benzodiazepines CNS depressants Paroxetine Dopamine agonists No known food interactions

Professional Opinion In my professional opinion, I would not recommend kava due to the warning issued by the Food and Drug Administration associated with liver damage and other safety concerns. ~ M. Wells

References: https://erowid.org/plants/kava/kava.shtml

1. Bian T, Corral P, Wang Y, Botello J, Kingston R, Daniels T, Salloum RG, Johnston E, Huo Z, Lu J, Liu AC, Xing C. Kava as a Clinical Nutrient: Promises and Challenges. Nutrients. 2020 Oct 5;12(10):3044. doi: 10.3390/nu12103044. PMID: 33027883; PMCID: PMC7600512. 2. U.S. Department of Health and Human Services. (n.d.). Kava. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/kava#hed2 3. Kava: An Overview. Kava: An overview. - american botanical council. (n.d.). https://www.herbalgram.org/resources/herbalgram/issues/39/ta ble-of-contents/article126/ 4. Clouatre, Dallas L. “Kava kava: examining new reports of toxicity.” Toxicology letters vol. 150,1 (2004): 85-96. doi:10.1016/j.toxlet.2003.07.005.

LAMINARIALES SPP. AKA: KELP, SEAWEED A Dietary Supplement Monograph for Spring 2022 by Student Pharmacist Kathryn Cavitt

Why Would You Use It? https://www.treehugger.com/things-know-about-beautiful-kelpforests-4863887

IS IT ALL THE SAME? There are several varieties of kelp: true kelp, which thrives in cool seas; giant kelp, and bladder kelp, which grows in the North Pacific.

Kelp is classified as an Iodine supplement, but it has also been used to treat thyroid disorders, arthritis, rheumatism, constipation, colds, high blood pressure, colitis, eczema, goiter, obesity, low vitality, poor digestion, nervous disorders, menstrual irregularities, glandular disorders, and water retention.

HOW DOES IT WORK?

Marine Plant in a Linear Style. https://www.canva.co m/design/DAE6Btc1p 08/bYteTxb2f6GKaof eklE5MA/edit#.

Numerous components of seaweeds have demonstrated varying degrees of antioxidant capability and carcinogen inhibition in vitro and in vivo, such as sulfated polysaccharides (including fucoidan), phenolic compounds (including phlorotannins and bromophenols), and the carotenoid fucoxanthin.

WHERE DID IT ORIGINATE? Different kinds of kelp have been eaten for nutritional value for over a thousand years. The Chinese used kelp and other types of seaweed as medicine as far back as 3,000 b.c. The Greeks used kelp to feed their cattle around the first century b.c. Kelp has been a staple food of Icelanders for centuries, and ancient Hawaiian nobles grew gardens of edible seaweed. Kelp was also used in Europe and Great Britain as fertilizer to nourish soil and assist plant growth. The largest consumer of kelp, however, has been Japan. The Japanese have incorporated kelp and seaweed into their diets for 1,500 years. During the seventh to ninth centuries, only the Japanese nobility consumed seaweed. In the seventeenth century, Japan began farming seaweed. The Japanese and other Asian cultures used kelp to treat uterine problems, genital tract disorders, and kidney, bladder, and prostate ailments. Kelp is still an integral part of the Japanese diet. The Japanese include kelp in almost every meal, using it in salads or as a garnish, or cooking it in soups, sauces, and cakes. Noodles made from kelp are a staple of the Japanese diet. Until recently, kelp was eaten almost exclusively by the Japanese. Now the Western population is beginning to take note of this nutrient-rich seaweed.

WHAT FORMS ARE AVAILABLE? Kelp is available as an aqueous extract, capsule, powder, and tablet.

HOW MUCH SHOULD I TAKE? There is not much information regarding dosing of kelp itself, but you should consume no more than 150 micrograms of iodine daily

IS IT EFFECTIVE? There is not enough information to say how effective kelp really is. Not many studies have focused on Kelp as there appears to be limited funding for such studies.

IS IT SAFE?

Overall, there is little evidence to support that kelp is safe or unsafe. Kelp absorbs arsenic from the ocean and may pass it to the consumer. Patients with hypersensitivity to kelp or iodine and pregnant women should avoid taking this.

WHAT ARE THE ADVERSE AND TOXIC EFFECTS?

There is a risk of laminaria dilators becoming trapped and fragmenting. Cases of hypersensitivity, including anaphylaxis, have also been reported. Following excessive consumption of Laminaria, iodine-induced hypothyroidism has been reported.

WILL IT INTERACT WITH OTHER THINGS I AM TAKING? There is no clear documentation that kelp will interact with other drugs.

Ocean Sea Wave with https://www.canva.com/design/DAE6Btc1p08/bYteTxb2f6GKaofeklE5MA/edit.

Sun.

https://atlanticseafar ms.com/products/rea dy-cut-kelp

https://thefishsite.com/articles/quantifying-how-kelp-and-shellfish-farming-can-help-casco-bay

OVERALL, WHAT IS A PROFESSIONAL OPINION? In my professional opinion, I would not recommend kelp to patients. It may seem like it provides a more natural source of iodine, but it could also introduce toxins it has absorbed. As a whole, there is not enough research available to say if the potential benefits of Kelp outweigh its risks. ~ K. Cavitt

REFERENCES Bai Y, Sun Y, Gu Y, Zheng J, Yu C, Qi H. Preparation, Characterization and Antioxidant Activities of Kelp Phlorotannin Nanoparticles. Molecules. 2020;25(19):4550. Published 2020 Oct 5. doi:10.3390/molecules25194550 Poulson B, Horowitz D, Trevino HM, eds. Kelp. Kelp - Health Encyclopedia - University of Rochester Medical Center. https://www.urmc.rochester.edu/encyclopedia/content.aspx? contenttypeid=19&amp;contentid=Kelp. Published 2022. Accessed March 4, 2022. Rouse J, Spoerke D, O'Reilly M. Kelp. Micromedex products. https://www.micromedexsolutions.com/micromedex2/librarian/PFDefaultActionId/ev idencexpert.DoIntegratedSearch?navitem=topHome&amp;isToolPage=true#. Published March 2003. Accessed March 4, 2022. Wurges J, Frey R. Kelp. Encyclopedia.com. https://www.encyclopedia.com/plantsand-animals/microbes-algae-and-fungi/moneran-and-protistan/kelp. Published February 28, 2022. Accessed March 4, 2022.

Kalin Hewett, Student Pharmacist Spring 2022

Dietary Supplement

Krill Oil Euphausia Superba

https://twilightzone.whoi.edu/explore-the-otz/creature-features/krill/

Background:

Antarctic Krill are small, crustaceans that live in the Antarctic Ocean. It is estimated that 300,000 million metric tons of Krill are located in the Antarctic Ocean, making them the largest reported biomass in the world. Krill are used as bait by fishermen and provide a source of human food in the form of paste and frozen tails. They have recently started providing use in the pharmaceutical and cosmetic industries.

Importance:

Krill Oil contains higher amounts of EPA & DHA and is better absorbed than Fish Oil. People can receive the similar therapeutic benefits to that of fish oil, but at much smaller dosage and less of a "fishy" aftertaste.

Pharmacology & MOA:

https://vivanaturals.com/collections/b est-sellers/products/krill-oil

Common Uses: Hyperlipidemia Chronic Inflammation Arthritis Premenstrual Syndrome

Omega-3 fatty acids compete with cyclooxygenase and arachidonic acid in the lipoxygenase metabolic pathway. Arachidonic Acid is converted to thromboxane (A2) a pro-inflammatory lipid. When Omega-3 Fatty Acids displaces A2, inflammation is reduced.

Dosing:

Hyperlipidemia: 1-3 g/day Chronic Inflammation: 300 mg/day Premenstrual Syndrome: 1 g/day

Dosage Forms: Capsule 89

https://vivanaturals.com/collections/best-sellers/products/krill-oil

Effectiveness: Krill Oil's Bioavailability is more efficient in comparison to Fish Oil. It has been concluded that Omega-3 Fatty Acids from Krill Oil are as efficient, or possibly more efficient compared to Fish Oil with reduced Lipid Levels and Inflammatory Markers

https://www.verywellhealth.com/krill-oil-what-should-i-know-about-it-89571

Interactions

Anti-Platelet Action: Use in caution or under direct physician supervision with: Anticoagulants: Warfarin Anti-Platelet Agents: Aspirin, Clopidogrel, Prasugrel Avoid if Allergic or Sensitivity to Crustaceans and/or Shellfish Avoid 2 Weeks Before or After Surgery

Safety: Generally Regarded as Safe Limited Information and Data on Pregnancy & Lactation

Toxicology: Limited Information

Adverse Effects: Flatulence, Nausea, Diarrhea, Loose Stools, Indigestion, Oily Skin

Professional Opinion

For individuals looking for a supplement to aid in managing lipid levels, I would recommend Krill Oil as an over the counter option. Many people use Fish Oil over the counter to help manage their triglyceride levels, and Krill Oil is extremely similar. Krill Oil is more appealing than Fish Oil in that the doses needed to provide therapeutic benefit are much smaller, and Krill Oil does not leave a "fishy" aftertaste that many people do not like with Fish OIl. Although it costs more than Fish Oil, Krill Oil could be a great option or alternative for people looking for a supplement to help manage their lipid levels. ~ K. Hewett

https://www.healthline.com/health/nutrition/expert-answers-krill-oil

References:

Krill Oil (Natural Products Database). LexiComp. https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/5999984? cesid=0RjpwBHOcEh&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3DKrill%252520Oil%26t%3Dname%26va%3DKr ill%252520Oil. Published February 22, 2021. Accessed March 2, 2022. Köhler A, Sarkkinen E, Tapola N, Niskanen T, Bruheim I. Bioavailability of fatty acids from krill oil, krill meal and fish oil in healthy subjects--a randomized, single-dose, cross-over trial. Lipids Health Dis. 2015;14:19. Published 2015 Mar 15. doi:10.1186/s12944-015-0015-4 Kwantes JM, Grundmann O. A brief review of krill oil history, research, and the commercial market. J Diet Suppl. 2015;12(1):23-35. doi:10.3109/19390211.2014.902000 Xie D, Gong M, Wei W, et al. Antarctic Krill (Euphausia superba) Oil: A Comprehensive Review of Chemical Composition, Extraction Technologies, Health Benefits, and Current Applications. Compr Rev Food Sci Food Saf. 2019;18(2):514-534. doi:10.1111/1541-4337.12427

LAVENDER

Did you know?

