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Nutraceuticals
Neutraceuticals and Herbal Medicines
| Question | Answer |
|---|---|
| Which type of prescription drug users are most likely to also take herbal supplements? What ethnic/sex groups are more likely to user supplements? | Fluoxetine (Prozac) @ 22%, compared to 16% of other prescription drug users; women and latinos |
| What is the most common reason why patients take supplements? | Healthy/good for you; arthritis, memory improvement, energy, immune booster, joint pain or flexibility, supplement diet, sleep aid, prostate, don't know, all others |
| The likelihood of supplement and prescription medication interactions is quite ___. | high; 81% of patients on supplements admitted to using at least 1 medication in previous week, and women ages 65>, 12% reported taking >10 medications |
| * * What law states that herbal supplements are classified as dietary supplements? What does this mean? | The US dietary supplement health and education act (DSHEA) of 1994; supplements can be sold without testing that they are safe or effective |
| * * According to the DSHEA, what 2 things is an herbal supplement manufacturer responsible for? | 1) truthfulness of the claims on label and 2) must have evidence that claims are supported |
| * * What are the problems with the DSHEA? | Does not provide a standard for the evidence needed; does not require submission of evidence to FDA; manufacturer permited to claim product affects structure of body though CAN'T CLAIM IT CAN TREAT SPECIFIC DISEASE + CAN'T SAY FDA APPROVED |
| * * If the FDA claims a product made by a manufacturer is unsafe, who has the burden of proof to show safety? Quality? Efficacy? | The FDA (for all of them) |
| * * What are the 3 main drawbacks of nutraceuticals? | Contaminants, lack of formulary standardization (amounts of active ingredient vary greatly), interactions with prescription drugs (often increase metabolism or act synergistically); Side effects common |
| What possible contaminants can be found in herbal remedies? | Pesticides, heavy metals, microorganisms, microbial toxins, prescription medications |
| What is ginkgo (Ginkgo biloba) used for? | Circulatory disorders, enhance memory, neurosensory conditions (vertigo, headache, tinnitus); improves blood circulation by dilating blood vessels, reduces platelet aggregation) |
| What other drugs can ginkgo (Ginkgo biloba) interact with? What can result from each? | Blood thinners and aspirin (result in bleeding diathesis); ginger, garlic, green tea; may interact with any medication metabolized by CYP [1A2,2C9, 2C19, 3A4, 2D6]) e.g. busopirone, efavirenz, fluoxetine ; may lower seizure threshold in diabetics |
| What are some side effects from using ginkgo? | Hear palpitations, upset stomach, headache, dizziness, nausea, diarrhea, constipation; seizures in diabetics; fertility problems (CONTRAINDICATED IN PRG WOMEN + bleeding disorders or surgery); leaf ok, but seed may be toxic |
| What is kava kava (piper methysticum) used for? | anxiety, nervousness, insomnia, nervous disorders; comparable effects to that of benzodiazepines without side effects of daytime drowsiness |
| What can kava kava interact with? | Sleep aids, alcohol, anti-seizure medications, opioid painkillers, benzodiazepines, beta blockers |
| What are some of the possible side effects of kava kava? | may worse depression or potentiate anesthesia; rare cases of SEVERE LIVER DAMAGE; may have been due to combinations of herbs and medications |
| What is saw palmetto (Serenoa repens) used for? | prostatic hyperplasia (BPH) to alleviate symptoms of prostate gland enlargement, inclduing urination frequency, difficulty urinating, or maintaining urination, nocturia; trials did not show efficacy better than placebo at relieving symptoms of BPH |
