Product Catalog 2017/18 - promedics.ca CA PRODUCT...Gymnema tablets 42 ... time of harvest,...

Product Catalog 2017/18Quality is our passion

2 MediHerb Product Catalog 2017/18 • Our philosophy

“MediHerb was born out of my desire for efficacious herbal therapy. This continues to underpin every aspect of our company from raw material sourcing, manufacturing, quality assurance and research through to our world-class education programs.”

PROFESSOR KERRY BONE MEDIHERB CO-FOUNDER AND DIRECTOR OF RESEARCH & DEVELOPMENT

MediHerb Product Catalog 2017/18 1

Table of Contents

Product InformationAdrenoCo tablets 23

Andrographis Complex tablets 24

Astragalus Complex tablets 25

Bacopa Complex tablets 26

Bilberry tablets 27

Boswellia Complex tablets 28

Cascara Complex tablets 29

Chaste Tree tablets 30

Chaste Tree 1:2 liquid extract 31

Cranberry Complex tablets 32

DiGest Forte tablets 33

Echinacea Premium tablets 34

Echinacea Premium Blend 1:2 liquid extract 35

FemCo tablets 38

Garlic tablets 39

Ginkgo Forte tablets 40

Golden Seal tablets 41

Gymnema tablets 42

Horsechestnut Complex tablets 43

Kava Forte tablets 44

Licorice High Grade 1:1 liquid extract 45

LivCo tablets 46

Livton Complex tablets 47

Nevaton Forte tablets 48

Rehmannia Complex tablets 49

Rhodiola & Ginseng tablets 50

Silymarin tablets 52

Sinus Forte tablets 53

Slippery Elm 400mg capsules 54

St John’s Wort tablets 55

Tribulus Forte tablets 56

Valerian Complex tablets 57

Vitanox tablets 59

Wild Yam Complex tablets 60

Withania 2:1 liquid extract 62

Withania Complex tablets 63

IndexesExcipient Glossary 67

Index of Herb Botanical Names 74

Index of Herb Common Names 73

Ingredient Index 70

ResourcesCore Products & Body Systems 18

Text Books 68

Herb/Drug Interaction Chart 75

How to Order & Account Information 101

MediHerb Philosophy 3

Practitioner Resources 65

2 MediHerb Product Catalog 2017

Our philosophy • MediHerb Product Catalog 2017/18 3

How we go beyond The MediHerb Philosophy “MediHerb was born out of my desire for efficacious herbal therapy. This continues to underpin every aspect of our company from raw material sourcing, manufacturing, quality assurance and research through to our world-class education programs.”

Professor Kerry Bone, MediHerb Co-Founder and Director of Research and Development

At MediHerb we have redefined quality in natural medicines and our commitment to exceeding this means we are the first choice for many health care professionals in Canada, Australia, USA, New Zealand, South Africa and the United Kingdom. We have engaged the right mix of passionate people to meet the challenge of addressing quality and understanding the key phytochemicals in each herb and how they work in the body in a complex, interactive way. It is a philosophy that we have always stood by, remains integral to our future focus, and is always supported by our values and commitments.

MediHerb is extremely proud to partner with ProMedics as our exclusive Canadian distributor for the MediHerb line of quality herbal products. With a mutual commitment to product quality, a strictly monitored manufacturing process and rigorous product testing, ProMedics mirrors our devotion to providing solutions for good health. Like us, ProMedics also recognizes the importance of patient education, and that is why our products are available exclusively through qualified health care professionals. Together we strive to uphold our belief that whole food supplements and herbal products are natural complements for optimal health.

Exclusive Canadian Distributor for MediHerb®


Our valuesWe proudly come to work every day to provide high-quality treatment solutions that deliver on the needs of our patients and yours. We are continually motivated and energized to help empower people to be healthier in the most natural way. This is emphasized through our knowledge, our relationships and our vision.

Our knowledge From discovering adulteration in Skullcap raw materials and developing a method to identify the correct species, to undertaking research with herb growers and agronomists for the best growing, harvesting and drying requirements for herbs; we are always investing in our knowledge base to share the latest developments with the industry in our quest for quality, safety and efficacy. We are a team of practicing natural health care professionals and scientists whose thought leadership has seen us partner with like-minded groups to drive herbal research, innovation, authenticity and safety.

Our relationshipsThe long-term relationships we have fostered with reputable growers ensure we always obtain optimal quality materials. Since the beginning, we have actively supported herb growers, and provide them with technical support and information on varietal selection, climatic and soil requirements, time of harvest, harvesting techniques, drying parameters, storage requirements, post-drying and feedback on herb quality. In addition, we collaborate closely on groundbreaking research projects to support our quest for quality, safety and efficacy. Our research partners (current and past) are part of leading Australian and international institutions, including the University of Queensland, Griffith University, Southern Cross University, the University of New England, Swinburne University of Technology, the University of Western Sydney, the University of Wisconsin, Oregon Health and Science University, the University of Pisa and the University of Modena and Reggio Emilia.

Our visionMediHerb was established by practitioners for practitioners, and from day one we have been passionate about investing in the future of natural medicine and delivering innovative health care solutions. We will continue to facilitate the mainstream acceptance of the professional natural medicine industry as a significant contributor to health globally. We are excited about the discoveries to come and to continue to advance knowledge and excellence through the latest scientific evidence and centuries of traditional wisdom. Most of all, we look forward to continuing to partner with you, our network of passionate practitioners, to give your patients natural health care solutions that work and make a difference in their lives.


Our commitmentMediHerb was co-founded in 1986 by Professor Kerry Bone; one of the world’s most inspiring herbal practitioners, scientists and academics whose reputation is cemented by his significant contribution to education, research and advocacy for the profession.

Today the genuine passion of our team continually upholds the values and commitment of our founder and drives our benchmark of quality, safety and efficacy in natural health care. This is supported by our focus to combine the time-honored wisdom of traditional knowledge with sound clinical experience, the rigor of scientific research and power of education to ensure we continue to deliver unparalleled quality in our products.

Every day patients worldwide will experience the MediHerb way in natural health—our unique manufacturing processes, unrivaled testing regimes, focus on research; and commitment to our practitioners, growers and suppliers; herb sourcing expertise, clinical formulations and of course, the passion of our people.

To qualityOur unique approach to quality is unsurpassed in the world today. It is paramount to everything we do and evident across our entire business. Herbal products in Australia are regulated by the Australian government’s Therapeutic Goods Administration (TGA), a body similar to Health Canada.

At MediHerb, we rigorously source and test all raw materials in our TGA-certified laboratories, and research and develop herb active constituents and therapeutic applications. Our unique manufacturing and extraction processes are revolutionary while our unique “Quantified Activity” (QA) system ensures consistent quality extracts with guaranteed minimum levels of active constituents. Only when all quality aspects of raw materials are confirmed does the manufacturing process begin.

Skullcap: championing authenticity in herbsOur stringent testing regimes are renowned for guarding against substitution of species, adulteration of herbs and poor quality. It is of paramount importance to us that the herbs approved for use in MediHerb products are of the correct species and plant part, have the legitimate active constituent profile and are free from contamination. Due to our rigorous testing processes, we have found many issues relating to quality over the years.

One of our most notable discoveries was the substitution of Scutellaria lateriflora (Skullcap) with other Scutellaria spp. and Teucrium spp. We also identified that the substitution of Stephania tetrandra by Aristolochia spp. has the potential to cause kidney failure. Amongst many other examples we also found that Crataegus monogyna (Hawthorn), Vitex agnus-castus (Chaste Tree) and Turnera diffusa (Damiana) extracts were adulterated with rutin, and samples of Vaccinium myrtillus (Bilberry) contained a coloring agent used to imitate anthocyanins (the compounds responsible for the ripe blue color of the berries).

Bilberry: changing global safety standardsIn 2003, we received samples of Vaccinium myrtillus (Bilberry fruit extracts), which showed differing behaviors. Using the industry standard method (spectrophotometric assay) to determine the anthocyanin (color quality marker) content, we found that two extracts had 25% levels as claimed by the manufacturers, but when we applied our high-performance liquid chromatography (HPLC) testing, one extract was found to contain just 9%.

Further testing identified the addition of an adulterant—amaranth, which is a synthetic dark red dye. The testing also revealed that when deliberate adulteration occurs in an extract, a spectrophotometric assay is inadequate to accurately determine the levels of compounds such as anthocyanins. One of our proudest achievements is that this work was published and led to a change in global regulatory testing standards for Bilberry.

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To safetySafety is paramount in every aspect of our operations and stringent testing regimes to guard against substitution, adulteration and poor quality. Our quality assurance process may test herbs for species identity, plant part, color, aroma, texture, content of specified actives, microbial levels, amount of extraneous matter, pesticides and herbicides, heavy metals and aflatoxins. Strict standards are predetermined to ensure only quality materials from reputable sources are used and every ingredient goes through thorough assessment for safety and toxicology.

To efficacyAs practicing health care professionals ourselves, we fully understand the necessity for efficacious products that meet a genuine health need. This is reflected by our diligence towards research and ability to select herbs phytochemically as nature intended. Based on the latest credible evidence, our team of naturopaths, scientists and herbal experts carefully collaborate to formulate every product with the highest quality ingredients. We are committed to the development of efficacious herbal therapies with a focus on meeting patient needs, validating the efficacy of herbal formulas through researching published clinical trials and in vitro research and researching the phytochemistry of medicinal plants. By combining phytochemical, biochemical, clinical and traditional herbal knowledge, we can continue to produce high-quality products to meet changing health care needs.

See diagram on page 7

Our commitment

Echinacea: the MediHerb “Quantified Activity” (QA) ProgramOur QA program is unique to MediHerb and uses the latest research and clinical experience underpinned by batch consistency to define stringent guidelines to produce consistent quality extracts with guaranteed minimum levels of active constituents. To date we have quantified the activity of over 70 herbs through this program—a world first.

Representing the most up-to-date scientific knowledge available, the process of developing QA extracts is complex, however, once constituents are selected and QA levels are set, we focus on ensuring the supply of consistent quality raw materials and the retention of the constituents throughout the manufacturing process. QA extracts are carefully selected whole herbs manufactured using our 1:2 Cold Percolation process to contain the active constituents from the raw herb. Our program links together all possible parameters that can affect product and extract quality, guaranteeing a high quality, efficacious extract every time.

Our commitment to guarantee supply of authentic Echinacea led to the development of our QA program, as the herb was suffering from global confusion over what constituted authentic Echinacea. This was due to another herb’s uncanny physical root similarity. We adopted sophisticated analyses to compare Echinacea’s chemical fingerprint with a certified reference sample from the correct species. We also investigated methods to quantify the herb’s alkylamides and other important compounds, resulting in our high performance liquid chromatography (HPLC) methodology. Armed with these stringent testing processes, we worked with Echinacea growers to determine appropriate growing conditions and handling parameters, and internally we established protocols to ensure optimum retention and stability of alkylamides during all phases of the production process. This allowed us to establish our standard for acceptance of Echinacea raw material based on alkylamide content.

Not for public distribution. For professional use only. Our philosophy • MediHerb Product Catalog 2017/18 7

MediHerb’s unique tableting process when using our liquid extracts

Bottled for saleTotal process takes

1 month

Herb

Granulation

Milled to tiny granules

and mixed with hypoallergenic tablet excipients

Tablet punch

Presses tablet and either hypromellose coating or enteric coating is applied

Low temperature

Vacuum oven

Low temperature

Vacuum concentrator

Turns liquid extract into concentrate and removes ethanol. This process ensures no damage to the

delicate active constituents

Liquid extract

1:2 proprietary Cold Percolation

Quality control analysisAs per quality chart on page 10




Pass

Pass

Pass

Pass

Fail

Fail

Fail

Fail

Reject

Reject

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Reject

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To manufacturingAfter testing, all herbs are transferred to our temperature-controlled warehouse to preserve the herbs before undertaking our unique 1:2 Cold Percolation manufacturing process. Extensive scientific testing proves that this is unlike any other herbal extraction method and is the benchmark for producing the highest quality extracts using no heat or concentration. It ensures herbal constituents remain intact with only ethanol or purified water (and occasionally glycerol).

Each liquid variety is processed using specific ethanol percentages for optimum extraction. Our extraction equipment is built from stainless steel, and we use pharmaceutical-grade filtering units. All process water is purified by reverse osmosis, and our experience with developing specific ethanol percentages for each herb helps us maximize quality. Our internal benchmarks for each herb must be met or exceeded for acceptance into manufacturing.

Our unique tablet manufacturing process also uses our 1:2 Cold Percolation liquid extracts to ensure potency equivalent to the original galenical liquid extract. It has also been subject to extensive research and development to ensure that the finished tablet is as efficacious as the liquid extract, and that the full phytochemical profile has been retained.


To testingHerbs are naturally complex and not all are grown, harvested, dried or stored in the same way. We use the latest technology, invest in the best equipment, and employ and train the best scientific talent who understand the complexities of phytochemistry in order to undertake highly detailed testing throughout all stages of the sourcing and manufacturing process. This guarantees validation of species and plant parts and efficacy of active ingredients and phytochemical profiles. Our tests include:

High Performance Thin Layer Chromatography (HPTLC) is a high resolution thin layer chromatography separation technique where liquid extract is precisely spotted onto a high-resolution silica gel plate and exposed to solvent to separate the extract into a series of molecules characteristic to the plant based on sample interactions with the plate and the solvent. HPTLC is the next generation of thin layer chromatography (TLC) as it is quicker and more sensitive. This means that the separation provides more detailed information allowing lower levels of adulteration to be detected. HPTLC may also be able to quantify compounds whereas TLC can only identify presence. HPTLC also features an auto sampler to eliminate any variation from different technicians setting up the sampling manually, which can happen under the TLC process.

Gas Chromatography (GC) is a separation technique performed in the gas phase for volatile components such as essential oils. Samples can be introduced either as a liquid or a gas (headspace injector) using an inert carrier gas into a hot injector block. The volatilized constituents then pass onto a heated capillary column separating the gaseous constituents based predominately on their boiling point and the interaction with the column chemistry. The constituents are moved into a flame and the resultant by-products pass through electrodes to generate a signal (detection can also be done by Mass Spectrometry).

Our commitment

Tableting: benchmarking qualityOur research has proven that the optimal method of herb processing for tableting involves the evaporation of the ethanol and water at low temperatures under vacuum. This important step minimizes the exposure of the delicate chemicals in the herbal matrix to the damaging effects of heat and oxidation.

Our tableting process takes this one step further to actually specify the optimal parameters employed during the evaporation and drying processes for each of the active constituents of the final tablet. As with our liquid herbal extracts, our tablets are manufactured to pharmaceutical standards. Each batch is tested for disintegration, friability, weight uniformity and for active constituents (if applicable). Our tablets are required by the TGA to disintegrate in less than 30 minutes for maximum efficacy.


Ultra High Performance Liquid Chromatography (UHPLC) is a separation technique performed in the liquid phase. Liquid samples are injected into a solvent stream under high pressure at an extremely rapid flow rate, which is carried onto a high resolution packed column and separated into individual constituents based on the interaction between the solvent and column chemistry. Constituents are detected and quantified by Photo-Diode Array (PDA), which measures the absorption spectrum of each chemical constituent at an extremely rapid acquisition rate (Mass Spectrometry can also be used). UHPLC offers a three times higher pressure rate than HPLC and is much faster and more sensitive. Notably, it allows us to gain more detailed information about the breakdown of various peaks and marker compounds for a more accurate identification. In addition, the use of less solvent is a great environmental benefit. UHPLC allows us to establish our own test methods for compounds creating a greater understanding of phytochemistry.

Mass Spectrometry (MS) is an extremely specific and sensitive technique that volatilizes, ionizes and filters molecules in complex mixtures. It can be used to identify molecular weights of molecules or for quantification purposes. They can be connected to most separation techniques to detect the eluting molecules from the column. MS is used routinely with GS and UHPLC testing.

Ultraviolet/Visible Detector (UV-vis) is a quantitative technique that exposes the sample to light and measures how the molecule interacts in the Ultraviolet/Visible region (electron excitation spectra). It can also be useful in elucidating molecular structure and can be attached to a UHPLC as a detection technique (i.e. photo diode array). UV-vis is a sensitive technique used to measure the spectrum of each phytochemical as it passes the detector (diode array) and depending on the herb being tested, is connected to UHPLC.

Fourier Transform Infrared Spectrometry (FTIR) is an identification technique that exposes the sample to light and measures how the molecule interacts in the infrared region (molecule vibrational spectra). This testing is useful in elucidating molecular structural information by identifying samples and quantification. FTIR is the next generation UV-vis. It is more sensitive and more detailed and useful for delivering unknown compounds as it gives detailed information about the functional groups attached to the molecule.

We hold all our suppliers to our benchmark testing standards, and before any herb is purchased, we analyze a batch sample to ensure compliance with our strict quality criteria. The purchased batch is also sampled and subjected to the same battery of tests. Only if the herb passes this second set of tests is the batch accepted into the factory for further processing. Our stringent testing processes reveal any quality issues from substitution of species to adulteration or simply a poor quality plant. All herbs approved for use in our products are the correct species, plant part, active constituent profile and are free from contamination.


Golden Seal: identifying substitution issuesGolden Seal (Hydrastis canadensis) is very expensive and has always been in short supply; thus it is commonly substituted with cheaper herbs that greatly affect efficacy. These cheaper species do not contain hydrastine; rather they contain only berberine and berberine-related compounds. They do, however, produce an extract of the same color as Golden Seal. Berberine is a potent antibacterial agent, but it is the hydrastine that is believed responsible for the unique trophorestorative effects of Golden Seal upon mucous membranes.

Similarly, the hair roots of Golden Seal, which have lower levels of hydrastine than the rhizome, are sold as the root and rhizome, which provides lower efficacy. The presence of hydrastine and the differentiation of adulterants are easily determined by UHPLC, and, therefore, we only purchase cultivated Golden Seal as it is now considered endangered.

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MediHerb quality assured sourcing of herbs

Raw material is sourced from quality herb suppliers worldwide

Pre-shipment sample requested

Samples sent to lab for:

Identification (HPTLC fingerprint)

Validation (species, plant part)

Efficacy (actives, phytochemical profile)

High Performance Thin Layer Chromatography (HPTLC):

The liquid extract is spotted onto a silica gel plate which is then placed into a trough containing solvent. The solvent then separates the extract into a series of bands (phytochemicals) characteristic to the plant

Order arrives

Quarantined samples taken

Chromatography

Method used to separate the phytochemicals in a herbal extract into individual components

To Lab: All QA procedures detailed above are repeated on the purchased batch samples

Mass Spectrometry (MS)

Method used to separate the phytochemicals in an herbal extract into individual components

Order is placed ONLY IF the above quality criteria have been met

Also tested for:

Macro/microscopic analysis

Pesticides/heavy metals/radiation

Aflatoxins

Microbial levels

Gas Chromatography (GC):

This method works only for volatile chemicals. The herbal extract is inserted into a hot injector block and the volatile constituents pass onto the heated column which separates the constituents based on their boiling point. The existing chemicals are then burnt in a flame and the resultant electric signal is detected

When, and only when, all aspects of quality control of the raw material are confirmed, will the manufacture of MediHerb products begin. A herb is sent back if it does not comply

Ultra High Performance Liquid Chromatography (UHPLC):

The herbal extract is injected into a liquid stream which is carried onto a column and separated into its various constituents. These are then detected when they exit the column. Normally a Photo-Diode Array (PDA) measures the absorption spectrum of each chemical constituent. However, not all constituents can be seen by PDA and therefore Evaporative Light Scattering Detection (ELSD), Fourier Transform Infrared Spectrometry (FTIR) and Mass Spectrometry (MS) are also used to detect compounds such as saponins


Bottled for sale

Cool room storage of herbs for quality assurance Minimizes degradation of actives, control of insects, ideal storage

condition for raw materials whose actives can degrade

Raw material milled under cryogenic conditions so no heat can affect the phytochemicals

Liquid extracts The majority of our liquid extracts are made as 1:2 liquid extracts as this is the most effective method toextract the full phytochemical profile in a convenient dosage unit. However we also make liquid extracts

with other ratios depending on the optimum extraction of the individual herb

Proprietary Cold Percolation A unique slow process over 7–10 days known ONLY to MediHerb, developed by Kerry Bone,

to extract the full spectrum of compounds of the herb without causing damage or degradation

Samples sent to the QA Laboratory where they are analyzed for phytochemical profile, level of actives,consistency, verification of original herb with no deterioration or degradation. This is the third round of

testing performed. When the extract meets all criteria

MediHerb manufacturing processes & quality control for herbs

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To researchWe are a global leader in herbal scientific knowledge and often partner on research projects to advance quality and efficacy with reputable establishments. Our outstanding team of scientists and health care professionals drive our research, development and quality control practices. We also collaborate with health care professionals for real-time patient feedback. Significant innovations include our revolutionary process of manufacturing herbal tablets from liquid extracts and 1:2 Cold Percolation manufacturing process. Our Research and Development team combine experience in food and herbal products, university research, drug analysis in hospitals, pharmaceuticals, quality assurance, technical writing, clinical nutrition and work in situ with our own herbalists and naturopaths, along with a board of leading American, Australian and other international herbalists. This ensures we can combine the best of science, traditional knowledge and current clinical knowledge to produce the most therapeutic herbal and nutritional solutions.