Lavandula angustifolia

its name derives from Latin 'lavare' meaning "to wash"

Common Name: English lavender Type: Herbaceous perennial Family: Lamiaceae

Jenny Liu, Student Pharmacist Spring 2022

Background The origin of Lavender is believed to be from the Mediterranean, Middle East and India. Its history goes back some 2500 years.

Mechanism of Action

The ancient Greeks called Lavender nardus, after the Syrian city of Naarda and was commonly called Nard. Lavender was one of the holy herbs used to prepare the Holy Essence and Nard, or ‘spikenard’ is mentioned in the bible in the ‘Song of Solomon’ among other places.

unknown mechanism but believed to : modulate NMDA receptors and inhibit SERT protect SH-SY5Y cells from hydrogen peroxide induced neurotoxicity Ltd S. New data shows pharmaceutical quality lavender oil significantly improves anxiety induced insomnia when taken as a daily capsule. ResponseSource Press Release Wire. https://pressreleases.responsesource.com/news/98288/new-data-shows-pharmaceutical-quality-lavender-oilsignificantly-improves-anxiety/. Published August 29, 2019. Accessed March 4, 2022.

Lavender oil. Canva image. https://.canva.com. Accessed March 4, 2022

Dosage form/ Typical Dosing Tea: 1 to 2 tsp of lavender herb can be steeped in 1 cup of boiling water Oral Product (Silexan): 80 or 160 mg/day for use in anxiety. Aromatherapy: a single to several drops of lavender essential oil (20 mg to 120 mg) diluted in a base/carrier oil, or added to hot water in a diffuser/humidifier inhalation

Lavender cookie. Canva image. https://.canva.com. Accessed March 4, 2022

Common Uses

Lavender is a flowering plant of the mint family known for its beauty, its sweet floral fragrance and its multiple uses. Oil: used as disinfectant, antiseptic, anti-inflammatory, and aromatherapy. internal medical conditions such as indigestion, heartburn, anxiety, stress, insomnia, and many more! Dried leaves used in culinary to delivers a floral, slightly sweet and elegant flavor to salads, soups, meat and seafood dishes, desserts, cheeses, and baked goods.

Adverse Effects

may cause allergic contact dermatitis and photosensitization GI complaints with oral use

Lavender oil can be added to a bath to help soothe away pregnancy aches

Safety Drug Interactions Sedative medications Lavender might cause sleepiness and slowed breathing Taking lavender with sedative medications might cause breathing problems or too much sleepiness.

References

Lavender oil is generally not poisonous in adults when breathed in during aromatherapy or swallowed in smaller amounts.

Lavender pill and oil. Canva image. https://.canva.com. Accessed March 4, 2022

Effectiveness

One study showed: Silexan (oral product of Lavender) is just as effective as lorazepam in adults with GAD and was also safe. also well-tolerated alternative to benzodiazepines for amelioration of generalized anxiety. lavender oil showed no sedative effects and no potential for drug abuse

Lavender uses, benefits & dosage - drugs.com herbal database. Drugs.com. https://www.drugs.com/npp/lavender.html. Accessed March 4, 2022. López V, Nielsen B, Solas M, Ramírez MJ, Jäger AK. Exploring pharmacological mechanisms of lavender (lavandula angustifolia) essential oil on central nervous system targets. Frontiers in pharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437114/. Published May 19, 2017. Accessed March 4, 2022. Welcome to Lavender Sense - Home: Lavender sense browse. Welcome to Lavender Sense - Home | Lavender Sense browse. http://www.lavendersense.com/. Accessed March 4, 2022. Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the lavender oil preparation Silexan in comparison to lorazepam for generalized anxiety disorder. Phytomedicine. https://www.sciencedirect.com/science/article/abs/pii/S094471130900261X ?via%3Dihub. Published December 3, 2009. Accessed March 4, 2022.

What's My Opinion?

I believe lavender is generally safe if it is consumed in a small amount. It has many benefits and has been used in culinary for years. ~ J. Liu

Hien Hoang Student pharmacist Spring 2022

LICORICE https://www.google.com/search?q=licorice+plant&tbm=isch&ictx=1&tbs=rimg:CY46LRmU459yIgiOOi 0ZlOOfcioSCY46LRmU459yERH11Gz4c1tq&hl=en&sa=X&ved=2ahUKEwi625yF4Kz2AhXog2oFHQ 05BFUQiRx6BAgAEAQ&biw=928&bih=735

Scientific Name: Glycyrrhiza glabra Common Names: Bois doux, Gan Cao, Glycyrrhizae extractum, crudum, Glycyrrhizae radix, Kanza.

Background/history: Licorice comes

Dosage Forms: Licorice root comes with

from the juice of the root of the plant name Glycyrrhiza Glabra. Licorice with the name of Liquorice has been found in 2300BC. It has been used in the ancient by Chinese people as a medicine. Now a day, they grow in North Africa, across the Middle East and to China. Today, Licorice is used as sweetener, supplement, oil and gel. Besides, people use it as tea.

vary forms, including chewing gum, chewing tobacco, deglycyrrhizinated chews, extract, intravenous solution, and tea.

Pharmacology/mechanism of action and common uses: Licorice contains an active metabolite is Glycyrrhetic acid. It inhibits the enzyme 11-Bhydroxysteroid dehydrogenase enzyme type 2 with a resultant cortisol-induced mineralocorticoid effect and the tendency towards the elevation of sodium and reduction of potassium levels. Licorice also used to kill MRSA via the disruption of the membrane permeability and the proton motive force. Today, Licorice is used to treat hepatitis, viral infections in adults and pediatric. Especially, it can treat dental care in children.

Typical Dosing: Ulcer and Gastritis: 1.5 to 3g daily Peptic Ulcer: 380 to 760 ml TID Upper respiratory tract: 0.5 to 1g daily General use root, oral: 1 to 5g TID for 6 weeks General use extract: 2 to 4ml TID Skin: 2% for 2 weeks

https://www.google.com/url?sa=i&url=https%3 A%2F%2Fstock.adobe.com%2Fsearch%3Fk%3 Dlicorice%2Bplant&psig=AOvVaw0ImJVFo9a vuUsDQjF17NZE&ust=1646496813776000&so urce=images&cd=vfe&ved=0CAsQjRxqFwoTC PDgleTsrPYCFQAAAAAdAAAAABAD

Professional Opinion: I found some studies on finding a cure for Covid-19 by using licorice. However, I do not think there is enough good evidence to support using it for Covid-19 treatment. Although licorice is used for many purposes, we still have to limit their uses because there is not enough reliable information to know if it might be helpful. ~ H. Hoang

https://www.google.com/imgres?imgurl=http s%3A%2F%2Fimages.vitaminimages.com%2Fpp %2FVF%2Fpuritanspride%2Fproduct_images%2 Fproduct_detail%2F022333.jpg&imgrefurl=htt ps%3A%2F%2Fwww.puritan.com%2FlicoriceEffectiveness: Licorice is effective to reduce the 621%2Fpplicorice-root450mg60capcount of Steptococcus Mutans and preventing 022333&tbnid=8kzzsaNdef7aXM&vet=12ahUKE dental caries in children. Licorice root also used to wj7h6L8-qz2AhWYRs0KHdkeep people teeth clean. One of a study has showed ZDMwQMygCegUIARDsAg..i&docid=kv2Y1Vjwx that licorice is effective to chronic hepatitis B in KmXcM&w=1001&h=1846&q=licorice%20supple Japan. In addition, using licorice gel to apply to ment&ved=2ahUKEwj7h6L8-qz2AhWYRs0KHdskin to reduce redness, swelling, and itching. ZDMwQMygCegUIARDsAg

Adverse effects: The main adverse effect of licorice is hypertension and hypokalemia. Although rare, arrhythmias, torsades de points, nausea, vomiting, diarrhea may occur.

Addition information: Eating a large amount of black licorice candy can cause severe side effect with heart health.

Interaction: Due to its mechanism of action, Licorice causes potassium fall. Therefore, patient who are taking fludrocortisone should avoid to take licorice. Licorice also interacts with ACE inhibitors, diuretics, digoxin, MAO inhibitors, warfarin, cisplatin, and liver medications.

Safety: Pregnant women should avoid to take licorice. This may cause a miscarriage or early delivery. Women who are breast-feeding do not take licorice. With people using this product as tea, do not take over 100ml per day to avoid adverse effects.

Toxicity: People consume too much licorice root or some products derived from licorice (candies, soft drink) can be dangerous because it lowers people’s potassium levels.

Reference: History of liquorice, https://tomsgroup.com/en/toms-history/the-storyof-liquorice/ Accessed March 4, 2022 Therapeutic basis of glycyrrhizin on chronic hepatis B, https://pubmed.ncbi.nlm.nih.gov/8783808/ Accessed March 4, 2022 Effectiveness of licorice in preventing dental caries in children, https://pubmed.ncbi.nlm.nih.gov/33402612/#:~:tex t=Conclusion%3A%20Licorice%20extracts%20pr oves%20to,is%20well%20accepted%20by%20chil dren, Accessed March 4, 2022 94

Joy Lovell, Student pharmacist Spring 2022 Monograph

Maca Lepidium meyenii Peruvian ginseng, Ayak chichira, Ayuk willku, Maino

Dosage Forms Commercially available in powder, liquid, tablet, and capsule formulations https://rhumveld.com/newsletter-12-2018-maca-powder/

Background/History The maca plant is native to South America, specifically in the high altitudes of the Andes Mountains near Peru where its notable cold tolerance allowed it to thrive. For thousands of years, Andean people have been using maca as both a food source and medicine, with the hypocotyl, or root, being the source of nutritional value. Cultivation of the plant has spread to other parts of the world due to growing popularity from claims such as improving sexual function, contributing to its nickname, “Peruvian ginseng.”

Common Uses

Dosing Daily dosing of 1 dried maca extract 450 mg capsule three times daily with food Maca root comes in many colors and has a butterscotchlike aroma. It can be eaten raw, boiled, dried, or ground into a powder/flour, allowing it to be incorporated into many different foods.

Most notably, maca is used for sexual dysfunction and/or enhancement. Other uses include performance enhancement, fertility, depression, fatigue, and hormonal regulation.

Pharmacology/Mechanism of Action Maca’s definitive mechanism of action is currently unclear, but some studies speculate that its possible androgenic mechanisms may come from testosterone-like compounds.

https://www.eatthis.com/maca-roothealth-benefits/ 95

Effectiveness Maca’s effectiveness is uncertain. A systematic review of maca’s influence on sexual function found multiple studies with differing endpoint results, ranging from no effect to possible positive effects. Other studies with its uses have yielded some data, but greater, comprehensive work is needed to better assess its effectiveness.

