Taxonomic class

Hydrophyllaceae

Common Trade Names

Multi-ingredient preparations: EarSol-HC, Feminease, Fen-Tastic, lerbal Gold Cigarrettes, Lung-Mend, Magic Cigarettes, MouthKote, Nature’s Sunshine SN-X, Nettle-Reishi Virtue, Oragesic, Pretz-D, Pretz Irrigation, Pretz Spray, Respirtone, Respitonic, Tot Tonic, #493 VRM3 Micro Pathogens, Yerba Manza-Eyebright Virute, Yerba Prima,Yerba Santa-Echinacea Virtue, Yerba Santa Resin-Rich Leaf

Common Forms

Available as a liniment, liquid extract (1:5), powder, syrup, and tea.

Source

Active components are derived from the leaves and roots of Eriodictyon californicum (syn. E. glutinosum Benth. and Wigandia californicum Hook. & Am.), an evergreen shrub that belongs to the waterleaf family and is native to the mountains of California, Oregon, and northern Mexico.

Chemical Components

The plant contains various acids (cerotinic, formic, and butyric), a resin (pentacontane, xanthoeriodictyol, priodonal, and chrysoeriodictyol), phenols (eriodictyol, homoeriodictyol, chrysocriol, zanthoeridol, and eridonel), chrysoeriol, cirsimaritin, glycerides of fatty acids, a phytosterol, eriodictyonine, tannins, a volatile oil, sugar, fixed oil, and a gum.

Actions

Physiologic mechanisms of action are poorly described. It is reported that yerba santa exerts expectorant and mildly diuretic effects. Two flavonoid isolates from the plant, cirsimaritin and chrysoeriol, show some promise as anticancer agents .

Reported Uses

Native Americans used yerba santa externally for bruises and inflammation, and they smoked or chewed the leaves for asthma. The herb has also been used to treat bronchial conditions, the common cold, cough, fever, hay fever, hemorrhoids, excessive mucus production, rheumatic pain, sore throat, and tuberculosis. The mashed leaves have been prepared as a poultice to treat insect bites, sores, sprains, and wounds.

Dosage

No consensus exists, but some sources suggest that a tea made from the leaves may be used for asthma, colds, coughs, and tuberculosis. Powdered leaves are used as a stimulating expectorant. A liniment formulation of the leaves is applied topically to reduce fever. Fresh leaves are applied as poultices for bruises, and younger leaves are applied to relieve rheumatism.

Adverse Reactions

None reported.

Interactions

Iron, other minerals: Yerba santa reportedly interferes with the absorption of iron and other minerals when taken internally. Separate administration times.

Contraindications and Precautions

Avoid using yerba santa in pregnant or breast-feeding patients; effects are unknown.

Special Considerations

• Advise the patient not to chew yerba santa leaves because they leave a gummy residue on the teeth.
• Inform the patient that no clinical data sUpport the use of yerba santa for any medical condition.
• Advise the patient not to depend on yerba santa alone to treat such conditions as asthma and tuberculosis.

Points of Interest

• Spanish colonists named this plant yerba santa (holy weed) after learning of its medicinal uses from the American Indians. Yerba santa is available in several OTC herbal preparations and as a pharmaceutical flavoring to mask the flavor of bitter drugs. The liquid extract is also used in foods and beverages.

Commentary

Information regarding the safety and efficacy of yerba santa is scant. No clinical trials or published case reports are available for evaluation. As a result, its use cannot be recommended.

Taxonomic class

Magnoliaceae

Common Trade Names

None known.

Common Forms

Available as liquid extract and powder.

Source

Indigenous to North America, magnolia’s medicinal parts are derived from the bark of the stem and root. The main active components are obtained from the bark of several magnolia species; the flower bud is also used in Chinese medicine. Drying and age cause its volatile, aromatic properties to be lost.

Chemical components

The active components found in the bark are alkaloids (for example, magnocurarine and tubocurarine) and essential oils (for example, magnolol, tetrahydromagnolol, isomagnolol, machiolol, and honokiol).

Actions

Components of magnolia bark have been studied in vitro and in animals for antimicrobial activity in the treatment of periodontal disease , for antifungal activity and as antitumorigenic promoters . The lignans isolated from the flower buds have been studied for their inhibitory effects on tumor necrosis factor-alpha production . Few, if any, data exist from human clinical trials. Magnolol, the active principle of the herb, has anti-inflammatory properties and has been shown to reduce prostaglandin E 2 and leukotriene-B 4 levels in the pleural fluid of mice and to suppress thromboxane-B 2 formation .

