Dietary Supplements Guide 2020 by ckohknox

Dietary Supplements Guide Spring 2020

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

Created by the students in PHPR 48900 Complementary and Alternative Medicine, Purdue University This assignment was comprised of creation of individual topic monographs, peer review of two monographs, and submission of final draft after receiving feedback from peers. Compiled by Cynthia P. Koh-Knox Sharp, PharmD, RPh Purdue University College of Pharmacy

Dietary supplement Author Page 5-HTP .............................................................Antonian, Samuel .............................................................................. 3 Acai ................................................................Awad, Jessica ..................................................................................... 5 Amino acids ...................................................Baker, Mary ....................................................................................... 7 Anise ..............................................................Ball, Lauren ........................................................................................ 9 Ashwaganda ..................................................Bes, Kata .......................................................................................... 11 Asian ginseng .................................................Carpenter, Grace ............................................................................. 13 Bilberry ..........................................................Chang, Tess ...................................................................................... 15 Black cohosh ..................................................Chou, Brayden ................................................................................. 17 Bladderwrack .................................................Clark, Leah ....................................................................................... 19 Blessed thistle ................................................Di, Jane ........................................................................................... 21 Blue green algae ............................................Diaz, Pedro ...................................................................................... 23 Blueberry .......................................................Domingo, Ella .................................................................................. 25 Cannabidiol ....................................................McCafferty, Delaney ........................................................................ 27 Chamomile .....................................................Epps, Amy ........................................................................................ 29 Chasteberry ...................................................Finn, Abbey ..................................................................................... 31 Chondroitin ....................................................Ganz, Allie ....................................................................................... 33 Cinnamon.......................................................Garson, Jennifer .............................................................................. 35 Cocoa .............................................................Zheng, Ying ...................................................................................... 37 Coenzyme Q10...............................................Grishin, Lana .................................................................................... 39 Cranberry .......................................................Hamidi, Ali ....................................................................................... 41 Creatine .........................................................Hebenstreit, Maridith ...................................................................... 43 Curcumin .......................................................Hebert, Karrie .................................................................................. 45 Devil's claw ....................................................Heng,Yi Fei ....................................................................................... 47 DHEA ..............................................................Hope, Heather ................................................................................. 49 DMHA ............................................................Jablonski, Sydney ............................................................................. 51 Dong quai.......................................................Jansen, Emily .................................................................................. 53 Echinacea .......................................................Jaworsky, Nathan ............................................................................ 55 Evening primrose ...........................................Kim, Hyun ....................................................................................... 57 Feverfew ........................................................Lam, Amy ......................................................................................... 59 Forskolin ........................................................Lam, Cindy ....................................................................................... 61 Garcinia cambogia .........................................Leal, Tim ......................................................................................... 63 Garlic ..............................................................Li, Xuxi ............................................................................................. 65 Ginger ............................................................Liang, Jasmine ................................................................................. 67 Ginseng ..........................................................Light, Kiara ....................................................................................... 69 Glucosamine ..................................................Liu, Emily ......................................................................................... 71 Goldenseal .....................................................Loh, Nathaniel ................................................................................. 73 Grape seed ....................................................Lok, Chris ....................................................................................... 75 Hawthorn .......................................................Mayorga, Heather .......................................................................... 77 Horny goat weed ...........................................Meyer, Sophia ................................................................................. 79 Horse chestnut ..............................................Mohamed, Fayrouz ......................................................................... 81 Huperzine ......................................................Mulhall, Alyssa ................................................................................. 83 Kava kava .......................................................Nies, Zach ....................................................................................... 85 Krill oil ............................................................Ogden, Montana ............................................................................. 87 Lavender ........................................................Patel, Amee ..................................................................................... 89 Lobelia ...........................................................Postma, Sophia ................................................................................ 91 Maca ..............................................................Qiu, David ....................................................................................... 93 Melatonin ......................................................Salanio, Ghenella Marie .................................................................. 95 Mitragyna speciosa ........................................Mahan, Ronald ................................................................................ 97 Omega-3/ omega-6 fatty acids ......................Scholl, Noah ..................................................................................... 99 Oscillococcinum .............................................Selle, Renee ................................................................................... 101 Pomegranate .................................................Smith, Elise .................................................................................... 103 Prebiotics/ Probiotics ....................................Speakman, Brandon ...................................................................... 105 Raspberry ketones .........................................Trykall, Caia ................................................................................... 107 Red yeast rice ................................................Wellington, Ashley ........................................................................ 109 SAMe .............................................................Yin, Sara ......................................................................................... 111 Saw palmetto .................................................Yoon, Brenden .............................................................................. 113 St. Johnâ&#x20AC;&#x2122;s wort ...............................................Zelli, Sarah ..................................................................................... 115 Tumeric ..........................................................Zhang, Rebecca ............................................................................. 117 Valerian ..........................................................Zheng, Jenny .................................................................................. 119

5-HTP

Scientific name: 5-hydroxytryptophan Common name: Oxitriptan

Sam Antonian, Student Pharmacist Spring 2020Â

History/background 5-HTP is a product that is produced from the seeds of an African plant known as Griffonia simplicifolia, particularly found in Liberia and Gabon. It was believed to treat pain, inflammation, burns, and vomiting. It was also given to chickens to cure lice.

Common uses

Image from:Â https://images.app.goo.gl/ocJ6fAJi9e2w2do36

Chronic pain Insomnia Depression Obesity Fibromyalgia Schizophrenia Anxiety

How it works 5-HTP is a chemical compound needed in order to make serotonin. 5-HTP works by increasing the levels of serotonin in the brain which plays a role in regulating depression, insomnia, and other conditions. Serotonin is believed to improve low mood and relieve symptoms of anxiety and other related mental disorders.

Dosage forms and typical serving 5-HTP is available as a 100mg and 200mg capsule. Directions for use: start at a low dose of 1 capsule a day, then increase slowly (every 3-5 days) up to a maximum of 4 capsules a day. All doses should be taken with food.

https://www.amazon.com/NOWSupplements-5-HTP-100Capsules/dp/B0013OQI1W

Food/drug interactions

Safety 5-HTP should not be used in children, during pregnancy, or lactating women

Those who are on a class of medications known as MAO-inhibitors, antidepressants, and drugs containing fenfluramine should not use 5-HTP.

Adverse Effects drowsiness heart burn stomach pain drowsiness muscle spams diarrhea

Effectiveness 5-HTP is POSSIBLY effective for depression. There is insufficient evidence for possible effectiveness for other indications.

Toxicology https://www.amazon.com/Amazing-Supplement-HydroxytryptophanSimplicifolia-Vegetarian/dp/B00YB2XRIA

Contraindications

Studies suggest there are no clear toxicities when using 5HTP.

Those who suffer from gut disorders such as gastric ulcers, irritable bowel disease, Crohn's disease, etc., should not use 5-HTP

From a Professional Standpoint

Through thorough research into 5-HTP, I have learned there is little clinical evidence for its efficacy. If depression was the main indication for using this product, I would recommend taking FDA-approved antidepressants so the condition doesn't worsen. Taking a product with little to no clinical efficacy for depression is a waste of money, and more therapeutic options should be considered for treatment.

Interesting Findings

Some studies have found that administration of 5-HTP alone facilitates the depletion of the hormones dopamine, norepinephrine, and epinephrine. Low levels of these hormones is also associated with depression and other mental disorders. Researchers recommend that although not deemed to be very effective, taking 5-HTP with other supplements such as Ltyrosine and L-dopa, which are precursors in the synthesis of these hormones, can help maintain balance. In conclusion, 5-HTP alone is contraindicated and could even worsen the disease state it's trying to treat.

References

1) 5-htp: Uses, Side Effects, Interactions, Dosage, and Warning https://www.webmd.com/vitamins/ai/ingredientmono-794/5-htp 2) The History Of 5-htp, Serotonin and Tryptophan https://www.oxfordvitality.co.uk/history-5-htp-serotonin-tryptophan 3) Serotonin and Depression: 9 Questions and Answers Colette Bouchez https://www.webmd.com/depression/features/serotonin#1 4) Hinz M, Stein A, Uncini T. 5-HTP efficacy and contraindications. Neuropsychiatr Dis Treat. 2012;8:323â&#x20AC;&#x201C;328. doi:10.2147/NDT.S33259

Acai Berry Jessica Awad, Student Pharmacist Spring 2020

Scientific Name: Background / History

Euterpe Oleracea

Common Names: The acai palm tree is native to South and Central America. It has served as an important source of food for indigenous peoples of the Amazon region for years. It has now become popular in the US due to its potential health benefits. Dosage Forms 

Berries (dried, frozen, fresh)



Juice



Powder



Tablets



Capsules Suggested Serving Size / Dosing 1000 mg /day

Common Uses / Benefits 

May lower the risk of Alzheimer’s and Parkinson’s disease because of its antioxidant properties



Reduce the risk of heart attack



Increase HDL (good cholesterol) and decrease LDL (bad cholesterol)



Anti-cancer properties



Promote healthier skin / help heal skin wounds



Boost digestive health



Weight loss



Arthritis

Acai, Acai Berry

How does it work in the body? Acai berries contain a high number of antioxidants, which are believed to help prevent various disease states by protecting the cells in the body from the harmful effects of oxidative stress.

Food / Drug Interactions

Effectiveness Acai is widely used and contains a high amount of antioxidants which may be beneficial, but very little research has been done to prove its efficacy and health benefits in people.



Acai does not have any known severe interactions when consumed with other foods or drugs.



The consumption of acai may affect MRI test results.

Research Toxicities / Adverse Effects 

Acai consumed in its pure form does not have any major adverse effects.



May potentially be toxic in very high doses, but inadequate research has been done.



A study was conducted involving ten overweight adults to determine the effects of acai on selected markers of metabolic disease risk in overweight adults. Participants were asked to consume 100 grams of acai pulp twice daily for one month.

Results Use caution when using acai  Reduced fasting glucose and insupplement products. They sulin levels. may contain additives that can be harmful.  Reduction in total cholesterol. 

Safety 

Although little research has been done, the consumption of acai is generally considered safe.



It is best to avoid supplement use while pregnant or breastfeeding, since its effects are unknown. Professional Opinion

Acai berries (especially in their No effect on blood pressure or exhaled nitric oxide metabolites. natural form) are safe to consume in moderation. They can be a great addition to any wellbalanced diet. However, they should not be used as a single component to treat underlying medical conditions. ~J. Awad

References: Acai. (2016, November 29). Retrieved from https://nccih.nih.gov/health/acai/ataglance.htm Acai: Uses, Side Effects, Interactions, Dosage, and Warning. (n.d.). Retrieved March 4, 2020, from https:// www.webmd.com/vitamins/ai/ingredientmono-1109/acai

Acai:Uses, Side Effects, Dosage, Interactions & Health Benefits. (2019, September 17). Retrieved March 4, 2020, from https://www.emedicinehealth.com/acai/vitamins-supplements.htm Udani, J. K., Singh, B. B., Singh, V. J., & Barrett, M. L. (2011). Effects of Açai (Euterpe oleracea Mart.) berry preparation on metabolic parameters in a healthy overweight population: A pilot study. Nutrition Journal, 10(1). doi: 10.1186/1475-2891-10-45 acacia berry Archives. (n.d.). Retrieved March 4, 2020, from https://acaiberryrecipes.com/tag/acacia-berry/ admin4. (2014, March 26). Acai Berry- Discover Health Benefits Of Taking This Wonder Berry Supplements. Retrieved March 4, 2020, from http://www.fitnesshealthzone.com/healthy-living/benefits-of-acai-berry-supplements/ Staff, N. E. (2018, July 23). Acai Berry Supplement Benefits, Uses & Side Effects. Retrieved March 4, 2020, from https://nootriment.com/acai-berry/

Dietary Supplement

Amino Acids Common Name: BCAA’s or Branched Chain Amino Acids

Indications

Supplement Therapy: For use after working out to aid muscle recovery2,3 Prevent fatigue, improve concentration, and improve performance4. Damage caused by liver damage given by a healthcare professional4.

Mechanism of Action They are absorbed after oral administration in the small intestine, commonly done by a co-sodium transporter (active transport). Amino acids are then absorbed into the bloodstream and distributed throughout the body to cells to be used in tissue repair and building muscle.

Available Dosage Forms

-Tablets -Intravenously (IV): Administered via a healthcare professional4 -Powders for reconstitution: Most commonly used as in protein shake https://familylivingtoday.com/best-amino-acid-supplements/

Purdue University Student Pharmacist Mary Baker Complementary and Alternative Medicine PHRM 489-Spring 2020 Scientific Name: Some examples are Isoleucine,

Typical serving size

-The serving size varies with each amino acid. It is recommended that before using an amino acid to look at the nutrition label and compare it to the Recommended Daily Allowance (RDA) for each of the essential amino acids in the supplement. (see Figure 1) Figure 1: RDA’s for essential amino acids

Valine, Lysine, and arginine.

Background ●

Amino acids were declared as a dietary supplement by GRAS (or Generally Recognized as Safe) in 1961 and have been repeatedly removed and added back since then.

●

According to the Legal definition of a Dietary supplement defined by the Dietary Supplement Health and Education Act of 19941, Amino acids are one of the 6 main categories of dietary supplement containing ingredients.

https://www.researchgate.net/figure/5-Essential-Amino-Acid-Intakes-comparedto-RDAs-in-supplement-users-and-non-users_tbl7_228599306

Effectiveness

It has been shown in a few studies from pub med that BCAA’s, most specifically Leucine is effective during post workout to facilitate recovery needed after the degradation of muscle cells after a rigorous workout. After a workout your body goes into a Negative Nitrogen Balance. This means that your body is losing more proteins than it is getting in your body. This commonly occurs when you are sick or after a rigorous workout. Taking essential amino acids in an adequate amount designated by their RDA’s, they will neutralize the nitrogen balance and build muscle back up by giving the body access to more amino acids, commonly referred to as building blocks of cells, to aid in recovery.

Safety The biggest safety concern with amino acids is the risk of potentially harmful impurities. There is a record of this happening in 1989 with an impurity in an amino acid supplement containing L-tryptophan which caused eosinophilia-myalgia syndrome (EMS)1. EMS is a rare condition that causes parts of your body to swell like lungs and muscles along with an increase in the white blood cell count, which affected thousands. In 1991 all L-tryptophan containing dietary supplements were banned and taken off the shelf5.

Adverse Effects

The most common: -Nausea, vomiting, diarrhea, and bloating6 More severe: -Hypertension and headaches6

Toxicities

Arginine in extremely high doses could cause hypotension. The chance of this happening is extremely rare2,6.

Food or Drug Interactions

There are no known food or drug interactions. The main concern is to avoid during pregnancy and breastfeeding.

Product Investigation

There are many different amino acid supplements you can get either online or in stores. After looking into one of them, I noticed that they claimed to be an amino acid supplement but nowhere on the nutrition label did it tell you what amino acids you were getting. This is misleading and could mean that the supplement doesn’t contain the essential amino acids, which are the most important ones since you do not make enough of them on your own and need them in your diet.

Professional Opinion: Amino acid supplements could be helpful for people with a negative nitrogen balance, which occurs after workouts. It is recommended that the product you use contains the right amount of the essential amino acids listed under “supplement-users” in Figure 1.

http://www.homegymfiend.com/benefits-of-working-out-at-home/

Resources 1. Dietary Supplement Health and Education Act of 1994 Public Law 103-417 103rd Congress. NIH Office of Dietary Supplements. https://ods.od.nih.gov/ About/DSHEA_Wording. aspx#sec3. Accessed March 6, 2020. 2. Blomstrand E, Eliasson J, Karlsson HKR, Köhnke R. Branched-chain amino acids activate key enzymes in protein synthesis after physical exercise. The Journal of nutrition. https://www.ncbi.nlm.nih.gov/pubmed/16365096. Published January 2006. Accessed March 6, 2020. 3. Norton LE, Layman DK. Leucine regulates translation initiation of protein synthesis in skeletal muscle after exercise. The Journal of nutrition. https://www.ncbi.nlm.nih.gov/pubmed/16424142. Published February 2006. Accessed March 6, 2020. 4.Branched-Chain Amino Acids (Bcaas): Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono1005/branched-chain-amino-acids-bcaas. Accessed April 5, 2020. 5. Institute of Medicine (US) Committee on Military Nutrition Research. Regulation of Amino Acids and Other Dietary Components Associated with Enhanced Physical Performance. Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations. https://www. ncbi.nlm.nih.gov/books/NBK209051/. Published January 1, 1994. Accessed March 6, 2020. 6. Institute of Medicine (US) Committee on Military Nutrition Research. Safety Concerns Regarding Supplemental Amino Acids: Results of a Study. Food Components to Enhance Performance: An Evaluation of Potential PerformanceEnhancing Food Components for Operational Rations. https://www.ncbi.nlm.nih.gov/books/NBK209070/. Published January 1, 1994. Accessed March 6, 2020.

PI MP I NEL L A A N IS U M COMMON NAMES: ANIS E, ANIS EED

LAUREN BAL L SPRING 2020 Pre-PA student

USES Anise, since over 4,000 years ago in Egypt, has been used as a diuretic, subsiding digestion issues, such as an upset stomach,TRADITIONAL and toothache pain. For the Greeks, it was said to be used for regulating breathing, subsiding pain and thirst, initiating urine output. Anise’s seeds can be used as a breath freshener. Anise essential oil is used as a fragrance such as in soap or perfumes. The seeds and oil are seen in some medications and aromatherapy. Some anise uses for women include an increased libido and menstrual purposes. Today, many people know of anise as an expectorant and carminative; however clinical data lacks in these purposes. It is commonly used to treat digestion problems in children. These digestion problems include indigestion and irritable bowel syndrome. It can be used to treat involuntary muscle spasms as well as prevent septic respiratory infections. People with lice, psoriasis, and scabies have used anise oils for treatment. Personal treatment of nicotine dependence, insomnia, diabetes, constipation, and seizures have also been supported from anise use. On the other hand, anise has been used in the food industry. Anise has been used for the flavor of black licorice and other candies as well as in alcoholic beverages.

DOSAGE Indigestion: 9g of anise powder every day for 4 weeks Irritable Bowel Syndrome: 200 mg of anise oil in capsule 3 times a day for 4 weeks Anise can be seen as an oil, powder, or in a capsule.

Pharmacological Effects Anise effects the muscle by a muscle relaxant effect of the trachea and smooth muscle. To organisms, it has an antibacterial, antifungal, insecticidal, and antiviral effect. In the nervous system, it acts as an anticonvulsant and analgesic. It acts as a laxative and reduces nausea in the gastrointestinal area. On the immune system, it is an antioxidant. Anise has evidence of having estrogen-like effects on the body.

History The anise herb has records of use in Egypt in France thousands of years ago. It is named as one of the oldest herbs known to man. In the Middle Ages, it was starting to be used in Central Europe. For example, in 1305 King Edward described anise to be a taxable drug. In the beginning, it was used in ancient times in foods to prevent discomfort in digestion. Furthermore, it was believed to prevent nightmares and “evil” if it was underneath one’s pillow. Irritated skin would also be treated with anise during these times.

EFFECTS EFFECTIVENESS AND EFFECTS ON THE BODY EFFECTIVENESS The effectiveness of anise used for menstrual pain and discomfort has evidence that reduces pain and the duration in the menstrual cycle. There is not enough clinical evidence to accurately determine how well anise treats the body for other issues. Anise used with other herbs or supplements have been shown to improve asthma, constipation, and lice in early research. SAFETY Anise has been discovered to be likely safe for adults to take by mouth. It has also been likely safe for children and pregnant women. INTERACTIONS Since anise may act like estrogen it may interact with birth control pills and make them not as effective. The same effect happens when taking estrogen pills and drugs that try to prevent hormone sensitive cancers. An example of this drug is Tamoxifen.

EFFECTS Anise has the possibility to cause an allergic reaction and lower blood sugar which is important for diabetics and people who recently underwent surgery to know. Due to the possibility of an allergic reaction, it is important to find an alternative when fighting a skin condition. It may also negatively affect people fighting a condition that interferes with hormones since anise has estrogen-like effects. TOXICITY Anise, when administered into the body as a spice or medicinal purpose, is non-toxic if consumed at the recommended dose. If too much anise oil is consumed, it may cause nausea, vomiting, and pulmonary edema. PROFESSIONAL STUDY In a systematic review, Iranian herbal medicines were studied to reduce menstrual discomfort. The data was gathered by two authors that used experimental methods to gather data. When trying to study the effects of hot flashes under the administration of anise, there was an alleviation. There was a notably difference between the decrease in hot flashes compared to the placebo group. A big limitation of this study was the small sample size. PERSONAL OPINION After researching Anise, I am very open to incorporating it in my life. It is overall harmless, if used properly, and may be beneficial to me.

Star Anise, Hand Selected. The Spice House. https://www.thespicehouse.com/products/hand-select-star-anise. Accessed April 2, 2020.

Anise: Health Benefits, Uses, Side Effects, Dosage & Interactions. (2019, September 17). Retrieved from https://www.rxlist.com/anise/supplements.htm Anise: Uses, Side Effects, Interactions, Dosage, and Warning. (n.d.). Retrieved from https://www.webmd.com/vitamins/ai/ingredientmono-582/anise Ghazanfarpour M;Sadeghi R;Abdolahian S;Latifnejad Roudsari R; (n.d.). The Efficacy of Iranian Herbal Medicines in Alleviating Hot Flashes: A Systematic Review. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27294213-the-efficacy-of-iranian-herbal-medicines-inalleviating-hot-flashes-a-systematic-review/ Review of Pharmacological Properties and Chemical Constituents of Pimpinella anisum. (2020, February 29). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405664/

ASHWAGANDHA KATA BES | STUDENT PHARMACIST | SPRING 2020

SCIENTIFIC NAME: Withania Somnifera

Background/History Ashwagandha has been used in traditional Indian medicine for thousands of years. It was thought to promote youth as well as increase happiness. It has been used to relieve stress, increase energy levels and improve concentration. More recently, studies have been done to see Ashwagandhaâ&#x20AC;&#x2122;s role in improving male fertility.

COMMON NAME: Ashwaganda, Indian Ginseng, Winter Cherry https://strictlymedicinalseeds.com/ product/ashwagandha-vedicwithania-somnifera-seeds-organic/

Mechanism of Action

DOSAGE FORMS: capsules, teas, powders

DOSING: Take 1-2 capsules by mouth twice daily

USES: May help with stress, insomnia, focus, arthritis, infertility and sexual dysfunction Adapted from Segpunta et al. (2018)

KATA BES | STUDENT PHARMACIST | SPRING 2020

EFFECTIVENESS

ARTICLE SUMMARY According to an article from Reproductive Biomedicine Online, Ashwagandha may play a role in the management of male infertility. Studies show Ashwagandha uses antioxidant activity to inhibit LPO in spermatozoa, which is a major influence on male infertility. Ashwagandha has also been associated with normalizing hormone levels for men who are under significant stress. The article argues that Ashwagandha treats several potentially causes of male infertility.

Not enough data to support efficacy of Ashwagandha.

SAFETY https://www.amazo n.com/ORGANICINDIAAshwagandhaSupplementCapsules/dp/B003P GE98K

Ashwagandha is possibly safe when taken by mouth when taken short-term. The long-term safety of Ashwagandha is not known.

REFERENCES

ADVERSE EFFECTS

Sengupta, P., Agarwal, A., Pogrebetskaya, M., Roychoudhury, S., Durairajanayagam, D., & Henkel, R. (2018). Role of Withania somnifera (Ashwagandha) in the management of male infertility. Reproductive BioMedicine Online, 36(3), 311â&#x20AC;&#x201C;326. doi: 10.1016/j.rbmo.2017.11.007

Headache, sleepiness/sedative effects, and stomach upset

Singh N, Bhalla M, de Jager P, Gilca M. An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med. 2011;8(5 Suppl):208â&#x20AC;&#x201C;213. doi:10.4314/ajtcam.v8i5S.9 Ashwagandha, Indian Ginseng: Herbal Remedies: Andrew Weil, M.D. (2018, December 12). Retrieved from https://www.drweil.com/vitaminssupplements-herbs/herbs/ashwagandha/

High doses can cause GI problem, diarrhea and vomiting.

TOXICITIES Toxicity can be reached in high doses.

FOOD AND DRUG INTERACTIONS Avoid in patients with diabetes and during pregnancy. Increased side effects with immunosuppressants, benzodiazepines and CNS depressants. Could interact with blood pressure and thyroid medications.

PROFESSIONAL OPINION In my professional opinion, I would caution anyone taking Ashwagandha as a supplement because it is not regulated by the FDA. I would also not recommend Ashwagandha because of the lack of knowledge of its long-term effects. It appears there are many drug interactions and can intensify side effects of other medications. However, it is an option to patients to seeking a nonpharmacological alterative, but to report any side effects to their physician.

A SI A N GI N SEN G PANAX GI NSENG N EW SLET T ER Grace Carpenter, student pharmacist Spring 2020

PURPORTED USES In traditional Chinese medicine, Asian ginseng (aka Chinese ginseng or oriental ginseng) was used as an energy booster. Today, it is used for general well-being, stamina, concentration, immune function,

https://www.quora.com/Why-is-ginseng-good-for-you

HISTORY Asian Ginseng has been used for at least 2,000 years as a medicinal supplement. It originates in the Far East (China, Korea, etc.).

PHARM ACOLOGY Ginsenosides are the main active ingredient in asian ginseng. Some research indicates that the hypothalamus pituitary adrenal axis and the immune system are affected which may explain its effects.

preventing aging, and relief for a variety of health issues

DOSAGE FORM S

(depression, anxiety, respiratory and cardiovascular disorders, hot flashes, and erectile dysfunction)

Asian ginseng may be found in tea form , an extract, dry root, or in a capsule.

TYPICAL DOSING The extract used in most research studies is given in a dose of 200 mg/day. However, in other forms, 0.5 to 2 grams may be necessary.

EFFECTIVENESS

INTERACTIONS

ADVERSE EFFECTS

According to research

Asian ginseng may cause

Adverse effects

studies, we are unable to

hypertension while used

associated with ginseng

draw conclusions about

with caffeine. It may also

include nausea,

how effective Asian

lower blood alcohol

euphoria, insomnia,

ginseng is.

content. Ginseng may

headaches, hyper- and

decrease warfarin

SAFETY

effectiveness, and may

Ginseng can cause

cause manic symptoms

hypoglycemic activity, so it

while used with

is not safe to use in

phenelzine.

patients with hypoglycemia or patients who are on insulin. Ginseng should be avoided in children or pregnant women until more research is done. Hypertension, asthma, infections, nose bleeds, and excessive

hypotension, mastalgia, and vaginal bleeding.

SUM M ARY This article discusses how Asian ginseng affects the

TOXICITIES Asian ginseng is typically well tolerated. Long term use of ginseng can lead to headaches, dizziness, nausea, and possible change in menstrual cycles in women.

immune system. It states that ginseng increased activity of different immunity-related molecules. However, certain necessary components have yet to be researched so further investigation is needed.

menstruation are all contraindications.

OPINION According to several sources,

https://www.consciouslifestylemag.com/panax-ginseng-health-benefits/

Lu JM, Yao Q, Chen C. Ginseng compounds: an update on their molecular mechanisms and medical applications. Curr Vasc Pharmacol. 2009; 7(3):293-302. doi: 10.2174/1570161 09788340767 Kiefer DS, Pantuso T. Panax ginseng. American Family Physician. https://www.aafp.org/2003/1015/p1539.htm 1. Published October 15, 2003. Accessed March 5, 2020. Kang S, Min H. Ginseng, the 'Immunity Boost': The Effects of Panax ginseng on Immune System. J Ginseng Res. 2012;36(4):354-368. doi: 10.5142/jgr.2012.36.4.354

ginseng may produce results, with no guarantees. I would recommend this if someone is looking for a natural product to boost immunity as long as no contraindications are present.

PHPR 489 SPRING 2020

TESS CHANG , STUDENT PHARMACIST

BILBERRY Scientific Name: Vaccinium myrtillus Common names: Heidelbeere; Huckleberry; Whortleberry

COMMON USES cardiovascular conditions , antioxidant potential in cancer , diarrhea , urinary tract infections , ocular conditions , diabetes and other conditions AVAILABLE DOSAGE FORMS Tablets , capsules , drops , fluid extract , dried berries , powder , leaves DOSING EYE HEALTH : tab / cap 60 - 160mg 3x daily NONSPECIFIC ACUTE DIARRHEA : tab / cap 20 60g daily GENERAL USE : 3 - 6mL of a 1 : 1 fluid extract daily

https://www.florihana.com/en/mother-tinctures/1628-bilberry-organic.html

BACKGROUND The bilberry plant originates from Europe and has been naturalized in the North American Rocky Mountains. Since the Middle Ages, the berriesÂ and leaves have been used for medicinal purposes for a variety of conditions, including diarrhea, scurvy, infections, burns, and diabetes. During World War II, British Royal Air Force pilots ate bilberry jam, believing it would improve their night vision. MECHANISM OF ACTION Bilberry has the chemical tannins that can help improve diarrhea and reduce inflammation. Flavonoids in the leaf may improve circulation for diabetics. It has a high concentration of antioxidants called anthocyanins which have health benefits.

Effectiveness There ’ s not enough scientific evidence to support the use of h tt ps:// cd n.shop i f y . c o m / s / fi l e s /1 / 0 03 9/ 5 0 3 1 /3 5 4 2 /p ro d u c t s /

bilberry for any

Bil berry _10 24x.jp g ? v = 15 37 6 01 5 81

health conditions .

Personal Investigation

Safety

With personal research regarding a bilberry

Fruit considered safe

fruit capsule product , it could be noted that

when consumed in

most of the capsule products found online

amounts typically found

were taken by patients in hopes of ocular

in foods , or as extract in

health over other uses . Although there are

recommended doses for

a few reviews that said there was no

brief periods of times .

noticeable improvement , majority of

Leaves may be unsafe

reviews from customers stated that they did

with high oral doses .

notice an improvement in their eye health . Consumers claimed better eye sight and gave a positive review on the medication .

Professional Opinion As a student pharmacist , I would not

Adverse Effects Information regarding adverse reactions is limited .

