Clinician's Pocket Drug Reference 2008

Melatonin 219tablets or capsules or fresh cut ginger in doses of 1–4 gms daily by mouth, dividedinto smaller dosesGinkgo Biloba Uses: Memory deficits, dementia, anxiety, improvement Sxperipheral vascular Dz, vertigo, tinnitus, asthma/bronchospasm, antioxidant, premenstrualSx (especially breast tenderness), impotence, SSRI-induced sexual dysfunctionDose: 60–80 mg standardized dry extract PO bid–tid Efficacy: Smallcognition benefit w/ dementia; no other demonstrated benefit in healthy adultsCaution: ↑ Bleeding risk (antagonism of plt-activating factor), concerning w/ antiplateletagents (D/C 3 d preop); reports of ↑ Sz risk SE: GI upset, HA, dizziness,heart palpitations, rash Interactions: ASA, salicylates, warfarinGinseng Uses: “Energy booster” general; also for pt undergoing chemo, stressreduction, enhance brain activity & physical endurance (adaptogenic), antioxidant,aid to control type 2 DM; Panax ginseng being studied for E.D. Efficacy: Not establishedDose: 1–2 g of root or 100–300 mg of extract (7% ginsenosides) PO TIDCaution: w/ cardiac Dz, DM, ↓ BP, HTN, mania, schizophrenia, w/ corticosteroids;avoid in PRG; D/C 7 d preop (bleeding risk) SE: Controversial “ginsengabuse synd” w/ high dose (nervousness, excitation, HA, insomnia); palpitations,vaginal bleeding, breast nodules, hypoglycemia Interactions: Warfarin, antidepressants& caffeine (↑ stimulant effect), DM meds (↑ hypoglycemia)Glucosamine Sulfate (Chitosamine) and Chondroitin SulfateUses: Osteoarthritis (glucosamine: rate-limiting step in glycosaminoglycan synth),↑ cartilage rebuilding; chondroitin: biological polymer, flexible matrix betweenprotein filaments in cartilage; draws fluids/nutrients into joint, “shock absorption”)Efficacy: Controversial Dose: Glucosamine 500 PO tid, chondroitin 400 mg POtid Caution: Many forms come from shellfish, so avoid if have shellfish allergySE: ↑ Insulin resistance in DM; concentrated in cartilage, theoretically unlikely tocause toxic/teratogenic effects Interactions: Glucosamine: None. Chondroitin:Monitor anticoagulant therapyKava Kava (Kava Kava Root Extract, Piper methysticum)Uses: Anxiety, stress, restlessness, insomnia Efficacy: Possible mild anxiolyticDose: Standardized extract (70% kavalactones) 100 mg PO bid–tid Caution: Hepatotoxrisk, banned in Europe/Canada. Not OK in PRG, lactation. D/C 24 h preop(may ↑ sedative effect of anesthetics) SE: Mild GI disturbances; rare allergicskin/rash rxns, may ↑ cholesterol; ↑ LFT /jaundice; vision changes, red eyes, puffyface, muscle weakness Interactions: Avoid w/ sedatives, alcohol, stimulants, barbiturates(may potentiate CNS effect)Melatonin Uses: Insomnia, jet lag, antioxidant, immunostimulant Efficacy:Sedation most pronounced w/ elderly patients with ↑ endogenous melatonin levels;some evidence for jet lag Dose: 1–3 mg 20 min before HS (w/ CR 2 h before hs)Caution: Use synthetic rather than animal pineal gland, “heavy head,” HA, depression,daytime sedation, dizziness Interactions: β-blockers, steroids, NSAIDs, benzodiazepines