Clinician Fact Sheet: Review of Herbal Supplements

(Vaccinium macrocarpon Ait. Family: Ericaceae)

1998 Retail Sales: $10,378,810¹

Part Used: Juice and extract from ripe fruit

Intended Indications

Prevention of urinary tract infections

Formulation and Dosage

• 300-400 mg of concentrated cranberry juice extract bid

• 300 ml/d commercial cranberry juice cocktail drink

Adverse Effects

Doses in excess of 3 L/d can produce GI upset and diarrhea; diabetic patients should use sugar-free varieties of cranberry juice; lactating women, children under 12 years, and patients with a history of oxalate stones should limit intake to 1 L/d

Interactions

• No significant interactions have been reported

Contraindications

• No significant contraindications have been reported

• Safety not determined in pregnancy and lactation, but likely safe at food doses

Valerian Root (Valeriana officinalis L. Family: Valerianaceae)

1998 Retail Sales: $8,650,521¹

Part Used: Root

Intended Indications

Anxiety, insomnia, nervousness, stress

Formulation and Dosage

• For anxiety, nervousness, and stress, 2-3 g/d dried valerian root as tea or in capsules up to four times daily

• For chronic insomnia, 600 mg dried aqueous/alcoholic extract standardized from 0.4-0.8% valerenic acid, 1-2 hours before bedtime

• F or full effect in chronic insomnia, take for at least two weeks and preferably four weeks

Adverse Effects

Generally well-tolerated, classified as GRAS for food use, occasional mild morning sedation and headache

Interactions

• Valerian may potentiate other sedatives

• Although valerian does not potentiate the effects of alcohol, it should not be combined with alcohol

Contraindications

• Valerian should not be used concomitantly with other sedatives or alcohol

• Patients should avoid driving and operating machinery for several hours after taking valerian

• Safety not determined in pregnancy and lactation

Evening Primrose (Oenothera biennis L. Family: Onagraceae)

1998 Retail Sales: $8,552,860¹

Part Used: Seed oil from flowers

Intended Indications

Atopic and irritant contact dermatitis, atopic eczema, cardiovascular disease, diabetes-related problems, endometriosis, mastalgia, multiple sclerosis, PMS, rheumatoid arthritis, Sjögren's syndrome

Formulation and Dosage

• Most products contain 300 mg linoleic acid and 40-45 mg essential fatty acid GLA

• 2-4 g/d; the higher doses are reserved for dermatitis, eczema, and rheumatoid arthritis

Adverse Effects

Nausea, indigestion; headaches; softened stools; weight gain is possible if large doses are taken; may effect lipid profile

Interactions

• Evening primrose oil should not be used concomitantly with anticonvulsants because it may lower the seizure threshold

• Avoid in schizophrenic patients taking phenothiazine and epileptogenic drugs as evening primrose may increase the risk of temporal lobe epilepsy

Contraindications

• Avoid in patients taking anticonvulsants

• Safety not determined in pregnancy and lactation, but GLA is secreted into breast milk

Bilberry (Vaccinium myrtillus L. Family: Ericaceae)

1998 Retail Sales: $6,441,501¹

Part Used: Extract of dried fruit and dried leaf

Intended Indications

Extract of dried bilberry fruit may promote healthy vision, increase visual pigment regeneration, treat diarrhea in children, and protect human LDL against oxidative injury, presumably by scavenging free radicals; bilberry leaf is frequently used in conjunction with diabetes, arthritis, gout, dermatitis, and hemorrhoids

Formulation and Dosage

• 80-160 mg fruit extract tid

• Standardized to contain 25% anthocyanosides

• Dosage recommendations for bilberry leaf are not provided because of lack of efficacy information

Adverse Effects

Chronic ingestion or higher doses of bilberry leaf in animals has resulted in cachexia, anemia, icterus, excitation, and death

Interactions

• No significant interactions have been reported with bilberry fruit extract

• Theoretically, bilberry leaf might lower serum triglyceride and blood glucose levels; dosing adjustments may be necessary if used concomitantly with antidiabetes drugs

Contraindications

• S afety 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.

McGuffin M, et al. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press; 1997.

McDermott JH. Herbal Chart for Health Care Professionals. American Pharmaceutical Association; 1999.

Natural Medicines Comprehensive Database. Stockton, CA: Therapeutic Research Center, Inc.

PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co.; 1998.

Schulz V, et al. Rational Phytotherapy. 3rd ed. Berlin: Springer-Verlag; 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.