Phytotherapy PGC 906 Lecture 1 PDF

BY: Enas Hussien Abdelrahman Professor, Pharmacognosy Department [email protected] Office hours: Sunday 9-11 am , Tuesday 12-2  Introduction ✓ Introduction to integrative medicine: definitions, CAM types ✓ Herbal medicine, aromatherapy...

BY: Enas Hussien Abdelrahman Professor, Pharmacognosy Department [email protected] Office hours: Sunday 9-11 am , Tuesday 12-2  Introduction ✓ Introduction to integrative medicine: definitions, CAM types ✓ Herbal medicine, aromatherapy as types of CAM(HM vs AV, HP) ✓ Safety and effectiveness of herbal drugs ? ✓ Herb adverse effects ✓ Herb/drug interaction(beneficial, harmful)  What is integrative medicine? an approach to medical care that combines conventional medicine with CAM practices with high scientific evidence for safety and effectivness. Holistic an approach stresses the patient's preferences, and it attempts to address the mental, physical, and spiritual aspects of health  Allopathy – conventional medicine-mainstream A system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery.  CAM Complementary medicine are treatments that fall outside the standard medical care (conventional medicine), used adjunctively, with it using acupuncture to help lessen some side effects of cancer treatment. Alternative medicine practices, products used instead of standard medical treatment. Homeopathy, Ayurveda, TCM CAM: a broad set of healthcare practices that are not part of that country's own tradition or conventional medicine  Integrative vs conventional Healing oriented: it focuses on overall wellness as opposed to treating illness or injuries (disease oriented) Whole-person based (holistic): biological, behavioral, social, environmental needs Based on the relationship between patients and providers high-quality studies support the effectiveness and safety of the treatments  IM Example: the addition of self-hypnosis or provider- administered acupuncture as an adjunct to analgesic drugs and standard wound care for management of post-surgical pain. As another example, use ginger-based products or Chinese herbs, for chemotherapy- or radiation-induced nausea and vomiting. Phytotherapy & Aromatherapy The term ‘phytotherapy’ was suggested by Henri Leclerc (1870–1955) who published numerous essays on the use of medicinal plants Types of CAM Homeopathy Ayurveda TCM Enas Hussein.Phytotherapy PG 807 Reasons for seeking CAM therapy To avoid side effects of conventional treatments Treat side effects of conventional treatments Low coast(mostly) to improve the person's overall quality of life.  National Center for Complementary and Alternative Medicine (NCCAM) – Research – Training and career development – Conferences and educational programs – Integration of scientifically proven CAM therapies into conventional medicine Originated in Germany: 1. Homeopathy is a based on the use of highly diluted substances, to stimulate the body’s healing responses 2. The minimal dose of the substance should be used in order to prevent toxicity. 3. Only a single remedy or substance should be used.  Only plant based medicines Medicinal plants used in material strength doses Possible potential for herb-drug interactions Uses plants, minerals or animal products (natural substance) in very diluted doses No drug interaction  originated in India practitioners use practices, including herbs, massage, and specialized diets, restore mind-body harmony through specific practices and approaches to promote overall wellness.  Ayurveda involves the use of medicinal plant extracts, massage, special diet based on improving the health to overcome diseases Only plant based medicines based on healing deviations in systems ✓ is the skilled and controlled use of essential oils for physical and emotional health (holistic healing) NAHA: national association for holistic aromatherapy ✓ a complementary therapy involving the use of essential oils to treat several diseases (as acne , nasal congestion, insomnia, myalgia and migraine ) ✓ the objective of achieving a health benefit from topical application, oral administration, or inhalation of a natural volatile organic compound(s) Counselling to avoid EO toxicity Topical application of EO may cause allergy, dermatitis(as TTO) concentrated EO should diluted before application to the skin. some oils (e.g. bergamot, lemon and orange) can react with sunlight cause photosensitivity  Naturopathic medicine Biologically-based (naturopathic medicine) includes herbs (botanicals), vitamins, minerals, and probiotics. They are widely marketed as dietary supplements According to NCCAM Dietary supplements: are products intended to supplement the diet. The "dietary ingredients" in these products may include: vitamins, minerals, amino acids, herbs (extracts or concentrates) , in forms of tablets, capsules, liquids, or powders.  