Safety Maca consumption has been shown to be relatively safe; however, due to a lack of adequate documentation, it is not recommended to be used in pregnancy or in women who are breastfeeding. Patients with thyroid conditions should also avoid maca as it contains glucosinolate metabolites, which may cause goiter growth if taken in excess and with a low iodine diet.

Professional Opinion In my opinion, I would not recommend someone take maca, even with its seemingly safe profile. The lack of strong studies and evidence, along with uncertainty pertaining to drug interactions, leaves its usefulness to be desired. ~ J. Lovell

https://www.gaiaherbs.com/pro ducts/maca-root

AEs/Toxicities Multiple studies report no adverse effects when consuming maca. While some related species have been found to contain cardioactive substances such as cardiac glycosides, no reports of cardiotoxicity have been reported for maca.

Interactions No significant documented interactions with maca have been reported.

Dording CM, Schettler PJ, Dalton ED, et al. A double-blind placebo-controlled trial of maca root as treatment for antidepressant-induced sexual dysfunction in women. Evid Based Complement Alternat Med. 2015;2015:949036. doi:10.1155/2015/949036 Kubala J. 4 Benefits of Maca Root (And Potential Side Effects). Healthline. https://www.healthline.com/nutrition/benefits-of-maca-root. Published January 6, 2022. Accessed March 3, 2022. Maca (Natural Products Database). Lexicomp. https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750247?cesid=9T8PYfgBayu&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dmaca%26t %3Dname%26va%3Dmaca. Accessed March 3, 2022. Shin BC, Lee MS, Yang EJ, Lim HS, Ernst E. Maca (L. meyenii) for improving sexual function: a systematic review. BMC Complement Altern Med. 2010;10:44. Published 2010 Aug 6. doi:10.1186/1472-6882-10-44 96

DH SUPPLIMENT Magnesium Oxide

MAGNESIUM SUPPLIEMENT DALTON HUFFMAN | STUDENT PHARMACIST

WHY MAGNESIUM BACKGROUND: MAGNESIUM IS A MATERIAL NATURALLY FOUND IN THE BODY. IT COMES NATURALLY FROM FOOD PRODUCTS THAT WE EAT. IT CAN BE FOUND IN SUPPLEMENTS, MEDICINES, AND ANTACID TABLETS AS WELL. PURPOSE: MAGNESIUM PLAYS AN IMPORTANT ROLE IN THE BODY, SUCH AS SUPPORTING MUSCLE, NERVE FUNCTION, AND ENERGY PRODUCTION. CHRONICALLY LOW LEVELS OF MAGNESIUM MAY RISK HIGH BLOOD PRESSURE AND HEART DISEASE. MECHANISM OF ACTION: MAGNESIUM IS A COFACTOR IN MORE THAN 300 ENZYME SYSTEMS. THESE ENZYMES INCLUDE PROTEIN SYNTHESIS, MUSCLE/NERVE FUNCTION, BLOOD GLUCOSE CONTROL, AND BLOOD PRESSURE REGULATION.

DOSING: MEN SHOULD TYPICALLY INGEST BETWEEN 400-420 MG PER DAY; WOMEN 310-320 MG. MOST COMMONLY SEEN AS TABLETS, CHEWABLE TABLETS, CRYSTALS, POWDER. OR ORAL SOLUTION. TYPICALLY TAKE 1-2 TABLETS WITH FOOD IN THE MORNING ONCE PER DAY IN ORDER TO SEE THE RESULTS OF THE SUPPLEMENT. 97

MAGNESIUM SUPPLIEMENT DALTON HUFFMAN | STUDENT PHARMACIST

Timing: There have been no conclusive evidence, but some sources say it takes around 2 weeks to start seeing results. There has been some evidence that the magnesium is effective in the treatment of leg cramps in pregnant women. It also is proven that it can help with the treatment of arrythmia, asthma, and migraines. Safety and warnings: There are not many safety concerns with the magnesium. The main safety concern is taking these with certain drugs may have adverse effects. It may also cause irritation in the eyes and nose. Interactions: There are many interactions mainly with antibiotics. There are many antibiotics that have interactions with magnesium. Those are the only dangerous side effects involved with the magnesium. Summary of article: The article talks about many health benefits including bone heath, diabetes, cardiovascular health, migraines, and anxiety. It is also used for people with magnesium deficiencies. It finally finished by speaking about types of drug interactions that can happen with magnesium. Opinion: In my profession opinion I see many benefits of taking magnesium. I think that it can help but should not be the first line of defense for patients with serious medical conditions. It should also be discussed with a doctor due to all the interactions. ~DHuffman Citations: (Magnesium: Health benefits, deficiency, sources, and risks, 2022) (Magnesium Supplement (Oral Route, Parenteral Route) Proper Use - Mayo Clinic, 2022) (Office of Dietary Supplements - Magnesium, 2022)

Mangosteen

Amanda Lowery, Student pharmacist Spring 2022

Scientific Name: Garcinia mangostana Botanical family: Guttiferae Common Names: Queen of fruits, mango cut, mangostan, sementah, san zhu

History

Mangosteen is originally from its native range in Southeast Asia, Malay Archipelago. It now originates from tropical and subtropical regions because it requires a very humid, hot tropical environment to grow and survive in. This exotic fruit was first discussed in Chinese record in the 15th century and has a long medicinal history in helping treat skin infections/wounds and dysentery. Later used in ayurveda to aid in diarrhea, cholera, and inflammation. The whole part of the fruit, bark, rind, and leaves have been used for medicinal purposes, with the rind being most used for its source of antioxidants. Mangosteen was banned in the United States because it was believed they harbored Asian fruit flies, but in 2007 the ban was lifted, and we now have fresh mangosteens being sold in North America. The rind and leaves have been used medicinally to treat diarrhea, dysentery, thick mucus, cystitis, thrush, fever, eczema, and pruritus. There is also medicinal value in creating a concentrate of mangosteen bark that has been used to treat genitourinary disorders, such as stomatosis and gonorrhea. It is now being studied for possible antioxidant, antiinflammatory, anticancer, and antihistamine properties, as well as a weight loss supplement. Clinical data in all these areas is lacking though, especially as a weight loss supplement.

Common Uses

MOA/Pharmacology

Cancer: Mangosteen exhibits Alpha-mangostin, mangostanol, and garcinone D extracts from the stem and root bark of G. mangostana and were shown to be cytotoxic against the CEM-SS cell line. Alpha-mangostin activates caspase-9 and caspase-3, and mediating the mitochondrial pathway in the apoptosis. Alpha-mangostin has been shown to inhibit growth of DLD-1 human colon cancer cells, and different studies have shown inhibitory effects on breast cancer, skin cancer, and leukemia. Antibacterial: Alpha-mangostin from the bark and several xanthones from the fruit hulls have shown antibacterial properties. Antihistamine: A pharmacological study of G. mangostana showed that alpha-mangostin is a selective and competitive H1 receptor antagonist, while gammamangostin is a selective and competitive 5-HT2A receptor antagonist. Anti-inflammatory: Xanthone gamma-mangostin potently inhibits prostaglandin E2 and COX-1 and COX-2 release in animal studies. Anti-oxidant: Xanthones found throughout the mangosteen are full of antioxidants. the hull of the mangosteen shows phenolic compounds which are responsible for the strong antioxidant activity, and one study showed neuroprotective activity from the hull extracts. Studies have also shown ferric-reducing activity and higher plasma antioxidant activity. Heart Disease: Different animal studies have shown that alpha-mangostin is inhibitory against beta-adrenergic catecholamine-induced myocardial toxicity and oxidative stress. It is also shown to inhibit oxidative changes in LDL by acting as a free radical scavenger.

Dosing/Dosage forms

There clinical data is lacking to provide dosing recommendations, and amounts vary by product and manufacturer. Average dosing: up to 560mg PO daily for up to twelve weeks Capsule/Tablet: 400mg, 475mg, 500mg, and 1000mg, 1500mg PO once daily Creams Powder: 3,000mg (1tsp) to 6,000mg (2tsp) is the maximum daily amount as directed by most physicians Tea: 1-2tsp of powder per 8oz of hot water

Effectiveness

There is not enough scientific evidence to determine if mangosteen is effective yet, there needs to be more clinical data and trials. There have been animal trials conducted on the anti-cancer and anti-inflammatory effects of xanthones in rodents and been shown beneficial. However, there are not many controlled human studies and there is also a limitation on the effects of long-term use. Thankfully, it is now being marketed as a "superfruit" and more and more studies are starting to be conducted, so hopefully in the future we will have more research and definite answers.

Safety

Not FDA approved and not much evidence or research has been put into it yet to prove long-term safety. For this reason it is recommended to take two days off a week or a week off each month when taking this supplement long-term. Have been reports of GI disturbances if taking mangosteen for too long. There has been one report of severe lactic acidosis with use longer than 12 months. No toxicity studies have been reported in humans. Mangosteen has been shown to act as a blood thinner and therefore should be used cautiously or not at all with anticoagulants or any other blood thinners. It also has been shown to interfere with chemotherapy agents, and can be contraindicated if on a certain regimen. However, for pregnancies it has been known to have a protective effect for the fetus. There needs to be more clinical trials conducted before recommending this to pregnant women, but it is a good start.

Contraindications

In people that are hypersensitive to manosteen. Mangosteen can increase the risk of bleeding during or after surgery, and is supposed to be stopped two weeks before surgery. Since it increases the risk of bleeding it is contraindicated in people with bleeding disorders. Contraindiated in pregnancy and lactation as well. Mangosteen juice should be used sparingly and knowingly in diabetic patients because of the high sugar content. It also is contraindicated with certain chemotherapeutic drugs because it may interfere with the mechanism of anti-coagulants action.

Interactions

anti-platelets anti-cancer therapeutics

Adverse Reactions Constipation bloating N/V tiredness/may cause sedation skin redness/itchiness severe lactic acidosis has been reported may slow blood clotting

Professional Opinion

In my professional opinion, I would not recommend mangosteen to patients because of the medication interactions with OTC NSAIDs, anti-coagulants, and anti-cancer therapies. There is not enough data on mangosteen to deem it safe enough for long-term consumption or what doses are potentially harmful. I might be inclined to recommend mangosteen cream if the patient is not on any other contraindicated medications. ~ A. Lowery

References

1. Login. Online.lexi.com. https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750253? cesid=6VEvtnhMIJE&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dmangosteen%26t%3Dname %26va%3Dmangosteen#ovv-adr. Published 2022. Accessed March 4, 2022. 2. Failla M. Biological Activities and Bioavailability of Mangosteen Xanthones: A Critical Review of the Current Evidence. PubMed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775248/. Published 2022. Accessed March 4, 2022. 3. Drugs H, Supplements H. Mangosteen: MedlinePlus Supplements. Medlineplus.gov. https://medlineplus.gov/druginfo/natural/1081.html. Published 2022. Accessed March 4, 2022.