To innovationInnovation is the lifeblood of our business and supports our culture of excellence. We undertake a rigorous new product development process to ensure that appropriate steps are undertaken when investigating the introduction of a new product. This allows us to develop a shortlist of key herbs that are then subjected to closer analysis. This involves detailed examination of the clinical outcomes, phytochemistry and biological activity, analytical methodology, continuity of supply, economic sustainability, synergy of the final formula, cost to the patient and practicality of final dose formulation. Once the prototype formulation is agreed upon, we may then undertake a human feedback trial to prove the efficacy and safety of the product and regularly supply product to support other industry research projects.

Echinacea: the landmark research projectThe most well-known herbal support for the immune system is Echinacea, yet it is both misunderstood and underestimated. There are many Echinacea products available, which differ according to plant species, plant part (root, leaves, seeds or a combination), quality markers and dosage. In 2003, MediHerb began an extensive research project designed to identify the bioavailable components of Echinacea Premium and how they exert an effect on the immune system. MediHerb’s research results made a substantial contribution to a new understanding of lipophilic extracts of Echinacea, which conclude that alkylamides must be used as the markers of quality and activity, the root of Echinacea is the preferred plant part given its high levels of alkylamides and the preferred species of Echinacea are E. angustifolia and E. purpurea since they contain high levels of alkylamides. In addition, our research has proven that Echinacea must be extracted using an alcohol percentage sufficiently high to efficiently extract the alkylamides.*

Saligesic and Cramplex: working together on clinical feedback trialsOur clinical feedback trials involve our network of health care professionals in the development and validation of new products prior to launch. By working together, we are able to gather valid clinical data in a timely and cost-effective manner. Feedback trials completed for Saligesic (a highly potent Willow Bark product for exercise-related lower back pain) and Cramplex (a formulated product for the relief of premenstrual pain) prior to their launch helped us clearly demonstrate their efficacy.*

Prior to trial

First menstrual

cycle

Second menstrual

cycle

Background Pain

Intervention Usage

8

7

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2

1

0

Worst Pain

Cramplex Feedback Trial Results

0 week 3 week 6 week

15

12

9

6

3

0

Saligesic Feedback Trial Results

Our commitment


To professional medicineWe are committed to actively support natural health care professionals and passionately advocate for quality, efficacy and safety to benchmark natural medicines to the highest of standards. In particular, our founder, Kerry Bone, was integral in establishing professional standards of the industry, including leading MediHerb’s discovery of the adulteration of a commonly available Bilberry extract—the catalyst for a global change in testing regulations. We invest significantly in our profession by funding clinical trials. Our reputation for scientific knowledge means we often collaborate on projects investigating herbal therapies, so we apply stringent criteria to assess viability. The trial must fit with our philosophy of superior quality, innovative, and holistic herbal solutions, and must be conducted at a reputable research establishment. We do not fund or involve ourselves with research that utilizes animals as human models. As practicing clinicians, we also regularly conduct professional seminars for health care professionals and are dedicated to being a key source of knowledge for the natural health care profession. Through our website, mediherb.com we also provide extensive clinic and reference tools, library resources and webinars.

To ingredients We handle and process raw materials with the utmost of care. As the largest purchaser and processing plant of herbs in Australia, we assist growers with support on varietal selection, climatic and soil requirements, time of harvest, harvesting techniques, drying parameters and storage requirements. Where possible, we source organically grown and wild-crafted herbs, including internationally where conditions and handling requirements are the optimum. For example, Cat’s Claw from Peru. We work with growers to help cultivate endangered species and our unique system of identifying and classifying any threat allows us to immediately find alternatives or reduce that threat. Our commitment to efficacy has also uncovered examples of substitution including Echinacea, commercial Wild Yam, Cat’s Claw and Golden Seal. If any herb does not meet our standards, we go out of stock rather than supply an inferior product, so you can always be confident in consistent results with patients from batch to batch.

Wild Yam: identifying quality issuesThere are around 600 species of Yam, many of them wild species that flourish in damp woodlands and thickets. Dioscorea villosa (also known as Colic Root or Wild Yam) is a twining, tuberous vine native to eastern North America. The roots initially taste starchy, but soon after are bitter and acrid—nothing like the taste of Yam or Sweet Potato. Commercial Wild Yam extracts available for use as raw materials are often from Dioscorea opposita (Chinese Yam Root), which has a different phytochemical profile. It is widely misconstrued that Dioscorea villosa contains diosgenin and many products have this as a statement on their labels. However it does not contain diosgenin, but rather the diosgenin precursors. Unfortunately, the phytochemical profile of Wild Yam is poorly defined and based on outdated scientific literature, so we undertook a project in conjunction with Associate Professor James De Voss from the University of Queensland Australia to investigate its phytochemistry.

Commercially available Dioscorea villosa is in the form of dried roots, usually harvested at the end of summer or fall when the plant is dying back to its rootstock. It was found that these roots contained only very small amounts of dioscin, not the predominance as previously thought. The major saponin found in the fall-harvested roots were in fact the furostanol-based saponins, methylparvifloside, and methylprotodeltonin, while the spirostanol-based saponins, Zingiberensis saponin I and deltonin, were the major saponins for samples harvested in summer. The storage saponins from the fall differ from the summer saponins by the presence of an extra glucose molecule. The two main compounds found in commercial material—harvested in the fall—are significantly different as they contain extra glucose residues.

Dioscorea villosa

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To sustainabilityIn addition to working with domestic growers, we also source herbs from abroad and recognize the importance of supporting indigenous communities in quality and sustainability standards. As these communities depend on the income of the herb crops for their well-being, it is particularly important that they understand quality issues and are educated as to how to best grow or sustainably harvest the herb. Working together, we can ensure that they will sell their crops and provide income for their community. In addition, we have a documented process to avoid using medicinal plants that are on the brink of becoming classified as endangered species. We have developed a system of identifying and classifying the “threat” to particular herbs. “Threatened” is not an official classification; rather it is determined by us based on information received from independent, reliable sources such as CITES (Convention on International Trade in Endangered Species of Wild Fauna and Flora), TRAFFIC (Wildlife Trade Monitoring Network) and United Plant Savers. When a wild-crafted herb is classified as “threatened” by us, steps are taken immediately to find alternatives to overcome or reduce the threat.

Guidelines: MediHerb’s commitment to endangered species1. Where the threatened status of an herb

is specific to a region or country, we do not acquire the herb from that region or country.

2. We use cultivated herb sources of threatened herbs.

3. Where no cultivated source is available, we seek to establish cultivation in conjunction with herb growers.

4. If 2 and 3 are not options, we then investigate the wild crafting techniques and protocols to ensure they are conducted sustainably and ethically.

5. In certain cases, substitution of the threatened herb with a medicinally interchangeable species will be possible. This option requires technical and Research and Development involvement.

6. We actively promote the use of alternate herbs in place of endangered herbs by educating health care professionals.

7. Where a threatened or endangered herb is part of a tablet or liquid formulation, we will reformulate the product to include a different herb.

8. When an herb is listed in the CITES Appendix II and a cultivated source is not available, we cease to use that herb and delete the product from the range, for example Pygeum.

Our commitment


“We want to deliver products as authentic as nature intended. Plants produce phytochemicals, which deliver health benefits, so the art of understanding them is a scientific endeavor. One thing that sets us apart is our desire to make sure that the phytochemistry is just right.”

LEE CARROLLMEDIHERB INTERNATIONAL BUSINESS & EDUCATION SPECIALIST

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Our peopleOur passionate team includes practicing natural health care professionals and scientists. We have a proud history of seeking out people with the right expertise to further our mission of providing you with the best possible products that deliver on the needs of you and your patients.

Kerry Bone BSc (Hons), Dip Phyto FNIMH, FNHAA, AHG, MCPP, FANTA

Kerry is recognized internationally as a pre-eminent herbal practitioner, scientist and academic with a reputation cemented by his significant contribution to excellence in education, research and advocacy. Kerry’s passionate commitment to product development, research, writing, education and clinical practice positions him as a pioneer in the international herbal industry. He is the founder of MediHerb, author of six books, contributor to over 100 articles on herbal therapy to peer-reviewed journals around the world and has remained dedicated to his practice for over 30 years.

Hans Wohlmuth PhD (Pharmacognosy), BSc (Biology)

Hans is MediHerb’s Research and Development Manager. During his 16 years at Southern Cross University, Hans taught pharmacognosy and complementary medicine. He also established the Medicinal Plant Herbarium and co-founded the Herbal Authentication Service. Hans is an active researcher and has published more than 50 scientific articles on medicinal plants, natural products and complementary medicine. He is a member of the TGA Advisory Committee on Complementary Medicines and serves on the Advisory Board of the American Botanical Council. He also has editorial roles with several journals including the “Australian Journal of Herbal Medicine” and “Advances in Integrative Medicine”.

David Leach BSC (Hon), PhD, MRACI, CChem

David is MediHerb’s Senior Research and Development Chemist, an Adjunct Professor at the University of Western Sydney and one of Australia’s most respected phytochemists. David has more than 30 years experience in the field of medicinal plant and natural product chemistry. His far-ranging expertise includes herbal medicines, native Australian plants and natural, plant-derived insecticides. David has also co-authored more than 100 scientific publications in international peer-reviewed journals and is an inventor of three patents on phytochemicals. He has given numerous presentations at conferences around the world and is a member of the Australian Standards Association’s Essential Oil Committee.

Michelle Morgan BSc (Chemistry), DHM

Michelle is a qualified herbalist and has worked in the scientific field as a laboratory technician for many years including more than three as a Quality Assurance Chemist. Since 1995, Michelle has worked at MediHerb as a Technical Writer responsible for information gathering and organizing technical publications. Michelle assisted in the research and writing of several herbal medicine textbooks including the award-winning “The Essential Guide to Herbal Safety” published by Elsevier in 2005.

Meet our leaders


Amanda Williams BBus, Adv Dip Nat, Dip Bot Med

Amanda is an experienced naturopath with more than 18 years clinical experience. Since 2000, Amanda has worked with MediHerb in international business development and was instrumental in the U.S. partnership with Standard Process. A popular speaker who can convey the technical complexity of herbal medicine in an easy to understand and clinically relevant manner, Amanda has traveled across the U.S. delivering seminars to health care professionals and in Australia to the general public.

Lee Carroll BSc, BHSc (WHM)

Lee is a practicing medical herbalist with more than 25 years of experience with MediHerb and 15 years with Standard Process. Working alongside Professor Kerry Bone, Lee has developed a unique insight into the clinical application of modern herbal therapy and travels extensively throughout the U.S. conducting informative and practical seminars on the clinical application of Western herbal medicine for health care professionals.

Berris Burgoyne BHSc, ND, Dip Herb

Berris is a renowned naturopathic clinician with more than 26 years of clinical experience. She owns and runs a highly successful naturopathic clinic in Brisbane, Australia and is a senior member of the MediHerb team as a technical writer and educator. Berris was one of Kerry Bone’s first herbal students and regularly lectures alongside him in Australia and New Zealand. She has also lectured extensively in the U.S., Canada, the UK and South Africa.

Joanne Boyd Adv Dip HSc (Nat), Adv Dip HSc (HerbMed), Dip (Nut)

Joanne is an Australian-trained naturopath who has worked in various areas of the complementary medicine industry for over 18 years. She has lectured at several colleges in Australia teaching herbal medicine, nutrition, and naturopathic clinical skills. Joanne has been a part of the MediHerb team for more than 14 years and provided education and support for sales representatives and clinicians in Australia, the U.S., Canada and the UK.

Our

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18 MediHerb Product Catalog 2017/18 • Product Information

Core Products & Body Systems

Cardiovascular SystemDigestiveLungsUrinary System

Core Products

AdrenoCo Stress Support

Andrographis Complex Strong Immune System Support

Boswellia Complex Joint Support

DiGest Forte Core Digestive Support

Echinacea Premium Immune System Support

Garlic Unique Garlic Formulation

Ginkgo Forte Mental Clarity

Gymnema Blood Sugar Metabolism

Kava Forte Naturally Relaxing

LivCo Liver Function Support

Nevaton Forte Core Nervous System Support

Rhodiola & Ginseng Complex Enhance Vitality & Stamina

Vitanox Natural Cellular Defense

Product Information • MediHerb Product Catalog 2017/18 19 Not for public distribution. For professional use only.

Cardiovascular SystemDigestiveLungsUrinary System

Cardiovascular System

Heart HealthGarlic Support Healthy Normal Cholesterol

Ginkgo Forte Circulation Support


CirculationBilberry Healthy Eye Support

Garlic Support Healthy Normal Cholesterol

Ginkgo Forte Circulation Support

Horsechestnut Complex

Venous Support


Digestive System

Upper GITDiGest Forte Core Digestive Support


Livton Complex Digestive Liver Support

Silymarin Core Liver Support

Lower GITGolden Seal GIT Immune System Support


Endocrine

Adrenal

AdrenoCo Stress Support

Bacopa ComplexNervous System & Memory Support

Rhodiola & Ginseng Complex Enhance Vitality & Stamina

Withania Complex Calming Stress Support

PancreasGinkgo Forte Circulation Support

Gymnema Blood Sugar Metabolism

Silymarin Core Liver Support

Body Systems Legend

Cardiovascular System

Digestive System

Endocrine

Female Health

Immune System

Male Health

Musculoskeletal

Nervous System

Respiratory

Skin

Urinary System

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Core Products & Body Systems

Female Health

Menstruation/PMS

Chaste Tree Natural Hormone Balance

FemCo Female Vitality



Child Bearing Years


FemCo Female Vitality


Tribulus Forte Tonic Support

Menopause


Valerian Complex Sleep Support

Wild Yam Complex Core Menopause Support

Immune System

Short-Term

Andrographis Complex Strong Immune System Support

Garlic Immune System Support

Golden Seal GIT Immune System Support

Long-Term

Astragalus Complex Immune System Support

Echinacea Premium Immune System Support

Garlic Immune System Support

Male Health

<50LivCo Liver Function Support

Rhodiola & Ginseng Complex

Enhance Vitality & Stamina

50+Rhodiola & Ginseng Complex




Skin



Urinary System

Cranberry Complex Core Urinary Tract Support

Musculoskeletal

Boswellia Complex Joint Support

Horsechestnut Complex Venous Integrity


St John's Wort Nerve Function Support

Nervous System

Ginkgo Forte Mental Clarity



Rhodiola & Ginseng Complex


St John’s Wort Nerve Function Support

Valerian Complex Sleep Support

Withania Complex Calming Stress Support

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22 MediHerb Product Catalog 2017 • Product Information

Beyond Comparison Our Products As a health care professional, you have invested a great deal of time and energy into earning your qualifications. At MediHerb we believe you should protect that investment by using only the highest quality herbal products supported by authoritative technical and clinical information. This document is a detailed reference of all MediHerb herbal products, indexed by herb (botanical and common names) and set out in an easy to use format.

Please take the time to read the MediHerb Philosophy so that you may understand the depth of our passion for superior quality, efficacious herbal remedies. MediHerb has a total commitment to quality, which covers every aspect of our approach from research and development right through to manufacturing. Like so many decisions you will make in your clinical practice, you need to evaluate the increasing number of herbal products and suppliers by certain criteria. It is vital to your success as a health care professional that you consider these criteria closely and carefully.

The MediHerb Product Catalog is an essential resource for any health care professional seeking to make an informed choice.


Please consult the product packaging label for the most accurate product information.

AdrenoCo

Glycyrrhiza glabra

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen and prior to use if you have a liver disorder. Do not use if you are pregnant or breastfeeding. Do not use if you are taking thiazide diuretics, cardiac glycosides, corticosteroids, stimulant laxatives or other medications which may aggravate electrolyte imbalance or if you have hypokalemia, high blood pressure, or a kidney or cardiovascular disorder.

AdrenoCo contains Licorice and Rehmannia, a combination

that contains many compounds including triterpenoid

saponins (especially glycyrrhizin), other saponins,

iridoid glycosides and many flavonoids.

Indications

Licorice is traditionally used in Herbal Medicine as an expectorant to help relieve chest complaints, such as catarrhs, coughs and bronchitis

Helps relieve inflammatory conditions of the gastrointestinal tract, such as gastritis in adults

Dosage and Administration

Adults: 1 tablet 3 times daily or as directed by your health care

practitioner. Consult a health care practitioner for use beyond

4 to 6 weeks.

Additional Therapies

Nevaton Forte

St John’s Wort

Valerian Complex

Withania Complex

Withania 2:1

Licorice High Grade 1:1

Each tablet contains:

Medicinal Ingredients: Dried Herb Equivalent (DHE):

Glycyrrhiza glabra (Licorice) root 1.75 g

Rehmannia glutinosa (Rehmannia) rhizome 750 mg

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24 MediHerb Product Catalog 2017/18 • Product Information Not for public distribution. For professional use only.

Andrographis Complex

Ocimum tenuiflorum


Adults: 1 tablet 3 times daily. Take at the first sign of infection.

For use beyond 8 weeks, consult a health care practitioner.


Echinacea Premium tablets

Sinus Forte tablets

Contraindications and Cautions: If symptoms worsen, consult a health care practitioner. If you are breastfeeding, are taking heart or blood pressure medication on immunosuppressants, or have a heart condition, diabetes, an autoimmune disorder, a progressive systemic disease such as tuberculosis, collagenosis, multiple sclerosis, AIDS and/or HIV infection, consult a health care practitioner prior to use. Do not use if you are pregnant or attempting to conceive. Rare cases of severe allergic reactions have been known to occur; use caution if you are allergic to plants of the Daisy family.

See Echinacea information on page 36 for Echinacea Quality Issues

Andrographis Complex contains a blend of herbs to

enhance the immune system.

Andrographis, Echinacea angustifolia root, Echinacea purpurea root

and Holy Basil provide a unique range of phytochemicals including

diterpenoid lactones (collectively referred to as andrographolide),

flavonoids, alkylamides, caffeic acid derivatives (especially

echinacoside and cynarin), and polyphenols. The blending of

E. angustifolia and E. purpurea roots ensures that a spectrum of

constituents (especially the alkylamides) are present in the optimal

form and quantity for immune enhancement. This tablet contains

herbs with standardized levels of key phytochemicals to ensure

optimal strength and quality: 50 mg of andrographolide and 2.0 mg

of alkylamides per tablet.

Indications

Helps to relieve the symptoms and shorten the duration of upper respiratory tract infections



Andrographis paniculata (Common Andrographis) leaf 2.0 g

Echinacea angustifolia (Echinacea) root 200 mg

Echinacea purpurea (Echinacea) root 300 mg

Ocimum tenuiflorum (Holy Basil) leaf 500 mg



Astragalus Complex

Astragalus membranaceus


Withania Complex tablets

Withania 2:1 liquid extract

Echinacea Premium tablets or 1:2 liquid extract

Contraindications and Cautions: Consult a health care practitioner prior to use if you have a history of kidney stones, autoimmune disorder, a progressive systemic disease such as tuberculosis, leucosis, collagenosis, multiple sclerosis or any type of acute infection; or if you are taking blood thinners or immunosuppressants. Consult a health care practitioner if symptoms persist or worsen. Do not use if pregnant or breastfeeding or if allergic to plants of the Asteraceae/Compositae/Daisy family or if you have high blood pressure. Hypersensitivity (e.g. allergy) has been known to occur; in which case, discontinue use.

See Echinacea information on page 36 for Echinacea Quality Issues

Astragalus Complex contains Astragalus,

Echinacea purpurea root and Siberian Ginseng.