Toxicities

personally recommend bilberry products to

Mutagenicity has not

patients as there is not much scientific

been observed . Long - term

evidence or studies that prove the

use of leaves is suspected

effectiveness of the product , If a patient

to be hazardous .

desires to try such products , I would not stop them , but first I would confirm there were no drug interactions for them . References Bilberry. Lexi -Drugs . Lexicomp . Wolters Kluwer Health, Inc. Riverwoods IL. Available at : http://online .lexi .com. Accessed March 1, 2020 . NCCCIH . Bilberry. Available at : https://nccih .nih.gov /health /bilberry. Accessed March 1, 2020 . World Health Organization . WHO Monographs on Selected Medicinal Plants . Available at : http://www.who.int/medicines /areas /traditional /selec monv4/en/index .html. Accessed March 1, 2020 .

Food/Drug Interactions Antiplatelet agents , anticoagulants , low molecular weight heparins , and thrombolytic agents . Bleeding may occur .

BILLBERRY | PAGE 2

Brayden Chou First-year Pharmacy Student Spring 2020 Latin Name: Actaea racemosa, Cimicifuga racemosa Common Names: black cohosh, black snakeroot, macrotys, bugbane, bugwort, rattleroot, rattleweed

https://www.naturalalternativeremedy.c om/wp-content/uploads/2013/07/blackcohosh-benefits.jpg

Background / History Black cohosh is a flowering plant that grows in the United States and Canada. Only the root is used for medicinal purposes. Native Americans used it for snake bites, musculoskeletal pain, fever, cough, pneumonia, sluggish labor, and menstrual irregularities. European settlers used black cohosh to support women’s reproductive health. Today, black cohosh is most commonly used for menopausal symptoms. Black cohosh was an ingredient in Lydia Pinkham's Vegetable Compound, a popular remedy for menstrual cramps used in the early 1900s. Purported Uses • Menopausal symptoms • Acne • Anxiety • Bug bites • Cough • Fever • Mole removal

• • • • • •

Painful menstruation Premenstrual syndrome (PMS) Rheumatism Snake bite Sore throat Wart removal

• • • • • • •

Rheumatoid arthritis Osteoporosis Osteoarthritis Breast cancer Infertility Heart disease Migraine headache

Pharmacology / Mechanism of Action Black cohosh contains phytoestrogens, a class of flavonoids with mild estrogenic activity. This is thought to normalize estrogen levels which are decreased due to menopause. Some believe black cohosh modulates serotonergic pathways or acts as an antioxidant or anti-inflammatory. Available Dosage Forms: dried herb, capsule, liquid extract, tablet, tea, patch, cream Typical dosing / Serving • 20-80 mg per day • 1 patch every 12 hours • 1 cup of herbal tea • 2-4 mL liquid extract

https://upload.wikimedia.org/wikip edia/commons/thumb/1/19/Cimicif uga_racemosa_002.jpg/1200pxCimicifuga_racemosa_002.jpg

Effectiveness Studies have found varying results for the plant’s effects on human physiology. Most of this research is for a specific commercial black cohosh product, Remifemin. The North American Menopause Society advise clinicians against recommending black cohosh stating it is “unlikely to be beneficial” in alleviating vasomotor symptoms. Safety • The black cohosh plant is in the same family as the buttercup plant, so people who have allergies to buttercups should not try black cohosh. • Black cohosh is not recommended during pregnancy or breastfeeding or for use in children. Adverse Effects • upset stomach • dizziness • headache

• • •

nausea vomiting low blood pressure

•

https://remedygrove.com/supp lements/Black-CohoshBenefits-Uses-Side-Effects-andRecommended-Dosage-Whereto-buy-Black-Cohosh

changes in heart rhythm

Toxicities • Black cohosh may cause liver damage. Do NOT use black cohosh if you have a history of liver disorders or experience abdominal pain, jaundice, or dark-colored urine. Food / Drug Interactions • Hepatotoxic drugs such as Lipitor • Alcohol Summary of One Study Leach and Moore from the School of Nursing & Midwifery at the University of South Australia A study conducted a study to evaluate the clinical effectiveness and safety of black cohosh for treating menopausal symptoms in perimenopausal and postmenopausal women. They concluded that “there is currently insufficient evidence to support the use of black cohosh for menopausal symptoms”. References 1. 2. 3. 4.

Black Cohosh. https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/. Published August 30, 2018. Black Cohosh. https://www.webmd.com/vitamins/ai/ingredientmono-857/black-cohosh. n.d. Goldman R. Black Cohosh: Uses, Benefits, and Side Effects. https://www.healthline.com/health/foodnutrition/black-cohosh#1. Published August 8, 2016. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. https://www.ncbi.nlm.nih.gov/pubmed/22972105?dopt=Abstract. Published September 12, 2012.

Personal Opinion I would not recommend this product due to the lack of evidence of its efficacy and the possible concern of liver damage.

Leah Clark, Student Pharmacist Bladderwrack Spring 2020 Scientific Name- Fucus vesiculosus Common Name(s)- black-tang; bladder focus; blasentang; cutweed; focus; kelpware; quercus marina; sea-wrack; seetang; tang; Varech vesiculeux Background/History- Has been found in diets of Atlantic coastal areas

https://www.lipotec.com/en/products/a ctiphyte-trade-bladderwrack-2/

Purported Uses: • Constipation • Diarrhea • Gastritis • Gastroesophageal reflux disease • Hypothyroidism • Indigestion • Heartburn • Low stomach activity • Wound healing • Weight loss

Mechanism of Action: Three major active parts: iodine, alginic acid, and fucoidan • • •

Iodine: necessary for the maintenance of normal thyroid functions in adults Alginic acid: dietary fiber Fucoidan: dietary fiber that contains sulfur groups to lower LDL cholesterol levels, blood glucose levels, anti-inflammatory activity, and possible anticoagulant, antibacterial, and anti-HIV activity.

Available Dosage Forms: • Powders • Capsules • Dried Typical Serving: • For Constipation: 1 teaspoon of powdered bladderwrack with 8 oz of water three times per day • For thyroid problems, gastritis, or heartburn: 5 to 10 grams of dried bladderwrack in capsules three times per day

https://buttersnblacksoap.com/products/bladderwrackpowder?variant=31818453254228&currency=USD&utm_campaign=gs-201909-29&utm_source=google&utm_medium=smart_campaign

https://www.swansonvitamins.com/natures-answer-bladderwrack-thallus90-vegcaps?SourceCode=INTL4071&DFA=1&UTM_Medium=Shopping&UTM_Source =GOOGLE&UTM_Campaign=SWAN_National_Gen_Shopping_Null_Null_All+P roducts_Low+405501+Energy&UTM_Content=PRODUCT_GROUP&SourceCode=INTL4071&ds_rl https://www.mountainroseherbs.com/products/bladderwrack/profile?utm_s =1262629&ds_rl=1263854&ds_rl=1262629&gclid=CjwKCAjwvZv0BRA8EiwAD ource=adwords&utm_medium=ppc&utm_term=&utm_campaign=**LP+9T2VXwTsWI6WeVSl2jtwVsdVe4G6OM_l6dR5bvnrLJLmCdSot+Shop+-+Herbs+%26+Spices+-+Other&hsa_tgt=aud-438031480231:plaX8a_hvBoCdBQQAvD_BwE 412793611353&hsa_acc=5389326775&hsa_src=g&hsa_cam=1059935649&hs a_net=adwords&hsa_mt=&hsa_ad=251167493455&hsa_grp=51509436705& hsa_ver=3&hsa_kw=&gclid=CjwKCAjwvZv0BRA8EiwAD9T2Vc77X3Hck8pgtcHS rcgmErTw72WYoiXwJ9PMaPGMAL9ylHSP3uvmIxoCgrUQAvD_BwE

Effectiveness: NO STUDIES HAVE BEEN DONE TO CONCLUDE THE EFFECTIVENESS OF BLADDERWRACK IN HUMANS Safety: Pregnancy and breast-feeding: Bladderwrack is LIKELY UNSAFE during pregnancy and breast-feeding. Bleeding disorders: Bladderwrack might slow blood clotting. In theory, bladderwrack might increase the risk of bruising or bleeding in people with bleeding disorders. Infertility: Preliminary research suggests that taking bladderwrack might make it harder for women to get pregnant. Iodine allergy: Bladderwrack contains significant amounts of iodine, which could cause an allergic reaction in sensitive people. Surgery: Bladderwrack might slow blood clotting. There is a concern that it might cause extra bleeding during and after surgery. Stop taking bladderwrack at least 2 weeks before surgery. Thyroid problems known as hyperthyroidism (too much thyroid hormone), or hypothyroidism (too little thyroid hormone): Bladderwrack contains significant amounts of iodine, which might make hyperthyroidism and hypothyroidism worse.

Adverse Effects: • • •

Acne Thyroid dysfunstion Heavy-metal contamination (particularly arsenic and lead)

Toxicities: No more than 150 mcg of iodine should be consumed per day

Food/Drug Interactions: • •

Antithyroid drugs Anticoagulant/ antiplatelet drugs

Personal Investigation of a Product Containing the Ingredient: I managed to find the product. The label did say the product wasn’t evaluated by the FDA. This product was more readily available as a combination product. The directions were clear to me on how to take the capsules. The amount of iodine was over the recommended daily intake though. My personal/ professional opinion:

References:

This supplement isn’t safe enough to use as a daily diet supplement. Most products are over the recommend daily amount of iodine. Your primary care provider and pharmacist should be aware of any and all supplements you are taking to evaluate any interaction medications may have with this supplement.

Bladderwrack: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-726/bladderwrack. Accessed March 3, 2020. Health Topics A-Z: Bladderwrack. PeaceHealth. https://www.peacehealth.org/medicaltopics/id/hn-3653002#hn-3653002-uses. Accessed March 3, 2020. Nomination Background: Bladderwrack. https://ntp.niehs.nih.gov/ntp/htdocs/chem_background/exsumpdf/bladderwrack_50 8.pdf. Published December 12, 2000. Accessed March 3, 2020

PHPR 489 Spring 2020

Blessed Thistle_ Di Qian (Jane)_2020

Written by Qian (Jane) Di, pharmacy P1 student- Spring 2020 Scientific name: Cnicus benedictus Common name(s): Blessed thistle, St. Benedict’s thistle, holy thistle, spotted thistle Background/history: This supplement is made from the plant name https://www.amazon.com/Naturesblessed thistle, which is a member of Asteraceae family. It is an annual Way-milligrams-Vegetarianflowering plant that has long narrow, spiked leaves with yellow flowers. Capsules/dp/B00TJ17KLI It is native to Mediterranean region and western Asia. During Middle Age period in Europe, it had been used to enhance digestion, eaten as food, and taken as a tonic nutrition. It was also used to treat boils during the Plaque. Blessed thistle represents purity in spirituality, so it was used in purification bath and wore as protection from evil. Purported uses: It is a galactagogue, which is a substance that increases milk supply. It may also be used to support digestion, keep skin healthy, treat seasonal allergies, and relieve cough. Pharmacology/ mechanism of action/ how it works in the body:  Increase milk supply- There are no clinical evidence to support blessed thistle’s purported use for increasing milk supply.  Support digestion- Blessed thistle contains glycosides that stimulates gustatory nerves, thus affects the taste bud, allowing more gastric juice secretion in the stomach and aiding digestion of food.  Treat seasonal allergies: Sesquiterpene lactones in this supplement plant provide protection from microbial attack, thus calming down histamine reactions.  Keep skin healthy: Mechanism of action is not found.  Relieve cough: Tannins in blessed thistle may be involved but exact mechanism is not found. Available dosage forms: tea, capsule, herbal tinctures, extract, alcoholic beverage flavoring Typical dosing/serving: Oral tincture- 7.5- 10 ml three times daily Liquid extract: 1.5- 3.0 ml three times daily Infusion: 1.5-2.0 g in 150 ml water three times daily https://www.gaiaherbs.com/blogs/ herbs/blessed-thistle Tea: 1- 3 tsp in 1 cup boiling water and taken as tea three times a day (Recommended to drink 30 mins before meals) Note that dosing may vary, depending on factors including age, health profile, and current medications. Other information/ Interesting facts:  It is used as flavoring in alcoholic beverage and is regarded as “generally recognized as safe” by FDA  It is mentioned in Shakespeare’s play called Much Ado About Nothing  Blessed thistle is different from milk thistle, which it is a supplement whose purpose to protect liver functioning

PHPR 489 Spring 2020

Blessed Thistle_ Di Qian (Jane)_2020

Effectiveness: There is not enough evidence for the effectiveness of this supplement to treat coughs, infections, boils, wounds, urination flow, and to treat milk flow. More evidence is needed. Safety: do not use this during pregnancy and not recommended for infant and children Adverse effects: potential allergic reactions (do not take this if you are allergic to ragweed) Toxicities: nausea, vomiting, and gastric irritation had been reported when used at high doses (>5 g per cup of tea) Contraindications: This supplement is not for patients with intestinal infections like Crohnâ&#x20AC;&#x2122;s disease

https://www.netclipart.co m/isee/ThJobb_nauseaand-vomiting-clipart/

Food/drug interactions: Taking blessed thistle may decrease effectiveness of antacids and decrease efficacy of H2 blockers and proton pump inhibitor medications Note: This not FDA approved and is not proven to treat, prevent, or cure any disease. It is recommended for you to consult licensed healthcare practitioner before using this supplement to avoid adverse effects such as allergies.

Summary of one self- study It was rather difficult to locate blessed thistle. After looking and failing to find this supplement in three different local drug store locations, I decided to do some online research and was able to easily find some consumer options for buying this supplement. One brand claims that it has 780 mg vegan and gluten free capsule options, though its daily value is not established. This leads me to wonder how the serving of 2 capsules was determined. The same brand also claims that the capsules only contain organic blessed thistle as its ingredient, which is most likely inaccurate. Excipients used to make this supplement is not included. Professional Opinion This is the first time I have heard and learned about this supplement, so I do not have any personal recommendation or views on it. Since the effectiveness of blessed thistle is not established, I would recommend anyone interested in getting this supplement to first confirm the safeness and potential effectiveness of taking it with healthcare providers. References

1. Blessed thistle, WebMD, https://www.webmd.com/vitamins/ai/ingredientmono-94/blessed-thistle. Accessed March 27,2020 2. Blessed thistle, National health products, https://www.nhc.com/blessed-thistle. Accessed March 27, 2020 3. Blessed thistle, National Library of Medicine, https://www.ncbi.nlm.nih.gov/books/NBK501775/. Accessed March 27, 2020 4. Blessed thistle, Mountain rose herbs, https://www.mountainroseherbs.com/products/blessed-thistle/profile. Accessed March 27,2020 5. Natures Way Blessed Thistle, 390 milligrams Per Cap, 100 Vegetarian Capsules, Amazon, https://www.amazon.com/Natures-Way-milligrams-VegetarianCapsules/dp/B00TJ17KLI/ref=sr_1_4?keywords=blessed+thistle&qid=1582774490&s=hpc&sr=1-4. Accessed March 27, 2020

Blue Green Algae Written by Pedro Diaz, Student Pharmacist, Spring 2020

Scientific Name(s):   

Arthrospira (Spirulina) fusiformis Arthrospira (Spirulina) maxima Setchell et Gardner Arthrospira (Spirulina) platensis (Nordstedt) Gomont

Common Name(s):    

Blue green algae Spirulina Tecuitlatl Dihe

https://encrypted-tbn0.gstatic.com/images?q=tbn%3AANd9GcSnacihDCgHAF7Uc-sAHpTSCgoF3ckvtNtXLBkRiItThpg0IQp

Background/History: 

Blue green algae has a history in literature since the 16th century. Spanish explorers saw the Aztecs harvesting blue mud that was then dried and eaten. Also, it has been harvested from the Sahara Desert and other places in Africa. In addition, blue green algae has been sold as a dietary supplement in the US since the late 1970s.

Purported Uses: High blood pressure

Anti-inflammatory

Antibacterial/Antifungal/Antiviral

Anti-cancer

Antioxidant

Anticoagulant

Lowers blood sugar

ADHD

Chelating agent

Weight loss

Hyperlipidemia

Fatigue

How it Works: 

Blue-green algae has a high level of protein, B-complex vitamins, vitamin E, betacarotene, zeaxanthin, gamma linolenic acid, and iron.

Available forms: 

Powder, tablets, and capsules

Serving size: 

1 to 10 g/day

Effectiveness: 

Most test have been done in vitro and clinical data is often inconclusive, or it has issues with the methods used. Not enough information to conclude its effectiveness for its claims.

Safety: 

Possible contamination by bacteria, microcystins, and heavy metals.

Adverse Effects:  

Contains the amino acid phenylalanine; therefore, individuals with phenylketonuria should avoid spirulina. Possibility of increased bleeding

Toxicities: 

Nontoxic to humans at normal doses. More research may still be necessary.

Food/Drug Interactions:  

May decrease effectiveness of immunosuppressants May increase bleeding with antiplatelets and anticoagulants

Product investigation: 

I searched online for a product containing blue green algae and it looked like a professional product initially. As, I went over the many claims of the product, I noticed that there is nothing to support this information nor are the possible negatives of the product included. However, the company has some information about how they grow the algae on the product page. Overall, I believe more information is needed.

My Opinion: 

I think that using blue green algae is similar to taking a vitamin; therefore, if the vitamin profile you are looking for matches up with the one for blue green algae and you are aware of the possible interactions, I believe it is fine to use.

References: RXList. Blue-Green Algae. Available at: https://www.rxlist.com/blue-green_algae/supplements.htm. Accessed March 4, 2020. Spirulina. Natural Products Database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed March 4, 2020. WebMD. BLUE-GREEN ALGAE. Available at: https://www.webmd.com/vitamins/ai/ingredientmono-923/bluegreen-algae. Accessed March 4, 2020.

Ella Domingo, Student Pharmacist (Spring 2020) Scientific Name: Vaccinium Common Name: Blueberry Background/History o Belongs to family Ericaceae o Native to USA and Southern Canada o Grows on hills and in woodlands o Ideal environment is acidic soil and plenty of sunlight o Medium-sized shrubs o Taste is sweet and tart o Harvested in summer, usually May to October o USA is main producer with some blueberry cultivation done in Europe, Asia, Africa, and Australia o Fruit and leaves used to make medicine

https://www.goodhousekeeping.com/health/dietnutrition/a20916472/blueberries-nutrition/

Pharmacology/Mechanism of Action/How It Works in the Body o Accumulation of free radicals in body can damage cells, proteins, DNA, and cell membranes via oxidation, which can lead to inflammation and/or cancer o Blueberry has antioxidant effects due to its high content of Vitamin C, antioxidants, and anthocyanidins that act to scavenge free radicals to prevent their reaction with oxygen o May also prevent bladder infections by stopping bacteria from attaching to bladder walls o High in fiber to help normal digestive function

https://oem.bmj.com/content/60/8/612

Available Dosage Forms o Raw food product/fruit Purported Uses o Food: jam, syrup, pie, soup, tart, cobbler, smoothie, o Supplement/extract â&#x20AC;&#x201C; capsules, tinctures, powder, and water-soluble cereals, yogurts, and beverages, etc. extracts o Supplement: mainly antioxidant and antiinflammatory https://sportsresearch.com/products/wildo Other uses with limited scientific research: memory blueberry-concentrate and cognitive skills, aging, cancer prevention, heart disease prevention, UTI treatment Typical Dosing/Serving o Dependent upon age, health, and other conditions o Not enough scientific information for dose range

Effectiveness o Possibly ineffective for high blood pressure o Not enough evidence to show effectiveness for the following: o Memory and cognitive skills o Aging o Cancer prevention o Heart disease prevention o UTI treatment Safety o Likely safe when taken by mouth in normal amounts in food o Precautions: may affect blood sugar control in diabetes and surgery o Watch for low blood sugar in diabetes o Stop use at least two weeks before a surgery Adverse Effects and Toxicities o Lack of scientific evidence to prove any adverse effects or toxicities https://medlineplus.gov/diabetes.html

Food/Drug Interactions o Minor: diabetes medications – blueberry might decrease blood sugar, so monitor blood sugar; dose of diabetes medication may need to be adjusted

References 1. Blueberry. MedlinePlus. https://medlineplus.gov/druginfo/natural/1013.html. Published May 8, 2020. Accessed March 1, 2020. 2. Blueberry. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono1013/blueberry. Published 2018. Accessed March 1, 2020. 3. Patel, S. Blueberry as functional food and dietary supplement: The natural way to ensure holistic health. Mediterranean Journal of Nutrition and Metabolism. 2014; 133-43. DOI:10.3233/MNM140013. Accessed March 1, 2020. 4. Wong, C. The Health Benefits of Blueberry Extract. Verywell Health. https://www.verywellhealth.com/blueberry-extract-89424. Published January 27, 2020. Accessed March 1, 2020.

Journal Article Summary o A 2014 study published in the Mediterranean Journal of Nutrition and Metabolism by Seema Patel in the Department of Biotechnology details research on blueberry (Vaccinium), a source of “functional phytochemicals” including phenolic acids and flavonoids (anthocyanidins), which are responsible for the antioxidant and antiinflammation effects. Ongoing studies explore the roles of blueberry in healthcare, with investigations in possible “relief from obesity, diabetes, retinal injury, heart, liver, stomach and kidney inflammation, tumors, microbial infection, cognitive decline and bone loss.” However, while the United States Department of Agriculture human nutrition center recommends blueberry’s inclusion in the diet due to these potential benefits, more scientific evidence must be acquired to make any definitive claims on blueberry’s effectiveness. https://www.medicalnewstoday.com/articles/325346

My Professional Opinion o Blueberry may be considered as a viable option to reduce inflammation due to its high Vitamin C and antioxidant content. o The raw blueberry fruit would be a better option to take than oral supplements since the raw form would provide the most benefits, including fiber, water content, and fewer synthetic additives. o Those taking blueberry should consider the precautions of monitoring blood sugar, dosing of diabetes medications, and stopping use before surgery to ensure safety. o Blueberry should not be used as a stand-alone treatment. Rather, as the name of “supplement” suggests, blueberry should be combined with healthy choices of diet and active lifestyle for best anti-inflammatory effects.

SPRING 2020

CANNABIDIOL Delaney McCafferty, Student Pharmacist

https://www.openaccessgovernment.org/differencecannabidiol-and-thc/77569/

Scientific Name: Â Cannabidiol Common Name: Â CBD, CBD Oil

https://nighthelper.com/7-benefits-uses-cbd-oil/

Pharmacology: -Antiepileptic mechanism unknown; does involve cannabinoid receptors -Researchers believe that CBD directs the body to use more of its own natural cannabinoids

Background: -Medicinal uses of cannabis plant as far back as 14,000-2,000 BC -1937 Marijuana Tax Act that regulated and taxed hemp -Act ruled unconstitutional in 1969 and marijuana was criminalized -Experiments with CBD in 1940's and 1950's -Dr. Roger Adams discovered CBD in hemp in 1940 -CBD was found to not have psychoactive activity -Discovery of cannabinoid receptors in the human body in the 1980's - Currently, all 50 states have CBD legalized with varying degrees of restriction and regulation -The federal government considers CBD in same class as marijuana

Uses: -Epilepsy -Parkinson's Disease -Schizophrenia -Diabetes -Pain relief -Multiple Sclerosis -Anxiety -Cancer -Anti-Acne Dosing: -2.5 mg/kg twice daily for seizure, may increase to 10 mg/kg twice daily -Start with a small dose and incrementally increase dose Dosage Forms: -Oil -Edible -Spray

https://cbddailyproducts.com/product/triple-strength-active-cbd-spray https://justcbdstore.com/product/cbd-gummies-750mg-jar/

Effectiveness: -Strongest scientific evidence for treatment of childhood epilepsy -Studies show effectiveness in lowering pain and inflammation -CBD is an unregulated supplement, so products are variable Safety: -Can cause abnormalities in liver function, so it is important to have liver function tests done Adverse Effects: -Depression -Dizziness -Hallucinations -Low blood pressure -Withdrawal symptoms https://www.health.harvard.edu/blog/cannabidiol-cbdwhat-we-know-and-what-we-dont-2018082414476

Personal Opinion: I think that if a patient wants to try CBD products to help a condition that it is shown to be indicated for, I would support it. The negative effects of CBD are relatively minimal, so it doesn’t necessarily hurt to try it. People with conditions that CBD are purported to help have shown benefit from using CBD oil. My dad has MS, and has used CBD oil to help ease some of his MS symptoms. While the impact wasn’t huge, it was still enough of a difference to support his use of CBD oil. Seeing that it made a slight difference in his wellbeing and management of his condition has made me supportive of the utilization of CBD oil in select conditions.

References:

Toxicity: -CBD-induced drug-drug interactions, hepatic abnormalities, diarrhea, fatigue, vomiting, and somnolence

Interactions: -Drug: affects concentration of drugs that are metabolized by CYP450 enzymes -Food: high fat or high calorie meals increase the extent of CBD absorption Summary of a Study: The study I chose regarded the regulation of PI3K/Akt/mTOR pathway by cannabidiol in the treatment of multiple sclerosis. The PI3K/Akt/mTOR pathway was found to be activated by cannabinoids in several immune and non-immune cells, but no previous data had been found on the effects on the PI3K/Akt/mTOR activity in MS. In the study, the researchers induced Experimental Autoimmune Encephalomyelitis in mice. The mice were treated with CBD and observed. At day 28, the mice were euthanized and tissues were sampled. A clear down regulation of the PI3K/Akt/mTOR pathway following EAE was found. CBD treatment was able to restore it, increasing the phosphorylation at PI3K, Akt, and mTOR. CBD treatment was also found to reduce cytokines IFN-y and IL-17 and inhibit JNK and p38 MAP kinases. These results support the regulation of the PI3K/Akt/mTOR pathway by CBD as a potential therapeutic target for MS patients.

1. Bauer, BA. CBD: Safe and effective? Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-andeffective/faq-20446700. Published December 20, 2018. Accessed February 18, 2020. 2. Giacoppo, S, Pollastro, F, Grassi, G, Bramanti, P, & Mazzon, E. Target regulation of PI3K/Akt/mTOR pathway by cannabidiol in treatment of experimental multiple sclerosis. Fitoterapia. 2019: 116: 77-84. 3. Grinspoon P. Cannabidiol (CBD) - what we know and what we don't. Harvard Health Blog. https://www.health.harvard.edu/blog/cannabidiol-cbdwhat-we-know-and-what-we-dont-2018082414476. Published August 27, 2019. Accessed February 18, 2020. 4. Huestis, MA, Solimini, R, Pichini, S, Pacifici, R, Carlier, J, & Busardò, FP. Cannabidiol adverse effects and toxicity. Current neuropharmacology. 2019; 17(10): 974-989.

CHAMOMILE

SCIENTIFIC NAMES: MATRICARIA CHAMOMILE (GERMAN CHAMOMILE) & CHAMAEMELUM NOBILE (ROMAN CHAMOMILE) AMY EPPS | STUDENT PHARMACIST | SPRING 2020

PURPOSED USES Dermatitis, Diarrhea, Infection, Inflammation, Mucositis, Nausea, Stomatitis, and Tension/ Anxiety

AVALIABLE DOSAGE FORMS Topical cream, topical ointment, topical lotion, oral inhalation, powder, https://www.pureplantessentials.com/products/chamomile-german-bulgaria-matricaria-chamomila-stem-distilled-flowers

BACKGROUND/ HISTORY

MECHANISM OF ACTION

tea, and volatile oil (essential oil)

Chamomile originated in Europe and West

Chamomile was found to inhibit lipid

Asia and has been used by Egyptians,

peroxidation and inhibited autooxidation

Romans, and Greeks for its medicinal

of DMSO by 76%. These antioxidant

TYPICAL DOSING

properties. They used it to treat erythema

effects could lead to an anti-inflammatory

(redness of the skin) and xerosis (dry skin)

effect. Also dried chamomile flowers

Oral doses are 1.1 to 15

caused by the dry weather as well as a

contains terpenoids and flavonoids when

calming beverage served as tea. Chamomile

contribute to its antioxidant effects.

was prescribed a lot during the medieval age by doctors and was used in a wide variety of medicines in the forms of ointments and medicinal baths.

g/day Topical applications are applied four times a day.

Toxicities & Food/Drug Interactions

Does it Work? My Professional Opinion:

Interactions between chamomile and cyclosporine (a drug

In my professional opnion, I would suggest

used to prevent rejection of organ transplats), warfarin (a

chamomile to anyone who is looking for a non-

blood thinner) have been reported to interact with

pharmacologic option for their anxiety or nausea. I

eachother. Also it has been shown that chamomile may

would also suggest for anyone who is looking for

inhibit cytochrome P-450. Patients who are taking other

another option when other medicatons have failed

drugs metabolize by the enzyme system should use

to work. However, I would not suggest to anyone

caution when ingesting chamomile products. Chamomile

who is taking cyclosporine or warfarin due to food/ drug interactions and health concerns.

https://www.amazon.com/RomanChamomile-Essential-Ultra-PremiumTherapeutic/dp/B00X8FZODW

is not a toxic plant, however, prolonged or excessive cosumption of their infusions or essential oils can cause gastrointestional irritation with vomiting sensation.

Effectiveness & Safety

Adverse Effects

It has been shown that chamomile has been somewhat effective in treating moderate to

o High dose can cause vomiting

severe general axiety disorder after using treatment for 2 weeks. Some research has

o Risk of conjunctiveitis

shown using a combination of chamomile and herbs can help an upset stomach. Chamomile is overall safe and few people are allergic to chamomile. If you are allergic to related plants such as ragweek or daises, you should be careful when considering to take chamomile.

SUMMARY OF SCIENTIFIC ARTICLE It was shown in a study that chamomile was significantly better when treating moderate to anxiety when tested against a placebo. Chamomile flower was found to have 120 different components. Teas brewed from chamomile contain approximately 10-15% of the essentials oils avaliable from the flowers. Chamomile has also been shown to possess antioxidant properties, although to a lesser degree compared to other medicianl and culinary herbs.

o Acute eczema, severe eczema & contact dermatitis o Anaphylaxis

References Howrey BT, Peek MK, McKee JM, Raji MA, Ottenbacher KJ, Markides KS. Chamomile Consumption and Mortality: A Prospective Study of Mexican Origin Older Adults. Gerontologist. 2016;56(6):1146â&#x20AC;&#x201C;1152. doi:10.1093/geront/gnv051 Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Rep. 2010;3(6):895â&#x20AC;&#x201C;901. doi:10.3892/mmr.2010.377 Chamomile. National Center for Complementay and Integrative Health. https://nccih.nih.gov/health/chamomile/ataglance.ht m. Published Novemenber 29,2016. Accessed March 5, 2020. Watson RR. Foods and Dietary Supplements in the Preventions and Treatment of Disease in Older Adults. Amsterdam: Elsevier/ Academic Press; 2015.