100

MILK THISTLE LUKE NGUYEN, STUDENT PHARMACIST, SPRING 2022

Other common names: Mary thistle, holy thistle, variegated thistle Scientific names: Silybum marianum, Carduus marianus

BACKGROUND Milk thistle is native to the Mediterranean region and was

Hepatoprotection in cirrhosis and chronic hepatitis Diabetes Indigestions (dyspepsia) Gallbladder disorders Allergic rhinitis/asthma Dyslipidemia Amanita mushroom poisoning Cancer treatment– related adverse effects

https://woodlandessence.com/products /milk-thistle-seed-liquid-extract

brought to North America by early

colonists. It is found in the eastern U.S., California, South America, Africa, Australia, and Asia. Silybum Marianum is a flowering herb related to the ragweed and daisy family. This herb grows up to 5 feet in height and flowers from June to September. The herb itself and its dried seeds are used in preparation to extract an active antioxidant ingredient called Silymarin. Milk thistle is marketed for its anti-inflammatory, antimicrobial, and CNS effects.

COMMON USES

PHARMACOLOGY

The possible antioxidant mechanisms of silymarin include: Prevention of free radical formation via inhibition of ROS‐producing enzymes Free radicals scavenger Ion chelation in the intestine Promotion of the synthesis of protective molecules, and activation of antioxidant enzymes. The active ingredient is called Silymarin It is composed of a complex of flavonolignans, fatty acids, proteins, and other compounds. Silymarin is poorly soluble in water.

DOSAGE FORMS Capsule Caplet Tablet Tea bag Oral tincture IV solution

https://www.gnc.com/milk-thistle/GNCHerbal PlusMilkThistle1300MG.html

https://www.ebay.com/itm/124808817420? chn=ps&mkevt=1&mkcid=28 https://www.amazon.com/Milk-Thistle-TinctureSupplement-Cleansing/dp/B07LGTTGFX

https://www.amazon.com/Organic-Thistle-Ec o-Conscious-Kraft-FGO/dp/B088QT4YCS

TYPICAL DOSING Daily dose: 420 mg/day orally in divided doses for up to 41 months Cirrhosis: 140 mg three times daily for 6-8 weeks, then a maintenance dose of 280 mg daily Mushroom poisoning, oral or IV infusion: 33 mg/kg/day Indigestion: 3.5 g of crushed milk thistle seed with 150 mL of boiling water three times a day before meals 101

EFFECTIVENESS In animal experiments, silymarin and

silibinin are indicated to have protective effects on rat or mouse liver against ethanol intoxication and© Thinkstock drug-induced hepatotoxicity including cisplatin, acetaminophen, carbon tetrachloride, thioacetamide, D-galactosamine, and thallium Cisplatin and ifosfamide-induced renal toxicity can be antagonized by silymarin without reducing the anti-tumor efficacy of these drugs in animal models. A study has shown that concurrent treatment with alloxan and silymarin in alloxan-induced diabetic rats prevented high plasma glucose levels and damage in pancreatic cells within 3 days of the first dose of silymarin administration and 5 days later the mentioned changes were completely prevented.

SAFETY Milk thistle is contraindicated in patients with allergy to any plants in the daisy family In a retrospective clinical report of 205 patients with Amanita poisoning, no fatality observed after administration of intravenous silibinin to 16 individuals Generally safe in patients with acute or chronic liver diseases Little clinical data on the use of milk thistle during pregnancy or while breastfeeding Use with caution in diabetic patients

ADVERSE EFFECTS Common adverse effects: GI disturbances (eg, bloating, abdominal pain, anorexia, changes in bowel habits, diarrhea, dyspepsia, flatulence, nausea Headache and pruritus Loss of appetite Rare/serious adverse effects: Anaphylaxis Hyperbilirubinemia and increases in ALT enzymes Muscle aches, joint pain, and sexual dysfunction

TOXICITIES Avoid the use of the aboveground parts of the plant in women with hormonesensitive conditions Mild allergies were reported with dosages greater than 1,500 mg/day Acute oral toxicity of milk thistle in rats, dogs, and monkeys has been estimated at dosages greater than 5 g/kg

INTERACTIONS Reduces efficacy of antivirals Decreases serum concentration of CYP2C9 substrates, Losartan, Metronidazole Increases serum concentration of deferiprone, fosphenytoin-Phenytoin, Raloxifene, Simeprevir, Sirolimus products, Vitamin K antagonists

PROFESSIONAL OPINIONS Based on current clinical data, I would recommend the use of Milk Thistle for its hepatoprotection effect in patients with cirrhosis and liver diseases. It does not have significant side effects or worsen other preexisting conditions. The uses of Milk Thistle in other diseases are still questionable due to the lack of evidence. ~ L. Nguyen

REFERENCES Abenavoli, L., Izzo, A. A., Milić, N., Cicala, C., Santini, A., & Capasso, R. (2018). Milk thistle (Silybum marianum): A concise overview on its chemistry, pharmacological, and nutraceutical uses in liver diseases. Phytotherapy research : PTR, 32(11), 2202–2213. https://doi.org/10.1002/ptr.6171 Beckerman J, ed. Milk thistle: Benefits and side effects. WebMD. https://www.webmd.com/digestive-disorders/milk-thistle-benefitsand-side-effects. Published June 9, 2021. Accessed March 2, 2022. Karimi G, Vahabzadeh M, Lari P, Rashedinia M, Moshiri M. "Silymarin", a promising pharmacological agent for treatment of diseases. Iran J Basic Med Sci. 2011;14(4):308-317. Milk thistle. Mayo Clinic. https://www.mayoclinic.org/drugssupplements-milk-thistle/art-20362885. Published November 19, 2020. Accessed March 2, 2022. Milk thistle. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/milk-thistle. Published August 2020. Accessed March 2, 2022. Milk thistle. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 2, 2022. http://online.lexi.com Milk thistle. IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed August 24, 2016. http://www.micromedexsolutions.com.

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Noni

Garrette Ozborn, Student Pharmacist, Spring 2022

(Morinda citrifolia L.)

Common Names:

Morinda, Indian mulberry, hog apple, canarywood, awltree, ice leaf

History: Noni is a fruit that grows from trees of the

Morinda citrifolia L. species. These trees grow among the lava flows of Polynesia, India, Australia, the Pacific Islands, and Southeast Asia. While all parts of the plant show some effect, the fruit appears to have the most use in traditional medicine. Although the fruit produces a strong, cheese-like smell and the juice is quite bitter, the fruit is still a staple food in many cultures and has been used in traditional medicine for over 2000 years. The fruit is rich in vitamins, antioxidants, and other valuable nutrients, and has shown both immune-stimulating and tumor-fighting properties. Today, the fruit juice and its extracts are used in dietary supplements that claim to promote the immune system and help with a variety of common disorders.

https://en.wikipedia.org/wiki/Morinda_citrifolia

Common Uses: While some cultures still consume the fruit in their diets, extracts and juices from the fruit have been used in natural healing formulations to treat a variety of conditions, including diabetes, high blood pressure, dyslipidemia, constipation, aging, anxiety, depression, cancer, tumor, burns, aches, arthritis, and infections. Dietary supplements containing Noni are promoted to prevent cancer and infections, treat hypertension, promote weight loss, lower cholesterol, and help manage other conditions.

Dosage Forms: Noni is supplied in its juice form and can be mixed with other juices to help the flavor. Noni extract is also supplied as immediate and extended-release tablets of 30, 60, or 90 milligrams. Additionally, Noni extract can be found as an ingredient in a variety of dietary supplements, essential oils, and topical formulations.

Typical Dosing: Typical dosing regimens for therapeutic effect include up to 600 milligrams of extract or 30http://pbio209.pbworks.com/w/page/11342399/Gupta%2C%20N%2

750 milliliters of juice per day

0-%20Noni%20tree

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Interactions: It is recommended that patients not take Noni with drugs that could further raise serum potassium, particularly potassium-sparing diuretics. Additionally, strong CYP3A4 inducers will reduce the efficacy of Noni products.

Professional Opinion: In my professional opinion, Noni possesses the potential for many positive therapeutic effects. While there are few studies to support the https://www.mauimedicinal.com/collections/noni

efficacy of these products, I would be

Pharmacology:

comfortable with patients trying these products

Noni has had several proposed mechanisms of action. Some studies have shown results that suggest it produces its metabolic and immunomodulatory effects by acting on gene transcription factors such as the Nrf2 pathway that control expression of antioxidant enzymes.

in addition to prescription treatment in mild to moderate cases in the absence of any kidney or liver problems. I would recommend that patients inform their doctor and pharmacist that they take this product in order to monitor for adverse effects and interactions. ~ G. Ozborn

Other students have suggested that Noni

References:

promotes Nitric Oxide release and modulates

Cunha JP. Noni juice: Herbals, uses, side effects,

the glucagon-like peptide-1 receptor to produce its antihypertensive effects.

Safety: Noni is generally considered safe when taken orally or administered topically. Few side effects have been reported in Noni studies. There have been cases of liver toxicity in some users, but the causality of the toxicity is unclear.

Adverse Effects/Toxicities: While generally safe, Noni studies have reported common side effects such as diarrhea and, due to the juice’s high potassium levels, elevated serum potassium. Additionally, though whether or not Noni causes this toxicity is unclear, there have been reports of acute hepatitis and liver toxicity in Noni studies.

dosages, interactions, warnings. RxList. https://www.rxlist.com/consumer_noni_juice/drugscondition.htm. Published August 19, 2021. Accessed March 3, 2022. Noni uses, benefits & side effects - drugs.com herbal database. Drugs.com. https://www.drugs.com/npc/noni.html. Accessed Noni. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/noni. Accessed March 3, 2022. March 3, 2022. Yoshitomi H, Zhou J, Nishigaki T, et al. Morinda citrifolia ( noni ) fruit juice promotes vascular endothelium function in hypertension via glucagon‐like peptide‐1 receptor‐camkkβ‐ampk‐ enos pathway. Phytotherapy Research. 2020;34(9):2341-2350. doi:10.1002/ptr.6685 Zhang K, Meng J, Li X, et al. Noni ( Morinda citrifolia L.) wine prevents the oxidative stress and obesity in mice induced by high‐Fat Diet.