This combination of herbs contains many compounds including

triterpenoid saponins, flavonoids, sterols, caffeic acid derivatives

(especially cichoric acid), alkylamides and a diverse group of

constituents called eleutherosides. The Siberian Ginseng component

of this tablet is standardized to contain 600 mcg of eleutheroside E

per tablet to ensure optimal strength and quality.

Indications


Supportive therapy in the treatment of upper respiratory tract infections (e.g. common colds)


Adults: 1 tablet 2 to 4 times daily. Take at the first sign of infection

or as directed by your health care practitioner. Avoid using two hours

prior to or after taking mineral supplements. Consult a health care

practitioner for use beyond 8 weeks.



Astragalus membranaceus (Astragalus) root 850 mg


Eleutherococcus senticosus (Siberian Ginseng) root 750 mg


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Bacopa Complex

Bacopa monnieri


Ginkgo Forte tablets

St John’s Wort tablets


Contraindications and Cautions: Discontinue during the treatment of any acute infectious illness. Do not use if pregnant or breastfeeding. Discontinue use 7 days prior to general anesthesia. Consult a health care practitioner if symptoms persist or worsen. Do not use if you have high blood pressure. Digestive upset has been known to occur. Discontinue use and consult a health care practitioner if digestive symptoms persist or worsen. Hypersensitivity (allergy) may occur. Use with caution if you have allergies to members of the Scrophulariaceae (figwort) family or Lamiaceae (mint) family. May cause nausea, dry mouth and fatigue.

See the LivCo information on page 46 for Schisandra Quality Issues

Bacopa Complex combines the herbs Bacopa, Schisandra,

Siberian Ginseng and the essential oil of Rosemary.

These herbs contribute key phytochemicals to the blend such

as dammarane saponins, other saponins, flavonoids, sterols,

dibenzocyclooctene lignans, a diverse group of constituents called

eleutherosides, monoterpenes and sesquiterpenes. This tablet

contains two herbs with standardized levels of key phytochemicals

to ensure optimal strength and quality.

Indication

Siberian Ginseng is used in Herbal medicine as a tonic to help relieve general debility


Adults: 1 tablet 3 to 4 times daily or as directed by your health care


1 month.



Bacopa monnieri (Bacopa) herb top 3.75 g

Schisandra chinensis (Schisandra) fruit 660 mg

Eleutherococcus senticosus (Siberian Ginseng) root 500 mg

Rosmarinus officinalis (Rosemary) herb top flowering essential oil 10 mg

Not for public distribution. For professional use only.



Bilberry

Vaccinium myrtillus

Bilberry Quality Issues

In 2003 MediHerb received samples of Vaccinium myrtillus or bilberry

fruit extracts which differed in behaviour to that normally received. The

standard method of determining the anthocyanin content at this time

was a spectrophotometric assay. Using this method, anthocyanin levels

of two extracts were found to be 25% as claimed by the manufacturers.

When high-performance liquid chromatography (HPLC) was used,

however, one extract was found to contain 9% anthocyanins probably

not derived from V. myrtillus but from another species as well as an

adulterant chemical. This adulterant was subsequently identified, using

HPLC, mass spectroscopy, and nuclear magnetic resonance, as amaranth

(3-hydroxy-4-[(4-sulfo-1-naphthalenyl)azo]-2,7- naphthalenedisulfonic

acid trisodium salts) a synthetic dark red dye. It was evident that when

deliberate adulteration occurs in an extract, a spectrophotometric assay

is inadequate to accurately determine the levels of compounds such

as anthocyanins. This has led to a change in the standard method

of analysis for bilberry extracts to a more sophisticated method of

analysis, (HPLC with photodiode array detection) to counter this form of

adulteration. The results of this discovery by the MediHerb team were

published (Journal of Agricultural Chemistry and Food Science 2006: 54:

7378-7382) and led to regulators around the world to review accepted

test methods for Bilberry. The British Pharmacopoiea also changed the

method of analysis for Bilberry as a result of this discovery.

During World War II, bilberry jam was reportedly

consumed by RAF pilots to improve their night vision.

Bilberry has antioxidant properties.

Indications

Used in Herbal Medicine to help slow the progression of disorders of the eye, such as diabetic and hypertensive retinopathy, and macular degeneration

Helps relieve symptoms related to non-complicated chronic venous insufficiency (CVI), such as sensation of swelling, heaviness and tingling of the legs


Adults: 1 tablet 3-4 times daily or as directed by your health

care practitioner.


Ginkgo Forte

Vitanox

Contraindications and Cautions: Consult a health care practitioner if symptoms worsen.



Vaccinium myrtillus (Bilberry) fruit 6.0 g

HPLC profile of Bilberry

Good quality Bilberry extract

Poor Quality (Hydrolysed) Bilberry


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Boswellia Complex

Boswellia serrata


Vitanox tablets

Rehmannia Complex tablets

Licorice High Grade 1:1 liquid extract

Contraindications and Cautions: Consult a health care practitioner prior to use if you have a history of gallstones, biliary tract obstructions and/or stomach ulcers or excess stomach acid or if you have diabetes or are taking anti-diabetic medication, antacids, or phenprocoumon. Consult a health care practitioner prior to taking this product if you are taking blood-thinning drugs such as warfarin or aspirin or if you have increased risk of hemorrhage. Do not use if you are pregnant or breastfeeding. Discontinue use 7 days prior to general anesthesia. Consult a health care practitioner if symptoms persist or worsen.

Boswellia Complex contains Boswellia, Celery Seed,

Ginger and Turmeric.

These herbs provide many phytochemicals including triterpene acids

(especially the boswellic acids), several essential oils (one of which

contains terpenes and phthalides), coumarins, flavonoids, pungent

principles (including gingerols) and yellow pigments referred to as

diarylheptanoids (including curcumin). This tablet contains two herbs

with standardized levels of key phytochemicals to ensure optimal

strength and quality. The Boswellia component is standardized to

contain 180 mg of boswellic acids per tablet, and the Turmeric

component contains 70.4 mg of curcuminoids per tablet.

Indication

Provides temporary relief of the pain and inflammation

of arthritis, osteoarthritis and rheumatism


Adults: 1 tablet 2 to 4 times daily or as directed by your health

care practitioner.



Zingiber officinale (Ginger) rhizome 300 mg

Boswellia serrata (Boswellia) gum oleoresin 1.9 g

Curcuma longa (Turmeric) rhizome 2.0 g

Apium graveolens (Celery) seed 1.0 g




Cascara Complex

Frangula purshiana

Contraindications and Cautions: Consult your health care professional if symptoms persist or worsen and prior to use if you have a kidney or cardiovascular disorder, high blood pressure and/or hypokalemia or are taking any medications/health care products which may aggravate electrolyte imbalance (such as diuretics or anti-coagulants) or taking cardiac medications. Discontinue use if hypersensitivity occurs or if you experience abdominal pain, cramps, spasms, diarrhoea, vomiting and/or fever or you develop symptoms of liver trouble. Do not use if you are pregnant or breastfeeding or if you have: liver or gall bladder disorders; undiagnosed rectal bleeding; severe dehydration, diarrhoea; allergies to plants of the Asteraceae/ Compositae/Daisy family; abnormal constrictions of the gastrointestinal tract; potential or existing intestinal blockage; atonic bowel appendicitis; inflammatory colon disease such as Crohn’s disease or ulcerative colitis or abdominal pain.

The combined action of the herbs in Cascara Complex

is predominantly a gentle laxative effect without causing

griping or colic.

Indications

Used in Herbal Medicine for the short-term relief of occasional constipation

Traditionally used in Herbal Medicine to help treat digestive disturbances and to help increase bile flow to aid digestion


Adults: Take 4 tablets once daily, 2-3 times a week with 250mL of

water. Allow 6 to 12 hours for laxative effect to occur. Take a single

dose at bedtime. If no effect, increase dose to 1 tablet 4 times daily,

every day. If no affect after 72 hours or for use beyond 7 days, consult

a health care practitioner. Take a few hours before or after taking

other medication/health products.


Livton Complex

Golden Seal

Slippery Elm 400mg



Frangula purshiana (Cascara sagrada) stem bark 560 mg

Taraxacum officinale (Dandelion) root 375 mg

Rumex crispus (Yellow Dock) root 375 mg


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Chaste Tree

Vitex agnus-castus

Chaste Tree Quality Issues

Chaste Tree (Vitex agnus-castus) contains three important classes

of phytochemicals: iridoid glycosides (such as agnuside and

aucubin), flavonoids (such as casticin) and diterpenoids (such

as vitexilactone, rotundifuran and vitetrifolin D). It is believed that

the diterpenoids are the more important of these constituents

and therefore MediHerb has developed analytical methods for the

determination of these constituents and manufactures extracts

containing high levels of these diterpenoids, but not at the

expense of other vital components.

Chaste Tree contains flavonoids (especially methoxylated

flavones), iridoid glycosides (such as aucubin), diterpenes,

sesquiterpenes, essential oils and other compounds.

Indication

Used in Herbal Medicine to help relieve premenstrual symptoms and symptoms associated with menopause.


Adults and children over 12 years: 1 to 4 tablets daily or as directed

by your health care practitioner. Use for a minimum of 3 months to

see beneficial effects.


LivCo tablets

Wild Yam Complex tablets

Livton Complex tablets

Tribulus Forte tablets

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen. Consult a health care practitioner prior to use if you are taking hormone-containing medications such as progesterone preparations, oral contraceptives or hormone replacement therapy.



Vitex agnus-castus (Chaste Tree) fruit 500 mg

Vitexilactone

Vitetrifolin D

Rotundifuran

Agnuside Vitexilactone

Vitetrifolin D

Rotundifuran

Agnuside

Top Line: MediHerb Chaste Tree TabletsSecond Line: Product XThird Line: Product Y




Each mL contains:


Vitex agnus-castus (Chaste Tree) fruit 500 mg

Vitex agnus-castus

Chaste Tree 1:2

Indication

Used in Herbal Medicine to help relieve premenstrual symptoms (PMS)


Take 1-4 mL daily. Use for a minimum of 3 months to see beneficial effects.

Contraindications and Cautions: Use only as directed by a health care practitioner. Consult a health care practitioner prior to use if you are taking hormone-containing medications such as progesterone preparations, oral contraceptives or hormonal replacement therapy. Consult a health care practitioner if pain or symptoms persist. Chaste Tree may interact antagonistically with dopamine receptor antagonists. Chaste Tree is best not taken in conjunction with progesterone drugs, contraceptive pill or hormone replacement therapy (HRT). Chaste Tree may aggravate pure spasmodic dysmenorrhoea not associated with premenstrual syndrome (PMS). Use cautiously in pregnancy and only in the early stages for treatment of insufficient corpus luteal function. Discontinue use 7 days prior to general anaesthesia.

See the Chaste Tree information on page 30 for Chaste Tree Quality Issues


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Vaccinium macrocarpon



Vaccinium macrocarpon (Cranberry) juice dry 2.5 g (equiv. fresh fruit)

Crateva magna (Three-leaf Caper) stem bark 1.0 g

Arctostaphylos uva-ursi (Uva-ursi) leaf 500 mg

Cranberry Complex

Cranberry Complex combines Cranberry, Crateva magna

and Uva-ursi.

Together, these herbs contribute procyanidins, flavonoids,

anthocyanins, organic acids, saponins, sterols, hydroquinone

glycosides (particularly arbutin), polyphenols and other compounds.

Indication

Used in Herbal Medicine to help relieve symptoms associated

with minor urinary tract infections such as burning sensation and/

or frequent urination


Adults: Take a few hours before or after any medication or

supplement. Take 2 tablets 3 times daily. For occasional use only.

Consult your health care practitioner for use beyond 1 week.


Echinacea Premium

Andrographis Complex

Contraindications and Cautions: Consult a health care practitioner prior to use if you are taking blood thinners or if you have a history of kidney stones, kidney disorder, liver disorder, or if urinary tract infection is associated with fever, spasms, or blood in the urine. Consult a health care practitioner if symptoms persist or worsen. Do not take with highly acidic foods (e.g. citrus fruits and juice) or medications which may acidify urine. Do not use if you are pregnant or breastfeeding.




Gentiana lutea

DiGest Forte



Artemisia absinthium (Wormwood) herb 100 mg

Gentiana lutea (Gentian) root 200 mg

Tanacetum parthenium (Feverfew) leaf 200 mg

Zingiber officinale (Ginger) rhizome 250 mg

Citrus reticulata (Tangerine) fruit peel 500 mg

DiGest Forte contains Gentian, Feverfew, Ginger,

Wormwood and Tangerine in order to provide a

broader range of bitter principles to interact with

more bitter receptors.

Indication

Traditionally used in Herbal Medicine as a digestive tonic

and bitter to aid digestion


Adults: Take 1 tablet once daily or as directed by your health

care practitioner. Take 15 minutes before meals. Consult your

health care practitioner for use beyond 4 months.


Astragalus Complex tablets

Gymnema tablets


Silymarin tablets


Contraindications and Cautions: Do not use if you are allergic to plants of the Asteraceae/Compositae/Daisy family or if you are pregnant, or if you have acute stomach irritation, inflammation, and stomach or duodenal ulcers, or if you have obstruction of the bile duct, cholangitis or liver disease. Consult a health care practitioner if symptoms persist or worsen and prior to use if you are breastfeeding or if you are taking blood thinners, or if you have gallstones or other biliary disorders. Exercise caution if operating heavy machinery, driving a motor vehicle or involved in activities requiring mental alertness. Hypersensitivity, such as an allergy, has been known to occur; in which case, discontinue use. Some people may experience headaches, sore mouth, mouth ulcers and/or gastrointestinal discomfort.


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Echinacea Premium

Echinacea angustifolia


Adults: Take 2 tablets once daily at first sign of infection or as

directed by your health care practitioner. Consult your health care



Andrographis Complex tablets



Contraindications and Cautions: Do not use if you are pregnant. Consult a health care practitioner if symptoms persisit or worsen or prior to use if you are taking immunosuppressants, if you have an autoimmune disorder, or a progressive systemic disease such as tuberculosis, leucosis, collagenosis, multiple sclerosis, AIDS and/or HIV infection. Rare cases of severe allergic reactions have been known to occur; use with caution if you are allergic to plants of the Daisy family.

Echinacea Premium combines the roots of Echinacea

angustifolia and Echinacea purpurea to enlist properties

unique to each. The blending of these two plant species

ensures that the specific caffeic acid derivatives (cichoric

acid, echinacoside, cynarin) and the lipophilic components

(especially alkylamides) are present in appropriate

quantities. This product contains 4.6 mg of alkylamides


Indications

Used in Herbal Medicine to help fight off infections

Helps relieve the symptoms and shorten the duration of upper respiratory tract infections









Each mL contains:




Echinacea angustifolia

Echinacea Premium 1:2

Indication

Used to fight off colds and infections, especially of the upper

respiratory tract.


Take 3 to 4 mL daily with water at first sign of infection or as directed

by your health care practitioner. May be used up to 10-21 days.

Contraindications and Cautions: Echinacea is contraindicated in persons taking immunosuppressant medication (eg transplant patients). Short term therapy only is suggested in this instance. Consult a health care practitioner prior to use if you have an autoimmune disorder or progressive systemic disease such as tuberculosis, leukosis, collagenosis, multiple sclerosis, AIDS and/or HIV infection. Discontinue 7 days prior to general anesthesia.

See the Echinacea Premium information on page 36 for Echinacea Quality Issues

Leading Echinacea liquid, used

by practitioners worldwide


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Echinacea Tablet Products

Echinacea Liquid Products

MediHerb has developed specialised knowledge in the manufacture

and testing of Echinacea products over the past 20 years. This includes

a PhD study, extensive analytical method development, development

of harvesting, drying and storage protocols to maximise retention of

actives and a successful clinical trial.

MediHerb Echinacea products are market leaders based on

the most up-to-date science and the best of traditional wisdom.

In November 2014, independent testing of nine Australian Echinacea

liquids and 4 tablet products showed that MediHerb Echinacea

Premium tablets and liquid extracts are higher in alkylamides (both

2-ene and 2,4-diene alkylamides), which are clinically relevant

active constituents. The testing was conducted by an independent

analytical laboratory holding a licence issued by the Therapeutic

Goods Administration.

2-ene alkylamides are only found in Echinacea angustifolia and are

an important measure of quality. MediHerb’s research has found that

2-ene alkylamides improve the bioavailability of 2,4-diene alkylamides

in Echinacea purpurea. This means that the alkylamides in MediHerb’s

unique blend, Echinacea Premium, are available to the body, resulting

in a better effect on the immune system.

MediHerb’s Echinacea Premium formula is patented in Australia,

New Zealand, USA and the UK to protect this important finding.

Beyond Comparison

Product Monoene Diene Total Alkylamides

Tablets required to meet 1 Echinacea Premium

MediHerb Echinacea Premium

1.22 4.40 5.62(Label Claim 4.6mg)

1

Product A 0.00 0.69 0.69 8

Product B 0.00 0.02 0.02 314

Product C 0.00 0.01 0.01 668

Product D 0.00 0.00 0.00 n/a Monoene Diene

Monoenes Dienes

6.00

5.00

4.00

3.00

2.00

1.00

0.00MediHerb Echinacea Premium

Product D

Product A

Product B

Product C

mg/

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Echinacea Tablet Product Comparison

3.50

3.00

4.00

4.50

5.00

2.50

2.00

1.50

1.00

0.50

0.00

mg/

mL

alky

lam

ides

Echinacea Liquid Product Comparison


1:2

MediHerb E. angustifolia

1:2

MediHerb E. purpureaa

1:2

Product D

Product H

Product G

Product A

Product B

Product E

Product I

Product C

Product F

Monoene Diene

Monoenes Dienes

6.00

5.00

4.00

3.00

2.00

1.00


Product D

Product A

Product B

Product C

mg/

tabl

et a

lkyl

amid

es


3.50

3.00

4.00

4.50

5.00

2.50

2.00

1.50

1.00

0.50

0.00

mg/

mL

alky

lam

ides



1:2


1:2


1:2

Product D

Product H

Product G

Product A

Product B

Product E

Product I

Product C

Product F

Alkylamides

Monoene = protects against degradation

Diene = immune active

Monoene Diene

Monoenes Dienes

6.00

5.00

4.00

3.00

2.00

1.00


Product D

Product A

Product B

Product C

mg/

tabl

et a

lkyl

amid

es


3.50

3.00

4.00

4.50

5.00

2.50

2.00

1.50

1.00

0.50

0.00

mg/

mL

alky

lam

ides



1:2


1:2


1:2

Product D

Product H

Product G

Product A

Product B

Product E

Product I

Product C

Product F

Monoene Diene

Monoenes Dienes

6.00

5.00

4.00

3.00

2.00

1.00


Product D

Product A

Product B

Product C

mg/

tabl

et a

lkyl

amid

es


3.50

3.00

4.00

4.50

5.00

2.50

2.00

1.50

1.00

0.50

0.00

mg/

mL

alky

lam

ides



1:2


1:2


1:2

Product D

Product H

Product G

Product A

Product B

Product E

Product I

Product C

Product F


Kerry Bone has always believed that a key aspect of modern

phytotherapy is a respect for traditionally-generated knowledge.

E. angustifolia root however is very expensive and was cost

prohibitive for many of his patients. To overcome this, Kerry developed

Echinacea Premium, a particular blend of E. angustifolia and

E. purpurea roots. In 2003 MediHerb began an extensive research

project which was designed to identify the bioavailable components

of Echinacea Premium and how they exert an effect on the

immune system.

