Dietary Supplement Guide Spring 2019 by ckohknox

This Photo by Unknown Author is licensed under CC BY-SA

Created by students enrolled in PHPR 48900 Complementary and Alternative Medicine, Purdue University, West Lafayette, Indiana. This assignment comprised of creation of individual topic monographs, peer review of two monographs, and submission of final draft after receiving feedback from peers.

Compiled by Course instructor Cynthia P Koh-Knox Sharp, PharmD, RPh Purdue University College of Pharmacy

ABCs last day of class

Table of Contents Dietary supplement (Author, major)

Page

5-Hydroxytryptophan (Javier Aguirre, Doctor of Pharmacy) .................................................................. 5 Acai (Emma Baker, Doctor of Pharmacy) ............................................................................................... 7 Aloe vera (Amanda Bitzel, Doctor of Pharmacy) .................................................................................... 9 Anise (Paige Boucher, Business Management) ..................................................................................... 11 Ashwagandha (D'Asia Bullock, Doctor of Pharmacy) .......................................................................... 13 B vitamins (Janice Chan, Biological Engineering) ................................................................................ 15 BCAA (Irene Jae Jung Choi, Electrical Engineering) ........................................................................... 17 Bee pollen (Natalie Coldiron, Pre-Pharmacy) ....................................................................................... 19 Bilberry (Jessica Czajkowski, Doctor of Pharmacy) ............................................................................. 21 Biotin (Hannah Dancer, Movement & Sport Sciences) ......................................................................... 23 Black cohosh (Britlyn Dues, Kinesiology) ............................................................................................ 25 Blueberry (Chandler Dykstra, Brain and Behavioral Sciences/Pre-Medicine) ...................................... 27 Boswelia (Jenna Ellis, Computer Science) ............................................................................................ 29 Calcium/ vitamin D (Amanda Gjerde, Nursing) .................................................................................... 31 Cannabidiol (Amy Griffey, Biology) ..................................................................................................... 33 Chamomile (Emily Hainer, Doctor of Pharmacy) ................................................................................. 35 Chasteberry (Aaron Haller, Accounting) ............................................................................................... 37 Chia seeds (Elizabeth Besenhofer, Doctor of Pharmacy) ...................................................................... 39 Chondroitin (LaSeanna Harris, Pharmaceutical Sciences) ...................................................................... 41 Chromium (Will Harris, Doctor of Pharmacy) ...................................................................................... 43 Cinnamon (Michele Holcombe, Biology) .............................................................................................. 45 Creatine (Nolan Huffaker, Chemistry)................................................................................................... 47 Devil's claw (Blake Jennewein, Doctor of Pharmacy) ........................................................................... 49 Docosahexanoic acid (Haley Joyner, Doctor of Pharmacy) .................................................................. 51 Dong quai (Sydney Judge, Pharmaceutical Sciences) ........................................................................... 53 Echinacea (Hatem Kawach, Doctor of Pharmacy) ................................................................................ 55 Evening primrose (Emma Kempf, Doctor of Pharmacy)....................................................................... 57 Feverfew (Jillian Knapp, Actuarial Science and 5Applied Statistics) ................................................... 59 Flaxseed (Tiffany Lin, Doctor of Pharmacy) ......................................................................................... 61 Folic acid (Ted Lingenfelter, Doctor of Pharmacy) ............................................................................... 63 Garcinia cambogia (Chang Liu, Psychological Sciences) ..................................................................... 65 Garlic (Donovan McDuffy, Doctor of Pharmacy) ................................................................................. 67 Ginger (Deep Mehta, Doctor of Pharmacy/Industrial Engineering ....................................................... 69

Table of Contents (continued) Ginseng (Amillia Mize, Doctor of Pharmacy) ....................................................................................... 71 Glucosamine (Valerie Moore, Doctor of Pharmacy) ............................................................................. 73 Goldenseal (Michael Nolan, Doctor of Pharmacy) ................................................................................ 75 Grape seed (Emma Pastula, Doctor of Pharmacy) ................................................................................. 77 Green tea (Liz Ra, Kinesiology) ............................................................................................................ 79 Hawthorn (Carly Richards, Biological Engineering) ............................................................................. 81 Hoodia (Kirsten Ricke, Biology) ........................................................................................................... 83 Horehound (Alexis Rini, Doctor of Pharmacy) ..................................................................................... 85 Horny goat weed (Emily Sajda, Doctor of Pharmacy) .......................................................................... 87 Horse chestnut (Erica Sanford, Pre-Dental)........................................................................................... 89 Iron (Addison Sarver, Doctor of Pharmacy) .......................................................................................... 91 Kava kava (Lucy Schenkel, Nursing) .................................................................................................... 93 Lavender (Abigail Seger, Doctor of Pharmacy) .................................................................................... 95 Lobelia (Ria Shah, Pre-Medicine) ......................................................................................................... 97 Magnesium (Matthew Shotts, Doctor of Pharmacy) ............................................................................. 99 Melatonin (Allison Smitherman, Doctor of Pharmacy) ....................................................................... 101 Methylsulfonylmethane (MSM) (Regina Solomito, Doctor of Pharmacy) ......................................... 103 Omega-3/ omega-6 fatty acids (Hailey Stoker, Doctor of Pharmacy) ................................................. 105 Oscillococcinum (Joseph Stoker, Doctor of Pharmacy) ...................................................................... 107 Potassium (Angela Tharp, Health and Kinesiology) ........................................................................... 109 Prebiotics/ probiotics (Lydia Trapp, Chemistry) ................................................................................. 111 Pycnogenol (Therese Gianne Trebajo, Doctor of Pharmacy) .............................................................. 113 Raspberry ketones (Megan Tuskey, Nursing)...................................................................................... 115 St. Johnâ&#x20AC;&#x2122;s wort (Christina Wilder, Doctor of Pharmacy) ..................................................................... 117 SAMe (Hannah Vyain, Pre-Pharmacy) ................................................................................................ 119 Saw palmetto (Daniel Wade, Doctor of Pharmacy) ............................................................................. 121 Selenium (Sierra Weaver, Doctor of Pharmacy) ................................................................................. 123 Stevia (Willson, Halley, Doctor of Pharmacy) .................................................................................... 125 Tea tree oil (Triston Yoder, Communication and Computer Science) ................................................ 127 Turmeric (Tarryn Zorola, Finance Management) ................................................................................ 129 Ubiquinone (Nicholas Sethman, Doctor of Pharmacy) ....................................................................... 131 Valerian (Debra Hughes, Biological Engineering) .............................................................................. 133 Xocai chocolate (Adrianna Strode, Pharmaceutical Sciences) ............................................................ 135 Yohimbe (Karlee Busscher, Doctor of Pharmacy) .............................................................................. 137

5-Hydroxytryptophan Javier Aguirre, Student Pharmacist, Spring 2019

Scientific Family: Caesalpiniaceae or Leguminosae

Common Names: 5-Hydroxytryptophan, 5-HTP, Oxitriptan (INN)

Background/History: G. simplicifolia shrub seeds are used as a source of 5-HTP. This plant is commonly found in Africa and Ghana. In Africa, the whole plant is used. Pulp from the bark can be topically used on syphilitic sores. Processing the leaves into a paste, this product can be used to treat burns. Sap from the shrub can be used for inflamed eyes. The stem and leaves can be used as a laxative and as a topical antiseptic. Chewing the stem can give an aphrodisiac effect.

Common Uses: Limited evidence from clinical trials have suggested therapy for anxiety, depression, and neurological conditions. Studies have found that it also may be useful as an appetite suppressant.

Pharmacology/Mechanism of Action: Tryptophan is enzymatically converted to 5-HTP by tryptophan hydroxylase (rate-limiting step) which can then be converted into serotonin. Stress, insulin resistance, vitamin B6 deficiency, and an insufficient amount of magnesium may all affect the rate at which 5-HTP is produced

Dosage Forms: 100 mg and 200 mg capsules

5-HTP. Nature's Bounty. https://www.naturesbounty.com/our-products/specialty/diet-supplements/5-htp100-mg-60-capsules/. Accessed April 1, 2019.

Typical Dose: For studies regarding depression, the most common dose is 200 to 300 mg/day. The short half-life of this makes 3 to 4 spaced out doses recommended to reduce potential of nausea

Effectiveness:

Clinical research suggests that 5-HTP is possibly effective for depression from doses of 150-3000mg daily for 2 to 4 weeks. There is insufficient evidence as to whether 5-HTP is effective for alcoholism, anxiety, Alzheimer’s, fibromyalgia, migraines, Parkinson’s, Schizophrenia, insomnia, PMS, and other conditions.

Safety:

Interactions:

5-HTP is “Possibly Safe” when taken by mouth in the recommended dose. Although rare, people who have taken this medication regularly have developed eosinophilia-myalgia syndrome (EMS). This case has also been linked to contamination of 5-HTP therefore scientific evidence is very limited. At large doses from 6-10 grams a day 5-HTP is “Possibly Unsafe” and may increase the likelihood of the adverse effects and toxicities stated below.

Due to 5-HTP altering the production of serotonin, drugs that increase serotonin should be avoided while taking this. 5-HTP has the same drug interactions as serotonergic agents. Tryptophans are specifically contraindicated with Methylene Blue and MOAI’s Use of SSRI’s and MAOI’s may increase the risk of serotonin syndrome.

Adverse effects and toxicities: Other potential adverse effects: -Eosinophilia (higher levels of eosinophils), myalgia, EMS -Heartburn, stomach pain -Suppressive effect on sexual behavior -Decrease in or lack of appetite

My Professional Opinion:

Most common: Nausea, vomiting -Drowsiness -Diarrhea, stomach pain -Dyspnea, hyperventilation -Hallucinations, diaphoresis -Mental stimulation (increased alertness, anxiety, aggressiveness, rapid speech) -Palpitations, bradycardia, hypotension, hypertension -Headache, insomnia

A compilation of reviews on WebMD rated 5-HTP a 4/5 for depression (100 reviews) and anxiety (89 reviews). The survey included ranking the effectiveness, ease of use, and satisfaction. 376 reviews were compiled in Everyday Health, averaging a 3/5. The major complaints were in the side effects such as nausea and anxiousness. My professional opinion if you are considering using it is to try at a low dose and monitor the effects. If your symptoms don’t get better or worsen, or if the adverse effects are too much, stop taking immediately. ~ J. Aguirre

References: 5-HTP. Facts and Comparison eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at www.online.factsandcomparisons.com. Accessed February 26, 2019. 5-HTP. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at http://www.micromedexsolutions.com. Accessed February 26, 2019. 5-Htp: Uses, Side Effects, Interactions, Dosage, and Warning. (n.d.). Retrieved from https://www.webmd.com/vitamins/ai/ingredientmono-794/5-htp. Accessed February 26, 2019.

Emma Baker Student Pharmacist Spring 2019

Background/History

Scientific Name

Açaí (AH-sigh-EE) Common name: • Acai berry • natures “purple gold” • “fruit that cries”

•

Typical Use

Located in South American rainforests, they are found on palm trees and look a lot like grapes or blueberries They began as a market for weight-loss and anti-aging purposes

They are mostly for consuming, found in many food products or can be eaten by themselves. They are very popular in “Acai bowl”, which is smoothie containing the acai berry

Dosage Forms • • • • • • •

Dried Frozen Juice Powder Tablet Capsule Food products

Effectiveness Daily consumption of anthocyanins can reduce the risk of heart attacks by 32% in young and middle-age women

Pharmacology/mechanism of action Antioxidants are thought to protect the cells in the body from damaging effects of chemical reactions with oxygen

Common Uses • • • • • • • • • • •

Their rich antioxidants and anti-inflammatory polyphenolic compounds suggest that the acai berry can lower the risk of age-related brain diseases such as Alzheimer’s and Parkinson’s Their abundance of anthocyanin promotes brain health Heart health Anti-cancerous properties The NCCIH claims that they may help reduce cholesterol and blood sugar levels in people with excessive weight Arthritis Erectile dysfunction (ED) Weight loss/obesity Detoxification Aging skin Natural food colorant in manufacturing

Professional opinion

Acai berries are safe to consume if an extra source of nutrients is desired in one’s diet, especially as a source of antioxidants. However, they should NOT be the only form of nutrients. There is not enough information to carry evidence that they can be the only source of care for diseases and health problems. ~ E. Baker

Safety It is always important that remember that a total nutritious diet is important for healthy living, so a variety of foods is better than to concentrate on an individual food population. Little reliable information about the safety

•

Adverse effects • • •

Side effects have not been reported Drinking raw acai juice has been linked to outbreaks of a disease called American trypanosomiasis or Chagas Disease There is not enough reliable information about the safety of taking acai if you are pregnant or breastfeeding. It is best to stay on the safe side and avoid use.

Interactions An oral contrast agent for gastrointestinal MRIs (might affect the results of MRI scans)

Sources: Acai. (2016, November 29). Retrieved February 25, 2019, from https://nccih.nih.gov/health/acai/ataglance.htm Acai: Uses, Side Effects, Interactions, Dosage, and Warning. (n.d.). Retrieved February 25, 2019, from https://www.webmd.com/vitamins/ai/ingredientmono-1109/acai Firman, T. (2019, January 18). 10 Things You Should Know About Açaí Berries, Nature's "Purple Gold". Retrieved February 25, 2019, from https://www.goodhousekeeping.com/health/diet-nutrition/a47009/what-is-acai/ Ware, M. (2018, May 23). Acai berries: Health benefits, nutrition, diet, and risks. Retrieved February 25, 2019, from https://www.medicalnewstoday.com/articles/305576.php Acai berry photo: https://www.tropicalacai.com/wp-content/uploads/2018/09/acai-berry-632x359.jpg Acai pill photo: https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcSen-gsY1OcB8zM2d7r1aEqMHAYdDf4X1WHK243ikuKJOcqx9cdrA Acai berry bowl photo: https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcSVBK6gSY7meowU7vx1_v3rB8mtMD9pZAdKZSUnI9gP_UOqE5HZ Acai berries in hand photo: https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcRQgpOMq2PZyWXyg_06nrmvlFumaYSNJts3_zIt9RBArzjQvO53A

Aloe vera Amanda Bitzel, Student Pharmacist Spring 2019 Scientific Name

MedicalNewsToday. Healthline Media UK; 2017. https://www.medicalnewstoday.com/article s/318591.php . Accessed February 19, 2019.

Aloe barbadensis Miller 1.

Common Names Aloe Gel, Aloe Latex, Burn Plant, Lily of the Desert, Plant of Immortality, Elephant’s Gall 2.

Background/History Aloe vera is the most common species of Aloe that is cultivated for medicinal use. Aloe drawings have been discovered in the Egyptian temples’ wall carvings constructed in the 4th millennium BC. In the Bible, Nicodemus combined myrrh and aloes to prepare Jesus’ body for burial. Furthermore, Alexander the Great conquered Socotra to gain control of aloe. In the 6th century AD, aloe was brought to Asia by Arab traders. In the 16th century, Spanish explorers and missionaries brought it to the New World. Today, the useful parts of the aloe are the gel and the latex, which treat the skin and relieve constipation respectively. 3.

Common Uses Minor burns (such as sunburn), Skin abrasions, Contact or atopic dermatitis, Constipation, Psoriasis, Acne, Weight loss, Dental plaque 2.

Pharmacology/Mechanism of Action Metallothionein in aloe vera gel scavenges hydroxyl radicals and stops the suppression of superoxide dismutase and glutathione peroxidase in the skin, which protects the skin against radiation damage. Aloe vera also inhibits the cyclooxygenase pathway and decreases prostaglandin E2 production from arachidonic acid, which makes it have anti-inflammatory properties. The anthraquinones in aloe latex act as a laxative by increasing intestinal water to stimulate mucus secretion and peristalsis. 4.

Dosage Forms Gel, Cream, Lotion, Swab, Patch, Capsule, Mouthwash, Cloth 1.

Typical Use Aloe vera gels, creams, or lotions are applied externally to the skin. Aloe cream for psoriasis might contain 70% aloe vera, while aloe cream for burns might contain 0.5% aloe vera. For constipation, 100-200 milligrams of aloe juice or 50 milligrams of aloe extract are taken by mouth daily as needed. 2.

Effectiveness Even though Aloe vera is widely used, more research needs to be completed to prove its effectiveness under different conditions. 4.

Safety Aloe gel is likely safe when used on the skin. It is possibly safe when taken orally on a short-term basis. Aloe gel has been taken safely for up to 42 days in a dose of 15 milliliters daily. Aloe latex taken by mouth is possibly unsafe at any dose, but likely unsafe at high doses. 2.

Adverse Effects/Side Effects High oral doses of aloe latex are dangerous. Prolonged oral use of aloe has resulted in adverse effects such as potassium depletion, albuminuria, hematuria, muscle weakness, weight loss, bloody diarrhea, and cardiac effects. 3.

Toxic Effects

Walmart.com. Walmart. https://www.walmart.com/i p/Spring-Valley-Aloe-VeraSoftgels-25-mg-50Ct/10316845. Accessed February 19, 2019.

Lengthy use of high-dose aloe (greater than 1 g/day) has reportedly caused hemorrhagic gastritis, nephritis, and acute renal failure. The use of aloe by mouth is contraindicated in children younger than 12, pregnant and breast-feeding women, patients with inflammatory bowel disease, and elderly patients with intestinal obstruction. 3.

Interactions Aloe latex causes a major interaction with Digoxin. Since aloe latex is a stimulant laxative, the potassium levels in the body may decrease, which can increase the side effects of Digoxin. Other moderate interactions include antidiabetic drugs, Sevoflurane, Warfarin, stimulant laxatives, and diuretics. 2.

Professional Opinion Aloe vera has been used for a long time to treat and relieve many ailments. I believe that it is a useful product for treating the skin, particularly sunburns. It helps to relieve the stinging and itching from the sunburn. Since aloe vera comes in many different dosage forms, it is easy to find and practically available everywhere. However, more studies need to be completed to determine if aloe vera is effective for other uses. -ABitzel

References 1. Aloe Vera Leaf. DrugBank. https://www.drugbank.ca/drugs/DB13906. Published November 2, 2018. Accessed February 19, 2019. 2. Aloe: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-607/aloe. Accessed February 19, 2019. 3. Aloe. Natural Products Database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed February 19, 2019. 4. Surjushe A, Vasani R, Saple DG. Aloe Vera: A Short Review. Indian J Dermatol. 2008;53(4): 163-6.

PAIGE BOUCHER | BUSINESS MANAGEMENT STUDENT SPRING 2019

PIMPINELLA

ANISUM

Scientific Name Common name: Anise, Aniseed, Sweet Cumin

COMMON USES:

-relieves gas/bloating -antispasmodic -antiseptic -relieves coughs, asthma, and bronchitis -lice, scabies, psoriasis -menstrual discomfort -increasing breast milk -increasing sex drive1,2

COMMON FORMS:

Powder capsules 3 Essential Oil

https://www.landrethseed.com/herb-seeds/anise

Background & History: Anise has been used as a spice and fragrance, being cultivated in Egypt for thousands of years. It has a distinctive licorice flavor in the fruits of the plant, which is native to Egypt and the Mediterranean region. This plant makes a soothing herbal tea and flavors liqueurs and has been used medicinally for a very long time. In ancient Greece, it was recorded to help breathing, relieving pain, provoking urine, and easing thirst. Now, the oil is used 3 commercially as fragrance, flavor, and medicinally. Pharmacology: The chemicals in anise act act like 2 estrogen effects and may also work as insecticides.

http://www.wholesalesuppliesplus.com/prod ucts/anise-certified-pure-essential-oil.aspx

Dosage Forms: For GI disorders: In limited clinical studies, anise 3 g powder taken after each meal (3 times per day) for 4 weeks has been studied for treatment of dyspepsia.3 For menopausal symptoms: Capsules containing P. anisum 330 mg taken 3 times daily for 4 weeks has been used for treatment of menopausal 2 symptoms.

PIMPINELLA

ANISUM

Common name: Anise, Aniseed, Sweet Cumin

Effectiveness: In the case of INTERACTIONS: lice, a clinical study found a Not enough combination of coconut and information has anise was recorded to be been provided on 0.43% more effective than interactions with permethrin. Limited clinical other drugs or data has shown anise powder foods.2 in the management of dyspepsia reports higher quality of life scores in the treatment group compared to the placebo. In a clinical trial of patients with irritable bowel syndrome, anise oil was compared to peppermint oil and there was a PROFESSIONAL decrease in scores of abdominal discomfort and other symptoms, and in another study of IBS patients by the OPINION: same researchers, they reported improvements in My professional opinion is depression with anise oil. Some clinical trials have that there is not enough looked at anise as a relief for menopausal effects, such as data that patients should be hot flashes, with positive findings.1 taking anise for treatment. With little information on Safety: Anise is believed to be an abortifacient, and interactions and adverse consuming amounts exceeding the normal levels found effects, I would not in food is not recommended during pregnancies.1 recommend that patients take anise while on other Adverse Effects/Toxicities: Adverse effects of anise can medication. include allergic reactions of skin, respiratory tract, and They should stick to the 1 gastrointestinal tract. The estrogenic effects may alter amount found normally in hormone therapy, which could include oral foods to avoid any strong contraceptives. Ingestion of anise oil may result in adverse effects. ~ P. Boucher 2 pulmonary edema, vomiting, and seizures. By Franz Eugen Köhler, Köhler's Medizinal-Pflanzen - List of Koehler Images, Public Domain, https://commons.wikimedia.org/ w/index.php?curid=255129

References: 1.Anise (Natural Products Database). (2017). Lexicomp. Retrieved from http://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750015 2.Shojaii A, Abdollahi Fard M. Review of Pharmacological Properties and Chemical Constituents of Pimpinella anisum. ISRN Pharm. 2012;2012:510795. 3.T. (2013). Anise. Encyclopædia Britannica. Retrieved from https://www.britannica.com/plant/anise.

D’Asia Bullock

Student Pharmacist

Scientific name: Withania somnifera Common names: Ashwagandha, Indian ginseng, and winter cherry

Dosage Forms: Infusion

Ashwagandha uses, Benefits & Dosage – Drugs.com Herbal Database. Drugs.com. https://www.drugs.com/npp/ashwagandha.html. Accessed February 22,2019.

Capsule: 1-2 capsules by

Decoction Dye

mouth twice daily

Spring 2019 Background and History: In use for over 3,000 years as a part of an older medicine system called Ayurveda medicine. Ashwagandha means “The smell of the horse” and is said to give the strength and vitality of the horse. Ashwagandha. MR-ginseng.com. https://en.mrginseng.com/ashwagandha/ . Accessed February 22,2019.

ASHWAGANDHA

Yurtoğlu N. Ashwagandha (Withania somnifera). History Studies International Journal of History. 2018;10(7):241-264. doi:10.9737/hist.2018.658.

Pharmacology: Serum - low blood concentration of Ashwagandha in the main bioactives Distribution – Volume of distribution is 0.043 L Mineral bioaccumulation – reduces mineral bioaccumulation in the body Phase II enzyme Interactions – increases the effects of prooxidants that cause the induction of HO-1 via Nrf2/ARE pathway Examine. com. Ashwagandha: UPDATED 2018 – Scientific review on benefits, side effects, dosage, & more. Examine. com. https:// examine.com/supplements/ashwagandha/. Published October 15,2018. Accessed February 23, 2019.

Common Uses: Restore strength Stimulates the immune system Helps prevent cancer Sedative Alleviates pain Anxiolytic

Mechanism of Action: Sedative and anxiolytic properties – activates GABA – A receptors

Anti-stress properties – reduces cortisol blood levels by ~ 28% Anti-inflammatory properties – mechanism is unknown Anti-cancer properties – acts as an antioxidant for normal cells Strength properties – increases testosterone levels in man by ~ 17%

Ashwagandha. MR-ginseng.com. https://en.mr-ginseng.com/ashwa gandha/ . Accessed February 22,2019.

Examine.com. Ashwagandha: UPDATED 2018 Scientific review on benefits, side effects, dosage, & more. Examine.com. https://examine.com/supplements/ashwagandha/. Published October 15, 2018. Accessed February 23, 2019.

Interactions:

Effectiveness:

Safety:

JNK inhibitors

There is limited and insufficient evidence regarding the effectiveness for ashwagandha.

Contraindicated in pregnancy

MAO inhibitors Antidiabetics

Avoid if you have hyperthyroidism Avoid if you have stomach ulcers The long-term safety of ashwagandha is unknown

Antihypertensives Immunosuppressants

There is no research regarding the application of ashwagandha directly to the skin

CNS depressants Ashwagandha Effectiveness, Safety, and Drug Interactions on RxList. RxList. https://www.rxlist.com/ashwagandha/supplements.ht m . Accessed February 23, 2019.

Ashwagandha Effectiveness, Safety, and Drug Interactions on RxList. RxList. https://www.rxlist.com/ashwagandha/supplements.ht m . Accessed February 23, 2019.

Ashwagandha The powerful Herb ever known, How to benefit yourself from this Magical Herb.

Adverse effects and toxicities: If ashwagandha is used in large doses it can cause intestinal problems such as vomiting and diarrhea.

Hypnotic effects may also occur if large doses are consumed. Ashwagandha. MR-ginseng.com. https://en.mrginseng.com/ashwagandha/. Accessed February 22, 2 019.

Professional Opinion: Ashwagandha is consumed to help protect the body when it undergoes any form of stress. The dietary supplement shields the entire body and has a broad spectrum of uses. Research revealed that there is a limited amount of drug interactions that will result in fatalities. The side effects of Ashwangdha are tolerable and occur only with excessively high doses of the supplement. With that being said I would encourage the use of Ashwagandha. It may be combined with a variety of other dietary supplements and causes limited complications with frequent medication regimens. -

Dâ&#x20AC;&#x2122;Asia Bullock

B VITAMINS Janice Chan Biological Engineering Student Spring 2019

VITAMINB12

Scientific name: Vitamin B12 Common name: B Complex History: Discovered by George Whipple and George Minot in 1934 Common uses: Keeps nerve and blood cells healthy and helps make DNA Mechanism of action: Hydrochloric acid separates vitamin B12 from the protein it is attached to. Vitamin B12 is combined with a protein made by the stomach and is absorbed by the body Dosage Forms: Pill form, naturally found in food, and can be prescribed in a shot Typical use for adults is 2.4 mcg

https://target.scene7.com/is/image/Target/GUEST_6d91eb7e-4ded-4fa0-8e1b-aa0740e196a3?wid=488&hei=488&fmt=pjpeg

VITAMINB7

https://target.scene7.com/is/image/Target/GUEST_1aad2f53-6a0c-4bc4-b904-873595c8a358?wid=488&hei=488&fmt=pjpeg

Scientific name: Biotin Common name: Vitamin B7 History: Discovered by Vincent du Vigneaud in 1942 Common Uses: Turns carbohydrates, fats, and proteins from food into energy Mechanism of action: Needed for enzymes that transfer carboxyl units and fix carbon dioxide to function properly, needed for metabolic functions Dosage Forms:Found in food but can also be found in multivitamin/multimineral supplements and B-complex supplements Typical Use for adults is 30 mcg.

VITAMINB12 Effectiveness: The amount of vitamin B12 needed depends on your age. But it is needed for proper red blood cell formation and neurological function

Safety: There are medicines that can interact with vitamin B12. Let your doctor, pharmacist, or healthcare provider know about taking vitamin B12 to see if it interacts with how your body can absorb nutrients

Adverse effects: None according to the Institute of Medicine Toxicities: Low potential for toxicity Interactions: Can potentially interact with certain medications like Chloramphenicol, Proton pump inhibitors, and H2 receptor antagonists

Professional Opinion: I think they are useful in gaining https://nutritionlab.co/wp-content/uploads/2018/07/Vitamin-B12-Foods.jpg

energy and if there is a deficiency in B12 intake, a daily supplement can be used. ~J. Chan

VITAMINB7

Effectiveness: Treats low blood levels of biotin and prevent biotin levels from becoming too low which can cause hair thinning and rashes Safety: Safe when taken appropriately ie. by mouth or application to skin.

Adverse effects: Unlikely to cause adverse health effects at maximum daily intake Toxicities: No evidence to support that biotin is toxic at high intakes according to Food and Nutrition Board

Interactions: Can change the rate at which medications are broken https://i.pinimg.com/originals/c1/4c/f6/c14cf62f94561de4105dcb36620ce0ea.jpg

down by the liver. Should not be taken along side Alpha- lipoic acid and Vitamin B5 ( pantothenic acid) . Consuming raw egg whites

OfficeofDietarySupplements- VitaminB12. NIHOfficeof DietarySupplements. https://ods.od.nih.gov/factsheets/VitaminB12HealthProfessional/. PublishedNovember29, 2018

can decrease absorption of biotin

AccessedMarch30, 2019.

OfficeofDietarySupplements- VitaminB12. NIHOfficeof DietarySupplements. https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/. AccessedMarch30, 2019.

Professional Opinion: I recommend taking biotin but consult your healthcare professional if you are taking any medication before taking biotin. ~ J Chan

Biotin: MedlinePlusSupplements. MedlinePlus. https://medlineplus.gov/druginfo/natural/313.html. Accessed April1, 2019.

Irene Choi Electrical Engineering Spring 2019 <BCAA> •

Scientific Name / Common Names/ Background History o BCAA is an acronym for Branched-Chain Amino Acids (Micromedexsolutions.com, 2019). o Amino acids composed in certain molecular structure (Bscg.org, 2019). o Since amino acids are building blocks of proteins, many athletes and professionals take extra amount of BCAAs to improve their muscle development during their training (Bscg.org, 2019).

•

Common Uses o Most common BCAAs are valine, leucine and isoleucine (Bscg.org, 2019). o Since human body cannot produce BCAA, people must get them through diet. o Amino acids have several functions related to energy production during and after physical exercises (Bscg.org, 2019). o Most people use BCAA to reduce fatigue o Improve concentration during normal life pattern. Pharmacology/Mechanism of action o The way the BCAA improve performance is through a reduction in serotonin, and this nulls the fatigue and increases exercise performance (Bscg.org, 2019). o Especially leucine, is a strong nutritional stimulus ▪ Able to enhance protein translation initiation and attenuate proteolysis (Mangan, 2013) Available forms/ typical serving o Dosing depends on quality of raw materials, manufacturing process and packaging o Oral ▪ Cirrhosis : 5-50 grams orally three times a day ▪ Hepatic Encephalopathy : tablets 4 times a day for one week ▪ Hepatocellular carcinoma : 50 grams three times daily for 12 weeks ▪ Mental performance in athletes : 5.3 grams mixture with drink ▪ Viral cirrhosis : 100 grams per day for 2 to 6 weeks o Intravenous ▪ Cirrhosis : 1 gram per kg body weight per day for 5 days ▪ Nitrogen loss (prevent or treat) : 1.5 g/kg per day ▪ Nutritional support : 0.8 to 3 grams/ kilogram of body weight per day

•

Effectiveness o Fix damaged muscles o Decrease muscle fatigue o Improve muscle function o Lower exercise-induced muscle damage o Facilitate muscle-protein synthesis o Muscle recovery

•

Adverse effects/ side effects o There are some adverse effects like thrombophlebitis, thrombocytopenia, hyperammonemia, nausea, flushing and fever (Micromedexsolutions.com, 2019). Toxic effects o Intravenous fat emulsion as part of a 3-in-1 solution containing amino acids, glucose, and lipids, are visually compatible and do not have a significant change in particle size distribution when it is stored for 24 hours at room temperature in a plastic container (Micromedexsolutions.com, 2019). o But with the addition of electrolytes, the particle size was increased slightly at 24 hours but no flocculation or further change occurred for a 72-hour study period (Micromedexsolutions.com, 2019).

•

Safety concerns/warnings o Precautions ▪ Hepatic failure ▪ Fluid restricted patient ▪ Sulfite sensitivity ▪ Acute renal failure patient

Interactions(food, drug) o As of drug interactions, one of the compatibilities solutions is dextrose. o Dextrose 10% in water in 3-in-1 admixtures also containing Amino acids 8.5% and Intravenous fat emulsion 10%, mixed 1:1:1, amino acids shows that it prevents the lowering of the emulsion pH (Micromedexsolutions.com, 2019).

Figure 1. Graphic of BCAA function (Tipton, 2017)

<Resources> Micromedexsolutions.com. (2019). Micromedex Products: Please Login. [online] Available at: https:// www.micromedexsolutions.com/micromedex2/librarian/CS/A79767/ND_PR/evid encexpert/ND_P/evidencexpert/ DUPLICATIONSHIELDSYNC/BB5929/ND_PG/eviden cexpert/ND_B/evidencexpert/ND_AppProduct/evidencexpert/ND_T/ evidencexpert/PFAc tionId/evidencexpert.DoIntegratedSearch?SearchTerm=bcaa&UserSearchTerm=bcaa&Se archFilter=filterNone&navit em=searchALL# [Accessed 26 Feb. 2019]. Bscg.org. (2019). [online] Available at: https://www.bscg.org/bcaa/ [Accessed 26 Feb. 2019]. Mangan, P. (2013). Mechanism of BCAA modulation of muscle growth - Rogue Health and Fitness. [online] Rogue Health and Fitness. Available at: http://roguehealthandfitness.com/mechanism-of-bcaa-modulation-of-muscle-growth/ [Accessed 26 Feb. 2019]. Tipton K. The truth about BCAA. Jeukendrup - Trusted sports nutrition advice & exercise science news. http:// www.mysportscience.com/single-post/2017/10/02/The-truth-about-BCAA. Published October 2, 2017. Accessed April 1, 2019.

Natalie Coldiron Pre-Pharmacy Student Spring 2019

Bee Pollen

Why do People Take Bee Pollen and What is it Used For? Scientific Name: none https://doesitreallywork.org/bee-pollenpills-review/

Common names: 

Bee Pollen Nuggets



Bee Pollen Power Extract



Super Bee Pollen Complex



Buckwheat pollen



Maize pollen



Pine pollen



Pollen d’ Abeille



Pollen



Pollen pini



Puhuang



Rape pollen



Sonfuuafen



Typha pollen

Background of Bee Pollen Bee pollen is a mixture of pollens picked up from flowers by worker bees as they fly from one flow to another. Bee pollen began as a popular folk remedy for conditions including PMS and enlarged prostate.

There is very little evidence proving that bee pollen has any health benefits; however, one study found evidence that side effects from radiation therapy for cancer have been reduced after taking bee pollen. There are other studies looking at if bee pollen can be used for men that are suffering from enlarged prostate or prostatitis. Another study also found that it can reduce symptoms of premenstrual syndrome (PMS).

Mechanism of Action None of the active ingredients in bee pollen have been linked to having therapeutic effects.

Dosage Forms Capsule, extract, granules, liquid, tablet. One to three grams are taken daily depending on the dosage form.

https://pngtree.com/freepng/flying-bee_188625.html

Bee Pollen

Effectiveness Bee pollen is ineffective when taken orally for increasing athletic stamina. There is also no sufficient information regarding the effectiveness of bee pollen for its other uses. Adverse Effects Bee pollen can be dangerous if taken by a patient that has pollen allergiesâ&#x20AC;&#x201D;it can increase the risk of allergic reactions. Also, bee pollen has been associated with two cases of acute hepatitis. Safety and Toxicity

https://en.wikipedia.org/wiki/File:Anthidium_February_2008-1.jpg

Professional Opinion

In my professional opinion, I think bee pollen would be a good alternative to patients if they do not have allergies to any types of pollen. ~ N. Coldiron

Patients that are children, women that are pregnant, or nursing mothers should not ingest bee pollen since there is a lack of data regarding these patients. With that being said, there is little risk of toxicity since the ingredients of bee pollen have not been linked to therapeutic effects.