Chasteberry Abigail Finn, Movement & Sport Sciences student, Spring 2020

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

Scientific name: Vitex agnus-castus Common names: chasteberry, chastetree, chaste tree berry, Vitex, monk’s pepper, lilac chastetree Background/history: • • • •

fruit of the chaste tree, native to Central Asia and Mediterranean region believed to promote chastity (chaste) Monks in Middle Ages used it to decrease sexual desire Used for reproductive disorders

Purported Uses • •

Today, used as dietary supplement for menstrual problems, menopause symptoms, infertility, and other conditions Possibly helps with treatment of PMS symptoms

Pharmacology/mechanism of action/how it works in body • • •

Chasteberry contains: flavonoids, iridoid glycosides, and essential oils Therapeutic effects have effects on hormones, specifically prolactin and progesterone. Hormonal effect is dependent on dose o Low doesà decreased estrogen and increased progesterone and prolactin due to inhibition of FSH release and increase of LH release o Lower doses might stimulate breast milk production § Higher doses have opposite effect

Available dosage forms • • • •

Liquid extract Capsules Tablets Essential oil

Typical dosing/serving • •

Dosages and preparations vary depending on trial Typical is 4 mg per day of extract o In United States, available as Femaprin from Nature’s Way

Effectiveness • • • •

Possibly effective with menstruation-related breast tenderness Possibly effective in relieving PMS symptoms Possibly effective n fertility disorders Not enough evidence to show improvement of libido or triggering lactation

Safety • •

in limited amounts, generally well tolerated, few side effects women on birth control pills or hormone replacement or a hormone sensitive condition should not use chasteberry

Adverse Effects • • •

minor effects gastrointestinal complaints dizziness

Toxicities • •

Pregnant women should not use chasteberry, no evidence if safe for children Should not be taken by those with hormone-sensitive cancer

Food/drug interactions • •

No major herb-drug interactions Do not use if taking any medicines, herbs, or other supplements

Summary of one article/study: A study of 104 women used either liquid or tablet chasteberry for three menstrual cycles. It was a placebo-controlled study. The treatment group reported improvement in menstrualrelated breast tenderness. References Chasteberry. American Family Physician. https://www.aafp.org/afp/2005/0901/p821.html. Published September 1, 2005. Accessed March 3, 2020. Chasteberry. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/chasteberry. Updated September 1, 2016. Accessed March 3, 2020. Chaste Tree (Chasteberry). University of Rochester Medical Center. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=19&contentid=ChasteTree. Updated January 20, 2020. Accessed March 4, 2020.

Personal opinion Overall, I think chasteberry could be effective in relieving premenstrual symptoms if the patient is not already taking other medicines or supplements. There are few adverse effects and if women want to dry an alternative method for relieving symptoms, chasteberry is a relatively safe option that comes in many convenient forms.

Chondroitin Allie Ganz Major: Nursing Spring 2020

Scientific name:

Common Names:

Chondroitin sulfate

Chondroitin, CSA, CDS, CSC

Background/history:

Swanson Vitamins, 2019. https://www.google.com/search?q=chondroitin&r lz=1C1CHBF_enUS831US831&sxsrf=ACYBG NRZjHnvi1IvE5v-iK4oTbjEirFFA:1583018939200&source=lnms&tbm=i sch&sa=X&ved=2ahUKEwiuq6yM9ffnAhUBS6 wKHWT7CwYQ_AUoA3oECBIQBQ&biw=150 0&bih=890#imgrc=ZCXeQVsbOvXaiM

Chondroitin sulfate was first extracted and purified in 1960. Then, the Food and Drug Administration (FDA) was introduced to Chondroitin when a petition for review of the natural supplement came in 2004. However, the FDA denied as it was concluded the experiments for Chondroitin use did not support the claim made. The first study conducted to assess the effectiveness of the natural supplement was in 2015, with the Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) sponsored by the US National Institute of Health. It was a multicenter study conducted to assess the short-term, six-month, effectiveness of both chondroitin and glucosamine in combination, and separately. A double-blind study was used, and 24 weeks of treatment were initiated. Results showed, Chondroitin, when compared to the placebo and against Celecoxib, showed no significant result in terms of decreased inflammation. Uses: Osteoarthritis and cataracts Mechanism of Action:

Chondroitin is a substrate of proteoglycans. It is essentially a complex carbohydrate that aids cartilage in retaining of water, which helps to relieve joint pain and decrease cartilage loss. Available dosage forms: Oral, topical ointment, topical eyedrops, intramuscular (IM) Oral (PO): 800-1,200mg daily. Can have doses divided. Topical ointment: 50mg/daily

Effectiveness: In general, chondroitin has been proven to not be effective in the treatment of osteoarthritis and cataracts. The National Center for Complementary and Integrative Health stated, â&#x20AC;&#x153;there have been more than 20 studies that show the effect of chondroitin on hip and knee osteoarthritis has varying results and concludes the supplement does not aid in pain management.â&#x20AC;? Safety: In the 20 studies done to test the effectiveness of chondroitin, there has never been severe or significant side effects, other than interacting with Coumadin to cause increased bleeding as both have anticoagulant properties. However, persons who have blood clotting problems and women who are pregnant, should report taking this medication to their provider due to the anticoagulant nature of the supplement. Adverse effects: Nausea, vomiting, heartburn, diarrhea, edema, allergic reactions, and abdominal pain Toxicities: No reported toxicities Food and Drug Interactions: Do not take in combination with Warfarin, Coumadin, and other blood thinners. Article Study: A meta-analysis was conducted in 2018 that found chondroitin had no superior effect over a placebo for treatment of osteoarthritis. Researchers utilized studies from PubMed, Embase, and Cochrane Library databases, and used inclusion data of studies pertaining to glucosamine and chondroitin use in osteoarthritis, and found by use of STATA software, chondroitin held no statistical significance in the treatment of OA. Researchers then even went on to recommend chondroitin not be sought out, or considered an alternative to patients. Personal Opinion: From the research done on chondroitin, I do not believe this supplement to be necessary nor effective in the treatment of osteoarthritis and cataracts. I feel as though patients should seek treatment for these conditions in other forms. References 1. 2. 3.

Glucosamine and Chondroitin. University of Michigan Medicine. https://www.uofmhealth.org/healthlibrary/aa59277spec. Published April 1, 2019. Accessed February 18, 2020. Glucosamine and Chondroitin for Osteoarthritis. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/glucosaminechondroitin. Published September 24, 2017. Accessed February 18, 2020. Shmerling RH. The latest on glucosamine/chondroitin supplements. Harvard Health Blog. https://www.health.harvard.edu/blog/the-latest-on-glucosaminechondroitin-supplements-2016101710391. Published September 16, 2019. Accessed February 18, 2020.

Jennifer Garson Student Pharmacist Spring 2020

Cinnamon Scientific names: Cinnamomum zeylanicum, Cinnamomum Cassia, Cinnamomum loureirii, Cinnamomum verum Common Names: Ceylon cinnamon, Chinese cassia, Chinese cinnamon, Cinnamon, Saigon cinnamon

www.canva.com

Background/History: Cinnamon dates back to Chinese writings in 2800 B.C., but is also referenced in ancient Egyptian text for use in embalming processes. Cinnamon is also mentioned in the Old Testament of the Bible as an ingredient in anointing oil. True cinnamon, or Cinnamon zeylanicum, is native to Sri Lanka. Its botanical name comes from the Hebraic and Arabic term amomon, meaning fragrant spice plant. In medieval times, physicians used cinnamon to treat coughing, hoarseness, and sore throats. It was also used as a preservative to prevent meat from spoiling. Cinnamon was once so highly prized that wars were fought over it. Sri Lanka (then called Ceylon) was the worldâ&#x20AC;&#x2122;s largest cinnamon supplier. Throughout the 17th century, the island of Ceylon was fought over because of cinnamonâ&#x20AC;&#x2122;s high value. Control of Ceylon moved from Portugal to the Netherlands to Holland to France to England throughout the century. In the 1800s, it was discovered that cinnamon could be easily grown in many countries, and it was no longer a rare, expensive commodity.

Purported uses: Cinnamon is most commonly used as a spice in cooking and baking or as an aromatic. It has historically also been used to combat microorganisms and treat a variety of ailments and disorders. These include GI upset, dysmenorrhea, and diabetes. Research around its use focuses on anti-inflammatory, antioxidant, and antimicrobial activity. Evidence behind clinical uses is minimal. Available dosage forms: Ground Powder, Tincture, Extract, Capsules, Tablets, Essential Oil, Ointment, Lotion, Tea Typical dosing/serving: Dosing depends on age, health, and what the cinnamon is being used for. In studies around diabetes, pre-diabetes, and metabolic syndrome, ground cinnamon is given in doses of 1 to 3 g/day. In a study of activity against Helicobacter, 80 mg of cinnamon ethanol extract was given daily.

Pharmacology/ mechanism of action/how it works in the body Cinnamon is believed to be effective in a wide variety of ailments and disorders, yet its mechanisms of action have yet to be confirmed. In diabetes, cinnamon has been shown to imitate the effects of insulin and increase the amount of glucose transporters such as GLUT4. This increases glucose entry into cells and lowers the blood sugar levels. Cinnamon bark contains tannins that have been shows to help wounds by acting as an astringent. It also contains procyanidins that possess antioxidant activities similar to superoxide-dismutase. Cinnamon has also been shown to have antimicrobial effects by decreasing intracellular adenosine triphosphate (ATP) concentration in Map cells that cause infection.

https://fineartamerica.com/featured/background-of-cinnamon-sticks-vsevolod-belousov.html

Effectiveness Research shows limited support or evidence that cinnamon is effective in treating clinical conditions.

Toxicity There is little known about the toxicity of Cinnamon. One study done in rats showed potential hepatotoxicity and nephrotoxicity at extremely high doses (discussed below).

Adverse Effects Adverse effects to cinnamon are uncommon,. At dosages of up to 6 g/day, no significant reactions have been reported. The most common adverse effects are allergic reactions causing skin or eye irritation. Large quantities of cinnamon bark and oil have shown increased heart rate, respiratory rate, and sweating.

Food/Drug Interactions There are no well documented food/drug interactions with cinnamon. However, because it may cause liver damage, it should be monitored in people on hepatotoxic medications. Additionally, Cinnamon was reported to interfere with the effectiveness of tetracycline antibiotics.

Article Summary: An article published on PubMed discusses in vitro and in vivo studies done on the safety of cinnamon extract (Cinnamon cassia). The studies were performed to learn more about the long-term general and genetic toxicity of the extract, due to its wide use in treatment of diseases in Asia. In the study, a group of rats were orally administered repeated high doses (2 g/kg) of cinnamon extract over a 13-week period. After the study, the body weights of the rats remained normal, but they displayed signs of liver and kidney damage. A variety of genetic toxicity tests were performed, and results indicated that cinnamon extract did not have mutagenic or clastogenic properties. The study concluded that further study was required. My personal/professional opinion: Cinnamon is very effective as a spice and taste enhancer in cooking and baking. I do believe that cinnamon can have some positive health effects, and I would encourage its use in cooking. If patients were to ask, I would explain its potential health benefits, but I would caution them not to rely on cinnamon. There is not enough clinical evidence or research completed on cinnamon's effectiveness, toxicity, etc. I would never recommend using cinnamon as monotherapy for the conditions that it is linked to. However, patients might try it for less threatening symptoms or adjunct therapy if they prefer natural treatment.

Safety Cinnamon is categorized as GRAS (Generally Regarded as Safe) by the FDA and USDA. Cinnamon was also approved as a dietary supplement in the U.S. under the Dietary Supplement Health and Education Act of 1994.

www.canva.com

References 1. Adawiyah, Rabiatul & SeratiNouri, et al. (2015). Assessment of Potential Toxicological Effects of Cinnamon Bark Aqueous Extract in Rats. International Journal of Bioscience, Biochemistry and Bioinformatics. 5. 36-44.10.17706/ijbbb.2015.5. 1.36-44. Accessed 2 Mar. 2020. 2. Filippone, P. (2019). Interesting Highlights in the Colorful History of Cinnamon. [online] The Spruce Eats. Available at: https://www.thespruceeats.com/ history-of-cinnamon-1807584. Accessed 3 Mar. 2020. 3. Cinnamon. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed Mar. 2020. 4. Medagama AB. The glycaemic outcomes of Cinnamon, a review of the experimental evidence and clinical trials. Nutr J. 2015;14:108. Published 2015 Oct 16. doi:10.1186/s12937-0150098-9. Accessed 28 Feb.2020. 5. Raman, R. (2019). 6 Side Effects of Too Much Cinnamon. Healthline. Available at: https://www.healthline.com/nut rition/side-effects-ofcinnamon#1. Accessed 28 Feb. 2020. 6. Rao PV, Gan SH. Cinnamon: a multifaceted medicinal plant. Evid Based Complement Alternate Med. 2014;2014:642942. doi:10.1155/2014/642942. Accessed 28 Feb. 2020.

Cocoa Ying Zheng Health Science/Pre-PA Spring 2020 Scientific Name: Theobroma Cacao Common Names: Chocolate, Cacao, Cocoa Bean

https://www.medicalnewstoday.com/articles/319180

History Cocoa was first cultivated in Central America and was consumed as a chocolate drink by Olmec, Mayan and Aztec civilizations. The bitter cocoa taste was often enhanced by the addition of sweet flavors such as vanilla, cinnamon, and cane sugar. Hot chocolate was considered an exclusive drink that could only be consumed by the elite and wealthy. However, the exclusivity of chocolate quickly diminished with the rise of the Industrial Revolution. The production of cocoa powder into solid chocolate has made it more affordable and easier to consume by the general public.

Purported Uses Antioxidant Cholecystography Lactose Intolerance

Typical Dosing Antioxidant: 27 to 80 grams of procyanidin-rich chocolate administered orally as a single dose Cholecystography: 26 to 46 grams of milk chocolate prior to procedure Lactose Intolerance: cocoa powder added to milk at 1.5% concentration

Pharmacology Dosage Forms Powder Processed food Liquid

Antioxidant Effect: positive effects on serum lipids such as an increase in HDL (i.e. good cholesterol) levels Gastrointestinal Effect: stimulates lactase Platelet Inhibitory Effect: reduced platelet activation through inhibition of unstimulated glycoprotein IIb-IIIa expression and inhibition of ex-vivo epinephrine and adenosine diphosphate

Safety & Toxicities

Food/Drug Interactions

Cocoa is likely safe when consumed in moderate amounts for most people. Cocoa consumption in larger amounts during pregnancy may be unsafe because of the caffeine it contains. Daily consumption of more than 7.5 pounds of milk chocolate by pregnant women may be associated with a higher risk of infant acute myeloid leukemia.

Taking calcium with chocolate may decrease the absorption of calories from chocolate.

Adverse Effects Cardiovascular Effects: increased diastolic blood pressure, coronary artery disease Central Nervous System Effects: childhood hyperactivity, migraine headaches

Professional Opinion In my professional opinion, cocoa may be beneficial in moderate amounts for its antioxidant effects. However, I would not recommend consuming large amounts of it in its processed form, such as chocolate bars. If one prefers chocolate bars, then I would recommend dark chocolate because it contains less sugar than milk chocolate.

Gastrointestinal Effects: reduce lower esophageal sphincter pressure, irritable bowel symptoms

Effectiveness There is limited evidence regarding the effectiveness of cocoa.

Dermatologic Effects: acne

Processed food

References

Liquid

Cocoa: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-812/cocoa. Accessed February 27, 2020. Klein C. The Sweet History of Chocolate. History.com. https://www.history.com/news/the-sweet-history-of-chocolate. Published February 14, 2014. Accessed February 28, 2020. Latham LS, Hensen ZK, Minor DS. Chocolate-Guilty Pleasure or Healthy Supplement? The Journal of Clinical Hypertension. 2013;16(2):101-106. doi:10.1111/jch.12223. Cocoa. Micromedex Solutions. Available at http://micromedexsolutions.com. Accessed February 20, 2020.

Coenzyme Q10

Lana Grishin | Student Pharmacist Spring 2020 Scientific Name: Coenzyme Q10 Common Names: Coenzyme Q, CoQ, CoQ10, Ubiquinone, Ubiquinone-Q10, Vitamin Q10 Background/History: First founded in 1940 and later isolated from mitochondria of beef heart in 1957 Mechanism of Action: CoQ10 works in the mitochondrial electron transport chain as a cofactor to accept electrons from complex I and II to enhance ATP production. It has antioxidant activity in the mitochondria and cellular membranes to protect against lipid membrane peroxidation which may reduce cholesterol through inhibition of LDL oxidation.

https://www.google.com/search?q=coenzyme+q10&safe=strict&sxsrf=ALeKk0328eUNt 4yiP7fvVDiuYacA6jEhuQ:1585085653704&source=lnms&tbm=isch&sa=X&ved=2ahUKE wicisaiLToAhXBKM0KHWPWCkkQ_AUoA3oECBsQBQ&biw=829&bih=682#imgrc=mWB2TdFB 5NXbuM Uses:

• •

• • • • • • •

Cardiovascular disease particularly congestive heart failure Correct reduced blood levels of CoQ10 that result from HMG-CoA reductase inhibitors used to treat elevated cholesterol levels Cancer Muscular dystrophy in Parkinsons Obesity Migraines Immune dysfunction May help with Diabetes Keeps skin young

Dosage Forms: • Tablet • Oil Based capsule • Powder filled capsule Typical Dosing: 5-300 mg by mouth daily 50-200mg by mouth daily has highest effectiveness

https://www.google.com/search?q=coq10+supplement&safe=strict&sxsr f=ALeKk03eMyh7STi1ElpA5HPJrgUSfhovzw:1585086391516&source=lnm s&tbm=isch&sa=X&ved=2ahUKEwjCwLf6irToAhWLKM0KHTeED1EQ_AUo A3oECBkQBQ&biw=829&bih=682&dpr=2#imgrc=V6opOY7eaaKY7M

Effectiveness: Uncertain. Studies still being done. Safety: Only mild side effects reported. Safe when taken by mouth Toxicities: Low level of toxicity since this is a natural enzyme Adverse Effects: • Nausea • Diarrhea • Epigastric distress • Loss of appetite Food/Drug Interactions: • Anticoagulants: Warfarin • Antidiabetics: Insulin • Statins • Beta Blockers: Propranolol • Piperine found in black pepper

Personal Opinion:

Investigation of Product: In Cancer 236 breast cancer patients were randomized to receive either CoQ10 or placebo for 24 weeks. Study found that levels of fatigue and overall the quality of life of patients who received CoQ10 supplementation were not improved compared to those who received placebo. 20 children treated for leukemia were given CoQ10 to see if it would protect the heart from damage by doxorubicin. Results showed that CoQ10 decreased doxorubicin effects on the heart. From these trials it is not clear if benefits reported were from CoQ10 therapy, other dietary supplements or standard cancer treatment.

References: •

CoQ10 does play a key role in the body but most healthy people produce enough naturally without needing an extra supplement. I don’t believe there is enough finding of effectiveness to recommend taking regularly.

https://www.google.com/search?q=coenzyme+q10&safe=strict&sxsrf=ALeKk0328 eUNt4yiP7fvVDiuYacA6jEhuQ:1585085653704&source=lnms&tbm=isch&sa=X&ve d=2ahUKEwicisaiLToAhXBKM0KHWPWCkkQ_AUoA3oECBsQBQ&biw=829&bih=682#imgrc=BB0A

•

Coenzyme Q10. (2017, October 13). Retrieved from https://www.mayoclinic.org/drugssupplements-coenzyme-q10/art20362602 Saini, R. (2011, July). Coenzyme Q10: The essential nutrient. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3178961/ The update and distribution of Coenzyme Q10 | Request PDF. (n.d.). Retrieved from https://www.researchgate.net/publi cation/6382957_The_uptake_and_dis tribution_of_coenzyme_Q10

Ali Hamidi, Student Pharmacist Spring 2020

Background/History

medicalnewstoday.com

In North America, cranberries were used in a variety of remedies and foods and for dye. In the U.S, cranberry cultivation was developed in 1816. 2

Mechanism of action

Purported Uses:

Research suggests that cranberry can prevent bacterial adherence to host cell surface membrane, and it the possible mechanism of action for preventing urinary tract infections. It has been found to inhibit hemagglutination of E. coli using type 1 and P adhesin using component compounds fructose and proanthocyanins.

Dosage Form/Typical Serving Cranberry juice concentrate (tablets and capsules) and dried extract are available as dietary supplements. One serving of cranberry pills is usually equivalent to 9 ounces of pure cranberry juice. Tablets and capsules are available typically from 450 mg to more than 1200 mg/day in divided doses.

         

Preventing urinary tract infections (UTIs) Lowering blood sugar in people with diabetes Benign prostatic hyperplasia Common cold Coronary artery disease Stomach ulcers Flu Kidney stones Metabolic syndrome Urine odor

naturemade.com

CRANBERRY

Scientific name: Vaccinium oxycoccos Common names: Northern cranberry

Effectiveness:

Professional Opinion

There is no scientific evidence or enough trials for the use of cranberry as a urinary acidifier and or prevention of UTI. But the Society of Obstetricians and Gynecologists of Canada (SOGC) guidelines on UTI (2010) recommend cranberry products as effective in reducing UTIs based on controlled data. A single experimental study showed that cranberry juice inhibits the adherence of E. coli and inhibiting the coaggregation of a substantial portion od dental plaque bacteria

There have been many studies about the effect of cranberry for UTIs, and it shows that cranberry can prevent, but not treating, urinary tract infections. Although, like many other dietary supplements, we need more clinical trials to prove or disprove this supplement. But there is very little research on cranberry for other medical conditions. In general, cranberry is a safe herbal product without any significant drug interactions. 1

References 1.

Cranberry may increase the absorption of vitamin B12 in patients who also are taking protein pump inhibitors. The hypoprothrombinemic effect of warfarin may be increased by cranberry.

Cranberry. National Center for Complementary and Integrative Health. Available at: http://nccih.nih.gov. Accessed March 01, 2020.

Cranberry for Prevention of Urinary Tract Infections. American Family Physician. Available at: https:// https://www.aafp.org/journals/afp. html. Accessed March 01, 2020.

Safety

Cranberry. Prescription Drug Information, Interactions & Side Effects. Available at: https:// https://www.drugs.com. Accessed March 01, 2020.

Food/Drug Interactions katymedsolutions.com

Adverse Effects/Toxicities Common side effects may include upset stomach, nausea, vomiting, and diarrhea. Patients must stop using cranberry and call their healthcare provider if they have pain or burning when they urinate or signs of a kidney stone, including pink or red urine and waves of sharp pain in the side or back spreading to the lower stomach and groin. 3

Cranberry appears to be a safe and welltolerated product, but large amounts can cause stomach upset. People should not use cranberry as a treatment for UTI.

Maridith Hebenstreit, Student Pharmacist, Spring 2020

Scientific Name: 2-[carbamimidoyl(methyl)amino]acetic acid Common Name(s): • Creatine • Creatine citrate • Creatine monohydrate • Creatine phosphate

Background History Creatine is a natural chemical produced by the body, specifically in skeletal muscles and the brain. Creatine helps produce ATP to give the body more energy.

Available Dosage Forms • Oral powder form

https://thescrutinizer.org/creatine-all-you-need-toknow/

Mechanism of Action Creatine binds to phosphate which forms the creatine phosphate compound catalyzed by creatine kinase. The phosphocreatine compound binds with ADP to create ATP, a major source of energy in the body.

https://jp.bodybuilding.com/store/opt/crea.html

• • • •

Purported Uses Athletic performance Creatine deficiency Gyrate atrophy Heart failure

Typical Dosing/Serving • For increased athletic performance: • Loading dose of 20 grams/day for 5-7 days then lower the dosing to 3-5 grams/day • For congestive heart failure: • 5 grams four times daily for 5 days http://www.burstathleticperformance.com/performa nce-training

Effectiveness • Evidence found effectiveness for: • Age-related muscle loss • Athletic performance • Low physiological creatine levels • Muscle strength

Toxicities Use of creatine as a supplement could cause gastroenteritis if consumed as an undissolved powder.

https://www.healthline.com/nutrition/creatinesafety-and-side-effects

Personal Opinion From my research and opinion, creatine seems to work as an enhancement for athletic performance when dosed appropriately and used cautiously. It is important for those using creatine as a supplement to be aware of hypersensitivities to kidney dysfunction and certain medications. As with any supplement, a patient should consult their doctor or a healthcare professional first to see if creatine would be useful to take.

Safety Caution with hypersensitivity to creatine, impaired kidney function, and drugs that contraindicate renal function (cimetidine, trimethoprim and NSAIDs).

Adverse Effects • • • • • •

Weight gain Water retention GI effects (diarrhea) Muscle cramping Kidney stones Dehydration

• • • • •

Food/Drug Interactions Ma Huang Caffeine Cimetidine Trimethoprim NSAIDs

Summary of Article/Study Creatine is commonly used and is a very popular supplement for athletic training. Although there is sufficient evidence proving its effectiveness in energy storage and muscle building, there also is evidence that creatine levels decrease the longer there is time spent exercising. References Cooper R, Naclerio F, Allgrove J, Jimenez A. Creatine supplementation with specific view to exercise/sports performance: an update. Journal of the International Society of Sports Nutrition. 2012;9(1). doi:10.1186/1550-2783-9-33. Creatine: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono873/creatine. Accessed March 5, 2020. IBM Micromedex: Creatine. (2020). Retrieved March 2, 2020.

Spring 2020

Karrie Hebert, Student Pharmacist

Curcumin

(1E,6E)-1,7-bis (4-hydroxy-3methoxyphenyl)-1,6-heptadiene-3,5-dione

What is Curcumin?

 Background & History

Curcumin is a naturally-occurring, chemical compound. It was first identified in 1815 and has been used for medicinal purposes for centuries for conditions such as depression and arthritis. It also provides the bright yellow pigment in turmeric, which is best known for being used in curry. It is scientifically known as Curcuma Longa, which is likely where curcumin gets its name.

 Purported Uses  How it works  Dosage forms & Typical Dosing  Effectiveness & Safety  Adverse Effects & Toxicities  Food & Drug Interactions  Recent News & Personal Thoughts  References

Special points of interest: • A turmeric root typically contains about 2-5% of curcumin. • Curcumin makes up 80% of the weight of turmeric.

• Some studies suggest that turmeric has benefits that curcumin alone doesn’t; however, more research is needed.

Curcumin is thought to work on various processes of the body. The mechanism by which it works is yet to be discovered.

Source: Google Images

INSIDE THIS ARTICLE:

Turmeric root is used as a cooking spice commonly found in India. Referred to as Indian saffron, yellow ginger, yellow root or kacha haldi.

Some studies have shown that curcumin is able to interfere with directly with AP1, a class of transcription factors released by tumor promotors that are involved with cell proliferation, survival and differentiation, therefore inhibi-

Unfortunately, curcumin is poorly absorbed and is quickly metabolized. To combat this, several formulations have been created.

Dosage Forms & Typical Dosing Curcumin can be extracted from turmeric to create supplements with a higher potency than turmeric alone.

curcumin. Some also have piperine to help increase bioavailability.

The most common regimen is one to three 500 Commercial supple- milligram capsules daily. ments are usually cap- This is the dosing comsules containing 95% mon for depression, hay Source: Google Images

tion could stop tumor production.

fever, and/or osteoarthritis. Even higher doses of 3-6 grams per day have been used for protective effects against ulcers while smaller doses are used as a stimulant and carminative.

Is Turmeric Safe to Consume During Pregnancy?

However, research on non-pregnant female rats suggested that large amounts of curcumin may benefit the female reproductive system by reducing ovarian cysts in rats with PCOS (polycystic ovarian syndrome). It was admitted that researchers haven’t carried out studies on the safety of curcumin consumption during human pregnancy. It was determined that pregnant women should be cautious and limit their consumption of curcumin.

References Anderson LA, Sinha S, et al. Turmeric Uses, Benefits & Dosage. Herbal Database. 2019 Jan 17. Gupta SC, Patchva S, et al. Therapeutic Roles of Curcumin: Lessons Learned from Clinical Trials. PMC. 2012 Nov 10. Higdon J, Drake VJ, et al. Curcumin. Lingus Pauling Institute. 2016 March.

Numerous preclinical trials have been completed for curcumin, many of which have shown therapeutic potential against a number of human diseases. Each study evaluated doses up to 8 grams per day for safety, tolerability and non-toxicity. From the completed clinical trials, curcumin’s clinal efficacy seems “too good to be true”. Poor bioavailability and limited adverse effects, in addition to the curcumin polyphenol, is the reason why this compound hasn’t been approved for human use. Generally speaking, curcumin seems safe, however more studies need to be conducted to further identify potential safety and efficacy.

Source: Google Images

A study from 2007 tested curcumin consumption on female rats during pregnancy and ultimately determined that the progeny had a slightly lower birth rate. A study from 2010 also linked curcumin intake with lower implantation rate and lower fetal weight.

Effectiveness & Safety

FOOD/DRUG INTERACTIONS There are no known food interactions; however, people on blood-thinning drugs (like warfarin) should avoid large doses of curcumin.

Adverse Effects & Toxicities The curcumin polyphenol has been reported to have undesired adverse effects associated with it. A dose-escalation study was completed to determine the maximal tolerable dose and safety of a single oral dose of curcumin ranging

from 500 to 12,000 milligrams. Safety was assessed 72 hours postadministration. Approximately 1/3 of the participants experienced diarrhea, headache, rash and yellow stool. Another study doses ranging

with from

0.45 to 3.6 grams per day for 1 to 4 months was associated with nausea and diarrhea in addition to increased serum alkaline phosphatase and lactate dehydrogenase contents. More studies need to be done to evaluate long-term toxicity.

Author's Thoughts After the extensive research completed in regards to curcumin, it seems as though this is a product that has several (likely) more beneficial than harmful effects that could be of assistance to a plethora of disease states. It would be great to see more research completed on the efficacy and long-term safety details in order to further support the use of curcumin.

