Dietary supplements guide Spring 2023

Dietary supplements guide Spring 2023

Complementary and alternative medicine (slideshare.net)

Created by the students in PHPR 48900 Complementary and Alternative Medicine, Purdue University This assignment for the course was comprised of creation of individual topic monographs, peer review of monographs, and submission of final draft after receiving feedback from peers.

Compiled by Cynthia P. Koh-Knox Sharp, PharmD, RPh Clinical Associate Professor, College of Pharmacy, Purdue University

FIRST DAY ABCs

LAST DAY ABCs

Dietary supplements guide Topic (Author, University)

Page

Acai (Spencer Stringham, Student pharmacist) ................................................................................................... 4 Ashwagandha (Jilian Banzon, Student pharmacist) ............................................................................................. 6 Asian ginseng (Laura Sheckell, Student pharmacist l) ......................................................................................... 8 Blueberry (Bardia Asadi, Student pharmacist)................................................................................................... 10 Chamomile (Alton Adams, Student pharmacist) ............................................................................................... 12 Chondroitin (Josh Downham, Student pharmacist) ........................................................................................... 14 Cinnamon (Allison Mack, Student pharmacist) ................................................................................................. 17 CoQ10 (Karysma Diego, Student pharmacist) ................................................................................................... 19 Cranberry (Madison Detzer, Student pharmacist) ............................................................................................. 21 Creatine (Ella Smith, Student pharmacist) ......................................................................................................... 23 Devil’s claw (Mina Lin, Student pharmacist) ...................................................................................................... 25 Dong quai (Amy Cho, Student pharmacist)........................................................................................................ 26 Echinacea (Alexa Carnahan, Student pharmacist) ............................................................................................. 28 Evening primrose (Claire Reyes, Student pharmacist) ....................................................................................... 30 Garcinia cambogia (Nathan Tuscherer, Biochemistry student) ......................................................................... 32 Garlic (Dillon Kish, Student pharmacist) ............................................................................................................ 34 Ginger (Haley Williams, Student pharmacist) .................................................................................................... 36 Ginkgo biloba (Luciano De Tramontana, Psychology student) .......................................................................... 38 Glucosamine (Sameer Varma, Student pharmacist) .......................................................................................... 40 Goldenseal (Madeline Russow, Student pharmacist) ........................................................................................ 42 Horny goat weed (Abby Hamilton, Student pharmacist)................................................................................... 44 Horse chestnut (Chloe Sullivan, Student pharmacist) ....................................................................................... 47 Melatonin (Anya Wappler, Student pharmacist) ............................................................................................... 49 Omega-3 Fatty acids (Bethany Hayden, Student pharmacist) ........................................................................... 51 Saw palmetto (Emery Frey, Student pharmacist) .............................................................................................. 53 St. John’s wort (Joyce Yu, Student pharmacist) ................................................................................................. 55 Turmeric (Emma Ronk) ...................................................................................................................................... 57 Valerian (Alyssa Gouty, Public health student) .................................................................................................. 59

ACAI

Purpose/Uses

Student Pharmacist Spencer Stringham

1. Cognitive function 2. Heart health 3. Anticancer properties

Spring 2023

Background/History Acai is cultivated from a palm tree. It is cultivated for its fruit. They are deep purple berries about 1-2 cm in diameter. Acai berries have been called a superfood with benefits such as improved skin, weight loss, and others. They are native to the rainforests of South America. There has been a claim that the taste is a mix of chocolate and berries with a slight metallic aftertaste.

According to the United States Department of Agriculture (USDA), one 3-gram teaspoon of acai berry powder contains

Dosing/Serving

•

20 calories

•

0 g protein

•

1.5 g total fat

•

1 g carbohydrate

•

1 g fiber

•

6 milligrams (mg) calcium

3-5 grams (formulation dependent)

Pharmacology/Mechanism of action

Dosage forms

The fiber and heart-healthy fats in acai also support heart health. Heart-healthy fats increase HDL “good”) cholesterol and decrease LDL (“bad”) cholesterol.

•

Powder for reconstitution

•

Berry fruit

•

Smoothie/drink/juice

Fiber intake also reduces LDL cholesterol.

•

Capsule

Fiber intake is not only associated with a lower incidence of cardiovascular disease, but also a slower progression of the disease in high-risk individuals.

•

Used in several combinations

•

Powder products

•

Packets to add to water

Effectiveness/Evidence

Safety/Toxicity/Warnings

Acai berries have not yet been studied extensively. The health claims surrounding acai are relatively new and more research is needed to solidify these claims.

Acai is very safe and is a natural berry

Adverse effects/Side effects

product. Patients should monitor for hypersensitivity reactions.

Interactions Acai has no known severe

Possible risk for upset stomach

interactions with other drugs. Acai

Side effect appears to be dose related.

has no known interactions with other

Article Summary One study compared heart disease with acai.

The study focused on the phytochemicals and the numerous phenolic compounds in acai. Invitro studies showed that acai possessed antiinflammatory properties. The study concluded that acai can protect against metabolic stress.

References Acai berries: Health benefits, nutrition, diet, and risks. www.medicalnewstoday.com. Published May 23, 2018. https://www.medicalnewstoday.com/articles/305576 Acai: Uses, side effects, interactions, dosage, and warning. www.webmd.com. https://www.webmed.com/vitamins/ai/ingredientmon o-1109/acai Acai: Side effects, dosages, treatment, interactions, warnings. RxList. https://www.rxlist/consumer_acai/drugscondition.htm

drugs.

Opinion In my opinion, acai supplementation should be recommended. There appears to be very little risk except for hypersensitivity risk. It is relatively cheap and could provide supplemental benefits for aging, antioxidant properties, blood sugar health, blood pressure health, and cognitive health. There appear to be no major food or drug related interactions and so it seems to only be a cheap positive way to supplement your overall health. ~ S Stringham

Ashwagandha Jilian Banzon, Student Pharmacist, Spring 2023

Scientific name of supplement/Common names Scientific name: Withania somnifera Common names: Winter Cherry, Peyette, Ginseng Indien, and Ghoda Asoda

Background/History Ashwagandha is a medicine herb from the Ayurveda system. It is a versatile herb that is talked about as having a nourishing tonic effect like ginseng and various health-promoting effects on the roots and fruits. Ashwagandha has been around since 6000 B.C . It's native to Asian and African countries, these countries are India, Sri Lanka, Pakistan, Afghanistan and China.

Common/Purported uses Ashwagandha is an adaptogen plant, which means it boosts flexibility and resilience to a variety of conditions. Ashwagandha is most commonly known for reducing stress and anxiety. Some purported uses about ashwagandha are its uses for stress, insomnia, ADHD, asthma, COPD, hypercholesterolemia and diabetes

Pharmacology/mechanism of action There is insufficient reliable information available about the pharmacokinetics of ashwagandha. There isn't an official mechanism of action for ashwagandha, but there is a common purposed mechanism of action and it is based on its stabilizing effect on the HPA axis where it becomes less reactive to stressors. It has been shown that Ashwagandha reduces morning cortisol and DHEA-S levels suggesting Ashwagandha has a moderating effect on HPA axis activity in stressed adults. This mechanism of action is focused on the ashwagandha's antianxiety effects.

Dosage Forms Ashwagandha only comes in one dosage form and it is orally. For the oral formulations, it can come in capsules and chewable gummies as well.

Typical dosing/serving For adult dosing ashwagandha has most often been used in doses of up to 1000 mg daily for up to 12 weeks. There is no typical dosing for children.

Effectiveness Ashwagandha may possibly be effective for insomnia and stress use.

Ashwagandha has insufficient evidence for it's use in aging, anxiety, ADHD, asthma, COPD, hypercholesterolemia and diabetes.

Safety concerns/warnings/toxicity Safety concerns: considered possibly safe, when used orally and appropriately, short-term. Ashwagandha has been used with apparent safety in doses of up to 1250 mg daily for up to 6 months Warnings: Ashwagandha is sometimes substituted or adulterated with a similar plant, Withania coagulans.

Toxicity: There is possible pregnancy and lactation toxicities associated with ashwagandha. It is considered to have abortifacient effects.

Adverse effects/side effects Most common side effects with ashwagandha are diarrhea, gastrointestinal upset, nausea, and vomiting. However, these adverse effects do not commonly occur with typical doses. There are some concerns for liver injury with ashwagandha treatment.

Interactions (drug, food) Drug interactions: antidiabetic drugs, antihypertensive drugs, benzodiazepines, CNS depressants, immunosuppressants, and thyroid hormone drugs Food interactions: herbs and supplements with hypotensive effects and sedative properties

Clinical trial of Ashwagandha A study was conducted to explore the effectiveness of naturopathic care on anxiety symptoms using a randomized trial. The naturopathic care group received dietary counseling, deep breathing relaxation techniques, a standard multi-vitamin, and ashwagandha for up to 12 weeks. The naturopathic group reported increased benefits in mental health, concentration, fatigue, social functioning, vitality, and overall quality of life. These were based on a questionnaire that is designed to measure subjective symptoms of anxiety, as well as discriminate between anxiety and depression. No serious adverse reactions were observed in either group.

Professional opinion In my professional opinion , I believe ashwagandha is an interesting supplement and may have medical benefits. I believe people should definitely do their own research when considering using this supplement because the mechanism of how it works is still not fully understood. It is hard to distinguish what absolute medical benefits this drug may have, but this calls for more possible studies that can focus on proving the purposed medical uses for ashwagandha.

~ J Banzon References 1. 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):208-213. doi:10.4314/ajtcam.v8i5S.9 2. Cooley K, Szczurko O, Perri D, Mills EJ, Bernhardt B, Zhou Q, Seely D. Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974. PLoS One. 2009 Aug 31;4(8):e6628. doi: 10.1371/journal.pone.0006628. PMID: 19718255; PMCID: PMC2729375.

3. Ashwagandha. Natural medicines - databases. https://naturalmedicines.therapeuticresearch.com/databases.aspx.

Accessed February 25, 2023.

4. Ashwagandha - Overview, history, uses, benefits, precaution, dosage.

Bhumija Lifesciences. https://www.bhumijalifesciences.com/blogs/news/ashwagandhaoverview-history-uses-benefits-precautiondosage#:~:text=History%20of%20Ashwagandha&text=It%20is%20traced %20back%20to,impressed%20with%20it%20years%20back. Accessed February 25, 2023.

Blueberries Drug Monograph Student Pharmacist Bardia Asadi Spring 2023

https://www.supermarketperimeter.com/articles/5104-new-studysuggests-blueberries-can-help-with-type-2-diabetes

Class/Family: Vanococcus within the genus Vaccinium Background/History: Native to North America, blueberries have been a part of life here for 13,000 years.

The history of blueberries: From Native American staple to domesticated superfood. Illinois Extension. Accessed February 21, 2023. https://extension.illinois.edu/blogs/garden-scoop/2019-0119-history-blueberries-native-american-staple-domesticatedsuperfood#:~:text=Blueberries%20are%20native%20to%20our,human%20inhabitants%20on%20our %20continent.

Proported Uses Lower risk of heart disease Lower risk of cancer Antioxidants

Improve Cholesterol Reduce High blood pressure Anti-Inflammatory

GLUT-2 and PPAR expression are both increased by blueberry extract, which also inhibits the inflammatory process and decreases blood sugar.

Can be in capsule form but, this primarily focuses on natural produce from a grocery store

1/2 cup or 74 grams is the typical serving size for natural blueberries, 100mg of blueberry capsules

Always consult a medical professional if you have any questions or concerns.

Effects Blueberries can benefit heart health, bone strength, skin health, blood pressure, diabetes control, cancer prevention, and mental wellness, with positive effects taking 4-6 weeks of regular dietary use.

Safety/Warnings:If you are expecting or nursing, keep your food intake normal. Blueberries may help diabetics with their blood sugar levels. If you have diabetes and consume blueberry products, be alert for symptoms of low blood sugar (hypoglycemia) and closely monitor your blood sugar levels.

Adverse effects: Blueberry whole fruit, juice, and powders are frequently ingested by mouth. Some people may experience nausea, vomiting, diarrhea, or constipation after consuming beverages containing freeze-dried blueberries.

Interactions with food and or drugs BLUEBERRY interacts with diabetic medications (antidiabetes medicines). Blood sugar levels may be lowered by blueberry fruit. When used with diabetes treatments, blueberries may cause dangerously low blood sugar levels.

Keep a watchful eye on your blood sugar.

Blueberry - Uses, Side Effects, And More.

WebMD. Accessed February 21, 2023. https://www.webmd.com/vitamins/ai/ingredien tmono-1013/blueberry

My Professional opinion as a pharmacy student, Is I think that adding blueberries to a healthy diet may have a number of advantages, such as improving heart health, brain function, and reducing inflammation.

Antioxidant-rich blueberries may also help defend the body against harm from free radicals. A healthy diet can benefit greatly from the addition of blueberries, but they shouldn't take the place of other necessary foods.

B Asadi

Canva Stock Image

Summary of article: According to this article, blueberries are full of antioxidants that can help shield the body from the harm that free radicals can do. Due to their high antioxidant content, blueberries may enhance heart health, brain function, and reduce inflammation. Furthermore a rich source of fiber, vitamin C, and vitamin K are blueberries.

Blueberries should not be relied upon as the only source of nutrients; nevertheless, they may offer potential health advantages when consumed as part of a balanced diet.

Wilhelmina Kalt, Aedin Cassidy. Recent Research on the Health Benefits of Blueberries and Their Anthocyanins. 2020; 11(2): 2- 130

Chamomile (Matricaria recutita)

Alton Adams Student pharmacist Spring 2023

Commonly referred to as: chamomile, German chamomile, Hungarian chamomile, wild chamomile, blue chamomile, scented mayweed

Background/history: Chamomile flowers have been used since around 500 BCE by the ancient Greeks, Egyptians, and Romans to treat erythema (patchy red skin due to irritation) and xerosis (dry skin) caused by dry weather. They also drank it in the form of a tea as a calming beverage. It is thought to have first been used by Hippocrates, or at least was first used in his time, the “father of medicine."

Pharmacology/Mechanism of Action: chamomile works by acting as a mild tranquilizer and sleep-inducer by its sedative effects. It is due to the flavonoid, apigenin that binds to benzodiazepine receptors in the brain. This flavonoid is also where chamomile gets its anxiety reducing effects. Apigenin also has potent anti-cancer effects.

