Phytotherapy and Herbal Medicine PHG 507 Lecture 1 PDF

Phytotherapy and Herbal Medicine PHG 507 Academic year2024-2025-Pharm D Dr. Sabah Hussein El Gayed Professor of Pharmacognosy Phytotherapy and Herbal Medicine PHG 507 Academic year2024-2025 Assessment : Midterm exam….. 15 marks Practical …….. 25 Marks Fi...

Phytotherapy and Herbal Medicine PHG 507 Academic year2024-2025-Pharm D Dr. Sabah Hussein El Gayed Professor of Pharmacognosy Phytotherapy and Herbal Medicine PHG 507 Academic year2024-2025 Assessment : Midterm exam….. 15 marks Practical …….. 25 Marks Final written exam….50 marks Oral exam….. 10 marks ✓ Introduction to CAM ✓ Phytotherapy to GIT disorders ✓ Phytotherapy to CNS disorders ✓ Phytotherapy to respiratory disorder. ⁕ Endocrine and metabolic diseases. ✓ Phytotherapy to Cardiovascular disorders Hypertension, angina,… , ✓ Urinary disorders ✓ Phytotherapy to skin disorders  Introduction ✓ Traditional medicine and EBM ✓ CAM: definition, types ✓ Herbal medicine as type of CAM ✓ Safety and effectiveness of herbal drugs ✓ Herb-drug interactions ✓ How are botanicals commonly sold and prepared? ✓ Herbal drugs monographs ✓ Pharmacovigilance.  Traditional medicine defined as: Medical practice that includes diagnosis, prevention and treatment, relying on practical experience and observations handed down from generation to generation, Includes practices approaches knowledge and beliefs not based on scientific evidence applied to treat, diagnose and prevent illness within a society.  Herbal medicine Traditional use of herbal medicines refers to documentary evidence that herbal medicine has been used over three or more generations of recorded use for a specific disorder Evidence-Based-Medicine (EBM) The use of herbal medicines in an evidence-based approach for treatment and prevention of disease (rational phytotherapy). Holism and The holistic approach of healing Holism is the view that individuals are composed of four interrelated elements Physiological psychological Sociological Spiritual Holism is the treatment of the whole person, an approach that considers the body, mind and spirit as a single unit. All CAM practices claim to be holistic  CAM 1-What is CAM 2-WHY people search for CAM 3-TYPES of CAM  CAM ???? Complementary: when a non-mainstream practice is used together with conventional medicine, Alternative: when a non-mainstream practice is used in place of conventional medicine e.g. Ayurveda, Homeopathy, traditional Chinese medicine  CAM ???? Reasons for seeking CAM therapy ⁕Conventional treatment didn’t work. ⁕ Adverse effects of conventional medicine. ⁕ Active participation in treatment. ⁕ Poor doctor communication previously. True alternative medicine is uncommon i.e. people use non- mainstream approaches along with conventional treatments  The most widely used CAM systems. Chinese and Indian medicine. Homeopathic medicine. Diet, nutrition and life style changes. Herbal medicine. Aromatherapy. Chiropractic Cupping Integrative medicine  Integrative medicine Defining principles: A holistic system of healthcare including body, mind, spirit and community a combination of conventional and complementary medical practices, with scientific evidence of safety and effectiveness emphasis on factors that influence health, wellness The patient and practitioner are partners in the healing process  Integrative medicine an integrative treatment for Alzheimer's disease may include: 1. Medication that increase certain brain chemicals 2. antioxidants as vitamin E and Ginkgo biloba extract 3. changes in lifestyle (walking programs and relaxation training), 4. music therapy to strengthen the immune system.  Integrative medicine An integrative treatment for cancer may include: 1. surgery, chemotherapy 2. acupuncture to relief nausea, pain 3. meditation, help release anxiety, insomnia 4. hypnosis, to lessen pain.  Acupuncture theory that there is a life force called Qi (Chi) that flows throughout the body in channels called meridians Traditional Illness or disease occurs when the flow of Qi is Chinese Medicine obstructed, unbalanced, deficient, or excessive Acupuncture techniques use needles or pressure to stimulate points of the body where meridians exist to promote the proper flow and balance of Qi  Ayurvedic medicine originated in India practitioners use practices, including Herbs specialized diets, with the intent of balancing the body, mind and spirit to promote overall wellness. Ayurvedic medicine Mind and Body Practices A. Mind-body therapy: e.g. yoga, hypnosis B. Body-based therapy: e.g. massage therapy, Chiropractic manipulation  Homeopathic medicine Originated in Germany : principles of homoeopathy, 1. Homeopathy is a "treatment" based on the use of highly diluted substances, to work with the body in healing process ‘ 2. like cures like ’ concept 3. The minimal dose of the substance should be used in order to prevent toxicity. 4. Only a single remedy or substance should be used. e.g. low doses of Cantharis in burning Homeopathic vs herbal medicine Uses plants, minerals or animal products in very diluted doses herbs and other natural substances are processed via serial dilutions and vigorous shaking between each dilution. No drug interaction Only plant based medicines Medicinal plants used in material strength doses not in homeopathic potency Potential for herb-drug interactions  Aromatherapy A form of CAM, uses essential oils to promote healing. The oils can be inhaled, massaged or applied into the skin. Is the skilled and controlled use of essential oils for physical and emotional health and well being(holistic healing) NAHA: National Association for Holistic Aromatherapy used to help with a wide range of health issues, as acne , nasal congestion, insomnia, myalgia and migraine  The medicinal Massage, use of aromatic Inhalers, Baths, substances Foot-baths, (essential oils) Vaporizers, for holistic Compresses, healing. EO must diluted in a Essential oils are highly suitable carrier oil concentrated and should not (coconut, jojoba