Clinical toxicology of Ayurvedic medicines

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Clinical toxicology of Ayurvedic medicines

• Ruben Thanacoody
• NPIS (Edinburgh)

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Ayurvedic medicine

• Comprehensive holistic medical system 4500BC
• Knowledge or science of life
• Kayachikitsa Internal Medicine
• Shalya Tantra General Surgery
• Bhutavidya Psychiatry
• Agada Tantra Toxicology
• Rasayana Tantra Nutrition, Detoxification and
  Rejuvenation
• Kaumarabhrtya Paediatrics/Obstetrics/
  Gynaecology
• Vajikarana Fertility and Virility
• Shalakya Otorhinolaryngology

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Ayurvedic medicines

• Individually prepared
• Based on herbs and minerals
• Classification in Caraka Samhita (150BC-100AD)
• Elemental constituents
• Taste
• Potency
• Postdigestive effect
• Therapeutic action (50 groups)

• Commercialisation
• Increasing use
• Wider availability
• Health food stores
• Ethnic shops
• Internet retailers
• Lack of Regulation

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THE MAKING OF MADONNA
India drug gives Alzheimer's hope
EXCLUSIVE MADONNA BABY BID
MADONNA is using old Indian fertility remedies
to try for a third child at the age of 46. She
hopes a stash of Ayurvedic medicines will help
her conceive.
Traditional medicine takes on the world
Source BBC website
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Clinical Toxicology

• Contamination/Incomplete processing/ Adulteration
• Heavy metal poisoning
• Herb-drug interactions
• Genotoxicity
• Teratogenicity

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Case history

• 37 year old man admitted with weakness, dizziness
  and muscle pain. He visited India and had bought
  several Ayurvedic medicines.
• Hb 7.8 g/dl
• Blood lead 58 µg/dl
• Urinary arsenic 24.1 µg/dl/L (normallt20)
• Lead content of Ayurvedic medicine 238 µg/gm .
• Spriewald et al. Occup Environ Med 1999 56
  282-283

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Heavy metal content

• England 1979 30 (11/37) samples of kushtay
• Aslam M et al.Public Health. 197993274-284
• India 1988 64 contain lead and mercury,
• 41 arsenic and 9 cadmium.
• McElvaine MD et al. JAMA. 19902642212-2213
• Boston USA 2003 20 (14/70) of preparations
  contain toxic concentrations of lead, mercury and
  arsenic.
• Saper KB et al.JAMA 2004292 2868-2873.

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Saper et al 2004
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Lead poisoning and anaemia

• Kales SN et al. Med Sci Monit. 200713 295-8

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Contaminant or incomplete processing?

• Vatsanabha (Aconitum sp.)
• Detoxification of aconite (samskaras)
• Crude aconite
• 100 mortality at a dose of 2.6 mg/mouse
• Fully processed aconite
• no mortality at 8x dose crude aconite).
• Thorat S, Dahanukar S. J Postgrad Med. 1991
  37(3)157-9.

• Medicinal properties
• Toxicity well-known
• Detoxification process
• Complex oxidation processes
• Bhasmas (Ash)

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Adulteration/Contamination

• Fake preparations containing steroids
• Organochlorine pesticide residues
• Rai V et al. Environ Monit Assess. 2007(in press)
  

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Herb-drug interactions

• Brahma Rasayana is beneficial for promoting
  mental clarity, improved memory and cognition
  whilst improving resilience to mentally demanding
  lifestyles. Amla (Emblica officinalis),
  Haritaki (Terminalia chebula), Mandukaparni
  (Centella asiatica), Pippali (Piper longum),
  Shankapushpi (Convovulus pluricalis), Plava
  (Cyperus scariosus), Musta (Cyperus rotundus),
  Chandana (Santalum album), Agaru (Aquallaria
  agolcha), Yastimadhu (Glycirrhiza glabra),
  Haridra (Curcuma longa), Vacha (Acorus calamus),
  Nagakeshar (Messua ferrea), Ela (Eletaria
  cardamomum), Twak (Cinnamomum zeylanicum), Bilva
  (Aegle marmelos), Agnimantha (Clerodendrum
  phlomides), Syonaka (Orroxylum indicum), Patala
  (Stereospermum suaveolens), Gambhari (Gmelina
  arborea), Shalaparni (Desmodium gangenticum),
  Brihat (Solanum indicum), Prishniparni (Uraria
  picta), Kantakari (Solanum xanthophylum),
  Gokshura (Tribulus terrestris), Punarnava
  (Boerhaavia diffusa), Mudga parni (Phaseolus
  trilobus), Mashaparni (Teramnus labialis), Bala
  (Sida cordifolia), Eranda (Ricinus communis),
  Jeevanti (Leptatenia reticulate), Shatavari
  (Asparagus racemosus), Shara (Saccharum munja),
  Ikshu (Saccharum officinarum), Kasha (Saccharum
  spontaneum), Darbha (Desmostachya bipinnata),
  Kapikacchu (Mucuna pruriens), Sesame oil, Rock
  sugar, Honey

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Pharmacodynamic interactions

• Sarpaghandha (Rauwolfia serpentina)
• Datura (Datura metal)
• Yavani (Hyoscyamus niger)
• Kapikachchha (Mucuna pruriens)

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Phenytoin/Shankhapuspi Interaction

• Single dose of phenytoin and this herb did not
  alter phenytoin serum levels in rats but
  decreased antiepileptic activity.
• Multiple dose co-administration reduced both
  antiepileptic activity and serum phenytoin
  levels.
• Dandekar et al. J Ethnopharmacol 199235 285-288.

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Ashwagandha and Digoxin Assay

• Ashwagandha
• (Withania somnifera) contains withanolides
  structurally similar to digoxin
• Interferes with both
• FPIA digoxin assay(falsely elevated)
• MEIA digoxin assays (falsely low) .

Dasgupta et al.Am J Clin Path 2005124229-336
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Teratogenicity

• Asparagus racemosus roots
• Teratogenic in rats
• Goel RK et al.Indian J Exp Biol. 2006
  44(7)570-3.
• Lead-containing preparations
• Congenital paralysis and sensorineural deafness

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Genotoxicity

• Birthwort (Isharmul, sunanda)
• Contraceptive
• Aristolochia indica
• Carcinogen banned in Europe and US
• Salacia oblonga roots
• Weak genotoxicity in vitro
• Flammang AM et al.Food Chem Toxicol. 2006
  44(11)1868-74.
• Arsenic-containing preparations
• Skin and haematological cancers

Gold LS. NEJM 2003 349 1576 (letter)
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• All substances are poisons there is none which
  is not a poison. The right dose differentiates a
  poison from a remedy.
• Paracelcus 1493-1541

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Charaka samhita

• Sutra sthana 1/124-127
• Type and dose of the drug as per the
  specification of every individual, if done by a
  physician before the use of the medicine, he
  should be called a quality physician
• If processed and used properly, a deadly poison
  can become a life saving medicine.
• A lifesaving medicine medicine can become poison
  if not used properly
• Rastogi et al. Int J Risk Saf
  Med.200719117-125

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Conclusion

• Ayurvedic medicines contain potent biologically
  active ingredients.
• Risk of heavy metal poisoning
• Regulation of these products desirable.