Dosage forms: tea, powder, tablet, capsule, or essential oils (Dosage1 and Dosage2) Dosing/serving: Tea (8 oz., 1-4 cups daily), tablet/capsule (900mg-1200mg), Powder (1 teaspoon with a cup of warm water, once or twice daily), essential oil (no info found on how to use)

Effectiveness: Relative to participants randomized to placebo, those who continued chamomile experienced a lesser increase in GAD-7 symptoms (P = 0.0032) and had overall better psychological well-being (P = 0.013), specifically in anxiety impacts on well-being (P = 0.0094).

Uses: hay fever, inflammation, muscle spasms, menstrual disorders, insomnia, wound healing, gastrointestinal disorders, rheumatic pain, hemorrhoids, anxiety, stress reduction and boosting your immune system.

Safety/Adverse Effects/Toxic Effects: nausea, dizziness, allergic reactions

Interactions (food/drug): could see interactions with sedatives, blood thinners (because it contains a small amount of coumarin, which can have small blood thinning effects), antiplatelet drugs, aspirin, NSAID painkillers such as Ibuprofen and naproxen. It could also interact with other supplements such as ginkgo biloba, garlic, saw palmetto, St. John’s wort and valerian. One should also stop taking chamomile two weeks before any surgery due to possible interactions with a nesthetic drugs.

Summary of one article or study: WebMD’s “What is Chamomile?” written by R. Morgan Griffin, reviewed by Melinda Ratini, MS, DO th

on March 20 , 2021 The article talks about how chamomile has been used for thousands of years to calm anxiety and settle stomachs. It is most common in the United States as a form of herbal tea. Sections in the article include ‘why do people take chamomile?’ which talks about the different uses for chamomile such as upset stomach, mild sedative, heartburn, nausea, and vomiting. Other studies show that a mouth rinse might relieve mouth sores caused by cancer treatments and diarrhea, hemorrhoids, anxiety, and insomnia. When used topically, it’s also been shown to be as effective as hydrocortisone cream for eczema.

The next section is ‘how much chamomile should you take?’ which talks about the effective doses of chamomile. There is no standard dose of chamomile, but studies shown that between 900-1200mg in capsule form daily show desired effects. In tea form, people drink anywhere from 1-4 cups daily.

The next section is ‘can you get chamomile naturally from foods?’ and the only information in this section is that chamomile flowers are common in teas, and they can be used as flavoring in other food and drinks.

The final section is ‘what are the risks of taking chamomile?’ which includes side effects, risks, and interactions. These include allergic reactions, complication with other drugs such as NSAIDs, blood thinners, antiplatelet medications, anesthetics, sedatives and other supplements like garlic, ginkgo biloba, St. John’s wort, saw palmetto and valerian.

Personal/Professional opinion: After completing my research, I believe this supplement has many great benefits in reducing anxiety and improving sleep quality and is very low risk in the case of interactions with other drugs and side effects. Anyone taking this supplement should still talk to their doctor if they notice any side effects or suspect any adverse interactions that may be occurring because of taking chamomile and other medications or supplements.

They should also mention their use of this supplement prior to any surgeries. ~A Adams References: • Griffin RM. What is Chamomile? WebMD. https://www.webmd.com/diet/supplement-guidechamomile#091e9c5e8066ce66-1-4. Published March 20, 2021. Accessed February 25, 2023.

• Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria Chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine : international journal of phytotherapy and phytopharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC564623 5/#:~:text=Relative%20to%20participants%20randomize d%20to,being%20(P%20%3D%200.0094). Published December 15, 2016. Accessed February 25, 2023.

• Introduction to chamomile - herbalgram. Introduction to Chamomile. https://abc.herbalgram.org/site/DocServer/CRCPRESSCh amomile-Section_1.5978-1-4665-77596.pdf?docID=6362. Accessed February 25, 2023.

• Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Molecular medicine reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC299528 3/#:~:text=Chamomile%20preparations%20are%20com monly%20used,extensively%20in%20cosmetics%20and% 20aromatherapy. Published November 1, 2010. Accessed February 25, 2023.

• Wack M. Top 8 chamomile tea benefits: Sleep, relaxation, and more. ArtfulTea. https://artfultea.com/blogs/wellness/chamomile-teabenefits#:~:text=Chamomile%20has%20been%20used% 20in,of%20chamomile%20tea%20can%20help. Published September 1, 2022. Accessed February 25, 2023.

• Patel K. Apigenin health benefits, dosage, safety, sideeffects, and more: Supplements. Examine. https://examine.com/supplements/apigenin/. Published October 4, 2022. Accessed February 25, 2023.

Downham 1

Chondroitin Joshua Downham Student Pharmacist Spring 2023

--------------------------------------------------Names/Common Names-----------------------------------------------Scientific name: Chondroitin-4-Sulfate Common Names: Chondroitin,1 CDS, GAG, Galactosaminoglucuronoglycan Sulfate.2 -----------------------------------------------Background/History---------------------------------------------Chondroitin Sulfate was first extracted and purified in 1960 from the cartage of animals. Studies suggested that cells involved in manufacturing proteoglycan could stimulate matrix synthesis if provided with enough Chondroitin3. This was thought to accelerate the healing process in joints becoming popular in 1997 as an arthritis treatment.

----------------------------------------------Purported/ Common Uses--------------------------------------------Arthritis. Taking chondroitin sulfate is thought to slow the progression of arthritis and improve joint function.3 Cataracts. An injectable solution that contains chondroitin sulfate used to protect and lubricate the eye during cataract surgery.2 ------------------------------------------Pharmacology/Mechanism of Action----------------------------------------Chondroitin is thought to have a chondroprotective action in two ways. The first being which chondroitin sulfate increases hyaluronan production by synovial cells in the joint. Chondroitin also stimulates chondrocytes to synthesize collagen and proteoglycan which is the basis for new cartilage. The second way chondroitin is thought to help with arthritis is by inhibiting enzymes such as elastase and hyaluronidase that are released by leukocytes when inflammation occurs.4 -------------------------------------------Dosage Forms and Typical Dosing/Serving-------------------------------Chondroitin is available in a capsule, tablet, liquid, or injectable form.3 Oral administration of chondroitin sulfate is 800 – 1,200 mg/day for the treatment of arthritis.1 This can be divided into lower doses a day (400mg three times daily) or taken once daily at a higher strength. Dosing for cataracts is 4% chondroitin sulfate 0.5-1ml injection.3 ----------------------------------------Effectiveness---------------------------------------Chondroitin in some clinical trials has been shown to significantly reduce pain and the rate in osteoarthritis progression. One study looked at the progression of joint space narrowing and found that 28% of people who were taking Chondroitin showed narrowing of the joint space versus 41% in those who took a placebo.4 Another study analyzed chondroitin’s effects on movement and pain. The study showed that chondroitin had a 28% improvement in pain and a 21% improvement in function compared to a placebo.4 However, many studies show a large inconsistency among the experimental protocols and

Downham 2 the outcomes of the studies.5 To say that chondroitin is an effective drug in the treatment of osteoarthritis is still ongoing with more studies that need to be done.

-------------------------------------Safety/Warning/Toxicities--------------------------------------------Chondroitin is well tolerated when taken orally and has been found to be safe for long term use with very few side effects. Some rare side effects are stomach pain and nausea.2 -------------------------------------------------Adverse Effect------------------------------------------------Rare adverse effects include increased risk of myocardial infarction, skin rash, nausea, bloating, abdominal pain. diarrhea, constipation, acute liver injury, increase in the liver enzyme aminotransferase, headaches, and increased chance of exacerbations.1 ----------------------------------------------------Interactions----------------------------------------------------Taking chondroitin with warfarin may increase the anticoagulant effects of warfarin.1 Taking chondroitin my decrease the effectiveness of NSAID’s.2 ------------------------------------------------------Article summary----------------------------------------------------Mount Sinai Health Care System6 Chondroitin is a molecule found naturally in the body and is a key component of cartilage. It is also available as a supplement, sourced from animals or synthesized. Chondroitin helps absorb fluid into connective tissue, blocks cartilage-breaking enzymes, and provides the building blocks for the body to produce new cartilage. Scientific studies have shown mixed results in the effectiveness of chondroitin as a treatment for osteoarthritis (OA). Some studies have suggested that chondroitin supplements may reduce OA pain, improve functional status, reduce joint swelling and stiffness, and provide relief from OA symptoms for up to three months after treatment. However, other studies have shown conflicting results, and it is unclear why these studies have different findings. Chondroitin is often taken with glucosamine, another supplement that also has conflicting results in scientific studies. Chondroitin has been suggested for the treatment of other conditions, but no studies have evaluated these claims. There are no major dietary sources of chondroitin, so it must be taken as a supplement. Chondroitin is commonly sold as chondroitin sulfate in capsules or tablets and is often combined with glucosamine and sometimes manganese. The recommended adult dose is 400 mg, three times a day, or 600 mg, twice a day, taken orally. Chondroitin is not recommended for children, and some supplements may not contain the amount of chondroitin stated on the label.

-------------------------------------------------------Conclusion--------------------------------------------------Chondroitin does not meet the efficacy standards required for inclusion in the guidelines for treating osteoarthritis. Therefore, healthcare providers should refrain from recommending it to patients.

However, if a patient is already using chondroitin, it is crucial to evaluate their medication history to avoid any possible drug interactions. When asked about chondroitin, patients should be informed that its effectiveness as a treatment for osteoarthritis may vary. While some patients may experience positive effects, others may benefit from a placebo effect. It may be worthwhile to let patients try chondroitin as a treatment option, while keeping in mind that there is no guarantee of effectiveness. (JDownham Spring 2023)

Downham 3

Citations 1. Natural medicines. Chondroitin Sulfate. https://naturalmedicines.therapeuticresearch.com/. Accessed February 22, 2023.

2. Chondroitin sulfate: Medlineplus supplements. MedlinePlus. https://medlineplus.gov/druginfo/natural/744.html. Accessed February 22, 2023.

3. Chondroitin (natural products database). Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 22, 2023. http://online.lexi.com 4. Jerosch J. Effects of glucosamine and chondroitin sulfate on cartilage metabolism in OA: Outlook on other nutrient partners especially omega-3 fatty acids. International journal of rheumatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150191/#:~:text=Their%20chondroprotective%20a ction%20can%20be,catabolic%20processes%20in%20the%20cartilage. Published 2011. Accessed February 22, 2023.

5. Fernández-Martín S, González-Cantalapiedra A, Muñoz F, García-González M, Permuy M, LópezPeña M. Glucosamine and chondroitin sulfate: Is there any scientific evidence for their effectiveness as disease-modifying drugs in knee osteoarthritis preclinical studies?-a systematic review from 2000 to 2021. Animals : an open access journal from MDPI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228516/. Published May 29, 2021. Accessed February 22, 2023.

6. About the Mount Sinai Health System. Mount Sinai Health System. https://www.mountsinai.org/about. Accessed February 22, 2023.

CINNAMON ALLISON MACK STUDENT PHARMACIST SPRING 2023

Antic, Stel, Superfood Capsules with Leaves, Canva.com, accessed February 25, 2023, <https://www.canva.com/>.

Ceylon Cinnamon (cinnamomum verum) -"true" cinnamon -found in most supplements

Cassia Cinnamon (cinnamomum aromaticum) -stronger and sweeter flavor profile Yakovleva, Daria, Cinnamon on Dark Background, Canva.com, accessed February 25, 2023, <https://www.canva.com/>.

Background & History -Historically used as an aromatic or as a flavoring agent -Cinnamon has a long history of use in traditional medicine in the Middle East and parts of Asia. Its bark being used as a spice and the flowers, leaves, and roots for their medicinal properties.

Sketchify, Globe, Canva.com, accessed February 25, 2023, <https://www.canva.com/>.

--> This actually becomes a barrier for accurate research and result comparisons, due to the differing cinnamon products and their purported uses. Chemical composition and therefore properties differing depending on what part of the cinnamon tree the product was extracted from.

-Ancient Romans and Egyptians used cinnamon for digestive and respiratory ailments, as well as an aromatic to make embalming and funerals of the deceased more pleasant.

Purported Uses Lower blood glucose levels in patients with Type II Diabetes Lowering of blood lipids and total cholesterol Antioxidant and anti-inflammatory agent Irritable Bowel Syndrome or other Gastrointestinal issues Topically, as an insect repellent

Pharmacology Cinnamaldehyde: --------Polyphenol that regulates IL1, IL6, and TNFα release= anti-inflammatory & antioxidant properties --------Regulation of insulin signaling pathways by activating intracellular cascades Stimulation of GLUT 4 for increasing glucose uptake into muscle and adipose tissue promoting glycogen synthesis in the liver Decreasing gene expression of regulators of gluconeogenesis

Eucalyp from amethyststudio, Molecular Gradient Icon, Canva.com, accessed February 25, 2023, <https://www.canva.com/>.

--------Inactivation of receptors on enterocytes that decreases the absorption of free cholesterol Effort Project Studio, Science DNA, Canva.com, accessed February 25, 2023, <https://www.canva.com/>.

Dosage Forms Capsules

sketchify, Freeform Gradient Healthcare Capsules, Canva.com, accessed February 25, 2023, <https://www.canva.com/>.

Essential Oils ImagineHarry from Trendify, Sleek Illustrative Handdrawn Essential Oil, Canva.com, accessed February 25, 2023, <https://www.canva.com/>.

Serving Size 1-3 grams/day Max= 6 g/day

Adverse Effects

increased heart rate intestinal motility increased respiratory rate perspiration (in large amounts)

Safety & Toxicity Considered safe when consumed in quantities found in food (GRAS) Contains coumarin may cause liver toxicity in large & prolonged amounts Allergic reactions-- contact dermatitis

Interactions Patients with liver disease Anticoagulants (warfarin) coumarin contributes to liver toxicity and anticoagulatory effect

Effectiveness Most recent studies have found that the most significant decline in blood glucose levels was after 40 days of taking 6 mg of cinnamon daily.

There are a limited number of relevant studies available on the effect cinnamon has on controlling Type II Diabetes Mellitus.

