Herbal Remedies

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Herbal Remedies The Pre-Hospital Care Provider

• Blair C. Schwartz, BSc
• Côte Saint Luc EMS
• City of Montreal

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Overview of Topic

• Herbal remedies constitute a major niche in
  current pharmaceutical market
• Their use has been significantly increased in
  past 10 years
• Understanding the reasons why patients may be
  taking such supplements gives clues into their
  PMH
• Several important interactions between these
  substances and prescription medications do exist

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Background Information

• Herbal remedies have played a major role in
  health care since the 1600s
• Many people view herbal medicine as nonsense, but
  important to remember that many of our current
  prescription medications have herbal origins.

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For example.Morphine

• Derived from Opium
• Route and dose is important, we dont just tell
  patients to chew poppies
• Active ingredient has been isolated and well
  studied

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Background Information

• Drug manufacturers must show that their product
  contains what it says and that it is effective
  for the conditions it claims to help with.
• Herbal remedies do not have to abide by these
  same rules. Must only prove that there have been
  no significant hazards after long term use.

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Echinacea

• It is extracted from the Purple Cone Flower
• Some evidence shows that it may reduce the
  symptoms of a cold
• Has NOT been shown to help it go away any faster
• Nor has it been shown to have a prophylactic
  role

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Echinacea

• Best extracts tend to be the Tinctures which
  are made by extracting the flower with an
  alcoholic solvent
• Contains class of compounds called Echinacosides
  that may act to improve the functions of white
  blood cells
• As it boosts immune function, not a good idea to
  be taken by patients with autoimmune diseases
• Echinacea can interact with corticosteroids or
  cyclosporin!

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Ginkgo Biloba

• Extracts from these leaves have been said to
  improve memory
• Ginkgo is a very common ornamental tree and it
  grows in many North American cities
• Studies have shown that Ginkgo does increase
  cerebral circulation and accordingly delivers
  more glucose to the brain, BUT this does not
  necessarily mean that memory is being improved,
  nor has that claim been scientifically
  substantiated

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Ginkgo Biloba

• However, some studies have shown that if given
  to Alzheimers patients at the onset of the
  disease, the patients deteriorate more slowly.
• It has been shown to interact with anticoagulant
  drugs, as a result of it being a Blood Thinner
  in and of itself.

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Saint Johns Wort

• Has been shown that it can be helpful in the
  treatment of MILD depression
• Mechanism of action involves the regulation of
  Serotonin in a manner similar to SSRIs like
  Prozac?
• However, has been shown to also enhance the
  activity of Cytochrome P-450 that plays a role in
  eliminating a wide variety of substances, thus
  has known interactions with

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St. Johns Wort Interacts With

• Cyclosporin Anti-Rejection Medication after
  organ transplants
• Tetracycline
• Tamoxifen Commonly used in the treatment of
  Breast Cancer
• Corticosteroids
• Mono Amine Oxidase Inhibitors (MAOIs)
• Protease Inhibitors
• Anesthetics Anti-Depressants

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Ginseng

• Often called the Root of Life
• Single root can often sell for 80-100
• Has played an important part in Chinese Culture
  for thousands of years
• Claimed as a Panacea, meaning a remedy for all
  ills.
• There has been no conclusive study indicating
  anything to be gained from taking Ginseng

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Ginseng

• Some studies have shown potential link to
  vaginal bleeding and birth defects if taken by
  pregnant mothers.
• A Toronto woman who was taking Ginseng gave
  birth to a baby with fully formed pubic hair.
  Turned out that her Ginseng, actually contained
  Chinese Silk Mine (which is much cheaper!).
• As with street drugs, the lack of content
  regulations mean you never know what you are
  getting.

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Ginseng

• Just FYI, the babys pubic hair fell out within
  a few days.
• On a more serious note, it has been shown to
  interact with MAOIs
• As well, in rare cases it has been linked with
  HTN and possibly even stroke. Though this is
  likely only in a small subset of the population.

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Kava Kava

• Isolated from Kava plant of the South Pacific
  Islands
• Active Ingredient Kavalactones, have been shown
  to reduce anxiety and produce a calming effect.
  Much in the same manner as Valium? or
  Benzodiazepines
• Has been shown that if taken in large
  quantities, often greater than recommended, that
  it can greatly increase the risk of liver disease

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Ephedra

• Was once used as a treatment for asthma, but has
  since been abandoned in light of better
  treatments
• Commonly sold under the name Ma Huang, as an
  appetite suppressant
• Has been shown to decrease appetite, largely by
  increasing noradrenaline secretion in the body
• Active ingredient is Ephedrine
• Can lead to HTN, Stroke, Palpitationsetc

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Garlic

• More garlic is consumed as a remedy than is used
  in food as flavour
• Has been claimed as a treatment for
  cholesterol, cancer, HTN and as an antibiotic
  agent
• Right now evidence is inconclusive for the use
  of garlic as a supplement

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Feverfew

• Has been scientifically proven to prevent
  migraines, though cannot cure them once you have
  it.
• Very few side effects as compared to some
  prescription medications
• Keep in mind that the active ingredients in
  Feverfew are Salicilates which act to thin the
  blood. Interactions with anticoagulants are common

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Black Cohosh

• Used for the treatment of menopausal symptoms as
  a substitute for Hormone Replacement Therapy
  (HRT)
• Has been shown to be effective, but acts by
  exerting hormonal effects on the body so no real
  reason to think that they are any safer than
  standard HRT
• Premarine, a common HRT drug, is also natural as
  it is isolated from the urine of pregnant horses!

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Saw Palmetto

• Successfully used for the treatment of Benign
  Prostatic Hypertrophy
• Does not decrease size of prostate, but enhances
  urinary flow, likely through action of fatty
  acids
• Shown to work as well as the prescription drugs
  for this condition.

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Conclusions

• Herbal remedies have the potential to exert
  positive effects in the treatment of a variety of
  medical conditions
• Further research is necessary to determine those
  active ingredients of interest and to standardize
  their content and dosage
• Major risk is that you may very well not be
  getting what you think you are, due to poor
  regulation of the supplement industry as well as
  growth of internet based supplement stores
• Herbal supplements can have serious interactions
  with standard prescription medications and
  information about which products have or are
  being consumed should be included in the any
  history taken by the patient care provider

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Special Thanks To

• McGill University, Department of Chemistry
• Drs. Schwarcz, Fenster and Harpp for the
  fanstastic knowledge they provided me with and
  their inspiration as educators.

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Any Questions?