YI FEI HENG STUDENT PHARMACIST SPRING 2020

DEVIL'S CLAW Scientific Name: Harpagophytum procumbens Common Names: Devil's claw; Grapple plant; Grapple vine; Radix Harpagophyti; Wood spider; Xwate

https://thefeelgoodlab.com/blogs/the-lab/the-sooner-you-know-about-devil-s-claw-root-the-better

Background/History: Devil’s claw (Harpagophytum procumbens) is a small plant that naturally grows in the Kalahari Desert and Namibian steppes of southwest Africa. It’s claw-like protrusions from its fruit that gives the plant its common name is meant to attach to animals so the seeds can be spread. The roots and tuber of the plant have been used as a folk remedy for liver and kidney disorder, allergies, headache, and most commonly rheumatism. Today, the herb is marketed as an anti-inflammatory and analgesic in low back pain and osteoarthritis.

Pharmacology: Harpagoside is a glycoside that is found primarily in the roots of Devil’s claw and is thought to be the major chemical component that contributes to the anti-inflammatory properties. The most agreed upon mechanism is via the inhibition of COX-2 enzymes, but other proposed mechanisms include antioxidant activity, reductions in expression of prostaglandin PGE2. There isdata that suggests the inhibition of COX-enzymes is dependent on the ratio of concentrations of harpagoside and three other chemical components.

Common uses: Low back pain Osteoarthritis Rheumatoid arthritis Muscle pain

Available dosage forms: Capsules Extract Powder

Typical Serving: Crude tuber: up to 9 g daily Extract: 1 to 3 g of extract Harpagoside: 50 to 100 mg.

Effectiveness and safety:

Food/Drug Interactions:

A literature review was conducted over fourteen studies that found that data supports Devil’s Claw’s efficacy in reducing pain. However, many of the published studies did not meet quality criteria and the populations were too small to be able to draw any conclusions on safety.

Do not use Devil's Claw with most heart medications (antiarrhythmic, chronotropic, or inotropic medicines) because here has been a decreased heart rate observed in rats. Use with caution if you are taking anticoagulant medications, including warfarin, aspirin, aspirincontaining products, NSAIDs, or antiplatelet agents. It is also recommended that you tell your doctor and pharmacist that you are taking Devil's Claw.

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

Toxic Effects: There have been no studies that show the toxicity of Devil’s Claw or its main ingredient.

https://www.herb-pharm.com/product/devils-claw/

Adverse Effects: Patients have reported headaches, tinnitus (ringing in ears) and anorexia with taking Devil's Claw. Patients with gastric or duodenal ulcers may experience bitterness and an increase in gastric secretions.

https://www.iconfinder.com/icons/231472 5/aspirin_medicine_no_sign_tablet_icon

Personal Opinion: In my personal opinion, Devil’s Claw can be used as a natural product for mild pain. I believe that other medications are more effective in managing pain and osteoarthritis, but if the patient is unable to take them, or prefers natural remedies, Devil’s Claw can be used as long as the patient is aware of potential side effects, takes the herb correctly, and notifies their physician and pharmacist.

https://www.nicepng.com/ourpic/u2w7w7o0w7u2i1i1_free-mortarand-pestle-clipart-rx-logo-pharmacy/#

References: Abdelouahab N, Heard C. Effect of the major glycosides of Harpagophytum procumbens (Devil's Claw) on epidermal cyclooxygenase-2 (COX-2) in vitro. J Nat Prod. 2008;71(5):746-749 Brien S, Lewith GT, McGregor G. Devil's Claw (Harpagophytum procumbens) as a treatment for osteoarthritis: a review of efficacy and safety. J Altern Complement Med. 2006;12(10):981-993 Mahomed IM, Ojewole JAO. Analgesic, antiinflammatory and antidiabetic properties of Harpagophytum procumbens DC (Pedaliaceae) secondary root aqueous extract. Phytotherapy Research. 2004;18(12):982-989.

DHEA

(dehydroepiandrosterone) Heather Hope Student Pharmacist Spring 2020

Scientific Name [3]

Dosage Forms [5]

-----------------------------------------

---------------------------------

3β-hydroxyandrost-5-en-17-one

•

Tablets

•

Capsules

•

Creams

•

Penssaries

•

https://www.bronsonvitamins.com/media/catalog/product/cache/c687a a7517cf01e65c009f6943c2b1e9/2/2/226b-0618-front-with-product.jpg

https://upload.wikimedia.org/wikipedia/commons/thumb/6/66/De hydroepiandrosteron.svg/1200px-Dehydroepiandrosteron.svg.png

Typical Dosing [3,7]

Backgound & History [4,5] -----------------------------------------

Gels

-----------------------------------------

•

Depression: 30-500 mg daily

•

Infertility: 75 mg daily

hormone in human plasma. For many years, DHEA was only thought of as an inactive

•

Vaginal atrophy: 10% cream applied daily

androgens. In 1965, however, scientists

After its discovery in 1934, DHEA was found to be the most abundant circulating steroid

•

Erectile dysfunction: 50 mg daily

intermediate in the synthesis of estrogens and

•

Adrenal insufficiency: 20-50 mg daily

•

reported that DHEA levels decline with age. Following this, DHEA became an interest to

Anti-aging: 50 mg daily

•

Osteoporosis: 50-100 mg daily

the scientific community for its possible antiaging effects.

-----------------------------------------

•

-----------------------------------------

DHEA is an endogenous hormone produced Common Names [3]

•

Pharmacology [1,5]

DHEA

Androstenolone

by the brain, the adrenal glands, and the gonads. It is primarily involved in the

bioconversion of cholesterol to estrogens and androgens (e.g. estradiol and testosterone). In both men and women, DHEA levels begin to

Purported Uses [2,3,7] -----------------------------------------

DHEA supplements are commonly used to

rise during puberty and peak between the ages of 20 and 30. Following this, DHEA

levels steadily decrease. As a result DHEA

help with depression, infertility, vaginal

has been implicated in many age-related

insufficiency. DHEA supplements are also

vaginal atrophy. Given that DHEA has weak

atrophy, erectile dysfunction, and adrenal thought to slow the aging process, and increase bone density and muscle mass.

conditions such as erectile dysfunction and androgenic and estrogenic effects, it is

thought to treat or prevent such conditions.

Effectiveness [3]

Drug-Drug Interactions [2,3,7]

-----------------------------------------

Intrarosa® (prasterone), an FDA-approved

•

Antipsychotics

vaginal suppository containing DHEA, has

•

been shown to be effective for vaginal

•

Anticoagulants / Antiplatelets

atrophy. Some research suggests DHEA may

•

also be effective for adrenal insufficiency,

Glucocorticoids

•

depression, infertility, aging skin and

Triazolam

•

Estrogen

osteoporosis. However, no current data

•

Testosterone

suggests DHEA is effective for erectile

•

Substrates of CYP3A4

Due

Antidepressants

dysfunction or for increasing muscle mass. Adverse Effects and Toxicities [2,3,7] -----------------------------------------

Article Summary [6] -----------------------------------------

The purpose of this study was to assess the possible antidepressant effects of DHEA in 21

•

Abdominal pain

•

Hirsutism

•

Acne

weeks, patients either received placebo or

•

Deepening of the voice

•

Hypertension

depression was determined using the

•

Decreased HDL cholesterol

•

Breast tenderness

of the study, individuals who received DHEA

•

Alopecia

•

Heart arrythmias

Depression Rating Scale than those who

individuals suffering from depression. For 6 DHEA (90 mg/day). The severity of their

Hamilton Depression Rating Scale. At the end had a greater decrease in Hamilton received placebo.

Safety [3]

Professional Opinion

-----------------------------------------

When taken orally, doses of DHEA less than 100 mg have been taken safely for up to 2

years. However, high doses or long-term use of DHEA may be unsafe because it increases

-----------------------------------------

While some research suggests DHEA may be effective for several conditions, long-term use requires further evidence of safety and

the risk of blood clots and hormone-sensitive

efficacy. Because DHEA is a hormone, it can

liver function, hormone levels, blood pressure

be used under the supervision of a healthcare

cancers. The use of DHEA may also alter and cholesterol control.

cause serious side effects so it should only provider.

Refrences

-----------------------------------------

[1] Dehydroepiandrosterone. Wikipedia. Wikimedia Foundation. https://en.wikipedia.org/wiki/Dehydroepiandrosterone. Published February 21, 2020. Accessed March 6, 2020 [2] DHEA. Mayo Clinic. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/drugssupplements-dhea/art-20364199. Published December 14, 2017. Accessed March 6, 2020. [3] DHEA. MedlinePlus. U.S. National Library of Medicine. https://medlineplus.gov/druginfo/natural/331.html. Published December 9, 2019. Accessed March 6, 2020. [4] Prasterone. Wikipedia. Wikimedia Foundation, https://en.wikipedia.org/wiki/Prasterone. Published February 26, 2020. Accessed March 6, 2020. [5] Rutkowski K, Sowa P, Rutkowska-Talipska J, Kuryliszyn-Moskal A, Rutkowski R. Dehydroepiandrosterone (DHEA): Hypes and Hopes. Drugs. 2014;74:1195–207. [6] Wolkowitz OM, Reus VI, Keebler A, Nelson N, Friedland M, Brizendine L, et al. Double-blind treatment of Major Depression with Dehydroepiandrosterone. The American Journal of Psychiatry. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pubmed/10200751. Published April 1999. Accessed March 6, 2020. [7] Wong, Cathy. The Health Benefits of DHEA Supplements. Verywell Health. www.verywellhealth.com/dhea-whatshould-you-know-about-it-89136. Published December 13, 2019. Accessed March 6, 2020

DMHA Spring 2020

Sydney Jablonski, Student Pharmacist

SCIENTIFIC NAMES: 1,5-dimethylhexylamine 2-amino-5-methylheptane 2-amino-6-methylheptane 2-aminoisoheptane 6-amino-2-methylheptane

MECHANISM OF ACTION: DMHA is a psychoactive central nervous system stimulant. It acts as a stimulant by increasing the uptake of dopamine and noradrenaline.

OTHER COMMON NAMES: Amidrine Octodrine Vaporpac

AVAILABLE DOSAGE FORMS: Powders Capsules Oral liquids

HISTORY:Â DMHA was originally developed in the 1950s as a nasal decongestant. PURPORTED USES: Improved athletic performance Weight loss Fat loss

TYPICAL SERVING: 1 mg/kg of bodyweight up to 160 mg per day 15-60 minutes before a workout, or taken between meals

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

EFFECTIVENESS: More evidence is needed to support DMHA's efficacy regarding its purported benefits. SAFETY: The safety of DMHA as an individual drug remains unknown due to the lack of placebo-controlled trials, but animal studies suggest potential for adverse cardiovascular effects. ADVERSE EFFECTS: Mood swings Tremor Concentration deficiency Energy crashes Anxiety High blood pressure Dyspnea Heartburn Rapid heart beat TOXICITIES: Large, toxic doses in animal studies have led to symptoms including dilated pupils, vomiting, and convulsions. PROFESSIONAL OPINION: Given this drug's potentially fatal cardiovascular effects and lack of placebo-based studies, I cannot recommend this supplement. There are other, more well-studied stimulants available on the market.

FOOD AND DRUG INTERACTIONS: Taking DMHA with any other stimulant medications is not advised; these may worsen the adverse cardiovascular effects of DMHA such as high blood pressure and rapid heart rate.

DMHA STUDIES: A recent study analyzed six supplements that listed DMHA as an ingredient, with the possibility that they might refer to 1,3-DMAA analogs, a banned substance in the U.S. and many other countries. Two 1,3-DMAA analogs and two banned stimulants were identified. DMHA itself was present in concentrations more than twice the largest pharmaceutical dose. SOURCES: 1. Catalani V, Prilutskaya M, Al-Imam A, et al. Octodrine: New Questions and Challenges in Sport Supplements. Brain Sciences. 2018;8(2):34. doi:10.3390/brainsci8020034. 2. Classification of Octodrine. MedSafe. https://www.medsafe.govt.nz/profs/class/Agendas/Agen63 /MCC63_72c_octodrine.pdf. Accessed July 2019. 3. Cohen PA, Travis JC, Keizers PHJ, Deuster P, Venhuis BJ. Four experimental stimulants found in sports and weight loss supplements: 2-amino-6-methylheptane (octodrine), 1,4-dimethylamylamine (1,4-DMAA), 1,3dimethylamylamine (1,3-DMAA) and 1,3dimethylbutylamine (1,3-DMBA). Clinical Toxicology. 2017;56(6):421-426. doi:10.1080/15563650.2017.1398328. 4. Is Octodrine Allowed in Sport? U.S. Anti-Doping Agency (USADA). https://www.usada.org/spirit-ofsport/education/octodrine/. Published January 3, 2020. Accessed March 5, 2020.

Dong Quai Angelica sinensis (Oliv.) Diels Emily Jansen, Student Pharmacist Spring 2020

Figure 1 https://www.vectorstock.com/royalty-free-vector/angelicasinensis-or-dong-quai-or-female-ginseng-vector-13809859

Common names: Chinese angelica, Danggui, Tang-kuei, female ginseng Chemical constituents: 1. Ferulic acid 2. Z-ligustilide 3. Butylidenephthalide 4. Various polysaccharides

Purported uses: - Analgesic for joint pain - Allergy suppressant â&#x20AC;&#x201C; anti-asthmatic, antispasmodic, anti-inflammatory - Menstrual disorders â&#x20AC;&#x201C; cramps, PMS, menopause - Anticoagulant

Available dosage forms and typical dosing: - crude root extract by decoction: 3-15g/day - powdered root: 1-2g up to 3x per day - tablets: 500mg up to 6x per day - in combination: 75mg-500mg may take up to 6x per day

Background/history: Dong Quai has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. It has generally been used for health issues in women as a blood strengthener in cardiovascular conditions, inflammation, headache, infections, and nerve pain.

Mechanisms of Action: 1. Antioxidant: Increased of IL-2 and IFN-gamma; decrease of IL-4 (polysaccharide) 2. Anti-inflammatory: Inhibition of TNF-a and NF-kB luciferase activity (Ferulic acid); Decreased secretion of IL6 and TNF-a during LPS stimulated activation of murine dendritic cells via the suppression of the NFkB dependent pathways 3. H2O2- induced IL-1b, TNF-a, matrix metalloproteinase-1 and matrix metalloproteinase-13 levels; increases SRY-related high mobility group-box gene 9 expression in chondrocytes; Stimulates NO production via induction of iNOS expression via female peritoneal macrophages 4. Anti-Cardiovascular: Decreased doxorubicin-induced myocardial damage and serum aspartate aminotransferase levels in male ICR mice 5. Anti-cancer: Induction of apoptosis and cell cycle arrest at G0/G1 phases; Increase in intracellular reactive oxygen species level, decrease Bax expression and cleaves caspase-3 and cytochrome C; Inhibit the growth of HeLa cells in nude mice by increased activity in caspase-9,3 and poly (ADP-ribose) polymerase (PARP) (Polysaccharides) 6. Anti-hepatotoxic (Z-ligustilide): Induction CYP2D6 and CYP3A4 7. Neuroprotective: Decreases level of malondialdehyde (MDA) and increases activities of the antioxidant enzymes glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) in mice brain tissue; Decrease in Bax and caspase-3 protein expression

Figure 1 https://healthy.net/wp-content/uploads/2019/08/cropped-angelica-flower1024x472.jpg

Food/drug interactions - increase CYP2D6 and CYP3A4 activity in the liver of rates (herb/drug interaction) - Antiplatelet/anticoagulant/NSAIDs/Salicyla tes/ Thrombolytic agents (medication or herbals) → increased risk of bleeding - Aminolevulinic acid/Verteporfin/Porfimer – May enhance the photosensitization effect Effectiveness: Effective for: prevention of deterioration of renal function, inhibition of IgE-production, antioxidant effect, antispasmodic in uterine contractions (all animal models). No more effective than placebo for menopausal symptoms No efficacy data for: migraine, angiogenesis, premenstrual syndrome

Toxicities - Phototoxicity - INR spike when used at the same time as warfarin - Increased risk of bleeding

Adverse effects 1. fever 2. gynecomastia 3. bleeding with concurrent warfarin use 4. risk of photosensitization

Safety: Do not use if: - You are on warfarin, heparin, or other anticoagulant /antiplatelet therapy - Have breast cancer, endometriosis, or other estrogen sensitive conditions - You are pregnant or breastfeeding – related species have been reported as abortifacient and affected the menstrual cycle

Figure 2 https://www.organicfacts.net/health-benefits/herbsand-spices/dong-quai.html

https://www.antibodies-online.com/resources/16/677/antiimmunoglobulin-e-ige-secondary-antibodies/

My professional opinion: Dong quai has been proven to have a bioactive role when taken as a supplement. Based on my research, dong quai may be useful for menstrual disorder symptoms and as a blood thinner. Since it is proven to have bioactive compounds, I would trust dang quai to help if I were unwilling to try prescription medications for these purposes. As a future pharmacist, I would not recommend this product to my patients, though, due to its high likelihood of interactions with medications my patients may be taking regularly and some foods. Article Summary: With an analysis of the absorption and metabolite components in plasma from a rabbit administered an oral solution of dong quai (also known as danggui), there were 70 compounds that were isolated and identified with only a handful having effects on the body. This method utilized chromatographic fingerprints of Danggui oral solution (DOS) and the rabbit plasma samples after administration of DOS. There were 32 peaks that were common both in the rabbit plasma and the DOS. This means that 32 of the compounds were absorbed into the systemic circulation of the rabbit. To identify which compounds were what, knowledge of the chemical structures and their molecular weights were used, along with UV spectrum information. Senkyunolide I, 3-butylidene-7hydroxyphthalide, falcarindiol, linolenic acid, linoleic acid, and Diels-Alder dimers of ligustilide were tentatively identified. Z-ligustilide and Z-butylidenephthalide are reported to be pharmaceutically active compounds within danggui. References: Chao WW, Lin BF. Bioactivities of major constituents isolated from Angelica sinensis (Danggui). Chin Med. 2011;6:29. Published 2011 Aug 19. doi:10.1186/1749-8546-6-29 Don Quai. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed February 20, 2020. Page II RL, Lawrence JD. Potentiation of Warfarin by Dong Quai. American College of Clinical Pharmacy. https://accpjournals.onlinelibrary.wiley.com/doi/epdf/10.1592/phco.19.10.870.31558. Published January 17, 2012. Accessed February 20, 2020. Wh, Huang, Chen, et al. LC-DAD-APCI-MS-based screening and analysis of the absorption and metabolite components in plasma from a rabbit administered an oral solution of danggui. Analytical and Bioanalytical Chemistry. https://link.springer.com/article/10.1007/s00216-0050008-7. Published January 1, 1997. Accessed February 28, 2020

Nathan Jaworsky Student Pharmacist

Spring 2020

https://nccih.nih.gov/health/echinacea/ataglance.htm

Commonly known as Echinacea and Eastern purple coneflower Echinacea is native to North America, and has about 10 different species. Echinacea was the most used medical plant by native americans in the midwest. Many different tribes would either make tea with the leaves or chew on the roots for colds and sore throats. Several tribes also found it to be used to treat snakebites. The plant was used in medications in 1887 by John Uri Lloyd, a pharmacist who specialized in herbal medicines. Even though Echinacea has fallen out in American medicine, Echinacea is still popular in Europe for immune support and upper respiratory health.

Common uses: common cold, anxiety, exercise performance, gingivitis, Herpes virus, HPV, influenza Available forms/ typical serving: Herb Juice 6-9mL orally daily, crude herb extract 2 tablets orally daily, Echinacea root tincture 900mg orally daily. Effectiveness: multiple studies have been done with different types of echinacea plants causing a lack of consistent and positive evidence.

pharmacology/mech of action (if unknown state so): Echinacea stimulates cytokines which activate natural killer immune cells. Echinacea also has properties that can stimulate the growth and activation of macrophages; however, this mechanism is not proven.

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

Safety concerns/warnings: Avoid use with autoimmune disorders, take caution when using with atopic conditions and when pregnant.

Adverse effects/side effects: abdominal pain, altered fertility, diarrhea, dizziness, skin rash, feer, nausea, vomiting, itching, sore throat.

http://www.differencebetween.info/difference-between -side-effects-and-adverse-effects

Toxic effects: lethal dose has not been determined. Do not exceed 2,500mg/kg when IV (no one has done this but it is the closest guess to the lethal dose)

Interactions (food/drugs): Beclomethasone, astragalus, maitake(mushroom), caffeine breaks down slower, P450 3A4 substrates, P450 1A2 substrates

In my professional opinion I think that Echinacea can be used, but would not be my first recommendation. If you are looking for a “natural remedy” and avoid a doctor’s visit or any over the counter drugs, Echinacea could be used for the common cold. This is the only condition that there have been positive studies for. You can take it for the other claimed uses, but I will not be able to tell you that it will help in any way. I would make sure that no one with an autoimmune disorder would use Echinacea. Also, make sure to check your medications to make sure there are no drug or food interactions. Echinacea: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-981/echinacea. Accessed February 29, 2020. Echinacea: Side Effects, Dosages, Treatment, Interactions, Warnings. RxList. https://www.rxlist.com/consumer_echinacea/drugs-condition.htm. Published May 17, 2017. Accessed February 29, 2020. Lawson L. Echinacea History. Yerba Prima. https://yerba.com/reading-room/herbs/echinacea-history/. Published February 26, 2018. Accessed February 29, 2020.

HYUN KIM

STUDENT PHARMACIST SPRING 2020

EVENING PRIMROSE Oenothera biennis | Sundrops/Suncups

BACKGROUND Native Americans first used it to heal wounds and to sedate Cherokee Indians used it for hemorrhoids by heating the root Iroquois used it for skin problems Introduced in Europe in the 17th century and became known https://nature.mdc.mo.gov/discover-nature/ field-guide/common-evening-primrose

PHARMACOLOGY The seeds of the evening primrose are rich in omega-6 essential fatty acids, which cause the direct effect of the therapeutic uses Dietary omega-3 and omega-6 EFAs reduce unsaturated fatty acids in tissues and shows eicosanoid actions Used for inflammation and joint pains (arthritis)

PURPORTED USES Used for arthritis, skin disorders, allergies, asthma, premenstrual syndrome, and depression Helps the liver after alcohol uses and helps with the withdrawal symptoms

DOSAGE Available Dosage Form: Soft gel capsules Typical Dosing 6-8g/day in adults 2-4g/day in children

https://www.walmart.com/ip/Spring-ValleyEvening-Primrose-Oil-Softgels-1000mg-75Softgels/10324999

P. 1

EFFECTIVENESS Evening primrose has been known for its effectiveness for eczema and breast pain

SAFETY https://www.healthline.com/health/eveningprimrose-oil-hair-loss

FOOD/DRUG INTERACTION Anticoagulants - May enhance the side effects of anticoagulants Antiplatelets - May enhance the side effects of antiplatelets. Bleeding might occur Salicylates - May enhance the side effects of salicylates. Bleeding might occur

MY PERSONAL OPINION I think that Evening Primrose would be a great choice for patients with dermatitis and other skin disorders. If the patients do not want to use Western medicine, it would be a great alternative option.

REFERENCES

Evening primrose is safe as long as the user does not use more than 6g/day

ADVERSE EFFECT Upset stomach, headache, nausea, and diarrhea

TOXICITY No observed toxic effect

INVESTIGATION OF A PRODUCT Contains GLA to support metabolic and cellular health Contributes to women's health Nourish dry skin Gluten-free and dairy-free Beauty support If pregnant, consult the user's doctor

Bayles, B., & Usatine, R. (2009). Evening Primrose Oil. American Academy of Family Physician. Retrieved from https://www.aafp.org/afp/2009/1215/p1405.html. Accessed March 4, 2020. Evening Primrose Oil. (n.d.) WebMD, 2020. Retrieved from https://www.webmd.com/vitamins/ai/ingredientmono-1006/evening-primrose-oil. Accessed March 4, 2020. Meyers, Liz (n.d.). Evening Primrose Oil. The Medicinal Herb Gardens at ONU. Retrieved from https://webstu.onu.edu/garden/node/333. Accessed March 26, 2020.

P. 2

Feverfew Tanacetum

parthenium

Amy Lam Pre-med student Spring 2020

Common names:

Background/History: In the 5th century BC, the ancient Greeks called the feverfew herb Parthenium, as it had supposedly saved the life of someone who had fallen from the Parthenon, a temple dedicated to the goddess Athena, during construction. The name was derived from use in treating menstural cramps, as the word Parthenos means virgin in the Greek language. The first century Greek physician Dioscorides used feverfew as an antipyretic, in which the herb was known as the â&#x20AC;&#x153;aspirinâ&#x20AC;? of the 17th century. Then in 1633, the plant was recommended for use to treat headaches in Gerardâ&#x20AC;&#x2122;s Herbal.

Common uses:

https://www.gaiaherbs.com/blogs/herbs/feverfew

Altamisa, Bachelor's button, Chamomile grande, Chrysanthemematricaire, European feverfew, Feather-fully, Featherfew, Featherfoil, Febrifuge plant, Feddygen fenyw, Flirtroot, Grande chamomile, Midsummer daisy, Mutterkraut, Nosebleed, Santa Maria, Vetter-voo, Wild chamomile, Wild quinine

Feverfew primarily used in prophylactic treatment of migraine headaches and associated nausea and vomiting. Other pharmacological actions include inhibition of prostaglandin synthesis, blockage of platelet granule secretion, effects on smooth muscle, antitumor activity, inhibition of serotonin release, inhibition of histamine release, and mast cell inhibition. The herb can also be planted around the house to purify the air because of its strong, lasting odor, and a tincture of its blossoms can be used as an insect repellant and balm for bites.

PHARMACOLOGY Mechanism of action: A proposed anti-inflammatory mechanism of action involves parthenolide inhibition of the NF-kappa-B pathway by blocking I-kappa B kinase, an activator of NF-kappa-B. The IKK-beta complex plays an important role in pro-inflammatory cytokine-mediated signaling. Additionally, a component of essential oil, trans-chrysanthenyl acetate, is a known inhibitor of prostanglandin synthetase and may contribute to anti-inflammatory effects, especially when used for the treatment of migraine headaches.

Available forms/Typical dosing: Most are standardized to parthenolide 0.7% in tablet or capsule dosage forms. Feverfew supplements are available fresh, freezedried, or dried and can be purchased in capsule, tablet, or liquid extract forms. Generally given for migraines at a daily dosage of 50 to 150 mg of dried leaves, 2.5 fresh leaves with or after food, or 5 to 20 drops of a 1:5, 25% ethanol tincture. An adult dosage of parentholide 0.2 to 0.6 mg/day is recommended for the prevention of migraine.

Effectiveness: Beneficial effects may be noted within 4 to 6 weeks after initiation with feverfew. Feverfew should be stored in a cool, dry, dark environment to protect the parentholide content.

Safety/Warning: Feverfew-containing products are not strictly regulated by the Food and Drug Administration. Products containing feverfew is not recommended for breast-feeding women or for children younger than 2 years of age. Pregnant women should not use the plant because the leaves possess potential emmenagogue activity. Due to its potential antiplatelet effects, it is not recommended for use in patients undergoing surgery. Patients with blood-clotting disorders should consult their health care provider prior to using products containing feverfew.

Adverse effects: Feverfew can induce widespread inflammation of the oral mucosa and tongue, often with lip swelling and loss of taste. Dermatitis has been associated with this plant, specifically with the handling of fresh leaves. Other adverse effects have included nausea, vomiting, abdominal pain, diarrhea, indigestion, and flatulence.

Food/Drug Interactions:

Toxicities: Because no studies of long-term toxicity have been performed on the plant, the safety of feverfew use has not been established. However, a genotoxic study of 30 migraine patients who have ingested feverfew for 11 months found no unexpected aberrations, suggesting that the plant does not induce chromosomal abnormalities.

Patients may prefer to take feverfew with food due to its bitter taste. Bleeding may occur if herbs are interacted with agents with antiplatelet properties, anticoagulants, other herbs, nonsteroidal antiinflammatory agents, salicylates, or thrombolytic agents, because the anticoagulant/antiplatelet properties in herbs may enhance the adverse/toxic effect of those agents.

Evidence-based: A clinical study enrolled seventeen migraine patients and was given either 50 mg of Migrelief feverfew daily or the placebo over a six-month period. Of the seventeen patients, eight patients, who remained on Migrelief, experienced continued relief of migraines, and the remaining nine who received the placebo had an almost three-fold increase in migraines. Other chief complaints of incapacitating, anxiety, insomnia and muscle and joint soreness were reported. Results concluded that treatment led to less vomiting episodes and fewer visual disturbances during migraines. Adverse events were mild consisting of primarily mild gastrointestinal symptoms and anxiety. https://www.migrelief.com/

Personal opinion: I would recommend of consumption of feverfew products, as feverfew action is not limited to a single mechanism. Though feverfew products are commonly used for migraine relief, the plant extracts affect physiological pathways that also include inhibition of prostaglandin synthesis, decrease of vascular smooth muscle spasm, and blockage of platelet granules secretion. If used safely, adverse effects are limited. Many clinical data resulted in long-term migraine relief in patients who have taken doses of feverfew daily when compared to those on the placebo.