A 2003 study------ summarized below A 2012 study showing lowered A1c levels after 3 months A 2013 meta-analysis displaying positive results, but was not controlled in the amount or kind of cinnamon used A 2019 study finding its positive effects on several blood parameters

Study Summary The purpose of the 2003 study was to determine cinnamon's effect on blood glucose, triglycerides, and cholesterol levels in patients with Type II Diabetes Mellitus.

There were 6 groups of individuals; 3 were given a placebo and the other 3 groups were given increasing doses (1,3, or 6 grams) of cinnamon for 40 days Fasting serum glucose levels were reduced 18-29%, triglycerides reduced 2330%, and total cholesterol reduced 12-26% at all 3 dosages of cinnamon given.

Limitations: all participants were taking sulfonylurea drugs it was not established how much of that almost 30% decrease in blood parameters was solely due to the cinnamon this study is only suggesting cinnamon's positive effects an an addition to an already established diabetes medication.

OpenClipart-Vectors, Pixabay, Educational Book Collection, Canva.com, accessed February 25, 2023, <https://www.canva.com/>

In My Opinion...

I would not rely on cinnamon as the primary way to reduce blood glucose and/or cholesterol levels. Because the studies that have been done have been promising, I think adding a low to medium dose with a prescription medication could be a helpful asset. ~ A Mack

References:

Cinnamon. Lexi-drugs. Lexicomp. Wolters Kluwer health, Inc. Riverwoods, IL. Accessed February 24, 2023. http://online.lexi.com Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. American Diabetes Association. https://doi.org/10.2337/diacare.26.12.3215. Published December 1, 2003. Accessed February 24, 2023.

Kawatra P, Rajagopalan R. Cinnamon: Mystic powers of a minute ingredient. Pharmacognosy Res. 2015;7(Suppl 1):S1-S6. doi:10.4103/0974-8490.157990

CoQ10 Karysma Diego, Student Pharmacist Scientific and Common Names While CoQ10 is the name commonly used for the supplement, other names of the compound include: Coenzyme Q10, Q10, Ubidecarenone, Ubiquinone, and Vitamin Q10¹.

Purported and Common Uses There are various purported uses of CoQ10, including as treatment for congestive heart failure, hypertension, and as an antioxidant¹ , ³. Additionally, CoQ10 may play a role in migraine prevention and in liver damage reduction.

Dosage Forms and Dosing CoQ10 can be administered orally via tablet or capsule, topically via solution, or intravenously¹ , ⁵. Depending on the intended treatment, oral doses range from 50 mg to 1200 mg per day. There is one case of an experimental topical application of CoQ10, which was given as an 85 mg/ml solution in soybean oil.

When administered through IV, patients are given 50 mg to 100 mg daily for up to one month or 1.5 mg/kg/day for 7 days⁵.

Spring 2023

Background and History CoQ10 was first isolated in 1957 from beef heart by Professor Fred Crane at the University of Wisconsin Madison. One year later, in 1958, Dr. Karl Folkers from Merk determined its chemical structure and theorized that CoQ10 could be used as a cardiovascular drug.

However, the patent was sold to a company in Japan. nearly twenty years later, in 1976, Japan approved a version of CoQ10 intended to treat cardiovascular disease. This version of CoQ10 remained popular in Japan until the 1990s².

Pharmacology / Mechanism of Action CoQ10 is involved in the electron transport chain (ETC) and consequently, adenosine triphosphate (ATP) production. Because of its role in ATP production, it may also contribute to an increase in B lymphocyte synthesis.

CoQ10 is the body’s only naturally synthesized, lipidsoluble antioxidant. As an antioxidant, CoQ10 stabilizes cell membranes and prevents free radical damage to the rest of the cell. As a free-radical scavenger, it is theorized that CoQ10 aids in the body’s immune system by minimizing damage done to DNA and other molecules. CoQ10 is found in Complexes I and II of the ETC and briefly in the Citric Acid cycle. Because of this, it is considered essential for maintaining tissue and organ health. In the ETC, CoQ10 accepts electrons from Complex I and II. Without sufficient CoQ10, ATP production would decrease. In the mitochondria, CoQ10 is able to inhibit LDL-cholesterol, oxidation and protect cellular membranes from peroxidation¹ , ⁵.

Effectiveness

https://pubchem.ncbi.nlm.nih.gov/ compound/Coenzyme-Q10.

CoQ10 takes between 2 weeks and 3 months to see results for patients with congestive heart failure. In these patients, CoQ10 levels in the blood increase with continued therapy. In patients with hypertension, it takes 3-4 weeks to produce results when consistently taking 100 mg per day⁵.

Food and Drug Interactions The effects of CoQ10 may decrease when taken concurrently with drugs meant to regulate or lower cholesterol, blood pressure, and blood sugar.

Additionally, CoQ10 may alter the way drugs such as insulin and warfarin are used¹. However, there are also studies showing that CoQ10 does not affect warfarin⁵.

Safety, Toxicity, and Warnings There are no reported adverse or toxic effect of CoQ10. Some side effects may occur, but none are considered severe⁴.

Side Effects While there may not be many serious side effects of CoQ10, some may experience gastrointestinal issues, such as nausea, headache, photosensitivity, and insomnia. Other potential side effects might include lethargy and increased liver enzymes¹, ³.

Article Summary The article written by Garrido-Maraver, Cordero, Oropesa-Avila, et al. is a comprehensive breakdown of the clinical application of coenzyme Q10. The article is an amalgamation of the various possible uses of CoQ10 and outlines different studies that aim to understand if, or how, CoQ10 is able to treat various conditions. Conditions in this article include, but are not limited to, CoQ10 deficiency, cardiovascular diseases, neurological diseases, and cancer. The article is overall an informative collection that summarizes studies³.

https://www.walgreens.com/store/c/nature% 27s-bounty-coq10-softgels,-100mg/ID=prod3430767-product

Personal / Professional Opinion CoQ10 can be a useful supplement but it is not one that should be taken without consulting a physician first. Not only is CoQ10 a naturally occurring compound, its drug interactions are not fully known. In doing research for this monograph, there were various conflicting statements about CoQ10's effect on medications, primarily warfarin and other blood thinners. However, the generally agreed upon benefits of CoQ10 could be something that benefits consumers. While its link to cancer and chronic diseases are not fully known, taking this supplement under physician guidance would not be particularly harmful to the patient. ~K Diego References 1. PDQ® Integrative, Alternative, and Complementary Therapies Editorial Board. PDQ Coenzyme Q10. Bethesda, MD: National Cancer Institute. Updated Apr. 06, 2022. Accessed Feb. 16, 2023. https://www.cancer.gov/aboutcancer/treatment/cam/patient/coenzyme-q10-pdq.

2. Pelton R. Coenzyme Q10: A Miracle Nutrient Advances in Understanding. Integr Med (Encinitas). 2020;19(2):1620. Published 2020 Apr. Accessed Apr. 2, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482328/.

3. Garrido-Maraver J, Cordero MD, Oropesa-Avila M, et al. Clinical applications of coenzyme Q10. Front Biosci (Landmark Ed). 2014;19(4):619-633. Published 2014 Jan 1. doi:10.2741/4231 4. National Center for Biotechnology Information. PubChem Compound Summary for CID 5281915, Coenzyme Q10.

Accessed Feb. 16, 2023. https://pubchem.ncbi.nlm.nih.gov/compound/Coenzyme-Q10.

5. Coenzyme Q10. IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed Feb. 16, 2023. http://www.micromedexsolutions.com.

Madison Detzer Student Pharmacist Spring 2023

Background: Cranberry (Vaccinim macrocarpon) is a type of plant, an evergreen shrub, that grows in wet regions and originates in the northeastern and north central parts of the United States.

Historically, the fruit and leaves of the cranberry bush have been used for bladder, stomach, and liver problems as well as for wounds1.

Image4

Common Uses: The most common uses of cranberry are for the prevention of urinary tract infections (UTIs).

Other alleged uses for cranberry are for benign prostatic hyperplasia, overactive bladder, cancer, cognitive decline, diabetes, and cardiovascular disease2.

Mechanism of Action:

Dosage Forms:

Cranberry contains about 90% water, and the

There are a few types of ways to take

other contents are rich with anthocyanidins,

cranberry. There is the natural fruit,

phenols, flavonoids, catechins, and organic acids.

cranberry juice, dried powder

The many antioxidants in cranberries help

supplement pills.

neutralize the free radicals in the body. Free

Dried powder pills are typically dosed as

radicals cause oxidative stress to cells and can be

250-1500mg daily for up to 6 months.

an aggravating factor in various disease states. In

Cranberry juice is typically used as

vitro studies have also shown cranberries have

250-750mL daily for up to 90 days2.

some antibiotic properties against3.

Effectiveness:

Safety:

Some research suggests that for those who

The consumption of cranberry is general

have recurrent UTIs, the use of cranberry can

considered as safe. If taken in too large of

reduce the risk of developing a UTI by about

amounts, like 3-4 L of cranberry juice a day,

one-third. Although, some of these studies

some adverse effects could be diarrhea and

have been reported on not being the highest

other gastrointestinal disturbances, but

of quality. It is not known how long it takes

cranberry is generally well tolerated.

to show results. Cranberry should not be

Information on toxic doses is insufficient,

used for the treatment of UTIs since there is

but there have been rat studies that suggest

no evidence shown of effectiveness1.

more than 5g/kg in rats can be lethal3.

Interactions: There is evidence that there could be moderate interactions with the drugs Atorvastatin, Nifedipine, and Warfarin by potentially increasing blood levels and adverse effects. If one takes any of these drugs, be cautious with supplementing of cranberry. There are no evidence of any interactions with other supplements2.

Article Summary:

Author’s Opinion:

Cranberries are a naturally

I think that cranberry, whether a daily glass (ex. 8 fl oz) or a

occurring fruit and have

dried powder supplement, can be beneficial to someone with

been used for various

reoccurring UTIs. I know many women who struggle with UTIs,

ailments throughout

and they say cranberry juice helps them. -M. Detzer

history, and there has been research over prevention of UTIs that point to some

1.

efficacy and is generally safe. Not many other studies have been done about other ailments, toxicity levels, adverse effects, and interactions1.

2.

3.

4.

References:

Cranberry. National Center for Complimentary and Integrative Health, National Institute of Health. U.S. Department of Health and Human Services. Bethesda, MD. Accessed February 21, 20223. https://www.nccih.nih .gov/health/cranberry Cranberry. Natural Medicines. Therapeutic Research Center. Somerville, MA. Accessed February 21, 2023. https://naturalmedi cines.therapeuticresearch.com Cranberry. Natural Products Database. Facts & Comparisons eAnswers.

Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 21, 2023. http://online.factsandcomparisons.com RuslamOmega. iStock by Getty Images. https://www.istockphoto.com/ photo/forest -cranberries-bush-of-ripe-berries-a-few-red-berries-gm 178121032-24998138. Published June 12, 2013. Accessed February 21, 2023.

CREATINE ELLA SMITH STUDENT PHARMACIST SPRING 2023

SCIENTIFIC NAME & FORMULA 2-[Carbamimidoyl(methyl)amino]acetic acid C4H9N3O2 COMMON NAMES

MECHANISM OF ACTION Creatine is stored in the muscle as phosphocreatine.

Phosphocreatine is a precursor for energy molecule ATP in skeletal tissues. Phosphocreatine paired with creatine kinase utilize ADP to resynthesize ATP. This ATP can then be used as energy when exercising for short 10-20second-high intensity energy bursts.

DOSAGE FORMS Creatine is available orally in a solid dosage form or a solution. Creatine is also available in the topical form but there is limited research on this form.

DOSING

Creatine Monohydrate, Creatine Phosphate, CrP, Phosphocreatine BACKGROUND In 1832, French Chemist Michel Chevruel discovered creatine as an organic meat component. Observation of wild foxes in 1847 proved that the flesh of those killed in the chase had about 10 times more creatine than those living in captivity. This observation later led to researchers from Harvard Medical School determining a connection between the ingestion of creatine and amplified creatine in muscle tissues in 1912. In the 1990s, creatine was finally studied for its effect on exercise performance in people. Reports found a 20% increase in muscle mass following creatine supplementation.

COMMON USES Although the trials are ongoing, creatine is most used as a supplement to enhance performance in high-intensity, shortduration exercises.

Adult dosing starts with a loading dose of 20 grams daily for up to 7 days. This is followed by a maintenance dose of 3-5 grams per day. This regimen can be maintained for several weeks to months without having serious side effects. Dosing in children has limited research.

EFFECTIVENESS Short term, high-energy work has been proven to improve slightly using creatine. For example, in a blind study with 18 male sprinters, creatine was found to aid in decreasing their times for the 60-meter sprint and 100-meter sprint.

So, creatine has been proven to enhance anaerobic, highintensity work, though not substantially.

SAFETY Creatine should not be used in patients with impaired kidney function. If an inadequate amount of water is consumed while using creatine, excessive dehydration can occur. For this reason, creatine should not be used with diuretics as well. The French Agency for Food, Environmental and Occupational Health and Safety has warned against the use of creatine at high doses due to cytotoxic compounds potentially being produced.

ADVERSE EFFECTS Orally taken creatine can cause adverse effects such as: diarrhea, dehydration, muscle cramps, GI upset, and water retention. Rare adverse effects of creatine can include renal dysfunction, interstitial nephritis, rhabdomyolysis, and venous thrombosis.

INTERACTIONS Although no food or drug interactions with creatine are well enough researched to be confirmed, there are a couple products that could potentially interact with creatine. There is one case in which Ma Huang, used in Chinese medicine, combined with creatine could have possibly caused an ischemic stroke in an individual. In another study, there is some evidence that consuming caffeine-containing foods or drinks while using creatine will decrease the ergogenic effects of creatine. However, there is not enough research to support either of these claims.

MY OPINION I believe that creatine is effective as a muscle enhance for anaerobic exercise when used correctly. Users of creatine should be exercising regularly and be adequately hydrated to see an effect. In the future I was searching for a performance enhancer, I would consider using a creatine supplement. ~E Smith

CREATINE STUDY In July of 2015, a study was conducted on 60- to 80-year-old women to see how creatine supplements affected their muscle mass and function while subject to resistance training. The resistance training consisted of 3 one-hour sessions per week for 12 weeks using elastic bands and weights. Half of the 50 participants received 5 grams of creatine per day while the other half received 5 grams of maltodextrin per day as a placebo. After the 12 weeks, the test group was found to be able to exert a significant amount of force more than the placebo group when testing the quadriceps isometric force on the quadriceps table.

