Taxonomic class

Asteraceae

Common Trade Names

Tansy Ragwort

Common Forms

Available as fresh and dried herb.

Source

The leaves, seeds, and flowers of Senecio jacobaea are commonly used. Ragwort is a member of the daisy family and native to North America.

Chemical Components

Limited information exists on the chemical composition of Senecio species. The volatile oil has been described for some species . Pyrrolizidine alkaloids (floridanine, florosenine, otosenine, and senecio nine) are the chief components isolated from the leaves, seeds, and flowers.

Actions

Several texts report that ragwort has an astringent, cooling, analgesic effect when applied topically or gargled. It is also claimed to have diuretic, weak expectorant, and uterine stimulant properties.

Reported Uses

Emollient poultices have been made from leaves. Plant “juice” has been used as a wash for bee stings, burns, rheumatism, and cancerous ulcers and as a gargle for ulcerations in the mouth and throat. Claims for use of the plant have also been made for treating functional amenorrhea and menopausal neurosis. These claims lack sufficient clinical trial data to validate their application.

Dosage

Only external use of the herb is recommended. Poultices are made by applying the bruised, fresh plant directly on the affected area. Dried herb can be used by soaking it in warm water before applying. A gargle is made by soaking the plant in warm water and then straining.

Adverse Reactions

GI: hepatotoxicity, nausea, vomiting.

Respiratory: pulmonary edema or effusion.

Interactions

Hepatotoxins: Increased risk of hepatotoxicity. Avoid administration with ragwort.

Contraindications and Precautions

Ragwort is contraindicated in patients who are susceptible to hepatic dysfunction. Avoid its use in pregnant or breast-feeding patients; effects are unknown.

Special Considerations

• Pyrrolizidine alkaloids are metabolized to hepatotoxic pyrrolic compounds. Death resulting from hepatic failure has been reported in animals and humans.
• Monitor liver function test results.
• Advise the patient to report signs and symptoms of hepatic dysfunction (abdominal pain, fatigue, fever, jaundice).
• Advise women to avoid using ragwort during pregnancy or when breast-feeding.

Points of Interest

• In South Africa, some Senecio species are used as food.

Commentary

Because there are well-documented cases of human and animal poisonings, ragwort presents an unacceptable risk and should not be used for any medicinal purpose.

Taxonomic Class

Rutaceae

Common Trade Names

None reported.

Common Forms

The two forms of tangerine peel are aged tangerine peel and green (young) tangerine peel. It is available as a peel and in pill form.

Source

After tangerines ripen, the skins are collected and dried.

Chemical Components

Tangerine peel contains dietary fibers and bioflavonoids (naringin and hesperidin). Tangerine seeds contain three limonoids: limonin, nomilin, and obacunone .

Actions

Information regarding the mechanism of action of tangerine peel is limited. Naringin acts as an antimicrobial and hesperidin acts as a blood pressure depressant. Both bioflavonoids have been pharmacologically evaluated as potential anticancer agents and anti-inflammatories and are thought to be associated with preventing hyperlipidemia.

Reported Uses

Tangerine peel has been used to treat anorexia, bloating, diarrhea, flatulence, hyperlipidemia, indigestion, muscle pain, nausea, and vomiting. It can also be used as a diuretic, an expectorant, and a sedative.

Dosage

None reported.

Adverse Reactions

None reported.

Interactions

None reported.

Contraindications and Precautions

Some sources suggest that tangerine peel may be contraindicated in patients who have a dry cough or red tongue or in those who are spitting up blood. The red tongue could be a sign of inflammation or infection, which would be aggravated and cause pain in tangerine peel is taken.

Special Considerations

Advise the patient to consult a health care provider before using herbal preparations because a treatment that has been clinically researched and proved effective may be available.

Instruct the patient to report new adverse reactions if using tangerine peel.

Although no known chemical interactions have been reported in clinical studies, consideration must be given to the pharmacologic properties of the herbal product and the potential for exacerbation of the intended therapeutic effect of conventional drugs.

Points of Interest

Tangerine peel essential oil is popular in aromatherapy.

A red or orange peel is favored by some herbalists.

Commentary

Because of the lack of human clinical data, the use of tangerine peel is not recommended. One study in rats appears to show a connection between tangerine peel extracts and the prevention of hyperlipidemia, but further clinical trials are needed to confirm its safety and efficacy.

Type of Drug:

Anticonvulsant; diuretic or “water pill”; antiglaucoma drug; carbonic anhydrase inhibitor.