Journal of Food Biochemistry. 2020;44(11). doi:10.1111/jfbc.13460

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Hunter Swindle Student pharmacist Spring 2022

Pomegranate (Punica granatum) Background/Common Uses

Pomegranate, Punica granatum, is a fruit-bearing deciduous shrub that bears a round, reddishbrown fruit with a hard outer coating. The fruit has been eaten and used to make juices for thousands of years. The fruit itself can also be referred to as a seeded apple. The fruits, juice, and extracts have been shown to have possible benefits on the cardiovascular system, diabetes, and glucose metabolism, and smaller studies have shown other potential risk lowering benefits. Pomegranate juice provides an excellent source of fructose, sucrose, and glucose; however, the health benefits are believed to be due to the tannins and flavonoids that possess antioxidant and preservative activities.1 Animals studies have been conducted and shown that there may also be benefits in many different forms of cancer.

Pharmacology

Pomegranate exhibits its cardiovascular benefits by reducing oxidative stress, lipid peroxidation, and generation of foam cells. This influences endothelial cell function by increasing nitic oxide levels, lowering glucose levels, and attenuating platelet aggregation. Pomegranate has been shown to provide protection from chemicals and drugs, and therefore it is thought to improve outcomes with some cancers and the cancer drugs. 2 Pomegranate is metabolized by cytochrome P450 enzymes, with one being CYP2D6. This is likely to cause many drug interactions, and genetic testing may be warranted.

Dosing

Pomegranate can exhibit its effects in many different forms including the peel, juice, and leaves. Numerous different formulations of pomegranate have also been studied. Doses of 50 to 750 ml/ day of pomegranate juice has been shown to have potential benefits on cardiovascular disease. Doses of 750 mg/day of pomegranate extract have some potential benefits on exercise endurance performance. Doses of 1-3 grams/day of pomegranate extract have effects at lowering prostate-specific antigen levels.3

Effectiveness Although studies have been conducted to show the benefits of

pomegranate in many different disease states, there are currently no FDA approved indications for pomegranate.

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Safety and Drug Interactions

Pomegranate is relatively safe and well tolerated by most people. Interactions with CYP P450 enzymes and its effects on other drugs needs to be monitored closely when taking pomegranate. Drug interactions are robust with this metabolism pathway and include drugs such as warfarin, carbamazepine, lisinopril, rosuvastatin, codeine, and many other commonly used prescription medications. Although no evidence suggests that it would be unsafe in pregnancy or while breastfeeding, use during these periods are not recommended until further studies are conducted.3

Adverse Effects and Toxicities

There have been three case reports of priapism lasting up to eight hours while using 50 mg of sildenafil and pomegranate juice concomitantly.4 There have been more than 30 cases of fecal impaction from pomegranate seed bezoars.5 One case of transient hyperphosphatasemia was reported in a 20-month-old who presented to the emergency department with a 2-month history of hyporexia and difficulties with feeding. This was following a daily diet of cereal porridge and pomegranate juice.6

Professional Opinion

Future studies are needed to see the true benefits or this natural product. Although it could benefit some patients, it may interact poorly in others that have predisposing genetic factors. Discussions with healthcare professionals needs to be considered before daily supplementation with this herbal product. ~ H. Swindle

References: 1. Zarfeshany A, Asgary S, Javanmard SH. Potent health effects of pomegranate. Adv Biomed Res. 2014;3:100. Published 2014 Mar 25. doi:10.4103/2277-9175.129371 2. Wang D, Özen C, Abu-Reidah IM, et al. Vasculoprotective Effects of Pomegranate (Punica granatum L.). Front Pharmacol. 2018;9:544. Published 2018 May 24. doi:10.3389/fphar.2018.00544 3. https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/7157521?cesid=8B9aSqKPd Fg&searchUrl=%2Flco%2Faction% 2Fsearch%3Fq%3Dpomegranate%26t%3Dname%26 va%3Dpomegranate#adr-nested. Published October 20, 2021. Accessed March 4, 2022. 4. Senthilkumaran S, Balamurugan N, Suresh P, Thirumalaikolundusubramanian P. Priapism, pomegranate juice, and sildenafil: Is there a connection?. Urol Ann. 2012;4(2):108-110. doi:10.4103/0974-7796.95560 5. El-Majzoub N, Soweid A. Rectal impaction by pomegranate seeds. Ann Saudi Med. 2014;34(6):555. doi:10.5144/0256-4947.2014.555 6. Molina Gutiérrez MA, Alcobendas Rueda RM, Martínez Villar M, de Miguel Cáceres C, Bote Gascón P. Transient Hyperphosphatasemia Due to Pomegranate Juice. Cureus. 2021;13(4):e14779. Published 2021 Apr 30. doi:10.7759/cureus.14779

Graphics:

7. Make pomegranate your go-to superfood for weight loss and glowing skin. Healthshots. https://www.healthshots.com/healthy-eating/superfoods/ benefits-of-pomegranate-for-weight-loss-and-glowing-skin/. Published September 27, 2021. Accessed March 31, 2022. 8. Make pomegranate your go-to superfood for weight loss and glowing skin. Healthshots. https://www.healthshots.com/healthy-eating/superfoods/ benefits-of-pomegranate-for-weight-loss-and-glowing-skin/. Published September 27, 2021. Accessed March 31, 2022. 9. Make pomegranate your go-to superfood for weight loss and glowing skin. Healthshots. https://www.healthshots.com/healthy-eating/superfoods/ benefits-of-pomegranate-for-weight-loss-and-glowing-skin/. Published September 27, 2021. Accessed March 31, 2022. 10. Home. Recipe, How to make Pomegranate Juice Recipe - Vaya.in. https://vaya.in/recipes/details/pomegranate-juice/. Published July 7, 2021. Accessed March 31, 2022. 11. Kawaguchi-Suzuki M, Anderson A, Suzuki S. Reconsidering sports pharmacists and anti-doping education as the world celebrates the olympic and Paralympic Games. American journal of pharmaceutical education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499666/. Published August 2021. Accessed March 25, 2022. 106

Soy Scientific Name: Glycine max (L.) Merr.1

Scientific Family: Fabaceae (bean)1

Sara Green, Student Pharmacist, Spring 2022

Class: phytoestrogen2

Common Names: Soy, Soy isoflavones, Soya, Soybean1

Background/History1 In Asian cultures, soy has been used for thousands of years and in some populations 60 to 90 grams of soy are eaten in a day. The soybean plant was introduced to Japan, Europe, and the United States by the early 1800s. 49% of the world’s soybeans are produced by the United States. Since the 1990s, foods with soy have increased in popularity and in 2000, approximately 27% of United States consumers had reported to using a soy product at least once a week. Products that may include soy are milk, flour, sufu, tofu, tempeh, miso, sprouts, soy sauce, soybean oil, textured soy proteins, soy protein drinks and livestock feeds. Soy protein is used in food programs in less developed countries because of its low cost, nutritional value, and versatility.

Common Uses1 • • •

Asthma Cancer: Breast and Prostate Cardiovascular disease risk factors

• • • •

Chronic kidney disease Cognitive effects Diabetes and glucose metabolism Food allergy/intolerance in infants

• • • •

Gastrointestinal effects Menopausal symptoms Obesity and nutrient intake Osteoporosis

• • •

Phototoxicity Polycystic ovary syndrome Resistance training

https://www.shutterstock.com/search/soybean

Pharmacology/Mechanism of Action2 Soy includes many isoflavones which degrade to genistein, glycitein, and daidzein. Genistein, glycitein, and daidzein are molecules structurally related to estradiol. Genistein is also an estrogen agonist or antagonist and blocks angiogenesis. 2

Typical Dosing • • •

Coronary Heart Disease Prevention: 25 g daily Hot Flush: 50 to 150 mg of soy isoflavones daily Hyperlipidemia: 25 g daily to lower blood cholesterol levels

•

Menopause: 200 mg soy isoflavones daily

•

Osteoporosis Prevention: 40 to 80 mg soy isoflavones daily

Dosage Forms • • •

Capsule2 Food (soybean, nut, soy milk, flour, oil)2 Powder2

• •

Tablet2 IsoRel3 107

Effectiveness2 • • • • •

Effective in treating coronary heart disease prevention and hyperlipidemia Possibly effective in treating cognitive function, diabetes, hypertension, menopause, migraine headache-menstrual, osteoporosisprevention, renal disease, and rheumatoid arthritis Inconclusive data for treating breast cancer, infant diarrhea, and prostate cancer Animal data in treating chemoprotection Ineffective in treating hot flush-breast cancer and muscle soreness-delayed onset 3

Safety

The safety of using this product for certain diseases or illnesses is not very well known. Soy is not intended to be used to diagnose, treat, cure, or prevent a disease.

Adverse Effects •

Allergic reactions such as skin rash, itching or hives, swelling of the face, lips or tongue3

• • • •

Breathing problems3 Constipation or diarrhea3 Gas3 Nausea3

• •

Stomach Upset3 Lower estrogen levels2

•

Longer menstrual cycle2 2

Toxicities

Human teratogenicity data is not available. The use of genistein during pregnancy and lactation has limited data and further studies are needed. Scientific evidence for the use of soy in pregnancy is not available. 2

Interactions • • •

Iron: Reduced iron absorption Levothyroxine: Reduced levothyroxine effectiveness Tamoxifen: Decreased tamoxifen effectiveness

•

Warfarin: Reduced warfarin effectiveness

Professional Opinion •

In certain disease states such as coronary heart disease prevention and hyperlipidemia, soy products may be beneficial to a patient. In other disease states however, they are no or not as much beneficial evidence. Large amounts of soy should be ingested with caution and under the supervision of a doctor. ~ S. Green

References 1. 2.