References: Brown D, Gaby A, Reichert R. Migraine Studies – Studies and References For Ingredients in MigreLief®: MIGRELIEFMIGRELIEF Migraine Studies Studies and References For Ingredients in MigreLief Comments. https://www.migrelief.com/migraine-studiesstudies-and-references-for-migrelief. Published July 14, 2010. Accessed March 4, 2020. Ehrlich SDED. Feverfew. Penn State Hershey Health Information Library. http://pennstatehershey.adam.com/content.aspx productid=107&pid=33&gid=000243. Published March 27, 2015. Accessed March 4, 2020. Feverfew. Natural Products Database. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: https://fco-factsandcomparisons-com.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/fc_rnp2/3750145? searchUrl=%2Flco%2Faction%2Fsearch%3Ft%3Dname%26nq%3Dtrue%26fs%3Dtrue%26q%3DFeverfew#ovv-use. Accessed March 4, 2020.

https://www.gaiaherbs.com/blogs/herbs/feverfew

CINDY LAM | STUDENT PHARMACIST | SPRING 2020

FORSKOLIN

Scientific Name: Coleus barbatus, Coleus coerulescens, Coleus forskohlii auct., Plectranthus barbatus Andrews, plectranthus forkskalaei, plectranthus forskohlii, Plectranthus grandis, Plectranthus kilimandschari Common Name: Adel Inj, Asthma X-5, Ele-max, Forskolin, ForsLean, GlucoLean, HL-362, Indian coleus, Interex, Makandi, Mao hou qiao rui hua, Meta-Burn EF, NKH477, Pashanabhedi

BACKGROUND HISTORY

https://images.app.goo.gl/VirvDH13Yf5oKbdH8

Forskolin has been used widely in Brazil, easterm and central Africa, India, and other Asian countries as part of traditional medicine. In India, the plant was cultivated for use in pickles. Though research is highly limited, traditionally, it has been used medically to treat heart, blood, and circulation conditions, and as well as cancers. Additional use included conditions such as digestive disorders (stomachache, gastric and intestinal spasm, nausea, as a purgative), skin (burns, wounds, insect bites, allergies), infections (syphilis, ringworm), stiffness, rheumatism, and as an emmenagogue and oral contraceptive. In the 70s, scientists discovered that the diterpene forskolin directly activates the adenylate cyclase and performed an investigation of itâ&#x20AC;&#x2122;s cardiovascular activity.

PURPORTED USES Natural remedy for treatment in cancer, obesity, glaucoma, allergies and asthma, heart failure, intestinal spasms, painful cramps during period (hypomenorrhea), irritable bowel syndrome, urinary tract infection, high blood pressure (hypertension), chest pain (angina), difficulty falling asleep (insomnia) and convulsions

PHARMACOLOGY Mechanism of Action: Stimulates adenylate cyclase, increasing cellular cAMP, which is involved in the glycogen and lipid metabolism. It is thought to relax a variety of smooth muscles and have been found to act through glucose transport and ion channels. Available Dosage Forms: Oral; Inhalation Typical Dosing: 10 mg daily over 2-6 months (Asthma); 250 mg of 10% forskolin extract twice daily for 12 weeks (Obesity/Metabolic Syndrome Adverse Effects: Clinical trial data are generally lacking. Adverse events reported with the use of colforsin (a forskolin derivative) include rapid or irregular heart rate. Forskolin should be avoided in patients polycystic kidney disease. Toxicities: Information is limited. Oral median lethal dose in rats has been reported to be more than 2,000 mg/kg body weight. Embryo-related toxicity has been reported that the hydroalcoholic extract of the plant can interfere with embryonic implantation and delay fetal development. Food/Drug interactions: No interactions have been reported. However, interactions with CYP3Adependent drugs are theoreticized.

SUMMARY Forskolin is an activator of adenylate cyclase where cyclic AMP phosphodiesterase inhibitor is present. This interaction does not need the presence of calcium or calmodulin. It can protect adenylate cyclase from human platelets, S49 lymphoma cells, and rat brain against thermal denaturation, proteolytic inactivation, and inactivation with N-ethylmaleimide. Due to its ability to vasodilate the peripheral properties, Forskolin can be a potent hypotensive agent. Itâ&#x20AC;&#x2122;s potential to hormonally activated cyclic AMP allows new opportunities in drug design.

PROFESSIONAL OPINION In my opinion, I do not believe that the Forskolin sound realistic due to its capability to be able to treat a vast majority of conditions with little scientific research behind it. Although Forskolin has been used historically, there is no evidence that patientâ&#x20AC;&#x2122;s have become better from their condition or even if it is a placebo effect. Additionally, there is no recorded evidence on what the therapeutic index should be when taking Forskolin, along with the side effects and toxicity of forskolin.

REFERENCES Forskolin. Facts & Comparisons. https://fco.factsandcomparisons.com/lco/action/doc/retrieve/docid/fc_rnp2/3750149? searchUrl=/lco/action/search?q=Forskolin%20&t=name&va=Forskolin%20. Published September 19, 2018. Accessed February 18, 2020. Forskolin Uses, Benefits & Dosage - Drugs.com Herbal Database. Drugs.com. https://www.drugs.com/npp/forskolin.html. Published 2019. Accessed February 18, 2020. Seamon KB. Chapter 29. Forskolin and Adenylate Cyclase: New Opportunities in Drug Design. https://www.sciencedirect.com/science/article/pii/S0065774308607058. Published April 10, 2008.

GARCINIA CAMBOGIA Timothy Leal Sudent Pharmacist

COMMONLY KNOWN AS: GARCINIA, MALABAR TAMARIND, OR BRINDLE BERRY

Spring 2020 History: Garcinia Cambogia, a distant relative to the mangosteen, is a tropical fruit that is natively found in India and Southeast Asia. There are 36 species of this fruit found in Semi‐evergreen forests. Before its use as a dietary supplement, Garcinia was used as a flavoring ingredient in foods with a use similar to tamarinds and lemons. They used it to flavor meats, curries, and drinks as well as preventing gas formation after a meal. Uses: ‐Weight loss ‐decreasing lipid activity Pharmacology/mechanism https://www.nccih.nih.gov/health/garcinia‐cambogia Garcinia contains a molecule called Hydroxycitric Acid (HCA) which is attributed to all the benefits of the fruit. HCA’s mode of action is that it is believed to blocks the actions of citrate lyase, an enzyme used to create fatty acids. This will also lead to the reduction of LDL and triglyceride levels. It is also believed to increase the production of serotonin in the brain to curb appetite and prevent unneeded snacking for increased weight loss. Available dosage forms Garcinia is available as a capsule, tablet, lotions, or powder. Because it is a fruit, its natural form is also available for consumption. Typical dosing Oral dosage forms are available in all different ranges of dosing, but the max dose per day is recommended to be 1500 mg/day. Effectiveness Clinical trials have found that taking Garcinia can reduce triglyceride levels in the body. It was not found to have an effect on the levels of lipids or antioxidants. Other clinical trials were done to test the weight loss claim of Garcinia but none were conclusive enough to point to Garcinia as the key ingredient in weight loss. Any effect on obesity and weight loss was minimal. Some studies attributed this to no bioavailability of the drug in the body. Overall, Garcinia is not proven to be effective in humans as a weight loss supplement. https://www.garciniacambogiasave.com/what‐is‐the‐most‐ effective‐dosage‐of‐garcinia‐cambogia/

Safety The product is not recommended in pregnant or lactating women due to the lack of data for its effectiveness and effect on the newborn. It is not FDA approved as a weight‐loss supplement and considered unsafe due to a lack of knowledge and regulation on the contents of oral dosage forms. When taken for short periods of time (less than 12 weeks), it appears to be safe. Adverse effects and Toxicities Garcinia can cause serious hepatoxicity (liver damage) due to inflammation and is therefore, not recommended by the FDA. Other common adverse effects include headache, dizziness, dry mouth, nausea, and vomiting. When taken at extremely high doses, there was no report of toxicity in animals but little to no studies done on humans. Food/drug interactions ‐ Hypoglycemia‐associated medications/supplements: can increase the effect of these agents ‐ Iron: Garcinia contains an iron and can add to the adverse effects of iron supplements ‐ Montelukast: increase risk of liver failure ‐ Serotonin: Can cause serotonin toxicity if taken together ‐ Statins: can cause rhabdomyolysis ‐ Summary of an Article on the efficacy and safety of Garcinia Cambogia This article describes Garcinia cambogia’s place in supplement stores as one for weight‐loss and appetite curbing. It works through the mechanisms of HCA on the metabolic pathway of lipid biosynthesis. When tested for, the side‐effects far out weight any inconclusive benefits that have been found, but it is still up to consumer decision on consumption of Garcinia. https://www.inlifehealthcare. Would I take this? com/2017/02/17/garcinia‐ cambogia‐myth‐or‐magic‐ I would personally not take this supplement for a few reasons. While the attraction of here‐are‐the‐amazing‐ weight loss is appealing, the studies done on it are inconclusive and do not point to any benefits‐for‐you/ significant benefit. On the other hand, the reported side effects and possible liver toxicity are not worth shedding a few extra pounds. References: “Garcinia Cambogia.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, 26 Feb. 2019, nccih.nih.gov/health/garcinia. Lexicomp. “Garcinia.” Login, online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750156?cesid=2x4XVsCBQCR&searchUrl=%2Flco%2Faction% 2Fsearch%3Fq%3Dgarcinia%2520cambogia%26t%3Dname%26va%3Dgarcinia#inter-nested. Ratini, Melinda. “Garcinia Cambogia: Safe for Weight Loss?” WebMD, WebMD, 6 Oct. 2019, www.webmd.com/vitamins-andsupplements/garcinia-cambogia-weight-loss.

Garlic Allium sativum Created by Xuxi Li, BSPS student | Spring 2020

Notes in Depth Pharmacology ⚫

Garlic is a bulbous herb

https://static.toiimg.com/photo/70173931.cms

isolated from the plant

Background

Allium

⚫ Garlic is among the oldest known horticultural crops. In the Old World,

potential

Egyptian and Indian cultures referred to garlic 5000 years ago and there is

sativum

with

antineoplastic

activity. Garlic contains a

clear historical evidence for its use by the Babylonians 4500 years ago

number

and by the Chinese 2000 years ago. Some writings suggest that garlic was

different

antineoplastic.

grown in China as far back as 4000 years ago. Garlic is used as a dietary supplement and serve in various food.

Dosage Forms ⚫

Softgels

⚫

Tablets

⚫

Powder

⚫

Extract

⚫

Topicals

⚫

Dosage

varied.

Ranging

from 250 mg to 5000 mg https://www.wuwm.com/sites/wuwm/files/styles/x_large/public/201912/AdobeStock_57397709.jpeg

Common Use ⚫

High Blood cholesterol

⚫

High Blood pressure

⚫

Common Cold

⚫

Potentially use to prevent cancer and other diseases

Effectiveness ⚫ Limited amount of clinical studies has shown that garlic reduces plaque in

Warning!

coronary arties disease and lower blood cholesterol. Another interesting study in H.pylori treatment showed that garlic supplement reduce death due to gastric cancer.

Adverse effects ⚫

Food/Drug interaction

⚫

Personal investigation/Opinion ⚫

Garlic may increase the

Nursing

mother

may

receive burns to the breast

garlic to cook vegetables and meats. I am deeply influenced by this food

from prolonged (2 days)

culture. And there’re other spices such as green onion, parsley, or ginger to

application of raw garlic to

improve health condition. I don’t know whether it’s placebo effect or

treat

culture influences, but I do believe certain herbs can alleviate and reduce

self-diagnosed

Candida infection

some symptoms.

Toxicity

References Drugs

and

Lactation

Database

https://www.ncbi.nlm.nih.gov/books/NBK501782/.

(LactMed)

Published

December

[Internet]. 3,

⚫

Drugs

No toxicity reaction has

2018.

been reported

Accessed March 16, 2020. Garlic.

due

risk of bleeding

⚫ Garlic is commonly used in many Asian dishes. My family always use

⚫

topical

dermatitis and burns

infection), and CYP3A and/or P-glycoprotein mediated interaction.

Garlic.

avoid

application

⚫ Garlic may interfere with anticoagulant, saquinavir (a drug treat HIV

⚫

Neonates

and

Lactation

Database

(LactMed).

⚫

Might be toxic to pets

https://www.ncbi.nlm.nih.gov/pubmed/30000841. Published December 3, 2018. Accessed March 16, 2020. ⚫

Garlic. National Center for Biotechnology Information. PubChem Compound Database. https://pubchem.ncbi.nlm.nih.gov/compound/6850761#section=Pharmacology-and-Bioch

⚫

emistry. Accessed March 16, 2020. ⚫

Safety Generally, it’s safe to use,

Li W-Q, Zhang J-Y, Ma J-L, et al. Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: follow-up of a

but

randomized

allergic to garlic

intervention

trial.

BMJ

(Clinical

research

ed.).

https://www.ncbi.nlm.nih.gov/pubmed/31511230?dopt=Abstract. Published September 11, 2019. Accessed March 16, 2020

some

people

are

PHPR 489 SPRING 2020

JASMINE LIANG STUDENT PHARMACIST

https://blog.piquetea.com/ginger-tea-benefits/

https://www.medicalnewstoday.com/articles/265990

GINGER Background/History Ginger is tropical perennial plant with green-purple flowers and a fragrant stem.[1] It is originated in South-East Asia, India, and China[1] but is also available in places such as parts of South America and Africa.[3] Asian medicine has documented ginger for uses of stomachache, diarrhea, and nausea.[1] Ginger is also widely used as flavoring agents for cooking and fragrance for cosmetic products.

Pharmacology/Mechanism of Action The phenolic compounds in ginger contributes to its distinct fragrant. Specifically, the main two compounds in ginger that has pharmacological activity are gingerols and shogaols. Gingerols have antiemetic properties, which means they can reduce nausea symptoms and act peripherally within the gastrointestinal tract. Studies also show that gingerols bind at the allosteric site of 5HT receptor as a potential antagonist. Thus, their activity inhibits serotonin that is released from the gastrointestinal tract. [5] Shogaols has an unknown mechanism that aids in pain relief and antiinflammatory effects.[4]

Scientific name: Zingiber officiale[1] Common Names: Ginger, Ginger root, Ginger Essential Oil Common uses: nausea, upset stomach, dizziness Other Possible Uses: osteoarthritis, rheumatoid arthritis, pain relief Available Dosage Forms: oral tablets, crystals, powder, capsules, liquid (oil extracts, tea), raw herb Typical Serving: 20-40g of fresh sliced ginger in a cup of hot water.[2] 1

PHPR 489 SPRING 2020

JASMINE LIANG STUDENT PHARMACIST

Effectiveness Studies have conducted to determine how can ginger be effective for nausea due to pregnancy. The study showed that ginger was effective non-pharmacologically than the placebo. Other studies have tested ginger against anti-histaminic drug that treats motion sickness and nausea; the results was that ginger was just as effective as a non-pharmacological alternative. Further studies can be conducted to test for further efficacy of ginger.[5]

Professional Opinion Personally, I use ginger mostly on cooking and in some herbal teas. At a young age, my parents always told me that ginger is â&#x20AC;&#x153;good for youâ&#x20AC;? but I never understood why. I knew it had to do with its efficacy of it as documented in Asian Medicine. After this research about it, I have found that ginger does have an interesting effect for nausea. I have decided to look into how herbal Asian medicine works pharmacologically in the future after this research on ginger. I would recommend people to use ginger in cooking as it gives a fascinating taste and unique odor to the food we make.

Reference [1] Ginger. (2016). National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/ginger. Accessed March 5, 2020. [2] Lewin, J. The health benefits of ginger. (2019). BBCgoodfood. https:// www.bbcgoodfood.com/howto/guide/ingredient-focus-ginger. Accessed March 5, 2020. [3] Ginger. WebMd. https://www.webmd.com/vitamins/ai/ ingredientmono-961/ginger. Accessed March 5, 2020. [4] Ginger. University of Rochester Medical Center. https:// www.urmc.rochester.edu/encyclopedia/content.aspx? contenttypeid=19&contentid=Ginger. Accessed March 5, 2020. [5] Lete I, Allue,J. (2016). The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy. US National Library of Medicine National Institutes of Health. https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC4818021/#b10-imi-11-2016-011. Accessed March 5, 2020.

Adverse Effects: Mild abdominal discomfort, heartburn, diarrhea, gas production [1], irritated skin[3], and bloating.[4] Toxicities: There is no significant toxicities when using ginger; however, studies show that minor stomach upset can be due to possible toxicities.[5] Safety: Generally, it is safe to use ginger; however, it does contain oxalate, which means that people with oxalate-containing kidney stones should avoid for eating too much ginger.[2] It is also safe to use it when pregnant; it is strongly recommended to consult doctor or prescribers for additional concerns and questions.[1] Lastly, people with gallstone diseases should be cautious in using ginger since it may increase bile flow.[1] Food/Drug Interactions: There are no definite studies on whether ginger interacts with other food or drugs but there is a possible interaction between ginger and anticoagulants (eg. Warfarin).[4]

Ginseng Panax quinquefolius Kiara Light, Student Pharmacist Spring 2020

(1) Ginseng is one of the most, if not the most, commonly used herbal product in medicine. Panax, part of the scientific name, is derived from the Greek word which means â&#x20AC;&#x153;all healing.â&#x20AC;? Ginseng has been used in medicine for over 2000 years across many cultures for a variety of diseases including: asthenia, blood disorders, erectile dysfunction, hypertension, liver disfunction, cancer, and postmenopausal disorder (3). Ginseng is commonly available in many forms including raw for chewing, powder, liquid extract, decoction, or infusion (3). Dosing varies with disease state. For example, 200-400mg is recommended for mental function whereas up to 6 grams is recommended three times daily for up to three months for COPD (3). (2)

How Ginseng Works in the Body The pharmacology of Ginseng varies and is not widely studied. However, cholinergic, adrenergic, dopaminergic, and nitric oxide actions are found to be associated with Ginseng. This leads to a wide variety of responses within the body: modulating insulin sensitization, increasing sexual arousal, and treating fatigue.

Effectiveness, Safety, and Personal Opinion Does it work? While ginseng is claimed to have a lot of beneficial effects, one its most important ones is that it is reported to boost immunity. But does it actually have an effect? According to a research study, ginseng was examined at the cellular level to see if any beneficial effect actually occurred. It was shown that on the cellular level, macrophages and natural killer cells were induced, T-cell proliferation was boosted, cytokine production was increased, and antimicrobial properties were discovered (4). So, on the cellular level at least, ginseng really does seem to work in boosting immunity. Is it safe? So now that ginseng is known to have an effect, the next question one should ask: is it safe? According to a clinical trial, ginseng was found to have no major adverse reactions, indicating safety. However, even though there were no serious consequences, some participants still had unwanted or bothersome side effects. These side effects ranged from dyspepsia, insomnia, headaches, nausea, and hot flashes in about 30% of participants (5). According to Lexicomp, embryotoxicity was found in use with ginseng, but no carcinogenicity, mutagenicity, or teratogenicity was discovered. Lexicomp also states that ginseng should be used in caution in combination with: antiplatelets, anticoagulants, antihypertensives, atorvastatin, hypoglycemia agents, imatinib, NSAIDs, salicylates, thrombolytic agents, and warfarin. Ginseng in Beauty While ginseng is popular for oral dosing to help aid in many ailments, ginseng is also found in many beauty products. It is claimed to help invigorate and provide energy for the skin for that “wide-awake” look. Reviews for a certain gel moisturizer that contained ginseng sung its praises, but the praises seemed to revolve around the hydration it provided. In over 814 reviews, few reported that they felt they radiated that “wide-awake” look. While it doesn’t seem that ginseng has a negative effect, its positive effects in this case don’t seem to have much support from the public. Personal Opinion In my personal opinion, I think ginseng may be effective for some. The extent of the effectiveness may not reach therapeutic levels, but if it provides any level of relief to a patient and does not possess any harm, then I think ginseng would be a good option for those looking for the benefits it carries. 1. Wong C. Panax Ginseng May Help With Diabetes, Cognition, and More. Verywell Health. https://www.verywellhealth.com/thebenefits-of-ginseng-89219. Published December 5, 2019. Accessed March 4, 2020.

2. Tetro J. A Component In Ginseng May Help Fight Obesity. HuffPost Canada. https://www.huffingtonpost.ca/jasontetro/ginseng-may-help-fight-obesity_a_23541618/. Published September 27, 2018. Accessed March 4, 2020.

3. Ginseng. Lexicomp. http://online.lexi.com.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/fc_rnp2/3750164?cesid=6mDhwqMrvbi&search Url=/lco/action/search?q=ginseng&t=name&va=ginseng#inter-nested. Accessed March 4, 2020. 4.

Kang S, Min H. Ginseng, the 'Immunity Boost': The Effects of Panax ginseng on Immune System. Journal of ginseng research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659612/. Published October 2012. Accessed March 4, 2020.

Lee N-H, Yoo S-R, Kim H-G, Cho J-H, Son CG. Safety and tolerability of Panax ginseng root extract: a randomized, placebocontrolled, clinical trial in healthy Korean volunteers. Journal of alternative and complementary medicine (New York, N.Y.).

Emily Liu (Student Pharmacist) Spring 2020

GLUCOSAMINE COMMON NAME

MECHANISM OF ACTION

-GLUCOSAMINE

Some studies have shown that glucosamine can affect the cytokine-mediated pathways regulating cartilage degradation, inflammation, and immune response. Thus, glucosamine supplements may reduce inflammation in the joints. It may also prevent degradation of articular cartilage. Stimulate synthesis of synovial fluid and provide some pain relief.

SCIENTIFIC NAME -(3R,4R,5S)-3-Amino-6-(hydroxymethyl)oxane-2,4,5-triol

BACKGROUND/HISTORY

Glucosamine is an amino-monosaccharide made from glucose and glutamine naturally in body from glucose. It is found in the fluid around joins and is used as the building blocks (proteoglycans and glycosaminoglycans) where it is converted to an ester that is incorporated into articular cartilage. Therefore, it is a direct precursor in the formation of the glycosaminoglycans in the cartilage. Most glucosamine supplements are made from crab, lobster or shellfish.

PURPORTED USE Glucosamine is commonly used for osteoarthritis. Joins are cushioned by fluid and cartilage. However, osteoarthritis can take place with aging as joint cartilage degenerates with wear and tear which eventually lead to bone hitting bone. Pain, stiffness, and join friction can occur with osteoarthritis

DOSING DOSAGE FORMS -Glucosamine Hydrochloride and Glucosamine Sulfate -Both forms can come in as a tablet, injections, or a topical cream

Oral: Glucosamine 500mg 3 times daily or 1500mg once daily Topical: A topical cream formulated of glucosamine 30 mg/g, chondroitin 50 mg/g, shark cartilage 140 mg/g, camphor 32 mg/g, and peppermint oil 9 mg/g that was gently messaged into joints as needed for 8 weeks Intramuscular Injection: 400 mg of glucosamine sulfate has been injected twice weekly for 6 weeks.

Emily Liu (Student Pharmacist) Spring 2020

Does it work? EFFECTIVENESS Glucosamine sulfate has been shown to have a more beneficial result because it is absorbed better. Glucosamine hydrochloride does not seem to work as well. Many glucosamine products contain chondroitin, but there is no evidence that these products work better than glucosamine sulfate itself. Research shows that taking glucosamine sulfate can provide some pain relief. However, it can take 4-8 weeks before it provides pain relief. In addition to relieving pain, glucosamine sulfate might also slow the breakdown of joints if it is taken for several years but it does not prevent people from getting osteoarthritis.

SAFETY

When taken by mouth: Glucosamine sulfate is LIKELY SAFE in most adults. Glucosamine sulfate can cause some mild side effects in patients. When given as a shot: Glucosamine sulfate is POSSIBLY SAFE when injected into the muscle as a shot twice weekly for up to 6 weeks. When applied to the skin: Glucosamine sulfate is POSSIBLY SAFE when applied to the skin in combination with chondroitin sulfate, shark cartilage, and camphor for up to 8 weeks.

Adverse Effects     

Nausea or headache Heartburn Diarrhea or constipation Drowsiness Skin reactions

FOOD/DRUG INTERACTIONS -Warfarin (Coumadin) -> Do not take with this!! -Medications for cancer -Acetaminophen (Tylenol, APAP) -Medications for diabetes

TOXICITY

Glaucoma: Glucosamine sulfate might increase the pressure inside the eye and could worsen glaucoma. Shellfish allergy: Some glucosamine sulfate products are made from the shells of shrimp, lobsters or crabs, there is concern that glucosamine products might cause allergic reactions in people who are allergic to shellfish.

SUMMARY OF A STUDY Seven systematic reviews and Meta-analysis, a statistical analysis that combines the results of multiple scientific studies, have evaluated the therapeutic effect of glucosamine for osteoarthritis in the past 10 years. Despite extensive research, the data related to the effect of glucosamine on pain relief have been inconsistent due to the disorganization of the research where the treatment duration was not determined. Metaanalysis research also exhibited contradictory results on the function of glucosamine. While some showed improved pain relief, others showed no effect on pain relief. Many of these clinical trials have been sponsored by the pharmaceutical companies that actually produce glucosamine, leading to bias toward positive outcomes.

PROFESSIONAL OPINION As a student pharmacist, after reading through all the articles and studies, I would not recommend glucosamine to my future patients. Glucosamine is not proven to be very effective. There is also compliance issue with oral dosage since patients would have to take it daily. Patients may even stop taking the supplements before therapeutic effect is showing since it may take several years to actually see any effects. I would only recommend this product as an add-on treatment if all the other treatment options are not helping applicable or are not effective for the patients.

REFERENCES -Glucosamine. Glucosamine – an overview | ScienceDirect Topics. Accessed March 4, 2020. -Glucosamine. Mayo Clinic. Published October 14, 2017. Accessed March 4, 2020. -Glucosamine Sulfate: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. Accessed March 4, 2020.

PHOTOS USED -https://www.dreamstime.com/cartoon-crab-vector-crab-illustrationcute-happy-crab-cartoon-crab-vector-illustration-isolated-whitebackground-image140258407 -https://www.naturelo.com/product/glucosamine-chondroitin-msm/ -https://www.verywellhealth.com/glucosamine-chondroitin-arthritisdosage-189818 -https://www.astasupreme.co.nz/news/astaxanthin-vs-glucosamineand-chondroitin-for-arthritis.html -http://www.nutrientsreview.com/carbs/glucosamine.html -https://www.mskcc.org/cancer-care/integrativemedicine/herbs/glucosamine

Goldenseal (Hydrastis canadensis) https://en.wikipedia. org/wiki/Goldenseal

Otherwise known as… Eye Balm, Eye Root, Fard Inolien, Framboise de Terre, Goldenroot, Goldsiegel, Ground Raspberry, Hydraste, Hydrastis canadensis, Indian Dye, Indian Plant, Indian Tumeric, Jaundice Root, Orange Root, Racine Orange, Sceau D'Or, Sello de Oro, Turmeric Root, Warnera, Wild Curcuma, Yellow Indian Paint, Yellow Puccoon, and Yellow Root

Dosage Forms: • • • • • • •

Tablets Capsules Oil Tincture Dried Root Dried Leaf Powder Extract

Dosing Information A safe dose of Goldenseal for healthy adults is anywhere from 50-300mg a day. Not recommended for newborns.

Nathaniel Loh, BSPS student Spring 2020

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

Background/History: Goldenseal is an herb native to the North American woodlands. Interestingly, it is thought to be the only hydrastis species still in existence. Native Americans used Goldenseal for centuries as an anti-cancer drug, an antiseptic, for digestive disorders, and many other indications. At some point in the 1800s, a commercial need for the plant arose, and, with the help of deforestation, pushed the plant on to the endangered plants list in 1991. Conservation efforts have steadily brought the population of Goldenseal plants back up.

Common Uses: Just like the Native Americans, now many people of different cultures use Goldenseal today for a wide variety of different medical reasons. Urinary tract infections, hemorrhoids, upset stomach, colitis, hay fever, stuffy nose, irregular menstrual periods, chronic fatigue syndrome, stomach pain and swelling (gastritis), peptic ulcers, colitis, diarrhea, constipation, hemorrhoids, intestinal gas, jaundice, gonorrhea, fever, pneumonia, malaria, whooping cough, eczema, acne, dandruff, ringworm, herpes blisters, cold sores, pink eye, earache, and even deafness. A widely believed myth is that Goldenseal may also mask the presence of drugs (specifically marijuana) within the urine. This came from a misinterpretation of pharmacist John Uri Lloyd’s experiments on Goldenseal.

Pharmacology: While many of its uses are not clinically verified, it is believed the alkaloids berberine, hydrastine, and canadine are responsible for the claimed antifungal and anti-inflammatory effects. Both alkaloids have the potential to decrease fungal/bacterial adhesion to membrane walls and possible antihistamine activity.

Effectiveness: According to The National Center for Complementary and Integrative Health (NCCIH), a subsidiary of the National Institute of Health, very little research has been done into the medical benefits or general health effects of Goldenseal. Though the little research done is not promising, showing that the majority of the potentially pharmaceutically active ingredients are not absorbed when Goldenseal is taken orally. However, the NCCIH is developing studies in which they will determine Goldensealâ&#x20AC;&#x2122;s antibacterial effects as well as figuring out how to make research grade Goldenseal for human studies. https://www.iherb.com/pr/Nature-s-Way-Goldenseal-Herb-400-mg-100VegetarianCapsules/97159?gclid=Cj0KCQiAwP3yBRCkARIsAABGiPoed56QoJM1u67jWy00W2E 4aEHmmISlByWXkAvk5fcVKgg8Y0Fs0AYaAtYjEALw_wcB&gclsrc=aw.ds

https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.asp x?hwid=zc1011

Toxicities: One study by the National Toxicology Program found significant hepatic carcinogenic properties of Goldenseal in male and female mice over a 2-year period. The same program found that the LD50 of Goldenseal in mice is about 350mg/kg. Considering Goldenseal is never recommended above 300mg a day, it is relatively safe. No clinical human studies have been conducted, so there may be possible longterm toxicities yet unknown. Sources: 1. Goldenseal: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-943/goldenseal. Accessed March 5, 2020. 2. National Toxicology Program. Toxicology and carcinogenesis studies of goldenseal root powder (Hydrastis Canadensis) in F344/N rats and B6C3F1 mice (feed studies). National Toxicology Program technical report series. https://www.ncbi.nlm.nih.gov/pubmed/21372858. Published August 2010. Accessed March 5, 2020. 3. Goldenseal. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/goldenseal#hed2. Published November 30, 2016. Accessed March 5, 2020.

Safety: Once again, not much is known about long-term safety of Goldenseal use. Right now, it is recommended that pregnant and breastfeeding mothers stay away. There is a risk of severe jaundice leading to kernicterus (a brain damaging disease) if given to newborns and infants. In general, it is recommended that you ask your doctor before consuming Goldenseal supplements.

Adverse Effects: Common side effects of Goldenseal include dry/irritated throat and mouth, certain digestive issues, and headache. Skin irritation noted when used topically. More serious adverse effects as a result of overindulgence include cardiac damage, hypotension, slow heart rate, and spasms

Drug Interactions: Do not take Goldenseal without medical advice if you are also taking drugs for: Heartburn, viral infection, cancer, anxiety, migraines, seizures, hypertension, or asthma.