How the Acetazolamide Product Works:

Anticonvulsant: Prevents or reduces seizures by slowing abnormal nerve impulses in the brain and central nervous system.

Diuretic: Reduces amount of fluid in the body by increasing urine formation.

Antiglaucoma: Reduces pressure in the eyes by decreasing the formation of fluid inside the eye.

Uses of The Acetazolamide:

To treat petit mal and un localized seizures.

To treat edema (excess fluid in tissues) which may accompany congestive heart failure, other circulatory system disorders, or other drug therapy.

Sustained-release capsules: To treat certain types of glaucoma. Usually used in combination with drugs applied directly to the eye.

To prevent or treat the effects of acute mountain sickness.

Precautions:

Blood disorder cancer while taking this medication. Patients should be routinely monitored to avoid this problem.

Potassium loss: By increasing urine formation, acetazolamide may cause loss of potassium from the body. Low potassium levels may be treated by eating foods and drinking fluids high in potassium, such as citrus (orange) juice, bananas, dates, raisins, melons, and tomatoes. If increasing potassium in the diet does not raise potassium levels to normal, a potassium supplement may be necessary to replace lost potassium.

Pregnancy: Adequate studies have not been done in pregnant women. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: Acetazolamide may appear in breast milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness in children have not been established.

Lab Tests: Lab tests are required during treatment with acetazolamide. Tests may include blood counts, electrolytes (eg, potassium, sodium, chloride), and liver and kidney function tests.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with acetazolamide. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs interact with acetazolamide.

• Cyclosporine (eg, sandimmune)
• Iithium (eg, eskalith)
• Primidone (eg, mysoline)
• Quinidine (eg, quinidex)
• Salicylates (eg, aspirin, Arthro pan, Doan’s Tusal)

Side Effects:

Every drug is capable of producing side effects. Many acetazolamide users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; vomiting; loss of appetite; diarrhea.

Skin: Unusual bleeding or bruising; rash; red or purple spots under the skin; sensitivity to light.

Other: Fever; tingling or numbness in hands or feet; drowsiness; confusion; allergic reaction; taste alterations; ringing in the ears; hearing dysfunction; excessive urination; electrolyte imbalance; metabolic acidosis; crystals in urine; kidney stones; abnormal blood cell counts; transient nearsightedness; sore throat.

Guidelines for Use:

• Epilepsy - Suggested total daily dose is 8 to 30 mg/kg in divided doses. Optimum range appears to be from 375 to 1000 mg daily. When given in combination with other anticonvulsant’s, the starting dose should be 250 mg once daily in addition to existing medications.
• Tablets can be crushed and mixed with sweet foods to mask bitter taste.
• Capsules can be opened and contents sprinkled on food, if necessary.
• Sustained-release capsules - Do not crush or chew.
• Doses more than 1 g per 24 hours do not produce an increased effect.
• For use of acetazolamide in acute mountain sickness, congestive heart failure, drug-induced edema, and glaucoma, see the Diuretics­Carbonic Anhydrase Inhibitors monograph.
• May cause stomach upset. Take with food.
• May cause drowsiness. Use caution when driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• May cause loss of potassium from the body. Contact your doctor if signs of potassium loss (eg, weakness, muscle cramps, nausea, dizziness) occur.
• Notify your doctor if sore throat, fever, unusual bleeding or bruising, tingling or numbness in the hands or feet, flank or loin pain, or skin rash occurs.
• When using acetazolamide, urination may increase; if possible, take early in the day ..
• Temporary nearsightedness (change in vision) has occasionally occurred with this medicine. It subsides when the dose is reduced or the medicine is stopped.
• May cause sensitivity to sunlight. Avoid prolonged exposure to the sun or other forms of ultraviolet (UV) light (eg, tanning beds). Use sun­screens and wear protective clothing until tolerance is determined.
• Store at room temperature (59 to 86°F).

ALTERNATIVE NAMES: COMMON HOLY BASIL, GARDEN BASIL, SWEET BASIL

Taxonomic Class

Lamiaceae

Common Trade Names

None known.

Common Forms

Available as chopped or powdered leaves and a tea.

Source

The crude drug is derived from the leaves of Ocimum basilicum (sweet or Common basil) or Ocimum sanctum (holy basil), members of the mint family (Labiatae).

Chemical Components

The active components of basil include eugenol, linalool, and methyl chavicol (estragole). Other components include monoterpenes (such as camphor, cineol, geraniol, and ocimene), phenylpropanes (such as methyl cinnamate), and sesquiterpenes.

