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PubMed2005

Prevalence of nonvitamin, nonmineral supplement usage among students in a Turkish university.

BACKGROUND: There have been multiple studies carried out in many countries with regard to the use of nonvitamin, nonmineral (NVNM) supplements. These studies have shown that the use of NVNM supplements is on the increase throughout the world, particularly in western countries. The aim of this study was to assess the extent of NVNM supplement use among Turkish university students. METHODS: The survey was conducted between September and December 2004 at Osmangazi University, a public university located in the west of Turkey. Responses were analysed, using the chi-square (x2) test, t test and percent (%) ratios, according to gender and consumers. Differences were considered significant for p <or= 0.05. RESULTS: Of 2253 students attending the university, 1871 participated in the survey (909 men and 962 women). Overall, the prevalence of NVNM supplement use was 16.5% (16.6% in men and 16.3% in women, p < 0.05). The three most commonly given reasons for use were 'improvement of energy and vitality (78.6%)', 'promotion of weight loss (71.1%)', followed by 'enhancement of athletic performance (64.3%)'. Twenty-six of the 308 reported NVNM users (26/308, 8.4%) reported having experienced an adverse reaction. Television (76.3%), magazines/newspapers (41.5%) and internet websites (37.3%) were the most frequently used sources for obtaining information about NVNM supplements. The three most frequently used NVNM supplements were echinacea, ginseng, and gingko biloba (38.6%, 36.4%, and 32.8%, respectively). Nutritional scores were higher in NVNM supplement users than in non-users (66.510.8 vs. 62.712.7) (p < 0.001). Users and nonusers of NVNM supplements differed significantly according to sex, age, Body Mass Index (BMI) values, types of school, mother and fathers' education levels, family income, most permanent place of residence up to the time of survey, smoking status, and participating in sports. CONCLUSION: The results indicate that the prevalence of NVNM supplement use is relatively modest among Turkish university students and more information is needed on why people use particular NVNM supplements.

Adolescent↗
PubMed2004

Complementary and alternative medicine use by patients enrolled onto phase I clinical trials.

PURPOSE: To describe the prevalence, clinical characteristics, and pattern of use of complementary and alternative medicine (CAM) in patients enrolled onto phase I trials. PATIENTS AND METHODS: Questionnaires were administered to 108 patients with advanced malignancies enrolled onto phase I chemotherapy trials at the Mayo Clinic Comprehensive Cancer Center (Rochester, MN). CAM was classified into two modalities, pharmacologic and nonpharmacologic. Clinical and demographic data, including age, sex, and prior cancer treatment, were subsequently obtained from patient charts and examined for any correlation with CAM use, using chi2 analysis. RESULTS: One hundred two survey forms were returned. Among respondents, 88.2% (90 of 102) had used at least one CAM modality; 93.3% (84 of 90) and 53.3% (48 of 90) had used pharmacologic and nonpharmacologic CAM, respectively; and 46.7% (42 of 90) used both modalities. Vitamin and mineral preparations constituted 89.3% (75 of 84) of all pharmacologic CAM used. Intake was highest for vitamins E (48.8% [41 of 84]) and C (38.1% [32 of 84]), and 71.4% (60 of 84) of respondents took nonvitamin/mineral agents. Green tea (29.8% [25 of 84]), echinacea (13.1% [11 of 84]), and essiac (9.5% [8 of 84]) were the most popular. Prayer and spiritual practices were the most commonly used nonpharmacologic CAM, accounting for 52.1% (25 of 48). Chiropractors, the most frequently visited nontraditional medicine practitioners, were consulted by only 10% (9 of 90) of those who practiced CAM. Both CAM modalities were used more frequently by women (53.5% [23 of 43]) than men (40.4% [19 of 47]). CONCLUSION: CAM use is common among patients in phase I trials and should be ascertained by investigators, because some of the agents used may interact with investigational agents and affect adverse effects and/or efficacy.

Adult↗
PubMed1999

Medicinal herbs: NTP extracts the facts.