| What is the proposed mechanism of action of saw palmetto? | inhibit 5-alpha reductase isoenzymes-->less binding of dihydrotestosterone to cytosolic androgen receptors in prostate cells; decrease DHT levels and raising testostorone levels-->antiestrogenic activity-->apoptosis of prostate tissue in BPH |
| What are the possible interactions of saw palmetto? | slow blood clottin (avoid blood thinners!) lowers level of estrogen containing meds; may cause hypertrigylceridemia and hypercoaguable state(?) |
| What are the possible side effects of taking saw palmetto? | dizziness, diarrhea, fatigue, abdominal and headache; may cause impotence; ocassional ACUTE PANCREATITIS, LIVER FAILURE, FATAL PERIOPERATIVE HEMORRHAGING |
| What is valerian (Valeriana officinalis) used for? | insomina, anxiety; sleping aid (with less side effects); safe and gentle with some effectiveness; mechanism (?): increase GABA release, inhibit GABA reuptake, inhibit GABA-degrading enzyme and contains exogenous GABA (blood brain barrier, though...) |
| What are some of the possible interactions of valerian? | safe for most, but avoid use in pregnant women, nursing women, children under 3; alcohol or sedating medications (benzodiazepine), sleep meds, anticonvulsants, tricyclic antidepressants |
| What are some of the possible side effects of valerian use? | sedation, confusion, lethargy, headache, stomach upset; may have UNEXPECTED SIDE EFFECT of causing euphoria and giddiness (opposite of sedating) |
| What is echinacea used for? | improve body's natural immunity (very commonly used); mixed results, but meta-analysis shows improvement in cold prevention and recovery |
| What possible interactions can echinacea have? | May potentiate drugs metabolized by CYP3A4 or CYP1A2; interacts with econazole; may potentiate caffeine jitter by decreasing caffeine metabolism |
| What are the possible side effects of echinacea? | dry mouth, diarrhea, fever, changes in gut flora |
| What are the uses of black cohosh (cimicifuga racemosa)? | Used to control symptoms of decreasing estrogen levels (perimenopausal and post-menopausal women); phytoestrogen (?), but can be estrogenic or anti-estrogenic |
| What are some contraindications for black cohosh? | Women with estrogen dependent medical condition (e.g. estrogen receptor positive cancer, ovarian cancer, uterine cancer, endometriosis, uterine fibroid); pregnant; breast feeding women; kidney transplant; protein S deficiency |
| What are the interactions of black conosh? What cytochrome P450 does it affect? | Decreases metabolism activity of CYP2D6 substrate; atorvastatin (lipitor), cisplatin (chemo), hepatotoxic medication |
| What are some possible side effects of using black cohosh? | stomach upset, cramping, headache, rash, fatigue, vaginal spotting or bleeding, weight gain |
| What is the lecithin used for? | fat essential to humans; alzheimer's, gallbladder disease, elevated cholesteor, anxiety, depression, liver disease, eczema; literature says it's only good at decreaseing fat in liver and reducing hepatic fibrosis in cirrhosis |
| What are the interactions of lecithin? What are some possible side effects? | None have been recognized; generally safe, though some GI upset and abdominal pain documented |
| What is hawthorne (crataegus monogyma and C. oxyacantha) used for? | herbal supplemtn for people with mild heart failure; has falvonoids and oligomeric proanthocyanidins; result in positive ionotropic activity, coronary blood flow, oxygen utilization, antioxidant, and vasodilation |
| How should hawthorne be used? Side effects? | Monitor blood pressure and heart rate regularly; mild rash, nausea, headache, migraine, palpitations, sweating, dizzines, sleepiness, agitatio, soft stools; high doses can cause sedation, hypotension, cardiac arrthyas |
| What can hawthorne interact with? | May potentiate cardiac glycosidic activity, interfere with digitalis or digitalis monitoring; with beta-blockers, may cause hypotensive effect; may enhance digoxin; CONTRAINDICATD IN PREGNANT AND BREASFEEDING AND NO CHILDREN UNDER 12 |