Soy (Natural Products Database). Lexicomp. https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750362?cesid=4Kc3fi4icGH&searchUrl=%2Flco%2Faction%2Fsearc h%3Fq%3Dsoy%26t%3Dname%26va%3Dsoy. Published 2022. Accessed March 4, 2022. Soy. IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/CS/740DFC/ND_PR/evidencexpert/ND_P/evidencexpert/DUPLICA TIONSHIELDSYNC/D3BFEB/ND_PG/evidencexpert/ND_B/evidencexpert/ND_AppProduct/evidencexpert/ND_T/evidencexpert/PFAc tionId/evidencexpert.DoIntegratedSearch?SearchTerm=soy&UserSearchTerm=soy&SearchFilter=filterNone&navitem=searchALL#. Published 2022. Accessed March 4, 2022. Soy isoflavones oral dosage forms. Cleveland Clinic. https://my.clevelandclinic.org/health/drugs/20099-soy-isoflavones-oraldosage-forms. Published 2022. Accessed March 4, 2022. 108

Emily Wood Student Pharmacist Spring 2022

St. John’s Wort https://sungodmedicinals.com/pages/herb-spotlight-st-johns-wort

Common names: Goatweed, Klamath weed

Scientific name: Hypericum perforatum L.

https://www.researchgate.net/figure/Scheme-1-Structures-of-St-Johnswort-main-antidepressant-components_fig1_6442263

https://www.nccih.nih.gov/health/st-johns-wort-and-depression-in-depth

History St. John’s wort has been used in traditional European medicine for centuries. It is named after John the Baptist due to the yellow-flowered plant blooming around the same time of year as St. John the Baptist day. Having been cited by well-known ancient Greek physicians such as Hippocrates, it was primarily used as an antidepressant and a diuretic. It was also noted for its healing properties. Today it is most commonly used to treat mild-to-moderate depression. It is available over the counter in the United States or by prescription in much of Europe. Common uses - Anti-inflammation - Antiviral/HIV - Depression - Irritable bowel syndrome - Menopause symptoms - Restless leg syndrome - Skin conditions - Wound healing https://minoritynurse.com/herbal-medicine-everything-you-need-to-know-about-st-johns-wort/

Pharmacology St. John’s wort is comprised of a large number of chemicals that can have a variety of effects. Most notably, it contains hypericin and hyperforin, which are thought to provide the supplement’s main pharmacological effects. Studies have shown that it inhibits the reuptake of several neurotransmitters, including norepinephrine, dopamine, and serotonin.

Dosage This supplement is available in a range of forms, mainly capsules. Other forms include tablets, tinctures, teas, and lotions. It is also available dried or powdered. Dosing can range from 200 to 1,800 milligrams daily, with the most common being 900 milligrams divided into three daily doses to treat depression. The lotion generally contains 3-5% hyperforin or 0.3% hypericin. 109

Safety and Effectiveness This supplement has been found to be comparable to antidepressants for treatment of mild-tomoderate depression. It also might be effective at healing wounds and treating symptoms of menopause. There is not enough evidence to know if it is effective for any other conditions.

St. John’s wort should not be taken if pregnant or breastfeeding.

Side Effects - Dry mouth - Nausea - Rash - Fatigue - Dizziness - Restlessness - Insomnia - Headache - Sunlight sensitivity

https://www.heb.com/product-detail/nature-s-bountyst-john-s-wort-standardized-extract-300-mgcapsules/1348607

Interactions St. John’s wort interacts with a wide range of medications, including antidepressants, birth control pills, some heart and cholesterol medications, antivirals, and warfarin. This is not an exhaustive list. It is important to talk to your doctor before taking this supplement. Article Summary A study published in 2017 was done with the goal of creating a more comprehensive conclusion on the effectiveness of St. John’s wort for depression. They collected data from 27 different clinical trials done between 1960 and 2016, and then compiled this data. What they found was that St. John’s wort is comparable to SSRIs, a common type of antidepressant, in treating mild-tomoderate depression. https://www.pinterist.com/pin/563724078329342441/

Professional Opinion St. John’s wort has a high risk of interactions with other medications and is not proven to be effective in treating much else besides mild depression. If a patient is interested in opting for natural methods to treat depression, then it may be something to discuss with their doctor. In general, however, I would not recommend this supplement. ~E Wood https://www.verywellmind.com/st-johns-wort-a2-89959

References St. John’s Wort. Natural Products Database. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 20, 2022. Mount Sinai. St. John’s wort. Accessed February 24, 2022. https://www.mountsinai.org/health-library/herb/st-johns-wort National for Complementary and Integrative Health. St. John’s wort. Accessed February 20, 2022. https://www.nccih.nih.gov/health/st-johns-wort Ng QX, Venkatanarayanan N, Ho CY. Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis. J Affect Disord. 2017;210:211-221. doi:10.1016/j.jad.2016.12.048

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Tea tree Oil Scientific name: Melaleuca alternifolia Common name: Melaleuca oil

Background/History Tea tree oil comes from distilled tea tree leaves from the steam method. The tea tree grows on the swampy southeast coast of Australia. The Latin name of the tea tree oil is Melaleuca alternifolia. The aboriginal people of Australia use tea tree oil as herbal medicine and antiseptic.

Common uses The tea oil is used externally for fungus, cuts, acne, athlete's foot, lice, nail, mite infection at the base of the eyelids, and insect bites.

Pharmacology/Mechanism of Action The tea tree oil contains components of terpinen-4-ol and alpha-terpineol that can disrupt the structure and function integrity of the bacterial membrane.

Dosage Forms

Dosage forms are liquid, gel, spray, soap, cream, oil, and ointment.

Typical Dosing ●

● ● ● ●

Decolonization of MRSA: Tea tree oil as a nasal cream (4% to 10%) applied three times a day for five days and 5% body wash for five days. Prevention of MRSA colonization: Body wash containing 5% tea tree oil daily. Acne vulgaris: 5% tea tree oil gel applied for 20 minutes twice daily, then washed off. Onchomycosis (fungal nail infections): 100% tea tree oil applied for six months. Tinea pedis (athlete's foot): 25% to 50% tea tree oil for four weeks.

Bao Van, Student pharmacist Spring 2022

111

Effectiveness Research about the effectiveness of tea tree oil on bacteria in human oral. The participation complained about the intensive and unpleasant taste of the tea tree oil solution, yet the compliance of the subjects was not affected. The experiment was based on the percentage of plaque on the teeth that got regrowth and where the bacteria appear. The research still has some limits such as they cannot blind test the solution because participation is the one who will mix the solution to do the experiment. The result shows not a big effect of tea tree oil on plaque regrowth and on the vitality of supragingival microflora. Interactions Still no well-known document of interaction with tea tree oil. Professional Opinion There is only a small amount of research on the use of tea tree oil for health benefits. The patient still has to take care of their health and talk with your health care providers about any complementary health approaches you use. ~ B. Van Additional Information There are many plants known as tea trees, but only the one with species M. alternifolia is the source of tea tree essential oil.

Safety Tea tree oil should not be swallowed, otherwise, it can lead to serious symptoms such as confusion, loss of muscle, breathing problems, and coma. Some of the cream products can cause allergic reactions to the skin or skin irritation. Still unknown about the safety of using tea tree oil during pregnancy and breastfeeding. Adverse Effects and Toxicities ● ●

●

The only adverse reaction shown is dermatitis. Tea tree oil becomes toxic whenever ingested orally. There are some cases of internal poisoning but no deaths were reported to the American Association of Poison Control Centers through 2012. Ingesting internally 10-70 mL can lead to ataxia and decreasing levels of consciousness. A couple of reports on cytotoxicity but still low based on experimental data and had been evaluated in guinea pigs, and strengths of 2% or less are considered safe for use. Skin applied to men can cause gynecomastia.

References: ●

● ● ●

Arweiler NB, Donos N, Netuschil L, Reich E, Sculean A. Clinical and antibacterial effect of tea tree oil - a pilot study. Clin Oral Investig. 2000;4(2):70-3. http://umiss.idm.oclc.org/login?url=https://www.proquest. com/scholarly-journals/clinical-antibacterial-effect-tea-tree -oil-pilot/docview/229543898/se-2?accountid=14588. Tea tree oil. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/tea-tree-oil. Accessed March 4, 2022. Tea tree oil. Uses, Interactions, Mechanism of Action |DrugBank Online. https://go.drugbank.com/drugs/DB11218. Accessed March 4, 2022. Tea Tree Oil (Natural Products Database). Lexicomp. https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rn p2/3750378? cesid=47N8NvuuwcI&searchUrl=%2Flco%2 Faction%2Fsearch%3Fq%3Dtea%252520tree%252520oil%26t%3Dname%26va %3Dtea%252520tree%252520oil#i nter-nested. Accessed March 4, 2022. https://www.subpng.com/png-n43j1j/ https://www.walmart.com/ip/Spring-Valley-100-Pure-Aust ralian-Tea-Tree-Oil-2-fl-Oz/550922073 https://www.sciencefocus.com/nature/can-tea-tree-oil-disr upt-hormones/ 112

Hannah Barry

Student Pharmacist

Background: Turmeric has traditionally been used as medically, as a food and as cosmetics. Turmeric is a spice that is used in some curry dishes and mustards. It has a unique yellow color and it sometimes used as a color additive in foods.

Pharmacology: Curcumin is the active form of turmeric. It has very low systemic bioavailability when given orally. Curcumin is given as a lipophilic form, curcuminoid, which is shown to be absorbed systemically unlike curcumin. With turmeric’s main use as an anti-inflammatory agent, the curcumin has been shown to interfere with the eicosanoid pathway, which involves cyclooxygenase and lipoxygenase enzymes.

Spring 2022

The Times of India. (2021, August 18). Surprising health benefits of turmeric you should know about - times of India. The Times of India. Retrieved March 31, 2022, from https://timesofindia.indiatimes.com/life-style/healthfitness/diet/surprising-health-benefits-of-turmeric-youshould-know-about/articleshow/85427219.cms

Common Uses: Turmeric has been used medicinally for hundreds of years in some cultures and countries. Many people use turmeric for its antiinflammatory properties such as the Hindus, while some use it for pain, wounds, and respiratory conditions. Turmeric is also used for preventing cancer, fighting depression, lowering risk of heart disease, fighting free radicals, and improving memory.

Interactions: The main interactions turmeric has is with anticoagulation properties and thrombolytic agents. 113

https://www.naturemade.com Effectiveness: A meta-analysis was done on the effectiveness of turmeric as an antiinflammatory product for arthritis. The conclusion of the analyses showed that although there was not enough data to show turmeric could prevent or heal arthritis on its own, turmeric is a great supplement adjunct to conventional arthritis therapy. The studies proved that turmeric has antiinflammation properties.

Dosage Forms: Most doctors recommend 500 mg/day as a normal supplemental dose. Standardized curcuminoid doses of 200 mg/day have been used in clinical trials of anti-inflammatory effects. Doses of up to 6 g/day have also been studied.

Safety: Turmeric has proven safe thus far. There have been no safety concerns with people taking turmeric within the recommended doses.