Actions

In human trials, O. sanctum and Ocimum album significantly lowered urine glucose as well as fasting and postprandial blood glucose levels in 40 patients with type 2 diabetes. Total cholesterol levels were also slightly decreased .

Animal studies have revealed some peripherally mediated analgesic effects of the fixed oil of O. sanctum . Another trial in guinea pigs found antasthmatic and anti-inflammatory properties in extracts from fresh leaves and the essential oils of O. sanctum leaves . In studies with rats, 0. basilicum components (aqueous extracts, flavonoid glycosides, and methanol extracts) were found to have anti ulcerative effects .

Reported uses

Basil is claimed to possess analgesic, anti-inflammatory, antioxidant, antiseptic, antiulcerative, and hypoglycemic properties.

Dosage

The dosage reported in one trial was 2.5 g of fresh, dried leaf powder once daily . A tea can be made by placing 2.5 g of fresh, dried leaf powder in 1/2 cup of water, straining, and drinking once or twice daily, as needed.

Adverse Reactions

Hepatic: hepatocellular carcinoma.

Metabolic: hypoglycemia.

Interactions

Insulin, sulfonylureas, other antidiabetics: May increase hypoglycemic effects. Avoid administration with basil.

Contraindications And Precautions

Avoid using basil in pregnant or breast-feeding patients because of the potential for increased menstrual flow and the mutagenic effects of estragole. Use cautiously in diabetic patients.

Special Considerations

Monitor the diabetic patient for hypoglycemia if he consumes basil in quantities that exceed amounts typically used for foods.

Instruct the patient to avoid long-term use of basil because of its potential multiage effect. Strangle is a known expatiating in animals.

Advise the female patient not to use basil during pregnancy or when breast-feeding.

Points of interest

Cultivation practices and soil variations can significantly change the chemical composition of basil.

Commentary

Few human studies examine the effects of basil for medicinal purposes. One study showed significant reductions in blood glucose levels, which led the investigators to comment on basil’s usefulness in the treatment of type 2 diabetes . Although the results of this small study are suggestive, they have not yet been duplicated in a large, controlled trial. Claims of efficacy in other diseases have not been substantiated in human trials.

The plasma cells are among the less common types of white blood cell in the bone marrow. They produce antibodies that help to destroy bacteria, viruses and other infectious agents and foreign cells. They also produce antibodies in response to vaccination or immunization. Normally, plasma cells make up only a small percentage of the cells in the marrow, but in multiple myeloma one plasma cell undergoes a malignant, or life-threatening, change and begins to multiply excessively. This has three serious effects. First, it disrupts the production of red blood cells, platelets and granulocytes (a type of white blood cell) in the marrow, which leads to anemia thrombocytopenia and a reduction of granulocytes in the blood. Second, the excess plasma cells cause destruction of bone. Third, the remaining normal plasma cells produce fewer antibodies and this reduces resistance to infection.

What are the symptoms?

Usually the first symptoms of myeloma are the symptoms associated with anemia. Increased susceptibility to infection may also appear early. The most characteristic symptom of the disease is pain in your bones, particularly in the vertebrae, or backbones.

What are the risks?

Myeloma is a rare disease, occurring in less than 4 of every 100,000 people in the United States. Myeloma affects mainly people over 50 and it is somewhat more common in men than it is in women.

Myeloma cannot be cured, but if you have the disease, treatment can give you several years of fairly normal life. Recurrent infection is a common problem with this disease, and it can be quite serious. There is a risk of chronic kidney failure and bleeding is another common problem.

What should be done?

If you are over 50 and you have developed bone pain, especially in your back, you should see a physician. If you have multiple myeloma, laboratory analysis of blood and urine samples and X-rays of the skeleton will usually detect it.

What is the treatment?

In the early stages of multiple myeloma, if there are no complications, the usual treatment that is currently used is an anticancer drug. The amount of the medication that is given must be carefully controlled, because too much of the drug can damage too many of the other cells in the bone marrow, and too little of it will not be able to halt the progress of the disease. Blood samples are taken during treatment to find an effective, safe dosage. Often steroids are also prescribed.

This treatment controls the disease in many but not all cases. Because your resistance to infection remains low during this treatment, antibiotics may be prescribed if you have any symptoms of an infection. Troublesome bone pain can usually be relieved by radiation therapy. If you respond to treatment at first, and then have a relapse, your physician may try different drugs.

If the disease is not in an advanced stage when it is diagnosed, and if you respond well to treatment, you will probably survive for about two years.