References 1. Klug H. Bee Pollen. Ucdenver.edu. http://www.ucdenver.edu/academics/colleges/pharmacy/currentstudents/OnCampusPharm DStudents/ExperientialProgram/Documents/nutr_monographs/Monograph-bee_pollen.pdf. Published 2003. Accessed February 26, 2019. 2. An Overview of Bee Pollen. WebMD. https://www.webmd.com/diet/supplement-guide-beepollen. Published 2019. Accessed February 26, 2019. 3. Wong C. 3 Reasons to Start Eating Bee Pollen. Verywell Health. https://www.verywellhealth.com/bee-pollen-what-should-i-know-about-it-88312. Published 2019. Accessed February 26, 2019.

Jessica Czajkowski, Student Pharmacist, Spring 2019

BILBERRY (Vaccinium myrtillus) AKA: Hurtleberry, Whortleberry

COMMON and TYPICAL USES www.arcticbilberry.fienarctic+bilberrywild+bilber ries+and+cultivated+blueberries/

Today, it is commonly used in the cases of cancer, acute diarrhea, gastric ulcer, hemorrhoids, hyperlipidemia, ocular disease, venous insufficiency, wound healing, and diabetes.

HISTORY

DOSAGE FORMS (Oral)

A relative to the blueberry that is native to regions of the Rocky Mountains, Europe, and Asia. In the Middle Ages, the berries and leaves were used for diarrhea, scurvy, infections, burns, and diabetes. During World War II, British pilots ate the jam improve their night vision.

PHARMACOLOGY (Studied in rats) ABSORPTION: 5% bioavailability with absorption in the gastrointestinal tract DISRIBUTION: Tissues with high collagen content such as skin, liver, and kidneys. Peak plasma concentration occurs in 15 minutes and declines in 2 hours. METABOLISM: unknown EXCRETION: Mostly through the kidneys and bile

https://nakedteasgalore.com/products/ organic-bilberry-leaf

Tablet Capsule Liquid extract Leaves Drops Powders

ADULT ADMINISTRATION *depends on conditions, extraction, and dosage form EYE HEALTH: 60-160 mg of fruit extract three times daily ACUTE DIARRHEA: 20-60 grams tablet/capsule daily INFLAMMATION OF MOUTH & THROAT: 10% gargle GENERAL USE: 3-6 mL of a 1:1 fluid extract daily

CHEMICAL COMPONENTS

Anthocyanside

15 anthocyanside compounds are the primary pharmacological effect Beta-sitosterol, lutein, zeaxanthin, phenolic acids, flavonoids, lavan-3-ols https://patents.google.com/patent/US20120328755

MECHANIISM OF ACTION Primarily due to anthocyansides • • • • • • • • • • • • •

Induces quinone reductase in hepatoma cells and suppresses growth in breast cancer cells Protects LDL from oxidation and vitamin E consumption that can lead to atherosclerosis and cardiovascular diseases Induces gastric mucus secretion and mucopolysaccharides interactions on gastric ulcers Interacts with collagen in blood vessels to normalizes the protease and limit the increase in vascular permeability in the skin and aorta during hypertension Decreases triglyceride and blood glucose levels Stimulates the release of endothelium-derived relaxing factor and activates local biosynthesis of mucopolysaccharides to stimulate perivascular tissues and facilitate regeneration of the vessel wall Induces relaxation of splenic arteries and stimulates prostacyclin synthesis in the walls of blood vessels Inhibits catechol-O-methyltransferase causing adrenaline-induced relaxation. Increases the intracellular concentrations of cAMP and decreases the concentration of thromboxane A2 in platelets for anti-platelet activity Stimulates the production of a prostacyclin-like substances Reduces blood loss in the urine by increasing capillary integrity in the kidney Decreases the biosynthesis activity of polymeric collagen in diabetic retinopathy Blocks histidine carboxylase which inhibits histamine-induced capillary hyperpermeability and protects from capillary fragility

EFFECTIVENESS

REGULATION and APPROVAL

• • • • • •

Bilberry fruit is approved by the German Commission for the treatment of acute diarrhea and mild inflammation of the mouth and throat. The American Herbal Products Association rated it as Class 4 due to insufficient data available. It is available as a dietary supplement under the Dietary Supplement Health Education Act.

•

Decreases capillary permeability and improved venous insufficiency Some benefits for cancer Inconclusive evidence for gastric ulcers Reduces hemorrhoidal symptoms Supported use in hyperlipidemia Prevents diabetic retinopathy and improves visual acuity, retinal function, and reduces permeability and hemorrhage in ocular diseases Inhibits platelet aggregation and lengthens bleeding time

COMPARISON to OTHER MEDICATIONS Bilberry is more effective than Centella Asiatica Selected Triterpenes with wound healing and increasing capillary protective activity. It is also more effective than ketoprofen with reducing hemorrhoidectomy discomfort due to postoperative symptoms of burning, edema, and pruritus. Finally, it is two times great than rutin in anti-inflammatory activity.

SAFETY Bilberry may cause varicose veins and hemorrhoids in pregnancy in high doses. It has been used as antigalactagogues but there is no scientific evidence in lactating women. Patients on warfarin or antiplatelet drugs should use caution. https://www.amazon.com/Attention-Warning-ExclamationPoint-Sticker/dp/B00RY3O638

TOXICITIES There have been no reported toxicities with doses three times higher than the normal human dose in animal studies.

INTERACTIONS https://steemit.com/art/ @nickdavison/ drawingablooddropletcoatofarmsforared crossworker-pkfqlhzo46

ADVERSE EFFECTS • • • •

May cause decreased platelet aggregation. Nausea can occur in high doses, but it can be relieved if the dose is taken with food. May cause darkened urine and feces. Chronic intoxication in animal studies were observed with a chronic administration of 1.5 grams/kilogram/day of bilberry leaves. Symptoms include cachexia, anemia, icterus, acute excitation, and disturbances of tonus.

Studies have shown that bilberry may amplify the effects of the following medications: Anticoagulants Antiplatelets Low molecular weight heparins Thrombolytics Taking these medications with bilberry may result in an increased risk of bleeding, especially postoperative. Patients should be monitored for signs and symptoms of bleeding. The dose of the anticoagulant may be adjusted if the patient is taking doses of bilberry chronically.

PROFESSIONAL OPINION Based on the research, I would recommend bilberry to patients with breast cancer, hemorrhoids, hyperlipidemia, ocular diseases, and venous insufficiency. It is proven to be efficacious and is even better than some medications for certain conditions. However, it is important to make sure there are no contraindications with medications or conditions and to monitor for worsening of symptoms. https://www.shutterstock.com/search/bilberry+extract

References • Bilberry. IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/CS/9B4766/ND_PR/evidencexpert/ND_P/evidencexpert/DUPLICATIONSHIELDSYNC/115C22/ND_PG/ evidencexpert/ND_B/evidencexpert/ND_AppProduct/evidencexpert/ND_T/evidencexpert/PFActionId/evidencexpert.DoIntegratedSearch? SearchTerm=bilberry&UserSearchTerm=bilberry&SearchFilter=filterNone&navitem=searchALL#. Accessed February 20, 2019 • Bilberry. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/bilberry. Published October 17, 2016. Accessed February 20, 2019. • Bilberry (Vaccinium myrtillus). Sigma-Aldrich. https://www.sigmaaldrich.com/life-science/nutrition-research/learning-center/plant-profiler/vaccinium-myrtillus.html. Accessed April 1, 2019.

BIOTIN Hannah Dancer

Movement & Sports Science Student

Spring 2019

Hexahydro-2-oxo-1H-thieno(3,4-d) imidazole-4-pentanoic acid, also known as biotin, is a dietary supplement also referred to as some of its common names including Biotina, Biotine, Biotine-D, Coenzyme R, D-Biotin, Vitamin B7, Vitamin H, and Vitamine B7. It is water-soluble and apart of the B-complex vitamins. Biotin is commonly used for hair loss, brittle nails, nerve damage, and many other conditions. It is most prevalent in egg yolk and beef liver. It was originally identified as a nutritive requirement of yeast, and referred to as “Vitamin H.” It wasn’t until 1935 that it became isolated in pure form due to the discovery of the requirement by animals. It became evident that biotin is a necessary dietary supplement when scientists and nutritionists discovered that the addition of uncooked egg white to a diet that is otherwise adequate produces toxicity and disease. This is due to a specific protein in egg white called Avidin that combines with biotin and prevents its absorption. A deficiency in biotin causes symptoms that include dermatitis and hair loss. Biotin is typically ingested orally. There is no recommended dietary allowance established for biotin, however, the adequate intakes 30 mcg for adults over 18 years.

Other than its role as a carboxylase prosthetic group, biotin regulates gene expression and has a wide repertoire of effects on systemic processes. “The vitamin regulates genes that are critical in the regulation of intermediary metabolism: Biotin has stimulatory effects on genes whose action favors hypoglycemia (insulin, insulin receptor, pancreatic and hepatic glucokinase); on the contrary, biotin decreases the expression of hepatic phosphoenolpyruvate carboxykinase, a key gluconeogenic enzyme that stimulates glucose production by the liver. The findings that biotin regulates the expression of genes that are critical in the regulation of intermediary metabolism are in agreement with several observations that indicate that biotin supply is involved in glucose and lipid homeostasis. Biotin deficiency has been linked to impaired glucose tolerance and decreased utilization of glucose. C, F. (2019).”

Taking biotin can help treat low blood levels of biotin, as well as prevent blood levels of biotin from becoming too low. A biotin deficiency can cause thinning of the hair and rash around the eyes, nose, and mouth. “Other symptoms include depression, lack of interest, hallucinations, and tingling in the arms and legs. Low biotin levels can occur in people who are pregnant, who have had long-term tube feeding, who are malnourished, who have undergone rapid weight loss, or who have a specific inherited condition. Cigarette smoking might also cause low blood levels of biotin. Taking biotin and zinc by mouth in

addition to applying a steroid cream to the skin might help reduce hair loss. Early research shows that taking high-dose biotin might improve vision and reduce partial paralysis in some people with multiple sclerosis. MedLinePlus (2019).”

Biotin can effectively treat and prevent biotin deficiency, although biotin deficiency is very rare and taking supplements is not usually necessary. Taking biotin by mouth for up to a year might increase the thickness of fingernails and toenails in people with brittle nails. While it’s available as a supplement, biotin is something you should only take if advised by your doctor. Most people get enough biotin through their regular diet. There are currently no known adverse side effects of biotin when taken as prescribed by a doctor or through normal dietary intake.

There are no known interactions between biotin and herbal medicines or other supplements. Nonetheless, always consult your doctor before adding any new supplements or drugs to your lifestyle. There are a few that can lower your biotin blood levels and require you to raise them by using biotin supplements. These include antibiotics taken for a long time, and anti-seizure medications such as carbamazepine, phenobarbital, phenytoin, and primidone. Smoking may also lower biotin levels. Consuming raw egg whites in your diet can prevent the body from absorbing biotin. Likewise, eating two or more raw egg whites every day for more than a few months could cause biotin deficiency.

My professional opinion on biotin is that biotin is helpful in treating hair and nail growth. I have taken it in the form of “hair, skin and nail” vitamins and notice a difference mainly in my finger nails. ~ H. Dancer

References C, F. (2019). Pharmacological effects of biotin. - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15992683 [Accessed 27 Mar. 2019].

MedLinePlus (2019). Biotin: MedlinePlus Supplements. [online] Medlineplus.gov. Available at: https://medlineplus.gov/druginfo/natural/313.html [Accessed 27 Mar. 2019]. National Center for Biotechnology Information (2019). Biotin. [online] Pubchem.ncbi.nlm.nih.gov. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/biotin#section=Top [Accessed 21 Feb. 2019].

Therapeutic Research Faculty (2019). Biotin: Uses, Side Effects, Interactions, Dosage, and Warning. [online] Webmd.com. Available at: https://www.webmd.com/vitamins/ai/ingredientmono-313/biotin [Accessed 21 Feb. 2019].

The Editors of Encyclopaedia Britannica (2019). Biotin | chemical compound. [online] Encyclopedia Britannica. Available at: https://www.britannica.com/science/biotin [Accessed 22 Feb. 2019].

Britlyn Dues

Kinesiology Student

Spring 2019

Scientific Names: Actaea Racemosa, Cimicifuga Racemosa Common Names: Black Coshosh, Black Bugbane, Black Snakeroot, Rattleroot, Rattleweed, Macrotys, Bugwort

Background: § § § §

Native to North America Member of the Ranunculaceae family Was traditionally used for a variety of ailments and even as an insect repellent The useful part of the plant is the root

Common Uses: § §

§ § §

Dietary supplement for hot flashes or other menopausal symptoms, menstrual cramps, premenstrual syndrome, painful menstruation Can also be used to induce labor o Help with pregnancy rates following in vitro fertilization and women with polycystic ovarian syndrome (PCOS) Alternative nonhormonal therapy for vasomotor symptoms Acne Weakened bones (osteoporosis)

Pharmacology/Mechanism of Action: §

Selective estrogen receptor modulator, through serotonergic pathways, as an antioxidant, or on inflammatory pathways

Dosing: § §

§ §

Extract is standardized to 2.5% 40 to 80 mg/day for symptoms of o Divided doses o Doses ranging from 6.5 to 40 mg daily for weak bones Sold as the dried root, tablets

of triterpene glycosides (1 mg/dose) menopause 160 mg/day for 1-12 months and capsules, as an extract

Background image: Black Cohosh. Digital Image. National Center for Complementary and Integrative Health. 29 November 2016. https://nccih.nih.gov/health/blackcohosh/ataglance.htm

Effectiveness:

Possibly Effective for: §

Menopausal symptoms

Insufficient Evidence for: § § § § §

Infertility Induction of labor Weak bones Acne PMS or painful menstruation

-Studies tested for menopause symptoms have had inconsistent results -Not enough reliable information for the other uses -National Center for Complementary and Integrative Health is funding research to help understand black cohosh more

Safety: § § §

Possibly unsafe to use during pregnancy or breast-feeding Could worsen conditions sensitive to estrogen o Ex: ovarian cancer, uterine cancer, endometriosis Might cause liver damage

Adverse Effects: § § § § § §

Hepatoxicity Upset stomach, cramping Rashes Vaginal spotting or bleeding Weight gain Headaches

Toxicology: §

Overdose could cause nausea, vomiting, dizziness, reduced pulse rate, increased perspiration, visual disturbances

Interactions: § §

Herbs: may enhance the adverse/toxic effects of herbs with estrogenic or hypotensive properties Medications for heart failure: interacts with angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and amiodarone Medications that interact or effect the liver in anyway

Personal Opinion: I personally think there needs to be more hard facts before I would use it

References: 1. Black Cohosh: Uses, Side Effects, Interactions, Dosage, and Warning. (2018). Retrieved January 30, 2019, from https://www.webmd.com/vitamins/ai/ingredientmono-857/blackcohosh 2. Black Cohosh. (2016, November 29). Retrieved January 30, 2019, from https://nccih.nih.gov/health/blackcohosh/ataglance.htm 3. Library Guides: Drug Information: Home. (2018, September 20). Retrieved January 30, 2019, from http://guides.lib.purdue.edu/druginforesources/home Background image: Black Cohosh. Digital Image. National Center for Complementary and Integrative Health. 29 November 2016. https://nccih.nih.gov/health/blackcohosh/ataglance.htm

Blueberry Scientific Name: Cyanococcus Higher Classification: Vaccinium

https://www.google.com/search?safe=strict&hl=en&q=grapes+on+hands&tbm=isch&tbs=simg:CAQSlwEJ3sANBQj-‐ IzQaiwELEKjU2AQaBAgVCAEMCxCwjKcIGmIKYAgDEiiyFpsemh6jD7AWkhezFtELuQvPHtYhyyiTIpsg0T7hN5Ei-‐zP6M-‐w0GjBPq-‐ 7ZC3SiF7yZ1PxB6_10X4G8zlLaPqPbiLPqlf3J1cZf8v7ZTXYDtcCmaOk2pY-‐MgBAwLEI6u_1ggaCgoICAESBCxHlHUM&sa=X&ved=0ahUKEwj-‐ uv6khc7gAhWn5YMKHVUDDt8Qwg4IKygA&biw=1440&bih=744#imgrc=csN0DmdZvP3caM:

Background and History: Chandler Dykstra, Brain & Behavioral Sciences (Pre-‐Med), Spring 2019

https://www.google.com/search?safe=strict&biw=1440&bih=744&tbm=isch&sa=1&ei=tDlvXPClBJfCjgSYhaDQAg&q=blueberry+supplemetn&oq=b lueberry+supplemetn&gs_l=img.3...26042.30893..31081...4.0..1.262.1135.12j0j1......1....1..gws-‐wiz img.......35i39j0i67j0j0i8i30j0i24.2Kzp3YGQMs4#imgrc=AUncod2v0g_TSM:

Pharmacology/Mechanism of action: -‐Blueberries contain many vitamins/minerals including: vitamin C, vitamin K, manganese, zinc, potassium, folate, etc. -‐Rich in antioxidants, which is believed t o be most beneficial aspect of blueberry consumption Antioxidant Effect: -‐Blueberries “contain anthocyanosides that are flavonoid derivatives of anthocyanins (the blue, red, or violet pigments found in many berry varieties)” -‐These compounds, (particularly A nthocyanins) are known for antioxidant properties, particularly free radical scavenging, and “have other beneficial effects such as, antidiabetic, antibacterial, and anticarcinogenic activities” -‐Accumulation of free radicals in the body (usually a byproduct of cellular respiration) create what is known as oxidative stress -‐ Free radicals react with various molecules and substrates in t he body, such as DNA, proteins, tissues, etc. and cause oxidative damage, leading to premature cellular aging, cancers, and cardiovascular/neurological diseases -‐High levels of antioxidants in blueberries combat oxidative stress by neutralizing free radicals and preventing further damage caused by oxidation

-‐Small fruit (0.2-‐0.6 inches in diameter) with 5-‐point crown on blossom -‐One of few fruits native to North America -‐Sacred to the Native Americans long before Colonial Era -‐Berries were consumed fresh (during spring/summer) or dried (during fall/winter), added to soups/stew, flavored meat, used medicinally to make cough syrup and tea (meant to “fortify blood”), and served as a dye for clothing/textiles -‐During Civil War, Union soldiers were given canned blueberries to prevent scurvy and improve overall health (it was not yet known why blueberries were beneficial) -‐Blueberry plant domesticated in early 20th century by Elizabeth White and Dr. Frederick Coville -‐Domestication resulted in increased fruit size and crop yield -‐United States cultivates roughly 90% of blueberries worldwide

Common/Typical Uses (available forms): Uses as a food product: raw consumption, preserved by freezing, drying, or canning, converted into jams and jellies, or squeezed for juices Can be added to smoothies, hot or cold cereals, salads, soups, batters, muffins, desserts, side dishes, etc. One cup (148g) of raw blueberries contains: 84 calories, 21g carbs, 15g sugar, 4g fiber RDI: 24% vitamin C, 36% Vitamin K, 25% manganese, 4% potassium

Uses as a supplement: can be consumed as blueberry powder or extract; commonly used for antioxidant properties is believed to reduce inflammation and damage caused by oxidative stress Other common uses not scientifically proven to be effective: used to improve mood, cognitive function, and reduce blood pressure

Dosage Form: * Insufficient evidence/data to determine proper dose, which may depend on numerous factors: age, health, weight, overall condition, etc. * Blueberry extract typically sold in capsules containing 600t 1000mg per serving

Interactions:

Blueberry

* Individuals taking medications to lower blood sugar are advised to not medicinally consume blueberry extract or powder * May also interact with antibiotics (not specified), anticholinergic, and antilipidemic drugs * Lack of scientific evidence/data on interactions between blueberry extract and prescription medications

Professional Opinion: Safety: * Limited data on safety of raw blueberry and blueberry extract consumption, likely safe in recommended dose (600t 1000mg/day) * Avoid if allergic to blueberry or other plants within the Ericaceae family (bilberries, cranberries, huckleberry) * May lower blood sugar to hypoglycemic levels (50 to 54 mg/dL), those with diabetes are advised to monitor blood sugar if regularly consuming blueberry products * Lack of data on blueberry consumption during pregnancy and breastfeeding * It is recommended to halt blueberry extract consumption prior to any surgery (only recommended, no sufficient evidence) * Speak with health professional (doctor, pharmacist) before taking this product

Adverse effects & Toxicity: Adverse and toxic effects have not been scientifically explored or reported

Effectiveness: -‐Lack of evidence on effectiveness of blueberry extract

-‐If used daily, do not exceed maximum suggested dose of 1000mg blueberry extract per day -‐If pregnant or breast feeding, discuss use with q ualified health professional before consumption -‐If diabetic or pre-‐diabetic, discuss use with q ualified health professional before consumption -‐If taking any of the aforementioned drugs, discuss use with qualified health professional before consumption -‐With minimal to no negative consequences reported, blueberries are believed to have many qualities beneficial for health and can be an effective way to incorporate many important vitamins/minerals into the diet -‐I would advise raw consumption of blueberries over taking blueberry extract or powder because the likelihood of overconsumption is far less -‐As with consuming any dietary product or supplement, moderation is key -‐ especially since there has been minimal research on potential negative effects of blueberry extract consumption ~ C. Dykstra

Works Cited: Eliane T, Marivane L, Vinícius C, Cândida K, Jairo KB, Sérgio FA. Anti-‐inflammatory and Antinociceptive Properties of Blueberry Extract (Vaccinium corymbosum). The Journal of Pharmacy and Pharmacology. 2007;59(4),591-‐6. Zegarac, JP. The Power of Blueberries. Today’s Dietitian. 2014;16(10),42. Sellappan S, Akoh CC, Krewer G. Phenolic compounds and antioxidant capacity of Georgia-‐grown blueberries and blackberries. J Agric Food Chem. 2002;50(8),2432-‐2438. Kalt W, McDonald JE, Ricker RD, Lu Z. Anthocyanin content and profile within and among blueberry species. Canadian Journal Plant Sci. 1999;79(4),617-‐623. Howell, AB. Update on Heath Benefits of Cranberry and Blueberry. Acta Horticulture. 2009;810,779-‐784. Sources that were not journal articles: United States Department of Agriculture. National Nutrient Database for Standard Reference, Release 26. http://ndb.nal.usda.gov. August 2013. Accessed February, 2019. Sigma Aldrich. Bilberry (Vaccinium myrtillus).https://www.sigmaaldrich.com/life-‐ science/nutrition-‐research/learning-‐center/plant-‐profiler/vaccinium-‐myrtillus.html. Accessed February, 2019.

https://www.google.com/search? safe=strict&biw=1440&bih=744&tbm=isch&sa=1&ei=G Dtv XNjiGKusjwSNxIt4&q=blueberry+&oq=blueberry

https://www.google.com/search?q=blueberry +extract&safe=strict&hl=en&authuser=0&source=lnms&t

Jenna Ellis Computer Science Student Spring 2019

Boswellia Other Common Names: Indian Frankincense, Indian Olibanum

Background and History

Boswellia resin is the gum that comes out of various species of small shrubs and trees native to the Red Sea region, northeastern Africa, and the mountains of central India. Boswellia resin historically has been used in Indian herbal medicine to treat arthritis, bursitis, nervous diseases, and other inflammation oriented illnesses. It was/is also externally used to treat ulcerations and sores in the form of gum or oil. Boswellia is also considered a highly prized incense; it was burned often in Roman and Greek Catholic churches in the form of frankincense. Frankincense was at one point considered essential to religious ceremonies and medical treatments in all areas from Rome to India. Frankincense is included in Christian religious stories about the birth of Christ; it was considered to be extremely valuable during that time period. Frankincense was used by the Egyptians for embalming and also for cosmetic purposes. Boswellia has a rich history of uses throughout the major ancient civilizations of the world, and its modern medicinal uses were known about back then.

Common Uses Boswellia is well known for reducing inflammation, so it is commonly used to treat osteoarthritis, rheumatoid arthritis, asthma, and inflammatory bowel disease. It is also often used as an effective painkiller and may prevent the loss of of cartilage. While this is less common, there are studies looking into the impact boswellia has on treating cancer (breast cancer in particular).

Pharmacology Boswellic acid can prevent the formation of leukotrienes; leukotrienes are molecules that cause inflammation and are linked to triggering asthma symptoms. Four acids in boswellia resin are attributed to its anti-inflammatory properties; these acids inhibit 5-lipoxygenase (5-LO), which is the enzyme that produces leukotrienes.

Dosage Forms Boswellia is taken as tablets or capsules. Each capsule is generally labeled by the percentage of boswellic acids in the resin or extract. The dosage recommendation is dependent on the boswellic acid content in a given boswellia supplement, which differs between manufacturers. In general, it is suggested that a user takes 300-500 milligrams by mouth two to three times a day.

Typical Use Boswellia is typically taken as a resin, a pill, or as a topical cream. It is typically used to treat chronic inflammation. Boswellia users usually have long term issues with inflammation, so they take boswellia supplements multiple times a day for a long period of time, as described in the dosage forms section.

Effectiveness The effectiveness of using boswellia as an anti-inflammatory varies between the ailment it is used to treat. When used to treat osteoarthritis (OA), it is widely accepted that it is effective in relieving OA pain and related inflammation; in an OA and boswellia, subjects reported that they had a decrease in knee pain, an increase in knee flexibility, and an increase in the distance they could comfortably walk. For rheumatoid arthritis (RA), there have been mixed results for the effectiveness of boswellia in treating the related inflammation. Some research has shown that boswellia helps reduce RA joint swelling; there are a lack of substantial patient studies to provide evidence for boswellia's effectiveness at this time. As for treating irritable bowel disease, it is suspected that boswellia is a very effective treatment. While studies are still in early stages, a special boswellia extract is equivalently effective in treating Crohn's Disease in comparison to existing prescription medications used to manage Crohn's. Studies similar to the Crohn's study report that boswellia may be effective in treating inflammation related to ulcerative colitis as well.

Safety Boswellia should not be taken by women who are pregnant or nursing. Boswellia may simulate blood flow in the uterus or pelvis, which can accelerate menstrual flow and may induce a miscarriage.

Adverse Effects and Toxicities One of the side effects of taking a boswellia supplement is increased blood flow in the uterus or pelvis, which can cause more severe blood flow during a woman's menstrual cycle. Boswellia can also cause nausea, acid reflux, diarrhea, and skin rashes as side effects.

Interactions Boswellia extract may interact with ibuprofen, aspirin, and other non-steroidal anti-inflammatory drugs.

My Professional Opinion Based off of the evidence of boswellia's effectiveness in treating chronic inflammation, I would recommend a boswellia supplement to a patient suffering from an inflammation related chronic illness. I would recommend boswellia after the patient has already tried regular anti-inflammatory medication, and would be sure to evaluate their comfort zone in not using regular NSAIDs anymore. Following the safety concerns, I would be sure that all women interested in taking boswellia aren't pregnant or planning to become pregnant before starting the supplement. I would also be hesitant to recommend this supplement to women who characteristically have issues with their menstrual cycle; since boswellia runs the risk of increasing blood flow, I'd be concerned that the boswellia supplement would further agitate a patient's issues with menstration. Besides these concerns, I think boswellia supplements are an effective means of treating chronic inflammation and should be considered if a patient needs better results from their treatment. Sources: Siddiqui MZ. Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309643/. Published May 2011. Accessed February 17, 2019. Boswellia. Medicine Hunter. http://www.medicinehunter.com/boswellia. Accessed February 20, 2019. Moncivaiz A. Boswellia (Indian Frankincense). Healthline. https://www.healthline.com/health/boswellia. Published November 9, 2017. Accessed February 17, 2019. Weil A. Boswellia. Weil. https://www.drweil.com/vitamins-supplements-herbs/herbs/boswellia/. Published March 19, 2014. Accessed February 20, 2019.

Calcium/Vitamin D Common Brands

Amanda Gjerde Nursing Student Spring 2019 Common Uses

Calcium/Vitamin D supplements are most often used for those who do not receive enough calcium from their diet. Calcium is needed for the building and maintenance of bone, so often people take calcium supplements when they do not receive enough from their diet in order to have healthy bones. In addition, calcium/vitamin D can be used for those with osteoporosis and those who have bowel diseases that prevent adequate calcium absorption. Some studies have shown calcium and vitamin D protecting against cancer, diabetes, and high blood pressure, but this evidence is not definitive.

Caltrate 600+ D3® Os-Cal® Vitafusion™

Background/History

Vitamin D was first discovered when trying to figure out the cause of rickets, a disease where bones are weakened. An English scientist was able to determine that limited exposure to sunlight plays a large role in acquiring rickets. He then discovered a new vitamin that he determined cured rickets, which he named vitamin D. The relationship between calcium and vitamin D was later discovered and it was found that vitamin D is essential for calcium absorption and regulation.

Available Forms/Typical Serving

Calcium/vitamin D supplements are available in several forms, including tablets, capsules, chews, liquids, and powders. It is recommended that calcium/vitamin D supplements be take in small doses of 500 mg or less at meal times for better absorption. The daily upper level is 2000 mg for those about fifty and 2500 mg for those nineteen to fifty, so daily intake must not exceed these values.

Pharmacology & Mechanism of Action

http://www.helpingyoucare.com/20402/u-‐s-‐preventive-‐ services-‐task-‐force-‐recommends-‐against-‐vitamin-‐d-‐calcium-‐ supplements

Calcium increases pH and lowers esophageal sphincter tone. In addition, calcium helps to decrease the rate of bone loss keep normal cardiac functioning. In order for calcium to be absorbed into the small intestine, vitamin D is required. Vitamin D also helps the bone secrete calcium into the bloodstream. The body naturally receives vitamin D from sun exposure.

1 2

Effectiveness

Studies have found calcium/vitamin D supplements to be especially beneficial to the elderly populations. Calcium/vitamin D supplements increased bone mineral density in postmenopausal women and older men. In addition, calcium/vitamin D supplements resulted in reduced fractures in institutionalized older populations.

Interactions

Taking the following drugs while also taking calcium/vitamin D will result in decreased effect and levels of the drug: corticosteroids, baloxavir marboxil, deferiprone, delafloxacin, omadacycline, rifampin, rilpivirine, and sarecycline.

Adverse Effects and Toxicities

The adverse effects of calcium include anorexia, constipation, flatulence, acid rebound, and milk-‐alklai syndrome. Calcium at toxic levels can cause nausea, vomiting, hypercalcemia, and hypophosphatemia. The adverse effects of vitamin D include muscle and bone pain, metallic taste, headache, dry mouth, and constipation. Vitamin D at toxic levels may result in nausea, vomiting, hypercalcemia, and arrhythmias.

Safety

Calcium/vitamin D supplements should be used with caution in those with renal failure because of impaired excretion. In addition, those with hypercalcemia should avoid using calcium supplements to avoid toxicity. Also, there has been some evidence presented that calcium/vitamin D supplements increase the risk for heart attacks and prostate cancer, but this evidence is not definitive and is still being researched. Lastly, it is important that when taking calcium/vitamin D supplements the daily upper limit is not exceeded, which is about 2000 mg.

https://montclairbreastcenter.com/keeping-‐ your-‐bones-‐strong-‐calcium-‐for-‐lifelong-‐bone-‐ health/

http://theconversation.com/how-‐vitamin-‐d-‐can-‐ improve-‐muscle-‐strength-‐73024

Professional Opinion

It is clear that calcium/vitamin D supplements are helpful for the elderly to prevent bone breakdown. Also, it is important that all individuals receive the recommended daily intake of calcium, so if an individual is not receiving that from their diet alone, calcium supplements are a great way to ensure adequate nutrition with few side effects. Overall, calcium/vitamin D supplements are a safe way to augment a diet deficient in calcium. ~ A. Gjerde

References List 1. Calcium Carbonate/Vitamin D3 (OTC). Medscape. https://reference.medscape.com/drug/caltrate-‐ os-‐cal-‐calcium-‐carbonate-‐vitamin-‐d-‐3-‐999885#0. Accessed February 19, 2019. 2. Mayo Clinic Staff. Calcium and Calcium Supplements: Achieving the Right Balance. Mayo Clinic. https://www.mayoclinic.org/healthy-‐lifestyle/nutrition-‐and-‐healthy-‐eating/in-‐depth/calcium-‐ supplements/art-‐20047097. Published October 3, 2018. Accessed February 19, 2019. 3. Vitamin D. National Institutes of Health. https://ods.od.nih.gov/factsheets/vitamind-‐ healthprofessional/. Updated November 9, 2018. Accessed February 20, 2019. 4. 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

What is it? Scientific name: Cannabidiol Common names: CBD, CBD oil • •

•

the second most active ingredient in cannabis and extracted directly from the hemp plant common uses: pain relief, reduction of anxiety and depression, acne, alleviation of cancer related symptoms, epilepsy common forms: oil, isolates, wax, crystals

How it works? CBD helps the body to be able to use the CB1 and CB2 receptors, which are involved in pain and inflammation. It also helps our body to know how to use the cannabinoids in our own body.

https://health.harvard.edu/log/cannidiol-cbd

BACKGROUND • Roger Adams, from Harvard University, was the first person to successfully extract CBD from cannabis in 1940. • All cannabis was first made illegal in the US with the Marihuana Tax Act in 1937. • 14 states, including Indiana, have legalized CBD oil and its uses

DOSAGE FORMS Amy Griffey, Biology Purdue University Spring 2019

Chronic pain: 2.5-20 mg of CBD (orally) twice a day Epilepsy: 200-300 mg of CBD (orally) daily Loss of appetite for cancer patients: 2.5 mg of CBD (orally) daily Multiple Sclerosis: 100-120 mg of CBD (orally) daily

Does CBD actually work? Because CBD is not wildly regulated, not all CBD products are created equally. This increases the importance of looking into the manufacturer and insuring the quality of the product, as well as all of the ingredients in it.

Adverse Effects and Toxicities No long term effects on central nervous system and there is no known information about toxicities of CBD.

Drug Interactions CBD could interact with any drug metabolized by CYP450 enzymes.

Is THC in CBD products? Yes, a small percentage, of THC is required as an active ingredient in most CBD products in order for the CBD to have the effects it has on the body. Is CBD safe for everyday use? Yes, it does. In fact, CBD oil has been FDA approved to help treat and manage the symptoms of two forms of epilepsy.

My Personal Opinion In my personal opinion as an Undergraduate at Purdue Unviersity studying Movement and Sports Sciecnes and Biology, I would recommend the use of CBD products when needed. Of course, always talk to your doctor to see which route to managing your symptoms. However, if chronic pain or seizures are a problem for a patient, I would feel comfortable recommending the use of CBD oil to manage these symptoms. It has proven its benefit again and again in the miedcal world and its time modern medicine accepts its abilities. ~ A. Griffey

https://ministryofhemp.com/blog/cbd-history/

References Mozafari, Nam. Graphene Proceed with Caution: What We know, What we donâ&#x20AC;&#x2122;t. Journal of Clinical Toxicology. 2015, 05(03). CBD History: The Past, Present And Future of Using CBD. Ministry of Hemp. https://ministryofhemp.com. Published July 12, 2018. Marijuana and Cannabinoids. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/marijuana. Published October 25, 2018.