However, when measuring the number of meters a participant could walk in 12 minutes, creatine showed no significant results. One can conclude from this study that creatine has a substantial effect on anaerobic performance, but not aerobic performance in older women.

REFERENCES Bunout D, Hirsch S. Effects of creatine supplementation on muscle mass and function among older women subjected to resistance training.

National Library of Medicine. 2014. NCT02188849.

Creatine. Encyclopedia Britannica. Accessed February 25, 2023. https://www.britannica.com/science/isoleucine#/me dia/1/142124/217200 Creatine. IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Accessed February 25, 2023. http://www.micromedexsolutions.com Creatine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 25, 2023. http://online.lexi.com Creatine. Natural Medicines. TRC Healthcare.

Stockton, CA. Accessed February 25, 2023. https://trchealthcare.com

Devil’s Claw (Harpagophytum procumbens) Mina Lin

History Devil’s Claw was native to Southern Aftrica as it is then introduced in early 1900s in Europe. It gets its name from the tiny hooks that covers its fruits.

Student Pharmacist Spring 2023

Pharmacology

Common Use It has many uses throughout history, but today is it commonly used for inflammation, relieving arthritis pain, headache, and lower back pain.

No known mechanism

Dosage Form Can be found in concentrated extract, capsules, tablets, or powder. As well as an ingredient in herbal tea(s).

Most typical dosing for Devil’s Claw is between 600 to 2,610 mg.

Effectiveness Overall, it may relieve inflammation like arthritis, but it is mostly best to speak to your doctor about it before taking it.

Safety Concerns Devil’s Claw put these health concerns at a higher risk like heart disorder, diabetes, gallstones, and stomach ulcers.

Article Two randomized placebo trials were placed in use of Devil’s Claw effectiveness towards osteoarthritis. One trial had no statistic calculation and the other trial composed of a hypothesis. One set of patients was given freeze dried Devil’s Claw and the other was given weak non-steroid anti-inflammatory drug (NSAID) for both trials. After 4 months, there was significant difference between the two treatments. In the end, it did show that Devil’s Claw did have fewer side effects.

Side Effects Most common side effects could be mild diarrhea. Other side effects can include allergic reaction, headaches, and coughing.

Interactions Devil’s Claw may slow the absorption of NSAID, enhance blood tinners, and may decrease effects of stomach acid reducers.

References Devil’s claw Information | Mount Sinai - New York. Mount Sinai Health System. Published 2009. https://www.mountsinai.org/health-library/herb/devils-claw

Professional Opinion I think the Devil’s Claw is a good supplement for relieving pain like arthritis and inflammation. A good advice would be talking to your physician first on taking the supplements and if it would benefit your health to do so.

M. Lin

Devil’s Claw: Benefits, Side Effects and Dosage. Healthline.

Published August 27, 2018. Accessed February 26, 2023. https://www.healthline.com/nutrition/devils-claw#side-effects Chrubasik S. Effectiveness of devil’s claw for osteoarthritis.

Rheumatology. 2002;41(11):1332-1333. doi:https://doi.org/10.1093/rheumatology/41.11.1332

Dong Quai Also Known As: -Angelica sinesis -female ginseng -dang gui -tang kuei -an kue

Amy Cho Student Pharmacist Spring 2023 Background/History - Chinese herb Used for more than 2,000 years Grown in cooler high altitudes in Asia For women hormonal disorders

Common Use Menopause symptoms Dysmenorrhea Lack of menstruation PMS symptoms Reduce inflammation Boost immune system

Dong Quai Extract. Mount Rose Herbs.

Accessed February 20, 2023. https://mountainroseherbs.com/dong-quaiextract

Mechanism of Action - Aqueous extraction: estrogen agonist activity - Ferulic acid, constituent of dong quai, treats osteoarthritis by reducing IL1-beta, TNF-alpha, and increasing SOX-9.

- Polysaccharides stimulate IGF-1 (insulin-like growth factor 1).

Available dosage form & serving size Dried herb (raw root) - boiled or soaked in wine before consuming Powdered herb (capsules) 500-600mg up to 6 times a day Tincture (drops) 40-80 drops - individualized dosing usually part of formula with synergistic herbs

Effectiveness Noticeable after 4 weeks but become more pronounced in 12 weeks of usage No clinical or scientific evidence to show its effectiveness for any common uses Adverse Effects & Toxic Effects -

Burping, flatulence, hypertension Intravenously : headache Could cause cancer

Article Summary: Dr. Al-Bareeq performed a placebo trial in which patients with prostate cancer to test whether Dong-Quai was effective in decreasing vasomotor symptoms associated with them, such as hot flashes. It was a double blind study. After the study was finished and the patients with the placebo and dong quai were compared, it showed that there was no significant difference in severity, frequency, or duration of hot flashes among the two different groups.

Safety Possibly safe when used orally and appropriately Possibly unsafe when used orally in large amounts for a long time Possibly unsafe when pregnant Interactions Anticoagulant - moderate Estrogens - moderate Warfarin - severe Personal Opinion: I personally believe that Dong quai is not effective and is not something that I would personally use. This is because there are no significant studies that show that it was effective in the common uses. Not only that, it could be a possible carcinogen with long term use, and it claims to work after long term use. - AC References 1.

2.

3.

Dong Quai in Treatment of Hot Flashes.

Nation Library of Medicine. Accessed February 20 ,2023. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2811999/ Dong Quai. Memorial Sloan Kettering Cancer Center. Accessed Febrary 20, 2023.https://www.mskcc.org/cancer-care/in tegrative-medicine/herbs/dong-quai Dong Quai. Gaia Herbs. Accessed February 20, 2023. https://www.gaiaherbs.com/blogs/herbs/do ng-quai

Dong Quai in Treatment of Hot Flashes. Nation Library of Medicine. Accessed February 20 ,2023. https://www.ncbi.nlm

Spring 2023

Alexa Carnahan - Student Pharmacist

Echinacea Eichnacea Purpurea - Purple Coneflower

Background/History Echinacea originates from North America, with first evidence of it dating back to the 18th century. It is a special species of the Asteraceae family. Information from traditional healers about its use ranges from external application for wounds and burns, to the chewing of roots for toothache and throat infections and internal application for pain, coughs, and stomach cramps. The first Echinacea preparation, known as Meyers Blood Purifier, arrived on the market around 1880, with rheumatism, neuralgia, and rattlsnake bites as indications.

Common Uses The extracts of Echinacea exhibit immunostimulant properties and are used mainly in the prevention and therapy of cold and flu symptoms.

Pharmacology/Mechanism of Action Alkamides and polysaccharides have been considered important constituents of the plant. Alkamides are involved in the immunomodulatory properties while polysaccharides play a role in the anti-inflammatory effect. The immunostimulant activity of the plant is caused by 3 mechanisms: phagocytosis activation, fibroblast activation, and the enhancement of respiratory activity that results in augmentation of leukocyte mobility.

Available Forms Three species of echinacea are commonly used for medical purposes: Echinacea angustifolia, Echinacea pallida, and Echinacea purpurea.

Echinacea is available in extracts, tinctures, tablets, capsules, and ointments. It's also available in combination with other immuneboosting herbs, vitamins, and minerals.

Dosing There are currently no official dosage recommendations for echinacea. Echinacea products are highly variable, making it hard to set a standard recommended dosage.

Research has found the following doses to be effective in aiding immunity: dry powdered extract - 300-500 mg of Echinacea purpurea, three times daily and liquid extract tinctures 2.5 mL, three times daily.

2023

Alexa Carnahan - Student Pharmacist

Effectiveness/Personal Opinion Some studies have observed that echinacea could be useful in preventing, as well as treating the common cold, but more research is needed to confirm its effectiveness. There's not enough evidence to show whether it is helpful for other health conditions. Personally, I would not take this for treating a common cold, as I believe there a better options with more evidence of effectiveness for treating a cold (A Carnahan).

Safety/Warnings For most adults, short-term oral use of echincea is safe; the safety of long-term use is uncertain. Some people have allergic reactions to echinacea, which may be severe.

Side Effects/Toxic Effects It is generally considered safe when used as directed, however there are a few side effects associated with it.

Potential side effects include, stomach pain, nausea, rash, difficulty breathing, and swelling of the skin. It can be safely used by women who are pregnant or breastfeeding, however it should be used with more caution. In terms of the toxic effects, in multiple controlled trials, echinacea by itself has not been linked to hepatoxicity (liver injury).

Interactions Current evidence indicates that the risk of interactions between echinacea supplements and most medications is low.

Summary of Study A study looked at the effects of echinacea on cytochrome P450 (enzyme) activity in vivo. It was found that echinacea reduced the oral clearance of substrates of CYP1A2 but not the oral clearance of substrates of CYP2C9 and CYP2D6. So, caution should be used when echinacea is coadministered with drugs dependent on CYP1A2 for their elimination.

References

Hostettmann K. Geschichte einer Pflanze am Beispiel von Echinacea [History of a plant: the example of Echinacea]. Forsch Komplementarmed Klass Naturheilkd. 2003;10 Suppl 1:9-12. doi:10.1159/000071678 Manayi A, Vazirian M, Saeidnia S. Echinacea purpurea: Pharmacology, phytochemistry and analysis methods. Pharmacogn Rev. 2015;9(17):63-72. doi:10.4103/0973-7847.156353 Icahn School of Medicine at Mount Sinai. Echinacea. Mount Sinai. Accessed February 20, 2023. https://www.mountsinai.org/health-library/herb/echinacea Raman R. Echinacea: Benefits, Uses, Side Effects and Dosage. Healthline. Updated October 25, 2018.

Accessed February 20, 2023. https://www.healthline.com/nutrition/echinacea Ajmera R. Can Echinacea Help You Fight the Common Cold? Healthline. Published December 6, 2019.

Accessed February 21, 2023. https://www.healthline.com/nutrition/echinacea-forcolds#effectiveness%20https://www.nccih.nih.gov/health/echinacea Gorski, J. Christophe., et al. “The Effect of Echinacea ( Root) on Cytochrome P450 Activity in Vivo.”

Clinical Pharmacology and Therapeutics, vol. 75, no. 1, 2004, pp. 89–100, https://doi.org/10.1016/j.clpt.2003.09.013.

LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Echinacea. [Updated 2019 Apr 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548440/

CLAIRE REYES STUDENT PHARMACIST

EVENING PRIMROSE

SPRING 2023

Oenothera biennis aka EPO, Evening Star, Sun Drop

History

What is it used for?

In the past, Native Americans used evening primrose to treat bruises and wounds. They also used it to treat skin inflammation, gastrointestinal problems, and sore throats. It was also used during the 17th century and called the "King's cure-all."

Evening primrose oil is used for rheumatoid arthritis, atopic dermatitis, premenstrual syndrome, breast pain, menopause symptoms, and diabetic nerve pain. 1

How does it work?

The seeds of evening primrose contain 7-10% gamma linoleic acid (GLA). GLA is an omega-6 fatty acid which is then converted to dihomo-gamma linoleic acid (DGLA). DGLA is a precursor for prostaglandins and thromboexnes.

Prostaglandins help regulate the immune system and thromboxanes help regulate inflammation. It can also help prevent the formation of proinflammatory molecules.2

Dosage Forms Evening primrose comes in an oil form or capsule form.

Typical Serving The typical dose of the oil form is 2-6 grams daily.

Toxic Effects No known toxic effects.

Side Effects

Safety Overall, evening primrose is likely safe when used orally and appropriately. It has been shown to be safe up to 6 grams daily for 1 year.

It is considered possibly safe for children, pregnant women, and lactating women when used orally.

The most common side effects include: abdominal pain diarrhea gasiness nausea vomiting dizziness headache

Effectiveness There is insufficient evidence that shows that evening primrose oil is effective for rheumatoid arthritis, atopic dermatitis, or breast pain.

Interactions Drug Interactions Moderate : Anticoagulant/antiplatelet drugs Lithium Lopinavir/Ritonavir (Kaletra) Phenothiazines Minor: Cytochrome P450 2C Condition Interactions: Bleeding disorders Epilepsy/Seizure Disorder Before operation

Professional Opinion "As a pharmacy student, I don't believe there is sufficient evidence for evening primrose to be used to treat rheumatoid arthritis, atopic dermatitis, menopause symptoms, or breast pain. If used, it should not be replacing any therapies and should be used with caution." ~C. Reyes

"Evening Primrose (Oenothera biennis) Oil in Management of Female Ailments" In this clinical study, researchers tested the effects of evening primrose oil on women's health. Data was gathered from several scientific resources and compiled together.

Based off of the mutiple resources, the clinical studies concluded that evening primrose oil had therapeutic potential for pre-menstrual syndrome, hot flashes, gestational diabetes, and cervical ripening. They also concluded that there were no adverse effects in the mice they were testing on. 3

Stover Seed, Showy Evening Primrose. Accessed April 4, 2023

References 1. Evening Primrose. Lexi-Drugs. lexicomp. Wolters Kluwer Health, Inc. Riverwoods,iL. Accessed February 24, 2023 http://online.lexi.com 2. Evening Primrose. Food, Herbs, and Supplements. Natural Medicines. Accessed February 24, 2023 Welcome to the Natural Medicines Research Collaboration (therapeuticresearch.com) 3. Mahboubi, Mohaddese. Evening Primrose (Oenothera biennis) Oil in Management of Female Ailments. J Menopausal Med. 2019; 25(2):74-82

Garcinia cambogia Nathan Tuchscherer; Biochemistry Student Spring 2023 Background/History Garcinia cambogia is found in India and Southeast Asia region. The rind of the fruit is traditionally used as a flavourant in fish curries, condiment, and food preservative.

The rind of the fruit contains hydroxycitric acid (HCA). HCA is associated with having suppressive effects on appetite.1,3

https://i0.wp.com/post.healthline.com/wp-content/uploads/2020/03/garciniacambogia-1296x728-header.jpg?w=1155&h=1528

Names1 Scientific Name: Garcinia cambogia Common Names: garcinia cambogia, garcinia, Malabar tamarind, brindle berry Latin Name: Garcinia gummi-gutta

https://cdn.shopify.com/s/files/1/0294/1134/4521/products/garcinia-cambogia-extractpowder-herb-root-powders-z-natural-foods-5-lbs-103602_900x.jpg?v=1669790422

Forms and Dosage The rind of garcinia cambogia can be purchased in whole or capsulated form.