What is Active Must First Be Absorbed

Which of the key phytochemicals in Echinacea Premium are

absorbed and therefore bioavailable? From MediHerb’s in vitro and

pharmacokinetic research we know:

ONLY alkylamides could be detected in the blood after taking

Echinacea Premium. No caffeic acid conjugates, degradation

products of these or the alkylamides were found1

The alkylamides mainly in E. purpurea were found to be rapidly

degraded by human liver microsomes

In contrast the alkylamides mainly in E. angustifolia were much

more slowly degraded

Interestingly, the alkylamides from E. angustifolia actually slowed

down the rate of degradation of the alkylamides from E. purpurea

The presence of only relatively small proportions of the

E. angustifolia alkylamides will result in a product with enhanced

bioavailability due to their protective effect

REFERENCES 1 Matthias A et al. Life Sciences 2005; 77: 2018-2029 2 Matthias A et al. Chemico-Biological Interactions 2005, 155: 62-70 3 Matthias A et al. Phytomedicine 2007; 14(9): 587-590 4 Stevenson LM et al. Molecules 2005; 10: 1279-1285 5 Matthias A et al. Fitoterapia 2008; 79(1): 53-58 6 Gertsch J, Schoop R, Kuenzle U et al. Alkylamides from Echinacea purpurea potently modulate TNF-alpha gene expression: Possible role of cannabinoid receptor CB2, NF-κB, P38, MAPK and JNK pathways. International Congress on Natural Products Research, Phoenix, Arizona USA, July 31-August 4, 2004, Lecture O: 9 7 Woelkart K, Xu W, Makriyannis A et al. The endocannabinoid system as a target for alkamides from Echinacea roots. International Congress on Natural Products Research, Phoenix, Arizona USA, July 31-August 4, 2004, Poster P:342 8 Matthias A, Lehmann RP, Bone KM. Echinacea in Health – Risks and Benefits. In: Watson, R, Preedy V (eds). Botanical Medicine in Clinical Practice. CABI, Wallingford, UK, 2008, pp 683-689. 9 Agnew LL et al. Journal of Clinical Pharmacy and Therapeutics 2005; 30: 363-369 10 Miller SC. eCAM 2005; 2(3): 309-314

The Science of Echinacea – MediHerb’s Research

This is a strong justification for the combination of E. angustifolia

root with E. purpurea root, as in the Echinacea Premium. A patent

has been applied for to protect this very important finding2

The total amount of alkylamides absorbed into the bloodstream

was essentially the same for both Echinacea Premium tablets and

Echinacea Premium 1:2 liquid3

Once Absorbed is it Active?

The key findings of recent studies on Echinacea and alkylamide’s

effects on the immune system are that:

Echinacea does not activate the immune response in the absence

of any immunological challenge (in vitro research)4

The Echinacea alkylamides tended to modulate the immune

response of macrophages and T cells in vitro, toning the response

down in the face of a strong stimulus4,5

These results, combined with the fact that alkylamides are the only

phytochemicals which are bioavailable from traditional lipophilic

extracts of Echinacea root (such as ethanolic liquid extracts)1, suggests

that the alkylamides are largely responsible for the systemic

immune effects of Echinacea lipophilic extracts

This immune modulating activity may (at least in part) due to the

interaction of alkylamides with cannabinoid receptors, specifically

CB2 (in vitro research) 6-8

Echinacea Premium alters the expression of heat shock protein

70 (hsp70) in leucocytes and increased white cell count in healthy

volunteers.8 E. purpurea root boosted the number and function of

natural killer (NK) cells (a class of white blood cell) in mice10

A New Understanding of EchinaceaThe research on Echinacea Premium by the MediHerb scientists has

made a substantial contribution to a new understanding of lipophilic

extracts of Echinacea. It can be concluded from this research that:

Alkylamides must be used as the markers of quality and activity

The root of Echinacea is the preferred plant part, since it is highest

in alkylamides

The preferred species of Echinacea are E. angustifolia and E. purpurea

since they contain high levels of alkylamides (compared to E. pallida)

Echinacea must be extracted using an alcohol percentage sufficiently

high to efficiently extract the alkylamides

The synergistic blend of E. angustifolia and E. purpurea

alkylamides in Echinacea Premium potentiate each other

for greater therapeutic potential

For more information on the Echinacea Research Project see page 6

One potential way in which the

bioavailable alkylamides modulate

the immune response is by

interacting with CB2 receptors

Echinacea root (rich in alkylamides)

also boosts the white cell count

The traditional way Echinacea was

used has been validated by scientific

research at the cutting edge of

modern immunology

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Paeonia lactiflora



Schisandra chinensis (Schisandra) fruit 1 g

Paeonia lactiflora (Chinese Peony) root 750 mg

Asparagus racemosus (Shatavari) root 600 mg

FemCo

Indication

Schisandra and Shatavari are used in Herbal Medicine as an adaptogen to help increase energy

and resistance to stress (e.g. in case of mental and physical fatigue related to stress)


Adults: Take 1 tablet 3 times a day. For prolonged use, consult your health care practitioner.



Chaste Tree tablets

AdrenoCo tablets


Nevaton Forte tablets

Contraindications and Cautions: Consult a health care practitioner prior to use if you are taking prescription medications or if you have serious or major conditions, any type of acute infection, deficiency or excess. Discontinue use and consult a health care practitioner if symptoms persist or worsen or if new symptoms develop. Do not use if you are pregnant or breastfeeding.

See the LivCo information on page 46 for Schisandra Quality Issues




Garlic

Allium sativum

Garlic contains sulfur compounds (particularly alliin)

and other compounds.

Indications

Used in Herbal Medicine to help reduce hyperlipidemia in adults


Adults and adolescents (14 years old and over): Take 1 to

2 tablets daily or as directed by your health care practitioner.

Adolescents (10-13 years old): Take 1 tablet daily or as

directed by your health care practitioner. Enteric coated tablets.

Do not crush.


Slippery Elm 400mg capsules


Andrographis Complex tablets

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen and prior to use if you are pregnant, have diabetes, or if you are taking blood thinners or protease inhibitors. Hypersensitivity (e.g. allergy) has been known to occur; in which case discontinue use.



Allium sativum (Garlic) bulb 3.6 g (equiv. fresh bulb)

Allium sativum (Garlic) bulb powder 45 mg

Garlic Quality Issues

Alliin (an odourless amino acid) is naturally found in garlic cloves but

is rapidly converted to allicin (a strong smelling volatile sulfide) when

exposed to the enzyme alliinase in the presence of water or when the

garlic clove is crushed – as shown below by the absence of the alliin

peak in the HPLC trace on the right hand side. Allicin is rather unstable

and is the precursor to a range of sulfur containing compounds including,

diallylsulfides, ajoenes and vinyldithiins. It is important that quality

products take this enzymatic process into account since the strongest

published evidence to date is for garlic preparations standardized this

way. Therefore alliin must be present together with the correct amount

of alliinase in the tablet to allow full conversion to allicin. Furthermore,

because stomach acid can degrade the activity of alliinase, quality products

should be enterically coated to protect the enzyme. That is why all

MediHerb Garlic tablets are enterically coated and tested not only for the

level of alliin but for its conversion into allicin, “its allicin releasing ability”.

Alliin

Alliinase

Allicin

Reaction of alliin in Garlic powder withalliinase to form allicin as shown by HPLC

Peak due to alliinhas disappeareddue to conversionto allicin

Formation of Allicin from Alliin


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Ginkgo biloba



Ginkgo biloba (Ginkgo) leaf 3.0 g

Ginkgo Forte

Ginkgo contains flavonoids, terpene lactones and other

phytochemicals. This product is standardized to contain

24% flavonoid glycosides and 6% terpene lactones per

tablet to ensure optimal strength and quality.

Indication

Helps to enhance cognitive function and memory in adults

Helps to support peripheral circulation


Adults: Take 1 tablet 3 times daily or as directed by your health

care practitioner. Consult a health care practitioner for use beyond

6 weeks.


Bacopa Complex tablets

Vitanox tablets

Contraindications and Cautions: Consult a health care practitioner prior to use if you are pregnant or breastfeeding or taking medications for diabetes, high blood pressure, or seizures. Do not use if you are taking health products that affect blood coagulation (e.g. blood thinners, clotting factor replacements, acetylsalicylic acid, ibuprofen, fish oils, vitamin E) as this may increase the risk of spontaneous bleeding.

Ginkgo Quality Issues

The ginkgo flavonglycosides (ginkgo flavone glycosides) of Ginkgo

biloba, comprising quercetin, kaempferol and isorhamnetin are the

phytochemicals most often referred to as indicators of quality and

efficacy. However, these compounds are mainly marker compounds

which are used to identify the extract. The therapeutically active

ingredients are believed to include the ginkgolides and bilobalide,

which cannot be tested by normal HPLC methods. They require more

sophisticated methods of detection such as Refractive Index (RI),

Evaporative Light Scattering Detectors (ELSDs) or Mass Spectrometry

(MS). MediHerb uses ELSD detection to accurately quantify the

levels of these therapeutically important phytochemicals. The other

important group

of phytochemicals

from Ginkgo are the

ginkgolic acids (C13:0,

C15:1 and C17:1 on

the third figure).

These compounds

have been identified

as contact allergens.

The maximum level

of ginkgolic acids in

Ginkgo biloba extracts

has been set by the

European authorities

at 5 ppm. Many poor

quality extracts contain

levels of ginkgolic

acids many orders of

magnitude higher than

this recommended

maximum.

HPLC detection of ginkgo flavonglycosides (ginkgo flavone glycosides)

LC – ELSD detection of bilobalide and ginkgolides

Ginkgolic acids by HPLC

Quercetin Kaempferol

Isorhamnetin

Bilobalide Ginkgolides

C13:0 C17:1

C15:1





Isorhamnetin


C13:0 C17:1

C15:1





Isorhamnetin


C13:0 C17:1

C15:1




Golden Seal

Hydrastis canadensis

Golden Seal contains alkaloids (especially hydrastine

and berberine) and other phytochemicals. MediHerb

Golden Seal tablets are made from a cultivated source

of Golden Seal.

Indication

Traditionally used in Herbal Medicine to help alleviate infectious and inflammatory conditions of the digestive tract such as gastritis.


Adults: Take 1 to 2 tablets 3 times daily or as directed by your

health care practitioner. May take up to one week to produce

beneficial effects.


Sinus Forte tablets


Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen and prior to use if you have blood pressure problems or a kidney disorder. Consumption with alcohol, other medications and/or natural health products with sedative properties is not recommended. Do not use if you are pregnant or breastfeeding.



Hydrastis canadensis (Golden Seal) root and rhizome 500 mg

Golden Seal Quality Issues

Golden Seal (Hydrastis canadensis) is an endangered herb and as a result

is very expensive and often substituted by other herbs. The substituted

herbs usually contain the substance berberine which provides the yellow

colour, but they do not contain hydrastine which is unique to Golden Seal.

Only HPLC enables this differentiation to be made. MediHerb only buys

cultivated Golden Seal to ensure sustainability of the herb long term.

MediHerb tests each batch of Golden Seal raw material and finished

product to ensure the claimed levels of hydrastine and berberine are

present. Using HPLC, MediHerb is able to clearly differentiate true Golden

Seal from other berberine containing herbs. The table demonstrates the

difference between the various berberine containing species. The top trace

is an example of substitution where a professional product being sold in

Australia as Indian Golden Seal matched the trace of Coptis chinensis.

Hydrastine Berberine

PRACTITIONERLIQUID

(Indian Golden Seal)

Coptis chinenis

Berberis aquifolium



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Gymnema sylvestre



Gymnema sylvestre (Gymnema) leaf 6.4 g

Gymnema

Gymnema contains a complex mixture of saponins (gymnemic acids) and other compounds.

This product is standardized to contain 100 mg of gymnemic acids per tablet to ensure

optimal strength and quality.

Indication

Helps to support healthy blood glucose levels


Adults: Take 1 tablet daily or as directed by your health care practitioner.



Vitanox tablets


Contraindications and Cautions: Consult a health care practitioner prior to use if you have diabetes, low blood sugar, or if you are taking insulin or oral hypoglycemic medication, if you have intestinal disorders, or symptoms such as abdominal pain, nausea, vomiting or fever. Discontinue use and consult a health care practitioner if you experience symptoms of hypoglycemia including feelings of anxiety, dizziness, tremor, sweating, nausea or headache. Do not use if you are pregnant or breastfeeding.




Aesculus hippocastanum



Ruscus aculeatus (Butcher’s Broom) root and rhizome 800 mg

Aesculus hippocastanum (Horsechestnut) seed 1.2 g

Ginkgo biloba (Ginkgo) leaf 1.5 g

Horsechestnut Complex

Horsechestnut Complex is a combination of Horsechestnut,

Butcher’s Broom and Ginkgo. These herbs contain steroidal

saponins, other saponins (a complex mixture known as

aescin), flavonoids, lipids, sterols, terpene lactones and

other phytochemicals. The Horsechestnut component

is standardized to contain 40 mg of aescin per tablet,

and the Ginkgo component contains 7.3 mg of flavonoid

glycosides per tablet.

Indication

Used in Herbal Medicine to help treat chronic venous insufficiency and associated symptoms

Used in Herbal Medicine to help treat varicose veins


Adults: Take 1 tablet 2 times daily with food or as directed by your

health care practitioner. Enteric coated tablets. Do not break or crush.


Garlic tablets

Vitanox tablets


Contraindications and Cautions: Consult a health care practitioner prior to use if you are taking medications for diabetes, high blood pressure, or seizures or if you are pregnant or breastfeeding or if you suffer from gastrointestinal disorders such as irritation, ulcers, gastric reflex, celiac disease, etc. Consult a health care practitioner if symptoms persist or worsen. Some people may experience headaches, dizziness, gastric irritation, or itchiness. If inflammation of the skin or subcutaneous induration, ulcers, sudden swelling of leg(s), cardiac or renal insufficiency occurs, discontinue use and consult a health care practitioner. Do not use if you are taking health products that affect blood coagulation as this may increase the risk of spontaneous bleeding.

See the Ginkgo biloba information on page 40 for Ginkgo Quality Issues


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Kava Quality Issues

Kava is derived from the rootstock of the sterile cultivated species of

Piper methysticum. The psychosedative property of Kava has been

attributed to the kavalactones, a group of structurally related lipophilic

lactones. These compounds can represent 3 to 20% by weight of the

dried rootstock, depending on the age of the plant and the specific

cultivar. The majority of the Kava used commercially in the world

is in the form of a high ethanol or other organic solvent extract,

which extracts little more than the kavalactones and has reported

potential hepatoxicity concerns. The Therapeutic Goods Administration

(Australian Regulatory Authority) allows water extracted or plain

unextracted root to be sold in Australia. Traditionally Kava beverages

are prepared by chewing or pounding the root to produce a cloudy,

milky mash, which is then consumed orally. It is known that extraction

with different solvents affects the phytochemical profile of the extract.

MediHerb investigated the difference in bioavailability of the water

extract of Kava and the 96% ethanol extract using the Caco-2

monolayer model. The kavalactones (as kawain) were found to be

potentially bioavailable as they all crossed the membrane quite readily

with the exception of one kavalactone (yangonin). The water extract

of Kava was only slightly less bioavailable than the ethanol extract.

Therefore the clinical effect of the water extract of Kava would be

similar to that of an ethanol extract, without the hepatoxicity concerns.

Kava Forte

This tablet contains Kava root extracted with 100%

water, which provides an extract with a full spectrum

of compounds including the kavalactones. This product

is standardized to contain 50 mg of kavalactones per


Indication

Used in Herbal Medicine as a calmative to help relieve restlessness and/or to aid sleep


Adults: Take 1 tablet 3 times daily. For use beyond 6 months,

consult your health care practitioner.


Valerian Complex tablets

Nevaton Forte tablets or St John’s Wort tablets

AdrenoCo tablets

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen. Consult a health care practitioner prior to use if you have a liver disease, epilepsy or if you are using conventional sedative-hypnotics or natural health products with similar effects, anxiolytics, MAO inhibitors and other psychopharmacologic agents, levodopa or other drugs for Parkinson’s disease, or antiplatelet agents. Consumption with alcohol or anti-convulsants is not recommended. Do not use if you are pregnant or breastfeeding. Discontinue use and consult a health care practitioner if you develop signs of liver trouble. Excessive use, or use with products that cause drowsiness, may impair your ability to operate a vehicle or use heavy machinery.



Piper methysticum (Kava) root 3.2 g

0

10

20

30

40

50

60

70

80

90

100

0 40 80 120 160

Time (min)

% a

pica

l

water

ethanol

standard

Kawain % apical average dataTime water ethanol standard10 11 11 1220 21 22 2330 30 31 3360 59 59 6190 80 81 84120 87 89 91150 92 95 97

Piper methysticum




Each mL contains:


Glycyrrhiza glabra (Licorice) root 1.69g

Glycyrrhiza glabra

Licorice High Grade 1:1

Indications

Traditionally used in Herbal Medicine as an expectorant to help relieve chest complaints


2-4 mL daily. May be used up to 4-6 weeks or as directed by health care practitioner.

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen and prior to use if you are pregnant or have a liver disorder. Do not use if you are taking thiazide diuretics, cardiac glycosides, corticosteroids, stimulant laxatives or other medications which may aggravate electrolyte imbalance. Do not use if you have hypokalemia, high blood pressure, or a kidney or cardiovascular disorder.


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LivCo

Schisandra chinensis

The combination of Schisandra, Rosemary and St Mary’s

Thistle (Milk Thistle) provides a range of compounds

including dibenzocyclooctene lignans, phenolic diterpenes

(including carnosol and rosmarinic acid), other terpenes,

flavonoids and flavanolignans (collectively known as

silybin or silymarin). The St Mary’s Thistle component

of this tablet is standardized to contain 24 mg of

flavanolignans per tablet to ensure optimal strength

and quality.

Indications

Helps to support liver function

Used in Herbal Medicine to help relieve digestive disturbances/dyspepsia

Traditionally used in Herbal Medicine as a liver protectant


Adults: Take 1 tablet 3 to 4 times a day or as directed by a

health care practitioner. Use for a minimum of 3 weeks to

see beneficial effects in liver function/protection.


Vitanox tablets

Silymarin tablets



Schisandra chinensis (Schisandra) fruit 1 g

Rosmarinus officinalis (Rosemary) leaf 500 mg

Silybum marianum (St Mary’s Thistle) seed 2.38 g

Contraindications and Cautions: Consult your health care practitioner if symptoms persist or worsen. Do not use if you are pregnant or breastfeeding. Hypersensitivity, such as allergy, has been known to occur; in which case, discontinue use.

See the Silymarin information on page 52 for St Mary’s Thistle Quality Issues

Schisandra Quality Issues

Schisandra is a well-known Chinese herb, however it is not well

known that two species of Schisandra are used in TCM, the

phytochemical profile of each being very different. Schisandra

chinensis (northern Schisandra) is the preferred species in TCM and

by Western health care professionals. It contains compounds called

schisandrins (schisandrin, gomisin A, deoxyschisandrin, gomisin N

and wuweizizu C) which are believed responsible for the therapeutic

effects. Southern Schisandra, Schisandra spenanthera, (see Product X

in the trace) is considered inferior due to lower levels of schisandrins,

however it is often used interchangeably with Schisandra chinensis.

Manufacturers therefore need to be very careful to avoid substitution

with Schisandra spenanthera. The species are readily distinguishable

morphologically and by HPLC. MediHerb routinely uses HPLC to ensure

the correct identity and guarantee consistent levels of schisandrins.

MediHerb

Standard

Product X

Schisandrin

Gomisin A Gomisin N Wuweizizu C

Deoxyschisandrin

Schisandra HPLC comparison of good quality product with poor quality product




Taraxacum officinale



Taraxacum officinale (Dandelion) root 400 mg

Bupleurum falcatum (False Bupleurum) root 300 mg

Chionanthus virginica (Fringe Tree) stem bark 160 mg

Cynara scolymus (Globe Artichoke) leaf 800 mg

Silybum marianum (St Mary’s Thistle) seed 7.0 g

Livton Complex

Livton Complex contains Globe Artichoke, Bupleurum,

Dandelion Root, St Mary’s Thistle (Milk Thistle) and

Fringe Tree. These herbs contribute key phytochemicals

to the blend such as sesquiterpene lactones, caffeic acid

derivatives, flavonoids, phenolic acids, triterpenes, sterols,

flavanolignans (collectively known as silybin or silymarin)

and triterpenoid saponins (called saikosaponins).

The St Mary’s Thistle component of this tablet is

standardized to contain 80 mg of flavanolignans


Indication

Used in Herbal Medicine to help relieve digestive disturbances

(such as dyspepsia) and increase bile flow.


Adults: Take 1 tablet 3-4 times daily or as directed by your health

care practitioner


Silymarin tablets

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen and prior to use if you are pregnant, or if you are taking metronidazole. In anemia and cases where iron supplementation is required, do not take simultaneously with meals or iron supplements. Do not use if you have a bile duct obstruction, liver or gall bladder disorders and/or bowel obstruction or if you are allergic to plants of Asteraceae/Compositae/Daisy family. Hypersensitivity (e.g. allergy) has been known to occur, in which case, discontinue use. Discontinue use if you develop symptoms of liver trouble. Discontinue 7 days prior to general anesthesia.