EMILY HAINER, STUDENT PHARMACIST

SPRING 2019

Chamomile Chameamelum nobile

PHRH 489

Complementary and Alternative Medicine

https://draxe.com/chamomile-benefits/

Common Uses

Dosage Forms

Analgesic, anti-inflammatory, antimicrobial, antispasmodic, autism, diabetes, estrogenic activity, mouth, mucositis, gingival bleeding, osteoarthritis, premenstrual syndrome, eczema, radiation dermatitis, ulcerative colitis.â&#x20AC;Š

Teas, Topical creams, Oils

Background/History: Used as antispasmodics and sedatives in treatment of digestive and rheumatic disorders. Teas, hair tint, oil, skin wash, have all been used to cleanse and treat infections.

Common Names:

Mechanism of action:

Common, English; Garden; Genuine; German; Hungarian; Lawn; Roman; Scotch; Sweet; True; Wild.

Similar to non-steroidal anti-inflammatory drugs. Selective COX-2 inhibitor with antiinflammatory activity.

Oral Doses

Typical oral doses are 1-15 g/day https://twitter.com/purduepharmacy

https://www.organicfacts.net/health-benefits/beverage/chamomile-

Typical Uses

tea-benefits-uses.html

In skin and mucous membrane inflammation and skin diseases, inhaled for RTIs, used in baths for inflammations and irritations, internally for inflammatory diseases, applied topically as analgesic.

https://www.target.com/p/celestial-seasonings-chamomile-

tea-20ct/-/A-13327378

EMILY HAINER, STUDENT PHARMACIST

SPRING 2019

Effectiveness and Safety Most studies have shown that chamomile has a positive effect on mood and have had a slight sedative effect. The use of chamomile should be avoided during pregnancy despite the adverse effects recorded are poorly documented. There is no clinical data on the use of chamomile during lactation.

https://www.target.com/p/celestial-seasonings-chamomile-tea-20ct/-/A-13327378

Interactions Herbs may enhance the adverse/toxic effect of agents with anti platelet properties, anticoagulants, NSAIDs, salicylates, thrombolytic agents, and other herbs.

Adverse Effects and Toxicities The use of tear and essential oils has resulted in anaphylaxis, contact dermatitis, and other hypersensitivity reactions. Cross-reactivity to asters, chrysanthemums, ragweed, and other members of Asteraceae family exists.

References Chamomile. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed February 22, 2019. Chamomile. Drug Facts and Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.factsandcomparisons.com. Accessed February 22, 2019.

Animals studies report low toxicity with the oral administration of chamomile.

Item detail. Chamomile. Available at: http://flipper.diff.org/app/ items/4019. Accessed February 22, 2019.

PROFESSIONAL OPINION From all my research I believe that there are benefits to chamomile. There is proven evidence of its benefits in terms of treating cold symptoms, having soothing and sedative abilities, and possibly have anti-inflammatory properties. I believe that for microbial infections, inflammation, analgesia, and various conditions, prescriptions should be the first line of defense. If prescriptions are not producing the desired effect or there are serious side effects, seeking out alternatives like chamomile can potentially be beneficial. I would take each patient as an individual case and work to determine the best treatment for that individual.

Chasteberry Vitex Agnus-Castus Aaron Haller Accounting Undergraduate Spring 2019

Background Chasteberry is the fruit of the Chaste tree found in Central Asia and the Mediterranean region. Common names include chastetree, chaste tree berry, Vitex, and monkâ&#x20AC;&#x2122;s pepper. It was originally believed to promote chastity, being used by monks to help reduce sexual desires. Early physicians recognized the effects of chasteberry on the female reproductive system, initially suggesting its use in helping control hemorrhages.

Chaste Berry Tincture.; 2019. https://shop.kauaifarmacy.com/ products/chaste-berry-tincture. Accessed February 26, 2019.

Uses

Chasteberryâ&#x20AC;&#x2122;s main use is in complementary medicine. It is mainly used to improve symptoms of progesterone deficiency disorders. Some of these disorders include female infertility, menopause, and premenstrual syndrome.

Dosages Chasteberryâ&#x20AC;&#x2122;s dosage forms vary including liquid extract, capsules, tablets, and essential oils. Doses typically range from 20 - 40mg daily.

Pharmacology

Chaste Berry (Vitex).; 2019. https://www.iherb.com/c/ chaste-berry-vitex. Accessed February 26, 2019.

Currently, no mechanism of action and pharmacologically active constituents has been clearly identified. The main mechanisms of action studied are antifertility effects, antimicrobial effects, dopaminergic effects, and hormonal effects. Studies show that it can inhibit prolactin release with no effect on follicle stimulating or luteinizing hormone levels. Other studies, however, claim it inhibits prolactin secretion but also increasing luteinizing hormone release.

Effectiveness The effectiveness of chasteberry is measured in comparison to two drugs, fluoxetine and pyridoxine. Chasteberry and the first drug listed, fluoxetine, compare their effectiveness in patients with premenstrual dysphoric disorder. Their effectiveness is measured by improved symptoms, and both drugs saw significant improvements after eight weeks. There was no difference between the two drugs. Chasteberry and the second drug, pyridoxine, measure their effectiveness in treating symptoms of premenstrual syndrome. Female Moon Tonic.; 2019. http://freespiritandmind.com/product/ The reference for symptom measurements is female-moon-tonic/. Accessed February 26, 2019. based off of the premenstrual tension syndrome scale. Chasteberry saw better results than pyridoxine, such as patient rating results showing 36.1% in the chasteberry group and 21.1% in the pyridoxine group being symptom free.

Safety Chasteberry is generally regarded as safe to use with few reported side effects. Chasteberry should be avoided by women with hormone-sensitive conditions. It should also be avoided by women on birth control or undergoing hormone replacement theory. Chasteberry is not associated with any major adverse reactions, with no noted toxicity effects. Those who use chasteberry may see mild or moderate side effects including headache, tiredness, dizziness, psychomotor agitation, epigastric pressure, nausea, vomiting, and dry mouth.

Interactions

Chasteberry has dopamine agonist activity meaning it may add that to other dopamine agonists. Due to this, chasteberry should be avoided in using with medications like amantadine, bromocriptine, and levodopa.

Professional Opinion

Vitex Essential Oil.; 2019. https://www.edensgarden. com/products/vitex. Accessed February 26, 2019.

Chasteberry would not be my initial recommendation for patients suffering from premenstrual or menopause symptoms, but I would not deter someone from this alternative if they are not on any form of birth control already. ~A. Haller

References

1. Chasteberry. NCCIH. https://nccih.nih.gov/health/chasteberry. Published 2019. Accessed February 26, 2019. 2. Chaste Tree (Natural Products Database). Lexicomp Online. http://online.lexi.com/lco/action/doc/retrieve/docid/fc_ rnp2/3750090. Published 2019. Accessed February 26, 2019. 3. Vitex Agnus Castus. Micromedexsolutions.com. https://www.micromedexsolutions.com/micromedex2/librarian/CS/14570B/ ND_PR/evidencexpert/ND_P/evidencexpert/DUPLICATIONSHIELDSYNC/A86FC5/ND_PG/evidencexpert/ND_B/evidencexpert/ND_AppProduct/evidencexpert/ND_T/evidencexpert/PFActionId/evidencexpert.DoIntegratedSearch?SearchTerm=chasteberry&UserSearchTerm=chasteberry&SearchFilter=filterNone&navitem=searchALL#. Published 2019. Accessed February 26, 2019.

CHIA SEEDS SALVIA HISPANICA ELIZABETH BESENHOFER | STUDENT PHARMACIST | SPRING ‘19

Picture from: https://www.hsph.harvard.edu/nutritionsource/food-features/chia-seeds/

COMMON USES Used in foods as prevention of chronic diseases especially cardivascular diseases.

PHARMACOLOGY Chia seeds are high in omega-3 fatty acids which have been shown to lower cholesterol, regulate heart rhythms and blood pressure which prevent blood clots and inflammation. This was shown in a Chinese cohort study of 63,000 individuals which showed that omega-3’s decreased risk of cardivascular mortality by 17%. Chia seeds also contain soluble fiber that may lower LDL (“bad”) cholesterol and slows down digestion which lessens blood sugar.

Spikes after meals and promote a full feeling. There are also animal studies that show that chia seeds affect cholesterol levels, weight loss, and satiety positively.

DOSAGE FORM Whole seed form sprinkled in cereals, salads, soups, stews, cake batter or gel form used to thicken smoothies and puddings.

BACKGROUND Once a major food crop in Mexico and Guatemala. Estimated to gross $2 billion in US by 2022. Originates back to 3500 BC

ELIZABETH BESENHOFER | STUDENT PHARMACIST | SPRING â&#x20AC;&#x2DC;19 -Not information to know if they are

safe in pregnancy or lactation so it is better to not use -Only eat salba seeds (type of chia seed) if you have high triglycerides because other chia seeds could increase triglycerides -Do not eat large amounts of chia seeds if you have/at risk of prostate cancer because the seeds have alpha- linolenic acid which can increase risk of prostate cancer

Picture from: https://www.eatingbirdfood.com/basic-chia-seed-pudding/

There are no known interactions for chia seeds and are safe to eat for 12 weeks and to use on your skin for eight weeks. No toxic effects.

In my professional opinion: Chia seeds are beneficial in moderate amounts to the average healthy individual to help curb appetite and provide intake of healthy fats. ~ E. Besenhofer

EFFECTIVENESS -

Study in 2009 had 90 overweight/obese adults consumed a placebo or 25 gms of chia seeds before their first and last meals and there was no change in body mass, body composition, or disease risk factors Chia seeds are high in calories and fat so they may help promote a feeling of fullness that curbs appetite The above studies done on substances found in chia seeds that help cardiovascular diseases

Picture from: https://news.vanderbilt.edu/2012/09/07/love-your-heart-

References: Chia Seeds. (2018, May 30). Retrieved from https://www.hsph.harvard.edu/nutritionsource/food-features/chia-seeds/ Chia Seeds and Weight Loss: Are They Effective? (n.d.). Retrieved from https://www.healthline.com/health/food-nutrition/chia-seeds-and-weightloss#heart-health Chia: Uses, Side Effects, Interactions, Dosage, and Warning. (n.d.). Retrieved from https://www.webmd.com/vitamins/ai/ingredientmono-

Chondroitin LaSeanna Harris Pharmaceutical Sciences SpringÂ 2019 https://pubchem.ncbi.nlm.nih.gov/compound/Chondroitin_sulfate

Scientific Name Chondroitin Sulfate

WHAT IS CHONDROITIN?

Condroitin is a component of the connective tissue found in cartilage and bones. Supplemental chondroitin in generally derived from animals.

Common Names Chondroitin, Chondroitin Sulfate

Pharmaceutical grade chondroitin usually comes from bovine trachea, pork byproducts, shark cartilage, and whale septum. The 800 to 1200 mg daily dose is generally taken in two to four doses. Chondroitin is often taken in combination with

Common use (1) Reduce pain and inflammation in joints (2) Improve join function (3) Slow progression ofÂ osteoarthritis (OA)

glucosamine. Patients should allow at least one month to notice an effect.

HOW DOES IT WORK?

Although no one is really sure on the definite mechanism of action, it has been proposed that chondroitin acts by restoring the extracellular matrix of cartilage. This explanation is challenged by some for a few reasons. First, it isn't entirely believed that it could be absorbed from the gut well and still perform it's intended action. Second, some challenge it when its in combination with glucosamine because

Dosage Forms - Capsules, Tablets, and Powder -800 to 1200 mg daily

human cartilage uses N-acetyl galactosamine, not glucosamine. Lastly, there is doubt because cartilage derived from animals may have drastically different structures depending on the source.

Is it Safe?

Based on what is currently known chondrotin is considered to be very safe. There aren't any serious adverse side effects known at this time.

Adverse Effects/Toxicities -Minor side effects include: diarrhea, constipation, & abdominal pain -If the tablets contain high levels of manganese, it can be problematic long term

Interactions

Bleeding risk can increase if taken with blood thinning medications

IS CHONDROITIN EFFECTIVE? STUDIES PROVIDE MIXED REVIEWS Many studies have been conducted recently to determine the effectiveness of condroitin. Here are some of the results. In 2006, a Glucosamine/Chondroitin Arthritis Intervention trial was conducted. It is the largest study to date using 1600 people with knee osteoarthritis. This study was conducted in three phases. The results were as follows: Phase 1 - A small subset with moderate to severe arthritis was shown to experience significant pain relief. Phase 2- It was shown that glucosamine and chondroitin, alone or together, did not slow joint damage.

Before using a chondroitin supplement patients should do thorough research to determine the safety of the ingredients. Care should be taken to avoid drug-drug interactions. Patients should always make physicians aware when starting new supplements -LaSeanna Harris

Phase 3 - Results showed that glucosamine and chondroitin were as effective as celecoxib (Celebrex) for pain relief in knee osteoarthritis. In 2010, a meta analysis was done on ten different trials that in total involved more than 3000 patients. This analysis concluded that there was no benefit from taking chondroitin and glucosamine together or alone. A study done in 2011 showed that taken chondroitin

References Arthritis Foundation. (n.d.). Chondroitin Sulfate for Arthritis. [online] Available at: https://www.arthritis.org/living-witharthritis/treatments/natural/supplements-herbs/guide/chondroitinsulfate.php [Accessed 26 Feb. 2019]. NCCIH. (2015). Glucosamine and Chondroitin for Osteoarthritis. [online] Available at: https://nccih.nih.gov/health/glucosaminechondroitin#hed1 [Accessed 26 Feb. 2019]. Science-Based Medicine. (2017). New Evidence for Chondroitin. [online] Available at: https://sciencebasedmedicine.org/new-evidence-forchondroitin/ [Accessed 26 Feb. 2019].

alone could produce significant improvement in pain and function in patients suffering from hand osteoarthritis. Considering the amount of conflicting research in circulation, further research is needed to conclude the true effectiveness of chondroitin alone or in combination.

Chromium

Scientific name: Chromium

Will Harris Student Pharmacist Spring 2019

https://www.vectorstock.com/

Background Chromium is an essential trace element, which means it must be consumed in diet to maintain good health. There are two forms of chromium: trivalent, which is the essential form, and hexavalent, a toxic mineral. Uses Chromium is used as a metabolism supporting dietary supplement to improve glycemic control in type 2 diabetic patients as well as increase insulin sensitivity, which reduces the need for hypoglycemic agents. Chromium is also used for decreasing serum lipids and for aiding weight loss. How Does It Work? Chromium is suggested to improve glycemic control in diabetic patients by improving the body’s response to insulin. The mechanism by which this is done is currently unknown.

https://www.walmart.com/ip/Spring-ValleyChromium-Tablets-1000-mcg-100count/13866106

Dosage Forms Tablet, capsule, or IV infusion • Chromium picolinate: organic form of chromium supplements, has a greater bioavailability • Chromium chloride: inorganic chromium supplement Strengths of specific products vary by manufacturer. See typical dosing for dosing regimen. Typical Dosing For non-insulin dependent (type 2) diabetes, the recommended daily allowance is 200-1000 mcg/day. The recommended daily intake for a healthy person is 50-100 mcg/day.

Efficacy Clinical studies have demonstrated that there is an improvement in glycemic control among type 2 diabetics who use chromium supplementation. Studies are conflicting or show no positive results for other uses of chromium. Adverse Effects, Toxicity, and Safety Several case studies are reported in which chromium has been listed as the cause for health defects including hemolysis, increased dream activity, hypoglycemia, renal insufficiency, rhabdomyolysis, and sudden contact dermatitis to leather. All reports of side effects except those for increased dream activity listed patients as taking more than 1000 mcg/day. Drug and Food Interactions Insulin: Concomitant therapy with insulin and chromium appeared to induce hypoglycemia through additive hypoglycemic effects of chromium and insulin. High sugar diet: Urinary chromium loss was shown to decrease anywhere between 10% and 300% in patients with high sugar diets. This could lead to chromium deficiency.

Professional Opinion Through research on the use, I believe that chromium is a useful supplement for lowering glucose levels in type 2 diabetic patients. Though the mechanism is not well known, it has been demonstrated in several studies to have a positive effect on managing hyperglycemia in patients. Due to a lack of sufficient evidence to prove its effectiveness, I would not recommend chromium to patients for aid in weight loss, lowering serum lipids, building muscle, or any other unlisted use, unless a chromium deficiency was apparent in the patientâ&#x20AC;&#x2122;s presentation. If you are considering chromium as a therapy option, it is recommended that you speak with your doctor or pharmacist to discuss the risks and benefits first. ~W. Harris References 1) WebMD. Chromium. Available at https://www.webmd.com. Accessed February 23, 2019. 2) Briggs, Stephanie; GirardCouture, Christine; Oâ&#x20AC;&#x2122;Reilly, Michael. Chromium. Micromedex Products. Truven Health Analytics, Inc. Ann Arbor, MI. Available at https://www.micromedexsolutions .com. Accessed February 22, 2019. 3) National Institutes of Health. Chromium. Available at https://ods.od.nih.gov/factsheets/ chromium-healthprofessional/. Accessed February 22, 2019.

Michele Holcombe Biology Student Spring 2019

Cinnamon

http://spiceparadise.lk/products/cinnamon/

Scientific Name: Cinnamomum zeylanicum, Cinnamomum Cassia Common Names: Ceylon Cinnamon, Cinnamon, Cannon, Canella

Background:

This small tropical, evergreen is well known for its bark. The name is derived from the Hebraic and Arabic term "amomon", which means fragrant spice plant. The C. zeylanicum plant is native to Sri Lanka anc C. cassia is native to China. Cinnamon dates back to 2800 B.C. in Chinese writing. C zeylanicum means "true cinnamon", while other cinnamon plants are not true cinnamon, such as cassia.

Common Uses:

Cinnamon is commonly used as a spice, aromatic, or spice enhancer. It is typically used to help GI disorders and menstrual cramping. The essential oil has been used to combat various microorganisms and fungi.

https://dlpng.com/png/155547

https://spicetrekkers.com/news/o-cinnamon-tree

Dosage Form and Dosing:: Alcoholic Fluid Extract (Tincture), Capsule, Powder, Essential Oil, Tablet, Tea (Cut or Ground Bark) Ground Cinnamon dosing is typically between 1 to 1.5 g/day.

Mechanism of Action: Cinnamon's mechanism of action has yet to be confirmed. However, research has found that there has been antioxidant and and insulin-like characteristics. It has also been shown that there is an effect on the sodium-potassium adenosine triphosphatase and catecholamine proteins. A few research experiments have found that cinnamaldehyde inhibits nitric oxide production and inhibits cyclooxygenase-2 catalyzed prostaglandin E2 biosynthesis.

Cinnamon Effectiveness: Research has not supported the idea that cinnamon can help any health conditions. It should not be used to replace conventional medical care or to delay seeking care.

https://www.peoplespharmacy.com/2016/10/17/isit-safe-to-drink-cinnamon-tea-every-day/

continued

Safety: Cinnamon bark is approved by the German Commission E for GI disorders. The American Herbal Products Association rated cinnamon as a 2b and 2d due to the contraindications in pregnancy and to not exceed the maximum dosage recommendation. Cinnamon was approved as a dietary supplement in the US under the Dietary Supplement Health and Education Act of 1994.

https://www.canva.com/photos/tag/cinnamon+sticks/

Adverse Effects, Toxicities, and Interactions:

Side effects are not common, however, the most common adverse effects are allergic reactions of the skin and mucous, irritant reactions, eczema, and dermatitis. Less commonly it can cause squamous cell carcinoma, topical burns, eye irritation, and gastrointestinal disturbances. Coumarin, a liver toxin, is present in cinnamon and high doses of cinnamon may become harmful to the liver. This can be reduced by making cinnamon tea. Cinnamon may reduce the effectiveness of tetracycline antibiotics.

Professional Opinion:

Based on past experiences and the research I have done I feel this is a product that is very effective as a taste enhancer. However, with the lack of positive results in human research in the treatment of ailments I would personally recommend sticking to conventional methods. However, I believe that, if you consult your physician, it would not be dangerous to take cinnamon as a complementary supplement to the conventional medicine. - M. Holcombe

References: 1. Cinnamon. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed February 23, 2019. 2. Cinnamon. National Center for Complementary and Integrative Health. National Center for Complementary and Integrative Health. Bethesda, ML. Available at: https://nccih.nih.gov/health/cinnamon. Accessed February 26, 2019 3. Cinnamon. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750101 . Accessed February 24, 2019 4. Filippone, Peggy T. Origin and Historical Usage of Cinnamon. The Spruce Eats. Available at: https://www.thespruceeats.com/history-of-cinnamon-1807584. Accessed February 24, 2019. 5. Cinnamomum what?. Bioweb. University of Wisconsin System. Wisconsin. Available at: http://bioweb.uwlax.edu/bio203/s2009/bero_jacl/Site_2/Classificati on.html. Accessed February 26, 2019

Nolan Huffaker | Chemistry Student | Spring 2019

Creatine Scientific Name: N-(Aminoiminomethyl)-N-methylglycine (Creatine, 2019).

https://broscience.co/wp-content/uploads/2018/07/creatinepowder.jpg

Common Names:

Creatine Molecule

Commonly known simply as creatine or creatine monohydrate https://pubchem.ncbi.nlm.nih.gov/compound/creatine#section=3D-

Background Creatine is a molecule that is naturally produced in the body, most commonly found in muscle tissues. It is synthesized mainly in the kidneys and liver. It is used in muscles a type of energy storage, and the phosphorylated form of creatine is believed to be a source to quickly replenish ATP. (Cooper, Naclerio, Allgrove, & Jimenez, 2012).

Available Forms: Creatine is readily available in powder forms to be mixed with liquids and drank. Typically, a ‘loading dose’ is given, which is between 20-30 grams/day for 5 days to 5 weeks, then reducing the amount to 5 grams/day a day for a ‘maintenance dose’. However, it is advised to cycle creatine use periodically due to potential concerns about its long-term effects on kidneys and kidney function. (IBM Micromedex: Creatine, 2019).

https://static1.squarespace.com/static/56bf431027d4bddbb17311ca/ t/58067e55d482e9d493bb9258/1478035724251/

Common Uses: Creatine is commonly used as a dietary supplement for athletes. Although it is possible to get some additionally creatine through eating some specific foods, the level of creating that athletes wish to have is achieved by creatine supplements, sold as a power and mixed with a drink. (Cooper, Naclerio, Allgrove, & Jimenez, 2012).

Adverse Effects Adverse effects include weight gain, water retention, gastrointestinal distress, dehydration, muscle cramping, and renal dysfunction. (IBM Micromedex: Creatine,

Pharmacology/Mechanism of Action It is believed that the increased amount of creatine concentrated in muscle cells allows people exercising to exert themselves longer without tiring themselves out. As a result of this effect, these people are able to build more muscle mass then those who do not use creatine supplements. (Cooper, Naclerio, Allgrove, & Jimenez, 2012).

Safety Concerns Those with a hypersensitivity to creatine, impaired kidney function, diuretic use, and dehydration should exercise caution. Additionally, it is advised to cycle out usage due to concern for long-term use and kidney damage. (IBM Micromedex: Creatine, 2019).

Toxic Effects

Effectiveness Some studies have shown that “regardless of the form, supplementation with creatine has regularly shown to increase strength, fat free mass, and muscle morphology…” (Cooper, Naclerio, Allgrove, & Jimenez, 2012). It seems that while creatine is “more effective on predominantly anaerobic intermittent exercise, there is some evidence of its positive effects on endurance activities” (Cooper, Naclerio, Allgrove, & Jimenez, 2012).

Interactions Since cimetidine, trimethoprim, probenecid, and nonsteroidal anti-inflammatories can also impair renal function, creatine should be used cautiously with these drugs (IBM Micromedex: Creatine, 2019).

Consuming the undissolved powder my cause gastroenteritis, and that one study showed renal dysfunction associated with use of creatine powder. (IBM Micromedex: Creatine, 2019).

https://encrypted-tbn0.gstatic.com/images?

Professional Opinion

References

It seems that, when used in appropriate dosages with sufficient hydration, creatine as a supplement is beneficial for athletic performance. Those with renal insufficiency/kidney disease should not take creatine supplements due to the increased risk of worsening renal insufficiency/ renal failure. People who use diuretics should also consider not using creatine for concern of worsening renal function as well.

Cooper, R., Naclerio, F., Allgrove, J., & Jimenez, A. (2012). Creatine supplementation with specific view to exercise/sports performance: An update. Journal of the International Society of Sports Nutrition, 9(1). Doi:10.1186/1550-27839-33 Creatine. (2019). Retrieved February 26, 2019, from https://pubchem.ncbi.nlm.nih.gov/ compound/creatine#section=Top IBM Micromedex: Creatine. (2019). Retrieved February 26, 2019, from https://bit.ly/2I3SiCz

Blake Jennewein, Student Pharmacist ~Spring 2019

Devil’s Claw (Harpagophytum procumbens)

https://draxe.com/devils-claw-benefits/

History and Background: Devil’s Claw (Harpagophytum procumbens) is a small shrub native to southern deserts of Africa. This plant grows close to the ground and produces its characteristic purple flowers, resembling a claw. Historically, Devil’s Claw was used as a folk remedy by the indigenous peoples living in the Kalahari Desert. They would dry and chop up the roots to relieve a variety of diseases ranging from liver and kidney disorders to allergies, headaches, and most commonly, rheumatism. Modern day clinical trials are generally supportive of its use as an antiinflammatory and analgesic for low back pain and osteoarthritis.

Pharmacology: In vitro studies are largely supportive of anti-inflammatory action. Inhibition of COX-2 has been strongly inferred as the mechanism of action for Devil’s Claw and harpagoside (a monoterpene glucoside) is assumed to be the active chemical agent in the plant. Other proposed mechanisms include inhibition of proinflammatory enzymes, antioxidant activity, reductions in expression of prostaglandin PGE2, and inhibition of cysteinyl-leukotrienes.

Modern Use: Today, Devil’s Claw is sold OTC, mainly as a vegetable capsule but also as a tincture. For symptoms of low back pain, muscle pain, and osteoarthritis, maximum daily doses of 9 grams of crude Devil’s Claw tuber or 1 to 3 grams of Devil’s Claw extract are recommended. These doses are based of studies which found a minimum dose of 50 to 100 mg of raw harpagoside (not sold commercially) was necessary for eliciting anti-inflammatory responses.

Safety & Efficacy

Osteoarthritis

Two specific RCT studies attempted to prove Devil’s Claw’s safety and efficacy. One showed that Devil's Claw was as effective as diacerhein and had significantly fewer side-effects. However, with a high drop-out rate and lack of quantifiable outcome parameters, their conclusions should still be treated with caution. The other trial showed that Devil's Claw significantly reduced pain compared with placebo at both 30 days and 60 days. However, the sample size was too small to reliably detect adverse effects. The use of Devil’s Claw with antiarrhythmics is contraindicated because of decreased heart rate observed in rodents and mild positive inotropic effects in rabbits.

http://www.shelbournephysio.ca/blog/post/osteoarthritis-Treatment-in-Victoria-BC

Inflammation

Additionally, Devil’s Claw may alter hemostasis and should be contraindicated in individuals with active bleeding. It should be used with caution in individuals with a history of bleeding, hemostatic disorders or in individuals taking anticoagulant medications. Devil’s Claw may also impede p-glycoprotein excretion of toxins, which could contribute to kidney injury.

Toxicology and Adverse Effects The active ingredient, harpagoside has not been found to have highly toxic effects. Although no long-term toxicity studies have been reported, rodents given oral doses of harpagoside http://www.biologymad.com/Immunology/inflammation.jpg

7.5 g/kg/day showed no clinical, hematologic, or gross pathologic changes. Although rare, GIrelated adverse effects have been reported in clinical trials including mild GI upset, anorexia, and loss of taste. Rarely, unspecified serious GI events have been reported. Headache and tinnitus have also been reported. Additionally, a case of symptomatic hypertension was documented in a 62-year-old healthy woman who consumed 500 mg/day of a product containing Devil’s Claw. Blood pressure returned to normal and complaints of headache and dizziness subsided in the two weeks following discontinuation of the product. Anecdotal reports indicate that Devil’s Claw should be avoided in people with gastric or duodenal ulcers.

Bottom Line

It should also be used with caution in patients with gallstones.

It is my professional opinion that Devil’s Claw is safe to use as a cheap alternative for mild pain and osteoarthritis. I do not believe there are sound studies that prove Devil’s Claw’s efficacy over other OTC pain therapies such as NSAIDs; however, for patients who prefer natural products, Devil’s Claw is a relatively safe alternative to traditional therapies when monitored by a health care professional. ~ B. Jennewein

References Brien, S. (1970, January 01). Devil's Claw (Harpagophytum procumbens) as a treatment for osteoarthritis: A review of efficacy and safety. https:// www.ncbi.nlm.nih.gov/books/NBK73219/. Accessed February 20, 2019. Brien, S. (1970, January 01). Devil's Claw (Harpagophytum procumbens) as a treatment for osteoarthritis: A review of efficacy and safety. https:// www.ncbi.nlm.nih.gov/books/NBK73219/. Accessed February 20, 2019. Grote, K. (2003, August). The Increased Harvest and Trade of Devil’s Claw (Harpagophytum procumbens) and Its Impacts on the Peoples and Environment of Namibia, Botswana and South Africa. http://www.underutilized-species.org/Documents/PUBLICATIONS/devils_claw.pdf. Accessed February 20, 2019. Devil's Claw. Lexi-Drugs (Natural Products). Lexicomp. Wolter Kluwer Health Inc. Riverwoods, IL. http://online.lexi.com. Accessed February 20, 2019. Ouitas, N. A., & Heard, C. (2010, March). Estimation of the relative antiinflammatory efficacies of six commercial preparations of Harpagophytum procumbens (Devil's Claw). https://www.ncbi.nlm.nih.gov/pubmed/19610038?dopt=Abstract. Accessed February 20, 2019.

HALEY JOYNER, STUDENT PHARMACIST

MARCH 31, 2019

Docosahexanoic Acid A.K.A Omega-3-fatty acid Irimia R, Gottschling M (2016) Taxonomic revision of Rochefortia Sw. (Ehretiaceae, Boraginales). Biodiversity Data Journal 4: e7720. https://doi.org/ 10.3897/BDJ.4.e7720. doi: 10.3897/bdj. 4.e7720.figure2f

Background/History Extensive research has been done on omega-3s, especially the types found in seafood (fish and shellfish) and fish oil supplements. Fish oil supplements are the nonvitamin/ nonmineralÂ natural product most commonly taken by both adults and children

Common Uses

-Anticoagulant -Antihyperlipidemic -Anti-inflammatory Dosage Forms

-Capsule -Emulsion -Food -Oil Typical Use

-Dietary supplement -Retinal and brain development -For inflammatory disorders

Pharmacology/Mechanism of action Possible cellular mechanisms include inhibition of acyl CoA:1,2 diacylglycerol acyltransferase, increased hepatic mitochondrial and peroxisomal beta-oxidation, and a reduction in the hepatic synthesis of triglycerides. Omega-3-carboxylic acids are directly absorbed in the small intestine. Administration with a high-fat meal results in an increased overall exposure of total and free baseline-adjusted EPA by ~140% and 80%, respectively, compared to fasting conditions; a 40% increase in AUC occurred for baseline-adjusted free DHA

Safety: -The safety profile of herbal medications and dietary supplements is not well known. -Omega-3s usually produce only mild side effects, if any. -There’s conflicting evidence on whether omega-3s might influence the risk of prostate cancer. -If you’re taking medicine that affects blood clotting or if you’re allergic to fish or shellfish, consult your health care provider before taking omega-3 supplements.

Effectiveness

Interactions

-Research indicates that omega-3 supplements don’t reduce the risk of heart disease -However, people who eat seafood one to four times a week are less likely to die of heart disease. -High doses of omega-3s can reduce levels of triglycerides. -Omega-3 supplements have not been convincingly shown to slow the progression of the eye disease age-related macular degeneration. -For most other conditions for which omega-3 supplements have been studied, the evidence is inconclusive or doesn’t indicate that

Warfarin: increased risk of bleeding (case report) Agents with Antiplatelet Properties : Omega-3 Fatty Acids may enhance the antiplatelet effect Anticoagulants

omega-3s are beneficial

Ibrutinib

My opinion In my opinion, this alternative medication is good as a dietary supplement but does not seem like a very effective alternative for anything else. There are little side effects but there is also little evidence that the medication does very much besides her reduce trigleycerides.

Adverse Side affects and Toxicities

Diarrhea, stomach upset, mild bleeding

rashes (topical), thrombocytopenia

hypervitaminosis if used with a product containing large amounts of Vit A and D

Citations: Yurtoğlu N. http:// www.historystudies.net/dergi// birinci-dunya-savasinda-bir-asayissorunu-sebinkarahisar-ermeniisyani20181092a4a8f.pdf. History Studies International Journal of History. 2018;10(7):241-264. doi: 10.9737/hist.2018.658. Omega-3 Supplements: In Depth. National Center for Complementary and Integrative Health. https:// nccih.nih.gov/health/omega3/ introduction.htm. Published May 8, 2018. Accessed February 25, 2019.

Dong Quai Angelica sinensis “female ginseng” Sydney Judge BSPS Student Spring 2019

Andrew Weil, M.D. Vitamins, supplements, & herbs. Herbs. Dong quai. November 15, 2013. https://www.drweil.com/vitamins-supplements-herbs/herbs/dong-quai/.

Aqueous extract of dong

Anticoagulation

quai increased uterine

happens due to the

excitability that stimulated

active ingredient, ferulic

uterine contractions. Most likely contributing to the

Uses of Dong Quai2

acid which inhibits polymerization of

Healthy blood circulation

platelets in blood. The

endometriosis, and other

Symptoms linked to menopause

acid also slows the

menstrual symptom relief.1

Prolonged menstruation

substances which cause

Endometriosis pain

platelets to become less

menopausal,

Dosage forms and

release of platelet

sticky and thus less

recommendations:

Premature ejaculation

2000mg-4000mg per day.

