Pharos Phytotherapy LEC 3&4 PDF

Cardiovascular diseases (CVD) Congestive Heart Failure (CHF). Atherosclerosis. Peripheral Vascular Disease. Hypertension. Hypotension. 31 Cardiovascular diseases (CVD) 32  CV...

Cardiovascular diseases (CVD) Congestive Heart Failure (CHF). Atherosclerosis. Peripheral Vascular Disease. Hypertension. Hypotension. 31 Cardiovascular diseases (CVD) 32  CVD: Hawthorn HAWTHORN (CRATAEGUS SPECIES) It improves the myocardial blood flow due to dilatory effects on the coronary blood flow The drug is positively inotropic and positively chronotropic Increases membrane permeability for calcium and inhibits the inward flow of potassium and phosphodiesterase, resulting in an increased action potential in cardiac ventricular cells. The extract is suggested to have antioxidant properties, and hypocholesterolemic action. High doses may cause sedation 33  CVD: Hawthorn HAWTHORN (CRATAEGUS SPECIES) Approved by Commission E: Decrease in cardiac output In folk medicine: Cardiotonic, hypertension, ischemia of the heart, arrhythmia. Sedative. High flavonoid content. Prevent collagen destruction in joints. Decrease inflammation and fragility of capillaries. 34  CVD: Hawthorn Precautions and contraindications It is contraindicated in Children under 12 years of age. During the first trimester of pregnancy. Nursing mothers 35  CVD: Hawthorn Drug interactions Potentiate the effects of cardiac glycosides, the dosage of standard cardiac glycosides should be adjusted downward. Hypotensive effect when used in combination with beta- blockers. Hawthorn has an similar action to similar to Class III antiarrhythmics (Amiodarone), use should be discouraged. Cisapride (gastroprokinetic agent, a drug that increases motility in the upper gastrointestinal tract) are likely to interact with Hawthor. (same mechanism of action) 36  CVD: Garlic GARLIC (ALLIUM SATIVUM) A. Antimicrobial properties. B. Lipid-reducing properties. C. Anti-oxidative and fibrinolytic effects. D. It has inhibitory effects on key enzymes in cholesterol biosynthesis, including HMG CoA reductase. E. It exerts antithrombotic effects through inhibition of platelet thromboxane formation (bleeding & clotting time). It has anti-platelet thromboxane formation. 37  CVD: Garlic GARLIC (ALLIUM SATIVUM) Approved by Commission E: Arteriosclerosis Hypertension Raised levels of cholesterol In folk medicine Inflammatory respiratory conditions, whooping cough and bronchitis. Gastrointestinal disturbances, particularly digestive disorders with flatulence and gastrointestinal spasms. Tonic for diverse illnesses and debilities. Externally, garlic is used for warts, muscle pain, neuralgia, arthritis. 38  CVD: Garlic GARLIC (ALLIUM SATIVUM) Dosage: Average daily dose is 4 gm of fresh garlic or 8 mg of essential oil. One fresh garlic clove, 1 to 2 times daily. Arteriosclerosis: Daily doses of 600-800 mg of garlic powder and dried garlic have been shown to be effective. Hyperlipidemia : A total daily dose of 600-900 mg of garlic powder (standardized to 1.3% of alliin content) has been shown effective Hypertension: The effective dose is garlic powder taken 200-300 mg three times daily. 39  CVD: Garlic Precautions and contraindications Consumption of more than five cloves daily causes 1. Heartburn. 2. Flatulence. 3. Gastrointestinal disturbances. 4. Decrease in hematocrit values and plasma viscosity. 5. Burns (6-18 hrs contact) Drug interactions A. Concomitant use of garlic with anticoagulants such as Coumadin (warfarin) and antiplatelets such as aspirin and dipyridamole could increase the risk of bleeding. B. NSAID's, such as indomethacin, could increase bleeding time by decreasing platelet aggregation 40  CVD: Garlic Garlic + ACE inhibitors A man whose blood pressure was 135/90 mmHg while taking lisinopril 15 mg daily began to take garlic 4mg daily (Odourless garlic oil capsules). After 3 days he became faint on standing and was found to have a blood pressure of 90/60 mmHg. Stopping the garlic restored his blood pressure to 135/90 mmHg within a week. Garlic has been reported to cause vasodilation and blood pressure reduction. Its general importance is small. 