See Silymarin information on page 52 for St Mary’s Thistle Quality Issues


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Nevaton Forte

Nevaton Forte contains St John’s Wort, Schisandra,

Skullcap and Saffron. These herbs provide a wide range

of phytochemicals including the naphthodianthrones

hypericin and pseudohypericin (hypericin), flavonoids,

phenolics, dibenzocyclooctene lignans, sesquiterpenes,

monoterpenes and other compounds. The St John’s

Wort component of this tablet is standardized to contain

375 mcg of hypericin tablet to ensure optimal strength

and quality.

Indication

Used in Herbal Medicine as an adaptogen to help increase resistance to stress


Adults: Take 1 tablet 3-4 times daily or as directed by your health

care practitioner. Use for a minimum of 1 week to see beneficial

effects. Consult a health care practitioner for use beyond 18 weeks.






Hypericum perforatum (St John’s Wort) herb top 750 mg

Schisandra chinensis (Schisandra) fruit 675 mg

Scutellaria lateriflora (Skullcap) herb top 500 mg

Crocus sativus (Saffron) stigma 22.5 mg

Contraindications and Cautions: Do not use if you are pregnant or breastfeeding, taking anti-cancer medications, blood thinners, antidepressant medications, anti-HIV agents, cardiovascular medications, immunosuppressants, and/or contraceptive medications. Consult a health care practitioner prior to use if you are taking prescription medications, anti-anxiety medications, seizure medications, antihistamines, bronchodilators, muscle relaxants and/or opiates. Consult a health care practitioner if symptoms persist or worsen or if new symptoms develop or if sleeplessness persists continuously for more than 3 weeks. Avoid prolonged exposure to sunlight, ultraviolet light (UV) or UV therapy. Consumption with alcohol, drugs and/or other natural health products with sedative properties is not recommended. Hypersensitivity, such as an allergy, has been known to occur; in which case, discontinue use. Some people may experience mild gastrointestinal disturbances, nausea, restlessness, drowsiness and/or headaches. Exercise caution if operating heavy machinery, driving a motor vehicle or involved in activities requiring mental alertness.

See St John’s Wort information on page 55 for St John’s Wort Quality Issues

See LivCo information on page 46 for Schisandra Quality Issues

Crocus sativus




Tanacetum parthenium



Rehmannia glutinosa (Rehmannia) root 350 mg

Bupleurum falcatum (False Bupleurum) root 700 mg

Hemidesmus indicus (Indian-sarsaparilla) root 500 mg

Tanacetum parthenium (Feverfew) herb top 165 mg

Rehmannia Complex

The combination of herbs in Rehmannia Complex contain

many compounds including iridoid glycosides, triterpenoid

saponins (called saikosaponins), other saponins, sterols,

sesquiterpene lactones of the germacranolide type,

particularly parthenolide and other terpenes.

Indication

Traditionally used in Herbal Medicine to help relieve headaches


Adults: Take 1 tablet 2-4 times daily. Reduce the dosage gradually

if treatment is to be paused or discontinued. Take with or after food.

Consult a health care practitioner for use beyond 4 months.



Boswellia Complex tablets


Vitanox tablets

Licorice High Grade 1:1 liquid extract

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen. Consult a health care practitioner prior to use if you are breastfeeding, or if you are taking blood thinners. Do not use if you are allergic to plants of the Asteraceae/Daisy family, or if you are pregnant. Hypersensitivity, such as an allergy, has been known to occur; in which case discontinue use. Some people may experience sore mouth, mouth ulcers and/or gastrointestinal discomfort.


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Rhodiola & Ginseng

Rhodiola & Ginseng contains Rhodiola and Korean

Ginseng, a combination which contains many

compounds including phenylpropanoids such as

rosarin, rosavin and rosin (rosavins), salidroside

(a hydroxyphenethyl glucoside), and a complex

mixture of steroidal saponins (called ginsenosides).

Indications

Used in Herbal Medicine as supportive therapy for:

The promotion of healthy glucose levels

To help support cognitive function and/or reduce mental fatigue (in cases of mental stress)

To help enhance physical capacity/performance (in cases of physical stress)


Adults: Take 1 tablet daily or as directed by your health

care practitioner. Not to be taken immediately before bedtime.

Consult a health practitioner for use beyond 3 months.


Valerian Complex

Withania Complex

Nevaton Forte

Bacopa Complex

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen and prior to use if you have diabetes or if you are pregnant or breastfeeding, or if you are taking antidepressant medication, blood thinners, or digoxin or hormone replacement therapy (HRT) or birth control pills. Do not use if you have bipolar disorder or bipolar spectrum disorder. If you experience irritability, insomnia, anxiety, or headaches, discontinue use.



Rhodiola rosea (Rhodiola) root 3.6 g (Rosavins 5.4 mg)

Panax ginseng (Korean Ginseng) root 500 mg

Rhodiola Quality Issues

Rhodiola rosea is commonly referred to as Golden Root or Roseroot and grows in dry sandy ground at high altitudes in the arctic regions of Europe and Asia. The freshly cut root has a rose-like odor that has led to its botanical name and one of its common names. The root has been used for centuries in the traditional medicines of Russia and Scandinavia. There are however 16 common species of Rhodiola growing in the Eurasian area. Of these, 11 have been tested in animal studies, but only R. rosea (17 studies) and R. crenulata (1) have been assessed in human trials.

Most of the Rhodiola species have been reported to contain the marker compound salidroside and this was originally used to standardize extracts of Rhodiola rosea. After more than a decade of research, however, it was shown that the chemical composition of R. rosea root is, in fact, different to the other species of the genus Rhodiola. Using newly developed methods of analysis, it was shown that R. rosea root contains three cinnamyl alcohol-vicianosides: rosavin, rosin, and rosarin that are specific to this species. They are collectively termed rosavins. HPLC offers a ready method to differentiate true Rhodiola rosea from the other species offered on the market. The two major rosavins found are rosavin and rosarin, with only very low quantities of rosin.

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Rhodiola rosea

Korean Ginseng Quality Issues

Panax ginseng is a widely used and misunderstood herb. Traditionally the main root of the plant has been preferred for therapeutic use. The other parts of the plant such as the root hairs, leaves, leafstalks, etc are considered inferior and are never used medicinally in the East. However, many herb traders will sell the other plant parts as they are substantially cheaper than the main root. The major marker compounds used to characterise Panax ginseng are the ginsenosides which occur in all parts of the plant and if you were to only consider

Korean Ginseng leaf dry extract

Korean Ginseng root dry extractKOREPE

Rd

Rb2

Rg2

Rc

Rf

Rg1

Re

Rb1

% ContentRg

1Re Rf Rg

2Rb

1Rc Rb

2Rd Total

Leaves 1.078 1.524 — — 0.184 0.736 0.553 1.113 5.188

Leafstalks 0.327 0.141 — — — 0.190 — 0.107 0.765

Stem 0.292 0.070 — — — — 0.397 — 0.759

Main root 0.379 0.153 0.092 0.023 0.342 0.190 0.131 0.038 1.348

Lateral roots 0.406 0.668 0.203 0.090 0.850 0.738 0.434 0.143 3.532

Root hairs 0.376 1.512 0.150 0.249 1.351 1.349 0.780 0.381 6.148

Main root dry extract 1.4 2.1 0.6 0.6 2.9 1.9 2.4 1.5 13.4

Panax ginseng

total ginsenosides the main root is not the highest in content.The importance is in the ratio of specific ginsenosides. The European clinical studies were undertaken on extracts manufactured from the main root of Panax ginseng which have a particular ratio of ginsenosides. To achieve the clinical results obtained traditionally and supported by clinical trials it is important to use raw material from the correct plant part and the correct species. This is readily achievable using HPLC which easily distinguishes the different preparations.


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Silymarin

St Mary’s Thistle (Milk Thistle) contains Silymarin

calculated as silibin/silybin, flavonoids and other

compounds. This product is standardized to contain

168 mg of silymarin per tablet to ensure optimal

strength and quality.

Indication

Promotion of a healthy liver


Adults: Take 1 tablet 2 times daily or as directed by your

health care practitioner. Use for a minimum of 3 weeks to see

beneficial effects.


LivCo tablets or Livton Complex tablets

Garlic tablets

Vitanox tablets

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen or prior to use if you have a liver disease or impaired liver function. Do not use if you are pregnant or breastfeeding. Hypersensitivity/allergy is known to occur, in which case, discontinue use. Discontinue use 7 days prior to general anesthesia.



Silybum marianum (St Mary’s Thistle) fruit 14.7 g

St Mary’s Thistle Quality Issues

St Mary’s Thistle (Silybum marianum) contains a range of

flavanolignans (silybin A and B, silychristin, silydianin, isosilybin and

2, 3-dehydro derivatives) collectively called silybin or silymarin,

as well as simple flavonoids such as taxifolin. Flavanolignans are

important indicators of quality and efficacy. The flavanolignans are

often measured analytically by the non-specific and less accurate 2,

4-dinitrophenylhydrazine colourimetric method, which also reacts

with any ketonic compounds, which includes the flavonoid taxifolin.

MediHerb has developed a High Performance Liquid Chromatographic

method to allow the individual levels of the flavanolignans to be

accurately measured, and determine a value for these which is not

inflated by the presence of simple flavonoids.

Silybum marianum




Sinus Forte

Sinus Forte combines the herbs Eyebright, Golden Rod,

Echinacea root, Golden Seal and Cayenne. These five

powerful herbs contain iridoid glycosides (especially

aucubin), saponins, flavonoids, diterpenoid lactones,

caffeic acid derivatives (especially cichoric acid),

alkylamides, alkaloids (especially hydrastine and

berberine), pungent principles (particularly capsaicin),

carotenoids and other compounds.

Indications

Used in Herbal Medicine to help fight off infections, especially of the upper respiratory tract




Adults: 1 tablet 3 to 4 times daily or as directed by your health care

practitioner. Take at the first sign of infection. Consult a health care




Solidago virgaurea (Golden Rod) herb 650 mg

Euphrasia officinalis (Eyebright) herb 650 mg


Hydrastis canadensis (Golden Seal) root and rhizome 125 mg

Capsicum annuum (Cayenne) fruit 10 mg



Golden Seal tablets


Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen prior to use if you have stomach ulcers or inflammation, if you are taking immunosuppressants, or if you have a progressive systemic disease such as tuberculosis, leukosis, collagenosis or multiple sclerosis, if you have a kidney disorder or if you have blood pressure problems. Do not use if you are allergic to plants of the Asteraceae/Compositae/Daisy family or if you are pregnant or breastfeeding. Hypersensitivity (e.g. allergy) has been known to occur, in which case, discontinue use. Consumption of Golden Seal with alcohol, other medications and/or natural health products with sedative properties is not recommended.

See the Golden Seal information on page 41 for Golden Seal Quality Issues

See the Echinacea Premium information on page 36 for Echinacea Quality Issues



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Ulmus rubra



Ulmus rubra (Slippery Elm) inner stem bark 400 mg

Slippery Elm 400mg

The key constituents of Slippery Elm stem bark are water-soluble polysaccharides.

This product is a vegetarian capsule and is suitable for vegetarians.

Indication

Traditionally used in Herbal Medicine for maintaining a healthy lower gastrointestinal tract


Adults: Take 1 capsule up to 5 times a day or as directed by your health care practitioner. Take with plenty of

water. Avoid using until two hours after taking other medications.


Golden Seal tablets

Vitanox tablets

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen. Contraindicated in intestinal obstruction. Discontinue 7 days prior to general anesthesia.




St John’s Wort contains the naphthodianthrones

hypericin and pseudohypericin (hypericin), flavonoids,

phenolics and other compounds. This product is

standardized to contain 990 mcg of hypericin per


Indications

Used in Herbal Medicine to help relieve restlessness and/or nervousness (sedative and/or calmative)

Used in Herbal Medicine to help promote healthy mood balance and relieve sleep disturbances associated with mood imbalance


Adults: Take 1 tablet 2 times daily or as directed by a health care

practitioner. Use for a minimum of 1 week to see beneficial effects.

Consult a health care practitioner for use beyond 18 weeks.


Echinacea Premium tablets or 1:2 liquid extract, or Andrographis Complex tablets



Contraindications and Cautions: Avoid prolonged exposure to sunlight, ultraviolet light (UV) or UV therapy. Consult a health care practitioner if symptoms persist or worsen. Consult a health care practitioner prior to use if you are pregnant or breastfeeding of if you are taking anti-anxiety medications, seizure medications, antihistamines, bronchodilators, muscle relaxants and/or oplates. Do not use if you are taking anti-cancer medications, blood thinners, antidepressant medications (e.g. selective serotonin reuptake inhibitors (SSRI)), anti-HIV agents, cardiovascular medications, immunosuppressants, and/or contraceptive medications. Hypersensitivity, such as allergy, has been known to occur; in which case, discontinue use. Some people may experience mild gastrointestinal disturbances, nausea, restlessness and/or headaches.



Hypericum perforatum (St John’s Wort) aerial parts 1.8 g

St John’s Wort Quality Issues

St John’s Wort is comprised of a wide range of phytochemicals of

which the naphthodiantrones (consisting mainly of hypericin and

psuedohypericin) are characteristic, while several other constituents

are found across a very wide variety of plant species: eg chlorogenic

acid, flavonoids and biapigenins. Studies have shown that hypericin

administered with flavonoid glycosides caused an increase in the

bioavailability of hypericin. St John’s Wort extracts containing the

flavonoid glycosides but devoid of hypericin and hyperforin have been

shown to be pharmacologically active in model systems. Additionally

extracts devoid of hyperforin have been proven effective in clinical

trials as have extracts containing hyperforin. In the graph, all extracts

contained the same level of napthodianthrones (hypericins), however

a wide range of variation was shown for the other constituents

when analyzed by HPLC – Some extracts having very low levels of

all the phytochemicals you would expect in a good quality extract of

Hypericum perforatum. MediHerb recognises the importance of all the

other constituents, particularly the OPCs and flavonoids and tests all

of its products using the techniques which allow the identification of

these components.

Hypericum perforatum

St John’s Wort


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Tribulus terrestris



Tribulus terrestris (Tribulus) aerial parts 13.5 g

Tribulus Forte

Tribulus Forte contains an extract of Tribulus terrestris

herb (aerial parts - leaves and stems) and contains

steroidal saponins, mainly furostanol glycosides

(including protodioscin and protogracillin) and small

quantities of spirostanol glycosides, sterols and other

compounds. This product is standardized to contain

110 mg of furostanol saponins as protodioscin per


Indication

Source of saponins with tonic properties


Adults: Take 1-2 tablets daily or as directed by your health

care practitioner. Consult your health care practitioner for use

beyond 4 weeks.



Wild Yam Complex tablets

Chaste Tree tablets or 1:2 liquid extract

Contraindications and Cautions: Consult a health care practitioner prior to use if you have benign prostate hyperplasia or prostate cancer (due to possible androgenic effects). Discontinue use if you experience breast pain, discomfort and/or tenderness. Do not use if you are pregnant or breastfeeding. Diuretic effects may occur. If this is the case, discontinue use. Hypersensitivity/allergy has been known to occur. If this is the case, discontinue use.

Tribulus Quality Issues

Tribulus terrestris is an herb which is endemic to many different

geographical zones, from the Mediterranean regions, India, China,

South Africa and Australia. Research undertaken by MediHerb has

shown that the phytochemical profile of the herb varies depending

upon the geographical origin and the plant part utilized. Only herb

sourced from the Central European regions of Bulgaria and Slovakia

have been found to contain protodioscin, which is an important

indicator of quality and efficacy. Additionally only the leaves and

stem of the plant contain protodioscin, the fruit does not contain this

phytochemical. MediHerb has undertaken this research to ensure that

our Tribulus product is of the correct phytochemical profile to ensure

phytoequivalence with the Bulgarian clinical trials and therefore

optimal therapeutic outcome.

Protodioscin

Slovakian Tribulus Herb

Indian Tribulus Fruit

Australian Tribulus Herb




Valerian Complex

Valerian Complex contains Valerian, Passionflower

and Zizyphus spinosa. This combination of herbs

contains many compounds including iridoids (known

as valepotriates), an essential oil, cyclopentane

sesquiterpenes (including valerenic acid), flavonoids

and dammarane-type saponins called jujubosides.

Indication

Helps promote sleep


Adults: Take 1 tablet 4 times daily or as directed by your health

care practitioner





Withania 2:1 liquid extract

Contraindications and Cautions: Consult a health care practitioner if symptoms persist, prior to use if you are pregnant or breastfeeding or if you are taking other sedatives, CNS depressants, or if you experience severe drowsiness and/or withdrawal symptoms upon abrupt discontinuation following chronic use. Consumption of alcohol, other drugs or natural health products with sedative properties is not recommended. Some people may experience drowsiness. Exercise caution if operating heavy machinery, driving a motor vehicle or involved in activities requiring mental alertness. Hypersensitivity (e.g. allergy) has been known to occur, in which case, discontinue use. Discontinue 7 days prior to general anesthesia.



Zizyphus spinosa (Zizyphus) seed 900 mg

Valeriana officinalis (Valerian) root and rhizome 700 mg

Passiflora incarnata (Passionflower) aerial parts 500 mg

Valerian Quality Issues

Valerian (Valeriana officinalis) contains Valerenic acids

(predominantly acetoxyvalerenic and valerenic acids and low levels

of hydroxyvalerenic acid) and valepotriates (valtrate and isovaltrate).

While other species of Valerian may contain the valepotriates only

true Valerian contains the valerenic acids. MediHerb has developed

a unique High Performance Liquid Chromatography analytical method

to determine the levels of valerenic acids and valepotriates in

Valerian. This method can also determine the level of the baldrinals

(valtrate degradation products) which are an indicator of poor quality

herb. By using this analytical method on all its Valerian products,

MediHerb assures that these products contain high levels of valerenic

acids and valepotriates, with no baldrinals.


Valeriana officinalis


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Passionflower Quality Issues

There are over 500 species of Passionflower, which includes the

edible passionfruit and varieties grown for their characteristic flowers.

The preferred medicinal species is Passiflora incarnata which is

native to the Americas and has many common names, including

‘Maypop’ and ‘Purple Passionflower’. The original forms of this plant

have flowers varying in colour from pale lavender through to dark

violet. There is also a white-flowered form which appears in the wild,

as well as in cultivation, and is sold as P. incarnata “Alba”. During

routine analysis in the MediHerb Research Laboratory it became

evident that there were two different phytochemical profiles of

Passionflower being encountered. The samples varied in the flavonoid

constituents which are among the proposed therapeutically active

components. In conjunction with Southern Cross University, Australia

it was determined that the different flavonoid profiles were related

to the colour of the flowers (purple or white). The clinical evidence

for Passionflower is derived from European clinical trials and the

corresponding phytochemical profiles have been published. By using

LC/MS it was determined that these profiles matched that of the

purple-flowered form. Two of the peaks are consistent between the

two different forms, however, the remaining 8 or more flavonoids

are different. Without using at least HPLC, or ideally LC/MS, this

differentiation is easily missed and the inappropriate form of herb

might be used.Passiflora incarnata

Valerian Complex

Valeriana officinalis




Vitanox

Vitanox contains a synergistic blend of herbs which

provide strong antioxidant protection. The herbs Rosemary,

Green Tea, Turmeric and Grape Seed provide phenolic

diterpenes (including carnosol and rosmarinic acid),

polyphenols including epigallocatechin gallate, essential

oils containing sesquiterpenes, yellow pigments referred

to as diarylheptanoids (including curcumin), flavonoids,

triterpenoids and oligomeric procyanidins. This product

contains three herbs with standardized levels of key

phytochemicals to ensure optimal strength and quality.

Indication

Provides antioxidants to protect against oxidative damage


Adults: Take 1 tablet 2 times daily or as directed by your health care

practitioner. Consult your health care practitioner for use beyond

12 weeks.



Rosmarinus officinalis (Rosemary) leaf 1.0 g

Camellia sinensis (Green Tea) leaf 4.17 g

Curcuma longa (Turmeric) rhizome 2.0 g

Vitis vinifera (Grape Seed) 6.0 g



Horsechestnut Complex tablets

Boswellia Complex tablets

Silymarin tablets

LivCo tablets

Contraindications and Cautions: Consult a health care practitioner if symptoms persist or worsen and prior to use if you have an iron deficiency, gallstones or bile duct obstruction or stomach ulcers or excess stomach acid or if you have liver disorder or develop symptoms of liver trouble (such as abdominal pain, dark urine or jaundice). Do not use if pregnant or breastfeeding.