Adverse Events and Toxicities: There have been very few adverse events reported with turmeric. The ones reported are such as GI effects, yellow stools, allergic contact dermatitis, and rashes. Studies were conducted on rats to determine toxicity of turmeric, and there were no toxicities reported. The lethal dose for rats was determined to be 2000 g/kg.

Professional Opinion: In my professional opinion, I think turmeric can be a great herbal supplement to take for inflammation. It should be taken with some type of healthy fats to increase absorption to increase efficacy to ensure the patient is getting the most benefit from the supplement. ~ H. Berry

Article References: Rao CV. Regulation of COX and LOX by curcumin. Adv Exp Med Biol. 2007;595:213-226. doi:10.1007/978-0-387-46401-5_9 7 health benefits of Turmeric. Cleveland Clinic. (2022, January 5). Retrieved March 3, 2022. from https://health.clevelandclinic.org/turmeric-health-benefits/ Daily, J. W., Yang, M., & Park, S. (2016). Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Journal of medicinal food, 19(8), 717–729. https://doi.org/10.1089/jmf.2016.3705

www.walmart.com/ip/Great-Value-OrganicGround-Turmeric-1-0-oz/50597546 114

Valerian

Frankie Zahariadis, BSPS, Student Pharmacist, Spring 2022

https://www.amazon.com/Solaray-Daily-ValerianExtract-Count/dp/B000U0IWG4

https://www.gardeningknowhow.com/edible/herbs/valerian/ growing-valerian-herb-plants.htm https:// store.optum.com/ shop/products/ natures-bountyvalerian-root450mg-capsules100ct/

Scientific name of supplement

Valeriana officinalis Common names of supplement

https://www.amazon.com/ Horbaach-Valerian-ExtractLiquid-Drops/dp/B07NSH2TL6

https://www.amazon.com/Natures-Answer-AlcoholFree-Valerian-2-Fluid/dp/B0014ATL8W

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All-heal

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Kesso root

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Baldrian

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Radix valerianae

Available (dosage) forms

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Cat’s Love

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St. George’s herb

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Cat’s Valerian

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Valerian

Aqueous Extract

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Garden heliotrope

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Valerian fragrant

Capsules

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Garden Valerian

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Vandal root

Combinations (with lemon balm or hops as a tea)

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Ethanolic Extract

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Root (fresh or dried)

Background/history This perennial herb is native to Asia, Europe, and North America. Its use medically extends back to the time of early Greece with its recorded history reaching all the way back to the Greek physicians in 460-377 BCE. Marcus Aurelius of the Romans used valerian for insomnia. It was also used in the 16th century for multiple indications. Valerian was used in England for treating the stress induced by the air raids during World War II.

https://www.medicalnewstoday.com/articles/valerian-root https://www.posterazzi.com/valerian-16th-century-nvalerian-valeriana-rubrawatercolor-italian-late-16th-century-poster-print-by-granger-collection-itemvargrc0050405/

Purported/Common uses

Typical dosing/serving

Valerian historically was used for treatment of insomnia, migraine, fatigue, and stomach cramps.

The medicinal properties of Valerian come from the roots and rhizomes. The aqueous extract comes in 400-900 mg by mouth before bedtime. Ethanol extract is 600 mg by mouth at bedtime. Fresh or dried root is 2-3 grams by mouth three times a day. In a combination with hops or lemon balm 320-500 mg are used by mouth at bedtime. Capsule doses range from 300-900 mg.

There is not significant evidence that valerian treats insomnia. Valerian has also been explored for use in treating dysmenorrhea and obsessive-compulsive disorder. Additional trials can be explored for identifying an indication that valerian is effective for.

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Effectiveness

Interactions (food, drug)

The efficacy of valerian has limited evidence. There is not significant support to show that valerian is effective for use in insomnia. There is not clear evidence that valerian treats dysmenorrhea and obsessive-compulsive disorder.

Valerian can increase the CNS depressant effects of alcohol and brimonidine meaning this therapy should be monitored if the patient is using either drug. Avoid combined use of valerian with the following drugs: azelastine, bromperidol, orphendrine, oxomemazine, paraldehyde, or thalidomide.

Safety/warning/toxicities Valerian is generally recognized as safe in the United States. There is potential that valerian is not safe in pregnant or breast-feeding women. Safety in children under three years old has not been determined. The estimated LD50 of valerian is 15,000 mg/kg and 3300 mg/kg. Adverse/side effects Possible side effects of valerian are dizziness, headache, stomach problems, or sleeplessness. There were not any notable adverse reactions of valerian on the those who used valerian supplements as well as those who farmed valerian. However, there have been several cases of hepatotoxicity reported.

Summary of Meta-analysis

In a meta-analysis of 60 studies evaluating the effectiveness of using valerian at treating sleep problems and associated disorders. With multiple active constituents and variety of quality of the valerian products used, there were not consistent outcomes regarding effectiveness. However, there was evidence that there were no severe adverse events associated with valerian use by those between seven and 80 years old. In order to acquire consistent outcomes and come to a conclusion on valerian’s efficacy, there must be more emphasis on quality control and having standards that apply for studies of valerian’s efficacy. https://www.walmart.com/ip/Solaray-Valerian-470mg-Relaxation-Support/47486961

Professional Opinion Valerian has been used for thousands of years. Upon reviewing research and drug databases, I believe that valerian is generally safe and should be further pursued for therapeutic uses and to understand more about efficacy. This supplement does not have physical or psychological addiction related to use while there are supplements such as caffeine that are highly addictive. Also in all the studies of valerian efficacy I reviewed, no patients experienced adverse events. People using or planning to use valerian need to be aware of potential drug-drug interactions with medications they are using. I believe it is important to learn more about the product one is intending to use, as there are inconsistencies in quality and the active constituents in valerian products. I believe setting standards for these two variables will allow for more effective research of and use of valerian. ~F Zahariadis

https://www.mayernikkitchen.com/ medicinal-plants/valerian-S

https://zellerag.com/en/news/phyto-story-valerianvaleriana-officinalis/

1. Shinjyo N, Waddell G, Green J. Valerian root in treating sleep problems and associated disorders-A systematic review and meta-analysis. J Evid Based Integr Med. 2020;25:2515690X20967323. doi:10.1177/2515690X20967323 2. Valerian. Drugs.com. Published June 9, 2021. Accessed February 22, 2022. https:/www.drugs.com/npp/valerian.html 3. Valerian. Nih.gov. Accessed February 22, 2022. https:// ods.od.nih.gov/factsheets/Valerian-HealthProfessional/ 4. Valerian. NCCIH. Accessed February 22, 2022. https:// www.nccih.nih.gov/health/valerian 5. Valerian. RxList. Accessed February 22, 2022. https:// www.rxlist.com/consumer_valerian/drugs-condition.html 6. Valerian. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed August 24, 2016. http:// online.lexi.com 7. Valerian: A safe and effective herbal sleep aid? Mayo Clinic. Published February 15, 2018. Accessed February 22, 2022. https://www.mayoclinic.org/diseases-conditions/ insomnia/expert-answers/valerian/faq-20057875

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Xiang Yu Li Computer graphics technology student Spring 2022

Vitamin D3 (Cholecalciferol)

Discovery

www.naturewise.com

Prior to the twentieth centrury, the nature of what was essential to the human diet was unknown. However, around 1913, two researchers, McCollum and Davis discovered vitamin A and started what has lead to common day supplements. Originally vitamin D was discovered as a cure to a disease common in the United Kingdom at the time, “rickets” where the researchers initially thought that the cure was due to vitamin A, but after isolating vitamin A out, discovered that the cause of the disease was due to a different vitamin deficiency which they named “vitamin D” Common Use The most common use, and study of vitamin D is in relation to bone strength, primarily due to vitamin D deficiency. Other reasons for common use involve COVID-19 prevention, muscle strength/function augmenting, cancer prevention, and support for depression prevention/treatment. Pharmacology In its primary function, vitamin D is a fat-soluble vitamin that when activated promotes intestinal calcium absorption. Vitamin D enables normal bone mineralization, growth, and remodeling. Other roles of vitamin D includes reduction of inflammation, modulation of cell growth, neuromuscular, immune function, and glucose metabolism. Dosage Many dosage recommendations operate with 1,000 – 2,000 IU (25 – 50 mcg) as the minimum intake of supplementation, however supplements with much higher dosages are available in a few different forms. The main forms of intake for vitamin D available are in either liquid, or tablet form as an oral supplement with dosages ranging commonly from 500 – 5,000 IU with lower and higher dosages appearing less frequently. In general, supplements are taken in the range of 1000 – 2000 IU per tablet, as one tablet, once per day. However, there are sources that claim benefit from higher amounts of intake. 117

Effectiveness The effectiveness of vitamin D as a supplement cannot be determined conclusively to affect health outcomes except for issues related to bone health. In terms of relieving bone fracture risk, studies show that periods over five years of supplement intake can reduce the risk of fracturing in elderly persons. Anecdotal evidence, and specific studies show effectiveness for many of the other prescribed common uses, however, conclusive evidence is yet to be found regarding uses other than long-term use for the purpose of improving bone health. Excessive Consumption/Toxicity Excessive consumption can result in renal failure, weight loss, calcification of tissue, cardiac arrhythmia, and as a result death. Regular use of vitamin D, however, has few side effects except as a result of the combination of use with other drugs. As a result of the way the pharmaceutical market functions, few supplement and drug combinations have reliable research done regarding the risks they may present and for consumers the most reliable way to determine the safety of such is by consulting a medical expert. Interactions Orlistat: combined with a reduced-fat diet, may lead to a reduction in the absorption of vitamin D from food or supplement. Steroids: may reduce calcium absorption and/or impair vitamin D metabolism. Thiazide diuretics: combined with vitamin D supplementation may lead to hypercalcemia Few drugs/supplements have significant documentation on the potential risks and side effects of an extensive list of drugs/supplements and as a result the best way to consume such supplements in combination with any other drug or supplement is by consulting a medical practitioner.