Decoctions made from magnolia have been cited to cause uterine contractions.

Reported Uses

Magnolia has been claimed to be useful as an antasthmatic, an anti-inflammatory, a muscle relaxant, and a stimulant. Its use has also been suggested for appetite stimulation, digestive disorders, dysentery, flatulence, nausea, and shortness of breath.

Dosage

No standard dosing is available.

Adverse Reactions

Other: allergic reaction.

Interactions

None reported.

Contraindications and precautions

Magnolia is contraindicated in pregnancy because of empiric uterinestimulating activity (flower buds).

Special considerations

Although primary allergy to magnolia is seldom reported, caution the hypersensitive patient to be wary of allergic reactions to magnolia. One patient, described as having allergies to several sesquiterpene lactone­containing plants, experienced a severe case of chronic lichenfied dermatitis to Magnolia grandiflora .

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.

Advise the pregnant patient not to ingest magnolia.

Points of Interest

A report in an FDA bulletin suggests that a M. stephania preparation may lead to acute renal failure and, possibly, permanent renal dysfunction .

The genus Magnolia is named after Pierre Magnol, a professor of medicine and botany at Montpellier in the early 18th century.

Commentary

Although magnolia is popular in Chinese medicine, scientific information from human trials to support its pharmacologic actions does not exist. Evidence to support claims is lacking. More research is needed before definitive recommendations can be made.

Type of Drug:Diuretics or “water pills.”

How the Loop diuretics Works:

Loop diuretics cause electrolytes (especially sodium and chloride) to be excreted in the urine. Water is excreted with the electrolytes

Uses of Loop diuretics:

To treat edema (fluid retention and swelling) due to congestive heart failure, liver disease (eg, cirrhosis), and kidney disease.

Precautions:

Furosemide and torsemide: To treat hypertension (high blood pressure) alone or with other high blood pressure medicine.

Ethacrynic acid: To treat fluid accumulation in the abdomen (ascites) due to cancer, liver failure, and other conditions, and to treat fluid accumulation in children due to congenital heart or kidney disease.

Loop diuretics: Loop diuretics are potent diuretics which can lead to pro­found increase in urine excretion with water and electrolyte depletion when given in large amounts. Careful medical supervision is required. The dose and dose schedule must be adjusted to the individual patient’s needs.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: Furosemide appears in breast milk. It is not known if other loop diuretics appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness for use of bumetanide in children younger than 18 years of age have not been established. Safety and effectiveness for use of ethacrynic acid in infants have not been established. Furosemide is indicated for use in pediatric patients. Safety and effectiveness for use of torsemide in children have not been established .

Lab Tests: Lab tests may be required during therapy. Tests may include electrolytes (eg, sodium, potassium, calcium, magnesium), blood counts, blood glucose (sugar), uric acid, urea nitrogen, creatinine, and cholesterol.

Drug Interactions:

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

• ACE inhibitors (eg, benazepril)
• Sminoglycosides (eg, gentamicin)
• Cholestyramine (eg, Questran)
• Cisapride (Propulsid)
• Cisplatin (eg, Platinol)
• Colestipol (Colestid)
• Digitalis glycosides (eg, digoxin)
• Hydantoins (eg, phenytoin)
• Lithium (eg, Eskalith)
• NSAIDs (eg, ibuprofen)
• Thiazide diuretics (eg, hydrochlorothiazide)

Side Effects of Loop diuretics:

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

Symptoms of Electrolyte Loss: Weakness; dizziness;confusion;appetie loss ;nausea; vomiting;muscle cramps;limb heaviness.

Digestive Tract: Difficulty swallowing; diarrhea (including sudden watery diarrhea); irritation of mouth or stomach; constipation; stomach pain; appetite loss; indigestion; bloating.

Nervous System: Restlessness; tingling or numbness of hands or feet; apprehension; nervousness; headache; insomnia.

Senses: Ringing in the ears; hearing loss (usually reversible).

Skin: Sweating; itching; rash, hives; jaundice (yellowing of skin or eyes); sensitivity to sunlight; unusual bleeding or bruising.