| What is creatine used for? | Amino acid converted to creatine phosphate in muscles for energy; not clear if creatine helps athletic performance, yt may help muscular weakness diseases like heart failure, parkinsons, and muscular dystrophy |
| What possible interactions can creatine have? | AVOID IN KIDNEY DISEASE, HIGH BP, OR LIVER DISEASE; may increase kidney damage with NSAIDs, cimetidine, probenicid, and diuretics; creatine, caffeine and ephedra may cause stroke |
| what are some possible side effects of creatine? | weight gain, muscle cramps, muscle strains, stomach upset, diarrhea, dizziness, high blood pressure, liver dysfunction, kidney damage |
| What is St. John's wort used for? | Alleviates short-term depression; people take it for anxiety, menopausal symptoms, chronic fatigue syndrome, ADHD, OCD, IBS, and many others/ |
| What is the proposed mechanism of action in St. John's wort? | Contains many potentially active molecules: hyperforin may inhibit synaptic uptake of dopamine, norepinephrine, aminobutyric acid, and L-glutamate |
| * * How is St. John's metabolized? | Both by CYP3A4 AND CYP2C19 |
| What are the possible interactions of St. John's wort? | aminolevulinic acid, amitryptyline, contraceptives, cyclosporine, digoxin, fenfluramine, irinotecan, indinavir, midazolam, nefazodone, neviripine, paroxetine, sertraline, simvastatin, tacrolimus, theophylline, and warfarin, ANTI-DEPRESSANT |
| What are some possible side effects of using St. John's wort? | Photosensitivity (use sun block); GI upset, fatigue, restlessness, dry mouth, headache, dizziness, impotence, diarrhea; mania (rare), hypertensive crises, cardiovascular collapse during surgery |
| What should you do if a patient asks you about the proper dosage for an herbal supplement/nutraceutical? | Can admit you aren't familiar enough with product to recommend-->however, MUST determine if product interacts with medications, health conditions, or organ insufficiency and warn of common side effects |
| What cytochrome do the following drug use to be metabolized: lovastatin, clarithromycin, cyclosporine, diltiazem, estrogens, indinavir, triazolam | CYP3A4 |
| What cytochrome do the following drug use to be metabolized: amitriptyline, clozapine, codeine, desipramine, donepezil, fentanyl, flecainide, fluoxetine, meperidine, methadone, metoprolol, olanzapine, ondansetron, tramadol, trazodone | CYP2D6 |
| What cytochrome do the following drug use to be metabolized: clozapine, cyclobenzaprine, fluvoxamine, haloperidol, imipramine, mexiletine, olanzapine, pentazocine, propanolol, tacrine, theophylline, zileuton, zolmitriptan | CYP1A2 |
| What cytochrome do the following drug use to be metabolized: amitriptyline, diazepam, zilueton, celecoxib, diclofenac, fluvastatin, glipizide, ibuprofen, irbesartan, losartan, phenytoin, piroxicam, tamoxifen, tolbutamide, torsemide, warfarin | CYP2C9 |
| What cytochrome do the following drug use to be metabolized: amitriptyline, carisoprodol, citalopram, diazepam, lansoprazole, omeprazole, phenytoin, warfarin | CYP2C19 |
| What are the most worrying adverse effects that you should monitor with herbal supplements? | hepatotoxicity, neurotxicity or convulsions, cardiotoxicity, renal toxicity |
| What do chaparall leaf or stem cause? | hepatotoxicity and renal toxicity |
| What do herbs rich in podophyllotoxin cause? | hepatotoxicity, neurotoxicity or convulsions |
| What does kava rhizome cause (ADR)? | hepatotoxicity, neurotoxicity, |
| What does mahuang cause (ADR)? | hepatotoxicity, neurotoxicity, cardiotoxicity |
| What does pennyroal oil cause (ADR)? | hepatotoxicity, renal toxicity |
| What does aconite root tuber cause (ADR)? | cardiotoxic, neurotoxic |
| What do herbs rich in colchicine cause (ADR)? | cardiotoxic, neurotoxic |
| What does squirting cucumber cause (ADR)? | One case of cardiotoxicity and renal toxicity |
Created by:
karkis77
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