Professional Opinion With responsible use, vitamin D is a very safe and stable supplement. While there may not be sufficient documentation for many of the prescribed common uses there is often little risk involved with supplementation in recommended dosages. With this in mind, I would generally recommend vitamin D as a supplement for those that have reason to believe they may have a vitamin D deficiency. Common use for the purpose of increasing quality of mood and depression are generally considered safe uses, and despite lack of conclusive evidence, my personal anecdotal evidence points toward vitamin D deficiency negatively affecting moods. ~ X. Li References 1. Deluca HF. History of the discovery of vitamin D and its active metabolites. Bonekey Rep. 2014;3:479. Published 2014 Jan 8. doi:10.1038/bonekey.2013.213 2. Office of dietary supplements - vitamin D. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed February 25, 2022. 3. Vitamin D. The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/vitamin-d/. Published February 1, 2022. Accessed February 25, 2022. 118

Xocia Chocolate

Blake Burnett- Student Pharmacist, Spring 2022 Background Xocia chocolate is made from unprocessed all natural cacao. It’s Scientific name is Theobroma cacao. It is typically known by the brand name of Xocia. The Aztec’s came up with a way to ferment the cocoa bean in order to get rid of the bitter taste, but xocai chocolate skips that step and is a product that has recently hit the market and is said to have a lot of antioxidant benefits. This idea of unprocessed chocolate was originally designed in Europe. It is said to be better than normal chocolate due to being all natural and not having any sugar or other products added to it. It is also thought to be diabetic and vegan/vegetarian friendly. It is also said that you can purchase this product with omega-3 fatty acids. This comes from being mixed with flax seeds and acai berries. Benefits and dosage forms It is said to be a great tasting alternative to the chocolate products we are used to consuming. It is said to be high in antioxidants. It has also been shown to have various cardiovascular benefits. These benefits come from its ability to create nitric oxide therefore causing vasodilation effects. These antioxidants are said to support your body’s natural defense system by fighting the effects that free radicals can have on your body. Another formulation comes with Omega-3 fatty acids which can help lower lipids and decrease cholesterol. One formulation comes with probiotics to aid in digestion and overall immune health. Another formulation comes in an on the go form which comes in a powder form that can be mixed in a beverage of your choice and provides antioxidants and in some products an energy boost. The last formulation is specifically created to help with weight loss. It is called Xocai high antioxidant meal replacement. It is designed to help you lose weight and provide a lot of antioxidants. The weight loss aspect is covered by the zero sugar content and the idea adding in exercise.

119

Mechanism of action There are many possible mechanisms for how this supplement works, but its main effects are in the antioxidant effects and ability to lower risk of diabetes. Dosing The typical dosing for xocai chocolate is typically one to two times daily with meals or for meal replacement. Effectiveness/safety Xocai Chocolate has been shown to have effects in insulin resistance and the free radicals, but is still lacking in effects on blood pressure and platelet aggregation. Overall, it has been found to be safe for people without a restricted caloric intake. Interactions and Toxicities The main interactions to look for with xocia chocolate are with drugs such as sleep aids, such as Ambien, and stimulants, such as Adderall, due to the fact it contains some caffeine, but overall it is safe for most patients. Some toxicities associated with Xocia chocolate are high blood pressure and anxiety due to it containing caffeine. Another possible problem with its consumption is an allergic reaction to its contents. If you are allergic to any kind of nuts or chocolate it is recommended not to take this product. Professional Opinion In my professional opinion, this product is fairly safe for most patients. The only patients who I would not recommend using this product as of now are patients with hypertension, patients taking sleep aids, patients taking stimulants, and patients who are allergic to chocolate or any type of nuts. The main reason I would not recommend xocia chocolate to these patients is because it contains caffeine and can raise blood pressure, decrease efficacy of sleep aids, and sleeplessness with stimulants. ~ B. Burnett Works Cited Xocai the healthy chocolate. the Healthy Chocolate. https://www.thechocolatecenter.com/xocai.html. Accessed March 3, 2022. Theobromine. Wikipedia. https://en.wikipedia.org/wiki/Theobromine. Published March 1, 2022. Accessed March 3, 2022. Xocai, a healthy chocolate? is there health in every bite? Saksynt. https://tjomlid.com/2012/07/05/xocai-a-healthy-chocolate-isthere-health-in-every-bite/. Published July 5, 2012. Accessed March 3, 2022. Katz DL, Doughty K, Ali A. Cocoa and chocolate in human health and disease. Antioxidants & redox signaling. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696435/. Published November 15, 2011. Accessed March 3, 2022. Dark chocolate drug interactions...can chocolate counteract your medications? Health Benefits of Dark Chocolate. http:// www.health-benefits-of-dark-chocolate.com/drug-interactions.html. Accessed March 3, 2022. McCoy W. Bad effects of chocolate. Our Everyday Life. https://oureverydaylife.com/bad-effects-of-chocolate-12189543.html. Published January 10, 2019. Accessed March 3, 2022. Kerimi A, Williamson G. The cardiovascular benefits of dark chocolate. Vascul Pharmacol. 2015 Aug;71:11-5. doi: 10.1016/ j.vph.2015.05.011. Epub 2015 May 27. PMID: 26026398. Magrone T, Russo MA, Jirillo E. Cocoa and Dark Chocolate Polyphenols: From Biology to Clinical Applications. Front Immunol. 2017 Jun 9;8:677. doi: 10.3389/fimmu.2017.00677. PMID: 28649251; PMCID: PMC5465250. 120

Leedell Tripp, Student Pharmacist Spring 2022

Yohimbe

Most common uses    

Erectile dysfunction Athletic performance Weight loss Angina

Scientific name

Pausinystalia johimbe Common names Aphrodien, Yohimbe Bark, Yohimbehe Yohimbehe Cortex, Yohimbine

Dosing and dosage forms

Yohimbe can be taken in the form of yohimbe tree extract in the form of tea by taking two cups of water in a saucepan and adding five teaspoons of the powdered bark into it and also in supplement pill form which is taken once a day

Pharmacology and mechanism of action Works by blocking receptors in the body called alpha-2 adrenergic receptors These receptors play an important role in inhibiting erections. Yohimbine is thought to help machismo erectile dysfunction by blocking the receptors responsible for preventing erections

History and background Yohimbe is an evergreen tree native to central and western Africa. It has a compound called yohimbine in its bark. The bark has been used traditionally as an aphrodisiac and to 121 enhance sexual performance.

Toxic and adverse effects

earch has shown some erse effects of yohimbe arrhythmias, sexual organ mmatory disorders, high d pressure, and seizure rders.

Drug interactions Yohimbine may also interact with other norepinephrine reuptake inhibitors, including tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors.

Professional Opinion

I would not recommend this product because I don’t believe the benefits outweighs the potential risk. There is no concrete evidence that it produces verifiable results and verifiable possibility of tachycardia furthermore calls into concern for safety precautions. ~L. Tripp

Safety and effectiveness Studies on the effectiveness of yohimbine have had conflicting findings. Some studies suggest it may be beneficial for men with organic erectile dysfunction. And some studies show it may be no more effective than a placebo. As far as safety because yohimbe is works with alpha 2, it has been associated with stomach problems, tachycardia, anxiety, and high blood pressure

References Yohimbe. (n.d.). NCCIH. https://www.nccih.nih.gov/health/yohimbe Yohimbe: Benefits, Uses and Side Effects. (2017, October 13). Healthline. https://www.healthline.com/nutrition/yohim be#TOC_TITLE_HDR_6 Login. (n.d.). Online.lexi.com. Retrieved March 3, 2022, from https://online.lexi.com/lco/action/doc/retrie ve/docid/fc_rnp2/3750416?cesid=16RqFPiq mfg&searchUrl=%2Flco%2Faction%2Fsearch %3Fq%3Dyohimbine%26t%3Dname%26va%3 Dyohimbine Graphics Premium Yohimbine Supplement. (n.d.). Jacked Factory. Retrieved March 3, 2022, from https://www.jackedfactory.com/products/yo 122 himbine

Dietary Supplements Guide Spring 2022

Articles inside

Xocai (Blake Burnett , University of Mississippi School of Pharmacy

Vitamin D (Li Xiang Yu, Purdue College of Science – Computer Graphics Technology

Soy (Sara Green , University of Mississippi School of Pharmacy

Turmeric (Hannah Berry , University of Mississippi School of Pharmacy

Tea tree Oil (Bao Van , University of Mississippi School of Pharmacy

St. John’s wort (Emily Wood, Purdue College of Pharmacy

Pomegranate (Hunter Swindle , University of Mississippi School of Pharmacy

Noni (Garrett Ozborn , University of Mississippi Coll School ege of Pharmacy

Milk thistle (Luke Nguyen , University of Mississippi School of Pharmacy

Magnesium (Dalton Huffman, Purdue College of Pharmacy

Kava kava (Mikiyala Wells , University of Mississippi School of Pharmacy

Licorice (Hien Hoang , University of Mississippi School of Pharmacy

Goldenseal (Yi Wen Ni, Purdue College of Pharmacy

Green tea (Hoa Tran , University of Mississippi School of Pharmacy

Ginseng Lexi Nash, Purdue College of Pharmacy

Ginkgo biloba (Hunter Smith , University of Mississippi School of Pharmacy

Ginger biloba (Lauren Mikell, Purdue College of Pharmacy

Gamma-linolenic acid (Radhika Patel , University of Mississippi School of Pharmacy

Garcinia cambogia (Kaitlyn Margraf, Purdue College of Pharmacy

Garlic (Julianna Massa, Purdue College of Health and Human Sciences/Pre-physician assistant

Feverfew (Elizabeth Loper, Purdue College of Science – Chemistry/Pre-medicine

Fenugreek (Will Moffett , University of Mississippi School of Pharmacy

Elderberry (Garnett Meggs , University of Mississippi School of Pharmacy

Devil’s claw (Cecelia Kaiser, Purdue College of Pharmacy

Collagen (Avery Claire Jones , University of Mississippi School of Pharmacy

Carnitine (Sean Graham , University of Mississippi School of Pharmacy

Chasteberry (Catera Hamilton, Purdue College of Pharmacy

Chondroitin (Andrew Hess, Purdue College of Pharmacy

Boswelia (Taylor Gannon , University of Mississippi School of Pharmacy

Calcium (Jacob Paulaskas, Purdue College of Pharmacy

Black cohosh (Claudia Chiang, Purdue College of Pharmacy

Apple cider vinegar (Gabriela Gmyrek, Purdue College of Pharmacy/BSPS

Alfalfa (Chadwick Cabanero , University of Mississippi School of Pharmacy

Blessed thistle (Boyang Dong, Purdue College of Pharmacy

Bladderwrack (Julie Doan, Purdue College of Pharmacy

Ashwagandha (Alaina Albrecht, Purdue College of Pharmacy

Asian ginseng (Alina Arzumanian, Purdue Health and Human Sciences – Nursing

Aloe vera (Connor Dowling , University of Mississippi School of Pharmacy