be used directly on the skin oil,..)for massage, or or near the eyes. bath dispersant when It may cause allergic adding to bath water. reactions; itching, rash. Nasal congestion eucalyptus(1,8 cineol), Aromatherapy peppermint (menthol), inhalation, nasal spray Muscles, joints pain Anxiety, insomnia eucalyptus, peppermint: Lavender oil(linalool) myalgia and headache inhalation Topical  Chiropractic Health is affected by alignment of spinal structures Therapy often sought for relief of pain related to back and neck injuries; therapy continued to promote balance and health Treatment methods include adjustment and manipulation of spine and adjacent structures, heat (diathermy), cold (ice), ultrasound, percussion on trigger points  Other common therapies Hypnotherapy Music therapy Light therapy Colour therapy Colonic irrigation Magnetic therapy  Naturopathic medicine 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.  Naturopathic medicine Nutraceuticals: functional foods, isolated nutrients formulated as pharmaceutical drugs. Dietary supplements: pharmaceutical preparations made from nutrients or herbs to boost health.  Naturopathic medicine Dietary supplements Examples: capsule of Vitamin E, extract of ginkgo biloba, a fatty acid (like omega-3).  Dietary supplements However : - Some without evidence of effectiveness or safety - Some are not standardized to ensure consistency and quality - Some herbs have not established recommended daily dosage  Herbal medicine Evidence-Based-Medicine (EBM): or scientific evidence refers to quantifiable data; as clinical trials in human, animal studies and other evidences of biological activities. The greater the consistency of evidence across all these kinds, the greater the strength of the evidence  Herbal medicine Herbal medicines offer the following advantages: Relatively safe, lower cost compared to conventional medicines, Plants possess medicinal effects that are not found with isolated components, (synergy).  Herbal medicine Herbal medicines include herbs, herbal materials, herbal preparations and finished herbal products. Active ingredients of herbal medicine: ingredients of herbal medicines with therapeutic activity Herbal medicines should be standardized to contain a defined amount of the active ingredients.  Herbal medicine Finished herbal products consist of herbal preparations made from one or more herbs. If more than one herb is used, the term mixture herbal product can also be used. Finished herbal products and mixture herbal products may contain excipients in addition to the active ingredients.  Monographs Each monograph contains two parts. The first part consists of : botanical features, distribution, identity tests, purity requirements, chemical assays, and active or major chemical constituents. The second part: summarizes clinical applications, pharmacology, contraindications, warnings, precautions, potential adverse reactions, and dosage. Does natural means safe??? 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.  Does natural means safe??? Examples: 1-Pyrolizdine Alkaloid-containing herb e.g. coltsfoot 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.  Does natural means safe??? -Milder adverse reactions Key examples: Tannin-containing herbs: oak bark, inhibit trace element and B vitamin absorption. not be used in high doses for long periods, or alternatively given away from food and other medications Saponins : horse chestnut ,are gastric irritants cause reflux and/or vomiting in sensitive individuals. The alternative is to prescribe them in enteric-coated tablets or with meals Licorice root (Glycyrrhiza spp) cause sodium and fluid retention and potassium loss. This effect only occurs with extended use at high doses (more than 3g/day) and can be minimized by a high potassium diet.  Does natural means safe??? Milder adverse reactions Korean ginseng : overstimulation, only at higher doses (≥1g/day) Bitter herbs in high doses may cause vomiting when given in liquid form Echinacea in liquid form cause tingling in mouth and promotion of saliva  Herb-Drug interactions ***Pharmacokinetic *Pharmacodynamic  Does natural means safe??? Adverse herb-drug interactions: 1- pharmacodynamic interactions unrelated to changes in blood concentrations a change in drug dosage will not counter it. Examples: combination of licorice with thiazide diuretics. combination of licorice 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 Kava combination with sedatives…drowsiness Caffeine-containing herbs with theophylline…. nausea, vomiting, insomnia, tremors, restlessness, uneven heartbeats, and seizure (convulsions)  Does natural means safe??? 2- pharmacokinetic interactions Affect drug concentration herbal changes the absorption, distribution, metabolism, protein binding, or excretion of a drug that results in altered levels of the drug or its metabolites in many cases, can be safely countered by adjusting the drug's dosage. St John’s wort decreases drug levels where the risk is assessed as medium, self-prescription of the herb in conjunction with the drug is not advisable  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,  2- pharmacokinetic interactions Interference with metabolism Cytochrome inhibitors (clarithromycin, erythromycin, diltiazem, itraconazole, ketoconazole, ritonavir, verapamil, goldenseal and grapefruit) Cytochrome inducers (St. John's Wort, schisandra, glucocorticoids,..) Examples 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  Safety of Herbal drugs  Special importance of drug –herb interactions  Pregnant women ◼ Patients with psychiatric problems ◼ Elderly people. ◼ Patients with chronic diseases. ◼ Immunocompromised patients. ◼ Drugs with narrow therapeutic index.  Does natural means safe??? The dose and form of a botanical preparation also play important roles in its safety. For example, peppermint tea is generally considered safe to drink but peppermint oil is much more concentrated and can be toxic if used incorrectly. Another example????