The National Toxicology Program (NTP) has announced that it will design and initiate studies to identify and characterize possible adverse health effects that may be associated with prolonged use or higher doses of some of the most popular medicinal herbs, including Ginkgo biloba, Echinacea angustifolia, and Panax quinquefolius (American ginseng). The NTP studies a large variety of substances to which the population may be exposed in the environment, occupationally, in the food supply, or elsewhere.

Animals↗
PubMed1999

Phytomedicine research in Germany.

In Germany since 1980, more than 300 clinical studies have been carried out with standardized phytopharmaceuticals, including Crataegus, Silybum, Ginkgo, Hypericum, Sabal, Urtica, Kava-Kava, Allium sativum, Valeriana, Aesculus, Echinacea, and Viscum drugs. These studies assessed the efficacy of phytopharmaceuticals for the treatment of moderate or moderately severe diseases and prevention. Several comparative clinical trials showed that these phytopharmaceuticals had full therapeutic equivalence with chemotherapeutics and had the simultaneous advantage of being devoid of any adverse effects. The mechanism of action of herbal drugs and their extract preparations, which differ in many respects from that of synthetic drugs or mono substances, can be characterized as a polyvalent action and interpreted as additive or, in some cases, potentiating. Currently, a rationale for the observed reversal effects and optimal effects with very low doses after a long-term application has not been developed, but is under investigation by systematic research at the molecular level.

Clinical Trials as Topic↗
PubMed2005

Herbal use among US elderly: 2002 National Health Interview Survey.

BACKGROUND: Use of herbal products among the elderly is an important concern for healthcare professionals. The presence of polypharmacy and multiple comorbidities places the elderly at high risk for herb-drug and herb-disease interactions. Limited data exist regarding herbal use among the US elderly population. OBJECTIVE: To evaluate the incidence of and attitudes toward herbal use in a nationally representative sample of US elderly patients >/=65 years of age. METHODS: We performed a descriptive analysis of public domain data collected in the 2002 National Health Interview Survey. Statistical analyses were conducted through use of SUDAAN software with Taylor series linearization for variance estimation. RESULTS: Analysis of weighted data revealed that 12.9% +/- 0.5% (mean +/- SE) of US elderly people had used an herbal supplement within the past 12 months. Use was greatest among individuals 65-69 years of age, females, Hispanic and non-Hispanic ethnic minorities, and respondents with a greater income, higher education level, or more positive self-reported health status. Among elderly people purchasing over-the-counter and prescription drugs, herbal use was 13.9% +/- 0.6% and 12.8% +/- 0.6%, respectively. Glucosamine, echinacea, and garlic supplements represented the most common herbals used. Benefit from combined herbal and conventional therapy was the most common reason cited for use; however, 50.9% +/- 2.2% of users did not discuss herbal therapy with a medical professional. Several theoretical herb-disease interactions were identified. CONCLUSIONS: The use of herbal products among the US elderly has risen over the past 5 years, whereas discussion of such use with medical professionals remains suboptimal.

Aged↗
PubMed2003

Herbal therapy use in a pediatric emergency department population: expect the unexpected.