Arthritis & anti-inflammatory

reason, dong quai

Either in a capsule of dried

properties

should not be taken

effective. For this

root, aqueous extract, or

with other

cream made of dong quai.2

anticoagulant drugs such as warfarin, this poses a bleeding risk.1

History of Dong Quai: Dong Quai means “restore proper order” directly related to the effects it has on menopausal symptoms. This medicinal herb is very important in China, Japan, and Korea. The herb is a member of the parsley family and both the leaves and roots are harvested for its properties. 3

Effectiveness: Science has confirmed the anti-inflammatory, pain relieving, and muscle relaxing effects of dong quai. Although, the statement that dong quai has “hormonal mimicking” effects have not been proven citing studies of women taking dong quai having no change in hormonal levels. The Natural Medicines Comprehensive Database concluded it is “possibly ineffective” for menopausal symptoms due to its lack of estrogenic effect. 4 Professional opinion: Dong Quai, or female ginseng, is used primarily for menopausal symptoms for women. Because some of the symptoms of menopause such as heat flashes, are not well understood I believe turning to alternative medicine is beneficial. Hormone replacement therapy was once used for these symptoms but resulted in strokes for these women. As long as it is cleared by a doctor and the patient has no adverse drug interactions, I believe Dong Quai is a positive alternative for women. Less research has been done in men, but again if has no adverse reactions I believe it is safe. ~S. Judge Toxicity in male patients may result in gynecomastia, or enlargement of male breasts. A high dose or “overdose” of dong quai would cause nephrosis.1

Side Effects

Toxicity Bloating, diarrhea, drowsiness, increased light sensitivity, anticoagulant effects

Anticoagulants and antiplatelet drugs; aspirin, ibuprofen, clopidogrel, heparin, and warfarin; birth

Drug Interactions

control; topical tretinoin

Dong quai may cause inability to form blood clots due to the

Safety Concerns

anticoagulatory effects. Additionally, using dong quai in the form of topical cream could increase skin sensitivity to light and increase risk of sunburn or skin cancer.

Sources

1 Zhu DPQ. dong quai. Amer J Chin Med 1987; 15 (3-4): 117-125. 2 Very Well Health. Holistic Health. Herbal Medicine, Dong quai. February 22, 2019. https://www.verywellhealth.com/the-benefits-of-dong-quai-89448. Accessed March 3, 2019. 3 Monterey Bay Spice Company. Plant overview of Dong quai. April 2018. https://www.herbco.com/c-379-dong-quai.aspx. Accessed March 26, 2019. 4 Andrew Weil, M.D. Vitamins, supplements, & herbs. Herbs. Dong quai. November 15, 2013. https://www.drweil.com/vitamins-supplements-herbs/herbs/dong-quai/. Accessed March 3, 2019.

Echinacea Hatem Kawach â&#x20AC;&#x201C; Student Pharmacist Spring 2019

https://tinyurl.com/yxwsghem

Background/History: Echinacea was used in traditional medicine by American Indians and was adopted by settlers. During the 1800s, claims were made that it was helpful for blood purification, treatment of dizziness, and even rattlesnake bites. During the early 20th century, extracts were used as anti-infectives until antibiotics were discovered. Now it is mainly used to stimulate the immune system.

Dosage: While no official dosage has been made, common dosage is: Dry powder extract: 300500mg three times daily (Echinacea purpurea) Liquid Tincture: 2.5mL three times daily, up to 10mL daily. https://ti nyurl.com /yxlnwth 7

Scientific Names: Echinacea angustifolia, Echinacea pallida, Echinacea purpurea. Common Names: American coneflower; Black Sampson; Black Susan; Comb flower; Echinacea; Echinaceawurzel; Hedgehog; Igelkopfwurzel; Indian head; Kansas snakeroot; Narrow-leaved purple coneflower; Purple coneflower; Purpursonnenhutkraut; Racine d'echininacea; Radix Echinaceae; Rock-up-hat; Roter sonnenhut; Scurvy root; Snakeroot; Sonnenhutwurzel

References: Echinacea. Monograph. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed February 18th, 2019. Raman, R. (2019). Echinacea: Benefits, Uses, Side Effects and Dosage. [online] Healthline. Available at: https://www.healthline.co m/nutrition/echinacea#do sage [Accessed 18 Feb. 2019]. Kiefer, D. (2019). Does Echinacea Work?. [online] WebMD. Available at: https://www.webmd.com/ a-to-zguides/echinacea#1 [Accessed 19 Feb. 2019].

Common uses: Echinacea is commonly used for decreasing the length and intensity of symptoms of the common cold, as studies have found it to be effective in helping your immune system combat infection from bacteria and viruses. Many studies for this however were conducted poorly, so while it may improve immunity, its effects on the common cold remain unclear. It has also been shown to lower blood sugar, and studies have shown it has anti-inflammatory properties. Pharmacology/Mechanism of Action: Echinacea has been shown to have antihyaluronidase activity, anxiolytic activity, and immunomodulative activity in animal studies. There have been demonstrations of enhanced macrophage function, cytokine production stimulation, enhanced NK cell production, and increased white blood cell counts in clinical trials. Many components play a role in echinaceaâ&#x20AC;&#x2122;s effects, but an exact mechanism of action is not fully known. Typical Uses/Dosing: Echinacea is typically used to treat the common cold, as well as to try to prevent it by boosting the immune system. People usually take 300-500mg of dry powder extract three times daily for management of cold symptoms.

Effectiveness: Echinacea is known to have many medicinal effects, but studies are inconclusive or poorly conducted. Test tube studies have shown echinacea to suppress enzymes that digest carbohydrates, but human based research is not sufficient per Healthline. Echinacea has been shown to reduce anxiety in mice and humans but there are only a handful of studies suggesting so.

https://tinyurl.com/yyhjh8jg

Adverse events and toxicities: Adverse events that can occur from Echinacea range from: rashes, itchy skin, hives, swelling, stomach pain, nausea, and shortness of breath. There is little evidence regarding toxicity with Echinacea.

Safety: Echinacea should be avoided in patients with any condition that affects immune stimulation such as HIV, Multiple Sclerosis, Tuberculosis, or immunosuppressive therapy. Echinacea should also be avoided in patients with hepatic impairment and sensitivity to ragweed, chrysanthemum, marigold, daisies, or other related allergens.

Drug Interactions: Echinacea interacts with amitriptyline, haloperidol and olanzapine, theophylline, zileuton, efavirenz and nevirapine, tamoxifen, and etoposide due to upregulation of certain CYP enzymes. Echinacea also has some interactions with clozapine, and nimodipine as they may decrease serum concentrations of the drugs. Echinacea should also be avoided with immunosuppressants, as it may diminish their therapeutic effect. https://tinyurl.com/y4bqk42 u

https://www. avenabotani cals.com/pro ducts/echina cea-rootliquid-extract

Photo of Echinacea tincture â&#x20AC;&#x201C; Used 3 times daily

Professional Opinion: Echinacea seems to have many benefits with few toxic effects, however studies are not evident enough. I would not discourage my patients from using echinacea unless they were patients on medications that have interactions with echinacea or have a risk of being on immunosuppressants. However, I would not recommend it. With the unpredictability of what is in supplements, I find it difficult to recommend supplements to patients who could just be on medication that is proven to be safe and effective in humans. Many supplements donâ&#x20AC;&#x2122;t even contain the product they are advertised to contain, and I do not feel comfortable recommending products that can contain a wide variety of substances in them without my patients being informed of it.

Evening Primrose

Common Names Evening primrose oil (EPO)

Emma Kempf Pharmacy Student Spring 2019

Scientific Name Oenothera biennis

Evening primrose

History •Native to North America but also grows in Europe and parts of the Southern hemisphere. •Named after its yellow flowers that bloom in the evening. •Native Americans used the whole plant to treat bruises and the roots to treat hemorrhoids. •They used the leaves to treat minor wounds, gastrointestinal problems, and sore throats. •Oil is obtained from the seeds of the plant.

McDermott A. 10 Benefits of Evening Primrose Oil and How to Use It. Healthline. https://www.healthline.com/health/evening-primrose-oil. Published January 23, 2019. Accessed February 21, 2019.

Common Uses Cyclic mastalgia, premenstrual syndrome, menopausal hot flashes, atopic diseases such as eczema, hypertension, hyperlipidemia, rheumatoid arthritis, thrombosis, autoimmune diseases such as multiple sclerosis, and Raynaud’s phenomenon, diabetic peripheral neuropathy

Pharmacology/Mechanism of Action EPO contains gamma-linolenic acid. The body can make GLA from linolenic acid but linolenic acid itself must come from the diet. The body uses gamma-linolenic acid to make anti-inflammatory prostaglandins.

Dosage Forms/Typical Use The dosage forms evening primrose oil come in are capsules and oils. The typical use in adults is 1-8 grams/day by mouth. For eczema, the typical use is 4-8 grams/day by mouth. For cyclical mastalgia, the typical use is 3-4 grams/day by mouth.

Evening Primrose Oil Effectiveness • Not proven effective for eczema, hypertension, hyperlipidemia, cyclic mastalgia, premenstrual syndrome, multiple sclerosis, or rheumatoid arthritis. • May be effective for diabetic peripheral neuropathy. • Diabetics are recommended to have a diet with healthy fats, which EPO contains.

Safety • No evidence that evening primrose oil is safe when taken long term. • Lacking evidence for safe use in pregnancy and breast feeding.

Adverse Effects and Toxicities • Most common side effects are mild gastrointestinal problems including nausea, vomiting, diarrhea, flatulence, and bloating. • Animal toxicological studies have shown evening primrose oil to have no toxicity.

Interactions • May enhance the adverse effects and toxicities of antiplatelet agents, anticoagulants, nonsteroidal anti-inflammatory drugs, salicylates, and thrombolytic agents. • May increase the risk of bleeding.

My Professional Opinion • In my opinion as a student pharmacist, evening primrose oil may be beneficial for a diabetic patient suffering from peripheral neuropathy to take. I would not recommend it to other patients, especially those on antiplatelet agents, anticoagulants, NSAIDs, salicylates, or thrombolytic agents, that want to take EPO for cardiovascular benefits because it would increase their adverse effects from their other medications. I think it would be generally safe for other patients to take but I do not believe it would have very much of an effect on relieving their conditions beyond a placebo effect. References Evening Primrose Oil. Drug Facts and Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.factsandcomparisons.com. Accessed February 12, 2019. Evening Primrose Oil. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed February 12, 2019. Evening Primrose Oil. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/eveningprimrose. Published November 30, 2016. Accessed February 12, 2019.

Feverfew Scientific Name: Tanacetum parthenium1 Other Common Names: altamisa, bachelor’s button, feather-fully, featherfew, featherfoil, febrifuge plant, federofy, flirtroot, flirtwort, midsummer daisy, mother herb, mutterkraut, nosebleed, parthenolide, Santa Maria, vetter-voo, wild chamomile, and wild quinine1

COMMON USES TODAY2

• • • • • • • • • • • • •

BACKGROUND & HISTORY

Feverfew is a daisy-like plant (shown in the background) with feathery leaves. The plant blooms from July to October, and it can be commonly found in gardens and along roadsides, fields, waste areas, and borders of woods. The plant is native to Asia minor and the Balkan Peninsula, but it is now found throughout most of the world. Typically, the leaves are dried and used for medicinal purposes, but fresh leaves and extracts are also used1.

Pharmacology & Mechanism of Action

In feverfew, the principal biologically active principle is parthenolide, found in the glands of Migraine headache prevention its leaves1. Feverfew action is not limited to a single mechanism, and its extracts affect a wide variety of physiologic pathways, some of which are discussed below. Problems with menstruation Rheumatoid arthritis • feverfew can be used as an anti-inflammatory because parthenolide can specifically Psoriasis bind to and inhibit a certain kinase complex which plays an important role in proAllergies inflammatory cytokine-mediated signaling1 Asthma • feverfew may inhibit muscle spasm in vascular smooth muscle by blocking open Tinnitus potassium channels (this has only been shown with fresh leaf extracts due to higher Dizziness concentrations of parthenolide as compared to dried powdered leaves)1 Nausea • feverfew extracts are potent inhibitors of serotonin release from platelets and Vomiting polymorphonuclear leukocyte granules (possible connection to claimed benefit of Intestinal parasites feverfew in migraines and arthritis)1 Skin cleanser to reduce or prevent skin infections Feverfew has been used around the Toothaches world for centuries. The ancient Dosage Forms & Greek called the herb “Parthenium” Typical Serving after it supposedly saved the life of a man who had fallen from the Parthenon in the 5th century BC. An Most commercially available products come early Greek physician used feverfew in a tablet or capsule dosage form and are as an antipyretic (its traditional use, typically standardized to 0.7% parthenolide 3 and from which its common name is per tablet/capsule . Feverfew can also be derived.) Feverfew was also known made into liquid extracts and teas2. The as the “aspirin” of the 18th century1. standard daily dosage is 50 to 150 mg of dried Historically, feverfew has been used leaves, or 2.5 fresh leaves with or shortly after all over the world as a treatment for food, or 5 to 20 drops of a 1:5, 25% ethanol 3 many different ailments including tincture . An adult dosage of 0.2 to 0.6 fevers, headaches, constipation, mg/day of parthenolide is recommended for 3 diarrhea, difficulty in labor, and the prevention of migraine . dizziness2.

https://gardenerspath.com/plants/ornamentals/how-to-grow-feverfew/ https://gardenerspath.com/plants/ornamentals/how-to-grow-feverfew/

Effectiveness Following evidence-based guidelines, the American Academy of Neurology and the American Headache Society suggest that a feverfew extract may be effective and should be considered for migraine prevention2. However, results have been mixed. Further, there is not enough evidence to conclude that feverfew effectively helps any other conditions2.

Safety Concerns & Warnings Pregnant women should not take feverfew because it may affect uterine contractions2. Additionally, feverfew may promote menstruation and induce abortion, and has traditionally been used to cause ejection of the placenta and fetal membranes3. Breast-feeding women and children should also avoid the use of feverfew4. Also, be mindful that handling the plant may cause skin irritation2.

Side Effects & Toxic Effects Side effects can include nausea, vomiting, abdominal pain, diarrhea, indigestion, flatulence, and bloating2. Sores and irritation of the mouth may occur is the fresh leaves are chewed2,3. Heart rate may also increase dramatically1. In rare cases feverfew caused outbreaks of dermatitis3. Further, people who take feverfew for long periods of time and then stop may have difficulty sleeping, headaches, anxiety, and stiff and painful muscles2. No studies of long-term toxicity have been performed on the plant3. However, a study over an 11-month period suggested that the plant does not induce chromosomal abnormalities1.

FOOD & DRUG INTERACTIONS Feverfew may interact with agents with antiplatelet properties, anticoagulants, other herbs with anticoagulant/antiplatelet properties, nonsteroidal antiinflammatory agents, salicylates, and thrombolytic agents3. Feverfew may affect the adverse/toxic effects of the above and bleeding may occur. Some of these drugs and herbs include aspirin, ibuprofen, naproxen, heparin, clove, garlic, ginger, and turmeric4. Feverfew may also interact with medications that are changed and broken down by the liver4. Feverfew could decrease how quickly the liver breaks down these medications. Some of the drugs include Zofran, Allegra, Prilosec, Valium, NSAIDs, Taxol, and Glucotrol4. There are no known interactions with foods4.

https://www.amazon.com/Herb-Pharm-CertifiedOrganic-Feverfew/dp/B0016B9Z44

MY PROFESSIONAL OPINION I WOULD RECOMMEND FEVERFEW TO SOMEONE WHO CHRONICALLY SUFFERS FROM MIGRAINES AND HAS BEEN UNABLE TO SEEK RELIEF FROM TRADITIONAL PRESCRIPTION MEDICATIONS. THE SIDE EFFECTS OF FEVERFEW ARE LIMITED AND NOT LIFE THREATENING, THEREFORE I THINK THIS IS A GREAT SUPPLEMENT FOR MIGRAINE SUFFERERS TO TRY IN ORDER TO PREVENT THEIR MIGRAINES. I WOULD NOT RECOMMEND THIS DRUG FOR ANY OF ITS OTHER COMMON USES AT THIS POINT BECAUSE THERE IS NO CLEAR EVIDENCE OF ITS EFFECTIVENESS.

-JILLIAN KNAPP

https://www.walmart.com/ip/Feverfew-HerbNature-s-Way-180-VCaps/31170324

References 1. Pareek A, Suthar M, Rathore GS, Bansal V. Feverfew (Tanacetum parthenium L.): A systematic review. Pharmacogn Rev. 2011;5(9):103-10. 2. Feverfew. NCCIH Web site. Accessed at nccih.nih.gov/health/feverfew on February 24, 2019. 3. Feverfew. Natural Products Database. Accessed at online.lexi.com.ezproxy.lib.purdue.edu/ on February 24, 2019. 4. Feverfew. Therapeutic Research Faculty, publishers of Natural Medicines, Prescriber’s Letter, and Pharmacist’s Letter. Last updated on August 5, 2018.

STUDENT PHARMACIST, SPRING 2019

TIFFANY LIN

Flaxseed Scientific Name: Linum usitatissimum L.

https://nccih.nih.gov/healt h/flaxseed/ataglance.htm

Common Names:

Flax, Flaxseed, Linseet, Lint bells, Line

https://behealthy.today/9-fantastic-benefits-flaxseed/

Background/History: • Flax has been used for 12,000 years as a source of fiber for producing linen. • It was also one of the earliest plants used for purposes other than food. • Flax is processed from fibers in the plant’s stem. Flaxseed or linseed oil, derived from the seed, has been used as a topical demulcent and emollient and as a laxative particularly for animals. •Flaxseed oil has also been used in paints and varnishes, and as a waterproofing agent.

https://www.amazon.com/ Spectrum-EssentialFlaxseed-OrganicGrnd/dp/B00012NHAC?th=1

Dosage Forms:

Whole or ground seed or oil from the seed Safety:

COMMON USE

FLAXSEED AND FLAXSEED OIL ARE EXTREMELY RICH IN ALPHA LINOLENIC ACID (ALA) AS WELL AS OTHER VARIOUS ESSENTIAL FATTY ACIDS.

FLAXSEED ITSELF (NOT THE OIL) HAS A HIGH FIBER CONTENT THAT MAY HAVE SIMILAR HEALTH BENEFITS COMPARED TO OTHER PRODUCTS ALSO RICH IN FIBER.

TOPICAL DEMULCENT AND EMOLLIENT, AS A LAXATIVE, AND AS A TREATMENT FOR COUGHS, COLDS, AND URINARY TRACT INFECTIONS.

Contraindicated in patients with sensitivity to flaxseed. Not recommended for pregnant or lactating patients

STUDENT PHARMACIST, SPRING 2019

TIFFANY LIN

Pharmacology/Mechanism of Action

Interactions

Flaxseed and flaxseed oil may possess anti-inflammatory properties due to the presence of ALA which when converted to EPA and DHA, inhibit neutrophil inflammatory responses in humans. Flaxseed is composed of multiple chemical constituents, the mechanisms of which have not been fully elucidated.

Oral drugs should be taken one hour before or two hours after flaxseed to prevent decreased absorption. Flaxseed, but not flaxseed oil, may increase or enhance the effects of laxatives due to the virtue of its fiber content. Flaxseed may exhibit weak estrogenic or antiestrogenic effects and has the potential to interact with oral contraceptives or hormone-replacement therapy. Linatine inhibits absorption of vitamin B6, and phytic acid reduces calcium, copper, iron, magnesium, and zinc absorption. Flaxseed oil may enhance the antiplatelet effect of ibrutinib: monitor therapy. Flaxseed can lower blood glucose levels; taking flaxseed along with diabetes medications may cause blood glucose to be too low.

Effectiveness Possibly effective for diabetes, high cholesterol, high blood pressure, breast pain, SLE, and weight loss. Possibly Ineffective for osteoporosis. Insufficient evidence for BPH, breast cancer, heart disease, colorectal cancer, hemodialysis, IBS, lung cancer, menopausal symptoms, metabolic syndrome, liver disease, pre-diabetes, prostate cancer, ADHD, HIV/AIDs, diverticulitis, and stomach upset.

Adverse Effects and Toxicities Flaxseed and flaxseed oil appear to be well tolerated, with few adverse reactions reported. Many reported reactions have been associated to flaxseed allergy: N/V, intestinal/abdominal pain, diarrhea, and general malaise. The FDA has not granted GRAS status to flaxseed or flaxseed oil, although the agency allows up to 12% flaxseed in food by weight. Flaxseed and its oil are safe in doses of up to 50 g/day An overdose of flaxseed or its oil may result in weakness, unstable gait, paralysis, or seizures.

My Professional Opinion Flaxseed has proven significant effectiveness as a laxative due to its fiber content as well as an antiinflammatory when applied onto skin for acne, burns, boils, eczema, and psoriasis. Flaxseed has also shown clinical effectiveness for diabetes, cancer, and high cholesterol. However, there is insufficient evidence for effectiveness to treat other diseases such as prostate cancer, liver disease, menopausal symptoms, and lung cancer. I believe that flaxseed is a good supplement, but not effective enough to treat major diseases. ~ T. Lin

REFERENCES Flaxseed. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed February 24, 2019. Flaxseed (Linum usitatissimum) | Plant Profiler. Sigma-Aldrich. https://www.sigmaaldrich.com/life-science nutrition-research/learning-center/plant-profiler/linum-usitatissimum.html. Published 2010. Accessed February 24, 2019. Flaxseed: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai ingredientmono-991/flaxseed. Accessed February 24, 2019.

Folic Acid Scientific Name: (2S)-2-[(4-{[(2-amino-4-hydroxypteridin-6-yl)methyl]amino}phenyl)formamido]pentanedioic acid Common Name: Folic acid, Tetrahydrofolic acid, and Folate

Student Pharmacist: Ted Lingenfelter PHPR 489 Spring 2019 Introduction In the 1960s, Richard Smithells and Elizabeth Hibbard noticed that women who had given birth to children with serious birth defects, notably neural tube defects, were likely to have an abnormal formiminoglutamic acid (FIGLU) excretion test indicative of impaired folate status than women with unaffected children. These observations encouraged Smithells to organize a multi-centre intervention study in which vitamin supplementation around the time of conception was given to women who had had a previous pregnancy with a neural tube defect. Participating women were given a multivitamin consisting of eight vitamins that included folic acid (0.36 mg/day), and women who were already pregnant or had declined to take part in the study served as controls. The risk of the recurrence of an unaffected pregnancy in supplemented women was about one-seventh that in the unsupplemented women. In 1980, the results suggested that folic acid, or another vitamin supplement, might reduce the risk of a recurrence.

Uses: Common: Megaloblastic macrocytic anemias due to folate deficiency Typical: Anemia, folate deficiency, hyperhomocysteinemia, age-related vision loss, depression

Mechanism of Action:

Absorption occurs in proximal part of small intestine. Folic acid is metabolized in the liver, and finally excreted through urine.

Dosage Forms:

capsule; tablet

https://www.google.com/imgres?imgurl=http%3A%2F%2Fwww.folarespharma.com%2Fimages%2Fstories%2Ffolares% 2Ffolartimg.png&imgrefurl=http%3A%2F%2Fradcrit.co.za%2Fwp-new%2F2017%2F02%2Ffolic-acid-folart-5mg-capsule-41915.p hp&docid=EXBV_AUGDrhOMM&tbnid=bXrwjmwuqRxZxM%3A&vet=10ahUKEwiTrMD_9rgAhUL_4MKHVnFCHAQMwh0KAMwAw..i&w=410&h=280&bih=689&biw=1280&q=folic%20acid%20capsule&ved=0ahUKEwiTrMD_9rgAhUL_4MKHVnFC HAQMwh0KAMwAw&iact=mrc&uact=8 https://www.google.com/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUK EwihyJWTgNvgAhUMjoMKHWX1Cu8QjRx6BAgBEAU&url=https%3A%2F%2Fwww.walgreens.com%2Fstore%2Fc%2Fnature-made-folicacid-400-mcg%2FID%3D prod3547-product&psig=AOvVaw2Xscdxaja2PZ5kK7R6-PfK&ust=1551325543937034

Folic Acid (continued)

Effectiveness: 1,195 subjects in a survey where the subjects have had a completed pregnancy in which the fetus or infant was known to have or not have a neural tube defect; 27 of these had a known neural tube defect, six in the folic acid groups and 21 in the two other groups, a 72% protective effect for folic acid (relative risk 0.28, 95% confidence interval 0.12-0.71).

Safety: 1. Contraindications: Folic acid hypersensitivity 2. Warnings a. Not appropriate for anemia with vitamin B12 deficiency b. Resistance may occur in depressed hematopoiesis, alcoholism, and deficiencies of other vitamins

Adverse Effects:

1. Contraindications: 2. Warnings: a) Not appropriate for anemia with vitamin B12 deficiency; b) Resistance may occur in depressed hematopoiesis, alcoholism, and deficiencies of other vitamins 3. Miscellaneous. Patients may have vitamin B12 deficiency due to prolonged folic acid treatment

Toxicities:

Oral folic acid (pteroylglutamic acid) is generally regarded as not toxic for normal humans but it may cause neurological injury when given to patients with undiagnosed pernicious anemia

Interactions: When taken in sync with fosphenytoin, folic acid may decrease the serum concentration of fosphenytoin. When folic acid is being used at the same time as green tea (common household beverage), the green tea may cause a decrease in serum concentration of folic acid.

Professional Opinion:

I would use folic acid starting 3 months prior from planning to become pregnant. While pregnant formulated folic acid is included in pregnancy multivitamins, and that would be most effective. Continue treatment up to 6 weeks postpartum then discontinue treatment. A dose of 0.4 mg - 1 mg is recommended with synthetic folic acid, while any additional required folate can come from the diet. Foods such as broccoli, orange juice, and spinach are high in folic acid. ~ T. Lingenfelter

Sources:

https://www.google.com/url? sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwiFxJPLhdvgAhWCx4MKHbn2Dt gQjRx6BAgBEAU&url=https%3A%2F%2Fwww.thekitchn.com%2Fhow-to-cook-broccoli-5ways-167323&psig=AOvVaw2P07DyygxtlZefvtLiZk0m&ust=1551326916311175 https://www.google.com/imgres?imgurl=http%3A%2F%2Fgo.colyer.co.uk%2Fstorefront% 2Fcatalog%2Fl%2F831905_324139388.JPG&imgrefurl=http%3A%2F%2Fgo.colyer.co.uk% 2Fstorefront%2FEuro-Shopper-Orange-Juice-from-Concentrate-1L-Case-of-12P-1138261&docid=xjk9BiHBcd6qIM&tbnid=aKWv3YOl4Cul9M% 3A&vet=10ahUKEwjBypDdhdvgAhVI6IMKHfISC_QQMwhGKAYwBg..i&w=600&h=600&bih= 689&biw=1280&q=non%20branded%20orange% 20juice&ved=0ahUKEwjBypDdhdvgAhVI6IMKHfISC_QQMwhGKAYwBg&iact=mrc&uact=8

Folic Acid. Drug Facts and Comparisons. Facts & Comparisons [database online]. St. Louis, MO: Wolters Kluwer Health, Inc; March 2005. Accessed February 25, 2019, from h ttps://fco.factsandcomparisons.com/lco/action/doc/retrieve/docid/fc_dfc/5548292 Folic acid dihydrate. (2019, January 15). Retrieved February 25, 2019, from https://pubchem.ncbi.nlm.nih.gov/compound/Folic_acid_dihydrate Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. MRC Vitamin Study Research Group. (1991, July 20). Retrieved February 25, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/1677062 Wald, & J, N. (2011, October 27). Commentary: A brief history of folic acid in the prevention of neural tube defects. Retrieved February 25, 2019, from https://academic.oup.com/ije/article/40/5/1154/660590

Chang Liu, Psychology Student Garcinia Cambogia Spring 2019

(From Wikipedia)

Scientific Name: Garcinia Cambogia Common Names: Malabar Tamarind, Brindleberry. Background/ history: A tropical fruit can be found in Southeast Asia, India, and west and central Africa. It is known as its effectiveness on weight-loss. Some people said it can decrease your desire to eat and blocks the ability to make fat at the same time. However, there is no scientific evidence to support its effect on weight control.

Common uses: The common uses of it is control weight and help weight-loss, as well as control the appetite.

Pharmacology/ mechanism of action: Garcinia cambogia contains an ingredient called hydroxycitric acid (HCA), and HCA was found that can boost the fat-burning potential of the body. Also, animal studies haca found that Garcinia cambogia has a positive relationship with make the body feel full throughout the day.

Dosage forms: Tablets, Fruits, Powdered form. Typical dosing: 2,800 milligrams each day or ask a doctor.

Effectiveness There are no relevant results that show the effectiveness on weight-loss. The research can prove that Garcinia cambogia can decrease animalsâ&#x20AC;&#x2122; appetite but no research shows the same result on human.

Safety: HCA may be linked to liver damage and accompany with some possible side effects. Adverse effect and Toxicities: HCA can cause dry mouth, nausea, gastrointestinal discomfort, and headaches. Garcinia cambogia can also cause dizziness, digestive upset and low blood sugar.

Interactions: There is potential for Garcinia cambogia to interfere with medication that treat people with diabetes, asthma and clotting disorder. Professional opinion: People with liver disease are not recommended. Women who are pregnant or breastfeeding should avoid using it.

References: Garcinia Cambogia: Safe for Weight Loss? WebMD. https://www.webmd.com/vitamins-and-supplements/garcinia-cambogia-weightloss#1. Accessed April 1, 2019. Garcinia gummi-gutta. Wikipedia. https://en.wikipedia.org/wiki/Garcinia_gummigutta. Published February 28, 2019. Accessed April 1, 2019. Johnson J. Garcinia cambogia: Does it work? Medical News Today. https://www.medicalnewstoday.com/articles/318030.php. Accessed April 1, 2019.

PHPR

https://www.google.com/url? sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwj_0t exis7gAhUB7oMKHa82Bd0QjRx6BAgBEAU&url=https%3A%2F %2Fwww.walmart.com%2Fbrowse%2Fhealth%2Fgarlicsupplements%2F976760_1005863_1001552_4450920&psig=A OvVaw2lxkFtOyAdG1q6p2pJ7wG0&ust=1550881423236535

489

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GARLIC SUPPLEMENTS By: Donovan McDuffy

Title: First Year Professional Pharmacy Student Spring 2019

Scientific Name: Allium sativum Common Name(s): Garlic, Ajo Common uses: Cooking, Warding Off Vampires, Supplement (Improve heart & circulatory function) Dosage Forms: Dried Powder, Raw herb, Capsule, Tablet Typical Use: Hypertension, Hyperlipidemia, Cancer, Anticoagulant, Diabetes Mellitus

Background/History: Garlic is believed to have been used for over 7000 years. Used in ancient Egypt to strengthen laborers, in ancient Greece as cleansing agent for heart problems and abdominal growths and in China and Japan to help digestion, diarrhea and treat intestinal worms Pharmacology/Mechanism of action: Hypertension - activate EDRF and nitric oxide to relax smooth muscle and vasodilate blood vessels Hyperlipidemia - HMG CoA Reductase Cancer - Mechanism unknown Anticoagulant - Inhibits the arachidonic acid cascade Diabetes Mellitus - enhancing insulin   production and protecting against insulin inactivation

EFFECTIVENESS

Adverse Effects: Body/breath odor Mouth/GI irritation Heartburn Flatulence Nausea/vomiting Diarrhea Topical reactions

Hypertension - decrease BP by 2-7% after 4 weeks of use Hyperlipidemia - modest decrease in LDL and TG (4-12%) at 25 weeks with garlic extract Cancer - Increased dietary garlic correlated with decreased stomach, colon and prostate cancer risk Anticoagulant - Garlic inhibits platelet aggregation Diabetes Mellitus - Few studies show decrease in blood glucose levels

Safety:

Don’t ingest large amounts at least 2 weeks before surgery; Don’t consume if allergic; Don’t apply directly to skin for long periods of time; Caution in diabetics; Large amounts may induce labor in pregnant women; Chopped garlic left to stand at room temperature for hours can grow dangerous bacteria

Interactions: ‣ Anticoagulants (aspirin, clopidogrel, etc.)

Toxicities ‣ NNRTIs  ‣ Oral contraceptives

No information currently available

‣ Hypoglycemic medications (sulfonylureas, insulin, etc) ‣ Cyclosporin

My Opinion: Personally I believe garlic has and deserves its place in medicine. From my research, I have uncovered various sources that have scientific evidence of how garlic can be used daily to improve our lives, illness or not. It may not be as effective as traditional medicine but if there is evidence of it being beneficial, then it shouldn’t be frowned upon when used for the purposes specified in this monograph.

References:

‣ Garlic. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http:// www.micromedexsolutions.com. Accessed February 24, 2019 ‣ Garlic. Herbal Safety. http://www.herbalsafety.utep.edu/herbal-fact-sheets/garlic/. Accessed February 22, 2019. ‣ Plant Sciences. Garlic: A Brief History. When Fertilizing Go Easy on the Sea Salt // Integrated Crop and Pest Management News Article // Integrated Pest Management, University of Missouri. https://ipm.missouri.edu/MEG/2015/9/Garlic-A-Brief-History/. Accessed February 22, 2019.

Ginger CAM Monograph Deep Mehta, Student Pharmacist, Industrial Engineering Student – Spring 2019

Scientific Name: Zingiber Officinale [1] Common Name(s): Ginger: Common, Cooking Stem, Canton [2]

Background / History: Ginger has been widely used in Asian countries like India, China, Japan, Korea since the last 2500 years. In India, it is predominantly used in vegetarian dishes and curries to enhance the flavor. The Greek started using it as an aid for digestion. [5]

Common uses:

https://foodrevolution.org/blog/ginger-health-benefits/

1. Nausea: Ginger is known to alleviate various symptoms of nausea and vomiting during pregnancy and in other common cases too. [1] Its effect in preventing nausea makes it a good choice for people who suffer from motion or sea sickness. Research has not shown its effect in reducing nausea, but people prefer it and have reported that they felt better. [7] 2. Osteoarthritis: In an arthritis condition, ginger extract has helped patients with the pain. They were given 170mg ginger extract, 400mg ibuprofen or placebo 3 times daily. It had a similar effect to placebo & ibuprofen, but no side effects were noted. [1]

Pharmacology / Mechanism of action:

http://archive.foundationalmedicinereview.com/publications/8/3/331.pdf

Ginger’s aromatic, spasmolytic, carminative, and absorbent properties of ginger show direct effects on the gastrointestinal tract. Pharmacological activities, including antipyretic, analgesic, antitussive, and hypotensive effects are displayed by compounds 6-gingerol and 6-shogaol. Like many other properties, research has failed to indicate ginger’s influence within the vestibular,

oculomotor or central nervous system. [1]

Typical use and Dosage forms: ❖ Various form of consumption of ginger include: dried powder form, fresh form. A variety of recipes use it as an ingredient and there are no restrictions in terms of dosage forms. It can be used in tea, candies and various other beverages also apart from dishes. ❖ Around 250 mg to 1 g of ginger in powder form can be taken 1 to 4 times a day, according to most studies. [3] When used to avoid motion sickness, it is recommended to begin using ginger 1-2 days prior to the trip. [1]

http://www.beesandbasil.com/lemon-ginger-tonic/

Effectiveness: There is no strong evidence to support ginger’s effects as a complementary and alternative medicine, but it is very popular at the same time.

Safety Concerns / Warnings: FDA has not confirmed ginger’s medicinal properties [7] or its safety for pregnant women. For this reason, Complete German Commission E Monographs does not recommend it for that purpose.[1] However, people have been using it for ages. So, there is a clear contradiction.