Dosages vary among capsulated forms but can typically be seen around a 1000mg supplement with varying concentrations of HCA contained within the supplement. Most supplements are directed to be taken between 1-3 times daily and commonly instructed to be taken before meals.

Mechanism HCA is a competitive inhibitor of ATP-citrate lyase which inhibits lipogenesis activity. HCA also causes decreased acetyl-CoA production which decreases fatty acid synthesis and lipogenesis.2 Common Uses Garcinia cambogia is associated with having effects on suppressing appetite and is commonly taken as a supplement for weight loss. Other symptoms that garcinia cambogia is marketed toward relieving are joint pain, digestive symptoms, and improve athletic performance.1

https://images.hollandandbarrettimages.co.uk/the-health-hub/2020/10/shutterstock_675379234-768x295.jpg

Effectiveness There is insufficient evidence to recommend garcinia cambogia for weight loss.4 Drug interaction: There may be unpredictable herb-drug interaction and further research is still needed to determine the safety of taking garcinia cambogia.5 Adverse effects Garcinia cambogia supplementation has been linked with the development of acute liver injury.6

https://www.hopkinsmedicine.org/-/media/images/health/1_-conditions/livergallbladder-and-pancreas/acute-liver-failure-teaser-image.ashx

Toxicity Studies Several research reports indicate that garcinia cambogia and HCA do not have significant toxic effects. There is suggestion that this supplement may have toxic effects towards spermatogenesis.8 Article Summary In an article from Crescioli (et al.) four cases of acute liver failure are presented from women taking garcinia cambogia. This article reports that since herbal supplements such as garcinia cambogia are often taken without medical supervision that there has been increasing cases of acute liver injury and failure. In conclusion, taking this supplement over the counter without any supervision can pose risk of liver damage to individuals.7 Personal Opinion Due to the various studies linking garcinia cambogia to acute liver injury, I would personally not recommend taking this as a dietary supplement for weight loss. Also, with the lack of evidence for effectiveness of garcinia cambogia, I would suggest contacting your primary care provider for their recommendations on the best methods of weight loss for your specific body. ~N Tuchscherer

References: 1. National Center for Complementary and Integrative Health (NCCIH). (2022). Garcinia Cambogia. Retrieved February 25, 2023, from https://www.nccih.nih.gov/health/garcinia-cambogia 2. Ariyanto E. F, Multom N. O, Berbudi A, Rohmawaty E, Sujatmiko B. Efficacy and Mechanism of Action of Aloe Vera, Cinnamomum Zeylanicum, Curcuma Longa, Garcinia Cambogia, and Garcinia Mangostana Extracts in Lowering Body Weight in Obesity: A Literature Review.

Biomed Pharmacol J 2021;14(4).

3. Ruchi Badoni Semwal, Deepak Kumar Semwal, Ilze Vermaak, Alvaro Viljoen. A comprehensive scientific overview of Garcinia cambogia, Volume 102, 2015, Pages 134-148, ISSN 0367-326X, https://doi.org/10.1016/j.fitote.2015.02.012.

4. Maunder A, Bessell E, Lauche R, Adams J, Sainsbury A, Fuller NR. Effectiveness of herbal medicines for weight loss: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2020 Jun;22(6):891-903. doi: 10.1111/dom.13973. Epub 2020 Feb 15. PMID: 31984610.

5. Cococcioni, G., & Baldi, A. (2018). The role of the pharmacist in the prevention and management of adverse drug reactions: A literature review and proposal of a new classification system. Internal and Emergency Medicine, 13(3), 315-328. doi: 10.1007/s11739-018-1880-4 6. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Garcinia Cambogia. [Updated 2019 Feb 13]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548087/ 7. Crescioli, G., Lombardi, N., Bettiol, A. et al. Acute liver injury following Garcinia cambogia weight-loss supplementation: case series and literature review. Intern Emerg Med 13, 857–872 (2018). https://doi.org/10.1007/s11739-018-1880-4 8. Chuah LO, Yeap SK, Ho WY, Beh BK, Alitheen NB. In vitro and in vivo toxicity of garcinia or hydroxycitric Acid: a review. Evid Based Complement Alternat Med. 2012;2012:197920. doi: 10.1155/2012/197920. Epub 2012 Aug 9. PMID: 22924054; PMCID: PMC3424601.

Garlic Dillon Kish, Student Pharmacist Spring 2023 Dose:

Mechanism:

Daily dose of 2 to 5 g of

The alliin in garlic is what

fresh raw garlic

creates the pharmacological

0.4 to 1.2 g of dried garlic

benefits. Once garlic is crushed

powder

alliin turns into allicin. Garlic

2 to 5 mg garlic oil

can inhibit the renin

300 to 1,000 mg of garlic

angiotensin aldosterone system

Common names:

extract (as a solid material)

and prostaglandin synthesis.

Allium, Camphor of the poor, Da-

2,400 mg/day of aged garlic

This process creates

suan

extract (liquid)

vasodilation because garlic can

Garlic powder ranged from

inhibit ACE, aangiotensin

Background/history:

300 to 2,400 mg/dayuses: for 2 to Purported/common

converting enzyme. A

The use of garlic dates to five

24 weeks whenasevaluating Garlic is used a dietary

reduction in ACE activity

thousand years ago. Garlic was

effects of garlic blood to supplement that on is thought

causes a reduction in

once used as antibiotics in

pressure help with cardiovascular and

angiotensin II, which is a direct

pharmaceutical products. Garlic

blood vessel conditions,

vasoconstrictor. This also

was used throughout various

including dyslipidemia,

causes a decrease of

pandemics such as influenza,

hypertension, reduces

aldosterone produced by the

dysentery, and cholera. Garlic was

inflammation, and

adrenal gland. The reduction of

used for health purposes by

antimicrobial activity.

aldosterone decreases the

https://www.bbcgoodfood.com/howto/guide/ingre dient-focus-garlic

reabsorption of sodium and

different regions of the world such as Egypt, Greece, Rome, China,

Scientific name: Allium

and Japan. But now garlic is mostly

sativum

used as a flavoring for food.

water from the distal convoluted renal tube. This decreases plasma volume.

Effectiveness:

Side Effects:

References:

Taking garlic for at least 8 weeks

Body odor, bloating, GI irritation

Garlic. EBM consult. EBM

reduced total cholesterol and low LDL in patients with hyperlipidemia.

Opinion: I believe that garlic is an effective alternative medicine.

Through learning about the

Consult, LLC. Bethesda, MD. February 25, 2023. https://www.ebmconsult.com/a rticles/garlic-lowers-blood-

Interactions:

mechanism of garlic in the body it

Anticoagulant/antiplatelet drugs:

works similarly to many

Garlic increases risk of bleeding

prescribed medications by

due to having antiplatelet activity

interacting with the same receptors

and can increase prothrombin.

in the body.

Antidiabetic drugs: Garlic can

D Kish

increase risk of hypoglycemia

Summary of Article:

Riverwoods, IL. February 24,

because garlic lowers blood

A clinical study on the relationship

2023. https://online-lexi-

glucose levels.

between aged garlic powder and

com.ezproxy.lib.purdue.edu/lc

Antihypertensive drugs: Garlic can

hypertension patients lasted 8

o/action/doc/retrieve/docid/fc_

increase the risk of hypotension

weeks. Forty patients were given

rnp2/3750159?cesid=6fohgqA

because garlic lowers blood

one capsule of 600 mg aged garlic

4LPn&searchUrl=%2Flco%2F

pressure.

powder twice a day for four

action%2Fsearch%3Fq%3Dga

Cytochrome P450 2E1 substrates:

weeks, then a control period with

rlic%26t%3Dname%26acs%3

Garlic can increase levels of any

no garlic. During the first phase,

Dfalse%26acq%3Dgarlic

drug that is metabolized by

patients’ systolic and diastolic

Garlic. Natural Medicines.

CYP2E1. Garlic can inhibit the

blood pressure both decreased.

Therapeutic Research Center.

activity of CYP2E1 by 39%.

During the second phase it was

Somerville MA. February 24,

seen that both their blood pressure

2023. https://naturalmedicines-

levels increased back to the

therapeuticresearch-

original levels.

com.ezproxy.lib.purdue.edu/da

Warnings:

tabases/food,-herbs-

Do not take if allergic to garlic.

supplements/professional.aspx

allergy.

?productid=300#effectiveness

https://www.walgreens.com/store/c/nature%27s-bounty-odorlessgarlic-1000-mg-dietary-supplement-softgels/ID=prod2497538product

pressurehypertension#:~:text= Garlic's%20ability%20to%20l ower%20the,2S%20that%20re sults%20in Garlic. Lexicomp. Wolters Kluwer Health, Inc.

GINGER

Zingiber Officinale Haley Williams, Student Pharmacist; Spring 2023

Scientific name: Ginkgo biloba

Why use Ginkgo biloba?

This supplement can have many benefits, however it is most famous for treating blood disorders and memory problems. Nowadays, people are using this supplement to keep their memory sharp (improves blood flow to the brain), although its primary use is to improve circulation by opening up blood vessels. It is also known to be a good antioxidant.

History:

The Ginkgo biloba is one of the oldest species of living trees in the world. It was the only survivor out of a group of trees that lived in this planet years before the dinosaurs. This means that the Ginkgo tree has been alive in the Earth for millions of years. For this reason, the species has earned the name "living fossil"

Ginkgo biloba Luciano De Tramontana; Psychology Major Spring 2023 Dosage:

This supplement is available as an oral tablet, capsule, tea or extract.

Dosing:

Typical adult doses range from 60-240 mg by mouth daily up to 6 months.

Gingko tree

Gingko Biloba leaf

Pharmacology:

The most beneficial components found in Ginkgo biloba are known to be flavonoids (antioxidant) and terpenoids (blood circulation). These antioxidant compounds fight particles known as free radicals (which can contribute to serious disease such as cancer) and stops them from damaging cells.

I believe that Ginkgo biloba is a supplement with great potential to help people suffering with blood disorders and to those that want to boost cognitive functions. However, I would not recommend this for boosting memory as more evidence is still needed to prove that it is efficient for this. - L. De Tramontana

Gingko oral tablets

In past studies, adults taking 120-240 mg of the supplement reported improvements 4 to 6 weeks after the initial dose.

DON'T take if you: Have a bleeding disorder Plan to have surgery (stop taking supplement 2 weeks prior to surgery) Are pregnant NEVER eat fresh seeds as they may lead to DEATH Avoid taking several roasted seeds/ crude plant as they may provoke seizures

Gingko Biloba chemical composition

Effectiveness:

Some evidence suggests that this supplement is possibly effective for anxiety, diseases such as dementia, hearing loss, helps with antipsychotic medicine side effects, vertigo and more. (WebMD)

Safety:

Interactions: Side effects:

Oral route of administration: dizziness, stomach ache, allergic skin reactions

Do not combine with Alprazolam, Ibuprofen, any type of medication broken down by the liver, medications for diabetes, anticoagulant drugs, Trazodone (WebMD) Works cited:

Article summary: A study published by the National Library of Medicine explored many components of the compound that might have medicinal properties. The study concluded that " EGb’s effects in vitro and in vivo, most have reported very positive outcomes with strong statistical analyses, indicating that EGb must have some sort of beneficial effect." It is important to note that the information from the clinical trial did not include important information such as: patient age, doses administered and duration, and participant's health condition.

Zuo, W. et al. (2017) Advances in the studies of ginkgo biloba leaves extract on aging-related diseases, Aging and disease. Available at: https://doi.org/10.14336/ad.2017.0615 (Accessed: April 13, 2023).

Ginkgo: Overview, uses, side effects, precautions, interactions, dosing and reviews. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-333/ginkgo.

Accessed April 13, 2023. Ginkgo. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-ginkgo/art-20362032.

Published November 18, 2020. Accessed April 13, 2023.

GLUCOSAMINE

HTTPS://WWW.BBC.COM/NEWS/MAGAZINE-37429050

Sameer VarmaStudent PharmacistSpring 2023

HTTPS://WWW.ISTOCKPHOTO.COM/VECTOR/PAIN-IN-THE-LEGS-PROBLEMS-VECTOR-FLATGM854529882-140573027

HISTORY/BACKGROUND COMMON USES Glucosamine was first prepared in 1876 by a man named Georg Ledderhose by the hydrolysis of chitin with concentrated HCL. However, it was not fully discovered until the 1930” s where a man by the name of Walter Haworth was able to understand the stereochemistry of this molecule. Most glucosamine supplements are made by harvesting shells from shellfish and are made in the lab.

COMMON/SCIENTIFIC NAMES -GLUCOSAMINE HAS 2 SCIENTIFIC NAMESGLUCOSAMINE SULPHATE AND GLUCOSAMINE HYDROCHLORIDE.

HTTPS://WWW.ISTOCKPHOTO.COM/VECTOR/PAIN-INTHE-LEGS-PROBLEMS-VECTOR-FLAT-GM854529882140573027

THE MOST COMMON USES OF GLUCOSAMINE SUPPLEMENTS ARE IN THE TREATMENT OF PATIENTS THAT SUFFER FROM EITHER OSTEOARTHRITIS WHICH IS THE INFLAMMATION OF THE BREAKDOWN OF CARTILAGE OR RHEUMATOID ARTHRITIS WHICH IS A CHRONIC AUTOIMMUNE DISEASE THAT MOSTLY AFFECTS THE JOINTS.

HOW IT WORKS IN THE BODY GLUCOSAMINE IS USED BY THE BODY NATURALLY TO MAKE CHEMICALS THAT BUILD TENDONS, LIGAMENTS, CARTILAGE, ETC. BY TAKING GLUCOSAMINE SUPPLEMENTS YOU HELP EXPEDITE THIS PROCESS AND THUS WILL ALLOW YOU TO PREVENT OR HELP THE BREAKDOWN OF CARTILAGE.

HTTPS://WWW.DREAMSTIME.COM/BONE-VITAMINS-GLUCOSAMINE-OMEGA-DIETARYSUPPLEMENT-BONES-ARTHRITIS-KNEE-JOINT-PAIN-LEG-MEDICAL-HEALTHCARESKELETON-X-IMAGE270993100

DOSAGE Glucosamine is available in capsules typically in the 1500mg range split into 3-4 capsules. A typical serving size of glucosamine is 4 capsules daily with meals and each capsule ranging from 300-500mg.