Professional Opinion: Without proper clinical trials or more scientific studies, in general, it is impossible to make an informed choice about using this supplement and I will personally not consume Goldenseal anytime soon

Grape Seed

Chris Lok, Spring 2020 Scientific Name: Vitis vinifera Common Name: Activin, Calzin, Muscat Purported Uses: It is generally used to help with circulation, decrease swelling and wound healing. It can also be used to lower blood pressure and improve heart rate.

Mechanism/ Pharmacology: no known mechanism Dosing: 150-2000 mg / day Dosage Form:

Capsules

Tablets

proanthocyanidin

Effectiveness: It depends. Some say grape seed is effective in treating chronic venous insufficiency, but there are also people claiming that grape seed doesn’t work at all. Toxicity: Nontoxic Adverse Effect: Nausea, Vomiting, Headache Interactions: possible interaction with blood thinners, NSAID, cancer treatments Summary of Article: There is an article published in the journal “Free Radical and Biology” stating that grape seed can make the wound healing process faster. Researchers conducted the experiment by applying proanthocyanidin onto the backs of mice and recording the wound size everyday. They found that grape seed contains resveratrol which upregulates the oxidizing environment at the wound site. The enhanced oxidizing environment promotes vascular endothelial growth factor which stimulates angiogenesis. Opinion: After reviewing several scientific articles about grape seed, I think grape seed is actually beneficial for wound healing. However, we need more scientific data to support its other uses like lowering blood pressure and better body circulation. Most of the grape seed products are in the price range of $20-30, so I think it’s worth a try for people who are seeking alternative medicine. I would recommend consulting with a doctor before using alternative medicines to ensure safety. References: Khanna S, Venojarvi M, Roy S, et al. Dermal wound healing properties of redox-active grape seed proanthocyanidins. Free Radical Biology and Medicine. https://www.sciencedirect.com/science/article/pii/S0891584902009991. Published October 2, 2002. Accessed March 6, 2020. Ratini M. Grape Seed Extract: Benefits and Side Effects. WebMD. https://www.webmd.com/diet/grape-seed-extract. Published February 12, 2019. Accessed March 6, 2020. Grape Seed Extract . Grape Seed Extract - Health Encyclopedia - University of Rochester Medical Center. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=19&contentid=grapes eedextract. Accessed March 6, 2020.

Heather Mayorga, Academic Advisor, Spring 2020 Common Names: Hawthorn

Hawthorn

Scientific Names Crataegus Laevigata Crataegus Monogyna Crataegus Oxycantha

Crataegus berries English Hawthorn Harthorne Haw May flower mayflowers Oneseed Hawthorn Quickthorn Shan Zha Whitehorn

http://ipm.ucanr.edu/PMG/GARDEN/PLANTS/hawthorn.html

About Hawthorn Hawthorn is a flowering shrub or tree in the rose family. It grows in temperate regions worldwide. German farmers used them as a hedge row to keep livestock penned in as their thorns are so sharp and dense. It can reach 30 feet in height. Uses Angina Anxiety Arrhythmia Arthritis Asthma Atherosclerosis Congestive heart failure Enlarged heart Heart Disease High blood pressure High cholesterol Indigestion Inflammatory disease Kidney Problems Mitral valve prolapse Protect and regulate collagen Scratchy and Sore Throats

How does it work? Lowers blood pressure Reduces blood cholesterol Prevents build up on artery walls Strengthens the heart Normalizes heart rhythm Improves circulation by dilating the coronary arteries Scavenges free radicals Reduces inflammation Relaxes smooth muscles in blood vessels so they won’t suddenly constrict and shut off blood flow Acts as mild diuretic to purge excess fluid from the tissues Forms & Dosage Available as Capsules, Tablets, Liquid, Tonics, Freeze dried berries, Tincture, and Concentrated extract that resembles tarlike syrup.

Typical dosing/serving  Liquid extract ¼ teaspoon 2‐3 times daily  30‐60 drops daily for a tincture 15‐20 minutes before a meal  Capsules take with food 160 milligrams 3 times daily  Capsules 150 milligrams 3 times daily  Daily dosages range from 150 mg to 1800 mg daily. Most physicians believe there is a greater effect in 600mg‐1800mg given in 2‐3 divided doses daily.

Effectiveness

Safety & Toxicity

Hawthorn has been studied for heart failure in a two‐ year study involving 2700 people across 13 European countries. Unfortunately, it was unable to confirm benefits; however, all patients were in advanced stages of heart disease. Another study showed patients symptoms worsened while taking hawthorn and their heart medication. There is a lack of evidence for using hawthorn for any other health condition. One source shows it can take weeks or even months to see results yet also states two weeks to a month to start working.

No deaths or major harm has been reported with use of hawthorn. Claims vary by source, one source claims to be safe long‐term but only in small doses. Many say do not use if pregnant or nursing.

Clinical Trials In a German Study of 78 patients with congestive heart failure between the ages 45 and 73, over an eight‐week period, half were given 600 milligrams of hawthorn extract daily. The other half were given a placebo. No one was on any heart medications and they all exercised daily on a stationary bicycle. In the end, those that received hawthorn extract showed improved performance on the bicycle, lower blood pressure, and lower heart hearts. However, the study doesn’t show any actual metrics to know how significant the improvement was, if at all. It also does not report on the placebo group.

Adverse Effects Adverse effects have been rare in most studies; however, in one study 1.3% of patients experienced an adverse effect while taking 900 milligrams of extract daily for eight weeks. Adverse effects include: vertigo, dizziness, nausea, indigestion, fatigue, sweating, palpitations, headache, dyspnea, sleeplessness, agitation, and epistaxis. Food/Drug Interactions It may interact in harmful ways with other drugs, specifically heart medications. Use cautiously when combined with herbs and supplements that have cardiovascular effects; such as, danshen, epimedium, ginger, Panax ginseng, turmeric, and valerian. There are also theoretical interactions with antiarrhythmics, antihypertensives, (vasodilators, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers), cardiac glycosides (digoxin), vasodilators (phosphodiesterase type 5 inhibitors), and antihyperlipidemic agents.

References

Personal Opinion

Dahmer S, Scott E. American Family Physician. Health Effects of Hawthorn. Available at https://www.aafp.org/afp/2010/0215/p465.html. Accessed March 1, 2020. Editors of FC&A Medical Publishing “eds”. Natural Cures and Gentle Medicines. Third Edition. Peachtree City, GA: FC&A Publishing; 2000. Maleskey G “eds”. Nature’s Medicines. Emmaus, Pennsylvania: Rodale Press, Inc.; 1999. Memorial Sloan Kettering Cancer Center. Hawthorn. Available at https://www.mskcc.org/cancer‐care/integrative‐medicine/herbs/hawthorn. Accessed March 1, 2020. National Center for Complementary and Integrative Health. Hawthorn. Available at https://nccih.nih.gov/health/hawthorn. Accessed March 1, 2020. Tassell MC, Kingston R, Gilroy D, Lehane M, & Furey A. US National Library of Medicine National Institutes of Health. Hawthorn (Crataegus spp.) in the Treatment of Cardiovascular Disease. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249900/. Accessed March 1, 2020.

In light of the clinical trials and resources I reviewed, I believe hawthorn has potential to be effective with cardiovascular health depending on the stage of the disease, dosage given daily, and tolerance of the patient to the plant, berry, or flower. Combined with diet change and exercise you could see significant improvement. Long term effects still need to be studied as the longest clinical trial was 24 months. Overall, the side effects of taking hawthorn are less severe than many FDA regulated drugs I’ve had doctors prescribe to me; therefore, I would try it.

https://cdn11.bigcommerce.com/s179w39yitm/images/stencil/1280x1280/products/395/1086/Horney_Goat_Weed__39621.1547950735.jpg?c=2?imbypass=on

HORNY GOAT WEED Epimedium/Damiana

Sophia Meyer: 4th Year Pharmaceutical Science : Spring 2020

BACK GR O UND Epimedium is a genus of plants of the Berberidaceae family. This family includes more than fifty species. While a variety of these species are often included in manufactured herbal supplements of horny goat weed, the specific species Epimedium grandiflorum is what is commonly known as horny goat weed named after the discovery of its aphrodisiac properties. This discovery was prompted by a Chinese goat herder who noticed an increased sexual activity in his heard after eating the leaves of the plant.

DO SAGE FOR M S

A N D

S U G G E S T E D

S E R V I N G

S I Z E S

Aromatherapy Stick and Capsules of varying weight with a suggested serving Size: 500mg-2000mg

P UR P OR TE D U SE S Erectile Dysfunction Ejaculation Problems Sexual Problems Osteoporosis Postmenopaulsal Conditions (ie. low estrogen and high cholesterol)

P HARMACOLOGY Mechanism of Action Active ingredients include Icariin, a flavonol glycoside. It is suggested that the active ingredient increases nitrogen oxide synthesis in the penis, enhances smooth muscle proliferation, inibits PDE5 in cavernosal smooth muscle, and mimics endogenous androgens. This is all suspected to contribute to the herb's aphrodesiac properties [1].

HTTPS://WWW.RESEARCHGATE.NET/PROFILE/KLAUS_PETER_JUENEMANN/PUBLI CATION/7987733/FIGURE/FIG4/AS:668832679075868@1536473545924/CAVERNALSMOOTH-MUSCLE-RELAXATION-DURING-ERECTION-DEPENDS-ON-NITRICOXIDE-RESULTING-IN-A.PPM

ADVERSE EFFECTS dissiness vomiting dry mouth thirst nosebleed spasms breathing problems

FOOD/DRUG INTERACTIONS Estrogens Drugs metabolized by CYP1A2 and 2B6 Antihypertensve drugs QT interval-prolonging drugs anticoagulants/ antiplatelets Coenzyme Q-10 fish oil stinging nettle clove garlic ginger ginkgo turmeric willow others

EFFICACY There is insufficient evidence to rate efficacy for any of the claims and common uses

SAFETY/ TOXICITY Pregnancy and Breast-Feeding: might harm developing fetus. Not enough is known about the safety of using horny goat weed during breastfeeding. Bleeding Disorders: might slow blood clotting and increase risk of bleeding Hormone Sensitive Cancers: Can make breast and uterine cancer worse Low Blood Pressure: can increase risk of fainting in people with low blood pressure Surgery: may increase risk of bleeding during surgery

PROFESSIONAL OPINION

The data present in the literature is not sufficient enough that I feel comfortable with consumers having the access to self-diagnose and self-medicate with horny goat weed. Though there are numerous suspected benefits from using this herb, the safety concerns outweigh the potential benefits. I would especially caution women and those with cardiovascular problems to not use this supplement because of its ability to activate estrogen pathways, and interact with blood clotting.

References 1. Corazza O, Martinotti G, Santacroce R, et al. Sexual enhancement products for sale online: raising awareness of the psychoactive effects of yohimbine, maca, horny goat weed, and Ginkgobiloba. Biomed Res Int. 2014;2014:841798. doi:10.1155/2014/841798 2. Horny Goat Weed: MedlinePlus Supplements. MedlinePlus. https://medlineplus.gov/druginfo/natural/699.html. Accessed March 1, 2020. 3. Shindel, A.W., Xin, Z.‐C., Lin, G., Fandel, T.M., Huang, Y.‐C., Banie, L., Breyer, B.N., Garcia, M.M., Lin, C.‐S. and Lue, T.F. (2010), Erectogenic and Neurotrophic Effects of Icariin, a Purified Extract of Horny Goat Weed (Epimedium spp.) In Vitro and In Vivo. The Journal of Sexual Medicine, 7: 1518-1528. doi:10.1111/j.1743-6109.2009.01699.x

HORSE CHESTNUT Done by: Fayrouz Mohamed Student Pharmacist Spring 2020 SCIENTIFIC NAME: AESCULUS HIPPOCASTANUM COMMON NAMES: HORSE-CHESTNUT, BUCKEYE, SWEET CHESTNUT, CONKER TREE

HISTORY AND BACKGROUND: There are multiple species of the horse chestnut and thought to have originated in the Balkan region of eastern Europe but is now present in every country in the northern hemisphere. They exist in nature as both a tree and shrub and is most frequently used in herbal medicines. https://aquariumwaterplants.com/products /aesculus-hippocastanum-horse-chestnutbonsai-tree-seeds-3-conkers

COMMON USES: - It is medicinally used to strengthen and tone the circulatory system, especially the venous system. veins, phlebitis, and hemorrhoids. - They reduce blood coagulation and clotting by thinning the blood. - They are also particularly useful to reduce fevers due to narcotic properties. - The aescin in the horse chestnut fruit has been used both internally and also been added to external creams to heal varicose veins, varicose ulcers, bruises, and sports injuries.

Team, F. H. (2019, October 17). How to Tell If You Have Iron Deficiency Anemia. Retrieved from https://health.clevelandclinic.org/h ow-to-tell-if-you-have-irondeficiency-anemia/

MECHANISM OF ACTION

The Editors at The HealthyUpdated: Sep. 02 2019. Horse Chestnut: How It Can Help Varicose Veins and More. The Healthy. https://www.thehealthy.com/nutrition/ho rse-chestnut-benefits/. Published September 2, 2019. Accessed March 6, 2020.

The exact mechanism of action is unknown. However, studies have shown that horse chestnut extract contracted both veins and arteries, with the veins being the most sensitive. Their action is partially mediated through 5-HT(2A) receptors, which is a subtype of the 5-HT2 receptors that belong to the serotonin receptor family. Contractions of arteries and veins are inhibited by acting as a 5-HT(2A) receptor antagonist. Human platelet aggregation is also reduced by horse chestnut causing thinning of blood.

DOSAGE FORMS AND DOSINGS: Dosage forms available: capsules, tablets, liquid drops, essential oil, and cream Typical dosing is 100–150 mg of aescin per day

Figure 2f from: 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.

EFFECTIVENESS AND SAFETY Effectiveness: to improve symptoms of leg pain, edema and pruritus with horse chestnut seed extract. It was shown that when taken as capsules, it took around 2 to 16 weeks for full effectiveness. Safety: The processed extract where esculin extract is removed is considered generally safe when used for short periods of time https://shop.theherbshoppepdx.com/product s/aesculus-hippocastanum-horse-chestnuttincture

ADVERSE EFFECTS The extract can cause some side effects, including itching, nausea, gastrointestinal upset, muscle spasm, or headache Are moths killing Horse Chestnut trees? Home page. https://butterflyconservation.org/news-and-blog/aremoths-killing-horse-chestnut-trees. Accessed April 10, 2020.

TOXICITY

LLC HDVM. Horse Chestnut Toxicity: HorseDVM Diseases A-Z. Horse Chestnut Toxicity | HorseDVM Diseases A-Z. http://www.horsedvm.com/disease/horsechestnut-toxicity/. Accessed April 10, 2020.

Raw horse chestnut seed, leaf, bark and flower that contain the esculin extract are toxic. The seed itself is classified as non-safe by the FDA.

DRUG & FOOD INTERACTIONS Drug interactions: as it is used for blood thinning, it should not be given with anticoagulant drugs such as Warfarin and Aspirin as it would cause bleeding. Taking horse chestnut would also decrease how well our bodies get rid of lithium. This would increase lithium levels in the body and cause serious side effects. Doses of lithium may then need to be altered. Horse chestnut also interacts with diabetes medications and cause increase in blood sugar levels. Food interactions: There is no evidence of food interactions with horse chestnut.

SUMMARY OF A STUDY Green coffee is a product that has high levels of chlorogenic acid, which is an ingredient present in horse chestnut and thought to be beneficial. It is used for high blood pressure, weight loss and metabolism. They are safe to use when taken by mouth appropriately and has been seen safe for up to 12 weeks of use of 200mg dose. Since it is caffeine, it is likely to cause insomnia, restlessness, stomach upset, increase in heart and breathing rate. Consuming large amounts of coffee might also cause headache, anxiety, ringing in the ears, and irregular heartbeats. Also, due to presence of the ingredient in horse chestnut, it could cause an interaction if patients are on anticoagulants as they would increase the chance of bleeding.

MY PROFESSIONAL OPINION I would personally not recommend the use of horse chestnut if it is not being monitored by a health care provider. It does have good medical uses such as for treatments of varicose veins, bruises, fever and blood coagulation. However, my concern is that the drug is present over the counter as a supplement with no control of how much the patient may be taking. The patient may be unaware of taking higher doses than they should be, or taking it with other medications that may have interactions with. this would lead to unwanted side effects. Moreover, with the mechanism of action unknown, we may not know the long-term effects of it and what other systems in the body it may be affecting. In my opinion, a solution to this would be having the herbal behind the counter so pharmacists can monitor the patient’s dosing levels, INR levels, potential side effects and possible drug-to-drug interactions.

References: Horse Chestnut. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/horsechestnut. Accessed April 10, 2020. Horse chestnut seed extract for long-term or chronic venous insufficiency. (n.d.). Retrieved from https://www.cochrane.org/CD003230/PVD_horse-chestnut-seed-extract-for-long-term-or-chronic-venousinsufficiency Green Coffee: MedlinePlus Supplements. (n.d.). Retrieved from https://medlineplus.gov/druginfo/natural/1264.html

Alyssa Mulhall Student Pharmacist

Huperzine

Spring 2020

Scientific Name Huperzia serrata

Lycopodium serratum

Common Names Brainmax, Chien Tseng Ta, Club moss, Jin Bu Buan, Memorzine, Neuroflow, Qian Ceng Ta, She Zu Cao, Shi Song

BACKGROUND/HISTORY The use of huperzine can be traced back to the Chinese pharmacopoeias of the Tang dynasty as Shi Song. It was first used for the treatment of rheumatism, colds, to relax muscles and tendons, and to improve blood circulation. As Qian Ceng Ta, it has been used for the treatment of bruises, strains, and swelling. The study of the chemistry and pharmacology of the plant and its alkaloids gained momentum in the 1980s from Chinese scientists.

Common Uses

HOW IT WORKS IN THE BODY

Memory impairment in Alzheimerâ&#x20AC;&#x2122;s disease

Huperzine is a cholinesterase inhibitor. There have been animal testing and in vitro experiments completed to figure out the mechanism of action. Huperzine appears to be a combination of anticholinesterase activity and antiglutamate, antioxidant, and neuroprotective effects. Huperzine crosses the blood-brain barrier effectively with a greater potency. Huperzine is selective for brain acetyl cholinesterase or plasma butyryl cholinesterase, which may account for its reported lower adverse effect profile in clinical studies.

Dosage Form Oral Tablet

Typical Dosing 0.2 mg twice daily between meals

EFFECTIVENESS Clinical trials have helped us understand the contributions huperzine makes in the treatment of Alzheimer’s disease. The many noncholinergic effects huperzine has in Alzheimer’s disease allows for it to be a possible highly effective drug and potentially serve as a diseasemodifying drug for Alzheimer’s disease. The clinical trials have only been short term trials, so it suggests that Huperzine could be beneficial if taken at the early stages of Alzheimer’s Disease. More long term clinical studies need to be completed before knowing if huperzine is beneficial for later stages of Alzheimer’s disease.

SAFETY Do not use if you have an allergy to Huperzine or any of its components

TOXICITIES Symptoms of acute toxicity include muscular tremor, drooling, tears, increased bronchial secretions, and incontinence.

ADVERSE EFFECTS Some include hyperactivity, insomnia, nausea, vomiting, diarrhea, nasal obstruction, dizziness, thirst.

PROFESSIONAL OPINION

FOOD/DRUG INTERACTIONS

My professional opinion is there is some data proving that huperzine can be affective in the early stages of Alzheimer’s disease. I would suggest trying it during the early stages. There is not much long term clinical data completed so I would not recommend it in the later stages of Alzheimer’s disease due to the lack of data.

Huperzine may decrease the effects of anticholinergic drugs including atropine, scopolamine, antihistamines, and antidepressants. Huperzine may increase side effects of other Alzheimer’s Disease medications, since both medications affect the brain. Huperzine may increase side effects of medications used for glaucoma, since both medications affect the body in similar ways.

REFERENCES Huperzine. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: https://www.micromedexsolutions.com. Accessed February 26, 2020. Huperzine. Drug Facts and Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://fco.factsandcomparisons.com. Accessed February 26, 2020. Zhong Ming Qian, Ya Ke. Huperzine A: Is it an Effective Disease-Modifying Drug for Alzheimer’s Disease? Frontiers in Aging Neuroscience. https://www.ncbi.nlm.nih.gov. Accessed February 26, 2020. Picture Citation: https://nootropicsdepot.com/huperzine-a-capsules/ https://www.webmd.com/vitamins/ai/ingredientmono-764/huperzine-a https://www.verywellhealth.com/the-benefits-of-huperzine-a-89464

Kava Kava Zach Nies, Student Pharmacist Spring 2020 Scientific name Piper methysticum Common name(s) Kava, Kava Kava, Ava Pepper, Ava Root, Kawa

Background • Native to the Pacific Islands • In the Piperaceae family • The roots from the plant are used in this remedy • Considered a sacred plant and used in many traditional ceremonies including marriages, funerals, healing ceremonies, naming ceremonies, and initiation for boys and girls • In Fiji, it has a symbolic function to bring two families together

Common Uses • • • •

Anxiety Improvement in cognitive function Cancer treatment in sarcoma cells Anti-coagulative effect on platelets

Photo By: Alan Carter, Medical News Today

Pharmacology & Mechanism of Action • Kava lactones are the active constituents of kava kava responsible for the pharmacological activity • Kava produces a mild euphoria that are like benzodiazepines • Suggested mechanisms include enhanced ligand binding at GABA receptors, reversible inhibition of MAO-B, and reduced uptake of dopamine (DA) and norepinephrine (NE)

Dosage Forms • • • •

Tablet Drink Capsule Powder

Maximum Daily Dose: 250 mg

Effectiveness •

•

a. Clinical studies in the last decade have shown that kava kava is non-addictive and is as effective as other prescription options. Studies also have shown that kava kava can improve concentration, memory and reaction time in patients that take this to improve their anxiety. If used short-term, this remedy should provide improvements, while still avoiding most of the shown adverse effects.

Safety •

•

• •

•

In controlled trials, more than 90% of participants found no significant differences in liver function tests or adverse reactions after four weeks. Long-term safety studies regarding the use of kava are still needed because the studies were only four weeks long. In 2002, the FDA has issued warnings about kava-containing products in the US. 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. There is no glutathione, which protects the liver from the kavalactones, in the tablet and capsule forms, which might explain the reported cases of hepatotoxicity.

My Professional Opinion Photo By: Amritpal Singh Saroya and Jaswinder Singh, Springer Link

Adverse effects/Toxicities • Linked to severe liver damage and toxicity • Long-term use associated with scaly skin rash • Mild and reversible gastrointestinal (GI) disturbances

Food/Drug Interactions: • Parkinson’s drugs • Benzodiazepines • CNS depressants • Paroxetine • Alcohol • Liver damaging drugs & food

Research has allowed me to believe that it is a safe, natural remedy for treating anxiety. This form has glutathione to help the body metabolize it. If used short-term and consulting with your physician, may result in positive effects on your overall health. ~ Z. Nies References Bilia A, Gallori S, Vincieri F. Kava-kava and anxiety: Growing knowledge about the efficacy and safety. Life Sciences. Volume 70, 2002:(22) 2581-2597. Dhwty. (2014, July 14). The Ancient Origins Of the Ceremonial Kava Drink Of the Pacific. Ancient Origins. https://www.ancient-origins.net/ancient-places-asia/ancient-origins-ceremonialkava-drink-pacific-001848 Hepatic Toxicity Possibly Associated with Kava-containing Products --- United States, Germany, and Switzerland, 1999—2002. (2002, November 29). CDC. Retrieved March 30, 2020 from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5147a1.htm Kava. Natural Products. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed March 4, 2020. Lau A, Salisbury A, Whitehouse J, Whitton P. Kava lactones and the kava-kava controversy. Phytochemistry. Volume 64, 2003:(3) 673-679.

Krill Oil Scientific name: Euphausia superba Common names: Krill, Euphausia antarctica Montana Ogden | Student Pharmacist | Spring 2020 Background: Although it was approved as a dietary supplement by the FDA in 1999, krill oil was not widely distributed or used until more recent years as an alternative to fish oil. It is extracted from Antarctic krill species Euphausia superba and contains high contents of omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as well as the antioxidant astaxanthin.

Common Uses: o o o o o o o

Blood clot prevention Nail and skin production Anti-inflammation High cholesterol Hypertension Arthritis Heart disease

Pharmacology:

Spring Valley (2019) Krill Oil Supplements

Krill oil is a potent source of essential omega-3 fatty acids which increase cell membrane functioning and decrease blood viscosity, ultimately lowering blood pressure and cholesterol. Omega-3 fatty acids are also shown to reduce inflammation by competing with arachidonic acid in cell membranes to decrease biosynthesis of inflammatory mediators such as leukotrienes.

Dosage Forms/Typical Dosing: Kill oil is often formulated into capsules containing 1 to 3 grams and administered once daily

Effectiveness: Clinical effectiveness for fish oils containing omega-3 fatty acids have shown to improve hypertension and improve functioning in those with heart disease in several clinical studies.. However, not many studies have been conducted to indicate the effectiveness of krill oil itself for these conditions.

Adverse Effects: o o o o o o o o

Loose Stool Heartburn Halitosis Nausea Taste Disturbance Bloating Gas

Toxicities:

Riisgård, Hans Ulrik. (2015). Filterfeeding mechanisms in crustaceans.

Not enough studies have indicated safety for use in pregnant or breastfeeding women.

Safety Concerns/Warnings: Patients with bleeding disorders or undergoing surgery should avoid krill oil due to increased bleeding risk. Patients will seafood allergies should avoid fish oils including krill oil.

Food/Drug Interactions: Krill oil increases risk of bleeding or bruising when used with other anticoagulant or antiplatelet drugs. Krill oil may decrease absorption of the weight loss medication Orlistat. Taking these medications at least two hours apart may increase absorption in the gut.

Research: One randomized clinical research study, “Effects of krill oil and lean and fatty fish on cardiovascular risk markers: a randomized controlled trial,” demonstrated that, in comparison to increased lean and fatty fish consumption, krill oil showed several health benefits, including reduced fasting blood glucose, increased vitamin D, and higher plasma-marine fatty acid content.

My Professional Opinion: Based off of the demonstrated clinical effectiveness of krill oil, I would recommend krill oil supplementation in those who are at increased cardiovascular risk. However, patients who are pregnant or nursing and patients who are taking anticoagulants or antiplatelet medications should be strongly advised to avoid taking krill oil due to the increased risk of bleeding or bruising.

References: Backes, J. M., & Howard, P. A. (2014). Krill oil for cardiovascular risk prevention: is it for real?. Hospital pharmacy, 49(10), 907–912. https://doi.org/10.1310/hpj4910-907 Luisa Deutsch (2007) Evaluation of the Effect of Neptune Krill Oil on Chronic Inflammation and Arthritic Symptoms, Journal of the American College of Nutrition, 26:1, 3948, DOI: 10.1080/07315724.2007.10719584 Ramprasath, V.R., Eyal, I., Zchut, S. et al. Enhanced increase of omega-3 index in healthy individuals with response to 4-week n-3 fatty acid supplementation from krill oil versus fish oil. Lipids Health Dis 12, 178 (2013). https://doi.org/10.1186/1476-511X-12-178

Dosing/Serving

Anxiety: Silexan 80-160 mg/day for 10 weeks has been used for anxiety regardless of diagnosis, but particularly for GAD Bath aromatherapy: 6 drops added to 20 L of bath water. 20100 g of dried herb in 20 L of bath water. Inhalation aromatherapy: 2-5 drops in 10 to 710 mL of boiling water, in an aromatic diffuser, Humidifier, infiltrated onto filter paper or on a cotton pad, or dripped in a jar for inhalation. Massage Aromatherapy: 1-4 drops per tablespoon of base or carrier oil; may mix with other essential oils. Management of Psychological Stress: :avender oil diluted to 1% has been used for massage for at least 30 minutes Oil for ingestion: 1-4 drops given on a sugar cube Sitz Bath: Sitz containing10 mL of betadine 10% & 0.25 mL of 0.96% lavender oil essence (2.4 mg) in 5 L of water for soaking (30 minutes twice daily for 5days) Tea: 1-2 tsp (5 to 10 mL) of lavender herb steeped in 1 cup of boiling water.

Scientific Name: Lavandula angustifolia Common Names: Lavender, English lavender, common lavender, French lavender Background: Lavender has been used for centuries and can be traced all the way back to the Egyptians who used it in the mummification process. In the 16th century, Europeans believed it was beneficial in increasing intelligence. It is native to the Mediterranean region, Arabian Peninsula and Russia and is grown in Europe, the United States and Australia. Lavender has a long history of use in boosting appetite and mood in addition to relieving GI problems and anxiety.

How it Works in the Body

Lavendar's suspected mechanism of action varies between how it is used. With respect to treating anxiety, the two primary terpenes in lavendar oil are linalool and linalyl acetate. Together, they act to produce a calming effect. It is believed that they do so by inhibiting voltage-gated calcium channels, reducing 5HT1A receptor activity and increasing parasympathetic tone. Available Dosage Forms

Tea from lavender leaves Vapor for inhalation can be made by mixing lavender oil (an essential oil) with boiling water Capsules Liquid extracts

Uses: Antibacterial Anxiolytic Antidepressant Analgesic Carminative Wound healing Anxiety Insomnia Pain

Amee Patel 1st Year Pharmacy Student Spring 2020

Effectiveness

My Professional Opinion

Food & Drug Interactions

There are several studies that suggest the use of lavender can be efficacious for a variety of purposes including pain, anxiety, insomnia and wound healing in humans. Some studies suggest that while effective, others suggest there may not be a direct effect. Studies still remain unclear on the efficacy with respect to the various uses.

With regards to the use of lavendar for a variety of purposes, I believe it can have varying benefits based on each individual. I would not recommend this being the sole treatment for things such as unbearable pain, however I do think if an individual is willing and able to try using lavendar for the various uses it is known to be used for, it could provide benefit. Based on the research already out there on the use of lavendar, it appears to not have any outrageous risks for individuals so I would feel comfortable trying it if I am looking for a non-pharmacologic approach to any of the issues listed on the first page. I do with more research existed for individuals who like data and studies to back their decisions.