BACKGROUND: In recent years investigators have reported widespread use of alternative medicine. Some herbal therapies have potentially harmful side effects as well as adverse interactions with medications. Data are lacking on the use in children and caregiver understanding of these products. OBJECTIVES: To determine the reported use of herbal products among a pediatric emergency department population and to evaluate the caregivers' understanding and source of information concerning these products. DESIGN/METHODS: A convenience sampling of pediatric emergency department patients and their caregivers occurred during a 3-month period in 2001. The interview consisted of 18 questions regarding the types of non-Food and Drug Administration-regulated herbal products and home remedies used, general product knowledge and sources of information used by the child's caregiver (including discussions with their child's primary physician). RESULTS: One hundred forty-two (93%) of 153 families approached participated in the study. The mean patient age was 5.3 years (range: 3 weeks-18 years). Forty-five percent of caregivers reported giving their child an herbal product, and 88% of these caregivers had at least 1 year of college education. Of the children receiving these therapies, 53% had been given 1 type and 27% were given 3 or more in the past year. The most common therapies reportedly used were aloe plant/juice (44%), echinacea (33%), and sweet oil (25%). The most dangerous potential herbal and prescription medication combination reported was ephedra and albuterol in an adolescent with asthma. The most unusual products reportedly used included turpentine, pine needles, and cowchips. Of all people interviewed, 77% did not believe or were uncertain if herbal products had any side effects and only 27% could name a potential side effect. Sixty-six percent were unsure or thought that herbal products did not interact with other medications and only 2 people correctly named a drug interaction. Of the people who used these therapies, 80% reported either friends or relatives as their primary source of information. Only 45% of those giving their children herbal products report discussing the use with their child's primary health care provider. CONCLUSION: Herbal and home therapies are commonly used in this pediatric population. An unexpectedly wide variety of products were reportedly given to this patient population. Caregivers reported limited knowledge regarding potential adverse medication interactions and side effects. Limited discussions with the child's primary health care provider were reported. It is therefore important for health care providers to have knowledge about herbal medications, to inquire about their use and to educate families about the risk/benefit as well as potential interactions these products may have with over-the-counter and prescription medications.

Adolescent↗
PubMedDate not supplied

Herb-drug interactions in oncology: focus on mechanisms of induction.

An increasing number of cancer patients are using complementary and alternative medicines (CAM) in combination with their conventional chemotherapeutic treatment. Considering the narrow therapeutic window of oncolytic drugs, this CAM use increases the risk of clinically relevant herb-anticancer drug interactions. Such a relevant interaction is that of St. John's wort with the anticancer drugs irinotecan and imatinib. It is, however, estimated that CAM-anticancer drug interactions are responsible for substantially more unexpected toxicities of chemotherapeutic drugs and possible undertreatment seen in cancer patients. Induction of drug-metabolizing enzymes and ATP-binding cassette drug transporters can be one of the mechanisms behind CAM-anticancer drug interactions. Induction will often lead to therapeutic failure because of lower plasma levels of the anticancer drugs, and will easily go unrecognized in cancer treatment, where therapeutic failure is common. Recently identified nuclear receptors, such as the pregnane X receptor, the constitutive androstane receptor, and the vitamin D-binding receptor, play an important role in the induction of metabolizing enzymes and drug transporters. This knowledge has already been an aid in the identification of some CAM probably capable of causing interactions with anticancer drugs: kava-kava, vitamin E, quercetin, ginseng, garlic, beta-carotene, and echinacea. Evidently, more research is necessary to prevent therapeutic failure and toxicity in cancer patients and to establish guidelines for CAM use.

Drug Prescriptions↗
PubMed2006

Metal content of ephedra-containing dietary supplements and select botanicals.

PURPOSE: The metal content of dietary supplements, including 13 ephedra-containing supplements, was studied. METHODS: Samples of botanicals (black cohosh, echinacea, goldenseal, kava kava, milk thistle, saw palmetto, Synephrine, and valerian root), ephedra-containing dietary supplements (Amp II, EPH 833, Ephedra, Ephedra 1000, Hydroxycut, Metabolife 356, Metabolift, Ripped Fuel, Ripped Fuel Extreme, Ripped Fuel [ma huang-free], Stacker 2 [two lots], Super Stinger, Virgin Earth, Xenadrine RFA-1 [two lots], Yellow Jacket), and nonprescription reference agents (NoDoz and Primatene) were digested in acid, reacidified, and then spiked with internal standards. Metals were quantified using Environmental Protection Agency quality assurance and quality-control standards 6020 and 200.8. Forty-seven metals were analyzed by inductively coupled plasma-mass spectrometry, with subpart-per-trillion detection limits. RESULTS: All metals detected were in concentrations below toxic levels or physiological limit levels for the daily doses specified by the products' labeling. Metals found in highest concentrations among all the supplements sampled were sodium, magnesium, calcium, potassium, aluminum, iron, titanium, mercury, strontium, lead, barium, and silver. Of the 27 supplements analyzed, those with the lowest metal concentrations were mostly single-ingredient botanical supplements, while multiple-component, ephedra-containing dietary supplements generally had higher metal concentrations. Significant lot-to-lot variations were found for two ephedra-containing dietary supplements. CONCLUSION: None of 47 metals was found in highly toxic amounts in 23 brands of dietary supplements and two nonprescription reference preparations.