Rosmarinus officinalis


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Dioscorea villosa



Asparagus racemosus (Shatavari) root 400 mg

Dioscorea villosa (Wild Yam) root and rhizome 400 mg

Actaea racemosa (Black Cohosh) root 100 mg

Hypericum perforatum (St John’s Wort) herb top 600 mg


Salvia officinalis (Sage) leaf 290 mg

Wild Yam Complex

Wild Yam Complex contains Wild Yam, Black

Cohosh, Shatavari, Korean Ginseng, St John’s Wort

and Sage. This combination of herbs contains

many compounds including several types of

saponins (including ginsenosides), an essential

oil (containing monoterpenes, including thujone),

phenolic compounds (such as rosmarinic acid),

naphthodianthrones hypericin and pseudohypericin,

and flavonoids. This tablet contains two herbs with

standardized levels of key phytochemicals to ensure

optimal strength and quality; 333 mcg of hypericin and

1.3 mg of total ginsenosides per tablet.

Indication

Helps relieve symptoms associated with menopause


Adult Women: Take 1 tablet 3 to 4 times daily or as directed

by your health care practitioner. Use for a minimum of 1 week

to see beneficial effects. For use beyond 2 weeks consult your

health care practitioner.


Chaste Tree tablets or 1:2 liquid extract




Contraindications and Cautions: Avoid prolonged exposure to sunlight, ultraviolet light (UV) or UV therapy. Consult a health care practitioner if symptoms persist or worsen. Consult a health care practitioner prior to use if you are taking digoxin or medications such as anti-anxiety and/or antidepressant, seizure, antihistamines, bronchodilators, muscle relaxants and/or opiates; if you have a liver disorder or if you have diabetes. Do not use if you are pregnant or breastfeeding, or if you are taking medications for anti-cancer, blood thinners, antidepressants (e.g. selective serotonin reuptake inhibitors (SSRI)), anti-HIV agents, cardiovascular, immunosuppressants, and/or contraceptive, if you have hormone sensitive conditions such as uterine, endometrial, breast or ovarian cancer as well as endometriosis and uterine fibroids, if you have a protein S deficiency as wild yam may increase the risk of thrombosis, or a seizure disorder (e.g. epilepsy). Hypersensitivity, such as an allergy, has been known to occur; and some people may experience mild gastrointestinal disturbances, nausea, insomnia, restlessness and/or headaches in which case, discontinue use.

Continued on the next page...




Compounds 1-2

1 – Methylparvifloside4 – Zingiberensis saponin I or glucosidodeltonin

Major Saponins of Dioscorea villosa

6 – Dioscin2 – Methylprotodeltonin5 – Deltonin

R = R =R =

Compounds 4-6

Wild Yam Quality Issues

There are some 600 species of Yam in the genus Dioscorea, many of

them are wild species that flourish in damp woodlands and thickets.

Dioscorea villosa, also known as Colic Root or Wild Yam, is a twining,

tuberous vine native to eastern North America. The roots initially

taste starchy, but soon after are bitter and acrid, nothing like the

taste of Yam or Sweet Potato grown for the dinner table. Commercial

Wild Yam extracts available for use as raw materials are often not

Dioscorea villosa but instead Dioscorea opposita (Chinese Yam Root)

which has a different phytochemical profile. It is widely misconstrued

that Dioscorea villosa contains diosgenin and many products have this

as a statement on their labels. However it does not contain diosgenin,

but rather the diosgenin precursors. Traditionally Dioscorea villosa

was believed to contain predominantly dioscin, however, the origin of

this assignment is unclear (dioscin is a steroidal glycoside precursor

of diosgenin). The phytochemical profile of Wild Yam is poorly-

defined and based on scientific literature from the 1940s. MediHerb

undertook a project in conjunction with Associate Professor James De

Voss, Chemistry Department, University of Queensland to investigate

the phytochemistry. Commercially available Dioscorea villosa is in

the form of dried roots, usually harvested at the end of summer or

autumn when the plant is dying back to its rootstock. It was found

that these roots contained only very small amounts of dioscin, not

the predominance as previously thought. The major saponin found

in the autumn harvested roots were in fact the furostanol-based

saponins, methylparvifloside and methylprotodeltonin, while the

spirostanol-based saponins, Zingiberensis saponin I and deltonin were

the major saponins for samples harvested in summer. The autumn

storage saponins differ from the summer saponins by the presence

of an extra glucose at the C-26 position of the diosgenin base

structure. The two main compounds found in commercial material

– harvested in autumn – are significantly different from dioscin by

having an extra one or two glucose residues in methylprotodeltonin

and methylparvifloside respectively. All of these compounds have

been reported from other Disocorea species, however, the profile of

saponins was different in the other species.

See St John’s Wort information on page 55 for St John’s Wort Quality Issues

See Rhodiola & Ginseng information on page 50 for Korean Ginseng Quality Issues


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Each mL contains:


Withania somnifera (Withania) root 2 g

Withania somnifera

Withania 2:1

Indications

Traditionally used in Ayurveda as Rasayana (rejuvenative tonic), a sleep aid, for memory enhancement, to balance aggravated Vata (nervine tonic, sedative) and to relieve general debility, especially

during convalescence or old age


Take 2 to 3 mL daily or as directed by your health care practitioner.

Contraindications and Cautions: Consult a health care practitioner prior to use if you are pregnant or breastfeeding. Consumption with alcohol, other drugs or natural products with sedative properties is not recommended.

See Withania information on page 63 for Withania Quality Issues




Withania Complex

Withania Complex contains Withania, Licorice, Skullcap

and Korean Ginseng. This combination of herbs contains

many compounds including steroidal compounds

(including the complex mixture of steroidal saponins

called ginsenosides), alkaloids, triterpenoid saponins

(especially glycyrrhizin), other saponins and many

flavonoids. The Korean Ginseng component of this tablet

is standardized to contain 1.68 mg of total ginsenosides


Indications

Helps support cognitive functions and/or reduce mental fatigue

Used in Herbal Medicine to help enhance physical capacity/performance


Adults: Take 6 tablets daily or as directed by your health care


4-6 weeks.



Scutellaria lateriflora (Skullcap) herb top 470 mg

Glycyrrhiza glabra (Licorice) root 750 mg

Withania somnifera (Withania) root 950 mg







Contraindications and Cautions: Do not use if you are pregnant or breastfeeding. Consult a health care practitioner prior to use if you have a liver disorder or diabetes, or if you are taking antidepressant medications or blood thinners or digoxin. When used as a sleep aid, consult a health care practitioner if sleeplessness persists continuously for more than 3 weeks (chronic insomnia). Consumption with alcohol, other drugs or natural health products with sedative properties in not recommended. Do not use if you are taking thiazide diuretics, cardiac glycosides, corticosteroids, stimulant laxatives or other medications which may aggravate electrolyte imbalance; or if you have hypokalemia, high blood pressure, or a kidney or cardiovascular disorder. Consult a health care practitioner if symptoms persist or worsen. Some people may experience insomnia, anxiety or headaches, in which case, discontinue use. Some people may experience drowsiness. Exercise caution if operating heavy machinery, driving a motor vehicle or involved in activities requiring mental alertness.


Withania somnifera


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Withania Quality Issues

Withania (Withania somnifera) is an Indian (Ayurvedic) herb which

contains a group of therapeutically important steroidal compounds

referred to collectively as withanolides. Withania contains more

than fifty withanolides which vary greatly depending upon the

geographic location and plant part. The withanolide profile and

content is a key determinant of Withania quality and efficacy.

Withanolide A Withaferin A

HPLC detection of Withanolides

100 150 200 250 300 350 400 450 500 550 600 650 700 750 m/z0e3

50e3

100e3

150e3

Int.417

435

453

503399 471

449375267 485391307285 515347 361171 245222 583 640191113 537145 597 616 719553 664 766 797681567 752

100 150 200 250 300 350 400 450 500 550 600 650 700 750 m/z

0e3

50e3

100e3

150e3

200e3

Int.471

435

453485

449299 417503391 407281 341311 363 525251145 229196 597573170 549 781102 706122 767645 751732674

Withaferin A Withanolide A

Liquid Chromatography/Mass Spectrometry (LC/MS) is the method of

choice for characterizing such a wide range of similar compounds and

unequivocably identifying key major components such as withaferin

A and withanolide D. This technique is used routinely in the MediHerb

Laboratories to identify and analyze Withania and other saponin-

containing herbs.

Withania Complex

Withania somnifera



Practitioner Resources • MediHerb Product Catalog 2017/18 65 Not for public distribution. For professional use only.

MediHerb Website

Our website, www.mediherb.ca is the most comprehensive website on natural medicine and an invaluable resource for practitioners and students. www.mediherb.ca features both public and member only information.

Public Area

Contains information on the MediHerb philosophy and the quality processes that deliver the world’s finest herbal products.

Members Only Area

This is where the site gets really interesting! You can go into the different areas to view comprehensive information on:

MediHerb Professional Library: use the dynamic search engine to discover all the herbal information we have produced dating back to 1987. You can search and view the Phytotherapist’s Perspective, Modern Phytotherapist and Professional Review by herb, phytochemical, condition or topic. It is a fantastic reference tool for all health professionals!

Products: view the most up-to-date information on new and existing products and product specials and search products by ingredient.

Seminars, News: see the latest information on all aspects of MediHerb and the world of natural therapies.

e-Newsletters: by registering your details on the MediHerb website, you will automatically receive a free subscription to our popular e-Newsletter. The e-Newsletter is emailed bimonthly and contains general interest articles, updates, clinical information and the e-Monitor. The e-Monitor is a comprehensive review of the latest research with a summary of what this research means for your practice and it also contains Kerry Bone’s popular Clinical Monitor.

Practitioner Resources

Keep Surfing!

We are continually adding to the website – so keep visiting to stay up-to-date!

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esou

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66 MediHerb Product Catalog 2017/18 • Practitioner Resources

Phytotherapist’s Perspectives

These publications provide website users with more clinical and technical information in a concise format. Like the rest of our Professional Library, the Phytotherapist’s Perspective can be searched by:

Herb – common or botanical name (eg ‘green tea’ or ‘Camellia sinensis’)

Phytochemical (eg ‘resveratrol’ or ‘flavonoids’)

Condition (eg ‘fatigue’)

Topic (eg ‘quality issues’)

Activity (eg ‘anti-inflammatory’ or ‘joint support’)

The Phytotherapist’s Perspective features phytotherapy articles written by Kerry Bone and Michelle Morgan, and includes:

Selected articles written by Kerry Bone for the Townsend Letter for Doctors and Patients.

Monographs detailing technical and clinical information on specific herbs written by Kerry Bone and Michelle Morgan.

An assortment of other articles outlining herbs suitable for use in specific conditions. Key constituents, quality issues, therapeutic activity and clinical studies are often a feature of these articles.

Modern Phytotherapist

The Modern Phytotherapist is an authoritative journal of phytotherapy blending current scientific information with traditional methods of herbal practice, and features articles by leading health care professionals from Australia and overseas.

Subjects Covered

Therapeutic Philosophy: discussion on philosophy and methodology of herbal practice. This may include discussion of modern therapeutics, or traditional systems such as Physiomedicalism or other systems such as Traditional Chinese Medicine (TCM) or treatment approaches based on modern research and practical traditional therapy.

Clinical Practice: herbal therapy and issues including recent medical information and herbal strategies which may be illustrated with case studies.

Case Studies: presentation of an individual case study outlining presentation of symptoms, therapeutic regime including herbal remedies and an indication of outcome.

Practice Management: methods and case studies relating to the management of effective herbal practice.

Reports: adverse reactions, updates from international conferences and seminars, updates from scientific literature, book reviews.

Letters to the Editors and editorials provide an avenue for discussion of new ideas.

Professional Review

The MediHerb Professional Review is a concise presentation of the traditional and current scientific information available on selected herbs. It provides detailed examination of individual herbs with attention to:

Botany, chemistry, pharmacodynamics, pharmacokinetics, toxicity

Clinical studies

Actions, indications and uses, dosage

Adverse effects, contraindications and precautions

The information is presented from traditional sources as well as from the latest medical and scientific research. The Professional Reviews are fully referenced for further study if required. Kerry Bone often proposes new and challenging interpretations of the research as it relates to the practice of modern herbal therapy. Each Professional Review generally focuses on a particular herb in detail. Other topics relevant to herbalists are also explored, such as the effect of medicinal plants on mental function, and dosage considerations in herbal therapy.

The Phytotherapist’s Perspective, Modern Phytotherapist and Professional Review are available through the MediHerb Professional Library at www.mediherb.ca (for qualified health care professionals only).

Seminars for Qualified Health Care Professionals

MediHerb regularly conducts professional seminars throughout the World with experienced speakers such as Professor Kerry Bone, BSc Dip Phyto., Angela Hywood, ND, Rob Santich, BHSc, ND, Berris Burgoyne, BHSc, ND and Tracey Cook, ND. These seminars combine the best of traditional knowledge with the latest scientific research.

1

a phytotherapist’s perspective

Key Points at a Glance

Berberine

� an alkaloid present in several herbs including the bark of Phellodendron amurense

� extensively studied, including clinical trials for doses of berberine greater than 500 mg/day

à administered in tablet form, usually as berberine hydrochloride, after having been originally extracted from plant sources

� major actions:

à hypoglycaemic and hypolipidaemic activity at daily doses of berberine of 500 mg or more (commonly 900 mg or more)

à antiarrhythmic activity at daily doses of berberine of 1200 mg or more

� a detrimental effect on probiotic flora is not expected at these doses of berberine

Indications

� Diabetes, hyperlipidaemia, metabolic syndrome.

� Adjunctive therapy in polycystic ovary syndrome and liver disorders.

Safety

� Extremely low oral toxicity. Some mild gastrointestinal discomfort observed, including at doses of 900–1000 mg/day, particularly constipation – sometimes required reducing the dose to 500–600 mg/day.

� Contraindicated in pregnancy and lactation. Interacts with immunosuppressive drugs such as cyclosporin and tacrolimus, although impact may be reduced if not taken simultaneously.

Caution is warranted in beta-thalassaemia, unconjugated hyperbilirubinaemia and those with obstructed bile ducts. Not advisable in jaundiced neonates. Best to avoid combining concomitantly with tannins.

Clinical Studies

� various therapeutic effects for berberine at doses of up to 1000 mg/day in:

à hypercholesterolaemia, metabolic syndrome, diabetes (including those with hyperlipidaemia), acute coronary syndrome, intestinal syndrome caused by radiotherapy

� hypoglycaemic and/or hypolipidaemic effects for berberine at doses of more than 1000 mg/day in:

à liver disorders (and improved liver function), polycystic ovary syndrome (and improved body composition), diabetes, dyslipidaemias

� beneficial effects for berberine at doses of more than 1000 mg/day also in:

à congestive heart failure (symptom improvement and antiarrhythmic activity), healthy volunteers (vascular health), lung cancer patients receiving radiotherapy

� mechanism of action for hypoglycaemic and hypolipidaemic activity explored experimentally and not known conclusively, but the following was observed in diabetics treated with berberine (1000 mg/day):

à increase in insulin receptor on lymphocytes

à improved insulin sensitivity, possibly due to reduced inflammation

à improved metabolism of free fatty acids

Not for Public Distribution. For Professional Use Only.

High-Dose Berberine: Focus on Dyslipidaemia & DiabetesBy Michelle Morgan

N+

OCH3

O

O

OCH3

Berberine

Phellodendron Amurense


Calcium Hydrogen PhosphateCalcium hydrogen phosphate is the binder or filler which actually holds the tablet together and allows it to be compressed to form a tablet. It also assists in formulation flow and resists the uptake of moisture, thus reducing the risk of poor stability.

CelluloseCellulose acts with calcium hydrogen phosphate as the binder that holds the tablet together. It also works to assist with tablet disintegration.

SilicaSilica is used as a glidant to assist with the flow properties of the tablet powder as it travels through the tablet machine. Good flow characteristics are crucial to the manufacture of tablets with consistent weight and active content. Silica is also used to increase the hardness of the tablet to ensure they are robust enough to handle coating, packaging and transport.

Sodium Starch GlycollateDue to the high proportion of herb used in the MediHerb tablets, an aid to disintegration is required to ensure that the tablets disintegrate in less than 30 minutes. Sodium starch glycollate performs this function best for the high potency tablets manufactured by MediHerb.

Magnesium Stearate – Vegetable OriginMost tablets need some form of lubrication to assist in the removal of the tablet from the tableting machine die. Magnesium stearate of vegetable origin is the most effective ingredient for this purpose.

Orange OilPressed oil from orange peel is used as a flavour masker.

Hypromellose (Cellulose Derivative)Hypromellose is used as a film coating agent on most MediHerb tablets. It is applied as a thin inert layer and has four important actions:

1. The thin layer makes the tablet much more resistant to dust formation in the packaging.

2. When the tablet surface is wetted in the mouth a lubricant, mucilaginous layer is formed on the tablet which facilitates swallowing.

3. The inert layer acts to hide any unpleasant odours or tastes that are found in many herbal tablets.

4. It aids in enhancing the stability of the product by forming a barrier to the external environment.

Enteric CoatingSome MediHerb tablets may have a specialised enteric coating which makes the tablets acid resistant. This is important for some herbs which can cause gastric discomfort and for herbs whose actives are damaged by stomach acid. Enterically coated tablets pass through the high acid environment of the stomach safely and then dissolve once they reach the pH neutral environment of the small intestine.

Solubility TestEnterically coated tablets must be stable for 2 hours in dilute hydrochloric acid and then dissolve within 1 hour when placed in pH 7 buffer.

Effervescent FactorsThe following ingredients are used in effervescent powders to adjust the pH and give the product fizz.

Calcium carbonate is a naturally occurring mineral, found as the following minerals and rocks: aragonite, calcite, chalk, limestone, marble and travertine.

Citric acid (anhydrous) is naturally occurring in plants and animals.

Potassium and sodium bicarbonates are naturally occurring inorganic minerals.

Tablet Excipients

MediHerb uses a range of low allergenic and pharmaceutical grade excipients in the manufacture of its tablet range. These excipients are carefully chosen using experience gained from over 10 years of manufacturing herbal tablets and are necessary to aid the manufacturing process, stability, disintegration and to allow ease of swallowing.

Excipient Glossary Prac

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68 MediHerb Product Catalog 2017/18 • Practitioner Resources

Herbal Medicine Text Books

Principles and Practice of Phytotherapy – Second Edition Modern Herbal MedicineBy Kerry Bone and Simon Mills

The first edition of Principles and Practice of Phytotherapy is well known as the leading text of

herbal medicine in naturopathic and herbal colleges throughout the world. Now the long-awaited

second edition brings a complete revision of the material in the first text including:

� 50 fully up-to-date evidence-based monographs including 7 new herbs: Gotu Kola, Willow Bark, Bugleweed, Butcher’s Broom, Boswellia, Myrrh and Tribulus.

� New insights on herbal management of approximately 100 modern disease states.

� A comprehensive revision of vital safety data, including an extensive herb-drug interaction chart addressing key safety issues to help the reader differentiate between false and real concerns.

� Extensive coverage of vital new topics such as asthma, atopic dermatitis, acne, fibromyalgia, inflammatory bowel disease, insulin resistance, migraine headaches and prostate cancer, to name a few.

This valued text was exhaustively researched and carefully compiled by Kerry Bone and Simon

Mills, who have more than 60 years of combined experience in clinical practice, education,

manufacturing and research. This text is a must-have resource for any herbal medicine

practitioner or student.

Winner of the 2013 James A Duke Excellence in Botanical Literature Award


The Essential Guide to Herbal SafetyEdited by Kerry Bone and Simon Mills

The first accurate and comprehensive book on herbal safety – a must for all health care professionals!

This innovative new book presents an extensive discussion of the principles of herbal safety and the current major issues relating to this important area. Leading international experts contribute to the book providing a wealth of information on issues such as quality, interactions, adverse reactions, toxicity, allergy, contact sensitivity and idiosyncratic reactions. In March 2006, the American Botanical Council (ABC) announced that The Essential Guide to Herbal Safety was the recipient of the James A. Duke Botanical Literature Award which honours the singular, outstanding contribution by a book to the knowledge and understanding of medicinal and aromatic plants.