Dietary supplements, are multi-targeted mixtures, present at low concentration, have not patent protection, some are not standardized, Pharmaceuticals are mostly uni-targeted pure compounds with high dose use and have governmental approval. However : some are without evidence of effectiveness or safety not standardized to ensure consistency and quality have not established recommended daily dosage A standardized herbal extract is an herb extract that has one or more components present in a specific, definite amount(as a percentage). Or an extract that have a constant chemical composition from batch to batch[depending on reference compound(s)] Is it possible for all? Yes: senna (sennosides), ginseng (ginsenosides)  plants have considerably less acute toxicity than many other drugs, as the chemicals in plants are diluted by a large percentage of inert plant material. Toxicity resulted from contamination or adulteration, or relate to known toxic herbs. e.g.: Arnica-digitalis-castor seeds, other than the fixed oil of the seed generally not recommended for internal use  1-PA-containing herb e.g. coltsfoot, butterbur :poisoning in humans include abdominal pain, ascites, hepatomegaly and raised serum transaminase level 2-Ephedra-containing dietary supplements :nausea, vomiting, psychiatric symptoms such as anxiety and change in mood, autonomic hyperactivity and palpitations.  Mild adverse reactions Oak bark (tannin-containing herbs): inhibit vitamin B absorption. Overcome: not be used in high doses for long periods, or given away from food and other medications Horse chestnut (Saponins-containing) is gastric irritants cause reflux and/or vomiting in sensitive individuals. Overcome: prescribed as enteric-coated tablets or with meals Licorice root sodium and fluid retention and potassium loss. This effect only occurs with extended use at high doses (more than 3g/day) Overcome : by a high potassium diet.  Mild adverse reactions Pungent herbs such as capsicum and ginger create a burning sensation which patients may find uncomfortable. High doses of ginger can cause heartburn Bitter herbs in high doses may cause vomiting Thujone –containing herbs: wormwood , sage can cause CNS stimulation and possibly epilepsy. Care should be exercised when giving thujone-containing herbs in high doses to epileptics. Beneficial HD interactions Schisandra reduce diarrhea and agitation associated with the use of immunosuppressant (tacrolimus) in people undergoing liver transplant. Schisandra increase the oral bioavailability of midazolam in healthy volunteers. Piperine enhances the absorption and bioavailability of herbal and conventional medicines, partly by modulating p- glycoprotein and metabolic enzymes Caffeine enhances ergotamine bioavailability Caffeine enhance paracetamol bioavailability Licorice is combined with sophora for cases of liver injury Herb-Drug interactions ***Pharmacokinetic *Pharmacodynamic  Herb-Drug interactions ***Pharmacokinetic *Pharmacodynamic -Occurs due to differences in the -Herbal supplement interact absorption, distribution, metabolism or with co-administered drugs as a excretion of a drug when taken in result of their intrinsic combination with herbal supplement, pharmacological effects. The compared with the predicted behavior interaction results in synergistic when taken individually. These or antagonistic outcomes, differences may cause changes in the without changing its conc. concentration of one or both H., drugs -Mostly, a change in drug which may affect treatment outcomes or dosage will not counter a increase toxicity. pharmacodynamic herb-drug -Mostly can be safely countered by interaction adjusting the drug's dosage.  Herb-Drug interactions HDIs may interact by more than one mechanism. Hypericum may interact with other antidepressants by pharmacodynamic mechanisms to produce a toxic serotonergic syndrome, and by pharmacokinetic processes with ciclosporin to cause transplanted organ rejection by reducing blood levels of the immunosuppressant  Herb-Drug interactions 1- pharmacodynamic interactions Kava combination with sedatives…drowsiness Caffeine-containing herbs with theophylline…. nausea, vomiting, insomnia, tremors, restlessness, uneven heartbeats, and seizure licorice combination with thiazide diuretics , with digoxin Garlic or gingko or ginger or angelica combination with anticoagulant drugs, e.g. aspirin, warfarin…..bleeding, increased INR or PT  Herb-Drug interactions 2- pharmacokinetic interactions Interference with cytochrome, P glycoprotein 1-Hypericum* with warfarin, theophylline, digoxin……reduce drug effects 2-Ergotamine with grapefruit………….ergotism 3-Colchicine with grapefruit or erythromycin…gastroenteritis hypotension, lactic acidosis then multisystem dysfunction  Herb-Drug interactions 2- pharmacokinetic interactions Interference with Absorption: 1-drugs combined psyllium (Plantago psyllium) or tannins like those found in tea (Camellia sinensis), pomegranate (Punica granatum), 2-lovastatin with pectin or oat bran experienced an increase in low-density-lipoprotein (LDL) levels,  The first category includes medical indications that are well established in some countries and that have been validated by clinical studies The clinical trials may have been controlled, randomized, double-blind studies, open trials, or well-documented observations of therapeutic applications.  The second category includes medicinal uses that are well established in many countries and are included in official pharmacopoeias or national monographs, having a pharmacological basis and supported by older studies that clearly need to be repeated The third category refers to indications described in unofficial pharmacopoeias and other literature, lack of scientific data,