41  CVD: G.biloba Ginkgo Biloba Ginkgolide B is a potent inhibitor of platelet-activating factor (PAF), inhibit PAF-induced bronchoconstriction and airway hyperactivity Ginkgo biloba exerts antioxidant effects through the flavonoids. The anti-oxidant and membrane-stablizing activity increases cerebral hypoxia tolerance. Spasmolytic properties It helps in prevention of lipid peroxidation. (Lipid peroxidation is involved in producing tissue and vascular damage, and neuronal loss, which may lead to dementia) 42  CVD: G.biloba MAIDENHAIR TREE (GINKGO BILOBA) Approved by Commission E: Symptomatic relief of organic brain dysfunction Intermittent claudication (impairment in walking and relieved by rest) Vertigo (vascular origin) Tinnitus (vascular origin) Folk medicine: Disturbed brain functions (dizziness, headache and anxiety). Improve concentration and memory deficits as a result of periph 43  CVD: G.biloba Precautions and contraindications Patients with known risk factors for intracranial hemorrhage should avoid the use of Ginkgo biloba (subarachnoid hemorrhage). Ginkgo has adverse effects on oocytes (female gametocyte or germ cell involved in reproduction) Drug interactions Anti-thrombolytic Agents (anticoagulants, antiplatelets and aspirin): Spontaneous bleeding has been associated with the herb due to its potent inhibitory effect on the platelet-activating factor (PAF). 44  CVD: G.biloba Ginkgo + Antiepileptics A 55-year-old man taking valproate and phenytoin for a seizure disorder suffered a fatal breakthrough seizure while swimming a year later. Analysis of his medical history showed that he had unexplained subtherapeutic serum levels of valproate and phenytoin on three occasions over the previous year. It was later found that the patient had also been taking numerous vitamins, supplements and herbal medicines without the knowledge of his physician, of which a ginkgo extract was stated to be the most common ingredient. 45  CVD: G.biloba Garlic + Antiepileptics Mechanism Unknown. Ginkgo seeds contain the neurotoxin 4-O-methoxypyridoxine (ginkgotoxin), which indirectly inhibits the activity of glutamate decarboxylase, which in turn results in seizure induction by lowering the levels of γ-aminobutyric acid (GABA). Another possible mechanism is induction of the cytochrome P450 isoenzyme CYP2C19 by ginkgo. Phenytoin is a substrate of CYP2C19 and therefore, in theory, ginkgo may increase the metabolism of phenytoin and thereby reduce its levels. 46  CVD: G.biloba Ginkgo + Proton pump inhibitors In one study, 18 healthy Chinese subjects were given a single 40-mg dose of omeprazole before and after a 12- day course of a standardised extract of ginkgo 140mg twice daily. The AUC of Omeprazole was decreased by 27-42%. Mechanism It was concluded that ginkgo increases the metabolism (hydroxylation) of omeprazole by inducing the cytochrome P450 isoenzyme CYP2C19. 47  CVD: Digitalis Digitalis The drug contains cardioactive cardenolide glycosides Positively inotropic, negatively chronotropic. Improve the contraction power of cardiac muscle. *Use of the raw product has become obsolete because the effect is not reproducible. The use of pure glycosides is recommended instead. 48  CVD: Digitalis Digitalis Drug interactions The simultaneous administration of arrhythmogenic substances (sympathomimetics, methylxanthines, phosphodiesterase inhibitors, quinidine) increases the risks of cardiac arrhythmias. 49  CVD: Ginseng GINSENG (PANAX SPECIES) Effects (complex) ❖ Stimulation of Nicotinic receptor of the CNS (neuroprotection against age associated cognitive disorder). ❖ Hepatoprotective effect by increasing hepatic gluathione peroxidase activity. (antioxidant activity). ❖ Antiplatelet effects (Panaxynol inhibits the aggregation, release reaction, and thromboxane formation). ❖ Indirect antiviral effect through inducing production of interferon, enhances natural killer cell and stimulates cell- mediated immunity. 50  CVD: Ginseng GINSENG (PANAX SPECIES) Effects (complex) ❖ Reduce LDL triglycerides and cholesterol (activate lipoprotein lipase). ❖ Hypoglycemic effect: i- Stimulate insulin release. ii- Iinsulin receptors. iii- Enhance glucose metabolism Ginseng helps in angina due to its 1. Inhibition of atherogenesis through decreased proliferation of smooth muscle cells. 