Winner of the 2005 James A. Duke Botanical Literature Award

A Clinical Guide to Blending Liquid Herbs: Herbal Formulations for the Individual PatientBy Kerry Bone

This highly practical guide explains in-depth how to use and blend liquid extracts for optimum results making it a must for all herbal medicine practitioners and students.

Monographs of 125 popular herbs used in the form of liquid extracts provide the herbal clinician with accessible and clinically relevant information. The monographs have been specifically designed for use in the clinic with an emphasis on providing the essential information in an easy to read format and outlines traditional use and the most up-to-date pharmacological and clinical studies. This guide is comprehensively referenced and contains appendices for thorough explanations, indices of herb and herb action as well as complete glossaries and a table of recommended dosages.

The Ultimate Herbal CompendiumBy Kerry Bone

A Desktop Guide for Herbal Prescribers

The Ultimate Herbal Compendium is a reliable ready reference designed for the busy health practitioner. It contains up-to-date easily found information on a wide range of herbs and conditions, including doses for herbs in tablet form as well as liquids. Careful research of all the available herbal information combined with Kerry Bone’s 25 years of clinical practice ensures that all valid herbal treatment options can be considered.

Phytotherapy Essentials: Healthy ChildrenBy Rob Santich and Kerry Bone

Healthy Children has been written with the special needs of children in mind. The benefits, risks and requirements for herbal therapy in children differ from those in adults. This book outlines the key principles that govern herbal practice for this special patient group. A well-researched text, written by Rob Santich and Kerry Bone who together have almost 50 years of clinical practice, this book provides a comprehensive treatise on the common health problems encountered by children. Sound, practical information based on clinical experience as well as evidence-based research, provides a balanced and authoritative approach to children’s health.

IN

PHY TOTHER APY ESSENTIALS:

Optimising Children’s Health with Herbs

If you would like to order any of the books listed above, contact:

Canada - ProMedics Toll Free: 877-268-5057 Fax: 604-730-7186 Email: [email protected]

Prac

titio

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esou

rces

70 MediHerb Product Catalog 2017/18 • Indexes

Ingredient IndexThe ingredient index lists all active ingredients used in MediHerb products.

Herb Botanical Name Product Page

AActaea racemosa, Cimifuga racemosa Wild Yam Complex tablets 60

Aesculus hippocastanum Horsechestnut Complex tablets 43

Allium sativum Garlic tablets 39

Andrographis paniculata Andrographis Complex tablets 24

Apium graveolens Boswellia Complex tablets 28

Arctostaphylos uva-ursi Cranberry Complex tablets 32

Artemisia absinthium DiGest Forte tablets 33

Asparagus racemosus Wild Yam Complex tablets 60

Astragalus membranaceus Astragalus Complex tablets 25

BBacopa monniera, Bacopa monnieri Bacopa Complex tablets 26

Boswellia serrata Boswellia Complex tablets 28

Bupleurum falcatum Livton Complex tablets 47


C

Camellia sinensis Vitanox tablets 59

Capsicum annuum, Capsicum spp. Sinus Forte tablets 53

Chionanthus virginica Livton Complex tablets 47

Cimicifuga racemosa, Actaea racemosa Wild Yam Complex tablets 60

Citrus reticulata DiGest Forte tablets 33

Crateva nurvala, Crateva magna Cranberry Complex tablets 32

Crocus sativus Nevaton Forte tablets 48

Curcuma longa Boswellia Complex tablets 28

Vitanox tablets 59

Cynara scolymus Livton Complex tablets 47

DDioscorea villosa Wild Yam Complex tablets 60

EEchinacea spp. Echinacea Premium Blend 1:2 35

Echinacea Premium tablets 34

Andrographis Complex tablets 24

Astragalus Complex tablets 25


Eleutherococcus senticosus Astragalus Complex tablets 25

Bacopa Complex tablets 26

Euphrasia officinalis Sinus Forte tablets 53

FFrangula purshiana, Rhamnus purshianus Cascara Complex tablets 29

GGentiana lutea DiGest Forte tablets 33

Ginkgo biloba Ginkgo Forte tablets 40

Indexes • MediHerb Product Catalog 2017/18 71 Not for public distribution. For professional use only.


Horsechestnut Complex tablets 43

Glycyrrhiza glabra Licorice High Grade 1:1 45

AdrenoCo tablets 23


Gymnema sylvestre Gymnema tablets 42

HHemidesmus indicus Rehmannia Complex tablets 49

Hydrastis canadensis Golden Seal tablets 41


Hypericum perforatum St John’s Wort tablets 55



OOcimum tenuiflorum Andrographis Complex tablets 24

PPanax ginseng Rhodiola & Ginseng tablets 50



Passiflora incarnata Valerian Complex tablets 57

Piper methysticum Kava Forte tablets 44

RRehmannia glutinosa AdrenoCo tablets 23


Rhamnus purshianus, Frangula purshiana Cascara Complex tablets 29

Rhodiola rosea Rhodiola & Ginseng tablets 50

Rosmarinus officinalis Bacopa Complex tablets 26

LivCo tablets 46

Vitanox tablets 59

Rumex crispus Cascara Complex tablets 29

Ruscus aculeatus Horsechestnut Complex tablets 43

SSalvia officinalis Wild Yam Complex tablets 60

Schisandra chinensis Bacopa Complex tablets 26

LivCo tablets 46


Scutellaria lateriflora Nevaton Forte tablets 48


Silybum marianum Silymarin tablets 52

LivCo tablets 46


Solidago virgaurea Sinus Forte tablets 53

Inde

xes



TTanacetum parthenium DiGest Forte tablets 33


Taraxacum officinale Cascara Complex tablets 29


Tribulus terrestris Tribulus Forte tablets 56

UUlmus rubra Slippery Elm 400 mg capsules 54

VVaccinium macrocarpon Cranberry Complex tablets 32

Vaccinium myrtillus Bilberry tablets 27

Valeriana officinalis Valerian Complex tablets 57

Vitex agnus-castus Chaste Tree 1:2 31

Chaste Tree tablets 30

Vitis vinifera Vitanox tablets 59

WWithania somnifera Withania 2:1 62


ZZingiber officinale Boswellia Complex tablets 28

DiGest Forte tablets 33

Ziziphus jujube var. spinosa Valerian Complex tablets 57

Indexes • MediHerb Product Catalog 2017/18 73 Not for public distribution. For professional use only.

Common Name Botanical Name

AAndrographis Andrographis paniculata

Astragalus Astragalus membranaceus

BBacopa Bacopa monnieri

Bilberry Vaccinium myrtillus

Black Cohosh Cimicifuga racemosa

Bladderwrack Fucus vesiculosus

Boswellia Boswellia serrata

Bupleurum Bupleurum falcatum

Butcher’s Broom Ruscus aculeatus

CCascara Frangula purshiana, Rhamnus purshianus

Cayenne Capsicum annuum, Capsicum spp.

Celery Apium graveolens

Chaste Tree Vitex agnus-castus

Chinese Peony, Paeonia Paeonia lactiflora

Cranberry Vaccinium macrocarpon

DDandelion Taraxacum officinale

EEchinacea Echinacea angustifolia, Echinacea purpurea

Eyebright Euphrasia officinalis

FFeverfew Tanacetum parthenium

Fringe Tree Chionanthus virginica

GGarlic Allium sativum

Gentian Gentiana lutea

Ginger Zingiber officinale

Ginkgo Ginkgo biloba

Globe Artichoke Cynara scolymus

Golden Rod Solidago virgaurea

Golden Seal Hydrastis canadensis

Grape Seed Vitis vinifera

Green Tea Camellia sinensis

Gymnema Gymnema sylvestre

HHemidesmus, Indian-sarsaparilla

Hemidesmus indicus

Holy Basil Ocimum tenuiflorum

Horsechestnut Aesculus hippocastanum

IIndian-sarsaparilla, Hemidesmus

Hemidesmus indicus

Common Name Botanical Name

KKava Piper methysticum

Korean Ginseng Panax ginseng

LLicorice Glycyrrhiza glabra

MMilk Thistle, St Mary’s Thistle Silybum marianum

PPaeonia, Chinese Peony Paeonia lactiflora

Passionflower Passiflora incarnata

RRehmannia Rehmannia glutinosa

Rhodiola Rhodiola rosea

Rosemary Rosmarinus officinalis

SSaffron Crocus sativus

Sage Salvia officinalis

Schisandra Schisandra chinensis

Shatavari Asparagus racemosus

Siberian Ginseng Eleutherococcus senticosus

Skullcap Scutellaria lateriflora

Slippery Elm Ulmus rubra

St John’s Wort Hypericum perforatum

St Mary’s Thistle, Milk Thistle Silybum marianum

TTangerine Citrus reticulata

Three-leaf caper, Crateva Crateva magna, Crateva nurvala

Tribulus Tribulus terrestris

Turmeric Curcuma longa

UUva Ursi Arctostaphylos uva-ursi

VValerian Valeriana officinalis

WWild Yam Dioscorea villosa

Withania Withania somnifera

Wormwood Artemisia absinthium

YYellow Dock Rumex crispus

ZZizyphus Zizyphus spinosa

Index of Herb Common Names

Inde

xes


Index of Herb Botanical Names

Botanical Name Common Name

AActaea racemosa, Cimicifuga racemosa Black Cohosh

Aesculus hippocastanum Horsechestnut

Allium sativum Garlic

Andrographis paniculata Andrographis

Apium graveolens Celery

Arctostaphylos uva-ursi Uva Ursi

Artemisia absinthium Wormwood

Asparagus racemosus Shatavari

Astragalus membranaceus Astragalus

BBacopa monniera, Bacopa monnieri Bacopa

Boswellia serrata Boswellia

Bupleurum falcatum False Bupleurum

CCamellia sinensis Green Tea

Capsicum annuum, Capsicum spp. Cayenne

Chionanthus virginica Fringe Tree

Cimicifuga racemosa, Actaea racemosa Black Cohosh

Citrus reticulata Tangerine

Crateva magna, Crateva nurvala Three-leaf caper, Crateva

Crocus sativus Saffron

Curcuma longa Turmeric

Cynara scolymus Globe Artichoke

DDioscorea villosa Wild Yam

EEchinacea angustifolia, Echinacea purpurea Echinacea

Eleutherococcus senticosus Siberian Ginseng

Euphrasia officinalis Eyebright

FFrangula purshiana, Rhamnus purshianus Cascara

Fucus vesiculosus Bladderwrack

GGentiana lutea Gentian

Ginkgo biloba Ginkgo

Glycyrrhiza glabra Licorice

Gymnema sylvestre Gymnema

HHemidesmus indicus Indian-sarsaparilla,

Hemidesmus

Hydrastis canadensis Golden Seal

Hypericum perforatum St John’s Wort

Botanical Name Common Name

OOcimum tenuiflorum Holy Basil

PPaeonia lactiflora Chinese Peony, Paeonia

Panax ginseng Korean Ginseng

Passiflora incarnata Passionflower

Piper methysticum Kava

RRehmannia glutinosa Rehmannia

Rhamnus purshianus, Frangula purshiana Cascara

Rhodiola rosea Rhodiola

Rosmarinus officinalis Rosemary

Rumex crispus Yellow Dock

Ruscus aculeatus Butcher’s Broom

SSalvia officinalis Sage

Schisandra chinensis Schisandra

Scutellaria lateriflora Skullcap

Silybum marianum St Mary’s Thistle, Milk Thistle

Solidago virgaurea Golden Rod

TTanacetum parthenium Feverfew

Taraxacum officinale Dandelion

Tribulus terrestris Tribulus

UUlmus rubra Slippery Elm

VVaccinium macrocarpon Cranberry

Vaccinium myrtillus Bilberry

Valeriana officinalis Valerian

Vitex agnus-castus Chaste Tree

Vitis vinifera Grape seed

WWithania somnifera Withania

ZZingiber officinale Ginger

Ziziphus spinosa Zizyphus

HDI Chart • MediHerb Product Catalog 2017/18 75 Not for public distribution. For professional use only.

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hosh

Act

aea

race

mos

a (C

imic

ifuga

race

mos

a)

Stat

in d

rugs

eg

ator

vast

atin

May

pot

entia

te in

crea

se in

live

r en

zym

es, s

peci

fical

ly A

LT.

Case

repo

rt.8

Mon

itor

(low

leve

l of r

isk)

.

HD

I Cha

rt

76 MediHerb Product Catalog 2017/18 • HDI Chart

Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Blac

k Co

hosh

Act

aea

race

mos

a (C

imic

ifuga

race

mos

a)

Stat

in d

rugs

eg

ator

vast

atin

May

pot

entia

te in

crea

se in

live

r en

zym

es, s

peci

fical

ly A

LT.

Case

repo

rt.8

Mon

itor

(low

leve

l of r

isk)

.

Blad

derw

rack

Fuc

us v

esic

ulos

us

Hyp

erth

yroi

d m

edic

atio

n eg

car

bim

azol

eM

ay d

ecre

ase

effe

ctiv

enes

s of

dru

g du

e to

nat

ural

iodi

ne c

onte

nt.9

Theo

retic

al c

once

rn, n

o ca

ses

repo

rted

.Co

ntra

indi

cate

d un

less

und

er

clos

e su

perv

isio

n.

Thyr

oid

repl

acem

ent

ther

apie

s

eg th

yrox

ine

May

add

to e

ffect

of d

rug.

Theo

retic

al c

once

rn li

nked

to a

cas

e re

port

whe

re “

kelp

” ca

used

hyp

erth

yroi

dism

in a

per

son

not

taki

ng th

yrox

ine.

10

Mon

itor

(low

leve

l of r

isk)

.

Bugl

ewee

d L

ycop

us v

irgin

icus

, Lyc

opus

eur

opae

us

Radi

oact

ive

iodi

neM

ay in

terfe

re w

ith a

dmin

istra

tion

of d

iagn

ostic

pro

cedu

res

usin

g ra

dioa

ctiv

e is

otop

es.11

Case

repo

rt.

Cont

rain

dica

ted.

Thyr

oid

horm

ones

Shou

ld n

ot b

e ad

min

iste

red

conc

urre

ntly

with

pre

para

tions

co

ntai

ning

thyr

oid

horm

one.

12

Theo

retic

al c

once

rn b

ased

on

delib

erat

ions

of G

erm

an C

omm

issi

on E

.Co

ntra

indi

cate

d.

Cat’

s Cl

aw U

ncar

ia to

men

tosa

HIV

pro

teas

e in

hibi

tors

May

incr

ease

dru

g le

vel.

Case

repo

rt, i

n a

patie

nt w

ith c

irrho

sis

bein

g ev

alua

ted

for a

live

r tra

nspl

ant.13

Mon

itor

(low

leve

l of r

isk)

.

Caye

nne

(Chi

lli P

eppe

r) C

apsi

cum

spp

. (S

ee a

lso

Poly

phen

ol-c

onta

inin

g he

rbs)

ACE

inhi

bito

rM

ay c

ause

dru

g-in

duce

d co

ugh.

Case

repo

rt (

topi

cal c

apsa

icin

). Th

eore

tical

con

cern

sin

ce c

apsa

icin

dep

lete

s su

bsta

nce

P.14M

onito

r (v

ery

low

leve

l of r

isk)

.

Theo

phyl

line

May

incr

ease

abs

orpt

ion

and

drug

leve

l.Cl

inic

al s

tudy

(he

alth

y vo

lunt

eers

, chi

lli-s

pice

d m

eal).

Abs

orpt

ion

and

drug

leve

l low

er th

an

durin

g fa

stin

g.15

Mon

itor

(low

leve

l of r

isk)

.

Cele

ry S

eed

Api

um g

rave

olen

s

Thyr

oxin

eM

ay re

duce

ser

um le

vels

of

thyr

oxin

e.Ca

se re

port

s.16

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

Cole

us C

oleu

s fo

rsko

hlii

Ant

ipla

tele

t an

d an

tico

agul

ant

drug

sM

ay a

lter r

espo

nse

to d

rug.

Theo

retic

al c

once

rn in

itial

ly b

ased

on

in v

itro

antip

late

let a

ctiv

ity o

f act

ive

cons

titue

nt fo

rsko

lin,

and

in v

ivo

antip

late

let a

ctiv

ity in

an

anim

al m

odel

(or

al d

oses

: sta

ndar

dise

d Co

leus

ext

ract

an

d fo

rsko

lin).17

Mor

e re

cent

in v

ivo

anim

al re

sear

ch: s

tand

ardi

sed

Cole

us e

xtra

ct re

duce

d th

e an

ticoa

gula

nt a

ctiv

ity o

f war

farin

.18

Mon

itor

(low

leve

l of r

isk)

.

Hyp

oten

sive

med

icat

ion

May

pot

entia

te e

ffect

s of

dru

g.Th

eore

tical

con

cern

bas

ed o

n ab

ility

of h

igh

dose

s of

fors

kolin

and

sta

ndar

dise

d Co

leus

ext

ract

to

low

er b

lood

pre

ssur

e in

nor

mot

ensi

ve a

nd h

yper

tens

ive

anim

als.

19,2

0 Clin

ical

dat

a fro

m w

eigh

t m

anag

emen

t tria

ls: n

o ef

fect

on

bloo

d pr

essu

re in

thre

e tr

ials

, tre

nd to

war

d lo

wer

blo

od p

ress

ure

in o

ne s

mal

l stu

dy.21

,22 N

o ex

perim

enta

l or c

linic

al s

tudi

es c

ondu

cted

with

hyp

oten

sive

med

icat

ion.

Mon

itor

(low

leve

l of r

isk)

.

Pres

crib

ed m

edic

atio

nM

ay p

oten

tiate

effe

cts

of d

rug.

Theo

retic

al c

once

rn b

ased

on

abili

ty o

f for

skol

in to

act

ivat

e in

crea

sed

intra

cellu

lar c

yclic

AM

P in

vitr

o.23

Mon

itor

(low

leve

l of r

isk)

.


Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Cran

berr

y V

acci

nium

mac

roca

rpon

Mid

azol

amM

ay in

crea

se d

rug

leve

ls.

Clin

ical

tria

ls w

ith h

ealth

y vo

lunt

eers

: effe

ct o

n dr

ug le

vels

con

flict

ing

– in

crea

sed

(dou

ble-

stre

ngth

ju

iceD ,

240

mL

tds;

defi

ned

as a

wea

k in

tera

ctio

nE )24

and

no

effe

ct (

cran

berr

y ju

ice,

F 200

mL

tds)

.25

Mon

itor

(low

leve

l of r

isk)

.

Sim

vast

atin

May

incr

ease

sid

e ef

fect

s of

dru

g.Ca

se re

port

(35

5–47

3 m

L/da

y cr

anbe

rry

juic

e dr

ink

(7%

juic

e), r

ated

as

‘pos

sibl

e’ in

tera

ctio

n).26

Mon

itor

(low

leve

l of r

isk)

.

War

fari

nM

ay a

lter I

NR

(mos

t fre

quen

tly in

crea

se).

Case

repo

rts (

whe

re re

porte

d th

e do

sage

was

ofte

n hi

gh: u

p to

200

0 m

L/da

y, ju

ice

stre

ngth

und

efine

d;

1.5–

2 qu

arts

(14

20–1

893

mL)

/day

of c

ranb

erry

juic

e co

ckta

il; 1

13 g

/day

, cra

nber

ry s

auce

).27-3

5 Cl

inic

al tr

ials

: no

sign

ifica

nt e

ffect

foun

d in

atr

ial fi

brill

atio

n pa

tient

s

(250

mL/

day

cran

berry

juice

coc

ktai

l),36

in p

atie

nts

on w

arfa

rin fo

r a v

arie

ty o

f ind

icat

ions

(8

oz

(236

mL)

/day

cra

nber

ry ju

ice c

ockt

ail),

37 b

ut in

crea

se w

as o

bser

ved

in h

ealth

y vo

lunt

eers

(ju

ice

conc

entra

te e

quiv

alen

t to

57 g

of d

ry fr

uit/

day)

.38 N

o al

tera

tion

of p

roth

rom

bin

time

in p

atie

nts

on

stab

le w

arfa

rin th

erap

y (4

80 m

L/da

y cr

anbe

rry ju

ice)39

or o

f thr

ombo

plas

tin ti

me

in h

ealth

y vo

lunt

eers

(6

00 m

L/da

y cr

anbe

rry ju

iceF ).

25 S

ee a

lso

note

D.

Mon

itor

(low

leve

l of r

isk

at

typi

cal d

oses

).

