Clinician Fact Sheet: Review of Herbal Supplements
February 1, 2000
Clinician Fact Sheet: Review of Herbal Supplements
Echinacea (Echinacea angustifolia DC; Echinacea pallida Nutt.; Echinacea purpurea L. Family: Asteraceae/Compositae)
1998 Retail Sales: $69,702,1441
Part Used: Root or aerial (pallida) parts
Intended Indications
Colds, immune system stimulant, influenza, minor external infections, upper respiratory tract infections (URTIs), urogenital infections, topical wound healing, adjunctive for colorectal cancer patients
Formulation and Dosage
-For short-term, acute use
-Fluid extract (1:1): 1-2 ml (1/4-1/2 teaspoonful) tid
-Dried root or solid extract (6:5:1): 300 mg tid
-Tincture (1:5) 45% alcohol (1/4-1/2 teaspoonful) tid
-Apply cream or liquid tid
-Preparations vary widely
Adverse Effects
Transient, tingling sensation on tongue, cross-sensitivity in patients allergic to the daisy family (chamomile, chrysanthemums, feverfew, and ragweed), GI upset, diarrhea
Interactions
-Echinacea should not be administered with immunosuppressant therapies
Contraindications
-Echinacea is not recommended by some authorities for patients with autoimmune diseases, AIDS, or leukemia because of T-cell and macrophage stimulation
-Safety not determined in pregnancy and lactation
Saw Palmetto
(Serenoa repens Bartr. Family: Arecaceae Palmae)1998 Retail Sales: $32,102,6221
Part Used: Berry extract
Intended Indications
Benign prostatic hyperplasia/hypertrophy
Formulation and Dosage
-160 mg bid of standardized fat-soluble saw palmetto extract containing 80-95% fatty acids and sterols
Adverse Effects
Generally well tolerated, occasional headache, mild abdominal pain, nausea, diarrhea, dizziness; there is no known effect on PSA
Interactions
-None known
Contraindications
-Saw palmetto should be avoided during pregnancy and lactation
-Saw palmetto should be avoided in patients with breast cancer
Kava Kava
(Piper methysticum Forest. Family: Piperaceae)1998 Retail Sales: $16,584,4251
Part Used: Rhizome and roots
Intended Indications
Anxiety, insomnia, restlessness, stress
Formulation and Dosage
-As an anxiolytic, 45-70 mg tid
-As a sedative, 180-210 mg, 1 hour before bedtime
-Product standardized to 30-55% kavalactones
Adverse Effects
GI upset, allergic reactions, dizziness, scaly rash, red eyes, puffy face, marked muscle relaxation, and long-term, chronic use may cause kava dermopathy
Interactions
-Kava may have additive effects with other muscle relaxants, sedatives, antianxiety agents, and antidepressants
-Alcohol should not be consumed concomitantly
Contraindications
-Avoid in endogenous depression
-May adversely affect motor reflexes and judgment and should be avoided if required to operate a car or machinery
-Safety not determined in pregnancy and lactation
Grape Seed Extract
(Vitis vinifera L. and Vitis Coignetiae. Family: Vitaceae)1998 Retail Sales: $12,113,5551
Part Used: Seeds, skin, oil from ground seeds
Intended Indications
Anti-enzyme nutritional supplement, atherosclerosis, causes endothelium-dependent vasorelaxation, inhibits LDL-oxidation, inhibits tooth decay, raises serum antioxidant capacity, reduces HDL-cholesterol levels, reduces platelet aggregation
Formulation and Dosage
-Freeze-dried extract contains 75-85% procyanidins, mixed with other flavonoids and organic acids
-Tablets or capsules containing 150 mg extract bid
-Red wine contains about 1 g polyphenols/liter
Adverse Effects
None documented. However caution should be exercised before recommending use in smokers given the harmful effects found among smokers taking beta- carotene; hepatoxicity has been shown in mice
Interactions
-None documented
Contraindications
- Safety not determined in pregnancy and lactation
References
1. Blumenthal M. Herb market levels after five years of boom. HerbalGram 1999;47:64-65.
Additional Resources
Alternative Medicine Alert. Atlanta, GA: American Health Consultants; 1998;1:1-144; 1999;2:1-144.
McDermott JH. Herbal Chart for Health Care Professionals. American Pharmaceutical Association; 1999.
PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co.; 1998.
The Review of Natural Products. St. Louis, MO: Facts and Comparisons.
Foster S, Tyler VE. Tyler's Honest Herbal. 4th ed. Binghamton, NY: The Haworth Herbal Press; 1999.