There are no well documented food or drug interactions.

Safety & Adverse Effects

The existing data suggests that the shortterm use of lavendar is relatively safe. Topical use of diluted lavendar oil is generally safe for use in most adults however some may experience skin irritation. With respect to aromatherapy, there is not enough evidence to determine its safety when inhaled. Some studies suggest topicals containing lavendar oil could affect sex hormone activity. Lavendar oil itself taken by mouth could be poisonous while extracts can cause stomach upset, joint pain and headaches.

References Koulivand PH, Khaleghi Ghadiri M, Gorji A. Lavender and the nervous system. Evidence-based complementary and alternative medicine : eCAM. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612440/. Published 2013. Accessed April 9, 2020. Lavender. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/lavender. Accessed April 9, 2020. Lavender. http://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750228. Accessed April 9, 2020. Lillehei AS, Halcรณn LL, Savik K, Reis R. Effect of Inhaled Lavender and Sleep Hygiene on Self-Reported Sleep Issues: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine. 2015;21(7):430-438. doi:10.1089/acm.2014.0327 Malcolm BJ, Tallian K. Essential oil of lavender in anxiety disorders: Ready for prime time? The mental health clinician. https://www.ncbi.nlm.nih.gov/pubmed/29955514. Published March 26, 2018. Accessed April 9, 2020.

Toxicity

The US FDA has classified lavendar as GRAS, or generally recognized as safe for consumption Research Study

A research study compared the effectiveness of lavendar in conjunction with sleep hygiene and sleep hygiene alone on sleep quality among 79 college students with self-reported sleep issues. One group wore an inhalation patch on their chest at night with 55 uL of lavendar essential oil while the other wore a blank patch over the course of 5 nights with baseline, post-intervention and two week follow-up assessments. The study was able to conclude that the group with lavendar and proper sleep hygiene together had better quality of sleep followed by sleep hygiene alone at a lesser degree. This effect remained at the follow-up as well.

Lobelia Sophia Postma, Student Pharmacist, Spring 2020 Scientific Name: Lobelia inflata Common Names: Asthma weed, Bladderpod, Eyebright, Gagroot, Indian tobacco, Indian weed, Pukeweed, Vomitwort

http://theherbhound.blogspot.com/2013/07/lobelia.html

Available Dosage Forms: Background/History: Lobelia is a flowering herb named after a Belgian botanist, Matthias de Lobel. Lobelia has been used since the 1700s by the Native Americans for ceremonial and medicinal purposes. The Native Americans used it as a tobacco substitute, to promote vomiting, as well as relaxing airways and muscles.

• •

Loose and dried leaves to brew into a tea Tablets, capsules, liquid extracts

Typical Dosing/Serving: • •

Depends on what you are trying to treat/prevent 100mg of dry herb up to three times a day (from traditional evidence)

Purported Uses: • • • • •

Asthma, bronchitis, cough Muscle soreness/relaxant Antispasmodic to prevent seizures Depression, ADHD Drug abuse, smoking cessation https://commons.wikimedia.org/wiki/File:Lobeline.png

Mechanism of Action: • • • •

The alkaloid form of lobelia is lobeline Lobeline has a similar affinity to the nicotinic acetylcholine receptor, therefore it has similar CNS and peripheral effects as nicotine Lobeline may inhibit dopamine transportation by blocking its uptake. Also, lobeline protects dopaminergic neurons from toxins that can cause neuron damage and death For asthma/COPD, lobeline relaxes bronchial tubes, stimulates breathing, and loosens phlegm by decreasing viscosity and promoting excretion of mucus in the respiratory system

Effectiveness: •

The FDA prohibited the sale of lobelia for the indication of smoking cessation in 1993 due to lack of evidence of efficacy The liquid extract has proven to be efficacious in providing local therapy for asthma symptoms Few human studies have been conducted on lobeline (lobelia’s active ingredient), but many animal studies have proven it be somewhat efficient in treating respiratory disorders

• •

https://www.nhc.com/lobelia-extract-by-herb-pharm

Safety: •

•

Adverse Effects (only at high doses): Lobelia should be avoided if pregnant or breast feeding due to the vomiting and nausea side effects Lobelia should be avoided if the patient has any GI problems because it irritates the GI tract Lobelia should also be avoided in anyone with heart disease because of its cardioactive effects

• • • • •

Nausea, vomiting, diarrhea Tremors Dizziness Coma Alkaloids have cardioactive effects and can cause cardiotoxicities (e.g. hypertension, tachycardia, and convulsion

Toxicities: •

Doses of 0.6-1mg are considered toxic and 4g of the leaf is considered fatal

Food/Drug Interactions •

•

Lobelia has a moderate interaction with lithium because it has similar effects to a water pill/diuretic Lobelia may negatively affect how efficiently the body excretes lithium which leads to an increase in the lithium resulting in serious side effects

https://uk.iherb.com/pr/nature-sway-lobelia-herb-425-mg-100capsules/1910

Personal/Professional Opinion: Since lobelia is sold over the counter at a dose that is appropriate and safe, I believe that it would be a good alternative to try for alleviating symptoms of any of the stated disease states. If someone doesn’t have insurance, this would be a cheaper therapy alternative. Also, if someone does not want to take prescription drugs, this is a good substitute that is natural. I would encourage people to be openminded about the product and try it.

Lobelia Study:

References:

In a study conducted by South Dakota State college of pharmacy professors, it was found that lobelia binds to nicotinic acetylcholine receptors and have antagonistic effects which produces antidepressantlike effects. After administering lobeline to mice 20 minutes before conducting a series of tests all designed to measure a drug’s antidepressant’s efficacy in animals, there were lower cortisone levels as well as increased norepinephrine and serotonin levels in the prefrontal cortex and hippocampus.

Streit L, MS, RDN, LD. Healthline. What Is Lobelia, and How Is It Used? Available at: https://www.healthline.com/nutrition/lobelia. Accessed March 2, 2020 Rahman S, Roni MA. Antidepressant-like effects of lobeline in mice: Behavioral, neurochemical, and neuroendocrine evidence. Progress in Neuropsychopharmacology & Biological Psychiatry 2013; 41: 44-51. DOI:10.1016/j.pnpbp.2012.11.011 WebMD. Lobelia. Available at: https://www.webmd.com/vitamins/ai/ingredientmono231/lobelia. Accessed March 2, 2020 https://articles.mercola.com/herbs-spices/lobelia.aspx

Maca Shengzhou Qiu Pharmaceutical Science Student Spring 2020 1

Background Lepidium meyenii, as known as maca, is the root of an native vegetable found in the Andes region of Peru. Sometimes it’s also called “Peruvian ginseng” although it’s not biologically related to ginseng. It has been used as a powerful plant medicine for 3000 years or more. Common Uses Maca is commonly used to treat erectile dysfunction.And it’s also used to increase libido. Effectiveness Many researches have been done to test the effectiveness of maca. It shows effects on improving rat sexual performance and it also shows anti-fatigue effect during animal experiments. Available Form Usually maca is sold as powder in capsules or serving as powder added to food. Both serving forms are shown in the pictures below.

Mechanism Although the holistic mechanism stays unknown but there are some researches have been done to prove that maca can increase the serum levels of luteinising hormone in female rats. Therefore, maca may have similar effects on human LH which is the hormone that regulates sex drive in human body. By influencing the LH level in human body, maca might effect the consumer’s libido and improve sexual performance.

Maca powder in gelatine capsules

Maca as dry powders

Picture by gaiaherbs.com

Picture by wildernesspoets.com

Picture by Kandola, Aaron. “10 Health Benefits of Maca Root.” Medical News Today, MediLexicon International, 30 Jan. 2020, www.medicalnewstoday.com/articles/322511. 1

Safety Concern When taken by mouth, maca is most likely to be safe even when a large amount is taken. And there isn’t enough research to indicate any safety concern towards pregnant or breast-feeding women. Side Effects There are research to support that maca can adjust hormone level. Therefore, if the consumer has any hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids, the consumer is not suggested to take maca which might make the condition worse. Toxic Effects Researches has been done on the toxicity of maca and the animal experiments shows no evidence for any major toxic effect so far.

Interactions There is not enough information to make any claim on the interactions of maca with other food or drug. The only information available is the taste described by the users. It’s said that it has nutty and earthy flavor which goes very well with cinnamon. Professional opinions Psychiatrist and functional medicine physician Hyla Cass, MD, says maca works. "In my practice, I have seen maca restore hormonal imbalance and related sexual desire and fertility in both men and women." Georgetown University Medical Center professor Adriane Fugh-Berman, MD, says, "Maca might have a positive effect on sexual dysfunction. Yet there are so many psychological and social aspects when measuring sexual healing that it is hard to be conclusive."

Reference: Cicero, A. F. G., et al. “Hexanic Maca Extract Improves Rat Sexual Performance More Effectively than Methanolic and Chloroformic Maca Extracts.” Andrologia, vol. 34, no. 3, 2002, pp. 177–179., doi:10.1046/j.1439-0272.2002.00490.x. Kandola, Aaron. “10 Health Benefits of Maca Root.” Medical News Today, MediLexicon International, 30 Jan. 2020, www.medicalnewstoday.com/articles/322511. Uchiyama, Fumiaki, et al. “Lepidium Meyenii (Maca) Enhances the Serum Levels of Luteinising Hormone in Female Rats.” Journal of Ethnopharmacology, vol. 151, no. 2, 2014, pp. 897–902., doi:10.1016/j.jep.2013.11.058. Wong, Cathy. “The Health Benefits of Maca Root.” Verywell Health, Verywell Health, 4 Jan. 2020, www.verywellhealth.com/ways-maca-may-benefit-your-health-89573. Zelman, Kathleen M. “The Truth About Maca.” WebMD, www.webmd.com/sex-relationships/features/the-truth-about-maca#1.

WebMD,

Ghenella Salanio Student Pharmacist, Spring 2020

MELATONIN Scientific Name: N-acetyl-5-methoxytryptamine | Common Names: Circadin, Melatonin, MEL, MLT

COMMON USES It is commonly used for sleep disorders, insomnia, jet lag, and analgesia.

DOSAGE FORMS Usually comes in tablet forms or as chewable gummies

PHARMACOLOGY Melatonin works by regulating the circadian rhythm, which is the central biological clock. It is released by the pineal gland in the brain during the absence of light. It then binds to the receptors, MT1 and MT2, in the central nervous system and downregulates protein activities. Lack of stimulus causes sedation, making melatonin a popular sleeping aid.

TYPICAL DOSING Insomnia: 3-5 mg every night for 4 weeks Jet lag: 0.5-2 mg preflight and 5 mg post flight up to 4 days Analgesia: 3-10 mg/day

https://nootropicsresources.com/melatonin-natural-sleeping-pill/

BACKGROUND

https://www.msn.com/enus/Lifestyle /rf-buying-guides/bestmelatonin-supplements-reviews https://www.msn.com/enus/Lifestyle /rf-buying-guides/bestmelatonin-supplements-reviews

Melatonin was first isolated from a cowâ&#x20AC;&#x2122;s pineal gland in 1958 by Aaron B Learner. His discovery prompted animal studies in mammals and birds to identify its function. Later studies from rats revealed that estrogen released during the day can be manipulated by controlling melatonin synthesis and release. This revealed association between melatonin and the daily light and dark cycle.

SAFETY & EFFECTIVENESS Melatonin is effective as it has been shown to improve sleeping conditions. Also, it is generally safe to use for adults and children, but it should be avoided during pregnancy and lactation.

ADVERSE EFFECTS & TOXCITIES Adverse effects include headache, dizziness, nausea, and sleepiness. Limited studies have been performed studying its toxicity, so lethal dose is currently unknown.

INTERACTIONS Melatonin is metabolized by the CYP-450 system, so it has multiple drug-drug interactions. It should be avoided with sedatives since it will enhance sleepiness. Additionally, melatonin should be used with caution when patient is also taking, anticoagulants, ant-depressants, antihypertensives, and anticonvulsants. Fluvoxamine, nifedipine, and warfarin should be avoided with melatonin. Alcohol has also shown to reduce melatoninâ&#x20AC;&#x2122;s efficacy so it should not be used at the same time.

ARTICLE SUMMARY One study analyzed the safety and efficacy of melatonin in pediatrics patients. Melatonin is often given to children with sleep onset insomnia, delayed sleep phase syndrome (DSPS), nighttime awakenings, and to those with developmental disorders. Sleep disturbances are commonly associated with neurological conditions, like ADHD, which affects quality and onset of sleep. They found that melatonin improves onset of sleep time, indicating its efficacy. They also found no major adverse reactions, so they concluded that the supplement is generally safe for children.

PROFESSIONAL OPINION Melatonin remains a popular sleeping aid, and I support its clinical use. I believe it is helpful for regulating and initiating sleep to those with jet lag or sleeping disorders. Studies and research indicate safety and efficacy of the supplement when used in moderation. It is important, however, for the patient to be aware of the adverse effects melatonin can cause prior to use. It is also prone to drug-drug interactions, so I would encourage patients on multiple medications to seek their doctor or pharmacist.

References Bruni O, Alonso-Alconada D, Besag F, et al. Current role of melatonin in pediatric neurology: Clinical recommendations. European Journal of Paediatric Neurology. 2015;19(2):122-133. doi:10.1016/j.ejpn.2014.12.007. Melatonin. Lexi-drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Published February 25, 2020. Accessed March 1, 2020. Melatonin: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-940/melatonin Accessed March 1, 2020.

Ronald Mahan

Student Pharmacist

Mitragyna Speciosa (Kratom, Kratum, Katum, Thom, Thang, Herbal Speedball, Biak, Mambog)

History: Where this plant is native to, Thailand, Indonesia and Malaysia, it is traditionally used as a way to keep workers from falling asleep while doing monotonous tasks. It has also been used as a natural painkiller, in religious worship ceremonies, and as a snack to house guests. Uses: Mitragyna Speciosa can be used to increase one’s energy, appetite, and sexual drive. It has also been known for its anesthetic effects and been used to relieve musculoskeletal pain, heal cuts and bruises, and act as a means to treat coughs, diarrhea, and gastrointestinal infections.

Mechanism: In high doses, Mitragyna Speciosa alkaloid subgroups, Mitragynin and 7hydroxymitragynin, activate the mu opioid receptors (MOR), stimulating an analgesic effect. These two alkaloid components are full agonists, and selective towards the mu receptor. Naloxone can be used as a way to block kratom from acting.

Dosage forms: Mitragyna Speciosa is present in leaves but can be pulverized into a powder and placed into various teas or condensed into capsule to be taken by mouth. Dosing: A typical dosing would be about ½ teaspoon (2.5 mL) of powder, about 2.5 grams, or 500 mg. of powder condensed inside of a capsule.

Anwar, M., Law, R., & Shier, J. (2017, August 24). Notes from the field: Kratom (Mitragyna speciosa) exposures reported to poison centers – United States, 2010–2015. Weekly, 65(29), 748–749

Safety Concerns: There have been a few major safety concerns with Mitragyna Speciosa, some of which include overdose, addiction, liver damage, and death. Since in high doses, this can interact with opioid receptors, so there is a possibility of overdose and addiction. It has also been known to cause liver damage, with reporters experiencing side effects such as dark colored urine and jaundice. Death has also been recorded of users taking high doses of Mitragyna Speciosa, with most of which coinciding taking antidepressants and mood stabilizers.

Effectiveness: Takes about five to ten minutes to experience the effects, and these effects last for about two hours to five hours Interactions: Mitragyna Speciosa can decrease the rate of drug metabolism by the liver, affecting the rate the liver metabolizes other drugs, resulting in a higher drug dose than intended. Drugs such as amitriptyline, carisoprodol, citalopram, diazepam, lansoprazole, omeprazole, phenytoin, and warfarin are all at a higher risk for interactions when taking Mitragyna Speciosa.

Warnings: Shouldn’t consume if pregnant or breastfeeding. More severe side effects occur when people are taking Mitragyna Speciosa with other sedating drugs. Side effects: • Weight loss • Dry mouth • Nausea and Vomiting Toxic Effects: The pharmacology of Mitragyna Speciosa is dose dependent. In low to moderate doses (5-15g.), Mitragyna Speciosa has a slight stimulant effect, but at high doses (above 15g.), increased cheek pigmentation, tremors, anorexia, weight loss, and psychosis have been observed with long term addiction of Mitragyna Speciosa. Past heavy users of opioids experienced prolonged effects of Mitragyna Speciosa when using it to aid in the symptoms of withdrawal.

Ronald Mahan

Summary: From the article I read, it seems like there are two very polarizing viewpoints on Mitragyna Speciosa, commonly known as Kratom. There was an account from a father whose son became a victim to the adverse effects of Kratom. The son was heavily involved in sports, and was a star athlete, but broke his back towards then end of his athletic career. The son started stealing Oxycontin from his mother and became addicted to opioids. Once the son went to college and stopped taking oxycontin, he started taking Kratom as a substitute. He would take it in high doses, sometimes 16 spoonfuls a day, and his whole life started to change ranging from his personality, to focus and academic ability. The son later checked into rehab to help taper off of Kratom, and regrets getting into this easily accessible product. Another account recollects a girl’s personal experience with kratom and how it has helped her manage her chronic arm and shoulder pain. From a young age, this female started experiencing chronic pain in her arm, making it difficult for her to perform simple tasks throughout the day and as a result, couldn’t hold down a stable job for a long time. She started her own bakery since she kept on getting fired because she couldn’t do many tasks at past jobs, and almost ran the business into the ground because she couldn’t work and manage her workers most of the days due to the excruciating pain. She looked into alternative pain medications and practices she could try, and she stumbled upon kratom. She started using it in teas and capsules and has experienced a better life because of the usage. She now reports feeling less lethargic, and decreased pain levels making her feel more energetic and like her old self again. She states that Kratom has saved her life and that she wouldn’t know what to do if it became illegal in the United States.

Student Pharmacist

Opinion: In my professional opinion, I think there is a lot of promising hope for this product in the near future as a way to help with the withdrawals from opioids. Since this product isn’t regulated by the FDA and is very negatively personified, there hasn’t been much Federal research funding for Mitragyna Speciosa. Since it acts on the mu receptors for opioids, it can help by activating these receptors on the body, but since it doesn’t have as much of a powerful effect on the receptors and other opioids, it decreases the symptoms of withdrawals, helping the patient suffering from addiction taper off of opioids. The use of Mitragyna Speciosa with helping with alcohol addiction have also been proved useful. Here at Purdue University at the Van Rijn lab, researchers have studied the effects of the main alkaloid components of Mitragyna Speciosa and their effects on alcohol use. They concluded that the extracts from Mitragyna Speciosa can help with a decrease in alcohol consumption but have other risks when exposed to prolonged use. A more selective delta opioid synthetic opioid might produce a safer and more effective way to aid with alcohol use disorder, resulting in less side effects than the natural Mitragyna Speciosa alkaloid extracts. I think that as the stigma of Mitragyna Speciosa decreases from a bad recreational used connotation to a more researchbased possibility, funding will increase, and more fruitful results will lead to the development of Mitragyna Speciosa based pharmaceutical products.

References Ada, Chris. Chris. Opioid-based plant might not be best solution for those seeking to curb habitual alcohol use. Purdue Foundation 2019. Green Vein Kratom. Green Kratom Strain, Spectrum Kratom. https://spectrumkratom.com/product/green-vein-maeng-da/. N.d. Accessed February 15, 2020. Mayo Clinic. Healthy Lifestyle Consumer Health. Available at https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/kratom/art-20402171. Accessed February 15, 2020. Miereles, V, Rosado T, Barroso M, et al Mitragyna speciose. Clinical Toxicological Aspects and Analysis in Biological and Non-Biological Samples. Medicines (Basel). 2019;6(1):35. Published 2019 March 4. Doi:10.3390/medicines6010035 Prozialeck, W.C., Jivan J.K., & Andurkar, S. V. (2012, December). Pharmacology of Kratom: An emerging botanical agent with stimulant, analgesic and opioid-like effects. Journal of the American Osteopathic Association, 112 (12), 792-799

Omega 3 and Omega 6 fatty acids

https://omegavia.com/why-enteric-coating-on-fish-oil-pills-fail/

Noah Scholl Student Pharmacist, Spring 2020 Omega 3 and 6 fatty acids are essential to life and can only be obtained from the diet, as the body cannot manufacture them on its own. Modern diets are rich in omega 6 fatty acids but are generally considered to not contain enough or the correct ratio of omega 3 fatty acids. The following is a brief discussion of those omega 3 fatty acids, to help guide consumers. The scientific names of the common omega-3 fatty acids are as follows: ALA (alphalinolenic acid) is commonly found in soybeans, walnuts, flaxseeds, spinach, kale, and canola oil. EPA (eicosapentaenoic acid) is found in fatty fish, and algae. DHA (docosahexaenoic acid) is also found in fatty fish, algae and small quantities in eggs. The body can convert ALA into EPA and DHA; however, most research has been focused on EPA and DHA, because it was noticed that diets rich in seafood had heart protective effects. They are also known to have antiinflammatory effects and are essential to brain development and health. While the exact mechanisms of action are not completely understood, EPA and DHA compete with precursors of inflammatory proteins, inhibit platelet aggregation, and are essential components of plasma membranes. Purported uses of omega-3 fatty acids include: lowering blood cholesterol, cardiovascular risk reduction, hypertriglyceridemia, bipolar disorder, Alzheimerâ&#x20AC;&#x2122;s disease, dementia, increase mental stamina, reduce inflammation, ADHD, male fertility, IgA

nephropathy, supplement in pregnancy for fetal development, cancer, hot flashes, depression, and rheumatoid arthritis are just a few. A considerable amount of research has been done on EPA and DHA. The following is a brief summary of the National Institutes of Health Omega 3 Fatty Acids factsheet for health professionals. ALA is the only essential fatty acid for adults, however human breast milk contains ALA, EPA. Supplements vary widely, so it is important to check the types and amounts of omega-3s in the product. Most children and adults in the United States consume adequate amounts of Omega-3s. Deficiency can cause rough scaly skin and dermatitis. Eating 8 oz of seafood a week reduces the risk of cardiovascular disease (CVD); however, the protective effect of omega-3 supplements is unclear. Consumption of 8 oz -12 oz of seafood a week during pregnancy and early infancy is beneficial for infant health and neurodevelopment, care should be used to choose seafoods low in methyl mercury, evidence is insufficient to recommend omega 3 supplementation. Omega 3s effect on cancer risk is still under investigation, many of the results are conflicting. The rest of the purported uses are still under investigation and there is no evidence to support omega-3 supplementation as a treatment. The FDA limits recommended dosing on dietary omega-3 supplements to 2 grams a day. They are available in liquid capsules, chewable tablets, and delayed release tablets. Common names include: Long-chain PUFAs, Fish Oils, Lovaza, Omega Power, Salmon Oil-1000, SeaOmega, Ocean Blue MiniCaps Omega-3, Odorless Coated Fish Oil, and many others. Adverse effects include the following: stomach cramps, fishy taste, heartburn, increased burping, muscle pain, constipation, throat pain, change in taste, joint pain, and diarrhea. Discontinue if abnormal heartbeat, dizziness, passing out, shortness of breath, chest pain, bruising, bleeding, swelling of arms or legs, allergic reactions. The supplement should not be used if you have: diabetes, liver disease, a pancreatic disorder, underactive thyroid, have active bleeding (peptic ulcer or intercranial), or drink more than 2 alcoholic beverages a day. Toxic dose has not been defined, increased bleeding is seen between 2 and 15 grams a day; however, the European Food and Safety Authority considers long term consumption of up to 5 grams a day to be safe. Possible drug interactions with anticoagulants or antiplatelet drugs, for example warfarin and NSAIDS especially at high doses of omega-3 supplementation. FDA states that clinically significant bleeding has not been observed, but patients INR status should be periodically monitored for changes. After my research I would recommend eating 8 oz seafood a week, preferably ones low in methyl mercury. The health benefits of such a diet are well documented and may include other nutrients that are currently lacking in the diet. References: 1.

NIH Office of Dietary Supplements. Omega-3 Fatty Acids. Available at: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/. Updated October 17, 2019. Accessed March 31, 2020. Omega-3 Fatty Acids. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/patch_f/6914?cesid=2iRCWFb8 xPW&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Domega%25203%26t%3Dname%26va%3Domeg a%25203. Updated March 23, 2020. Accessed March 31, 2020. Simopoulos AP. The omega-6/omega-3 fatty acid ratio, genetic variation, and cardiovascular disease. Asia Pac J Clin Nutr 2008;17 (S1): 131-134

By: Renee Selle Student Pharmacist Spring 2020 https://www.gnc.com/homeopathic-products/215548.html

Scientific Name: None Common Names: Anas Barbaria, Anas Barbariae, Anas Barbariae Hapatis et Cordis Extractum HPUS Common Use: Treatment of cold & flu symptoms Dosage Form: Tablet/ dissolving pellets Mechanism of Action: Unknown

https://www.healthproductsforyou.com/p-boironoscillococcinum-cold-and-flu-quick-dissolving-pellets.html

Dosing: Dissolve the pellets of one tube in the mouth every 6 hours for adults. Ask

doctor for kids.

•

Discovered by a French physician names Joseph Roy.

•

He was on military duty when the Spanish flu hit, and he studied the microorganisms.

•

He found a ‘universal germ’ between multiple different disease states on his microscope which he called oscillococci. (No one has been able to find it since and it’s impossible to find due to some of the diseases are not caused by microbes and can’t be seen by a microscope.)

•

He always believed in homeopathic beliefs and no one knows why he turned to the Muscovy duck.

Oscillococcinum Effectiveness: Most of the effect is said to be due to the placebo effect. There is no proven effect. Safety: Ask health care professional before using if pregnant or breastfeeding or for kids under 2 years of age. Adverse Effects: Relatively safe for most people. Severe cases report severe swelling and some headache. Toxicities: None Food/Drug Interactions: None

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

My Opinion:

Study • • • • •

Cochrane did a study to see whether oscilococcinum was more effective than placebo There were six studies with two prevention trials and four treatment trials In the prevention trial it showed that oscilococcinum did not prevent the flu. In the four treatment trials it showed some benefit at 48 hours but that can be due to bias. Overall the evidence was proved low quality.

Since there are not real toxicities, adverse effects or safety issues I don’t see the harm. If you feel like it helps then I can’t tell you not to take it. You have to be aware that the reason it works for you could be the placebo effect. However, I will not advise you to take it because there is no evidence to support that it works.

References • •

The True Story of Oscillococcinum. Quackwatch. https://quackwatch.org/homeopathy/history/oscillo/. Published August 27, 2003. Accessed March 6, 2020. Oscillococcinum. BOIRON USA. https://www.boironusa.com/products/oscillococcinum/. Accessed March 6, 2020.

•

Oscillococcinum: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-1080/oscillocc\occinum. Accessed March 6, 2020.

•

Mathie RT, Fry J, Fisher P. Homeopathic Oscillococcinum  for preventing and treating influenza and influenzalike illness – Mathie, RT – 2015: Cochrane Library. Cochrane Database of Systematic Reviews. https://www.cochranelibrary.com/cdsr/doi/10/1002/14651858.CD001957.pub6/abstract. Publushed January 28, 2015. Accessed March 6, 2020.

POMEGRANATE "punica

granatum"

Background The pomegranate tree originates in a region ranging from Iran to the Himalayas in Norther Indian. The pomegranate is the traditional representation of fertility and has origins in most dry regions in Asia.

https://pixabay.com/photos/ pomegranate-exotic-fruit-fruit-cut-3383814/

The usual season for pomegranate is September to February (Norther

Mechanism of Action

Hemisphere) and March to May (Southern Hemisphere).

-Â Antioxidnat properties: antioxidants

Potential Uses

can help in the prevention of cardiovascular inflammation and

-Heart

other disease by preventing

problems: decrease risk of heart

oxidative stress that produces toxic

attack or stroke

metabolites

-Stomach Disorder: helps with digestion

-Anti-inflammatory properties:

-Dental

pomegranate has been shown to

care: reduce dental plaque

inhibit a variety of different

-Osteoarthritis:

inflammation mechanisms in similar

preventing the creation of minerals

was to non-steroidal anti-

that break down connective tissue

inflammatory drugs (i.e.

-Diabetes:

ibuprofen)

prevent coronary illness in diabetes patients

-Carcinogenesis: pomegranate has

-Anemia:

shown inhibitory effects on different

help maintain a healthy blood flow

types of cancer cells

Dosing and Potential Dosage Forms

-Angiogenesis: pomegranate has shown to improve the development of new blood vessels

Dosage Forms - Juice

-Apoptosis: pomegranate is able

- Seeds

to alter the process of programmed

- Powder

cell death

-Capsule -Vital enzymes: pomegranate is able to inhibit different enzymes

Dosing of pomegranate depends largely on the users age, health, and any other potential medical conditions.

ELISE SMITH

Student Pharmacist | Purdue University | Spring 2020

Effectiveness

Potential Side Effects

Pomegranate is semi-effective when

When pomegranate juice is taken by

used in an abundant quantity. It has some health benefit when taken regularly as well as other health precuations.

Food/ Drug Interactions Pomegranate can have moderate interactions with: -High blood pressure medications -Medications broken down in the liver

Article Summary

mouth it is most commonly safe for human consumption. There is a potential for anaphylaxis. Pomegranate can lower blood pressure to dangerous levels, if blood pressure is already low.

Professional opinion In my professional opinion, pomegranate is great for a snack or a sweet treat, but I would not personally use It for any medicinal purpose.

There are many benefits to pomegranates as a dietary supplement. Pomegranates contain two plant compounds with powerful medicinal properties, these being Punicalagins which are very potent antioxidants and Punic Acid which is a conjugated linoleic acid with very potent set of biological effects. Along with this, pomegranate has a very high antiinflammatory effect. It is thought to help in heart disease, cancer, type 2 diabetes and Alzheimerâ&#x20AC;&#x2122;s disease. Pomegranate juice on the regular has been shown to lower blood pressure levels. Pomegranates also show some antibacterial and antiviral properties.

https://pixabay.com/photos/fruitpomegranate-red-nature-1323080/

Sources Volume 1 Issue 5 Online Available at www.phytojournal.com ... http://www.phytojournal.com/vol1Issue5/Issue_jan_2013/6.1.pdf. Accessed March 27, 2020. Pomegranate History. http://maderachamber.com/pf/?page_id=67. Accessed March 27, 2020. Leech J. 12 Health Benefits of Pomegranate. Healthline. https://www.healthline.com/nutrition/12-proven-benefits-of-pomegranate#section13. Published August 15, 2018. Accessed March 27, 2020.