2. Dilatation of coronary arteries in rabbit tissue in vivo. 51  CVD: Ginseng GINSENG (PANAX SPECIES) Approved by Commission E: Lack of stamina Ginseng is used internally for fatigue and debility, and for a decrease capacity for work and concentration. In Folk medicine : Loss of appetite, general weakness and neuralgia Impotence and sterility. Insomnia and anxiety. 52  CVD: Ginseng Precautions and contraindications A. Caution should be taken in patients with cardiovascular disease or diabetes. B. “Ginseng Abuse Syndrome” is a hypertension syndrome associated with prolonged high dose Ginseng with concomitant use of caffeine. C. Post menopausal vaginal bleeding. (Oral Ginseng and Ginseng face cream) D. Not recommended during pregnancy or lactation due to possibility of neonatal androgenization. 53  CVD: Ginseng Drug interactions A. Caution should be taken when taking an antidiabetic agent or insulin to lower blood glucose (Increased hypoglycemic effects). B. Phenelzine (MAOI) — Headache, tremors, and mania have been reported with concomitant use of phenelzine and Ginseng C. Avoid concomitant use with antiplatelet agents or NSAIDS due to the antiplatelet effect of Ginseng. D. Avoid with Loop Diuretics: Germanium, present in most Ginseng products, causes nephrotoxicity in the nephron segment where loop diuretics 54work.  CVD: Camphor Camphor Tree (Cinnamomum camphora) Externally, camphor acts as a bronchial secretolytic and hyperemia Internally, the effect is that of a respiratory analeptic and bronchospasmolytic. It should be noted that the effect only sets in at dosages considered toxic. An antibacterial effect has been noted in vitro, with cineol the main active. 55  CVD: Camphor Camphor Tree (Cinnamomum camphora) Folk medicine: External uses in folk medicine include muscular rheumatism and cardiac symptoms. Internal uses are hypotonic circulatory regulation disorders and digestive complaints. Inflammation of respiratory tract mucous membranes is treated with both internal and external applications. 56  CVD: Camphor Camphor Tree (Cinnamomum camphora) Approved by Commission E: Arrhythmia Cough / bronchitis Hypotension Nervous heart complaints Rheumatism 57  CVD: Soybean Soybean (Glycine soja) 60% of dry soybeans by weight (protein at 40% and oil at 20%). The remainder consists of 35% carbohydrate The phospholipids extracted from soya lecithin was shown to have lipid-reducing properties Approved by Commission E: Raised levels of cholesterol Folk medicine use: Liver and gallbladder complaints. Anemia Poor concentration, cerebral and nerve conditions, General debility. 58  CVD: Soybean Soybean + Levothyroxine A 45-year-old woman who had hypothyroidism after a near- total thyroidectomy. Required unusually high oral doses of levothyroxine (300 micrograms daily) to achieve clinically effective levels of free thyroxine (T4). She had routinely been taking a ‘soya cocktail’ protein supplement immediately after her levothyroxine. Taking the soya protein cocktail in the morning and the levothyroxine in the evening avoided this effect. 59  CVD: Soybean Soybean + Levothyroxine Mechanism of interaction Soya formula or other similar products might decrease levothyroxine absorption in some individuals. Soya isoflavones inhibited the activity of thyroid peroxidase, an enzyme required for thyroid hormone synthesis. 60  CVD: Horse chestnut Horse chestnut (Aesculus hippocastanum) ❖ Hydroxycoumarin can improve of venous tone. The mechanism of action appears to be related to the inhibition of leukocyte activation, an important pathophysiological mechanism contributing to CVI. ❖ Aescin is also thought to decrease vascular leakage by inhibiting elastase and hyaluronase. 61  CVD: Horse chestnut Horse chestnut (Aesculus hippocastanum) Approved by Commission E: Venous conditions (chronic venous insufficiency, CVI) Folk medicine use: Eczema, superficial and deep varicose veins, leg pains, phlebitis, hemorrhoids, pains before and during menstruation. the leaves are used as a cough remedy, as well as for arthritis and rheumatism. 62  CVD: Horse chestnut Horse chestnut (Aesculus hippocastanum) Drug interactions: Horse Chestnut leaf has a coumarin component and may interact with warfarin, salicylates and other drugs with anti- coagulant properties 63