Clinician's Pocket Drug Reference 2008

NATURAL and HERBAL AGENTSThe following is a guide to some common herbal products. These may be sold separatelyor in combination with other products. According to the FDA: “Manufacturersof dietary supplements can make claims about how their products affect thestructure or function of the body, but they may not claim to prevent, treat, cure,mitigate, or diagnose a disease without prior FDA approval”.Black Cohosh Uses: Sx of menopause (eg, hot flashes), PMS, hypercholesterolemia,peripheral arterial Dz; has anti-inflammatory & sedative effects Efficacy:May have short-term benefit on menopausal Sx Dose: 20–40 mg twice dailyCaution: May further ↓ lipids &/or BP w/ prescription meds Contra: PRG (miscarriage,prematurity reports); lactation SE: w/OD, N/V, dizziness, nervous system& visual changes, bradycardia, & (possibly) Szs, liver damage/failureChamomile Uses: Antispasmodic, sedative, anti-inflammatory, astringent,antibacterial. Dose: 10–15 g PO daily (3 g dried flower heads tid–qid betweenmeals; can steep in 250 mL hot H 2 O) Caution: w/ allergy to chrysanthemums, ragweed,asters (family Compositae) SE: Contact dermatitis; allergy, anaphylaxis Interactions:w/ anticoagulants, additive w/ sedatives (benzodiazepines); delayed ↓gastric absorption of meds if taken together (↓ GI motility)Cranberry (Vaccinium macrocarpon) Uses: Prevention & Rx UTI.Efficacy: Possibly effective Dose: 300–400 mg twice daily or 6 oz. juice QIDTincture 1 ⁄2–1 tsp up to 3x/day, tea 2–3 tsps of dried flowers per cup; creams-applytopically 2–3 to 3 × s/day PO Caution: May ↑ kidney stones in some susceptibleindividuals, V SE: None known Interactions: None significantDong Quai (Angelica polymorpha, sinensis) Uses: Uterine stimulant;anemia, menstrual cramps, irregular menses, & menopausal Sx; anti-inflammatory,vasodilator, CNS stimulant, immunosuppressant, analgesic, antipyretic,antiasthmatic Efficacy: Possibly effective for menopausal Sx Dose: 3–15 gm daily,9–12 g PO tab bid. Caution: Avoid in PRG & lactation. SE: D, photosens, skincancer. Interactions: Anticoagulants (↑ INR w/warfarin).Echinacea (Echinacea purpurea) Uses: Immune system stimulant;prevention/Rx URI of colds, flu; supportive care in chronic infections of theresp/lower urinary tract Efficacy: Not established; may ↓ severity & duration ofURI Dose: Cap 500 mg, 6–9 mL expressed juice or 2–5 g dried root PO Caution:Do not use w/ progressive systemic or immune Dzs (eg, TB, collagen–vascular dis-(Adapted from Haist SA and Robbins JB: Internal Medicine on Call, 4th ed., 2005McGraw-Hill).217Copyright © 2008 by Leonard G. Gomella. Click here for terms of use.