EFFECTIVENESS Glucosamine has been shown to vary results in effectiveness with some studies saying it is an effective supplement and others saying it is not.

Glucosamine supplements take about 6-8 weeks for results to be present.

HTTPS://WWW.GLUCOSAMINE.COM/EN/GLUCOSAMINE-POWDER

SAFETY / SIDE EFFECTS Safety warnings/side effects- as of now there are no safety or severe side effects reported from people who have taken glucosamine, but if you are on warfarin common blood thinner it is recommended you stay away from glucosamine.

MY OPINION In my opinion, I would only recommend taking this supplement if you are suffering from Osteoarthritis or Rheumatoid arthritis, and my reason is that there are no significant side effects or interactions it's a safe supplement to be taking. But I would advise if no change is seen after 3 months to discontinue use and consult your lead physician. V. Sameer

INTERACTIONS Warfarin-recommended to avoid due to increased effects of warfarin-increased risk of bleeding. No known food interactions with glucosamine.

SUMMARY According to the study done in 2012 by Yves Henrotin, Ali Mobasheri, and Marc Marty, they deemed that glucosamine does not significantly affect patients with OA or Osteoarthritis, but due to the fact that it has no significant backlash it can be used for patients with Osteoarthritis and in someone cases can be helpful for them in the management of OA.

REFERENCES Henrotin, Y., Mobasheri, A., & Marty, M. (2012, January 30). Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis?

Arthritis research & therapy. Retrieved April 13, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392795/ Mayo Foundation for Medical Education and Research. (2020, November 12).

Glucosamine. Mayo Clinic. Retrieved April 13, 2023, from https://www.mayoclinic.org/drugs-supplements-glucosamine/art20362874#:~:text=Glucosamine%20is%20a%20natural%20compound,hydrochlor ide%20and%20N%2Dacetyl%20glucosamine.

U.S. Department of Health and Human Services. (n.d.). Glucosamine and chondroitin for osteoarthritis. National Center for Complementary and Integrative Health.

Retrieved April 13, 2023, from https://www.nccih.nih.gov/health/glucosamine-andchondroitin-forosteoarthritis#:~:text=No%20serious%20side%20effects%20have,)%20drug%2 0warfarin%20(Coumadin).

Goldenseal Hydrastis canadensis

Madeline Russow - Student Pharmacist - Spring 2023 Goldenseal is a plant native to North America. It is historically significant among Native Americans, who used it for purposes such as skin disorders, fevers, and other conditions. It is now a dietary supplement used to treat colds and upper respiratory infections, along with digestive upset.

Also Known As...

Goldenseal is an herb with many other names Including eye balm, goldenroot, ground raspberry, orange root, wild curcuma, yellow Indian paint, and yellow puccoon among others.

Uses Goldenseal is currently used as a dietary supplement to treat colds, upper respiratory Infections, UTI's, colitis, ulcers, digestive upset, and allergic rhinitis.

Pharmacology Goldenseal has been found to have therapeutic qualities through interactions of the active constituents with various Cytochrome p450 enzymes.

Goldenseal shows inhibitory effects on p450 enzymes, though the complete mechanism of action Is not yet known.

Dosage Forms Goldenseal is available in a variety of dosage forms including dried root in a capsule or tablet, tea, liquid extract, tincture, mouthwash, and topical ointments.

Dosing -Dried Root Capsule/Tablet: 0.5-1 g orally three times daily -Liquid: 0.3-1 mL orally three times daily -Tincture: 2-4 mL orally 3 times daily (60% ethanol) -Mouthwash/Topical: Rinse 3-4 times daily

Effectiveness Berberine is the most active component of goldenseal. Berberine has shown anti-microbial, antipruritic, anti-inflammatory, neuroprotective, cardiovascular protective, lipidlowering, and insulin resistance improving actions. However, there Is not yet enough clinical data to prove the efficacy of goldenseal in any form of drug.

Safety Not enough studies have been done to prove the safety of goldenseal.Women who are pregnant or breastfeeding should avoid this.

Patients with type 2 diabetes should avoid this. Patients on other medications should speak with a provider before starting. Infants should not be given goldenseal. This Is also contraindicated In hyperbilirubinemia, hypertension, and inflammatory GI conditions

Adverse Side Effects Potential side effects include: irritation of the throat/mouth, nausea, increased nervousness, digestive upset, constipation, hallucinations, excitability, and cardiac damage.

Interactions Main drug interactions include cyclosporine, digoxin, anticoagulants, antiarrhythmics, antipsychotics, metformin, and beta-blockers. Many other drugs include potential interactions as well.

Article Summary Berberine is the most bioactive alkaloid component in goldenseal. Berberine shows various types of therapeutic effects. Research suggests potential therapeutic effects of goldenseal. This article examines randomized, doubleblind clinical studies on the efficacy and pharmaceutical activity of this supplement.

Personal/Professional Opinion This supplement seems like it is promising as a potential form of drug therapy. However, before suggesting this to patients I would want to make sure that more clinical trials are performed and there is adequate data available to back up the efficacy. I would also want to check a patients medications for potential interactions. ~M Russow

References 1. Mandal SK, Maji AK, Mishra SK, et al. Goldenseal (Hydrastis canadensis L.) and its active constituents: A critical review of their efficacy and toxicological issues. Pharmacological Research. 2020;160:105085. doi:https://doi.org/10.1016/j.phrs.2020.105085

2. Goldenseal Uses, Side Effects & Warnings. Drugs.com. https://www.drugs.com/mtm/goldenseal.html 3. Goldenseal. NCCIH. Accessed February 25, 2023. https://www.nccih.nih.gov/health/goldenseal#:~:text=Background 4. Goldenseal: Side Effects, Dosages, Treatment, Interactions, Warnings. RxList. https://www.rxlist.com/consumer_goldenseal/drugs-condition.htm 5. Goldenseal: Common Cold Uses, Warnings, Side Effects, Dosage. MedicineNet. https://www.medicinenet.com/goldenseal/article.htm 6. Goldenseal Information | Mount Sinai - New York. Mount Sinai Health System. Accessed February 25, 2023. https://www.mountsinai.org/healthlibrary/herb/goldenseal#:~:text=Cyclosporine%3A%20Goldenseal%20may%20cause%20levels 7. Goldenseal Drug Interactions. Pharmacy Times. https://www.pharmacytimes.com/view/goldensealdrug-interactions

HORNY GOAT WEED Abby Hamilton | Student Pharmacist Spring 2023

ORIGIN Epimedium Sagittatum, Yin Yang Huo, and Barrenwort are all alternative names for Horny goat weed. This supplement belongs to the Berberidaceae botanical family and is traditionally found in China, Japan, and the Himalayas.

Horny Goat Weed is a traditional Chinese medicinal herb used to, "nourish," the kidney and it is used as an aphrodisiac.

COMMON USES & MECHANISM OF ACTION Horny goat weed is employed to treat impotence, as well as to increase libido or sexual desire.

This plant is also used to treat arthritis, as well as chronic pain in the lower body.

Various related species are also used to treat rheumatism and high blood pressure in women with menopause.

Evidence on the efficacy of this herbal supplement is lacking and therefore cannot be safely recommended to treat any of the above uses.

Icariin is the active ingredient of the Epidemium species. It is a flavonol glycoside and has been demonstrated to exert inhibitory activity against phosphodiesterase type 5. PDE-5 inhibition increases Eucalyp, Amethyststudio. levels of cyclic GMP, which enhances smooth muscle Atom Gradient Icon, Canva.com. Accessed March 30, 2023. relaxation and blood flow to the penis and promotes https://www.canva.com erection.

DOSING

Horny goat weed is most frequently found as capsules or tablets. It can be found in its herbal form and as an extract as well.

There are no clinical studies (on humans) of horny goat weed to provide a basis for dosage recommendations. Tablets and capsules are typically sold in varying strengths of 250 to 500 mg standardized to Icariin content.

Depending on the disease state there are discrepancies on how long until an effect is seen. For erectile dysfunction it is recommended taking a higher dose of around 1000 mg about 90 minutes before sexual activity.

Some types of horny goat weed are possibly unsafe for a long period of time or in high doses. Serious side effects including severe breathing problems have been reported after use.

SAFETY/WARNINGS/TOXICITY Horny goat weed is possibly safe when used short-term

PREGNANCY

BREAST-FEEDING

SURGERY

Horny goat weed is possibly unsafe when taken during pregnancy. It might harm the developing fetus and its use should be avoided.

There is little information on whether or not horny goat weed is safe to use when breast-feeding.

Therefore, it is safer to avoid using it.

Horny goat weed may increase the risk of bleeding during surgery.

Stop taking it at least 2 weeks before surgery.

HORMONE SENSITIVE CANCERS Horny goat weed acts like an estrogen and can worsen some estrogen-sensitive conditions, such as breast and uterine cancer.

BLEEDING DISORDERS Horny goat weed might slow slow blood clotting which will increase the risk of bleeding.

This could make bleeding disorders worse.

DRUG INTERACTIONS There is some evidence to suggest that Horny goat weed could have interactions with drugs used to lower blood pressure, medications that slow blood clotting, and estrogen hormones.

Taking this supplement can also change the speed at which the liver metabolizes other drugs so always speak with a provider about taking supplements.

STUDY SUMMARY

GDJ, Pixabay. Hand-drawn Rat Illustration.

Canva.com. Accessed March 30, 2023. https://www.canva.com

The aim of the study was to evaluate the blood flow and tissue effects of Icariin (ICA) on rats who have an injured cavernous nerve (the main penile nerve regulating erection). After the nerve injury the rats were subsequently treated for 4 weeks with daily feedings of placebo solution vs. the Icariin solution. In conclusion, ICA may have neurotrophic effects in addition to known phosphodiesterase type 5 inhibiting effects.

Horny goat weed could be an option for patients who are looking to self treat or who are trying to avoid prescription medications. I would not discourage a patient from trying out the supplement but I would caution them if they are taking certain/multiple prescription medicines. The limited testing on therapeutic efficacy leaves me skeptical about recommending the product especially because it is not very cost effective. ~ A Hamilton

References: Horny Goat Weed. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed August 24, 2016. http://online.lexi.com Horny Goat Weed - Uses, Side Effects, and More. Web MD. Accessed February 20, 2023. https://www.webmd.com/vitamins/ai/ingredientmono-699/horny-goat-weed Shindel AW, Xin ZC, Lin G, et al. Erectogenic and neurotrophic effects of icariin, a purified extract of horny goat weed (Epimedium spp.) in vitro and in vivo. J Sex Med. 2010;7(4 Pt 1):1518-1528. doi:10.1111/j.1743-6109.2009.01699.x Gonzalez Stuart A. Horny Goat Weed. University of Texas El Paso. Accessed February 20, 2023. https://www.utep.edu/herbal-safety/herbalfacts/herbal%20facts%20sheet/horny-goatweed%20.html

l

Horse Chestnut Chloe Sullivan, BSPS Student Spring 2023

What is horse chestnut?

Definition & history: A tree native to the Balkan Peninsula that was brought to the United Kingdom during the 16th century and has been used medicinally for its anti inflammatory properties for centuries. The reason it’s called horse chestnut is most likely because it used to be fed to horses with respiratory problems.

Other names: aesculus hippocastanum, buckeye, conker tree, European chestnut

Dosing: capsules

Take 300-600mg daily for 8-12 weeks Adverse effects

• Dizziness • Upset GI • Headache • Itching

Uses

Today, horse chestnut is primarily used to treat CVI (chronic vein insufficiency) by improving circulation and reducing the related symptoms including: • Varicose veins • Pain • Tiredness • Swelling of legs • Itching • Water retention Other uses: treatment of IBS, treatment of male infertility, general anti-inflammatory treatment

Dudek-Makuch M, Studzińska-Sroka E. Horse chestnut – efficacy and safety in chronic venous insufficiency: An overview. Revista Brasileira de Farmacognosia.

2015;25(5):533-541. doi:10.1016/j.bjp.2015.05.009 Horse chestnut. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/horse-chestnut.

Horse chestnut. Uses, Interactions, Mechanism of Action | DrugBank Online. https://go.drugbank.com/drugs/DB13195.

Woodland Trust. Horse Chestnut (aesculus hippocastanum). Woodland Trust. https://www.woodlandtrust.org.uk/trees-woods-and-wildlife/british-trees/a-zof-british-trees/horse-chestnut/.

Mechanism of action

The active component to horse chestnut is called aescin, which has several different effects in the body: • • •

Anti-inflammatory activity: inhibition of phospholipase A2, an enzyme that has a role inflammatory mediator synthesis Anti-oedematous activity: inhibition of adhesion and aggregation of neutrophils, which increase vascular permeability and increase tissue fluid retention Vascular tension: increased production of prostaglandin F2, which stimulates vasoconstriction and inhibits vascular tissue catabolism, improving blood flow

Note: There is little research currently available regarding the precise mechanisms of aescin in horse chestnut. This list summarizes just one article.

Safety & toxicity

Horse chestnut contains esculin, which is poisonous if eaten raw and must be removed before consumption. Horse chestnut should not be taken with anticoagulant/antiplatelet drugs.

Efficacy

Based on the current available research, horse chestnut has been proven to produce beneficial therapeutic effects in the treatment of CVI. Its effects are comparable to those of hydroethylrutoside, pycnogenol, or compression therapy.

Professional opinion

Professional opinion: Overall, there is simply a lack of research available for horse chestnut, as well as many other supplements or nonpharmaceutical forms of treatment. I believe that horse chestnut possesses properties than can be beneficial to someone suffering from poor circulation, but more research should be done in order to fully understand the extent of its mechanisms and effectiveness. ~C. Sullivan

MELATONIN Anya Wappler, Student Pharmacist, Spring 2023 Melatonin is a hormone produced by the pineal gland. Melatonin production is stimulated by darkness, and begins around 9 PM. Secretion peaks between 2 and 4 AM. Melatonin secretion levels decrease with age. Melatonin is a dietary supplement derived as a synthetic product from animals, and it has not been FDA-approved. It was first discovered in 1958.