Dietary Supplements↗
PubMed2002

Potential interactions between herbal medicines and conventional drug therapies used by older adults attending a memory clinic.

OBJECTIVE: Herbal medicines and conventional drug therapies are often taken in combination. The objective of our study was to identify the range of natural health products and conventional drug therapies used by older adults (aged 65 years and over) attending a memory clinic, and to specifically evaluate the frequency of potential interactions between herbal medicines and conventional drug therapies. DESIGN: We interviewed consecutive patients attending the Memory Disorders Clinic at the Baycrest Centre for Geriatric Care, a University of Toronto teaching hospital, between 4 July and 15 August 2000. Patients were asked to bring to their appointment all natural health products (i.e. herbal medicines, vitamins and minerals) and conventional drug therapies (i.e. prescription and over-the-counter) they were currently using. We collected information on current and previously used natural health products and current conventional drug therapies. Patients were classified as having the potential for an interaction if they were using a current herbal medicine in combination with a conventional drug therapy and the interaction had been reported previously in the medical literature. PARTICIPANTS: We interviewed 195 consecutive patients attending the Memory Disorders Clinic at the Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada. RESULTS: Of the 195 patients in our sample, 33 (17%) were 'current users', 19 (10%) were 'past users', and 143 (73%) were 'never users' of herbal medicines. Among the 52 patients who were 'current or past users', the most frequently used herbal medicines were ginkgo (Ginkgo biloba) [39 users], garlic (n = 10), glucosamine sulphate (n = 9) and echinacea (n = 8). Among the 33 patients who were current users, the most commonly used herbal medicines were Ginkgo biloba (n = 22), glucosamine sulphate (n = 8) and garlic (n = 6). Among the 33 current users, we identified 11 potential herb-drug interactions in nine patients. The 11 herb-drug interactions we identified were between ginkgo and aspirin (acetylsalicylic acid) [n = 8], ginkgo and trazodone (n = 1), ginseng and amlodipine (n = 1) and valerian and lorazepam (n = 1). CONCLUSIONS: Herbal medicines are widely used. Almost one-third of current users of herbal medicines were at risk of a herb-drug interaction. The most common potential herb-drug interaction was between ginkgo and aspirin. This finding has important potential implications because both of these products are regularly used by older people. Physicians and other healthcare providers should be aware of potential herb-drug interactions and should monitor and inform their patients accordingly.

Aged↗
PubMed2007

Ocular adverse effects associated with systemic medications : recognition and management.

This article reviews several retrospective case series and reported adverse events regarding common ocular adverse effects related to systemic therapy. It is not intended as a comprehensive summary of these well described adverse drug reactions, nor is it intended to cover the complete spectrum of all ocular adverse effects of systemic therapy. Many systemic drugs may produce ocular toxicity, including bisphosphonates, topiramate, vigabatrin, isotretinoin and other retinoids, amiodarone, ethambutol, chloroquine and hydroxychloroquine, tamoxifen, quetiapine, cyclo-oxygenase (COX)-2 inhibitors, erectile dysfunction agents and some herbal medications. For this review, the certainty of the adverse effect profile of each medication was evaluated according to the WHO Causality Assessment Guide.A certain relationship has been established for pamidronate and alendronate as causes of scleritis, uveitis, conjunctivitis and blurred vision. Topiramate has been established as adversely causing symptoms consistent with acute angle-closure glaucoma, typically bilateral. Vigabatrin has been shown to cause bilateral irreversible visual field defects attributed to underlying medication-induced retinal pathology. Isotretinoin should be considered in the differential diagnosis of any patient with pseudotumour cerebri. Patients taking amiodarone and hydroxychloroquine should be monitored and screened regularly for development of optic neuropathy and maculopathy, respectively. Sildenafil has been reported to cause several changes in visual perception and is a possible, not yet certain, cause of anterior ischaemic optic neuropathy. Patients taking tamoxifen should also be monitored for development of dose-dependent maculopathy and decreased colour vision. COX-2 inhibitors should be included in the differential diagnosis of reversible conjunctivitis. Several herbal medications including canthaxanthine, chamomile, datura, Echinacea purpurea, Ginkgo biloba and liquorice have also been associated with several ocular adverse effects. It is the role of all healthcare professionals to detect, treat and educate the public about adverse reactions to medications as they are an important health problem.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2005