Adverse effects and Toxicities: Ginger in general is very safe to use. It is on U.S. Food and Drug Administration’s GRAS (generally recognized as safe) list. [1] Hence, there are no documented adverse effects and toxicities as such. However, some side effects may include heartburn, diarrhea, unusual menstrual bleeding & stomach related discomfort. [4]

Interactions: No interactions are commonly known. Although, due to ginger’s effect on platelets, patients using anticoagulants should consume it with caution. [1]

Professional opinion: In my opinion, ginger is a package deal for the following reasons: ❖ Tastes good as a spice in your food, helps digestion and has medicinal properties. ❖ Powdered ginger can make a fantastic summer drink & provide relief from inflammation of throat when it gets cold outside. ❖ Include a small amount of ginger, in any form, in your daily diet to enjoy its benefits!

https://aromaticstudies.com/beloved-ginger/

References: 1. Archive.foundationalmedicinereview.com. (2003). Alternative Medicinal Review. [online] Available at: http://archive.foundationalmedicinereview.com/publications/8/3/331.pdf [Accessed 26 Feb. 2019].

2. Roscoe. Zingiber officinale - Roscoe. Pfaf Plant Search. https://pfaf.org/user/Plant.aspx?LatinName=Zingiber officinale. Accessed February 26, 2019.

3. Ginger: An Overview - American Family Physician. https://www.aafp.org/afp/2007/0601/p1689.html. Accessed February 26, 2019.

4. Ginger. https://www.webmd.com/vitamins/ai/ingredientmono-961/ginger. Accessed February 26, 2019. 5. Complementary and Alternative Medicine (CAM) for Pain, Herbal Anti-Inflammatory Drugs. https://eujournal.org/index.php/esj/article/viewFile/908/950. Accessed February 26, 2019.

6. Ginger History - Origin and Traditional Uses of Ginger. http://www.vegetablefacts.net/vegetable-history/gingerhistory/. Accessed February 26, 2019.

7. Ginger Uses, Side Effects & Warnings - Drugs.com. https://www.drugs.com/mtm/ginger.html.Accessed February 26, 2019.

Amillia Mize-Student Pharmacist- Spring 2019

Ginseng. https://www.consciouslifestylemag.com/panaxginseng-health-benefits/

Ginseng Scientific Name: Panax L.

History Ginseng was discovered in the mountains of Northern China over 5000 years ago. In the Classic of Herbal Medicine of Shennog, was the first documentation of ginseng being used for medicine. It was written between 206bc - 220ad. Ginseng quickly became popular in China because it was revered for its healing powers. It was hunted so much that it is almost extinct in China due to the demand of the royals at that time. Another interesting fun fact is that Native Americans in North America were also recorded using ginseng in the same fashion that the Chinese were using it for.

Common uses Ginseng is used for many, many different things. It is most commonly used to treat erectile dysfunction or sexual dysfunction. It has been used to treat COPD by increasing lung function and helping symptoms. It has also been used to help treat Alzheimerâ&#x20AC;&#x2122;s disease by improving mental performance and function. The Chinese and many other people still see ginseng as a cure all herb. There is little or no evidence of this herb helping these disease states.

Mechanism of action The pharmacology of ginseng is very complex and much of it is still unknown. The active compound in ginseng is ginsenosides. There are as much as 20 ginsenosides in ginseng. Each one has multiple pharmacological effects on the body. One reason for this is because of the structural isomerism and stereoisomerism of all the ginsenosides. The second reason for this is because of their ability to target many receptors in the body. One mechanism of action is started on the plasma membrane, since ginsenosides are amphiphilic, and it causes electrolyte imbalances to trigger different signaling pathways. Another mode of action of ginseng is to bind to steroid receptors and transcription factors in the nucleus to carry out many different functions.

Dosage forms & Dosing Ginseng is usually taken by mouth. It is mostly found in the form of a tablet or capsule even though the herb comes from a root. It can be found in your local pharmacy or most general stores such as WalMart. Dosing is determined by what condition the patient is trying to treat with the ginseng. Overall 200-400 mg of ginseng extract are recommended daily for anyone.

Safety

Ginseng, 2017. https://www.gnc.com.

Ginseng could be possibly unsafe when the patient has been taking it by mouth for longer than six months. It is unsafe for children, and it is unsafe for pregnant women to take due to birth defects.

Adverse effects & toxicities High doses of ginseng have been known to cause insomnia in patients. Ginseng has also been known to cause agitation in certain patient populations such as people with schizophrenia. It could interfere with blood clotting so be cautious. Also, since ginseng activates the immune system, it could cause trouble or organ rejection for patients who have recently had an organ transplant. The final population it could cause some side effects for are patients who are sensitive to the hormones because ginsenosides acts like estrogen. Overexposure to ginseng has been termed as ginseng abuse syndrome. Some of the symptoms of this toxicity have been sleeplessness, skin eruptions, edema, agitated. The average daily dose to cause this was 3 grams of ginseng roots.

Interactions Ginseng has many possible interactions. Patients should remain cautious and do plenty of research before taking this herbal supplement. It can interact with caffeine, alcohol, insulin, Lasix, antidiabetic medication, antidepressant medication, stimulant drugs, warfarin, medications that slow blood clotting, medications that decrease the immune system, and medications changed by the liver.

Effectiveness There is not a lot of evidence for the effectiveness of ginseng. One study conducted by the NCBI in 1999 included sixteen trials to see if individuals taking ginseng had improved their physical performance, psychomotor performance, cognitive function, immune system, diabetes, or mellitus. However, there was no evidence connecting ginseng to any of these states improving. There is such a widespread use and love for it and many people attest to the healing effects of it.

Professional opinion I had never heard of ginseng before being assigned this assignment. After completing extensive research, I have mixed emotions. I am skeptical that the herb works since there is no scientific data. However, since so many people support the herb, I would be open minded to try it or recommend to a friend. Sources: 1.VoglerBFK.Efficiencyofginseng. Ncbi.nlm.nih.gov.https://www.ncbi.nlm.nih.gov/pubmed/10541774. Accessed 2/12/19 2. GinsengHistory.Ginsenggeek.org.http://www.ginseng.org./ginseng history.Accessed. 2/12/19 3. Cough Cold. Panax Ginseng: Uses, Side Effects, Interactions,Dosage,Warning.WebMD.https://www.webmd.com/vita mins/ai/ingredientmono-1000/panax-ginseng.Acessed 2/12/19

Is Glucosamine a viable treatment for osteoarthritis? By Valerie Moore, Student Pharmacist Spring 2019 BACKGROUND For a growing population of individuals suffering from osteoarthritis, there has been a recent push to use natural supplements to manage pain associated with this disease state. The typical medication regimen for osteoarthritis related pain is nonsteroidal anti-inflammatory drugs, NSAIDs. Although NSAIDs provide sufficient pain relief, these medications have many adverse side effects such as increased risk of gastrointestinal bleeding, heart attack, and stroke. Patients looking for a more natural approach to managing their osteoarthritis pain have turned a supplement commonly and scientifically known as Glucosamine. Glucosamine is commonly combined with Chondroitin, and both are amino acid sugars that are made naturally by our own bodies. They are precursors for components of cartilage, which plays a structural role in cushioning spaces between bones.

MECANISM OF ACTION Because glucosamine is a precursor to cartilage, the theory behind glucosamine supplementation is to rebuild cartilage to treat arthritis. The formation of glucosamine is the rate limiting step in glycosaminoglycan synthesis, so providing more glucosamine could increase the production of cartilage.

Osteoarthritis is characterized by the degradation of cartilage glycosaminoglycans shown in the picture above. The mechanism above is thought to replenish what has been degraded from the disease, along with creating extra cartilage to combat future damage. DOSAGE Glucosamine is available in tablets, capsules, liquid or powder, and can be found over the counter in many pharmacies or supplement vendors. The recommended amount is 1,500mg divided into three doses daily. To the left is a picture of a typical over the counter bottle of Glucosamine.

EFFICACY STUDIES Patients have been excited to use this natural product because of the claims of relieving arthritis pain, slowing the deuteriation of cartilage, and improvement of mobility without the adverse side effects seen with NSAIDs. There has been major controversy between medical professionals on the efficacy of glucosamine for treating osteoarthritis pain. There have been two major studies of the effect of Glucosamine for osteoarthritis of the knee performed by Europeans and the National Institutes of Health, NIH. They each had conflicting results. In multiple studies performed in Europe, patients reported pain relief in their knee after taking a large daily dose of prescription Glucosamine sulfate (NCCIH). The NIH conducted a study to compare the effects of Glucosamine, Chondroitin, Glucosamine with Chondroitin, Celecoxib, and a placebo in patients with arthritis. After six months, the patients receiving Celecoxib had better short-term pain relief than the placebo group. The patients receiving the supplements had no significant improvement, but there was a small subgroup that had improvement taking Glucosamine and Chondroitin together (NCCIH). ADVERSE EFFECTS: Glucosamine has been reported to cause mild itching, diarrhea, heartburn, nausea, and vomiting. Glucosamine is also reported to increase the anticoagulant effect of (R) and (S) Warfarin.

PROFESSIONAL OPINION After my research on glucosamine, I would recommend this product for osteoarthritis patients who have contraindications to NSAIDs or who are experiencing extreme unwanted side effects. My concern about glucosamine is the controversy of efficacy. Before recommending this supplement, I would tell the patient that this medication has shown positive results but is not proven to be 100% effective. My greatest concern is the wellbeing of the patient, so overall, I would be willing to recommend this medication if the patient needs an alternative pain reliever for osteoarthritis. CITATIONS

NCCIH. (2019). Glucosamine and Chondroitin for Osteoarthritis. [online] Available at: https://nccih.nih.gov/health/glucosaminechond roitin#hed1. Accessed 26 Feb. 2019. Hess, Alex. Chondroitin Sulfate and Glucosamine Supplements in Osteoarthritis. www.arthritis.org. https://www.arthritis.org/living-witharthritis/treatments/natural/supplementsherbs/glucosamine-chondroitinosteoarthritis.php. Accessed February 26, 2019. Glucosamine. DrugBank. https://www.drugbank.ca/drugs/DB01296. Accessed February 26, 2019. Glucosamine. www.arthritis.org. https://www.arthritis.org/living-witharthritis/treatments/natural/supplementsherbs/guide/glucosamine.php. Accessed February 26, 2019.

Michael Nolan, Student Pharmacist Spring 2019 http://www.southernexposure.com/g oldenseal-8-rhizomes-p-986.html

Scientific name

Hydrastis canadensis

Common names Goldenseal Warnera Wild Curcuma Yellow Indian Pain Yellow Paint Yellow Puccoon Yellow Root.

https://www.romanticasheville.com/wild_food .htm

Goldenseal Monograph

https://www.herbco.com/p-350goldenseal-root-cs.aspx

Background and History

Goldenseal, a woodland plant native to North America with roots and rhizomes that are utilized medicinally, has many different names and is believed to be the only species in the Hydrasitis genus that is still living. The plant was first used by Native American tribes, like the Iroquois and the Cherokee, as a treatment for many diseases as well as an insect repellent when mixed with bear grease. Early Americans were consequently taught about goldenseal by the Native Americans and they likewise used it for its medicinal qualities. Goldenseal was first sold commercially and popularized in the early to mid 1800s which resulted in the plant being highly overharvested as it was mainly harvested from the wild. As a result, goldenseal was placed on the endangered species list on 1991 and many states encouraged production of goldenseal as a farm crop. Today, goldenseal can be purchased in stores all across America and is still used for many of the same things that the Native Americans and early settlers used it for. It should be noted that the efficacy of goldenseal is supported through tradition and holds little scientific backing.

Common Uses

masking illegal drugs in urine tests (possibly ineffective), treatment for UTIs, hemorrhoids, stomach upset, loss of appetite, stomach ulcers, colitis, menstrual irregularities, chronic fatigue syndrome, conjunctivitis, nasal congestion, and hay fever,

Dosage forms Capsules Tablets Oil Tincture dried root dried leaf powder

Pharmacology

Active ingredient: Berberine Antibiotic: inhibits adhesion of bacteria to cells and blocks the effect of secretory toxins released by bacteria Antipyretic: lowers fever by increasing immune systemâ&#x20AC;&#x2122;s ability to handle pyrogens Anti-inflammatory: antihistamine activity

Dosing

Diarrhea: one 500-1000 mg capsule or tablet 3 times a day Infection: 1.25-5 ml fluid extract orally Mouth sores: 5 ml extract steeped in cup of boiling water for 15 minutes then swish and gargle

Safety

Effectiveness

Although the three active compounds in goldenseal, mainly berberine, are seen to have significant relative efficacy, they are very poorly absorbed in the GI tract and so most likely will not reach efficacious concentrations.

Contraindications include pregnancy and breast feeding, infants, allergy, glucose-6phosphate dehydrogenase deficiency. Also, may change metabolism of many medications. Should not be used as douche.

Toxic effects

LD50 of 1000 mg/kg (extremely low toxicity), strychnine-like convulsions, GI relaxation, jaundice and hemolytic anemia in glucose-6-phosphate dehydrogenase deficient patients.

https://myhealth.alberta.ca/Health/aftercareinformation/page s/conditions.aspx?hwid=zc1011

Side-effects

Kernicterus (form of brain damage) and worsened jaundice in infants, mucus membrane irritation and ulceration, altered vitamin B absorption with prolonged use, hypernatremia, hypertension at high dose, nausea, vomiting, diarrhea, high doses may also cause anxiety, depression, seizures and paralysis

Interactions

may enhance effect of antihypertensives. May inhibit metabolism of amiodarone, cyclosporine, losartan, lomitapide, midazolam, oseltamivir, and pimozide through inhibition of CYP enzymes. May decrease effect of warfarin due to coagulative effects.

https://gomerblog.com/2015/11/side-effects/

Professional Opinion

I believe that Goldenseal may have some value as a local antiseptic or as a cure for GI infection due to its evident antimicrobial activity. However, I do not believe Goldenseal has much use in treating any condition that requires the drug to reach systemic circulation due to the fact that itâ&#x20AC;&#x2122;s active ingredients show very low absorption.

References

WebMD. Goldenseal. https.www.webmd.com. 3/31/19.

McCracken M. Goldenseal, Hydrastis canadensis L.: A long and colorful Folk history Native Plant. www.mastergardenersmecklenburg.org. 3/31/19. Micromedex Solutions. Goldenseal. www.micromedexsolutions.com. 3/31/19. NIH. Goldenseal. https://nccih.nih.gov. 3/31/19. Lexicomp. Goldeseal. https://fco-factsandcomparisons-com. 3/31/19.

Grape Seed Vitis vinifera

Background The grape plant has been used for centuries by people around the world. The grape plant has been distributed and planted in many civilizations. Even without an understanding of the body, the Greeks attributed many health benefits they had to the wine they drank. Since then the curiosity surrounding the grape plant has remained, evolving into what it is today.

Emma Mary Pastula Student Pharmacist Spring 2019

Common Uses Grape seed extract has been attributed to antioxidant effects, cardiovascular effects (mainly lowering heart rate and consequently lowering blood pressure), anticarcenogenic effects, lessening mild edema, wound healing and improving neurodegenerative conditions.

https://www.worldofmolecules.com/antioxidants/proan thocyanidins.htm

A proanthocyanidin, common compound found in grape seed

Pharmacology Grape seed is known to contain compounds such as polyphenols, and proanthocyanidins. These compounds act as antioxidants that protect the body and cells from harmful radical compounds that would otherwise cause damage to cells. Studies show that 28% of orally ingested grape seed remains after a day. It is excreted mostly in fecal matter, with the remaining excreted in urine, or exhaled as C02

Dosage Forms A vast amount of manufacturers has led to many preparations of grape seed extract in different dosage forms and strengths. The most common dosage forms include: capsules, tablets, and liquids. Strengths of grape seed vary greatly between manufacturers. The most common strengths are about 150mg.

Safety

Effectiveness

Do not take grape seed extract if you are allergic to grapes, or any other component of the formulation.

Clinical trials have shown a reduction in blood pressure and heart rate as well as a slight decrease in cholesterol levels in the blood. Animal studies have also shown promising results, causing apoptosis in some cancer cells, and a decreased incidence of tumors.

Adverse Effects

There were no reported adverse effects from clinical trials with grape seed.

Toxicities

Interactions Grape seed can interact with antiplatelet and anticoagulants to cause extensive bleeding. Interactions with anti-inflammatory agents, salicylates and thrombolytic agents can cause increased incidence of adverse effects and increase risk of bleeding

Professional Opinion While grape seed can be effective for preventative measures, many of the conditions grape seed is used for are very serious and a doctor should be consulted before using grape seed as primary treatment. It may have benefits, but should not be trusted alone for any serious medical condition.

Grape seed has caused no reported toxic effects from clinical trials.

References Header and Footer photo - http://www.kscapitalquilters.com/grapevine-groups.html Grape Seed. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed February 18, 2019. Grape Seed. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed August 24, 2016. Grape Seed Extract. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/grapeseed/ataglance.htm. Published March 16, 2017. Accessed February 25, 2019. National Center for Complementary and Alternative Medicine (U.S.). Grape seed extract. Published 2012. Accessed February 25, 2019.

Green Tea GREEN TEA: SCIENTIFIC NAME/ COMMON NAMES/ HISTORY

Hyerim Ra/ Kinesiology/ Spring 2019

Green tea, meaning of a tea made from unfermented leaves that is pale in color and slightly bitter in flavor, produced mainly in China and Japan for medicinal purposes, which is known with common names: green tea, black tea, and Chinese tea. The scientific name of Green tea is Camellia sinensis, which is a name of a plant in Latin that could be used for many different ways by how stronger or lightly it gets steamed, and green tea is the one with lightly steamed Camellia sinensis.

Tea PlantCamellia sinensis. (n.d.). Retrieved from http://www.ediblewildfood.co m/tea-plant.aspx

COMMON USE/INGREDIENT/ MECHANISM OF ACTION/ EFFICACY Green tea has been consumed to people as a liquid extracts and capsules or tablets, but commonly, it is sold as a beverage and dietary supplement that enables mental concentration to improve, smoothness of digestive function, relieving headaches and helps to loss weights. In addition, there is a research states that one of the components of green tea, EGCG, enables to repair damaged cell, however, it is still remained as uncertain that it could also effective to prevent cancer. On the other hand, it could be utilized for obese people to prevent obesity, which leads to heart disease, since green tea helps to reduce LDL, which is known for bad cholesterols but increases good cholesterols, the HDL. According to the National Center for Biotechnology Information (NCBI) mentions mechanism of action of catechins that is four molecules and enables pharmacological effect of modulating apoptosis of death cells by different mechanisms. Moreover, the anti- inflammatory happens with capillary sealing by bradykinin and prostaglandin. The Health Benefits and Side Effects of Green Tea Pills Explained - Cup & Leaf. (2019, March 11). Retrieved from https://www.cupandleaf.com/blog/green-tea-pills Whiteman, H. (2017, October 13). How a green tea compound could prevent Alzheimer's. Retrieved from https://www.medicalnewstoday.com/articles/319748.php

DOSAGE FORMS OF GREENTEA -

The dosage form of green tea from the drugs.com states that the “daily intake of 3 of 5 cups per day, which is about 720ml to 1,200ml) of green tea provides 180mg of catechins and 60mg of theanine. Green tea extracts should not be taken with empty stomach due to the potential for hepatotoxicity from excessive levels of epigallocatechin gallate (EGCG).” In addition of dosage form, drugs.com also says that: “Anogenital warts: Topical application of sinecatechins (polyphenon E 10% or 15%) was used for up to 16 weeks in a clinical study. Cardiovascular risks: Green tea catechins or extract (160 to 2,488 mg/day) have been used in trials, often in divided dosages (treatment duration, 2 weeks to 3 months). Cognitive impairment: Two 430 mg capsules (each capsule containing green tea extract 360 mg and L-theanine 60 mg) administered twice daily, 30 minutes after meals, for 16 weeks (total daily green tea extract dose, 1,440 mg; total daily L-theanine dose, 240 mg). Depression: 2 to 4 or more cups/day of green tea has been used to lower the prevalence of depressive symptoms.

SAFETY CONCERNS/ SIDE EFFECTS/ TOXIC EFFECTS Green tea in a form of beverage with moderate amount is considered as safe to adults but according to NIH, (National center for complementary and integrative center) there were a report with “liver problems of people who took the concentrated green tea extracts. Since the green tea contains caffeine, too much amount of it could cause people feeling “jittery, and shaky and interfere with sleep,” and could “possibly cause irregular heartbeat and caffeine also could affect blood sugar control.” People who has a symptom of anxiety disorders who drinks green tea will worsen the symptom. It could also cause a person who are suffering in diarrhea worsen in diarrhea when taking it with a large amount. One interesting interactions of a green tea with a cocaine. According to the webMd, they made an interaction with cocaine and green tea since the cocaine is a drug which enables speeding up the nervous system and stimulates the heart rate and the blood pressure to go up and the green tea works as same as the cocaine does by the factor of caffeine. The page also states that since cocaine, the drug, and the green tea, which is contained of caffeine will eventually cause toxic element, so “avoid taking stimulant drugs along with caffeine.”

Personal Opinion on Green tea & Monograph Throughout researching this monograph, my perspective on green tea changed. As an Asian, I have known the beneficial effect of green tea, but have not known the side effects and drug form of this dietary supplement. Now, I have recognized how this dietary supplement could have influence on each person since every single person has different body regulation and symptoms.

REFERENCE COLD, F. &. C., HEALTH, E. AND DISEASE, H. Green Tea: Uses, Side Effects, Interactions, Dosage, and Warning In-text: (Cold, Health and Disease, 2019) Your Bibliography: Cold, F., Health, E. and Disease, H. (2019). Green Tea: Uses, Side Effects, Interactions, Dosage, and Warning. [online] Webmd.com. Available at: https://www.webmd.com/vitamins/ai/ingredientmono-960/green-tea [Accessed 26 Feb. 2019]. CHACKO, S. M., THAMBI, P. T., KUTTAN, R. AND NISHIGAKI, I. Beneficial effects of green tea: A literature review In-text: (Chacko et al., 2019) Your Bibliography: Chacko, S., Thambi, P., Kuttan, R. and Nishigaki, I. (2019). Beneficial effects of green tea: A literature review. FRANK, K., PATEL, K., LOPEZ, G. AND WILLIS, B. Green Tea Catechins Research Analysis In-text: (Frank et al., 2019) Your Bibliography: Frank, K., Patel, K., Lopez, G. and Willis, B. (2019). Green Tea Catechins Research Analysis. [online] Examine.com. Available at: https://examine.com/supplements/green-tea-catechins/ [Accessed 26 Feb. 2019]. GREEN TEA USES, BENEFITS & DOSAGE - DRUGS.COM HERBAL DATABASE In-text: (Drugs.com, 2019) Your Bibliography: Drugs.com. (2019). Green Tea Uses, Benefits & Dosage - Drugs.com Herbal Database. [online] Available at: https://www.drugs.com/npp/green-tea.html [Accessed 26 Feb. 2019].

Carly Richards - Biological Engineer - Spring 2019 Wang (2013) 4

Botanical Name3: Crataegus Oxyacantha, Cataegus Monogyna Common Names3: Hawthorne1, Haw, May, Mayblossom, Maybush, Mayflower, Whitehorn

Pharmacological Properties4

Typical Uses 1. Heart Tonic 3

Antioxidant Activity Positive Antioxidant Activity

Flavonoids enhances heart muscles ability to contract

2. Increase Blood and Oxygen Supply to the Heart3

Positive Inotropic Anti-inflammatory

3. Treatment for 3

Anti-cardiac Remodeling

Angina Pectoris

Antiplatelet Aggregation

Arrythmia

Vasodilating

Atherosclerosis

Endothelial Protective

Wang (2013) 4

Ischemia

Reduction of Smooth Muscle Cell Migration and Proliferation

Disease of the heart and blood vessels such as Congestive Heart Failure (CHF)

Protective Effect Against Ischemia/Reperfusion Injury

Low and High Blood Problems

Antiarrhythmic Lipid-lowering Effect Decreases Arterial Blood Pressure

History Not much is known about the origins of how hawthorn became a medicinal herb, but it is clear that it was originally used with the intended purpose to treat cardiac and related vascular disorders.

4. Digestive Aid4

Mechanism of Action Although the specific mechanism is not clear, the release of antioxidants, antiinflammatories, inotropic, anticardia remodeling active ingredients are the primary targets.

Dosage Forms Capsules/Tablets 160-1800 mgncbi in 2-3 doses daily2 Tea4 Tinctures4 Liquid containing extracts of hawthorn leaf, flower, or berry diluted with either 45% Ethanol, 60% Methanol, or a

water-base2,4 Jams/ Jellies/Candy/Wine4 NCCIH (2016) 2

Pharma-active derivatives:

Flavonoids4 Derived oligomeric procyanidins (OPC)

Triterpenic Acid4 Ursolic, oleanolic, and crataegolic acids

Phenol Carboxylic Acids4 Chlorogenic, caffeic acids, & various amines

Unsubstantiated Claims1,3 “Calmative agent” “Mild sedative” “Circulatory stimulant” “Aids with menstrual problems” “Increase urine output” “Aid digestive irritation” (indigestion/ diarrhea/ stomach pain) “Treats Tape worm” “Intestinal infections” “Insomnia”

Effectiveness Potent drug that can have ranging effects depending on the individual’s heart disorder.3 Hawthorn will not stop attacks.1 Placebo controlled studies showed some evidence objective improvements in patients with mild forms of heart failure, hyperlipidemia, and hypertension.4

Professional Opinion Before taking Hawthorn, one should talk to their health care professional amount concerns and to see if supplement will counteract any other kind of medication or condition of the patient. The patient should continue to monitor fluxion of their heart rate for abnormal arrhythmias. In my professional opinion, I would not advise taking Hawthorn regularly. I would also not advise taking Hawthorn if you have severe heart problems, take sleeping supplement, medication that have effect or have cardiovascular side effects, or notice significant changes in heart rate. Studies are not yet definitive and long-term studies show even less promise according to the NIH, and so I would not strongly encourage the use of Hawthorn (at least as a first mode of defense). Due to the non-specific binding (supported by research from Wang) and the support evidence from studies suggesting positive support from those who suffer from congestive heart failure, Hawthorn should be taken in short time segments less than six weeks, small doses, and in the absence of worsen conditions for mild congestive heart conditions (2013). With the various binding targets, it does not surprise me the effects of consuming Hawthorn are widespread and does not suggest possessing strong effects on a specific disorder.

Safety People with heart failure should not take Hawthorn. People on other heart medication show worse symptoms with the use of Hawthorn and on a short study people taking Hawthorn were more likely to cause congestive heart failure than the placebo, mostly likely due to the other medications the volunteers were on. REFERRENCES Natural Medicines Comprehensive Database Consumer Version (2018). Therapeutic Research Faculty (2016). Hawthorn. 3 University of Rochester Medical Center (2019). Encyclopedia-Hawthorn. Rochester, NY. 4Wang, J., Xiong, X., & Feng, B. (2013). Effect of crataegus usage in cardiovascular disease prevention: an evidencebased approach.Evidence-based complementary and alternative medicine: eCAM.49363. 1

2NCCIH

ADVERSE EFFECTS & TOXICITY Hawthorn is tolerated by most people but can cause sedative effects and significantly low blood pressure at higher doses.3 Hawthorn has been associated to death and mortality4, but the common side effects are2: Dizziness/vertigo Palpitations Headaches/migraine Digestive complaints Nausea

INTERACTIONS Do not take Hawthorn with other heart medications, sedatives, sleeping medications, or phosphodiesterase - 5 inhibitors (sildenafil, tadalafil, vardenafil).2,3 German health authorities advise to limit intake of Hawthorn to less than 6 weeks at a time3 while the NCBI recommends intake for 4-8 weeks to see effects. 4 *Hawthorn should not be taken by women and children.3 *People with heart failure should not take Hawthorn.3

Kirsten Ricke Biology Student Spring 2019

â&#x20AC;&#x153;Experts say there aren't enough Hoodia plants in the world to account for all the alleged Hoodia products on the market.â&#x20AC;?

HOODIA

Hoodia gornonii (Masson) Sweet ex Decne Common Names: hoodia, Kalahari cactus, Xhoba Hoodia, native to the Kalahari Desert in southern Africa, was originally used by Xhomani Bushman as a hunger and thirst suppressant to keep the hunters going in tough conditions and long journeys. Hoodia is a cactus-like plant that is actually a leafless succulent. During this time, most of the men would just chew on the stems which would prevent hunger and thirst. Today hoodia is still being used for similar reasons. Hoodia is an appetite suppressor and a lead to prevent obesity. However you still must put in some work if you are looking to lose weight. More research is being done to use this product as an antiobesity agent. However new ways to use hoodia have been discovered since. The stems could be dried and used to make capsules, powders, teas, chewable tablets, etc. all to assist in the suppression of appetite. The typical serving size is between 1,500mg-3,000mg, with a maximum dose of Image retrieved from: 4,500mg. The beginning dosage is typically http://www.herbalsafety.utep.edu/herbal-factsheets/hoodia/ 800mg-1,500mg once or twice daily. Active Ingredients

Image retrieved from https://www.gondwanacollection.com/blog/hoodia-hardy-plant-ofthe-desert/

There have been studies done to determine how hoodia is effective. It has been determined that a specific molecule in hoodia, P57, has an effect on the hypothalamus which may help regulate hunger. P57, the active ingredient in hoodia, has been known to regulate your hunger for up to 24 hours. P57 activates a G-protein, GPR119 which is a direct target to weight loss. With this information in mind, it is evident that P57 has a big opportunity to help with metabolic diseases. Although, since P57 has an effect of the hypothalamus, it may also lead the person to lose their desire for thirst and the person may become very dehydrated.

Effectiveness The effectiveness of hoodia has not completely been confirmed. The one study done on humans proved that the people who took hoodia did not lose any more weight than those who took placebos.

Safety Not much is known about the safety of hoodia because of the few studies that have been done with humans. However, in the study completed, the participants had more side effects than those taking a placebo. There have also been increases in blood tests due to hoodia. This product is often deemed alarming because of the cardiovascular side effects of the supplement. Toxicity The interactions with other medicines or supplements is still currently unknown.

Adverse Effects Hoodia is not recommended for all people. Because hoodia is known to suppress appetite by sending signals to the hypothalamus it is possible for people with diabetes that the body would think it has the appropriate amount of blood sugar and not alert you with signs of low blood sugar. Also hoodia usage for people with eating disorders would be very dangerous.

After doing research on hoodia, I have concluded that hoodia is not exactly the first supplement that I would be interested in trying. With the lack of research that has been done and the side effects that often occur with the usage of hoodia I would be skeptical about using this product to help regulate hunger and thirst. There has been some research that has been done that I believe someday hoodia may be an effective treatment due to the specific molecule P57 which has an effect on the hypothalamus. It is also very important to know what kind of products you are purchasing because some hoodia products are known to not contain any hoodia. Doing the appropriate research on specific brands ant the supplement itself is very important before considering to purchase any sort of supplement. Image retrieved from https://nccih.nih.gov/health/hoodia

Amusan, L. POLITICS OF BIOPIRACY: AN ADVENTURE INTO HOODIA/XHOBA PATENTING IN SOUTHERN AFRICA. African Journal Of Traditional Complementary And Alternative Medicines, 14(1), 103-109. Published 2017. Accessed February 20, 2019. Herbs at a Glance. https://permanent.access.gpo.gov/gpo29942/Herbs-At-A-Glance-Hoodia-06-14-2012-0.pdf. Published August 2007. Updated April 2012. Accesssed February 25, 2019. Miers, R. The Hoodia Dosage for Maximum Effectiveness and Safety. https://www.streetdirectory.com/etoday/the-hoodia-dosage-for-maximum-effectiveness-andsafety-uuealj.html. Accessed March 31, 2019. National Center for Complementary Alternative Medicine. Hoodia Bethesda, Md.]: U.S. Dept. of Health and Human Services, National Institutes of Health, National Center for Complementary and Alternative Medicine. Published 2012. Updated April 2012. Accessed February 13, 2019. Robb-Nicholson, C. By the way, doctor: Can Hoodia help you lose weight? https://www.health.harvard.edu/newsletter_article/By_the_way_doctor_Can_Hoodia_help_you_lose_weight. Published August 2008. Accessed February 13, 2019. Stuart, A. G. Hoodia. http://www.herbalsafety.utep.edu/herbal-fact-sheets/hoodia/. Accessed February 9, 2019. Zhang, Shuyong, Ma, Yuyong, Li, Jing, Ma, Junjun, Yu, Biao, & Xie, Xin. Molecular matchmaking between the popular weight-loss herb Hoodia gordonii and GPR119, a potential drug target for metabolic disorder. Proceedings of the National Academy of Sciences of the United States of America, 111(40), 14571-6. Published 2014. Accessed February 20, 2019.

ALEXIS RINI, STUDENT PHARMACIST (SPRING 2019)

Horehound Scientific name: Marrubium vulgare Background/History Horehound is orginially from Europe and is a member of the mint family. Now horehound is able to be found throughout North America in very sunny places. Roman encylopaedist Aulus Cornelius Celsus believed that horehound was a remedy for coughs and congestion, while others believed that horehound was a magic herb that could protect agaisnt witches spells.

Common uses •

Cough Relief

•

Digestive Aid

•

Motion Sickness Remedy

•

Bronchitis

•

Appetite Stimulant

https://www.rareseeds.com/whitehorehound/

MECHANISM OF ACTION Horehound helps to relieve coughing because it contains the active chemical compound marrubin. Marrubin has expectorant abilities, which means it can loosen up mucus in the chest and produce more productive coughs. This expectorant effect also helps those who are suffering from bronchitis. Along with this effect horehound has been found to have antispasmodic and analgesic effects. All of these provide cough relief. The bitterness of horehound helps to increase the production of saliva and gastric juices which helps to aid in digestion, and can even help with indigestion and gas. This increase in saliva and gastric juice can also stimulate someone’s appetite, which is helpful for people who may have a health condition that causes a decrease in appetite. There is no scientific research about the mechanism of action of horehound to help with motion sickness.

Available Forms/Typical Serving

https://cdn.shopify.com/s/files/1/0004/8132/9204/files/horehound drops.jpg

Horehound comes in either fresh horehound leaves, a dry powdered herb, or as a candy that can be used as a lozenge. If horehound is made into a tea, then it is recommended to have 30- 60 mL a day. If horehound is made into a syrup, take one teaspoonful three times a day for acute illness (The dose of the syrup is not specified). A lozenge can be taken as http://medicinalherbinfo.org/000Herbs2016/1her needed for cough relief. bs/horehound/ 1

SIDE EFFECTS

SAFETY One safety concern with horehound is that it should be avoided by women who are pregnant or lactating. Some reports believe that it has emmenagogue and abortifacient effects.

There is no reported evidence on the effectiveness of horehound. https://www.pnwflowers.com/flower/marrubium-vulgare

Studies have shown a lethal dose of horehound is 370 mg/kg when administered orally to rats, and 100 mg/kg when injected into mice.

Nausea

•

Dry Mouth

•

Excessive salivation

•

Dizziness

•

Anorexia

DRUG AND FOOD INTERACTIONS

EFFECTIVENESS

TOXICITIES

•

There is very little clinically supported informtaion regarding interactions. One possible interaction is between horehound and anticoagulant medications.