Other: Blood in the urine; dehydration; joint pain; fever; chills; breathing difficulties; yellow vision; blurred vision; premature ejaculation; impotence; difficulty maintaining an erection; dry mouth; excessive urination; rectal bleeding; fluid retention; muscle pain; cold; cough; sore throat; decreased potassium levels; elevated blood sugar.

Guidelines for Use:

• Dosage is individualized .
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist. Use exactly as prescribed.
• Take ethacrynic acid after meals, if necessary.
• Drug will increase urination. Take early in the day to avoid sleep disruption.
• Notify your doctor if muscle weakness, cramps, nausea or dizziness occurs.
• Orthostatic hypotension (dizziness or lightheadedness when arising from a seated or lying position) may occur. Get up slowly.
• Diabetes mellitus patients - May increase blood glucose (sugar) levels.
• Photosensitivity (sensitivity to sunlight) may occur. Use sunscreens and wear protective clothing until tolerance is determined.
• Additional potassium may be required while taking loop diuretics.
• Patients with high blood pressure should avoid medications that may increase blood pressure, including nonprescription decongestant products for cold symptoms and stimulant weight-control products.
• Weight should be monitored throughout treatment with loop diuretics. Loss of fluid should not be excessive within a narrow band of time.
• Lab tests will be required. Be sure to keep appointments.
• Store at room temperature (59 to 86°F) in well closed, light-resistant contain or. Do not freeze.

Taxonomic Class

Asteraceae

Common Trade Names

Chicory

Common Forms

Available as the crude herb, extracts, root (roasted and unroasted), and teas.

Source

Active components are extracted from the dried roots of Cichorium intybus, a biennial or perennial herb that is native to Europe. The leaves of young plants are used as potherbs, whereas the leaves of older plants can be blanched and eaten like celery. The roots can be boiled and eaten with butter or, more commonly, can be roasted and added to coffee or tea for a bitter taste. The roasted, dried root is also used as a coffee substitute.

Chemical Components

The flowers contain cichoriin, and the leaves contain carbohydrates, catechol tannins, chicoric acid (dicaffeoyl tartaric acid), flavonoids, glycosides, tartaric acid, and unsaturated sterols and triterpenoids. The roots contain many steam-distillable aromatic compounds. The characteristic aroma of chicory stems from acteophenone. The roots also contain inulin; on roasting, inulin is converted to oxymethylfurfural, which gives off a coffeelike aroma. Chicory also contains maltol, a taste modifier that intensifies the flavor of sugar.

Actions

Chicory is commonly used as a water-soluble or alcoholic extract. The water-soluble fraction is thought to exhibit sedative effects and, therefore, may antagonize the stimulating effects from coffee and tea. Alcohol extracts have demonstrated anti-inflammatory activity . Although little information exists regarding chicory use in humans, several animal studies have shown that it reduces the cardiac rate by an action similar to that of quinidine, suggesting its possible usefulness in treating arrhythmias. Interesting information surrounds the potential application of chicory to reduce the risk of colon cancer.

Reported Uses

In herbal lore, chicory is primarily touted as a coffee or tea additive because of its ability to antagonize the CNS stimulation brought on by these substances. It has also been used as a coffee substitute because of its coffeelike aroma and taste. In folk medicine, chicory root is used as a diuretic and laxative; human data are lacking for these uses.

Dosage

Little information is available.

Crude herb: 3 g P.O. daily.

Adverse Reactions

Skin: contact dermatitis .

Interactions

None reported.

Contraindications And Precautions

There are no known contraindications for chicory. Use it cautiously in patients with cardiac disease because of its potential action on the heart.

Special Considerations

Inquire about chicory use when taking the patient’s drug history.

Advise the patient with cardiac disease to avoid using chicory or to use it cautiously.

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

Chicory has been shown to take up the fungicide quintozene through its roots, which may lead to colonization with certain bacteria in the soil and subsequent contamination of the plant.

Commentary

Chicory has a long history of traditional use. Because of its flavor and aroma, the root has been used as a substitute for coffee and tea. Unlike coffee, chicory may exhibit sedative properties, which may explain its traditional use in offsetting the stimulant properties of teas and coffee. These claims are unproven. The plant may have some use as an antiarrhythmic, but further studies are needed. Its use as a laxative is also unclear and should be reserved until human trials are completed. Of greatest interest is the potential application of chicory and its dietary fructans, inulin and oligofructose, as colon carcinogenesis inhibitors.