Alcoholism/Drug Abuse, Alzheimer's Dementia, Anxiety (Panic)/Depression, Asthma/Allergy, Black/Blue Cohosh, Bleeding Disorders, Chamomile, Cochrane Library, Common Cold, DHEA, Diet-Nutrition, Echinacea, Evening Primrose, Fatigue, Garlic, Ginger, Ginkgo, Ginseng, Gout, Heart Disease, Herbals, Huntington's, Menopause, Prostate, Rheumatoid Diseases, Saw Palmetto, Sleep (Insomnia), Sleep Apnea, St. John's Wort, Stress, Sunscreen, Valerian

Key points about commonly used herbals

Dr. Darrell Hulisz from Case Western Reserve University School of Medicine in Cleveland, Ohio has written a continuing education article on herbals.

Here are the author’s take-away points, with additional references added.

Echinacea purpurea and the common cold

  • Modestly effective for prevention in those at risk (people in contact with sick people).
  • Unclear if it can reduce the duration of cold symptoms.
  • The Cochrane review draws different conclusions.
  • Patients allergic to ragweed, or with progressive autoimmune disorders (eg, rheumatoid arthritis), and taking drugs that can be toxic to the liver should avoid echinacea.

Garlic and cardiovascular disease

  • Use cautiously if taking blood pressure medicine, and monitor blood for orthostatic hypotension (eg, large decrease in blood pressure and possibly fainting when standing).
  • Avoid in the following situations
    • People with a history of orthostatic hypotension or unexplained dizziness.
    • Taking drugs that can increase bleeding, such as aspirin, warfarin and ibuprofen.
  • Dosing is not well defined, but to lower cholesterol, 600 to 1200 mg of garlic powder daily in divided doses, or up to 4 g of raw garlic daily may be taken.
  • A more negative perspective on garlic is here.

Ginkgo biloba and Alzheimer’s disease

  • Reasonable to take by patients with Alzheimer’s disease who are also receiving medical care.
  • Its antiplatelet activity may make it inappropriate for people with a bleeding disorder or taking antiplatelet or anticoagulation drugs.
  • More info here.

St. John’s wort and depression

  • OK for mildly depressed patient with an aversion to prescription drugs.
  • Depressed people should take it under medical supervision.
  • Check for drug interactions.
    • Recently published reviews of drug interactions with St. John’s wort are discussed here
  • The most studied dose for depression is 300 mg taken 3 times a day.
  • More info here.

Valerian, chamomile, ginger and calming effects

  • Safe for most people.
  • Modest effectiveness.
  • People with chronic anxiety and insomnia should be under the care of a healthcare professional.
  • Here’s a summary of drugs and herbals to treat insomnia.

Ginseng and energy

  • Lack of good study data.
  • Don’t exceed the labeled dosage since adverse effects may occur.
  • Caution in people who are on blood thinners, and those with cardiovascular or metabolic disease, such as high blood pressure and diabetes.
  • I’ll add there is concern about its effect on the hormone system coupled with a lack of data about its safety in long-term use.

Saw palmetto and the prostate

  • Men with obstructive urinary symptoms or benign prostatic hypertrophy (BPH) should not self-medicate with saw palmetto.
    • BPH symptoms can mimic more serious disorders — prostate cancer and prostatitis.

Black cohosh and hot flashes

  • Results of studies are conflicting.
  • It appears to be safe, but use should be limited to not more than 6 months and should not be used in those with a history of estrogen-dependent tumors.
  • I’ll add there are different points of view on its liver effects here and here.

1/5/08 18:53 JR