By the 1990s, studies led to increased use of melatonin for insomnia, jet lag, preventing pregnancy in large doses, boosting the immune system, preventing cancer, extending life, and protecting cells from free-radical damage4.

Common Uses: •

Jet Lag

•

Delayed sleep-wake phase disorder

•

Sleep disorders in children

•

Anxiety before and after surgery6

Pharmacology

Dosing

Melatonin is produced from tryptophan in the pineal gland. The tryptophan is converted to 5hydroxytryptophan, then to serotonin, then to Nacetylserotonin, then to melatonin (N-Acetyl-5methoxytryptamine). Once synthesized, melatonin is collected by the venous capillary system and secreted into cerebrospinal fluid and venous systemic circulation. In the brain, melatonin increases the binding of GABA to its receptors. Melatonin regulates the body’s circadian rhythm, endocrine secretions, and sleep patterns. It can also aid with growth hormone secretion, sexual maturation, pain control, balance, and sexual activity5.

•

For Analgesia: 3-10mg per day by mouth for various durations

•

For Insomnia: 3-5mg per day by mouth in the evening over 4 weeks; 1-2 mg before bedtime for elderly patients

•

For Jet Lag: 0.5-2mg by mouth preflight; 5mg by mouth postflight over a period of up to 4 days4 购买Melatonin (NSC 113928). Selleck.cn. Published 2016.

Drug Interactions

Interactions with alcohol, broccoli, cannabis, and tobacco4

•

Anticoagulants—may increase risk of bleeding

•

Anticonvulsants—may increase frequency of seizures

•

Antidiabetic drugs—may increase risk of hypoglycemia

•

Antihypertensive drugs—may increase risk of hypo/hypertension

•

Caffeine—may increase melatonin levels

•

CNS depressants—may increase sedative effects of CNS depressants

•

Contraceptive drugs—may increase effects and adverse effects of melatonin

AdornThemes. Neuriva Sleep Think Bigger. Schiff Vitamins. Melatonin Bottle.

Dosage Forms

5

•

Tablet

•

Chewable tablet

•

Sublingual tablet4

Effectiveness

Melatonin

•

Delayed Sleep Phase Syndrome—Melatonin has been shown to shorten the time needed to fall asleep in children and adults with DSPS

•

5

Improves non-24-hour sleep wake disorder in blind children and adults

Safety •

Can safely use up to 8mg every day for up to 6 months

•

Can safely use up to 10mg every day for up to 2 months

•

Do not use frequently or in high doses if pregnant5

•

Do not use in patients with autoimmune diseases4

Warnings

Time. Melatonin Brain Activity.

Published October 2019.

•

Usually melatonin supplements are made in a lab, but in some cases it may be derived from animal pineal gland. This should be avoided due to risk of contamination.

•

Some supplements have been found to be contaminated with serotonin

•

Many supplement labels do not show the correct dose that is actually contained in the supplement

•

Do not drive or operate machinery for 4-5 hours after taking melatonin5

Side Effects •

Dizziness

•

Drowsiness

•

Headache

•

Nausea

•

Increased risk for seizure (rare)5

I believe that Melatonin is beneficial for its indicated uses when used correctly. However, I think that people who are just taking Melatonin in whatever doses they deem best fit for them is unsafe. Practicing good sleep takes time, but in the long run it is better to try to naturally fix your sleep cycle rather than just pop a pill every night before bed ~A Wappler~

Since the pandemic, studies have shown that more adults are taking higher doses of melatonin to help them fall asleep. Melatonin can have negative side effects when used in too high of a dose too frequently. Some of these side effects include headache, nausea, confusion, mild anxiety, depression, tremors, and low blood pressure. It is also dangerous, because many melatonin pills have been found to contain much larger amounts of melatonin than what is advertised. This is due to the fact that the FDA doesn’t fully regulate melatonin, so the pills do not have to be tested. Unfortunately, many adults do not fully realize that melatonin is not just a supplement, but that it is actually a hormone that regulates the body’s sleep cycles. Studies have found that there actually isn’t much benefit from melatonin and that other methods of training your brain to sleep are more effective2.

References 1. AdornThemes. Neuriva Sleep Think Bigger. Schiff Vitamins. Accessed February 24, 2023. https://www.schiffvitamins.com/pages/ neuriva-sleep-think-bigger?&utm_source=bing&utm_medium=cpc&utm_campaign=_CN%7CSLEEP-SUPPLEMENTS_CC% 7CPROD_KC%7CGEN_MT%7CPHR&utm_term=supplements%20to%20help% 20sleep&utm_content=Supplements&gclid=3e67acee4b2e1b02b222cf19e6b42080&gclsrc=3p.ds 2. CNN SL. Using melatonin for sleep is on the rise, study says, despite potential health harms. CNN. https://www.cnn.com/2022/02/01/ health/melatonin-overuse-wellness/index.html 3. Markham Heid. Is Melatonin Safe to Take Every Night? Time. Published October 2019. https://time.com/5672106/melatonin-safety/ 4. Melatonin. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 24, 2023. http://online.lexi.com 5. Melatonin. Natural Medicines. Therapeutic Research Center. Stockton, CA. Accessed February 24, 2023. http://online.lexi.com 6. National Center for Complementary and Integrative Health. Melatonin: What You Need To Know. NCCIH. Published January 2021. https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know 7. 购买Melatonin (NSC 113928) | MT Receptor agonist | 价格 | IC50 | 只能用于研究. Selleck.cn. Published 2016. Accessed February 24, 2023. https://www.selleck.cn/products/Melatonin.html

Spring 2023 | Student Pharmacist; Bethany Hayden

OMEGA-3 FATTY ACIDS COMMON TYPES Alpha-linolenic acid (ALA) Eicosapentaenoic acid (EPA) Docosahexaenoic acid (DHA) REASON FOR USE Omega-3 has many positive effects on the human body. They are a vital part of the cell membranes in the body. They are known to provide a start point for the hormones that regulate blood clotting, heart contraction and relaxation, and inflammation. Omega 3-fatty acids are essential fats meaning the human cannot produce them on its own and it must come from an outside source.

BACKGROUND Research for this supplement began in Greenland where they discovered it in both diets and blood in 1978. EPA was the first omega-3 fatty acid to be studied and tested for various chronic conditions. In 1985, three major studies were published in the New England- Journal of Medicine. A few years later, in 1989, long term study results were becoming known. The Lancet, medical journal, released a two-year study that eating fish decreased all-cause mortality in people who have been victims of heart attacks. Omega-3 fatty acids biggest leap was when REDUCE-IT, a evidence providing organization that tests reduction of cardiovascular risk, published its own study. They pointed out that to see results, you have to take a high enough serving size/dose to get the healthy heart benefits.

HOW IT WORKS Omega-3 fatty acids (OM3FA) main purpose is to lower triglycerides in the body by suppressing lipogenic gene expression, increasing beta-oxidation of fatty acids, and increasing expression of LPL. AVAILABLE FORMS W/SERVING SIZE Gummy Chews - 1200 mg daily (2 gummies) Soft Gels - 600 mg daily (1-2 softgels) Tablet - 550 mg daily (2 tablets) Liquid - 1200 mg daily (1 tsp

EFFECTIVENESS Different types of omega-3 fatty acid supplements take different lengths of time before seeing effects because of the various dosing and forms. As a broad range, it is expected 6 weeks to 6 months before seeing effectiveness from the omega-3 fatty acid supplements.

WARNINGS Bleeding: can increase anticoagulants or antip;latelet effects; watch for signs and symptoms of continuous bleeding FIsh Allergy: be cautious taking medication with fish oil if you have a known fish or shellfish allergy Lipid: can increase LDL levels; monitor LDL levels throughout therapy SIDE EFFECTS In the United States, 1% to 10% have reported cardiovascular effects such as atrial fibrillation or flutter and gastrointestinal effects such as dysgeusia (loss of taste), dyspepsia (upset stomach), or eructation (burping). Also, it is very rare but there have been reports of a skin rash, constipation, vomiting, or an increase in LDL cholesterol levels.

INTERACTIONS Omega-3 fatty acids may increase the effect of anticoagulant or antiplatelet medications.

ARTICLE/STUDY On December 27, 2018, Gammone, Riccinoi, Parrinello, and D’Orazio published the study “Omega-3 Polyunsaturated Fatty Acids: Benefits and Endpoints in Sport”. The study focuses on the influence of this supplement on the physical function and body metabolism in the body, specifically focusing on athletes and physical activity. Omega-3 fatty acids showed an increased number of neutrophils and monocytes, providing an anti-inflammatory response. An increase in blood flow with this supplement also increases oxygen supply to the working skeletal muscle. Even though Omega-3 dietary supplements have shown positive effects to chronic conditions relating to the heart, this study provides data of the benefits to athletic performance by reducing oxidative stress, enhancing muscular performance and immune function.

OPINION Omega-3 is a supplement used for all sorts of conditions and health issues. It has shown positive outcomes in better blood flow, decrease in inflammation, and higher amounts of oxygen in the bloodstream. Many studies did speak on the minimum therapeutic daily dose and how a higher dose must be given to see effects. From my research, with minimum side effects and high possibility for healthy body benefits, I would recommend this supplement. B Hayden REFERENCES Office of dietary supplements - omega-3 fatty acids. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/. Accessed February 26, 2023.

OmegaQuant. The long, winding road of omega-3 research: A brief history according to dr. Bill Harris. OmegaQuant. https://omegaquant.com/the-long-winding-road-of-omega-3-research-a-brief-history/. Published December 13, 2022. Accessed February 26, 2023.

Omega-3 fatty acids. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 24, 2023. http://online.lexi.com Gammone MA, Riccioni G, Parrinello G, D'Orazio N. Omega-3 polyunsaturated fatty acids: Benefits and endpoints in Sport. Nutrients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357022/. Published December 27, 2018.

Accessed February 26, 2023.

Saw Palmetto Emery Frey, Student Pharmacist Spring 2023

Scientific Name: Serenoa repens Common Names: ● Dwarf palmetto ● Fan palm Background/History Saw Palmetto is native to the Southeastern United States where the berries of the plant began to be used medicinally. Native tribes of Florida relied on the berries for food. Saw Palmetto was introduced to Western medicine in the 1870s, and men began using the berries to treat urinary tract problems in the early 1900s. Saw palmetto berries were officially added to the US Pharmacopeia in 1906 and 1916.

Common Uses ● Treatment of symptoms of benign prostatic hyperplasia (BPH) ● Transurethral resection of the prostate (TURP) Mechanism of Action ● Saw Palmetto has antiandrogenic effects which may be responsible for the relief of BPH symptoms. It inhibits type I and type II 5α-reductase, which prevents the conversion of testosterone to dihydrotestosterone, which is a more potent androgen than testosterone. ● Saw palmetto also has anti-inflammatory and antiproliferative effects.

Dosage Forms ● Capsules ● Liquid extract ● Tea ● Dried berries Typical Dosing ● 320-960mg/day for BPH

Effectiveness Evidence of the effectiveness of saw palmetto is limited. Two studies done by the National Institutes of Health (NIH) found that it was no more effective than a placebo in treating BPH symptoms. However, this also depends on the specific saw palmetto product used, since different compositions may have different outcomes. On the other hand, one study showed that the effects of finasteride and saw palmetto on BPH symptoms were comparable.

Safety/Warnings/Toxicity ● Saw palmetto should not be used in pregnancy or while breastfeeding. ● Children younger than 12 years should not use saw palmetto.

Adverse Effects/Side Effects ● Abdominal pain ● Constipation ● Decreased libido ● Headache Interactions ● Finasteride/Dutasteride: Since Saw Palmetto seems to work similarly to these medications, it may enhance their adverse/toxic effects. ● Anticoagulants (i.e., Warfarin): Saw Palmetto may enhance the effects of anticoagulants and the blood’s ability to clot. ● Estrogens/Contraceptive Drugs: Saw palmetto may decrease the effectiveness of estrogens and contraceptive drugs.

Summary of Article In this study, the effectiveness of n-hexane lipido-sterol extract of Serenoa repens (LSESr) used in the treatment of benign prostatic hyperplasia was analyzed. The levels of testosterone (T), dihydrotestosterone (DHT), and epidermal growth factor (EGF) were measured from patients’ BPH tissue samples after being treated with 320 mg LSESr/day for 3 months. The results showed a decrease of DHT and EGF and an increase in T in BPH tissue of patients. This confirmed that LSESr has the ability to inhibit 5α-reductase in human pathological prostate. The results were similar to those of finasteride, an FDA-approved 5α-reductase inhibitor.

Personal/Professional Opinion From a woman's perspective, I would not buy this supplement since it doesn’t have many indications for women. If I was a consumer of this product, it would most likely be for a family member. In this case, I would refer to their primary care provider in order to make a decision. From a professional opinion, I wouldn’t encourage nor discourage a patient to buy this supplement. If they really wanted to try it, I would simply advise them to start on the lowest dose and monitor therapy. In general, I believe there is a growing responsibility to be knowledgeable about supplements. ~E Frey References

1.

2.

Amazon.com: Nature's bounty saw palmetto 450 mg capsules 250 ea (pack ... https://www.amazon.com/Natures-Bounty-Palmetto-Capsules-Pack/dp/B06XY2SYFJ. Accessed February 26, 2023.

Di Silverio F, Monti S, Sciarra A, et al. Effects of long-term treatment with Serenoa repens (Permixon) on the concentrations and regional distribution of androgens and epidermal growth factor in benign prostatic hyperplasia. Prostate. 1998;37(2):77-83. doi:10.1002/(sici)1097-0045(19981001)37:2<77::aid-pros3>3.0.co;2-i

3.

Saw Palmetto (Natural Products Database). Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 25, 2023. http://online.lexi.com

4.

Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients.

Prostate. 1996;29(4):231-242. doi:10.1002/(SICI)1097-0045(199610)29:4<231::AID-PROS4>3.0.CO;2-E

5.

Saw palmetto. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/saw-palmetto#:~:text=Currently%2C%20saw%20palmetto%20is%20promoted,hair%20loss%2C%20and%20other%20conditions. Published May 2020. Accessed February 25, 2023.

Saw Palmetto. Natural Medicines. Therapeutic Research Center. Accessed February 25, 2023. https://naturalmedicines-therapeuticresearch-com.ezproxy.lib.purdue.edu/databases/food,-herbs-supplements/professional.aspx?productid=971#effectiveness Snell C, Emilio DT, Gardiner L. Saw palmetto. Kew. https://www.kew.org/plants/saw-palmetto. Published July 5, 2021. Accessed February 25, 2023.