MY PROFESSIONAL OPINION In my professional opinion, I believe that horehound can be very useful for patients who are experiencing minor symptoms, such as sore throat, cough, or stomach upset. I do not believe that horehound will be useful for anything more serious such as bronchitis. I personally believe there is not enough evidence to back up horehound as being a viable solution to serious medical conditions. ~ A. Rini

WORKS CITED 1. "Horehound.". Horehound. The Columbia Encyclopedia, 6th ed. https://www.encyclopedia.com/plants-andanimals/plants/plants/horehound. Published 2019. Accessed February 24, 2019. 2. Horehound. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed February 24, 2016. 3. Marrubium vulgare. Wikipedia. https://en.wikipedia.org/wiki/Marrubium_vulgare. Published September 5, 2018. Accessed February 24, 2019. 4. Price A. Forget Over-the-Counter Drugs: This Is Nature's Herbal Cough Suppressant. Dr. Axe. https://draxe.com/horehound/. Published September 3, 2017. Accessed February 24, 2019.

HORNY GOAT WEED EPIMEDIUM GRANDIFLORUM L. EMILY SAJDA • STUDENT PHARMACIST • SPRING 2019

COMMON USES

COMMON NAMES

• • • • •

• • • •

Horny Goat Weed Arrow-leaf Barrenwort Chien-Hsieh Yin-Yang-Hua Icariin

Erectile Dysfunction Menopausal symptoms Atherosclerosis High blood pressure DOSAGE FORMS

BACKGROUND

Horny Goat Weed has been traditionally used in Chinese medicine for more than 2,000 years as an aphrodisiac to treat impotence and to “nourish” the kidney.

• Tablets • Capsules • Tea Clinical information is lacking to establish a set daily dose.

MECHANISM OF ACTION

https://www.amazon.com/Extra-StrengthExtract-Arginine-Tribulus/dp/B01JAHQ1HE

The active ingredient in Horny Goat Weed is Icariin which is a prenylated diglycosdie flavonoid. It is not a stable compound in the human intestine and is rapidly absorbed via hydrolysis. Icariin is a selective PDE5 inhibitor which blocks the degradation of cGMP in smooth muscle cells causing vasodilation making it useful for erectile dysfunction. Horny Goat Weed also contains phytoestrogens that can mimic estrogen and lead to decreased bone loss in menopausal women.

https://www.crocus.co.uk/plants/_/epimedium-grandiflorum-lilafee/classid.2000013206/

PROFESSIONAL OPINION

EFFECTIVENESS

In my professional opinion, I believe that there are not enough clinical studies to prove the efficacy for the indicated uses of Horny Goat Weed. I would recommend only for the use of the placebo effect in individuals with erectile dysfunction who will not be affected by the safety concerns. Otherwise, the potential side effects do not outweigh the benefits in the other common uses and I would recommend turning to possible Western medication options.

There is a lack of clinical information on the overall efficacy of Horny Goat Weed. The PDE5 enzyme inhibition in Horny Goat Weed is 80 times less effective than the erectile dysfunction medication Sildenafil currently on the market.

SAFETY CONCERNS & WARNINGS There is a hypotensive effect making it contraindicated for individuals with low pressure. It is also contraindicated in pregnant and breastfeeding individuals due to a lack of studies. Horny Goat Weed slows blood clotting which results in an increased risk in bleeding.

https://draxe.com/horny-goat-weed/

ADVERSE EFFECTS & SIDE EFFECTS However, clinical information is lacking, but side effects seen include low blood pressure, irregular heartbeats, dry mouth, dizziness. Taking high doses has been seen to cause a stimulatory effect and sweating. INTERACTIONS

TOXICOLOGY

Limited studies and no mutagenicity results recorded. Animal studies did conclude with a decrease in thyroid activity with extended lengths of use.

There are severe interactions observed with the drug belimumab. No known food interactions. Known to offset some side effects of corticosteroids so they are often taken together to reduce unwanted corticosteroid side effects. https://nootriment.com/horny-goat-weed-tea/

References: Examine.com. Horny Goat Weed - Scientific Review on Usage, Dosage, Side Effects. Examine.com. https://examine.com/supplements/horny-goat-weed/. Published June 14, 2018. Accessed February 19, 2019. Brahic C. Horny goat weed could be better than Viagra. New Scientist. https://www.newscientist.com/article/dn14825-horny-goat-weed-could-be-betterthan-viagra/. Accessed February 24, 2019. Horny Goat Weed. Beta-Blockers for Mitral Valve Prolapse | Michigan Medicine. https://www.uofmhealth.org/health-library/hn-4391000#hn-4391000-uses. Accessed February 20, 2019. Horny Goat Weed. Drug Facts and Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.factsandcomparisons.com. Accessed February 19, 2019. Horny Goat Weed: Side Effects, Dosages, Treatment, Interactions, Warnings. RxList. https://www.rxlist.com/consumer_horny_goat_weed/drugscondition.htm. Accessed February 24, 2019.

Erica Sanford Pre-Dental Student

Horse Chestnut

Spring 2019

Scientific Name Aesculus Hippocastanum1

Common Names horse chestnut, buckeye, Spanish chestnut1

Common Uses Used in the treatment for varicose veins and many other poor circulatory symptoms such as pain, tiredness, swelling of the legs, itching and water2 22

retention. Dosage Forms

For poor blood circulation (chronic venous https://www.naturalpedia.com/horse-chestnuts-sources-health-benefits-nutrients-uses-andconstituents-at-naturalpedia-com.html

insufficiency): 300 mg of horse chestnut seed extract containing 50 mg of the active ingredient, Aescin, twice daily.2

Background/History

Pharmacology Mechanism of Action Treatment of chronic venous insufficiency.3

Typical Use

Clear evidence that higher percentage content of active component, Aescin, proves higher therapeutic effectiveness.3

Usually taken orally,

Pharmacodynamic actions: Anti-Oedematous Properties 2. Anti-Inflammatory Activities 3. Venotonic Properties 1.

sometimes topical use of drug can be used as well2

Horse chestnut trees are native to the Balkan Peninsula but are grown worldwide.1 Horse chestnut seed extract when first discovered, it was used for joint pain, bladder and gastrointestinal problems, fever, and leg cramps.1 Usable parts of the plant include the seed, bark, and leaf, but seed extracts are most common.1

Safety The unprocessed seeds, leaves, bark, and flowers of horse chestnut contain esculin, which is poisonous and could increase the risk of bleeding.1 Fortunately, properly processing horse chestnut seed extract removes the esculin. The processed extract is considered generally safe when used for short periods of time. 1

Interactions § Lithium2 § Medications taken for Diabetes2 § Medications that slow blood clotting2

Toxicities Toxic to Dogs, Toxic to Cats, Toxic to Horses2 Toxic Principle: Aesculin and other saponins2

https://selfhacked.com/blog/horse-chestnut/

https://nccih.nih.gov/health/horsechestnut#hed4

Adverse Effects § Upset stomach, headache or dizziness can occur. If these symptoms persist, a doctor should be contacted right away.2 § Horse Chestnut could cause urine to turn red, which is completely harmless.2 § This product could also cause hypoglycemia (low blood sugar), especially in patients with diabetes.2 Effectiveness §

Proven effective for: o Varicose veins and other circulatory problems (chronic venous insufficiency).1 § Insufficient evidence for: o Male infertility, Hemorrhoids, Diarrhea, Fever, Cough, enlarged prostate, Eczema, Menstrual Periods and other conditions still being tested.1 Personal Profession Opinion §

As a person who has bad circulation and could benefit from this drug, I believe the substantial evidence is great enough to without a doubt give it a try. The side effects are very low and mild, and this drug seems to be very safe and have great benefits for not only circulation but other things as well.

References 1. 2. 3.

National Center for Complementary and Integrative Health. Horse Chestnut. November 2013. https://nccih.nih.gov/health/horsechestnut. Accessed February 20th, 2019. Web MD. Horse Chestnut. (n.d.) https://www.webmd.com/vitamins/ai/ingredientmono-1055/horse-chestnut. Accessed February 20th, 2019. Sirtoli. CR. Semantic Scholar. Aescin: Pharmacology, Pharmacokinetics and Therapeutic Profile. https://pdfs.semanticscholar.org/08e1/5f22a5113ed9ec6c35fe38484cadb946adf0.pdf. Accessed February 20th, 2019.

Spring 2019

Addison Sarver Student Pharmacist

PHARMACOLOGY Ferrous Sulfate: Replaces iron lost by the body to restore formation of hemoglobin ADME- Taken orally, absorbed from GI tract primarily in duodenum and proximal jejunum between 10-60% of dose given, transported from GI directly to blood to be bound to transferrin and then subsequently taken to the bone marrow for hemoglobin formation, when hemoglobin breaks down iron is released but often is conserved and reused rather than being excreted, 11.5mg/day of iron is excreted in the nails, hair, feces, and urine. Ferrous Sulfate. Global Library of Women's Medicine. https://www.glowm.com/resources/glowm/cd/pages/drugs/f011.html. Accessed February 24, 2019.

COMMON AND TYPICAL USES Iron supplements are taken to help treat iron deficiency (and anemia) caused by: Inadequate dietary intake Blood loss ▪ ▪

Ex. Heavy Menses Ex. Frequent blood draw/donation

Pregnancy Anti-coagulant drugs (aspirin, Warfarin, etc.) Chronic disease

▪ ▪ ▪

Ex. Cancer Ex. Heart Failure Ex. Kidney Failure

Office of Dietary Supplements - Iron. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Accessed February 24, 2019.

AN “IRON” BY ANY OTHER NAME… As a dietary supplement there are many different forms of iron available OTC with varying levels of efficacy. The following are some common names one might find on the shelf along with the chemical form the iron is found as: Name (scientific name) dosage form NatureMade Iron (Ferrous Sulfate) Tablet Enfamil Fer-In-Sol (Ferrous Sulfate) Droplets Slow Fe (Ferrous Sulfate) Extended-Release Tablet Nature’s Bounty Gentle Iron (Iron Glycinate) Capsule Fergon (Ferrous Gluconate) Tablet Iron. Walgreens: Trusted since 1901. https://www.walgreens.com/store/c/vitamins-and-supplementssupplements-iron/ID=365304-tier3?o=acs&fromBack=true. Accessed February 25, 2019.

IRON’S STRONG HISTORY Iron deficiency is potentially one of the most frequently occurring nutritional problems today and many historians believe it was even a problem for prehistoric humans. While the idea of taking oral iron supplements (ferrous sulfate originally) was not introduced until the 19th century by Pierre Blaud, humans were treating symptoms caused by iron deficiency (fatigue, dizziness, cramps, chest pain, and pallor) by soaking in iron-containing chalybeate “healing” waters in famous ancient cities like Bath. Today there are many oral formulations of iron supplements that are available without prescription as well as prescription drugs that can be administered orally and IV to treat iron deficiency. Cançado RD, Muñoz M. Intravenous iron therapy: How far have we come?. Revista Brasileira de Hematologia e Hemoterapia. 2011;33(6):461-9. Poskitt EME. Early History of Iron Deficiency. British Journal of Haematology. 2003;122(4):554-562. doi:10.1046/j.1365-2141.2003.04529.x.

Watermark image: Yiikrazuul. Heme; 2010. https://commons.wikimedia.org/wiki/File:Heme_b.svg. Accessed February 24, 2019.

IRONING OUT THE KINKS Safety/Adverse Effects/ Toxicity Total iron intake (food and drug) is safe for most patients at or below the following parameters:

Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc: A Report of the Panel on Micronutrients. Washington, DC: National Academy Press; 2001. https://www.nap.edu/read/10026/chapter/1. Accessed February 25, 2019

Taking more than 20mg/kg orally of iron in any form may lead to upset stomach, constipation, nausea, vomiting, and faintness. One time ingestion of oral iron in any form at a dose greater than or equal to 60mg/kg could result in multisystem organ failure, coma, convulsions, and death. Children are especially at risk of fatal overdoses of iron, and iron supplements need to be kept out of reach of children to prevent accidental ingestion. Interactions with Medications Levodopa- iron supplements reduce the absorption of levodopa likely through chelation Levothyroxine- iron supplements diminish the absorption of levothyroxine when taken together and should be spaced out in 4-hour windows Proton-pump inhibitors- PPIs reduce the acidity of the stomach and also the absorption of iron taken orally Office of Dietary Supplements - Iron. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Accessed February 24, 2019.

EF(FE)CTIVENESS In one study conducted by researchers in a primary care facility, subjects not exhibiting iron deficiency anemia were given iron supplements or placebos. Subjects given iron supplementation did subjectively report feeling less fatigued than placebo-given subjects, but neither group had objective improvements in physical capacity (ex. maximal oxygen consumption during exercise). Iron-supplement-receivers did have significantly increased serum hemoglobin levels compared to baseline testing.

Houston BL, Hurrie D, Graham J, et al. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic irondeficient adults: a systematic review of randomised controlled trials. BMJ Open 2018;8:e019240. doi:10.1136/ bmjopen-2017-019240. https://bmjopen.bmj.com/content/8/4/e019240. Accessed February 24, 2019

THIS (FE)MALEâ&#x20AC;&#x2122;S OPINION: Taking oral iron supplements is effective for many patients who may be experiencing iron deficiency or anemia, but not incredibly useful for healthy individuals. Patients should consult their pharmacist or doctor if they believe they are not getting enough iron in their diets (vegan and vegetarian diets for example) or if they believe they are experiencing symptoms of anemia. From there, a recommendation can be made whether oral OTC iron supplementation, prescription oral iron supplementation, or IV iron supplementation needs to be used. If patients are getting enough iron in their diets, iron supplementation may have little to no effect on them positively and incorrect usage may lead to unwanted side-effects and even danger. ~ A. Sarver

Watermark image: Yiikrazuul. Heme; 2010. https://commons.wikimedia.org/wiki/File:Heme_b.svg. Accessed February 24, 2019.

Photo by: Steven Foster, NCCIH

Lucy Schenkel – Nursing Student Spring 2019

Kava Kava Scientific name: Piper methysticum Common names: Kava, Kava Kava, Ava Pepper, Ava Root, Kawa

Background/History: • • •

Native to the South Pacific islands Member of pepper family Considered a sacred plant and used in many traditional ceremonies

Common Uses: Anxiety Positive effects on cognitive function Potential cancer applications Stress, fatigue, insomnia, UTI’s and menopausal symptoms

• •

tablet, drink, capsule, powder, Max daily dose is 250 mg

Typical Use: • • •

The root and underground stem are used to make drinks Other uses include extracts, capsules, and tablets Roots can be chewed or ground to a pulp and added to water

Pharmacology/ MOA Kava lactones (kawain, methysticin, yangonin, and dihydrokawain) are considered to be the active constituents of kava-‐kava responsible for the pharmacological activity in humans and animals. The different methods of extraction of the kava lactones from the roots may explain the toxicity of Western products compared with the safe use of the Photo by: Richard Whelan, Medical Herbalist

• • • •

Dosage Forms:

traditional beverage.

Effectiveness: •

A 2013 randomized controlled trial involving 75 participants with generalized anxiety disorder (GAD) concluded that standardized kava extract may be a moderately effective short-‐term option for the treatment of GAD.

•

A 2011 review of 66 studies of herbal medicine for depression, anxiety, and insomnia found some evidence that kava may produce beneficial and relaxing effects for anxiety disorders.

•

A 2003 Cochrane review of 12 randomized controlled trials found that compared with placebo, kava extract may be an effective symptomatic treatment for anxiety, although the effect size appears small.

-‐ Although there are warnings for hepatotoxicity, in 2013 a randomized controlled trial of 75 participants found no significant differences in liver function tests after 6 weeks. They also found no significant adverse reactions. Because this was only a 6-‐week long study, long-‐term safety studies regarding the use of kava are needed. -‐ While there is current data that supports kava’s efficacy against anxiety, kava and kava-‐containing products were withdrawn from Canadian, French, and British markets due to concerns about hepatotoxicity. The FDA has issued warnings in the US.

Photo from Amazon.com

Safety

-‐ The reason that kava lactones have been linked to hepatotoxicity is because they depend on the cytochrome P450 enzymes to be cleared by the liver. Safe use of kava has continued and documented for about 2,000 years, possibly because traditional preparations of the kava root, the kava lactones are balanced by the availability of glutathione. In the tablet and capsule forms of standardized extracts, there is no glutathione, which might explain the reported cases of hepatotoxicity.

Interactions • • • • •

My Professional Opinion After researching this plant, my professional opinion is that it is a safe alternative to benzodiazepines and antidepressants for treating anxiety if consumed in it’s natural form, which contains glutathione to help the body metabolize it safely. Safe use and dosages, in moderation and in communication with your physician, may result in positive effects on mental and physical health.

Parkinson’s drugs Benzodiazepines CNS depressants Paroxetine Alcohol and other liver damaging drugs and foods

Adverse effects/toxicities -‐ -‐ -‐ -‐

Linked to severe liver damage and toxicity Long term use associated with yellowing and dry scaling skin Heavy use associated with heart problems and eye irritation Most of these effects have only been seen in Europe; not in the US and Australia

References: Cassileth B. Kava (Piper methysticum). Integrative Oncology: Complementary Therapies, Herbs, and Other OTC Agents.2011;4:384 Lexicomp Online, Kava. Natural Products, Lexi-‐Drugs Online, Hudson, Ohio: Wolters Kluwer Clinical Drug Information, Inc.; 2016. Lau A, Salisbury A, Whitehouse J, Whitton P. Kava lactones and the kava-‐kava controversy. Phytochemistry. Volume 64, 2003:(3)673-‐679. National Center for Complementary and Integrative Health (NCCIH). Kava, 2018.

LAVENDER Abigail Seger, Student Pharmacist, Spring 2019

Scientific Name: Lavandula angustifolia Common Name: Lavender Background/history: Scientific name originates from the latin word, lavare which means to bathe. Was used to wash linens in Europe due to its antiseptic qualities Cathy Wong. https://www.verywellmind.com/lavender-forless-anxiety-3571767. Accessed Feb 24, 2019

Common Uses: - Perfume linen - Aromas used to keep flies and mosquitos away - Sachet herb - mixed with other herbs to keep laundry drawers smelling fresh - Remedy for digestive issues, headaches, grief and stress

Therapeutic Actions of Lavender - Dilates capillaries and increases blood circulation - Supports the nervous system Mechanism of Oral Lavender - Inhibitor of voltage dependent calcium channels in synaptosomes. The inhibition stops calcium channels from opening -Targets MAO-A, SERT, GABAa, and NMDA receptors

Integrative Therapeutics. https://www.integrativepro.com/Resources/Integrative-

Typical use: Dosage forms: Blog/2016/How-Lavender-(Lavandula-angustifolia)-Works. Accessed Feb 24th, 2019. - Flower infused in water - Nervine Medicine: used as a sedative for stress, anxiety, and insomnia. - Lavender oil - Depression - Topical - Hepatic and bile stimulant for gas, IBS, and nausea

Effectiveness: - Lavender oil was used in a study that measured patientâ&#x20AC;&#x2122;s anxiety levels using the Hamilton Anxiety Rating Scale (HAMA). The results concluded that Lavender oil was efficacious in reducing the participantâ&#x20AC;&#x2122;s HAMA score - When measuring the efficacy for depression, lavender was found to begin working within only 2 weeks, whereas other many monoamine reuptake-inhibiting antidepressants take anywhere between 4-6 weeks to produce their desired effect

Safety: Its MOA of inhibiting voltage dependent calcium channels appears to be safe. There is no relation to inhibiting or inducing cytochrome P450 enzymes, which lowers the risk for any adverse effects. Adverse Effects and Toxicities: - Study shows that adverse events appear similar to a placebo study - Any effects that did occur only resulted in mild GI discomfort https://www.lavenderranch.com/shop/cer tified-organic-dried-lavender-bouquets/

Interactions: There was no information stating that Lavender was known for causing any interactions. Since there is no evidence of induction/inhibition of cytochrome P450 enzymes, it is safe to assume there are no likely drug interactions regarding lavender. Professional Opinion: In conclusion, studies show that lavender has many therapeutic Wonder How To. https://mindbenefits while proving to be safe. I think it seems like a great hacks.wonderhowto.com/how-to/expert-advice-fourways-doctors-keep-themselves-healthy-0157537/ alternative to use if feeling stressed or anxious. It is also a Accessed Mar 27th, 2019 beneficial product if you're wanting to keep things smelling fresh. References: Chestnut School of Herbal Medicine.https://chestnutherbs.com/lavenders-medicinal-and-aromatherapy-uses-and-lavender-truffles/. Accessed Feb 24th, 2019 Integrative Therapeutics. https://www.integrativepro.com/Resources/Integrative-Blog/2016/How-Lavender-(Lavandula-angustifolia)Works. Accessed Feb 24th, 2019. Benjamin J. Malcolm. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007527/. Accessed Feb 24, 2019

Lobelia Ria Shah Pre-Med Student Spring 2019

Background/history: Historically, Native Americans used Iobelia as medication/treatment for respiratory conditions, lung-related ailments, and to help stop alcoholism and smoking. Although used heavily, many side effects occurred, and it was discovered that Iobelia may not be as effective as the Native Americans thought it was. Iobelia was heavily used in the 19th century until recently. Research has been conducted on Iobelia and there is not much evidence to prove the safety/effectiveness of this herbal remedy. It has been used a lot and served as a medication back in the 19th century. However, recently more research and evidence has been conducted on Iobelia.

Common/Typical Uses: Lobelia is an aid to help with alcoholism, smoking, and is a treatment of other drug dependencies as well. In addition, Iobelia is said to treat respiratory illnesses, fever, rheumatism, asthma, bronchitis, pneumonias, and other lung-related ailments. It is also used as a sedative to help people relax.

Pharmacology/Mechanism of Action: There is no recent clinical evidence to support the use of Iobelia.

StyleCraze. 6 Medicinal Uses and 8 Side Effects of Lobelia Herb. StyleCraze.com. https://www.stylecraze.com/articles/medicinal-uses-andside-effects-of-lobelia-herb/#gref6%20M. Accessed [March 30, 2019]

Available form/typical serving: Iobelia is available in liquid extracts, tinctures, and as a dried herb in capsules and for teas. It may also be applied to the skin in the form of ointments, lotions, and plastics. The appropriate dose depends on factors such as age, health, and other conditions. While the appropriate range of doses for Iobelia is undetermined due to not much research, the traditional use of the leaf suggests 100 mg of dry herb up to three times a day.

Scientific Name: Lobelia Inflata

Common Names: Iobelia, Indian Tobacco, Indian Weed, Vomit Wort, Wild Tobacco

Effectiveness: There is not enough research/data to prove the effectiveness or ineffectiveness of Iobelia.

Interactions: If you are taking Lithium, taking Iobelia might decrease how well your body gets rid of Lithium. Taking Iobelia could increase how much Lithium is in your body and result in serious side effects. Other interactions include: nicotine patches, Chantix, cigarette, and smokeless tobacco. Lobelia. Wikipedia. https://la.wikipedia.org/wiki/Lobelia. Accessed [March 30, 2019].

Safety Concerns/Warnings: There has not been enough research to determine whether Lobelia is safe or not. Taking Lobelia is considered unsafe when taken by mouth. Do not take Lobelia if you are pregnant or breast-feeding, if you have irritability of the Gastrointestinal tract, or heart problems.

References: Gale Encyclopedia of Alternative Medicine. Lobelia. Encyclopedia.com. https://www.encyclopedia.com/plants-andanimals/plants/plants/lobelia. Accessed [February 18, 2019]. HonCODE. Lobelia. Drugs.com. https://www.drugs.com/npc/lobelia.html. Accessed [February 18, 2019]. Penn State Hershey. Lobelia. Penn State Hershey Milton S. Hershey Medical center. http://pennstatehershey.adam.com/content.aspx?prod uctId=107&pid=33&gid=000264. Accessed [February 18, 2019]

Adverse Effects: Lobelia can cause nausea, vomiting, tremors, weakness, diarrhea, and dizziness at large doses. Parts of the plant affect the heart, and heart related problems such as: low blood pressure, rapid heart rate, skin reactions, and convulsion, have been reported.

Toxic Effects: Toxic dosages of the plant have described as: 1 gram of leaf is toxic, while 4 grams of leaf is considered to be a fatal dose. Clinical signs of intoxication include: hypothermia, hypertension, respiratory depression, paralysis, seizures, euphoria, nausea, emesis, abdominal pain, salivation, tachycardia, and coma.

Professional Opinion: After doing research on Iobelia, I do not think this herbal remedy should be allowed. Although it has helped people in the past and present, there is not enough evidence about the drug. Studies have been done, but none that indicate the safety or effectiveness of usage. The risks and side effects to using Iobelia are high and there is too much unknown about this drug. Overall, I believe that there needs to be more evidence done but until then, I believe this drug is skeptical and poses as a risk to people who use it. ~R. Shah

MAGNESIUM Matthew Shotts, Student Pharmacist Spring 2019 Scientific Name: Magnesium Common Names: Mg, “mag”, various brand names

History

Mechanism of Action Magnesium supplements are used to increase magnesium levels in the body. It does so via absorption in the GI tract and distribution through plasma. The mechanism of action of other magnesium products are varied. One other example is magnesium sulfate, which is used to treat preeclampsia (high blood pressure in pregnant women). This compound is believed to cause vasodilation in the brain’s blood vessels, thus reducing the chance of ischemia and eclamptic seizures.

Dosage Forms Image courtesy of http://denimandtweed.jbyoder.org/category/science/page/2/

• Magnesium was first discovered outside the Ancient Greek city Magnesia (thus the name) • Magnesium was first isolated in 1808 by Sire Humphrey Davy, who originally called it “magnium” • In the 1600s, water from the Epson spring in England was thought to have many curative and cosmetic benefits. It was later found that the spring was rich in magnesium sulfate (hence the name Epsom Salt, a naturallyoccurring form of magnesium sulfate)

Common Uses

Image courtesy of https://dentagama.com/news/what-s-the-difference-betweenpills-capsules-tablets-caplets-and-chewables

• • • • • • •

Capsule Capsule, Liquid Filled Tablet Tablet, Extended Release Tablet, Chewable Powder (All in various doses)

• Magnesium has many important functions in the body, such as maintaining blood pressure Typical Use and bone structure As mentioned above, the most common use of • For this reason, magnesium may be used to treat hypomagnesemia, or magnesium levels magnesium is as a dietary magnesium supplement. It is often included in below the normal range in the body • Magnesium has also proven to be effective in multivitamin/mineral products. treating constipation, indigestion, high blood pressure during pregnancy, and irregular heartbeat

Effectiveness The clinical effectiveness of magnesium has been proven for many indications, including low dietary magnesium, constipation, indigestion, heartburn, upset stomach, high blood pressure during pregnancy, and irregular heartbeat.

Safety (Including Adverse Effects and Toxicity)

Image courtesy of https://www.safetysign.com/products/6786/class-6-toxic

Excessive magnesium in the body, or hypermagnesemia, is cleared by the kidneys when consumed as food. However, hypermagnesemia from drugs are not cleared as easily and can cause nausea, cramping, and diarrhea. In extreme cases of hypermagnesemia, magnesium toxicity can occur. Symptoms of magnesium toxicity include abnormally low blood pressure, nausea, vomiting, flushing, urine retention, depression, lethargy, and blockage of the GI tract. These can lead to more severe symptoms, like muscle weakness, difficulty breathing, extreme hypotension, irregular heart rhythm, and even cardiac arrest.

Interactions Magnesium has the potential for many interactions with other medications and natural products. Absorption of magnesium is reduced when taken with high doses of zinc. Magnesium can decrease the absorption of bisphosphonates and tetracycline-derived antibiotics. Taking diuretics and proton pump inhibitors can deplete magnesium stores in the body, which sometimes requires discontinuing that medication as dietary magnesium supplements will not replete magnesium stores.

My Professional Opinion When taken properly (in the right dose and without harmful drug-drug interactions), magnesium has many clinical uses. I would recommend that everyone monitors their intake of vitamins and minerals, and if the recommended daily allowance is not being met, I would advise that they take supplements such as daily multivitamins. I would also recommend magnesium to those experiencing constipation, indigestion, and high blood pressure during pregnancy, at their doctorâ&#x20AC;&#x2122;s discretion. Works Cited Ancient Minerals. (2018). Magnesium Facts and Information. [online] Available at: https://www.ancient-minerals.com/magnesium-benefits/facts-info/ [Accessed 29 Mar. 2019]. Hart, T. (2012). Preeclampsia Revisited. [online] Uspharmacist.com. Available at: https://www.uspharmacist.com/article/preeclampsia-revisited [Accessed 29 Mar. 2019]. Mayo Clinic. (2019). Magnesium Supplement (Oral Route, Parenteral Route). [online] Available at: https://www.mayoclinic.org/drugs-supplements/magnesium -supplement-oral-route-parenteral-route/description/drg-20070730 [Accessed 29 Mar. 2019]. Office of Dietary Supplements. (2018). Magnesium: Fact Sheet for Health Professionals. [online] Available at: https://ods.od.nih.gov/factsheets/Magnesium HealthProfessional/ [Accessed 29 Mar. 2019]. WebMD. (2019). Magnesium: Uses, Side Effects, Interactions, Dosage, and Warning. [online] Available at: https://www.webmd.com/vitamins/ai/ingredientmono -998/magnesium [Accessed 29 Mar. 2019].

https://fco.factsandcomparisons.com/lco/me dispan/drugimages/jpg/NLV06150.JPG

Other Common Names

https://www.s hophealthy.in/i mage/cache/d ata/HealthSup plements/Natr ol/010-11000x1000.jpg

Pharmacology

Melatonin binds to MT1, MT2, and MT3 receptors, which may Circadin, MEL, MLT, and N- contribute to the sleep-promoting properties because MT1 acetyl-5-methoxytryptamine and MT2 regulate circadian rhythms and sleep. Melatonin (N-acetyl-5-methoxytryptamine) is a neurohormone Dosage Forms produced by pinealocytes in the pineal gland during the 1, 3, 5, or 10 mg sublingual dark hours of the day-night cycle. Prolonged or oral tablet administration of oral melatonin has reportedly induced (also available in phase-setting effects on circadian rhythms, such as the timed-release tablets) sleep-wake cycle and rest-activity. The hormone has been Common Uses reported to produce reentrainment of circadian rhythms • Cachexia - Cancer after time zone shifts, and entrainment of previously free• Cancer running rhythms in the blind. • Cluster headache; Prophylaxis • • • • • • • • • • • •

Depression Headache; Prophylaxis Hyperpigmentation of skin Jet lag Kleine-Levin syndrome Light and ultraviolet-induced dermatosis Postoperative confusion Sedation Shift work sleep disorder Sleep disorder Tinnitus Chemotherapy side effects

Typical use for treatment of sleep disorders

Allison Smitherman, Student Pharmacist Spring 2019

History Early animal studies of melatonin in the mid-1960s revealed its ability to affect sexual function, skin color, and other mammalian functions. It is a mediator of photo-induced antigonadotropic activity in photoperiodic mammals, and it affects thermoregulation and locomotor activity rhythms in birds. Early studies showed that diurnal variations in estrogen secretion in rats could be regulated by changes in melatonin synthesis and release, induced by the daily cycle of light and dark via the efferent limb of the reflex in the sympathetic innervation of the pineal gland. Continual darkness depresses the estrous cycle. Studies in the 1990s led to widely expanded uses of melatonin, including easing insomnia, combating jet lag, preventing pregnancy (in large doses), protecting cells from free-radical damage, boosting the immune system, preventing cancer, and extending life.

Interactions

Professional Opinion

Abiraterone Acetate: May increase the serum concentration of CYP1A2 substrates. Monitor therapy. Alcohol: Alcohol (ethyl) may enhance the adverse/toxic effect of melatonin. Alcohol (ethyl) may diminish the therapeutic effect of melatonin. Benzodiazepines: Melatonin may enhance the sedative effect of benzodiazepines. Calcium Channel Blockers: Melatonin may diminish the antihypertensive effect of calcium channel blockers (dihydropyridine). Monitor therapy. Cannibis: Cannabis may decrease the serum concentration of CYP1A2 substrates. This interaction has only been described with smoked cannabis herb. Cimetidine and Fluvoxamine: Cimetidine may increase the serum concentration of melatonin.CYP1A2 Inducers (Moderate): CYP1A2 inhibitors may decrease the metabolism of CYP1A2 substrates. CYP1A2 Inducers (Strong): May increase the metabolism of CYP1A2 Substrates. Consider therapy modification. CYP1A2 Inhibitors (Moderate): May decrease the metabolism of CYP1A2 substrates. Monitor therapy. CYP1A2 Inhibitors (Strong): May decrease the metabolism of CYP1A2 substrates. Consider therapy modification. Cyproterone and Deferasirox: May decrease the serum concentration of CYP1A2 substrates. Monitor therapy. Hypnotics: Melatonin may enhance the sedative effect of hypnotics. Imipramine: Melatonin may enhance the adverse/toxic effect of imipramine. Obeticholic Acid: Obeticholic acid may increase the serum concentration of CYP1A2 substrates. Peginterferon Alfa-2b: Peginterferon alfa-2b may increase the serum concentration of CYP1A2 substrates. Teriflunomide: Teriflunomide may decrease the serum concentration of CYP1A2 substrates. Thioridazine: Melatonin may enhance the adverse/toxic effect of thioridazine. Vemurafenib: Vemurafenib may increase the serum concentration of CYP1A2 substrates.

Melatonin is a very safe option to consider when trying to correct sleep pattern or help with insomnia, but it is not a permanent solution to recurrent sleep issues. Using melatonin repeatedly can reduce the effects of the drug. ~A. Smitherman

References 1.

Safety Therapeutically, melatonin has a very wide margin of safety. It has not been studied in pregnant or lactating individuals for effect on the baby or infant. It is contraindicated for patients with autoimmune diseases. https://www.s hophealthy.in/i mage/cache/d ata/HealthSup plements/Heal thAid/HealthAi d%20Melatoni n%203mg%20 %20%2060%20Tabl ets1000x1000.jpg

Adverse Effects and Toxicities • • •

Melatonin. IBM Micromedex. https://www-micromedexsolutionscom.ezproxy.lib.purdue.edu/micromedex2/librarian/PFDefaultActionId/evidencexpert. • DoIntegratedSearch?navitem=topHome&isToolPage=true#. Published March 20, 2019. Accessed March 31, 2019. Melatonin. Lexicomp. https://fco-factsandcomparisonscom.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/fc_rnp2/3750262. Published July 16, 2018. Accessed March 31, 2019. Sleep Science. Johns Hopkins Medicine. www.hopkinsmedicine.org/health/healthysleep/sleep-science/melatonin-for-sleep-does-it-work. Accessed March 31, 2019.

Dizziness, enuesis, excessive daytime somnolence, headache, nausea, insomnia, nightmares, and transient depression Drowsiness could be experienced within 30 minutes and up to an hour which could affect driving or operating machinery Little or no evidence of major toxicities, even at high doses ADULTS: In one study, melatonin 1 g/day for 25 to 30 days was well tolerated; CHILDREN: Ingestions of 3 to 80 mg have resulted in minimal toxicity. After reportedly ingesting up to 85 melatonin 5 mg gummies, two 3-year-old boys (both weighing 14.9 kg) developed only mild irritability and drowsiness (longer than normal naps of up to 3.5 hours).

dissolved into an oral solution. It also comes in pills and tablets, but these

Pharmacology MSM is an oxidation product of dimethyl sulfoxide (DMSO), and its medicinal properties are similar to DMSO. It is thought to exhibit strong photoprotective, anti-inflammatory and antioxidant effects, as well as decreasing the skinâ&#x20AC;&#x2122;s sensitivity to allergens. Many of its benefits are related to increasing the amount of available sulfur in the body.

httpmmmmmmmm/

https://bodyandmindstudio.co.uk/natures-sunshine-msm-methylsulfonylmethane-90-tablets/

Effectiveness Despite a 2006 pilot study showing that six grams of MSM “improved symptoms of pain and physical function without major side effects” in men and women with knee osteoarthritis (n=50), no other large-scale studies have been performed regarding the supplement2.