New considerations in the treatment and prevention of rhinovirus infections.

Rhinoviruses are a very common cause of infections in children. Although these infections are most closely associated with the common cold, recent studies have established the rhinoviruses as important causes of other upper and lower respiratory illnesses as well. Treatment of these infections is limited to symptomatic therapy. There is no clear evidence that treatment with zinc or echinacea have any role in these infections. Interruption of transmission by handwashing remains the only method for prevention of rhinovirus infections.

Adult↗
PubMed2005

Antimutagenic effect of phenolic acids.

In the present study, the Salmonella typhimurium tester strain TA 100 was used in the plate-incorporation test to examine the antimutagenic potential of caffeic, ferulic and cichoric acids extracted from plant species of genera Echinacea (L) Moench, as well as of another phenolic acids, on 3-(5-nitro-2-furyl)acrylic acid (5NFAA) and sodium azide mutagenicity. All tested compounds possess antimutagenic activity. In the case of 5NFAA, the antimutagenic potency of tested compounds was in the order of gallic acid > ferulic acid > caffeic acid > syringic acid > vanillic acid. The mutagenic effect of sodium azide was inhibited by tested phenolic acids by about 20-35 %. The most effective compound, gallic acid inhibits this effect by 82 % in the concentration of 500 mug/plate. The only exception from favourable properties of tested phenolic acids is cichoric acid, which in the contrary significantly increased the mutagenic effect of 5NFAA.

Antimutagenic Agents↗
PubMed1999

Alternative medicine: what the data say about common herbal therapies.

An increasing number of Americans are turning to complementary and alternative medicine to help manage or prevent the onset of chronic disease, improve cognitive function, boost overall general well-being, and increase longevity. Some of the more widely-used herbal preparations designed to help accomplish these objectives include St. John's wort, ginkgo biloba, echinacea, garlic, and ginger. In general, the clinical trial data on these preparations is in the embryonic stages, whereas the popularity of these compounds is fueled in part by anecdotal evidence. Given the embrace by Americans--especially older persons--of these alternative remedies, knowledge of their uses and potential side effects can help the primary care physician better collaborate on a course of care that makes effective use of the best treatments, both traditional and alternative.

Aged↗
PubMed2000

[Interactions between herbal medicines and drugs].

At present the use of medicaments of plant origin is on the increase. It is therefore necessary to take into consideration that there exist known as well as potential interactions between the medicament of the medicinal plant. The problematic plants include Echinacea, Allium cepa, Gingko biloba, Panax ginseng, as well as Hypericum perforatum, Valeriana officinalis, or Glycyrrhiza glabra. Its use should be limited, or completely excluded in the cases of simultaneous therapy with, e.g., warfarin, hepatotoxically acting medicaments, MAOI inhibitors, phenelzin sulphate, or phenytoin, as they may decrease of completely eliminate the therapeutic effect of the administered drugs, or they may cause a toxic damage to the organism.

Drug Interactions↗
PubMedDate not supplied

Hydrolysis and redox factors affecting analysis of common phenolic marker compounds in botanical extracts and finished products.