6.

7.

St. John's Wort

Joyce Yu | Student Pharmacist | Spring 2023 Common Names St. John’s Wort has a scientific name of hypericum perforatum. However, it is also commonly referred to as Klamath weed or goatweed.

Background St. John’s Wort is a plant with yellow flowers that has been used in traditional European medicine as far back as the ancient Greeks. The name St. John's wort apparently refers to John the Baptist, as the plant blooms around the time of the feast of St. John the Baptist in late June.

Mechanism of Action Brien, Rosana. “Hypericum Calycinum Flower.” Hypericum St. John's Wort - How to Grow Hypericum Calycinum, My Garden Plot, https://www.mygardenplot.com/hypericum-st-johnswort-care/. Accessed 13 Apr. 2023.

Common Uses St. John’s Wort is promoted for depression, menopausal symptoms, attention-deficit hyperactivity disorder (ADHD), somatic symptom disorder (a condition in which a person feels extreme, exaggerated anxiety about physical symptoms), obsessive-compulsive disorder, and other conditions.

The extract from the St. John’s Wort plant acts as a serotonin reuptake inhibitor. Serotonin uptake is reduced at neuronal synapses, along with dopamine and norepinephrine. A common belief is that elevated levels of neurotransmitters are helpful when treating depression.

Typical Dosage 300-400mg, up to three times a day to be taken with meals.

Available Dosage Forms The plant is compressed as a dry herb into capsules/tablets. The tablets are also characterized into the regular coating and extended-release versions.

Side Effects Insomnia, anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction may present after taking St. John’s Wort.

Effectiveness Several studies support the therapeutic benefit of St. John's wort in treating mild to moderate depression. In fact, some research has shown the supplement to be as effective as several prescription antidepressants. However, there’s not enough information to prove its effectiveness in the treatment of severe depression.

Safety Warnings Patients may experience an increased sensitivity to sunlight, especially when taken in large doses.

Summary of One Article/Study The National Center for Complementary and Integrative Health has released its findings regarding St. John’s Wort and its effects on treating depression. They have gathered lots of information regarding the short-term effects of St. John’s Wort on depression. It’s not consistently effective and experts advise to not use it to replace conventional care. However, not enough information is known about the long-term effects. What we do know about the safety of St. John’s wort is that it limits the effectiveness of many prescription medicines and combining it with antidepressants can lead to a lifethreatening amount of serotonin produced.

Interactions with other Medications Buproprion (Wellbutrin SR), Alprazolam (Xanax), dextromethorphan, fexofenadine (allegra), Omeprazole (Prilosec), Warfarin (Jantoven), narcotics, ketamine, statins, antidepressants

Opinion I would only advise taking this medication if the patient is able to adhere to all requirements due to how reactive the medication is. In addition, only patients with mild condition depression should be taking this medication as directed due to the severity of potential side effects and the lack of information presented for severe clinical depression. ~J. Yu

References Hypericum perforatum. Hypericum perforatum (Common St. John's-wort, Goatweed, Klamath Weed, St. Johns Wort) | North Carolina Extension Gardener Plant Toolbox. https://plants.ces.ncsu.edu/plants/hypericum-perforatum/. Accessed February 25, 2023.

MEDSAFE. Interactions with St. John's Wort (Hypericum perforatum) Preparations. https://www.medsafe.govt.nz/profs/puarticles/sjw.htm. Accessed February 25, 2023.

St. John's Wort and Depression: In depth. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/st-johns-wort-and-depressionin-depth. Accessed February 25, 2023.

Issue Emma Ronk – Student Pharmacist Spring 2023

Scientific and Common Names: Curcuma longa L. Curcuma/Curcumin Indian Saffron

Turmeric Benefits. (n.d.). Johns Hopkins Medicine. Retrieved 2023, from https://www.hopkinsmedicine.org/health/.

Turmeric History of Use Around the World Curcumin and turmeric have been essential in many of the natural remedies for various conditions among different cultures and areas in the world. In the ancient Indian, or Ayurvedic, medical system, it has been used as treatment for numerous respiratory conditions (eg. asthma, bronchial hyperactivity, allergies, etc.), liver disorders, diabetic wounds anorexia, rheumatism, cough, and even sinusitis. It was highly valued, especially for its supposed wound healing properties. Similarly, in ancient Hindu medicine practices, it was used to treat sprains and swelling due to its antiinflammatory aid. Also in traditional Chinese medicine, it has often been used as an agent to treat certain conditions linked to causing abdominal pain. In other words, this supplement has made its mark on many of the century-old medical practices, and it seems to continue to prove itself a powerful natural product.

More Than a Spice?

Turmeric, and the natural curcuminoids it so richly contains, has been utilized by many different cultures all around the world for its medicinal benefits for hundreds of years. It has traditionally been used within the culinary realm due to its bright yellow-orange pigment and warm and bitter taste, but has also been found within the treatments of a variety of medical conditions. .

Uses

Dosing and Forms

This bright colored herb has made quite an impression on the world of dietary supplements and homeopathy. While many of the ongoing clinical trials have targeted the active ingredient curcumin rather that turmeric itself, it has reputedly exhibited pain relieving, antiinflammatory, and antioxidant effects for the treatment of various conditions including osteoarthritis, major depression, cardiovascular issues, metabolic syndrome, obesity, and even cancer.

Turmeric is available commercially in the form of capsules, gummies, powders, teas, and even extracts. For antiinflammation purposes, curcuminoid doses ranging from 200mg/day to 6000mg/day have been used within clinical trials to assess its capabilities.

However, it has also been tested as a 1g/day dose as a monotherapy option or 500mg/day when paired with other analgesics to treat arthritis pain.

Effective?

While there is no true evidence regarding the level of effectiveness of this supplement, most of the clinical trials set out to prove its value spanned from about 4 weeks to 4 months in which results may have been seen.

Mechanism of Action

Many clinical trials set out to determine the efficacy of this supplement have focused on its active ingredient, curcumin, rather than turmeric itself. However, it has a very limited medical profile in terms of ability within the body due to its hydrophobic nature and having a low bioavailability after being taken orally. Since this herb is used in hopes to target different therapies, it has different actions in the body to reflect that. For example, to have its antiinflammatory effect, curcumin has been shown to interfere with the eicosanoid pathway and further the signaling molecules that play a role in the immune response and local inflammation. It has also proven to inhibit the expression of growth and metastases promoting genes as well as regulate enzymes that control tumor growth in trials for cancer treatment.

Safety & Warnings

Adverse & Side Effects

Interactions

While there is not much toxicology data and there have not been many safety reasons for concern, there are a few warnings regarding certain groups and health conditions that have been advised to avoid taking turmeric supplements. One of which being women who are pregnant and lactating due to stimulation of menstrual flow and of the uterus.

Also, patients with gallstones, bile duct obstruction, or passage obstruction should be cautious with turmeric and curcumin.

This herbal supplement has very few adverse and side effects. Even when taken at relatively high doses, such as in a cancer trial, very few systemic repercussions were found. However, it has been found that dyspepsia, or recurring stomach upset symptoms, and itchy skin on some areas of the body has been correlated to taking turmeric. In rare cases, contact dermatitis and anaphylaxis have occurred, but compared to other drugs and oral supplements, turmeric has a favorable side effect profile.

Due to the way this herb is metabolized and broken down in the body, it does interact with a few different kinds of medications. If taken together, it may increase and enhance the adverse and toxic effects of those agents. Turmeric potentially interacts with antiplatelet agents, anticoagulants, non-steroidal antiinflammatory drugs, salicylates, thrombolytic agents, and a few others.

Turmeric and Curcumin as Topical Agents in Cancer Therapy

Living Color. (2020). Turmeric plant. Grow Your Own Superfood: Turmeric . Retrieved 2023, from https://livingcolorgardencenter.net/gardening/gr ow-your-own-superfood-turmeric/.

References Turmeric. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 20, 2023. https://online.lexi.com Kuttan, R., Sudheeran, P. C., & Josph, C. D. (1987). Turmeric and curcumin as topical agents in cancer therapy. Tumori Journal, 73(1), 29-31.

Hay, E., Lucariello, A., Contieri, M., Esposito, T., De Luca, A., Guerra, G., & Perna, A. (2019). Therapeutic effects of turmeric in several diseases: An overview. Chemico-biological interactions, 310, 108729.

A study conducted at the Amala Cancer Research Centre in Thrissur, India set out to prove the medicinal use of one of their most popular cooking spices, turmeric, as a topical ointment in treating cancerous lesions. They evaluated sixty-two patients, all with locally recurring ulcerating tumors that smelled, itched, and were painful either in the oral cavity, breast, skin, vulva, or random site. Every patient had tried and failed to respond to treatments such as radiotherapy, surgery, or chemotherapy. After applying the ointment with its respective dose of curcumin three times a day and receiving weekly evaluations, most of the patients experienced positive responses in their lesions such as the reduction of smell, itching, exudate, lesion size, and overall pain. While this study was published in 1985 and many more tests have been done to further examine this herb’s role as a medicinal agent, it was the beginning of a movement for curcumin in cancer therapy.

Would I Consider Turmeric for Myself?

I have been fortunate enough at this point in my life to not have any underlying health conditions that may require the intervention of a supplement such as turmeric. However, if at some point I needed medicical care and being in the position I am as a future pharmacist, I am honestly not sure if turmeric and curcumin would be the first product I would turn to. ~ E Ronk

Alyssa Gouty Public Health major Spring 2023 Scientific name/Common name(s) Scientific name: Valeriana Officinalis Common name(s): Valerian, Valerian Root, Garden Heliotrope, All-heal History: Origin: Asia, Europe Historically valerian was promoted as a therapeutic herb dating back as far as the time of ancient Greece and Rome. Valerian was used to treat nervousness, trembling, headaches, and heart palpitations in the 16th century. Following this time, in the 19th century, Valerian was rediscovered as a stimulant, defying what it had previously been used to treat. It was later promoted for the treatment of stress, anxiety, hyperactivity, sleep difficulties, and other distress disorders.

Common Uses: Sedative • Insomnia • Nervous tension How it works in the body: It is still not well understood how valerian works in the body. Researchers have identified the following active compounds that may be responsible for its impact on the human brain and body.

• Iridoids – valepotriates • Essential oils – valerenic acid, valeric acid • Lignans • Flavonoids • GABA (at low levels) Available (dosage) forms: • Tea • Tincture • Fluid extract • Capsulated, dry powered extract Kubala J. Valerian: How does it help you relax and get better sleep? Healthline. https://www.healthline.com/nutrition/valerian-root. Published December 21, 2021. Accessed April 13, 2023.

Typical dosing/serving: Valerian is recommended 1 to 2 hours before bedtime, or up to 3 times throughout the day with the last dose near bedtime.

• Tea: Pour 1 cup of boiling water over 1 teaspoon (2 to 3 g) of dried root, steep 5 to 10 minutes.

• Tincture (1:5): 1 to 1 ½ to 1 tsp (1 to 2 mL) • Fluid extract (1:1): ½ to 1 tsp (1 to 2 mL) • Dry powdered extract (4:1): 250 to 600 mg

Effectiveness: Clinical data for treating sleep disorders is inconclusive, but valerian may offer some therapeutic benefits for sleep disorders and associated common symptoms.

Safety/Warnings/Toxicities: Avoid taking valerian if the following apply to you as it may be unsafe or toxic.

• Pregnant or breast feeding • Driving • Children under 3 • Operating dangerous machinery • Liver disease Adverse/side effects: Few adverse effects are attributed to valerian. Reports from clinical studies listed several common side effects.

• Headache • Insomnia • Upset stomach • Drowsiness • Feelings of uneasiness • Dry mouth • Heart rate changes • Vivid dreams Interactions (food/drug): Effects felt by valerian may be enhanced or cause adverse reactions if taken with other sedative medications, herbs, or dietary supplements with sedative properties and other depressants.

• Benzodiazepines • Dietary supplements o Xanax®, Valium®, Ativan®, o St. John’s wort, kava, and and Halcion® melatonin • Barbiturates or central nervous • Alcohol system (CNS) depressants • Narcotics o Phenobarbital, morphine, and propofol Summary of ONE article/study: Valerian Root in Treating Sleep Problems and Associated Disorders – A Systematic Review and Meta-Analysis The prevalence of sleep problems commonly coupled with many other symptoms, including anxiety, encouraged the analysis of valerian to understand its effects. This study had a goal to provide updated data as well as address inconsistencies commonly found in other studies analyzing the effects of valerian on sleep disorders and their associated comorbidities. The results suggested that various outcomes were potentially due to “variable quality of herbal extracts.” Further evidence suggested that valerian did offer therapeutic benefits and could be a safe herb to promote sleep and associated symptoms. The overall effects are limited due to the inconsistent active constituents and further quality control processes need revision.

Personal/Professional opinion: After reviewing various research and published articles on the oral supplement Valerian, it appears to be a relatively safe supplement for people to consume. Using valerian for a short amount of time, up to 28 days, has been found in studies to create no difficulties in most adults.

Studies on long-term use have not been performed. Generally, valerian appears to be safe if utilized in moderation. ~ A Gouty

References (AMA): 1 Kubala J. Valerian: How does it help you relax and get better sleep? Healthline. https://www.healthline.com/nutrition/valerian-root. Published December 21, 2021.

Accessed April 13, 2023..

2. Office of dietary supplements - valerian. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Valerian-HealthProfessional/#en39. Accessed February 25, 2023.

3. Shinjyo N, Waddell G, Green J. Valerian root in treating sleep problems and associated disorders—a systematic review and meta-analysis. Journal of Evidence-Based Integrative Medicine. 2020;25. doi:10.1177/2515690x20967323 4. Summer J. Valerian root: Sleep benefits and side effects. Sleep Foundation. https://www.sleepfoundation.org/sleep-aids/valerian-root. Published February 7, 2023.

Accessed February 25, 2023.

5. Valerian. Complementary and Alternative Medicine. https://ssl.adam.com/content.aspx?productid=107&pid=33&gid=000279&site=riverviewss l.adam.com&login=RIDG9829. Accessed February 25, 2023.

6. Valerian. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/valerian. Accessed February 25, 2023.