Safety, Adverse Effects, and Toxicities The FDA has decided that MSM is Generally Regarded As Safe (GRAS). According to multiple studies on its toxicity, doses up to 4.8 grams are safe for human consumption. MSM can cause mild side effects such as nausea, bloating, diarrhea, or irritation of the skin. It is also not recommended to be mixed with alcohol. No studies have confirmed this, but other sulfur-containing compounds have adverse effects with alcohol3.

Professional Opinion Methylsulfonylmethane is a generally safe compound that can provide relief to certain patients who suffer from symptoms of pain due to another condition. Though it a natural product, its purity or effectiveness cannot be guaranteed, but since there seem to be no major adverse effects, the possibility of reducing pain is worth more to some patients than the risk of potential side effects. MSM is a viable option for those who seek an alternative solution to their pain.

1. Sunderman, A. “How much MSM should I take?” Swanson Health Products, www.swansonvitamins.com/blog/amy/msmdosage-how-much-to-take.

2. “MSM for Arthritis.” Www.arthritis.org, www.arthritis.org/living-with-arthritis/treatments/natural/supplementsherbs/guide/msm.php.

3. Kubala, J, MS, RD. “8 Science-backed benefits of MSM supplements.” Www.healthline.com, https://www.healthline.com/nutrition/msm-supplements#section9

Scientific Name:Omega-3/Omega-6 Fatty Acids Common Names:“Essential Fatty Acids (EFAs)”

Omega-3 & Omega-6 Fatty Acids Hailey Stoker, Student Pharmacist Spring 2019

as well as the following:

Omega-3 Fatty Acids

Omega-6 Fatty Acids

α-Linolenic acid (ALA) Stearadonic acid (SDA) Eicosatetraienoic acid (ETA) Eicosapentaenoic acid (EPA) Docosapentaenoic acid (DPA) Docosahexaenoic acid (DHA)

Linoleic acid (LA) γ-Linolenic acid (GLA) Dihomo-γ-linolenic acid (DGLA) Arachidonic acid (AA) Docosapentaenoic acid (DPA)

Background/History: In the 1930s, omega fatty acids were known to help with the development of human growth, but it was not until more recently that these fatty acids were well understood. These chained fatty acids were discovered to be “essential” in 1929. This use of “essential” simply related to the help in growth and development, but as time has passed, the term “essential fatty acids” has come to have new meaning. These fatty acids cannot be made by the human body, and therefore must be derived by consuming specific foods, or

https://lpi.oregonstate.e du/mic/othernutrients/essential-fattyacids

dietary supplements. These foods are shown to the right.

Dosage Forms/ Serving Size: As stated before, these essential fatty acids can be found in several food groups, or in many different dietary supplements. Therefore, there are a wide variety of dosage forms. In supplements, 4 g of Omega-3 FAs are taken per day to reduce triglycerides.

Pharmacology:

Common Uses:

https://coopercom plete.com/blog/typ es-of-omega-3fatty-acids/

Some common uses of these EFAs are for coronary heart disease(CHD), diabetes mellitus (T2DM), inflammatory diseases, neuropsychiatric disorders, as well as Alzheimer’s and dementia. There has recently been some discussion of EFAs used to prevent cancer, but there is not significant research to make a definitive decision on this matter.

When referring to the omega-3 and -6 fatty acids, these two act very similarly. The general idea is that the anti-inflammatory responses are induced as these fatty acids decrease PGE2 and 4. Different fatty acids will do this in different ways, as they may competing for a specific receptor. Essentially, they work by blocking the body’s inflammatory response. Another mechanism of action is the esterification of other fatty acids, thereby reducing the ability of enzymes to make triglycerides.

https://www.tctmd.com/ news/no-cardiovascularbenefit-omega-3-fattyacid-supplements-metaanalysis

Effectiveness: CHD, T2DM, inflammatory disease, neuropsychiatric disorders, Alzheimer’s and dementia all have significant data to show that the use of these EFAs are effective at specific dosages. For cancer, however, there is not enough significant data to show that EFAs can or will prevent cancer. This is still undergoing studies.

Safety and Adverse Effects/Toxicities These EFAs are generally seen as safe. Some possible side effects that were seen included- loose stool or diarrhea, belching, heartburn, nausea and a fishy aftertaste. Some more threatening side effects include a potential for excess bleeding and the potential for a suppressed immune system.

Interactions The most well-known interaction of omega-3 and -6 fatty acids is with Warfarin. Warfarin is an anticoagulant, and as these fatty acids already have the potential for excess bleeding, the interaction can be fatal.

My Opinion: In my professional opinion, there is enough evidence available to show that omega-3 and -6 fatty acids are an essential part of everyone’s diets. Although it may not correct every problem that it is sometimes said to correct, these fatty acids play an essential role in the structure of cell membranes, as well as a source of energy. I also believe that there is enough information to conclude that these EFAs could be beneficial to those with CHD, T2DM, inflammatory diseases, neuropsychiatric disorders, Alzheimer’s and dementia. Essential Fatty Acids. Linus Pauling Institute. https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids. Published January 30, 2019. Accessed February 26, 2019. Holman RT. The Slow Discovery of the Importance of ω3 Essential Fatty Acids in Human Health. The Journal of Nutrition. 1998;128(2). doi:10.1093/jn/128.2.427s. Office of Dietary Supplements - Omega-3 Fatty Acids. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/. Accessed February 26, 2019. Omega-3 fatty acids. DrugBank. https://www.drugbank.ca/drugs/DB11133. Accessed February 26, 2019. Peppone LJ, Inglis JE, Mustian KM, et al. Efficacy of omega-3 (ω3) supplementation versus omega-6 (ω6) supplementation for reducing pain among breast cancer survivors: A URCC NCORP RCT. Journal of Clinical Oncology. 2018;36(15_suppl):10118-10118. doi:10.1200/jco.2018.36.15_suppl.10118.

Oscillococcinum Joseph Stoker Student Pharmacist Spring 2019 https://www.oscillo.com/

Scientific name(s): No scientific name Common Name(s): No other common names Active Ingredient: Anas Barbariae Hepatis et Cordis Extractum

Mechanism of Action: No known mechanism of action

Dosage form: Tablet Typical Serving: Dissolve entire contents of one

https://www.allaboutbirds.org/guide/Muscovy_Duck/overview

tube in mouth every 6 hours up to 3 times per day. Common Uses: Commonly used to treat cold and flu like symptoms Typical Use: Typically used to for symptoms of sickness, mainly of cold and flu

Background/History: The word Oscillococcinum was first used to describe the medicine created by Joseph Roy while on military duty during the Spanish flu epidemic. He observed many patients with viral diseases and noticed a commonality in the blood of each patient, a bacterium which he named Oscillococcus due to its oscillating motion he observed under the microscope. Roy believed that this bacterium was the culprit of various diseases ranging from eczema to cancer. Roy then began using the bacterium extracted from ducklings to attempt to vaccinate patients from various diseases but was unsuccessful. Today this product prepared using the liver and heart of the Muscovy duck.

Effectiveness: Generally, the effectiveness of this product must remain solely on placebo-like phenomenon, due to the lack of presence of scientific evidence and product quality. Interestingly enough, there is little to no active ingredient left in the final product due to substantial dilutions in the production of it. There is a moderate following on this product even still that says there are benefits to taking this supplement.

Safety concerns/Warnings: There are no known safety concerns or warnings associated with Oscillococcinum.

Adverse Effects and Toxicities: There are no adverse effects or toxicities associated with this alternative medicine, as the finished product mainly contains sucrose and lactose.

Interactions: Since this medicine is mostly just sugar, there are also know known interactions with any other medicine that is not meant to be taken with sucrose or lactose.

In my professional opinion, if one deems that this product helps their own personal cold and flu- like symptoms, then they should continue using this product as they seem benefits those or any other symptoms. I also believe there is lack of sufficient evidence and frankly an abundance of evidence to the contrary, that this product can and should relieve cold and flu-like symptoms. I believe that this product may, due to its moderately large following, offer some placebo-like effect that may or may not help the actual ailment, but could perhaps improve the perception of the ailment in the patientsâ&#x20AC;&#x2122; psyches, thus relieving symptoms by an indirect method. NHS Choices. https://www.nhs.uk/conditions/flu/. Accessed February 26, 2019. Ruoling Guo, Max H. Pittler, E Ernst (November 2007). "Complementary Medicine for Treating or Preventing Influenza or Influenza-like Illness". The American Journal of Medicine. Accessed February 26, 2019. Abgrall, Jean-Marie (2000). Healing Or Stealing: Medical Charlatans in the New Age. Algora. pp. 40â&#x20AC;&#x201C;41. ISBN 978-1-89294151-0. Accessed February 26, 2019 "The Curious "Science" of Oscillococcinum". Office for Science and Society, McGill University. 2012-12-20. Archived from the original on 2013-10-23. Accessed February 26, 2019. Dan McGraw. Flu Symptoms? Try Duck. U.S. News & World Report 2/9/97 page 2. Accessed February 26, 2019. Park, Robert L. (2002). Voodoo Science: The Road from Foolishness to Fraud (reprint ed.). Oxford University Press. p. 53. ISBN 978-0-19-860443-3. Accessed February 26, 2019. National Science Board (April 2002). "Chapter 7 - Science and Technology: Public Attitudes and Public Understanding". Arlington, Virginia: National Science Foundation Directorate for Social, Behavioral and Economic Sciences. Accessed February 26, 2019.

A N G E L A T H A R P : H K ST U D E N T , S P R I N G 2 0 19 Sci en t i f i c N am e: K al i u m , At om i c Sy m bol : K Com m on N am e: POTASSI UM

https://legionathletics.com/potassium-deficiency/

BACK GROUN D/ H I STORY: - Pot assiu m w as discover ed in 1807 by

PH ARM ACOLOGY/ ACTI ON : - Pot assiu m is a m ajor cat ion

Hu m ph r y Davy. Th e n am e is der ived

in side cells, w h ile sodiu m is a

f r om t h e En glish w or d

m ajor cat ion ou t side of t h e cells.

Pot ash .

Th e balan ce bet w een t h e t w o is

- Pot assiu m is t h e m ost

m ain t ain ed by ion pu m ps in t h e

abu n dan t in t r acellu lar cat ion an d is an essen t ial n u t r ien t ,

- Th e cell m em br an e pot en t ial

su pplem en t s. - Th e aver age h u m an con su m es u p t o 7 gr am s of pot assiu m a day, an d st or es abou t 140 gr am s in t h e body cells. - It is pr esen t in all body t issu es, an d h elps m ain t ain in t r acellu lar f lu id volu m e, an d t r an sm em br an e elect r on gr adien t s.

COM M ON / TYPI CAL USES: - In cr eased in t ake of pot assiu m is u sed

- 4,700 m g of pot assiu m is r ecom m en ded per day f or adu lt s. - It is est im at ed t h at 85-90% of pot assiu m is absor bed

cell m em br an e.

h t t ps:/ / w w w.m edicaln ew st oday.com / ar t icles/ 287212.ph p

f ou n d in m an y f oods or diet ar y

DOSAGE/ AVAI LABLE FORM S:

bet w een sodiu m an d pot assiu m gen er at e an act ion pot en t ial, w h ich also cr eat es an elect r ical

t h r ou gh t h e diet . - Exam ples of f oods h igh in pot assiu m (per ser vin g): - Apr icot s- 1,101 m g

ch ar ge. - Th e abilit y of cells t o pr odu ce t h is

- Len t ils- 731 m g

elect r ical ch ar ge is cr it ical f or

- Raisin s- 618 m g

body f u n ct ion s su ch as m u scle

- Or an ge ju ice(1 cu p) -496

con t r act ion , an d h ear t f u n ct ion . Pot assiu m is also an

essen t ial m in er al

- Ban an as- 422 m g

n eeded t o r egu lat e

- Pot assiu m OTC

t o con t r ol h yper t en sion an d pr even t

w at er balan ce, blood

st r oke.

Su pplem en t s: less

pr essu r e, an d levels

100 m g

- For bon e h ealt h - To pr even t k idn ey st on es

of acidit y.

- Blood glu cose con t r ol/ h elp con t r ol t ype 2 diabet es - Regu lat ion of h ypok alem ia

http://www.bloodpressureuk.org/microsites/salt/Home/Howtoeatmorepotassium/Fruit

https://guysandgoodhealth.com/2013/08/17/the-benefits-of-potassium/

EFFECTI VEN ESS:

https://www.swansonvitamins.com/blog/lindsey/benefits-of-potassium

TOX I C EFFECTS: - Pot assiu m t oxicit y ef f ect s ar e sh ow n in , ch ar act er ist ic, acu t e

- A diet h igh in pot assiu m h as been sh ow n t o h elp con t r ol

car diovascu lar ch an ges w it h ECG abn or m alit ies. -

gen er al m u scu lar w eak n ess an d ascen din g par alysis.

h igh blood pr essu r e, pr even t st r ok e, m ain t ain bon e h ealt h , con t r ol blood glu cose in t h ose w it h t ype 2 diabet es, h elp w it h h ear t an d k idn ey disor der s. It

I N TERACTI ON S: - M edicat ion s u sed t o t r eat h igh blood pr essu r e(ACE in h ibit or s, ARBs) in t er act w it h pot assiu m . Th ese m edicat ion s, in con ju n ct ion w it h pot assiu m su pplem en t s, can in cr ease pot assiu m levels in t h e blood. - Som e diu r et ics or ?w at er pills? can also in cr ease levels of pot assiu m in t h e body if t aken w it h a pot assiu m su pplem en t .

an d h as elect r olyt e f u n ct ion s. SAFETY: - It is n ot r ecom m en ded t o t ak e a pot assiu m su pplem en t u n less pr escr ibed by you r doct or f or

Gast r oin t est in al sym pt om s m an if est as n au sea, vom it in g, an d local m u cosal n ecr osis w h ich m ay lead t o per f or at ion

can also h elp en h an ce m et abolism , w at er balan ce,

Besides car diovascu lar ef f ect s, n eu r om u scu lar sym pt om s in t h e f or m of

PROFESSI ON AL OPI N I ON : I per son ally believe t h at u n less som eon e is pr escr ibed a pot assiu m su pplem en t by t h eir doct or f or specif ic m edical r eason s, t h ey sh ou ld n ot be t ak in g t h em . As st at ed in t h is m on ogr aph , pot assiu m is h igh in m an y f oods w e eat daily. If som eon e is low on pot assiu m t h ey can alw ays t ake a look at

h ypok alem ia, or an ot h er h ealt h t h eir diet an d add in m or e pot assiu m r ich f oods. r elat ed issu e. Th is is becau se so m an y f oods ar e h igh in pot assiu m , an d it is f air ly easy t o com e by. - Too m u ch pot assiu m in t h e

Bu t , in m y opin ion , t ak in g act u al pot assiu m diet ar y su pplem en t s is u n n ecessar y an d can be dan ger ou s w it h ou t m edical clear an ce. It is ext r em ely im por t an t t o in clu de t h e r ecom m en ded in t ake of pot assiu m in you r diet t h ou gh , becau se h ypok alem ia can lead t o

body can lead t o dan ger ou s side im balan ces in t h e body, an d is a m ajor h ealt h ef f ect s list ed below.

r isk . h t t ps:/ / w w w.h ear t .or g/ en / h ealt h y-livin g/ h ealt h y-eat in g/ eat -sm ar t / sodiu m / pot assiu m

ADVERSE EFFECTS: - Pot assiu m can be dan ger ou s if t ak en in h igh doses. Som e side

Ref er en ces Of f ice of Diet ar y Su pplem en t s - Pot assiu m . NIH Of f ice of Diet ar y Su pplem en t s. h t t ps:/ / ods.od.n ih .gov/ f act sh eet s/ Pot assiu m -Healt h Pr of ession al/ . Accessed Febr u ar y 25, 2019.

ef f ect s of t oo m u ch pot assiu m m ay be:

Poor olajal J, Zer aat i F, Solt an ian AR, Sh eik h V, Hoosh m an d E, M alek i A. Or al pot assiu m su pplem en t at ion f or m an agem en t of essen t ial h yper t en sion : A m et a-an alysis of r an dom ized con t r olled t r ials.

- m u scle w eak n ess or par alysis - ir r egu lar h ear t beat - Con f u sion - Car diac ar r h yt h m ias su ch as: sin u s br adycar dia, ven t r icu lar

Plos One. 2017;12(4). doi:10.1371/ jou r n al.pon e.0174967.

Pot assiu m cat ion . Dr u gBan k . h t t ps:/ / w w w.dr u gban k .ca/ dr u gs/ DB01345. Accessed Febr u ar y 25, 2019.

Pot assiu m . Nat ion al Cen t er f or Biot ech n ology In f or m at ion . Pu bCh em Com pou n d Dat abase. h t t ps:/ / pu bch em .n cbi.n lm .n ih .gov/ com pou n d/ pot assiu m #sect ion =Top. Accessed Febr u ar y 25, 2019.

t ach ycar dia, or ven t r icu lar f ibr illat ion .

Saxen a K. Clin ical Feat u r es an d M an agem en t of Poison in g Du e t o Pot assiu m Ch lor ide. Medical Toxicology and Adverse Drug Experience. 1989;4(6):429-443. doi:10.1007/ bf 03259924.

SPRING 2019 PHPR 489

PROBIOTICS & PREBIOTICS Lydia Trapp - Chemistry Student Common names: Probiotics and Prebiotics Common Probiotic Scientific Names: Lactobacillus and Bifidobacteria

MECHANISM

HISTORY & BACKGROUND Our bodies need certain kinds of bacteria for our immune system and digestion. Probiotics and prebiotics help to control this microbial environment. Probiotics are defined as living microorganisms that have beneficial properties while prebiotics are non-living substances that protect and cultivate the 1

bacteria in our bodies.

Elie Metchnikoff was the first to conceptually introduce probiotics and prebiotics to the medical field in the early 1900s. Metchnikoff believed that consuming certain microorganisms could be beneficial to human’s microbial balance.

Studies are still being conducted today to Bermudez-Brito M, Plaza-Díaz J, Muñoz-Quezada S, et. al. Probiotic mechanisms of action. Annals of Nutrition and Metabolism. 2012;61:160–174

COMMON USES

figure out which probiotics are most effective and results have varied between studies.

DOSAGE FORMS The dosage for probiotics varies depending on the strain of

Intestinal inflammation IBS/Crohn’s Antibiotic diarrhea Improve immune system Colitis/Clostridium difficile Minimizing allergies Oral health Lower cholesterol levels Lower pH to inhibit growth of harmful bacteria

probiotic used but is typically expressed in number of living organisms. For example, a typical dose could be 1 billion organisms in a pill. On the other hand, a healthy dose of prebiotic fiber would consist of 25-40 grams.

Both nutritional agents can be found in foods such as some 4

yogurts, cheeses, and kimchi. A healthy dose can be obtained by eating foods high in probiotics and prebiotics or it could be achieved using supplemental pills.

SAFETY

The safety of probiotics and prebiotics is still being studied because of the wide variety of probiotic

PROFESSIONAL OPINION

species. Since the strands have different properties the safety may differ between them, requiring much more time to research safety issues.

ADVERSE EFFECTS Probiotics have been known to cause mild digestive issues such as gas. However, if you are

Probiotics and prebiotics can

critically ill or have a weakened immune systems, probiotics could cause dangerous infections.

both be found naturally which is

why I would consider testing them as a form of alternative

INTERACTIONS There are no known interactions between probiotics or prebiotics with any medications.

medicine. I think enough research 6

has been done to prove that there is not much harm in adding good,

EFFECTIVENESS

living microorganisms to the body in order to increase gut health

There is evidence that some probiotics can help

and strengthen the immune

prevent diarrhea and irritable bowel syndrome symptoms. Research on which probiotics are helpful and how much of the probiotic is a sufficient dose is still being conducted. There is

system. I would recommend starting with low doses of one or the other to see if you personally

still so much that is unknown about the probiotic and prebiotic functionality in our

experience any adverse effects before using both in tandem.

bodies that declaring it as an effect form of alternative medicine would be a very premature claim.

REFERENCES 1. Tackett K. Buyer’s guide: Probiotic species and strains. Flourish by Pharmaca. 2016. 2. Abbasi J. Are probiotics money down the toilet? Or worse? JAMA: American Medical Association. 2019. 3. Bermudez-Brito M, Plaza-Díaz J, Muñoz-Quezada S, et. al. Probiotic mechanisms of action. Annals of Nutrition and Metabolism. 2012;61:160–174 4. Probiotics. WebMD. https://www.webmd.com/diet/probiotics#1-3. Accessed February 27, 2019. 5. What is the difference between probiotics and prebiotics? 2 Oceans Tarifa. 2016. http://www.2oceanstarifa.com/what-is-the-differencebetween-probiotics-and-prebiotics. Accessed February 27, 2019. 6. Probiotics: In depth. National Center for Complementary and Integrative Health. U.S. Department of Health and Human Services. 2018. nccih.nih.gov/health/probiotics/introduction.htm.

Common Name: Pycnogenol

Therese Gianne Trebajo

Scientific Name: Proanthocyanidin

Student Pharmacist Spring 2019

Background/History In the 1960s, Charles Haimoff discovered and developed Pycnogenol which comes from a water-soluble extract found in the bark of a French maritime pine tree. Pycnogenol began to be sold as a dietary supplement in Europe in the late 1960s.

Common Uses • • • •

Heart Vision Skin and Beauty Movement/Mobility

https://www.pycnogenol.com/fileadmin/images/Photos/ Pycnogenol_trees_H04.JPG

Dosage Form • • •

Capsule: taken orally Cream: applied topically Powder: applied topically https://nootriment.com/pycnogenol-50mg-supplements/

Typical Uses Asthma: Decrease symptoms associated with asthma Circulation Problems: Increase blood flow Athletic Performance: Increase production of nitric oxide Hypertension: Maintains normal vascular diameter Skin Care: helps skin replenish its elasticity

Pharmacology/Mechanism of Action Pycnogenol is a strong antioxidant that acts a free radical scavenger. In addition, it can improve blood flow, stimulate the immune system by increasing the number of immune cells generated, reduce inflammation throughout the body, and decrease the chance of infections.

Effectiveness

Adverse Effect and Toxicity

Overall pycnogenol has been shown to be safe to take. It has been shown that it is safe in adult patients for long term use and for short term use in pediatric patients.

Overall there are no major side effects associated with taking pycnogenol. Minor side effects can include mild upset stomach, dizziness, and headache, and mouth sores.

There are have been more than 420 scientific publication written to discuss the effectiveness of pycnogenol for different indication. Pycnogenol has been added to the Generally Recognized as Safe (GRAS) list and is considered Kosher. Pycnogenol has been awarded multiple times for its safety and the research behind the product.

No major toxicity presented.

Interactions Pycnogenol increase immunity so it might not be suggested for those with autoimmune diseases. Conditions include rheumatoid arthritis, multiple sclerosis, celiac disease, and lupus.

Professional Opinion Based on my research on this dietary supplement, I support the clinical use of pycnogenol. It has been proved to be an effect antioxidant which increases immune system function which can be used for multiple indications. There are multiple indications that pycnogenol can be used for and it has minimal side effects reported. The main concern is for patients taking immunosuppressive drugs because the supplement would cause the opposite effect. In addition, there has been an extensive amount of research conducted to back up its claim of effectiveness and safety. Furthermore, there has been no reports of severe effects or detrimental events associated with taking pycnogenol.

Reference Maritime Pine: Uses, Side Effects, Interactions, Dosage, and Warning. (n.d.). Retrieved from https://www.webmd.com/vitamins/ai/ingredientmono-1019/maritime-pine “Pycnogenol® French Maritime Pine Bark Extract, by Horphag Research.” Home, www.pycnogenol.com/home/?L=36. Wong, C., & Fogoros, R. N. (n.d.). The Possible Benefits of Pycnogenol. Retrieved from https://www.verywellhealth.com/pycnogenol-what-should-i-know-about-it-89069

Raspberry Ketones Scientific name: 4-Hydroxyphenyl-2-butanone (7) Common names: Frambione, Frambinone, Oxyphenylon, Rasketone, Rheosmin (9)

Megan Tuskey, Nursing, Spring 2019 http://www.spoonerberries.com/crops/raspberries/

Background/History Raspberry ketone is a substance found naturally in raspberries. It can also be found in other berries or fruits. This substance, either natural or artificially produced, is approved for use in manufacturing to create an artifiical raspberry scent or flavor. There has been some research of raspberry ketone use in rats to support fat loss and hair growth. Raspberry ketone is similar to capsaicin and synephrine, which are commonly used in weight loss supplements (6). Dr. Oz got his hands on raspberry ketones, and presented them on his show in 2012 as a “miracle fat burner” (10). After the show, the supplement exploded on the market as a fat loss supplement. Although it has gained popularity, it has not been studied clinically for use for fat loss in humans. So is raspberry ketone a miracle fat burner that it’s claimed to be?

Common Use

Typical Use This compound is originally approved for use in food products, cosmetics, fragrances, and flavoring agents. It gives these products an artificial raspberry scent or flavor.

Raspberry ketones have been studied and proven to fix hair loss in rats and humans (6). Raspberry ketones are now commonly found in weight loss or fat burner supplements. There are supplelments that use raspberry ketone in addition to other substances such as green tea, capsaicin, and garcinia cambodia, but it can also be marketed as a stand alone supplement.

Pharmacology A ketone is defined as an organic compound containing a carbonyl group bonded to two hydrocarbon groups (7). This ketone is found in raspberry fruits and can be classified as a stimulant. In studies on raspberry ketone in hair growth, it stimualtes insulin-like growth factors that increase hair growth (6). The makeup and function of raspberry ketone is found to be similar to capsaicin (found in chili peppers and commonly used for weight loss) and syneprhine (a metabolic stimulant) (8). The claim of raspberry ketone, as a stimulant, is that it effects the susceptibilty of fat cells to norepiphrine which is responsible for their breakdown . It is also thought to effect adiponectin, which is a hormone that regulates fatty acid breakdown and glucose levels (8). Raspberry ketone is a stimulant, like synephrine, which can increase the bodies metabolism which is responsible for the chemical processes in the body. Therefore, raspberry ketone acts to increase fat cell susceptiblity to breakdown, increase adiponectin, and stimulate metabolism. C10H1202

Dosage Forms 0.01% raspberry ketone can be used topically for effective hair growth in rats and humans (3). The oral dosage form for humans is undetermined. Can find supplements claiming anywhere from 100mg to 1000mg of raspbery ketone. There has been no studies deteremining effective and safe doses of oral raspberry ketone for humans.

https://www.am azon.com/100Pure-RaspberryKetones1000mg/dp/B01 D54RSNE

https://mypu ritylabs.com/ products/ras pberryketone-ultra

https://www.pl supplements.co m/PrivateLabelRaspberryKetone-Blendp/17030-60c.htm

https://innovuspha rma.com/beyondhuman-raspberryketone-weightloss-supplement60-capsules/

Effectiveness Raspberry ketone has been found to be effective in studies involving rats and isolated cells. Raspberry ketone has been found to increase expression and secretion of adiponectin, increase fatty acid oxidation, and decrease overall fat and energy intake (8). Raspberry ketone has not been properly tested in human subjects, and, additionally, has not been tested in the oral form. The results from the studies on rats and cells cannot be translated to humans without proper study for safety and effectiveness. Raspberry ketone is also commonly included with other supplements in products and research, so its individual effectiveness cannot be properly determined in humans (2). Safety / Toxic Effects The amount of raspberry ketone that is eaten with natural berries is a very small fraction of what is used in supplements. The chemical compound of rapsberry ketone is similar to synephrine, a stimulant, which is also similar to the compound ephedra (6). Ephedra is another stimulant that has been used for weight loss and increased performance. In 2004, the FDA banned the sale of ephedra due to the increased risk for heart problems and stroke (5). The NCAA has also banned the use of ephedra supplements due to health risks. With raspberry ketone being similar to ephedra and a lack of research on the safety of the supplement, it should be used with caution. This drug has not been tested enough to determine safety for those who are pregnant or nursing, or for those with other medical conditions. Consult your doctor before using this supplement. Adverse Effects

Interactions

As a stimulant, raspberry ketone may cause jitteriness, shakiness, pounding heart rate, increased heart rate, and increased blood pressure (5). Raspberry ketone can also be chemically produced, so it should be monitored for other adverse effects with use (4).

As a stimulant, this supplement should be used in caution with those with heart or blood pressure diseases. It should also be used with caution with those taking medications for heart disease, hypertension, dysrhythmias, diabetes, or using other supplements.

Professional Opinion Although raspberry ketone has been found effective in some research, this research is only in rats or individual cells. There is just not enough data for me to believe that it is truly effective and safe for human use as a weight loss supplement. Raspberry ketone needs to have a large dose or be chemically made to create an effect for weight loss, which can come with side effects and risks to health. The doses have not been determined to be safe, and the stimulant compound is similar to other dietarty supplements that can be dangerous or ineffective. While it can be used for hair growth or flavoring safely, I donâ&#x20AC;&#x2122;t believe it has enough proven benefit for weight loss. I think it would be much more effective and safe to focus on a balanced diet and exercise to promote weight loss. The supplement needs much more research and regulation before I can trust it for consumers.

References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Arent SM, Habowski SM, Hoftheins JE, Ferrando AA, Lopez HL, Weir JP, Ziegenfuss TN. Eight weeks of supplementation with a multi-ingredient weight loss product enhances body composition, reduces hip and waist girth, and increases energy levels in overweight men and women. Journal of the Internaitonl Society of Sport Medicine. 2013; 10(22). Abdel-Mottaleb Y, Attia RT, El-Abhar HS, El-Maraghy, NN. Raspberry ketone and garcinia cambogia rebalanced distrupted insulin resistance and leptin signalling in rats fed high fat fructose diet. Biomedicine & Pharmacology. 2019; 110: 500-509. Banh T, Belury MA, Bruno RS, Cole RM, Cotton BM, Diamond SA, Hsiao YH, Li J, Simons CT, Vodovotz Y. Raspberry ketone fails to reduce adiposity beyond decreasing food intake in C57 BL/6 mice fed a high-fat diet. Royal Society of Chemistry. 2017; 8: 1512-1518. Beekwilder J, Broekgaarden M, Hall RD, Mikkelson JD, Qvist I, Sibbeson O, van der Meer IM. Microbial production of raspberry ketone. Biotechnol Journal. 2007; 2(10): 12701279. Ephedra. National Center for Complimentary and Integrative Health. https://nccih.nih.gov/health/ephedra. September 2016. Accessed February 26, 2019. Harada N, Kurihara H, Nakagata N, Narimatsu N, Okajuma K. Effect of topical application of raspberry ketone on dermal prodcution of insulin-like growth factor-I in mice and on hair growth and skin elasticity in humans. Growth Hormone and IGF Research. 2008; 18: 335-344. National Center for Biotechnology Information. 4 (4-Hydroxyphenyl)- 2- butanone. PubChem. https://pubchem.ncbi.nlm.nih.gov/compound/4-_4-Hydroxyphenyl_-2butanone#section=Top. Accessed February 26, 2019. Park KS. Raspberry ketone increase both lipolysis and fatty acid oxidation in 3T3-L1 adipocytes. Planta Med. 2010; 76: 1654-1658. Raspberry Ketone. ChemSpider. http://www.chemspider.com/Chemical-Structure.20347.html. Accessed March 30, 2019. Raspberry Ketone. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-1262/raspberry-ketone. Accessed February 26, 2019.

ST. JOHN’S WORT HYPERICUM PERFORATUM L. WRITTEN BY CHRISTINA WILDER, STUDENT PHARMACIST, SPRING 2019

Image extracted from: https://www.shaloahskincare.co.uk

COMMON NAMES

COMMON USES

Amber touch-and-heal, Esbericum,

❖ Treatment of depression with fewer

Goatweed, Gol-raei, Hofariqoun, Hyperforat, Hyperiforce, John's wort, Kira,

and milder adverse reactions ❖ Reducing symptoms in menopause,

Klamath weed, LI 160, Millepertuis,

premenstrual syndrome, and seasonal

Neuroplant, Psychotonin, Rosin rose,

affective disorder

Sedariston

❖ As a diuretic, as well as for gastritis and insomnia

BACKGROUND St Johns Wort is a perennial plant native to

PHARMACOLOGY/MECHANISM

Europe but found in the United States and

OF ACTION AND DOSING

Canada. It typically grows in the dry ground of roadsides, meadows, and hedges, reaching a height of 0.3 to 0.61 meters. The plant is famous for its ovalshaped leaves and golden-yellow flowers that bloom from June to September.

HISTORY

St Johns Wort contains many active ingredients including hyperforin. Studies revealed St. Johns wort is capable of increasing immunity but can suppress immunity at high concentrations for antiinflammatory activity. Compounds found in St. Johns Wort have been shown to reduce nuclear factor kappa B, TNF-

St Johns Wort typically blooms on the

alpha, COX-2, p38, and other key factors

birthday of the biblical John the Baptist

in inflammatory signaling pathways.

and is named after him. The plant is said

Hypericin from the plant has unclear

to have ancient use for warding off evil

antiviral actions, and hyperforin has

spirits. It was primarily used as an herbal

unclear cytocidal activity against tumor

remedy for anti-inflammatory and healing

growth.

properties since the Middle Ages. It has

Dosage Forms: tea, tablets, capsules,

been approved since 1984 by the

liquid extracts, topical preparations

German Commission E for the treatment of anxiety, depression, and insomnia but fell

TYPICAL USE

into disuse for a time. A renewed interest

❖ 900mg of extract daily in 3 divided

in Western countries has led to use as a

doses for up to 12 weeks for

component of numerous preparations.

depression; used in clinical studies for a variety of indications with doses Background image extracted from: https://www.herbco.com/images/Category/large/c-195-st-johnswort.jpg

ranging from 300mg per day to 1,800 mg per day ❖ Topical hypericum cream containing hypericin 1% and 1.5% for skin conditions and wounds

EFFECTIVENESS St Johns wort extracts were more effective than placebo in treatment of mild to moderate depression in multiple clinical trials and demonstrated similar efficacy as other antidepressant agents. The plant was also shown to be effective against

INTERACTIONS ❖ Contraindicated with antineoplastics, anticoagulants, anti-infectives, antivirals, boceprevir, cobicistat, telaprevir, and voriconazole ❖ Drugs with a narrow therapeutic window should be monitored closely ❖ Can significantly lower medication effectiveness ❖ Possible interactions with many drug classes

cancer in vitro. Conflicting studies exist

PROFESSIONAL OPINION

about efficacy against ADHD, IBS,

Modest evidence supports the use of St.

infection, premenstrual syndrome, and

Johns wort for major depression disorder,

inflammation.

but due to conflicting and insufficient data I do not recommend using St. Johns wort

SAFETY Not well known, partially due to its status as an unregulated supplement. It is generally considered safe when used orally in appropriate doses. However, side effects can cause agitation, anxiety, burning or prickling sensations, dizziness, diarrhea, photosensitivity, insomnia, irritability, hypoglycemia, vivid dreams, and headaches. There isn't enough information about the

for treatment. I advise avoiding use during pregnancy and in lactation due to lack of data. Use caution if taking other medications and supplements as St Johns Wort can lower the effectiveness of these agents or cause other interactions. Tell your provider and pharmacist if using St Johns Wort. Facts & Comparisons® eAnswers. http://online.factsandcomparisons.com/StartPage.asp x?url=/index.aspx&qs=. Accessed February 20, 2019.

safety of using St. John's wort topically.