Many of the marker compounds analyzed in herbal products are redox-active phenolic molecules, which are commonly found in plants as components of glycosides and starch polymers. Variability in degree of sample hydrolysis can occur due to differences in water content, pH, and temperature. Sonication versus shaking during extraction can also influence hydrolysis and oxidation of sensitive compounds. Some traditional botanical extract marker compounds are esters and glycosides of phenolics such as echinacoside from Echinacea while others are free phenolics, such as quercetin from glycosides in Ginkgo. Optimizing hydrolysis conditions maximizes free quercetin levels, but lowers echinacoside levels. Furthermore, acidic hydrolysis conditions mimic stomach conditions encountered by oral supplements and protect resulting free phenolics from oxidation. Oxidative degradation of botanical phenolic markers can be initiated by light, sonication, oxygen, basic pH conditions, heat, redox-active solvents, and formulation additives. Some phenolic markers reversibly cycle through multiple oxidation states creating a formula-specific equilibrium of oxidation states. Finished product formulations that include easily oxidized phenolics, carbonates, phosphates, and transition metals affect sample hydrolysis degree and redox equilibria, and quantitation. By recognizing and controlling hydrolysis and oxidation variables, more accurate and rugged methods can be developed allowing for improved botanical standardization and finished product analysis.

Hydrolysis↗
PubMedDate not supplied

[Activity of cytoplasmic proteinases from rat liver in Heren's carcinoma during tumor growth and treatment with medicinal herbs].

The dynamics of the acid and neutral proteinases general enzymes activity change in the hepatocytes postnuclear fraction in the rats suffering from the Heren's carcinoma was investigated. It was determined that in the tumor development of the enzyme activity level of both the acid and neutral proteinases increased 2,6-fold. The natural preparation of the herbs (Calendula officinalis L., Echinacea purpurea L., Scorzonera humilis L., Aconitum moldavicum Hacq.) normalizes both the activity of the investigated enzymes and coefficients of the liver weights of the sick animals. The chemical medicinal preparation 5,6-benzcumarine-5-uracil normalizes the activity of the neutral cytoplasmatic proteinases and reduces the level of the proteolytic activity of the acid enzymes in comparison with the control group of the animals as well as increases of the liver weight coefficients.

Animals↗
PubMed2001

Prevalence of complementary and alternative medicine use in cancer patients.

Interest in complementary and alternative medicine (CAM) has grown dramatically over the past several years. Cancer patients are always looking for new hope, and many have turned to nontraditional means. This study was conducted to determine the prevalence of complementary and alternative medicine use in cancer patients and what if any agents are being used. Approximately, 100 adult cancer patients in a private nonprofit South Florida hospital completed a descriptive cross-sectional survey questionnaire. The mean age of participants was 59 years; 42 patients were male and 58, female. According to survey results, 80% of patients reported using some type of CAM; 81% took vitamins, 54% took herbal products, 30% used relaxation techniques, 20% received massages, and 10% used home remedies. Among patients who took vitamins, 65% said they took a multivitamin, 39% took vitamin C, and 31%, vitamin E. The most common herbal remedies used were green tea, echinacea, shark cartilage, grape seed extract, and milk thistle. Meditation and deep breathing were the two most common relaxation techniques practiced. A large majority of cancer patients are using CAM. In light of the growing interest in CAM, health-care professionals need to be educated about the most common therapies used.

Adult↗
PubMed2001

Herbal medicine. What is the evidence?

This is the final in the series of 13 articles looking at current herbal therapy. It reviews those plants with clinical and scientific evaluation sufficient to consider adoption into orthodox medicine. Surprisingly some commonly used herbs, such as the purple coneflower (Echinacea purpura), valerian and ginseng, do not as yet pass the test, but others such as St John's wort, ginkgo, saw palmetto now have sufficient clinical studies to consider orthodox use. With the huge interest in herbal treatment it is likely that other plants will join the list following adequate clinical evaluation.

Evidence-Based Medicine↗