Prebiotics and Probiotics Brandon Speakman, Student Pharmacist, Spring 2020

Background Prebiotics are compounds, most commonly types of fiber, that are meant to support the microbiome. These compounds are often indigestible and unusable and have the sole purpose of feeding gut bacteria. Probiotics, on the other hand, are live bacteria that are meant to replace or replenish the existing gut bacteria. Taking prebiotics and probiotics for therapeutic purposes became popular around the time that the gut microbiome was discovered. Purported Uses

https://www.vectorstock.com/royalty-freevector/probiotics-good-bacteria-andmicroorganisms-for-vector-22324726

Prebiotics and probiotics have most commonly been purported to help to treat or alleviate the symptoms of various gastrointestinal (GI) issues. These GI issues include irritable bowel syndrome (IBS), ulcerative colitis, and diarrhea. These supplements have also been suggested to boost the immune system, help manage weight, and reduce inflammation. How They Work in the Body Prebiotics and probiotics are geared toward managing the commensal gut bacteria. These bacteria are important for many functions, ranging from digestion to managing the immune system. Available Dosage Forms While prebiotics and probiotics are most commonly found in different types of food, they are also available as supplements. Forms of these supplements include tablets, powders, gummies, and capsules.

https://target.scene7.com/is/image/Target /GUEST_8c5a63a6-e531-4ed6-8fbf21fbcc48ad07?wid=325&hei=325&qlt=80&f mt=webp

Typical Serving If you are getting these supplements from food, a typical serving size of the particular food item you are consuming should suffice. If you are getting these supplements from a product that is marketed to supply them, a typical serving is one gummy/capsule per day

https://www.stonyfield.com/product s/yogurt/smooth-creamy/wholemilk-plain-32oz

Safety These supplements are generally considered to be safe in overall healthy adults. However, individuals who have compromised immune systems or severe illnesses are at greater risk for adverse effects, some of which could be severe Adverse Effects and Toxicities The most common side effects that are experienced are gas and bloating. However, less commonly, the probiotic organisms have the potential to produce harmful compounds by metabolizing normally harmless compounds and cause infection. Drug Interactions Drug interactions may result, for example increased rate of metabolism of the drug, but this has not been extensively studied and would likely vary from individual to individual. Effectiveness

https://www.pharmaceuticaljournal.com/pictures/180x120/4/6/9/ 1068469_direct-mechanismmicrobiome-drug-interactions-15.jpg

There is no general consensus as to whether or not taking prebiotics and probiotics are an effective form of treatment for any condition. Summary of One Study One study preformed a meta-analysis of studies that looked at the effects of prebiotics and probiotics on irritable bowel syndrome (IBS) chronic idiopathic constipation (CIC). The results of the meta-analysis demonstrated that probiotics improve the outcomes of patients with IBS and that both probiotics and synbiotics have positive effects on CIC. My Professional Opinion Based on current research available, prebiotics and probiotics seem to have potentially beneficial effects on gastrointestinal conditions. While they should not replace any drug therapy you may be currently on, they might be able to supplement the therapy. Consult with your primary care provider to come up with a personalized plan of treatment. -B. Speakman REFRENCES Digestive Health Team. How to Pick the Best Probiotic for You. Health Essentials from Cleveland Clinic. https://health.clevelandclinic.org/howto-pick-the-best-probiotic-for-you/. Published December 17, 2018. Accessed February 14, 2020. Ford AC, Quigley EMM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. PubMed.gov. https://www.ncbi.nlm.nih.gov/pubmed/25070051. Published October 2014. Accessed February 19, 2020. Prebiotics, probiotics, and your health. Mayo Clinic. https://www.mayoclinic.org/prebiotics-probiotics-and-your-health/art-20390058. Published May 21, 2019. Accessed February 14, 2020. Probiotics: What You Need To Know. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/probiotics/introduction.htm. Published August 22, 2019. Accessed February 23, 2020. Ratini M. Probiotics: Supplements for Digestive Health. WebMD. https://www.webmd.com/diet/probiotics#1. Published July 18, 2017. Accessed February 19, 2020.

RASPBERRY KETONES Scientific Name: 4-(4-Hydroxyphenyl)-2-butanone Common Names: Frambione, Frambinone, Oxyphenylon, Rheosmin, Rasketone

Caia Trykall, Student Pharmacist Spring 2020

Background/History Raspberry ketone is a chemical found in red raspberries. They are also found in kiwifruit, peaches, grapes, apples, other berries, some vegetables (like rhubarb) and the bark of yew, maple, and pine trees. Raspberry ketones have many proposed uses. Natural abundance is very low, so it is produced industrially. Probably its first use was from food manufacturers for its potent smell. Raspberry ketones are used today in berry-flavored candy, soaps, and candles. However, the raspberry ketone did not become a popular dietary supplement until 2012. In February 2012, Dr. Oz presented raspberry ketones as a weight-loss aid during a television segment called “Raspberry ketone: miracle fatburner in a bottle.”

Pharmacology The mechanism of action is not exactly known, but there are animals studies that try to explain how raspberry ketones work. In 2005, a study conducted by Life Sciences journal found that mice fed a high fat diet found that raspberry ketone prevented weight gain in the liver and gains of visceral fat that surrounds organs. (Live Science). Later in 2010, the journal Planta Medica found that raspberry ketone caused fat cells to secrete more adiponectin. Adiponectin is involved in fat metabolism; it can increase the rate at which the body burns fat and it plays a role in reducing appetite. Also in 2010, it was discovered that the molecular structures of ketones are similar to two other molecules, capsaicin and the stimulant synephrine. In test-tube studies of fat cells in mice, raspberry ketones made cells more susceptible to breakdown by epinephrine. For hair growth, a 2008 study in the journal Growth Hormone and IGF Research found that directly applying raspberry ketone improved skin elasticity and hair growth over only 5 months. There were only 15 participants in this study.

https://www.google.com/urlsa=i&url=https%3A%2F%2Fen.wikipedia.o rg%2Fwiki%2FRaspberry_ketone&psig=AOvVaw1w62S7Eie8UCNW0W _Aek0&ust=1583352790163000&source=images&cd=vfe&ved=0CA0 QjhxqFwoTCNCS3oGQ_-cCFQAAAAAdAAAAABAD

Picture included free with Canva.com

COMMON USES

Raspberry ketones are approved for use in foods, cosmetics, fragrances, and as flavoring agent. People also apply to the skin for hair loss. Recently it is commonly found in dietary supplements as a weight-loss agent.

AVAILABLE DOSAGE FORMS AND TYPICAL SERVING

Capsules, taken orally Solution, taken orally The appropriate dose of raspberry ketones depends on factors like age, current health, and other health conditions, but there is not enough research to determine specific doses. Typical serving is 1-2 capsules daily or 2 droppers of solution.

https://www.whiteone.com/en/product/raspberry-ketonesupplements https://www.evolution-slimming.com/collections/all-products/products/raspberry-ketone-drops

Effectiveness

There is insufficient evidence available to rate the effectiveness of raspberry ketones for hair loss or weight loss. Studies in mice and rats used massive doses of raspberry ketones -- much higher than one would see in a supplement. No studies have been completed in humans.

Safety/Toxicity

As a food additive, raspberry ketones are "generally recognized as safe" (GRAS) by the FDA. In supplements, they have been used safely in combination with other ingredients, like caffeine. There is not enough reliable information about effects in pregnancy/breastfeeding, but it is best to avoid use. Raspberry ketones may also lower blood sugar levels, which may be dangerous in people with diabetes.

Picture included free with Canva.com

Food/Drug Interactions No known food interactions. Raspberry ketones act as CYP 3A4 inducers. Be cautious of raspberry ketone in combination P H O T O B Y with MARTIN R. SMITH Medications for diabetes Stimulant drugs Medications metabolized by CYP3A4, like warfarin

Adverse Effects

Because raspberry ketones have similar structures to the stimulant, synephrine, adverse effects include Feelings of jitteriness Rapid heartbeat Increased blood pressure

Product Investigation A certain raspberry ketone weight loss supplement product claims to cause break down of the fat found the cells with the greatest efficiency, helping you to eliminate (burn) fat sooner. The article evaluates each individual ingredient of the product (African mango extract, acai berry extract, green tea extract, caffeine, resveratrol, etc.) and describes each substance's purported use in weight loss. The author of this article rated this particular supplement 8.8/10, because the other ingredients are natural extracts from fruits or plants, assuming that natural equals safe.

Professional Opinion

In my professional opinion, i belive that there is not enough significant evidence in humans to prove beneficial for weight loss. The doses tested in mice are very large in comparison to what one would see in a supplement, so the animal studies cannot really attest for how effective raspberry ketones are in humans. The stimulant-like effects are also a health concern. As a food additive, I think raspberry ketone is perfectly safe, but I think people should focus their efforts on healthy foods and exercise for weight loss.

R EF E R E N C ES

1. S. Sporstøl & R. R. Scheline (1982) The metabolism of 4-(4-hydroxyphenyl)butan-2-one (raspberry ketone) in rats, guinea-pigs and rabbits, Xenobiotica, 12:4, 249-257, DOI: 10.3109/00498258209052463 2. Ushiki M, Ikemoto T, Sato Y. Anti-obese activities of raspberry ketone. Aroma Research 2002;3:361. 3. Morimoto C, Satoh Y, Hara M, et al. Anti-obese action of raspberry ketone. Life Sci 2005;77:194-204. 4. Raspberry Ketone: MedlinePlus Supplements. (n.d.). Retrieved March 3, 2020, from https://medlineplus.gov/druginfo/natural/1262.html 5. 4-(4-Hydroxyphenyl)-2-butanone. (n.d.). Retrieved March 3, 2020, from https://pubchem.ncbi.nlm.nih.gov/compound/4-_4Hydroxyphenyl_-2-butanone 6. Raspberry Ketone: Uses, Side Effects, Interactions, Dosage, and Warning. (n.d.). Retrieved March 3, 2020, from https://www.webmd.com/vitamins/ai/ingredientmono-1262/raspberry-ketone

Red Yeast Rice

Ashley Wellington | Student Pharmacist | Spring 2020

Monascus purpureus

Background / History Red yeast rice is a traditional Chinese culinary and medicinal product dating back to 300 BC. It is made by fermenting monascus purpureus (a type of yeast) over red rice. Common Uses Red yeast rice is mainly used to help lower cholesterol levels. It can also be used for heart disease, and to improve blood circulation and digestion. Nonpharmacologic uses are as food coloring for food products like tofu, rice vinegar, and a lot of other traditional Chinese dishes

FIGURE 1REFERRED TO AS RED RICE KOJI - RED YEAST RICE. HTTPS://WWW.CHIROECO.COM/RED-YEAST-RICEBENEFITS/. ACCESSED FEBRUARY 24, 2020

Pharmacology / Mechanism of Action / How it Works in the Body The actual mechanism is unknown; however, it contains monacolin K (which is also in lovastatin) and the drug works by inhibiting an enzyme essential for the creation of cholesterol in the body. Once fermented, it contains HMG-CoA reductase inhibitors. HMG-CoA reductase is the ratelimiting step in endogenous cholesterol biosynthesis, so inhibiting it stops cholesterol from being synthesized. The inhibitor is monacolin K Available Dosage Forms Red yeast rice is available as a powdered form as a food coloring for fish, alcoholic beverages, and cheese (in Chinese communities). More commonly, it is found as a dietary supplement in capsule or tablet form Typical Dosing / Serving

FIGURE 2HTTPS://IMAGES.VITAMINIMAGES.COM/PP/VF/PURITAN SPRIDE/PRODUCT_IMAGES/PRODUCT_DETAIL/006210.JPG

Doses range from 200-4800mg and the usual dosing that you will see is 600mg by mouth 2-4 times daily

Effectiveness Since it contains the same active ingredient as some of the market statin drugs, it is very effective and has less adverse side effects than prescription drugs Toxicities Going above 2400mg can lead to liver damage Safety This should not be used while pregnant or breastfeeding. Caution use for people under 20 years of age. People with kidney disease, thyroid problems, musculoskeletal disorders or at high risk for cancer should not use.

FIGURE 3REFERRED TO AS RED RICE KOJI - RED YEAST RICE. HTTPS://WWW.CHIROECO.COM/RED-YEAST-RICEBENEFITS/. ACCESSED FEBRUARY 24, 2020

Adverse Effects This can cause some adverse effects, especially if being consumed with other medications. This can cause abdominal discomfort, heartburn, gas, headache, and dizziness. If any of these occur in a severe manner, consult your doctor or physician Food & Drug Interactions

HTTPS://ENCRYPTEDTBN0.GSTATIC.COM/IMAGES?Q=TBN%3AAND9GCQGQPZVLXHR7IKCU5NLVROT8LOBWU9JDLQNKF6KGOS_CAA XZ0FU

References 1. National Center for Complementary and Integrative Health.https://nccih.nih.gov/he alth/redyeastrice#hed2. Published July 2013. 2. Mayo Clinic: Red yeast rice. https://www. Mayoclinic.org/drugs-supplements-red-yeastrice/art-20363074. Published October 2017. 3. Penn State Hershey: Milton S. Hershey Medical Center.http://pennstatehershey.ad am.com/content.aspx?productid=107&pid=33&gid=0 00323. Published March 2015.

Since this acts like lovastatin, it has a lot of the same drug interactions. For example, it can interact with a variety of drugs and increase the risk of rhabdomyolysis (for drugs like certain antibiotics, the antidepressant nefazodone, drugs to treat HIV infections). Also, grapefruit juice can increase harmful side effects because it can increase the amount of drug in your body Professional Opinion In my personal opinion as an aspiring pharmacist, I would recommend the use of red yeast rice products when needed. Since tis rice has the same active ingredient as a common cholesterol medication on the market, if someone is nonadherent to medications this would be a great alternative. It is present in many foods as well as dietary supplements so it can be easy to incorporate into your diet.

Sara Yin, Student Pharmacist Spring 2020 eninoihtem_lysonedA-S/ikiw/gro.aidepikiw.ne//:sptthO

HERE'S MY STORY: SAMe was discovered in Italy in 1952. Since then, numerous clinical studies have been performed to determine its efficacy. SAMe has been available by prescription since the 1970s in Europe to treat arthritis and depression. In the United States, SAMe is available as a supplement.

SAMe Scientific name: S-adenosyl-L-methionine

USED FOR Depression Osteoarthritis Liver Disease Brain Health

HOW IT WORKS IN THE BODY SAMe is a naturally occurring molecule that is produced in the body. This production is from a reaction of the amino acid methionine with adenosine triphosphate. SAMe is a precursor of many amino acids that contribute to pain, depression, liver disease, and other conditions. As an antidepressant, SAMe contributes to the production of melatonin and epinephrine, both of which have a direct impact on mood. SAMe also has anti-inflammatory and tissue healing properties that help with arthritis pain.

AVAILABLE DOSAGE FORMS Oral, Intravenous, Intramuscular injection

TYPICAL DOSING

Depression: 200 to 1600 mg/day Osteoarthritis: 1200 mg/day initially then maintenance 400 mg/day Liver Disease: 800 to 1000 mg/day

ADVERSE EFFECTS

Side effects are rare, and if they occur, usually mild. They can include: Upset stomach Nausea Mild insomnia Dizziness Irritability Anxiety Sweating Constipation Diarrhea

DRUG INTERACTIONS

EFFECTIVENESS Might be effective in treating osteoarthritis and depression.

SAFETY

Generally safe, however, may interaction with antidepressants.

TOXICITIES Safe at high doses. 218/stelbaT -06-gm-002-eninoihteM -L-lysonedA-S-e-MAS-sdooF -woN/rp/moc.brehi.www//:sptth

Do not take SAMe with antidepressants, antipsychotics, narcotics, amphetamines, dextromethorphan, St. Johnâ&#x20AC;&#x2122;s Wort or other drugs/supplements that increase levels of serotonin due to increased risk of serotonin syndrome.

SUMMARY OF AN ARTICLE ON SAME SAMe has a variety of benefits and is a great supplement. However, dosing needs to be monitored to prevent adverse effects. SAMe is recommended to try as a natural alternative to an antidepressant drug.

MY PROFESSIONAL OPINION In my opinion, SAMe is worth trying if the consumer is experiencing mild symptoms of depression, osteoarthritis, or other indications, has not tried any prescription medication for these conditions previously, or prioritizes a natural remedy. This supplement may be expensive, especially compared to alternative drug therapies. Nonetheless, SAMe is a relatively safe supplement

REFERENCES: SAMe. (2017, October 24). Retrieved February 27, 2020, from https://www.mayoclinic.org/drugssupplements-same/art20364924SAMe Supplement: Benefits, Uses, Side Effects, Dosage & Interactions. (2019, September 17). Retrieved from https://www.medicinenet.com/same /supplements-vitamins.htmSAMe Uses, Benefits & Dosage - Drugs.com Herbal Database. (n.d.). Retrieved from https://www.drugs.com/npp/same.h tmlSupplement Police. (2015, December 15). Retrieved February 27, 2020, from https://supplementpolice.com/same /

Brenden Yoon Student Pharmacist Spring 2020

Saw Palmetto Scientific Name: Serenoa repens, Serenoa serrulate, Sabal serrulate Common Names: Saw palmetto Background/History: Saw Palmetto was first found by the native tribes of Florida. Tribes treated Saw palmetto berries as food, however, Europeans often found the taste of berries unpleasant. While medicinal use of this berry is not officially recorded, saw palmetto was introduced into Western medicine in the 1870s and it became increasingly popular between medical practitioners for treating prostate and other urologic conditions. After, saw palmetto berries officially became included in the US Pharmacopeia (USP) in 1906 and 1916 and in the National Formulary from 1926 to 1950. Soon, the United States declined the of saw palmetto but Europeans has been using it as a staple phytomedicine. However, Western medicine reconsidered using the berry and saw palmetto and currently ranked among the top 10 herbal products in the United States, primarily for its use in BPH. Common use: 1) prevent hair loss 2) improve urinary tract function 3) support prostate health 4) decrease inflammation 5) help regulate testosterone level 6) migraine 7) diabetes 8) bronchitis 9) low libido

https://www.amazon.com/Saw-Palmetto-Supplement-Prostate

Dosage form & Dose: Doses are available 300-1200mg per day. It is available in many different forms capsules, tablet, powder, raw and dry berry, and gel. https://shop.theherbshoppepdx.com/products

How it works: The general mechanism of how saw palmetto works in our body is unclear. There have been hypotheses of mechanism in cancer cells that induces apoptosis of cancer cells. However, data on these studies usually have poor reliability and itâ&#x20AC;&#x2122;s not done on humans. Chemical Composition: Free fatty acids, phytosterols, long-chain alcohols, oleic, lauric, myristic, palmitic, linoleic, caproic, caprylic, capric, palmitoleic, steric, and linolenic acids.

Effectiveness: Clinical trials have shown that saw palmetto is no more effective than a placebo in relieving urinary tract symptoms. Use of saw palmetto is not currently supported by science. Safety: â&#x20AC;˘Saw Palmetto is not FDA approved supplement product thus, there is no data that shows it is safe to take it. Nevertheless, the manufacturers claim it is safe to use the product. â&#x20AC;˘Used in children under the age of 12 is not recommended due to possible effects on their androgen and estrogen metabolism.

https://www.amazon.com/Saw-Palmetto-Supplement-Prostate

Adverse effects: 1)Hot flashes 2)GI irritation 3)headache Toxicity: Clinical trials in humans are limited and there is not much information of toxicity. The therapeutic and toxic effective limits are unclear but CAMUS clinical trial using 3 times the usual dosage over 18 months did not show any signs of toxic effects. Interactions: 1)Estrogen derivatives: Herbs can intensify the adverse effect of estrogen derivatives. 2)Warfarin: increase anticoagulant effect of warfarin. My Professional Opinion: If patients believe the supplement works for their conditions, they should take the product with a caution. However, if they have underlying conditions or current medications that can cause interactions with this product, they should consult with professionals before taking this. Moreover, if patients see any side effects from taking the product, they should stop taking it immediately.

References: Complementary and Alternative Medicine, eds. Saw Palmetto. Edition updated Apr. 2012. Bethesda, MD: U.S. Dept. of Health and Human Services, National Institutes of Health, Center for Complementary and Alternative Medicine. Saw Palmetto. National Center for Complementary and Integrative Health. Published December 1, 2016. Saw Palmetto. Natural Products Database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: Http://online.lexi.com.

St. John's Wort Hypericum perforatum L.

Written by Sarah Zelli Pre-Veterinary Student in PHPR 489 Spring 2020

Common Names Hypericum, Klamath weed, Goatweed, Perforate St. John’s-wort, Tipton Weed, Rosin-Rose

Background St. John's Wort is a multi-stemmed, herb that grows to 1–3 ft. It has long slender stems growing at the soil surface or just below the ground. It is native to Europe but found in Canada and the United States. Pharmacology Two proposed mechanisms of action for the antidepressant effects of St John's wort extract are: inhibition of the uptake of serotonin (5-HT), dopamine (DA) and norepinephrine (NE) from the synaptic cleft of interconnecting neurons. A contributing mechanism is the ability to bind to the major neuro-inhibitory receptor, (GABA-A and GABA-B) receptors, to block the binding of GABA.

History First recorded medicinal uses: in ancient Greece, administered as a remedy by the Roman military doctor Proscurides. Mainly used for magic potions to ward off spirits during the Middle Ages. Purported Uses to treat mental disorders and nerve pain. a sedative, a balm for wounds, burns, and insect bites. depression, anxiety, and/or sleep disorders. Typical Dosage Use and Available Forms Dosages vary person to person, including in clinical studies. Ranging from 300 mg-1200 mg per day. Common dosage: 900 mg split into 3 doses a day for 12 weeks to treat depression. capsules, tablets, teas,topicals, liquid extracts

Effectiveness In multiple clinical studies, St. John's Wort was shown to be more effective than placeo against mild to moderate depression and other antidepressants.

Safety Not entirely well known due to being unregulated. In most cases it is deemed safe to ingest orally, but side affects may occur. These can include dizziness, anxiety, diarrhea, agitation, prickling sensation, etc. Some studies show that taking this Adverse Effects and Toxicity supplement with other drugs can Adverse effects may include: confusion, mania, anxiety, GI upset, cause negative effects. Ask your doctor before starting. etc. No information regarding Personal Opinion toxicity. Due to the lack of sufficient evidence regarding safety and toxicity, I would Interactions/Study Summary advise to use other treatments Some studies show that taking this before considering St. John's Wort. I supplement while taking other would advise against using it if you medications can have negative interactions. For example, a study by are currently taking any other medications, due to the negative Kerb et al. found an increased 6-βinteractions with some and hydroxycortisol excretion after decreasing the effectivity of others. repeated doses of St John's wort. References Picture Source: PNGimage.net

Types of medications that this may interact with can include: anticoagulants, antivirals, antineoplastics, telaprevir, etc. It has also been shown to decrease other medications effectiveness.

Yue, Qun-Ying, Bergquist, Carin.Safety of St. John's Wort. The Correspondance 2000;355(9203):576-577 Kerb RBauer SBrockmöller JRoots IUrinary 6-β-hydroxycortisol excretion rate is affected by treatment with hypericum extract.Eur J Clin Pharmacol. 1997; 52 (abstr): A186 Butterweck, V. (2003). Mechanism of Action of St John???s Wort in Depression. CNS Drugs, 17(8), 539–562. doi: 10.2165/00023210200317080-00001 St. John's Wort. (2016, December 1). Retrieved from https://nccih.nih.gov/health/stjohnswort/ataglance.htm Pöldinger, W. (2000, December 14). History of St. Johns wort. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11155493

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Common Names: C rc ma, C rc min, Haldi, Indian saffron, T rmeric

BACKGROUND T rmeric is a plant fo nd thro gho t So theast Asia, China, A stralia, and the So th Pacific. It is al ed for its medicinal properties and abilit to treat inflammator conditions. Kno n for its distincti e ello color, t rmeric is also fo nd in ario s foods and cosmetics.

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PURPORTED USES T rmeric has been sed for its pain-relief, antiinflammator and antio idant effects for a ariet of health conditions. Some of these incl de osteoarthritis, cardio asc lar disease, metabolic s ndrome, infection, and cancer.

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PHARMACOLOGY C rc min, the acti e ingredient in T rmeric, is linked to its most highl to ted health effects. C rc min has been s ggested to interfere ith the inflammator eicosanoid path a . T rmeric displa s anti-inflammator acti it b blocking ke en mes in this path a .

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DOSAGE FORMS & TYPICAL DOSING A ailable dosage forms incl de po der, caps les/tablets, tea, g mmies, ellness shots, and face masks. There is no set recommended dosing. Standardi ed c rc minoid dosages sed in clinical trials range from 2 mg/da to 6 g/da .

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EFFECTIVENESS C rc min has limited medicinal se d e to its lo s stemic bioa ailabilit ith oral doses. It is h drophobic, cannot be gi en intra eno sl (IV), and rapidl diff ses from tiss es after intraperitoneal administration. Does t rmeric ork? St dies lack strong clinical evidence for t rmeric se in h man indications.

SAFETY, ADVERSE EFFECTS, & TOXICITIES T rmeric does not ha e an established safet profile b t does not displa an major to icities. Cons mption sho ld be monitored d ring pregnanc . While se ere ad erse effects are ncommon, bitter taste, GI-related s mptoms, ello stools, and allergic contact dermatitis ha e been reported after se.

FOOD/DRUG INTERACTIONS Concomitant se of black pepper has been sho n to impro e c rc min's bioa ailabilit . T rmeric ma enhance the properties of anticoag lant/anti-platelet dr gs (increased risk of bleeding) so a oid concomitant se ith anticoag lants, antiplatelets, lo molec lar eight heparins, and thrombol tic agents.

PERSONAL OPINION Se eral online articles s ggest that t rmeric can be sed for eight loss b stabili ing mood le els and therefore helping to red ce calorie intake. I am do btf l of these claims and o ld not recommend sing t rmeric for eight loss. Ho e er, I think t rmeric has a generall beneficial effect on inflammation. Patients ho s ffer ith chronic inflammation may find relief from reg lar se. It is good to note that t rmeric tends to be harmless in lo doses and does not displa an se ere side effects. R. Zhang REFERENCES Benefits of T rmeric. Uni ersit of Utah Health. https://healthcare. tah.ed /healthfeed/postings/2 2 / 2/t rmeric.php. P blished Febr ar 5, 2 2 . Accessed Febr ar 23, 2 2 . T rmeric. IBM Micromede Sol tions. https:// -micromede sol tionscom.e pro .lib.p rd e.ed /micromede 2/librarian/CS/CE586E/ND PR/e idence pert/ND P/e idence pert/DUPLICATIONSHIELDSYNC/87789C/ND PG/e idence pert/ND B/e idence pert/ND AppProd ct/e idence pert/ND T/e idence pert/PFActionId/e idence pert.DoIntegratedSearch?SearchTerm=t rmeric&UserSearchTerm=t rmeric&SearchFilter=filterNone&na item=searchALL#. Accessed Frebr ar 26, 2 2 .

T rmeric. Nat ral Prod cts Database. Le icomp. http://online.le i.com/lco/action/doc/retrie e/docid/fc rnp2/375 389? cesid=68R8l2f8OUF&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dt meric%26t%3Dname%26 a%3Dt meric# ses-nested- - . Accessed Febr ar 23, 2 2 .

VALERIAN Valeriana Officinalis Common Names

Background

Garden Heliotrope, All-Heal, Cut-Heal, English Valerian, Great Wild Valerian, Hardy Heliotrope, and Vandal Root

Valerian is a plant native to Asia and Europe, and naturalized to North America. The therapeutic uses for valerian was described by Hippocrates. Ancient Greece and Rome used the plant as medicinal herb. During WWII, England used valerian for stress,

Common Uses Insomnia Anxiety

Valerian Plant Pharmacology The Mechanism for Valerian is unknown. However, a possible mechanism mentions that valerian extract increases the amount of gamma aminobutyric acid (GABA) in the synaptic cleft to cause sedation.

https://www.herbco.com/c-133-valerian.aspx

Typical Dosing

Dosage Forms

Mild to Moderate Sleeping Disorders

Capsule

extract, oral: 400 to 900 milligrams before bed infusion (tea), oral: 2 to 3 grams of dry extract tincture, oral: 1 to 3 milliliters Restlessness and tension Valmane (R) extract, oral: 150 to 300 milligrams daily

Oil Extract Tincture Tea

Toxicity There are no known toxicities that have been reported

Jenny Zheng | Student Pharmacist | Spring 2020

Effectiveness

Safety

Clinical studies have shown positive results in treatment of mild to moderate insomnia and showed sedative effects through treatment of tension and anxiety.

Women who are pregnant or nursing should not take valerian without medical advice Children under three should not take valerian because possible risks have not been evaluated

Adverse Effects Hepatotoxicity Gastrointestinal Effects Morning drowsiness, headache, or sense of anxiety (these effects are rare)

Summary of Article Valerian has been widely used to treat insomnia, a sleep disorder that affects 1/3 of adults. A 30 day study on geriatric inpatients experienced sleep quality improvement by having the subjects take 100 mg of the extract three times a day. There was improvement in 85% of the valerian extract group and 51% improvement in the placebo group.

Food/Drug Interactions Barbiturates increase CNS depression (animal data) Benzodiazepines: addictive central nervous system depression (case report) Opioid Analgesics: additive CNS depression (animal data)

My Professional Opinion I do not believe that the research for valerian is very consistent. Most studies did not show correlation between the use of valerian and improved sleep quality. Valerian may have a role in treating insomnia, but more research should be conducted for effectiveness.

Valerian Supplement References Bent, S., Padula, A., Moore, D., Patterson, M. and Mehling, W. (2020). Valerian for Sleep: A Systematic Review and Meta-Analysis. The American Journal of Medicine. Office of Dietary Supplements - Valerian. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/ValerianHealthProfessional/.

https://www.letlex.com https://www.wholefoodshealth.co.nz

Valerian. Natural Products Database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: https://online.lexi.com.