St. John's Wort. National Center for Complementary

ADVERSE EFFECTS AND TOXICITY

https://nccih.nih.gov/health/stjohnswort. Published

Avoid use in lactation and pregnancy due

Micromedex Products: St Johns Wort.

to lack of studies. Potential adverse reactions can include GI symptoms, confusion, induction of mania, effects on reproductive capabilities, and impaired glucose tolerance. No information on toxicology.

and Integrative Health. September 24, 2017. Accessed February 20, 2019. http://www.micromedexsolutions.com/home/dispatch. Accessed February 20, 2019. St. John's wort. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-stjohns-wort/art-20362212. Published October 13, 2017. Accessed February 20, 2019.

Hannah Vyain Pre-Pharmacy Student

Spring 2019

Scientific name: S-Adenosyl-L-Methionine Common names: SAM & AdoMet https://en.wikipedia.org/wiki/SAdenosyl_methionine#/media/File:S-

BACKGROUND & HISTORY

Adenosyl-L-methionin.svg

https://en.wikipedia.org/wiki/S-

S-adenosyl-L-methionine (SAMe)

Adenosyl_methionine#/media/File:Sadenosylmethionine.png

is a naturally occurring chemical in the human body. This chemical product was discovered in the

PHARMACOLOGY

1950â&#x20AC;&#x2122;s, and is made from

S-adenosyl-L-methionine is an intermediate in the metabolism of methionine. This intermediate metabolite plays an important role in the body through the donation of a methyl group in the transmethylation process. Its role in the transmethylation process aids the bodyâ&#x20AC;&#x2122;s cells with growth and repair as well as maintains the phospholipid bilayer. SAMe is also involved in the function of hormones and neurotransmitters that work to affect mood.

methionine, which is an amino acid that can be taken in through our diet. SAMe is important for regulating many important cellular functions in our body. Researchers chose to look further into it because they found that abnormal levels of

COMMON USES

SAMe occurred in patients with

SAMe is most commonly used for the treatment of depression, osteoarthritis, and liver

liver disease and depression.

diseases such as cholestasis. This supplement is usually taken orally but can be taken http://www.uniquet

intravenously and intramuscularly. SAMe is commonly used to help with osteoarthritis

raininggroup.com/s

pain, as patients say that it works similarly to NSAIDs but with fewer side effects. This

am-e-for-

supplement is beneficial for patients with low serotonin levels, as well as patients

depression-s-

whose bodies do not produce adequate amounts of S-adenosyl-L-methionine.

adenosylmethionine -same/

DOSAGE FORMS Depression

Osteoarthritis

Liver Disease

Fibromyalgia

(alcohol related)

Oral tablet:

400-1600mg

200mg 3 times

800mg daily

daily

IV: 200-2000mg daily for 15-30

adenosylmethionine

IV/IM:

IV: 400mg daily

days

-pure-

200-400mg daily

https://pureprescrip

Oral tablet: 1200-1600mg daily

IM: 200mg daily for 30 days

tions.com/product/s ame-s-

encapsulations/

EFFECTIVENESS Although SAMe may prove to be effective for some patients, the data regarding this supplement overall is inconclusive. Researchers have studied the effectiveness of SAMe, but the studies have all been done for too short of a time or have had contradictory results. Studies have shown that SAMe can be effective in the treatment of depression and osteoarthritis, but once again, there have not been any conclusive findings. SAMe is also like https://nccih.nih.gov/health/supplements/SAMe

any other supplement where it may help one patient but not another.

https://www.brainmdhealth.com/blog/3-ways-

DRUG INTERACTIONS

same-can-help/

It is possible that SAMe may cause a decrease in the effectiveness of the drug Levodopa, which is used in the treatment of Parkinson’s patients. SAMe may also cause an adverse reaction in patients who take other supplements or drugs such as antidepressants, St. John’s Wort, and Ltryptophan because these treatments cause an increase in the body’s serotonin levels. Since SAMe also raises serotonin levels, taking it with any of these medications can cause the serotonin levels to become too high, leading to many unwanted side effects.

SAFETY & TOXICITY

ADVERSE EFFECTS

Since SAMe is a naturally occur product in the body, the safety and toxicity

SAMe has been shown to be overall a safe

concerns are small. Studies have shown that SAMe is safe, even when taken in

product. The side effects associate with this

large doses. The main concern with this product is that it may promote the

supplement are vomiting, diarrhea,

growth of Pneumocystis carinii in immunocompromised patients.

constipation, headache, nausea, anxiety, dry

https://sane scohealth.co

mouth, insomnia, sweating, dizziness, and

m/same-

anorexia. Patients with bipolar disorder

ingredient-

should not use SAMe because it may cause

overview/#b ookmark/0/

their depressive state to switch to mania.

In my professional opinion, I believe that SAMe is generally safe to use, but I would take precautions if you are pregnant or immunocompromised in any way. SAMe can be a good option for patients, but I would first try other options that https://taspens.com/products /sam-e-liquid

have more supporting evidence. – H. Vyain

References “Same Effectiveness, Safety, and Drug Interactions on RxList.” RxList, RxList Inc., 2019, www.rxlist.com/same/supplements.htm. “S-Adenosyl-L-Methionine (SAMe): In Depth.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, 24 Sept. 2017, nccih.nih.gov/health/supplements/SAMe. “Ademetionine.” DrugBank, 2 Jan. 2019, www.drugbank.ca/drugs/DB00118. “Same (Herbs/Suppl).” Medscape Drugs & Diseases, WebMD LLC., 30 Dec. 2016, reference.medscape.com/drug/ademetionineadenosylmethionine-same-344548.

Saw Palmetto Daniel Wade Student Pharmacist Spring 2019

Scientific Names: Serenoa repens, Serenoa serrulata, Sabal serrulata Common Names: Saw palmetto. American dwarf palm tree, cabbage palm

Common Uses The berries of saw palmetto are often used to treat urinary symptoms of benign prostatic hyperplasia (BPH). It has also been used to treat bladder disorders, hair loss, decreased sex drives, hormone imbalances, chronic pain of the pelvis, and prostate cancer.

Available Dosage Forms and Dosing There are many different forms of saw palmetto available. The ripe fruit can be ground, dried, or eaten as whole berries. When used in this way, usual dosing is 1-2 grams per day. Saw palmetto can also be processed and is available as a liquid extract, tablet, capsule, and an infusion for tea. The typical dosing for these forms when used for BPH is 320 mg/day.

Pharmacology The way that saw palmetto suppresses the symptoms of BPH is poorly understood, but there are several hypotheses. One hypothesis is that saw palmetto has antiandrogenic and anti-inflammatory properties. Another hypothesis is that saw palmetto inhibits growth factors and adipocyte differentiation which causes antiproliferative and proapoptotic actions.

https://ucantribe.com/product/saw-palmetto-berry/

History Saw palmetto berries were used as food by native tribes of Florida, but there is no documentation that they were used for medical remedies. 1870s Saw palmetto is first introduced to Western medicine as a treatment for prostate conditions and other urologic conditions. 1906/1916 Saw palmetto berries are officially included in the US Pharmacopeia. 1926-1950 Saw Palmetto berries are included in the National Formulary. Today Saw palmetto is one of the top ten herbal products in the United States.

https://www.herbco.com/p-744-saw-palmetto-berry-whole.aspx

Effectiveness

Adverse Effects

Different clinical trials have shown that saw palmetto is no more effective than a placebo in relieving urinary tract symptoms caused by an enlarged prostate. Currently, the use of saw palmetto for any condition is not supported by science.

Based off of clinical trials, saw palmetto may cause slight stomach discomfort and headaches.

Safety Interactions Saw palmetto may increase anticoagulant properties of Warfarin and may also increase adverse and toxic side effects of estrogen derivatives. In both cases patients should be monitored carefully.

Toxic Effects: Information about toxic effects is very limited. One clinical trial proved there to be no toxicity when patients were given three times the usual dosage for 18 months.

Children under 12 should not use saw palmetto due to possible effects on androgen and estrogen metabolism.

My Professional Opinion I think that as long as patients are not taking anything that will interact with saw palmetto, it may be a good option for some patients with BPH. While studies show that saw palmetto is no more effective than a placebo, the patient could still get some benefits from taking this drug, since even a placebo shows some effect in patients. -Daniel Wade

References: National Center for Complementary and Alternative Medicine (U.S.), eds. Saw Palmetto. Edition updated Apr. 2012. Bethesda, MD: U.S. Dept. of Health and Human Services, National Instituties of Health, National Center for Complementary and Alternative Medicine

Another SawHeadline Palmetto. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/palmetto/ataglance.htm. Published December 1, 2016. Accessed February 20, 2019. Here Saw Palmetto. Natural Products Database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed February 18, 2019.

Sierra Weaver, Student Pharmacist Spring 2019

WHAT IT IS & HOW IT WORKS:

•

Selenium was discovered to be an essential trace element in 1957. It is known for its antioxidant properties, as it is a cofactor to many enzymes and metabolic pathways. Examples of these enzymes are the glutathione peroxidase (GPX) and thioredoxin reductase (TR), which reduce molecules to provide antioxidant properties. It is also involved in cell-signaling processes and thyroid hormone metabolism. 3

•

Selenite

WHAT IT AFFECTS:

•

Selenate

Selenium, AKA:

•

Selenomethionine

•

Selenocysteine2

Periodic Table Selenium Tile Coaster on CafePress.com. CafePress. https:// www.cafepress.com/. Accessed February 18, 2019.

It is believed that low selenium levels correlates with an increased risk of cardiovascular disease. Low levels are characterized by muscle inflammation, white fingernail beds, psuedoalbinism, clubbing and inflammation of fingers (osteoarthropathy). Selenium has been observed to be correlated with lower rates of carcinogenesis, endemic goiter, sudden infant death syndrome, multiple sclerosis, and schizophrenia.3

WHERE IT COMES FROM: Selenium is mostly consumed through diet, absorbed as L-(+) selenomethionine. Studies have shown that supplementing with selenomethionine raises tissue selenium levels more so than does the selenite and selenocysteine forms available.3 Selenium Rich Foods. Medindia. https:// www.medindia.net. Published June 13, 2018. Accessed February 18, 2019.

AVAILABLE DOSAGE FORMS: • •

Capsule Tablet

SELENIUM-RICH FOODS: •

Brazil nuts & other nuts

•

Eggs

TYPICAL DOSING

•

Tuna & other fish

(FOR VARIOUS COMMON USES):

•

Steak & other meats

•

Whole grains1

Recommended Dietary Allowance (RDA): 70 (mcg)/day for males & 55 mcg/day for females

•

Asthma: 100 mcg/day

•

Cancer Prevention: 200 mcg/day

•

Acute Skin Infection: 300-1000 milligrams/day as sodium selenite

•

HIV: 80 mcg/day

•

Male Infertility: 100 mcg/day

•

Myocardial Infarction/Cardiovascular: 100 mcg/day

•

Rheumatoid Arthritis: 200 mcg/day2 Office of Dietary Supplements - Selenium. NIH Office of Dietary Supplements. https:// ods.od.nih.gov. Accessed February 18, 2019.

EFFECTIVENESS: •

Inconclusive evidence of effectiveness for: asthma, tumor treatment, cancer prevention, burns, skin infection treatment and prevention, male infertility, miscarriage, heart attack prevention, and rheumatoid arthritis

•

Ineffective in: cognitive function improvement and cutaneous systemic sclerosis

•

TOXICITIES:

SAFETY: Safe in most cases, be aware of: •

Safe to breastfeed while on Selenium supplements

•

Hypothyroidism with iodine deficiency can be worsened by selenium supplementation if not in conjunction with iodine supplementation

•

Over-supplementation can cause vomiting and diarrhea, which can present to be a health danger if chronically occurring2

Possibly Effective in: radiationassociated lymphedema, thyroiditis, and selenium deficiency2

•

Occurs when taking 1000 micrograms daily for 2 years

•

Toxicity symptoms include nausea, abdominal pain, diarrhea, garlic-odored breath, change in appearance of hair and nails, peripheral neuropathy, fatigue, and irritability2 INTERACTIONS:

•

No reported food or drug Interactions2

ADVERSE EFFECTS:

Prescription Drugs – Proceed with Caution. Professional Supplement Center. http:// blog.professionalsupplementcenter.com . Accessed February 19, 2019.

•

fatigue

•

irritability

•

nausea, vomiting

•

abdominal pain and cramps

•

Diarrhea

•

garlicky breath

•

nail and hair changes2

Hess-Fischl A. Dietary Supplements for Back Pain. SpineUniverse. https:// www.spineuniverse.com.

DOES IT WORK? MY PROFESSIONAL OPINION: REFERENCES: 1

Selenium. Energy | NZ Nutrition Foundation. https:// nutritionfoundation.org.nz/nutrition-facts/minerals/selenium.

Accessed February 18, 2019.

Selenium. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed August 24, 2016.

Thorne Research. Selenium. SemanticScholar.org.

https://

Selenium supplements are a good idea for somebody presenting signs of selenium deficiency (these signs are listed under “What It Affects”). All other suggested indications have very little to no empirical data supporting the effectiveness of selenium supplementation, with the exceptions of lymphedema and thyroiditis. In situations other than those just mentioned, I would not recommend selenium supplementation in conjunction with normal dietary intake of the element.

-Sierra Weaver, Student Pharmacist

pdfs.semanticscholar.org/25e1/27ef648ef3751b87d3c0672d246e98a

f05dc.pdf. Published 2003.

Spring 2019

Stevia DRUG MONOGRAPH Halley Willson Student Pharmacist Spring 2019

History Stevia, or Stevia rebaudiana, has been in use since before the 16th century. It is native to Paraguay and was used by the indigenous people to sweeten medicines and foods. This sweetener is made from dried stevia leaves, and today stevia is grown and harvested in many countries.

Common Uses Stevia is most commonly used as a sugar substitute, but also has uses as an antioxidant, antidiabetic, antimicrobrial, and antihypertensive agent.

Common Names Stevia is also called Candyleaf, Honeyleaf, Sweetherb, Sweetleaf, and Truvia.

Dosage Forms Stevia is dosed as either a ground powder or in capsules. Stevia is dosed according to taste, or to a maximum of 8 mg per kg.

The stevia plant has been used traditionally for more than 200 years.

Image from: https://www.google.com/search?q=stevia&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjgxc68j9fgAh UMCawKHWf7C9EQ_AUIDygC&biw=1366&bih=625#imgrc=caVG-9Q4kHRyEM:

MECHANISM OF ACTION Stevia works through its glycosides. Glycosides are molecules that contain glucose residues bound to other non-sugar substances called aglycones. The taste receptors on the tongue react to these glycosides and perseve a sweet taste. Stevia has glycosides found in its leaves that interact with both the taste receptors and a protein channel called TRPM5. The channel potentiates the signal from the sweet receptors, amplifying the taste of other sweet tastes. Different steviol glycosides have different levels of sweetness, with the two most prominent being stevioside and rebaudioside.

Stevia rebaudiana

Image from: https://www.google.com/search?q=stevia&source=lnms&tbm=isch&sa=X&ved=0ahUKEwj t9qrZxtfgAhXJpYMKHVWvBscQ_AUIDygC&biw=1366&bih=625#imgrc=sa4EF354DdfHFM:

EFFECTIVENESS AND SAFETY Stevia has been found to be approximately 200-300 times sweeter than sugar, making it an effective sweetener. However, no research has been done to confirm the use of stevia for conditions such as diabetes or weight management. However, stevia products are considered safe by the FDA, even for those who are pregnant. Whole-leaf stevia is not approved for commercial use, but may still be grown for home use.

ADVERSE EFFECTS, INTERACTIONS, AND TOXICITY There are no major contraindications, warning, or adverse reactions documented concerning stevia. It is a possibility that hypersensitive or allergic reactions may result with products belonging to the Asteraceae family. Furthermore, no toxic effects of stevia have been reported. Steviol glycosides have been assigned GRAS status by the FDA; however, stevia leaf and crude stevia extracts are not considered GRAS and are not FDA-approved for use in food. Stevia has no known adverse interactions with drugs or foods.

PROFESSIONAL OPINION In my professional opinion, FDA-approved stevia is a good choice for a calorie-free, natural alternative to sugar. I would caution using stevia for other purposes, given that there is no scientific research to support any true effectiveness of stevia as an antioxidant, antidiabetic, antimicrobrial, or antihypertensive agent.

REFERENCES Everything You Need to Know About Stevia. Healthline.com. https://www.healthline.com/health/food-nutrition/stevia-side-effects. Accessed February 26, 2019. History of Stevia. Steviabenefits.org. https://steviabenefits.org/history/. Accessed February 26, 2019. Stevia. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed February 26, 2019.

T E A

T R E E O I L

M E L A L E U C A

BACKGROUND Tea tree oil, or melaleuca oil is derived from the leaves of a tea tree. The tea tree is native to Australia, and tea tree oil has been used as a traditional medicine by the native people of Australia. COMMON USES Common usages include treatment for acne, infections, funguses. It is also used as an antiseptic, cleansing, and a cleaning agent. PHARMACOLOGY Tea tree oil exhibits anti-bacterial, anti-fungal, and anti-viral activities, by disrupting the structural and functional integrity of a bacterias membrane. DOSAGE FORMS Tea tree oil is available in both undiluted (neat) or diluted forms. TYPICAL DOSING For many fungal treatments, a light coat of diluted oil (25-50%) is common. For acne, a dilution of 5% is typical.

A L T E R N I F O L I A

https://www.theplantguru.com/tea-tree-melaleuca-essential-oil.html

https://www.publicgoods.com/products/tea-tree-oil-1oz

https://www.healthline.com/nutrition/tea-tree-oil

TRISTON YODER COMMUNICATION & COMPUTER SCIENCE STUDENT

S P R I N G 2 0 1 9

https://shop.aromatichealthcare.com/product/tea-tree/

T E A

T R E E

O I L

EFFECTIVENESS Tea tree oil has been shown to have mild to moderate effects on acne, cure fungus infections of the nails, and relieve symptoms of athlete's foot. Many other uses have been suggested, but few have been verified with research. SAFETY Tea tree oil is toxic when swallowed, and some people may have reactions to it when applied to the skin. ADVERSE EFFECTS Most people suffer no side effects when using tea tree oil, however it can cause irritation, rash, stinging, burning, scaling, redness, and dryness on the skin of some people. TOXICITIES Tea tree oil is toxic when swallowed. Poison control should be contacted immediately if ingested. INTERACTIONS There are no known drug interactions. PROFESSIONAL OPINION In my opinion, tea tree oil can be a helpful tool to use as an antifungal, or acne treatment. Starting with a more diluted form and increasing to a dosage recommended by a primary care physician would be wise for someone not yet exposed to tea tree oil, to ensure they are not allergic to the oil. -T. Yoder

https://bombashearley.com/products/tea-tree-essential-oil

https://naturallydaily.com/tea-tree-oil-for-scabies/

https://naturallivingfamily.com/tea-tree-oil-uses/

Works Cited Lis-Balchin M, Hart SL, Deans SG. Pharmacological and antimicrobial studies on different tea-tree oils (Melaleuca alternifolia, Leptospermum scoparium or Manuka and Kunzea ericoides or Kanuka), originating in Australia and New Zealand. Phytotherapy Research. 2000;14(8):623-629. doi:10.1002/1099-1573(200012)14:8<623::aid-ptr763>3.0.co;2-z Tea tree oil. DrugBank. https://www.drugbank.ca/drugs/DB11218. Accessed February 20, 2019. Tea Tree Oil. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/tea/treeoil.htm. Published December 1, 2016. Accessed February 17, 2019. Tea tree oil. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-tea-tree-oil/art-2036 4246. Published October 24, 2017. Accessed February 20, 2019.

Tarryn Zorola Finance, Management, Economics Student â&#x20AC;&#x201C; Spring 2019

YOU CAN CALL ME

WHERE I COME FROM

Scientific Name: Curcuma longa, Curcuma aromatica, Curcuma domestica

Turmeric is grown throughout India, parts of Asia and Central America. It is used in many ways such as in food, cosmetics and medicine or as a coloring agent. It is known for its warm and bitter taste and yellow color.

Common Names: Curcuma, Curcumin, Haldi, Indian Saffron, Turmeric, Turmeric Root

I can be used to treat respiratory conditions such as asthma, or in other ways such as to treat liver disorders or diabetic wounds. In India it is valued for healing properties of all sorts and in China it is used for abdominal pain. It is also common in Hindu medicine for its anti-inflammatory properties.

TURMERIC

Image Source: Google Images

PHARMACOLOGY

I CAN BE USED FOR

DOSAGE

The most important active polyphenolic ingredient in Turmeric is curcumin as it reduces histamine levels by increasing the production of natural cortisone by adrenal glands resulting in the suppression of acute and chronic inflammation.

Turmeric is used for many reasons such as pain relief (osteoarthritis), antiinflammatory (arthritis), and growth-suppressant (cancer). It can also be dried out into a power and made into a paste to treat some skin conditions.

A safe dosage of turmeric depends on the method for which it is being ingested. In capsule form the correct dosage would be 1-3 500mg capsules per day. If used in a tea the dosage changes to 4.59g/day and if the root is used in powdered form the correct dosage is 0.5-3g per day.

Turmeric is taken orally in capsule form as it cannot be given intravenously as it is hydrophobic and if given intraperitoneally, it disappears rapidly from tissues.

SAFETY

ADVERSE REACTIONS

INTERACTIONS

OPINION

Turmeric should not be used while pregnant or during excessive menstruation. It has been known to have anti-fertility effects (60%-100% reduction in offspring in rats) and it should not be used in the case of gallstones.

There have only been a few adverse reactions associated with turmeric. It has been known to cause GI-related symptoms when taken at high doses, 2 cases have been reported showing use of turmeric resulted in allergic contact dermatitis, and 1 case has resulted in anaphylaxis.

Turmeric has been found to add to the effect of anticoagulants (increase risk of bleeding), antiplatelet agents, and low molecular weight heparins.

Overall, I think turmeric has a greatly beneficial effect in the realms of antiinflammatory and antibacterial treatments. However, I am more doubtful about other claims for the uses of turmeric as there has been little study and only test results for rats. Fertility impacts also deter me from the use of turmeric.

Image Source: Google Images SOURCES: Turmeric. Natural Products Database. Lexicomp. Wolters Kluwer Health Inc. Riverwoods, IL. Available athttp://online.lexi.com. Accessed February 25, 2019. Turmeric. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/turmeric/ataglance.htm. Published November 27, 2018. Accessed February 25, 2019. Turmeric. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed February 25, 2019.

Information Technology Solutions

Ubiquinone (Coenzyme Q10 / CoQ10) Nicholas Sethman, Student Pharmacist â&#x20AC;&#x201C; Spring 2019

Routes of Administration

First discovered in 1957 by Fredrick

While Ubiquinone is sold on

University of Wisconsin-Madison

shelves as either a capsule

Enzyme Institute.

L. Crane and his colleagues at the

or gelcap to be taken orally, Chemical structure found by Karl

it can be found in special

Folkers in 1958.

areas as a topical solution. In clinical settings it can be

Was studied heavily in the 80s

uses intravenously.

where Lars Ernster studied its use as a free-radical scavenger antioxidant.

https://images-na.ssl-images-amazon.com/images/I/71IddG8eaLL.jpg

Uses/Dosing: Ubiquinone is used primarily by people to improve heart function and/or treat heart failure. It has also been used as a prophylactic agent against migraines and nueropathy due to diabetes. Adults normally take 150-600mg daily in divided doses chest pains, a max of 150mg daily for heart failure or migraine prevention and 800-1200mg per day for use against Parkinsonâ&#x20AC;&#x2122;s Disease.

http://www.ims2000.org/imscoq10/17510/coq10-untuk-sperma/

Mechanism of Action: CoQ10 acts as an antioxidant with vitamins C and E to help prevent freeradical damage to our cells. It also is used to help turn the energy we gain from eating carbohydrates into ATP, the energy source our cells can use to function in our body.

Effectiveness

Opinion Column Due to ubiquinone being primarily harmless to the body in small doses (a http://www.physiquebodyshop.com/wp-content/uploads/2013/04/structure-of-CoQ10.jpg

maximum of 200mg in most adults), I do not think it is a product to stay away from.

Most evidence surrounding ubiquinone is contradictory. It has not been shown to directly treat cancer but may reduce the risks of heart damage caused by a type of chemotherapy drug. No studies have given results that show CoQ10 being a valid agent in preventing heart disease but there is mild eveidence that it may reduce the risk of some complications of having a heart surgery. Overall, there is just too little evidence for a legimate conclusion to be drawn at this time.

However, if it would cause an adverse reaction with a prescription medication a patient is already on, I would advise against it.

Safety/Adverse Effects

Re ferences Ubiquinone. Micromedex Solutions. Truven Health

Do not take if you have a hypersensitivity to Coenzyme Q10 or have deiabetes mellitus. Beyond this, there are no known toxic effects.

Drug Interactions Anticoagulants, such as Coumadin or Jantoven

Can cause diarrhea, heartburn, nausea, appetite suppression, headache, irritability and/or a mild skin rash.

Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed February 20, 2019.

Ubiquinone. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed February 20, 2019.

Be sure to consult a doctor before beginning this supplementation as there are medications you could be on that interact with CoQ10.

Bentinger, M., Tekle, M. and Dallner, G. (2019). Coenzyme Q â&#x20AC;&#x201C; Biosynthesis and functions.

Valerian Valeriana officinalis L.

A natural remedy for insomnia and anxiety Deb Hughes Biological Engineering Student Spring 2019

Common names Garden valerian, garden heliotrope, setwall, Phu, and all-heal are common names. Valerian is derived from the Latin word valere meaning strong and healthy.

Background/History Valerian roots were used as sedatives, treating insomnia, anxiety, hyperactivity, muscle relaxer, etc. in ancient Greece and Rome. It has been compared to Valium in terms of sedative strength without the feeling of grogginess. In World War I and II, it was prescribed to soldiers with PTSD and other nervous disorders from fighting in the wars. Valerian (herb). (2019, February 17). Retrieved from https://en.wikipedia.org/wiki/Valerian_(herb)

Common Uses

Valerian is sold as a dietary supplement to fight insomnia or is the primary ingredient in sedatives or sleep aids. Its roots, called rhizomes, and underground stems are dried and prepared in teas or tinctures or keys parts are extracted and put into tablets for oral digestion.

Mechanism of Action The mechanism of action for Valerian have not been discovered or proven.

Dosage Forms Valerian comes in pill capsules, powder, and liquid form.

Typical Dosage According to Healthline.com, the recommended dosage of valerian to sooth insomnia symptoms is 300 to 600 mg of the root 30 to 120 minutes before bedtime. It is best effective when taken for two weeks consecutively. Do not take it for more than a month without talking to a doctor about the potential side effects.

Effectiveness The National Institute of Health randomly reviewed nine studies for bias or poor study design. All had flaws but three were noteworthy. The studies tested Valerian against an OTC option. The valerian extract showed statistically significant improvement in time required to fall asleep, sleep quality, and number of nighttime awakenings than the placebo; whereas the OTC solution did not yield statistically significant results, making Valerian effective in its claims.

Fun Fact: Valerian roots were used by exterminators to bait rats because rats are attracted to their pungent odor!

Adverse Side Effects

Known side effects include dizziness, headache, stomach problems or sleeplessness. It may not be if you’re pregnant or breast-feeding or a child under three years old. Do drive or operate machinery after taking valerian.

Toxicities None.

Interactions Valerian may act as an enhancer for other sleep aids. It also increases sedative side effect of depressants, like alcohol, benzodiazepines, and narcotics. Valerian may interact with St. John’s Wort and other dietary supplements.

Professional Opinion In my opinion, Valerian root is not well-researched enough to warrant using it as an aid toward sleeping. The mechanism of action is not known and experiments testing efficacy have not been well-built, tested, or replicated. Results have not been statistically significant or replicated. ~ D. Hughes

References Al Majed, A. A., Al Yahya, A. A., Al Bekairi, A. M., Al Shabanah, O. A., and Qureshi, S. Studies on the cytological and biochemical effects of valerian in somatic and germ cells of Swiss albino mice. Food https://www.walmart.com/ip/SpringChem Toxicol 2006;44(11):1830-1837. Valley-Valerian-Root-Capsules-500Fereidoon Shahidi and Marian Naczk, Phenolics in food and nutraceuticals mg-100-Ct/654159730 (Boca Raton, Florida, USA: CRC Press, 2004), pp. 313–314 Archived 2013-06-24 at the Wayback Machine ISBN 1-58716-138-9. Learn About Valerian Plant History. (n.d.). Retrieved from https://blog.gardeningknowhow.com/tbt/valerian-planthistory/ Office of Dietary Supplements - Valerian. (n.d.). Retrieved from https://ods.od.nih.gov/factsheets/ValerianHealthProfessional/

Xocai Chocolate: Healthy or Hoax? Adrianna Strode | Pharmaceutical Sciences Student | Spring 2019 What is Xocai Chocolate? Scientific Name: Common names: Dependent on seller  Well-beyond: beyond healthy chocolate  Healthy Chocolates: Naked nature and CHOCOWelness products

file:///C:/Users/Adrianna/SkyDrive/Spring%202019/CAM/xnuggetsheet.pdf

Where does it come from? The history of Xocai Chocolate begins with the history of regular chocolate. Originally a bitter drink consumed daily by the Olmecs in southern Mexico, chocolate became more specific to the upper class and important ceremonies by the Mayans and Aztecs. There are several theories on how it got to Spain, but once there it quickly spread to the rest of Europe and eventually the American colonies. With this chocolate became sweeter and different formulations created a powder and milk chocolate. Dark chocolate today resembles the bitter drink used by ancient civilizations. Known for its health benefits, dark chocolate consumption has increased, creating a market for companies who promise an increased health benefit.

https://www.healthychocolates.com/buy/

What does it do? How it works: flavanols (powerful antioxidant and anti-inflammatory compound) neutralizes free radicals Effects Seen in the Body (according to Well-beyond)           

Minimize inflammation throughout the body Slow free radicals Protect the heart and blood vessels Support the immune system Promote antibacterial/antiviral activity in the body Relax and dilate blood vessels Modify blood sugar levels Protect the brain Preserve cellular integrity Protect and repair the liver Positively modify hormone activity

How does it differ from regular chocolate?

Dosing:

Normal Chocolate Manufacturing

Beyond healthy chocolate: chocolate squares; serving size 1 piece every 3-4 hours

1. Alkalizing (also called "dutching") neutralizes its antioxidants 2. Heating further destroys its antioxidants and other vital nutrients 3. Addition of waxes, milk solids, hydrogenated oils and sugar further degrade the antioxidant firepower of cacao Well-beyond Manufacturing 1. Proprietary cold-processing preserves antioxidants and other crucial nutrients

• Sold in 60 and 120 piece/servings (month supply for one person) • Different varieties with ingredients to target an area of wellness (Xolove bites—sexual performance, XoBiotics—promote gut biome health)

2. Does not alkalize its chocolate 3. Uses only natural cacao butter, sweeteners and other natural ingredients

No information was found on safety or interactions about Xocai.

4. Contains no artificial ingredients 5. Category creator and leader of healthy chocolate industry

Is it effective? ORAC6 testing—measures neutralization of free radicals

What are the adverse reactions? Beyond chocolate squares contain soy and are manufactured with machines that process milk, peanu t, and tree nut products. Avoid if you are allergic.

Professional Opinion Xocai chocolate is essentially dark chocolate with other ingredients to enhance its antioxidant properties. Because of this, I do not see any risks in taking it as long as patients consult with their healthcare provider beforehand. ~ A. Strode

https://nccih.nih.gov/health/yohimbe

Extract, tablet, and capsule

Dosage Forms

Yohimbe is a compound in the bark of an evergreen tree that contains the active ingredient yohimbine. This tree originates in Western Africa where they would make tea from the bark to increase sexual desire.

Background/History

yohimbe, johimbe

Common names

Karlee Busscher Student Pharmacist Spring 2019

Pausinystalia Johim be

Yohimbine hydrochloride is a standardized form and is used for erectile dysfunction in the US, but a prescription is needed for this.

Typical Use

Yohimbe is often used as a dietary supplement for athletic performance, weight loss, chest pain, high blood pressure, diabetic neuropathy, impotence, and even more.

Common uses

https://www.bulksupplements.com/blog/herba l/what-is-yohimbe-bark/

https://www.botanicchoice.com/liqu id-extracts/yohimbe-bark-liquidextract-1-oz.axd

The yohimbine can increase blood flow and nerve impulses. It can also counteract the sexual side effects that come from certain anti-depressant drugs.

Pharmacology/Mechanism

Effectiveness

Yohimbe products have been associated with stomach problems, tachycardia, anxiety, and high blood pressure. It is not appropriate for unsupervised use. It is not safe for children because they seem to be extra sensitive to it.

Adverse Effects and Toxicities

I would personally not recommend this product. This product is not proven to be effective and has a few serious side effects. I would not take the risk of taking this when there are other, more effective and safer, medications out there. ~K. Busscher

Professional/ Personal Opinion

https://www.cordlife.com/sg/ivf-journey-in-the-east

There are various amounts of yohimbe from product to product. Research shows that the prescription products with yohimbine are more effective. Lot of research shows it is not a very effective product for anxiety, depression exercise performance, blood pressure, dry mouth, exhaustion, chest pain, diabetic complications. Research shows little effectiveness for erectile dysfunction.

https://www.verywellhealth.com/medical-office-assessment-2317547

Safety Been related with heart attacks and seizures; either synthetic or highly processed plant extract.

Interactions Anti-depressants, clonidine, quanabenz, antihypertensive drugs, naloxone, phenothiazines, stimulant drugs

References NCCIH. (2019)Yohimbe [online] Available at: https://nccih.nih.gov/health/yohimbe [Accessed 23 Feb. 2019]

Cold, F ., Health, E., Disease, H. and Disease, L. (2019). Yohimbe Uses, Side Effects, Interactions, Dosage, and Warning. [online] Webmd.com. Available at: https://www.webmd.com/vitamins/ai/ingredientmono-759/yohimbe [Accessed 23 Feb. 2019].

www.micromedexsolutions.com.ezproxy.lib.purdue.edu. (2019) Purdue Web Authentication. [online] Available at https://www-micromedexsolutionscom.ezproxy.lib.purdue.edu/micromedex2/librarian/ss/true [Accessed 23 Feb. 2019].