Dan

She

n S

alvi

a m

iltio

rrhi

za

Mid

azol

amM

ay d

ecre

ase

drug

leve

ls.

Clin

ical

tria

l with

hea

lthy

volu

ntee

rs.40

Mon

itor

(med

ium

leve

l of r

isk)

.

War

fari

nM

ay p

oten

tiate

effe

ct o

f dru

g.Ca

se re

port

s: in

crea

sed

INR.

41-4

3Co

ntra

indi

cate

d.

Dev

il’s

Claw

Har

pago

phyt

um s

pp.

War

fari

nM

ay in

crea

se b

leed

ing

tend

ency

.Ca

se re

port

(pu

rpur

a) w

ith v

ery

few

det

ails

.44 U

nlik

ely

to o

ccur

.M

onito

r (v

ery

low

leve

l of r

isk)

.

Don

g Q

uai

Ange

lica

sine

nsis

, Ang

elic

a po

lym

orph

a

War

fari

nM

ay p

oten

tiate

effe

ct o

f dru

g.Ca

se re

port

s: in

crea

sed

INR

and

PT;45

incr

ease

d IN

R an

d w

ides

prea

d br

uisi

ng.46

Mon

itor

(low

leve

l of r

isk)

.

Echi

nace

a E

chin

acea

ang

ustif

olia

, Ech

inac

ea p

urpu

rea

Ant

iretr

ovira

l dru

gsH

IV n

on-n

ucle

osid

e tra

nscr

ipta

se

inhi

bito

rs e

g et

ravi

rine:

May

alte

r dr

ug le

vels

.

Clin

ical

tria

l (E.

pur

pure

a ro

ot; H

IV-in

fect

ed p

atie

nts)

: no

effe

ct o

vera

ll, b

ut la

rge

inte

rindi

vidu

al

varia

bilit

y oc

curr

ed (

from

nea

r 25%

dec

reas

es to

up

to 5

0% in

crea

ses

in d

rug

conc

entra

tions

).

All m

aint

aine

d an

und

etec

tabl

e vi

ral l

oad.

47

Mon

itor

(low

leve

l of r

isk)

.

HIV

pro

teas

e in

hibi

tors

eg

daru

navi

r M

ay d

ecre

ase

drug

leve

ls.

Clin

ical

tria

l (E.

pur

pure

a ro

ot; H

IV-in

fect

ed p

atie

nts)

: no

effe

ct o

vera

ll, b

ut s

ome

patie

nts

show

ed

a de

crea

se b

y as

muc

h as

40%

. All

mai

ntai

ned

an u

ndet

ecta

ble

vira

l loa

d. (

Patie

nts

wer

e al

so ta

king

a

low

dos

e of

rito

navi

r.)48

Mon

itor

(low

leve

l of r

isk)

.

Imm

unos

uppr

essa

nt m

edic

atio

nM

ay d

ecre

ase

effe

ctiv

enes

s

of d

rug.

49,5

0

Theo

retic

al c

once

rn b

ased

on

imm

une-

enha

ncin

g ac

tivity

of E

chin

acea

. No

case

s re

port

ed.

Cont

rain

dica

ted.

Mid

azol

amD

ecre

ases

dru

g le

vels

whe

n dr

ug

adm

inis

tere

d in

trave

nous

ly.G

Clin

ical

stu

dy (

E. p

urpu

rea

root

, 1.6

g/d

ay).51

Mon

itor

(med

ium

leve

l of r

isk)

whe

n dr

ug a

dmin

iste

red

intra

veno

usly.

HD

I Cha

rt

Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Even

ing

Prim

rose

Oil

Oen

othe

ra b

ienn

is

Phen

othi

azin

esM

ay d

ecre

ase

effe

ctiv

enes

s

of d

rug.

Repo

rts

of w

orse

ning

epi

leps

y in

sch

izop

hren

ics.

No

caus

al a

ssoc

iatio

n de

mon

stra

ted

and

no e

ffect

ob

serv

ed in

late

r tria

ls.52

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

Gar

lic A

llium

sat

ivum

(Se

e al

so H

ypog

lyca

emic

her

bs)

Ant

ipla

tele

t an

d an

tico

agul

ant

drug

sA

spiri

n: M

ay in

crea

se b

leed

ing

time.

Clop

idog

rel:

May

pot

entia

te e

ffect

of

dru

g.

War

farin

: May

pot

entia

te e

ffect

of

drug

. Lar

ge d

oses

cou

ld in

crea

se

blee

ding

tend

ency

.

Conc

ern

may

be

over

stat

ed, a

s an

tipla

tele

t/an

ticoa

gula

nt d

rugs

are

ofte

n co

adm

inis

tere

d eg

asp

irin

and

war

farin

.

Her

b A

lone

Case

repo

rts

of in

crea

sed

blee

ding

tend

ency

with

hig

h ga

rlic

inta

ke. I

n th

ree

of th

e fo

ur c

ases

the

blee

ding

occ

urre

d af

ter s

urge

ry.53

-56

Anec

dota

l: ga

rlic

take

n sh

ortly

bef

ore

test

ing

inte

rfere

s w

ith p

late

let a

ggre

gatio

n in

con

trol

sub

ject

s.57

Sing

le-d

ose

stud

ies,

and

stu

dies

dem

onst

ratin

g a

bene

ficia

l effe

ct o

n di

sord

ered

func

tion,

in

clud

ing

for e

xam

ple,

in a

ther

oscl

eros

is, a

re e

xclu

ded.

Clin

ical

stu

dies

(3

g/da

y or

less

of f

resh

ga

rlic)

: inh

ibite

d pl

atel

et a

ggre

gatio

n in

thre

e tr

ials

† (a

bout

2.4

–2.7

g/d

ay, p

atie

nts

and

heal

thy

volu

ntee

rs),58

-60 b

ut n

o ef

fect

on

plat

elet

agg

rega

tion

in o

ne tr

ial†

(ab

out 1

.8 g

/day

, pat

ient

s);61

de

crea

sed

seru

m th

rom

boxa

ne in

one

tria

l (3

g/da

y, h

ealth

y vo

lunt

eers

)62. †

See

not

e H

.

Clin

ical

stu

dies

(4.

2–5

g/da

y of

fres

h ga

rlic,

pat

ient

s an

d he

alth

y vo

lunt

eers

): no

effe

ct o

n pl

atel

et

aggr

egat

ion,

fibr

inog

en le

vel,

prot

hrom

bin

time,

who

le b

lood

coa

gula

tion

time.

63-6

5

Clin

ical

stu

dies

(8–

10 g

/day

of f

resh

gar

lic, h

ealth

y vo

lunt

eers

): in

hibi

ted

plat

elet

agg

rega

tion

and

incr

ease

d cl

ottin

g tim

e.66

,67

Her

b an

d D

rug

Asp

irin:

No

publ

ishe

d st

udie

s.

Clop

idog

rel:

Gar

lic ta

blet

(“o

dorle

ss”,

dos

e un

defin

ed)

adde

d to

impr

ove

drug

ther

apy,

redu

ced

plat

elet

hyp

erac

tivity

in tw

o pa

tient

s.57

War

farin

: Tw

o ca

ses

of in

crea

sed

INR

and

clot

ting

times

, ver

y fe

w d

etai

ls (

garli

c pe

arls

, gar

lic ta

blet

s:

dosa

ge u

ndefi

ned)

.68 C

linic

al tr

ial:

no e

ffect

in h

ealth

y vo

lunt

eers

(en

teric

-coa

ted

tabl

ets

equi

vale

nt to

4

g/da

y of

fres

h ga

rlic)

.38

Mon

itor

at d

oses

equ

ival

ent t

o

≥ 3

g/da

y fre

sh g

arlic

(lo

w le

vel o

f ris

k).

Stop

tak

ing

at le

ast o

ne w

eek

befo

re s

urge

ry.

HIV

pro

teas

e in

hibi

tors

Dec

reas

es d

rug

leve

l.Sa

quin

avir:

Tw

o cl

inic

al s

tudi

es (

garli

c ex

tract

, sta

ndar

dise

d fo

r alli

cin

cont

ent)

with

hea

lthy

volu

ntee

rs69

,70 –

larg

e va

riabi

lity

(in o

ne s

tudy

,70 d

ecre

ase

(15%

) w

as n

ot s

igni

fican

t).

Rito

navi

r-bo

oste

d at

azan

avir:

Cas

e re

port

(6

stir-

frie

d ga

rlic

clov

es th

ree

times

per

wee

k).71

Mon

itor

(med

ium

leve

l of r

isk)

.



Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Gin

ger

Zin

gibe

r offi

cina

le

Ant

acid

sM

ay d

ecre

ase

effe

ctiv

enes

s of

dru

g.Th

eore

tical

con

cern

sin

ce g

inge

r inc

reas

es g

astr

ic s

ecre

tory

act

ivity

in v

ivo

(ani

mal

s).49

Mon

itor

(low

leve

l of r

isk)

.

Ant

ipla

tele

t an

d an

tico

agul

ant

drug

sPh

enpr

ocou

mon

: May

incr

ease

ef

fect

iven

ess

of d

rug.

Case

repo

rt (

dosa

ge u

ndefi

ned)

: inc

reas

ed IN

R.72

Mon

itor a

t dos

es e

quiv

alen

t to

<

4 g/

day

drie

d gi

nger

(lo

w le

vel o

f risk

).

War

farin

: Inc

reas

ed ri

sk o

f sp

onta

neou

s bl

eedi

ng.

Conc

ern

base

d on

ant

ipla

tele

t act

ivity

and

pot

entia

l to

inhi

bit t

hrom

boxa

ne s

ynth

etas

e.

Her

b A

lone

Clin

ical

stu

dies

: inh

ibiti

on o

f pla

tele

t agg

rega

tion

(5 g

, div

ided

sin

gle

dose

, drie

d gi

nger

) in

he

alth

y vo

lunt

eers

,73 a

nd c

oron

ary

arte

ry d

isea

se p

atie

nts

(10

g, s

ingl

e do

se, d

ried

ging

er),74

bu

t no

effe

ct in

hea

lthy

volu

ntee

rs (

2 g,

sin

gle

dose

, drie

d gi

nger

),75 o

r cor

onar

y ar

tery

dis

ease

pa

tient

s (4

g/d

ay, d

ried

ging

er);74

inhi

bitio

n of

pla

tele

t thr

ombo

xane

pro

duct

ion

in h

ealth

y vo

lunt

eers

(5

g/d

ay, f

resh

gin

ger)

.76

Her

b an

d D

rug

Case

repo

rt: b

leed

ing

(gin

ger d

osag

e un

defin

ed).77

No

phar

mac

okin

etic

or p

harm

acod

ynam

ic e

ffect

de

mon

stra

ted

in a

clin

ical

tria

l with

hea

lthy

volu

ntee

rs (

3.6

g/da

y, d

ried

ging

er).78

Epi

dem

iolo

gica

l st

udy:

gin

ger (

as a

com

plem

enta

ry m

edic

ine)

was

sig

nific

antly

ass

ocia

ted

with

an

incr

ease

d ris

k of

se

lf-re

port

ed b

leed

ing

in p

atie

nts

taki

ng w

arfa

rin.79

The

se re

sults

sho

uld

be v

iew

ed c

autio

usly

(s

ee n

ote

J).

Mon

itor

at d

oses

equ

ival

ent t

o

< 4

g/da

y dr

ied

ging

er (

very

low

risk

).

Cont

rain

dica

ted

unle

ss u

nder

clo

se

supe

rvis

ion

at d

oses

equ

ival

ent t

o

> 4

g/da

y dr

ied

ging

er.

Nife

dipi

neM

ay p

rodu

ce a

syn

ergi

stic

an

tipla

tele

t effe

ct.

Clin

ical

stu

dy (

1 g/

day,

drie

d gi

nger

) in

hea

lthy

volu

ntee

rs a

nd h

yper

tens

ive

patie

nts.

80Co

ntra

indi

cate

d.

Gin

kgoK

Gin

kgo

bilo

ba

Ant

icon

vuls

ant

med

icat

ion

eg c

arba

maz

epin

e, s

odiu

m v

alpr

oate

M

ay d

ecre

ase

the

effe

ctiv

enes

s of

dru

g.Ca

se re

port

s, tw

o w

ith w

ell-c

ontr

olle

d ep

ileps

y,81

oth

ers

anec

dota

l and

unc

erta

in.82

-84

Mon

itor

(med

ium

leve

l of r

isk)

. In

crea

sing

the

inta

ke o

f vita

min

B6

may

be

advi

sabl

e fo

r pat

ient

s ta

king

an

ticon

vuls

ants

.L

HD

I Cha

rt

Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Gin

kgoK

Gin

kgo

bilo

ba (

cont

inue

d)

Ant

ipla

tele

t an

d an

tico

agul

ant

drug

sPr

olon

gatio

n of

ble

edin

g an

d/or

in

crea

sed

blee

ding

tend

ency

.Co

ncer

n ba

sed

on a

ntip

late

let a

ctiv

ity.

Blee

ding

eve

nts

asso

ciat

ed w

ith G

inkg

o al

one

or in

com

bina

tion

with

thes

e an

d ot

her d

rugs

hav

e be

en re

port

ed b

ut a

cau

sal r

elat

ions

hip

was

not

est

ablis

hed

conc

lusi

vely.

Alth

ough

a re

tros

pect

ive

popu

latio

n-ba

sed

stud

y fo

und

risk

of h

aem

orrh

age

was

ass

ocia

ted

with

eld

erly

pat

ient

s (6

5 ye

ars

or o

lder

) w

ho w

ere

taki

ng G

inkg

o al

one.

85

Her

b A

lone

Rare

cas

e re

port

s of

ble

edin

g.86

-88

Met

a-an

alys

is o

f ran

dom

ised

, pla

cebo

-con

trol

led

tria

ls (

heal

thy

volu

ntee

rs a

nd p

atie

nts)

: res

ults

in

dica

te s

tand

ardi

sed

Gin

kgo

extra

ct d

oes

not i

ncre

ase

the

risk

of b

leed

ing.

89 R

ando

mis

ed, 5

-yea

r tr

ial (

elde

rly p

artic

ipan

ts; G

inkg

o 50

:1 e

xtra

ct, 2

40 m

g/da

y, e

quiv

alen

t to

12 g

/day

of d

ried

leaf

):

no s

igni

fican

t diff

eren

ce in

inci

denc

e of

hae

mor

rhag

ic e

vent

s.90

Her

b an

d D

rug

Retr

ospe

ctiv

e po

pula

tion-

base

d st

udy

in T

aiw

an: t

he re

lativ

e ris

k of

hae

mor

rhag

e as

soci

ated

with

th

e us

e of

Gin

kgo

extra

ct c

ombi

ned

with

dru

gs (

clop

idog

rel,

cilo

staz

ol, t

iclo

pidi

ne, w

arfa

rin)

was

not

si

gnifi

cant

.85 S

ee a

lso

note

M.

Asp

irin:

Cas

e re

port

s (2

, ble

edin

g;86

one

, ext

ensi

ve b

ruis

ing

afte

r a fa

ll –

alth

ough

pos

sibl

y hi

gh G

inkg

o do

se (

400

mg/

day,

und

efine

d)).91

Clin

ical

stu

dies

: no

addi

tiona

l effe

ct o

n pl

atel

et fu

nctio

n, p

late

let

aggr

egat

ion

or b

leed

ing

time.

92-9

4

Cilo

staz

ol: C

linic

al s

tudi

es w

ith h

ealth

y vo

lunt

eers

(G

inkg

o ex

tract

(un

defin

ed):

sing

le d

ose

120

mg)

–

blee

ding

tim

e pr

olon

ged;

no

chan

ge in

pla

tele

t agg

rega

tion

or c

lott

ing

time,

and

no

sign

ifica

nt

corr

elat

ion

betw

een

prol

onga

tion

of b

leed

ing

time

and

inhi

bitio

n of

pla

tele

t agg

rega

tion;

95 n

o ef

fect

on

pha

rmac

okin

etic

s or

ble

edin

g tim

e, th

e in

crea

se in

pla

tele

t agg

regr

atio

n w

as n

ot s

igni

fican

t (G

inkg

o ex

tract

(un

defin

ed):

160

mg/

day)

.96

Clop

idog

rel:

Case

repo

rt (

brui

sing

and

ble

edin

g).97

Clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

(G

inkg

o ex

tract

(un

defin

ed):

sing

le d

ose

120

mg)

– n

o ef

fect

on

plat

elet

agg

rega

tion,

ble

edin

g tim

es.95

Ticl

opid

ine:

Cas

e re

port

(bl

eedi

ng).87

Clin

ical

stu

dies

: no

sign

ifica

nt a

dditi

onal

effe

ct o

n bl

eedi

ng ti

me

or p

late

let a

ggre

gatio

n (G

inkg

o 50

:1 e

xtra

ct: s

ingl

e do

se 8

0 m

g, e

quiv

alen

t to

4 g

of d

ried

leaf

; he

alth

y vo

lunt

eers

),98 a

nd a

t the

hig

her d

ose

(120

mg/

day)

did

not

affe

ct d

rug

leve

ls;99

incr

ease

d in

hibi

tory

resp

onse

of p

late

lets

to te

stin

g w

ith tw

o ag

onis

ts (

ie a

ntip

late

let e

ffect

) fo

r dru

g an

d he

rb c

ompa

red

with

dru

g al

one,

alth

ough

effe

ct w

as s

mal

l and

sta

tistic

al a

nd c

linic

al s

ignfi

canc

e is

unk

now

n (G

inkg

o ex

tract

(un

defin

ed):

160

mg/

day;

pilo

t stu

dy o

f pat

ient

s w

ho h

ad a

n ac

ute

isch

aem

ic s

trok

e or

tran

sien

t isc

haem

ic a

ttac

k).10

0

War

farin

: Cas

e re

port

(bl

eedi

ng).86

Clin

ical

stu

dies

(he

alth

y vo

lunt

eers

and

pat

ient

s): n

o ad

ditio

nal

effe

ct o

n IN

R, p

late

let a

ggre

gatio

n, c

oagu

latio

n pa

ram

eter

s or

pla

sma

drug

leve

l.78,1

01,1

02

Mon

itor

(low

leve

l of r

isk)

.

Ant

ipsy

chot

ic m

edic

atio

n

eg h

alop

erid

ol, o

lanz

apin

e, c

loza

pine

May

pot

entia

te th

e ef

ficie

ncy

of

drug

in p

atie

nts

with

sch

izop

hren

ia.

Rand

omis

ed, c

ontr

olle

d tr

ials

(G

inkg

o 50

:1 e

xtra

ct: 1

20–3

60 m

g/da

y, e

quiv

alen

t to

6–18

g/d

ay o

f dr

ied

leaf

).103-

106

Pres

crib

e ca

utio

usly.

Red

uce

drug

if

nece

ssar

y in

con

junc

tion

with

pr

escr

ibin

g ph

ysic

ian.

Ant

iretr

ovira

l dru

gsH

IV in

tegr

ase

inhi

bito

rs e

g ra

ltegr

avir:

May

alte

r dru

g le

vels

Clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

(G

inkg

o 50

:1 e

xtra

ct: 2

40 m

g/da

y, e

quiv

alen

t to

12 g

/day

of

drie

d le

af)

foun

d an

incr

ease

in p

lasm

a le

vels

, due

to la

rge

inte

rindi

vidu

al v

aria

bilit

y, n

ot c

onsi

dere

d to

be

of c

linic

al im

port

ance

. (Th

e dr

ug’s

pha

rmac

okin

etic

s ar

e kn

own

for c

onsi

dera

ble

intra

- an

d in

terin

divi

dual

var

iabi

lity.

)107

Mon

itor

(low

leve

l of r

isk)

.

HIV

non

-nuc

leos

ide

trans

crip

tase

in

hibi

tors

eg

efav

irenz

: May

de

crea

se d

rug

leve

ls.

Case

repo

rt.10

8M

onito

r (m

ediu

m le

vel o

f ris

k).



Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Gin

kgoK

Gin

kgo

bilo

ba (

cont

inue

d)

Ato

rvas

tati

n –

See

Stat

in d

rugs

bel

ow

Benz

odia

zepi

nes

May

alte

r dru

g le

vel.

Alpr

azol

am: C

linic

al tr

ial i

n he

alth

y vo

lunt

eers

foun

d no

effe

ct (

Gin

kgo

50:1

ext

ract

: 240

mg/

day,

eq

uiva

lent

to 1

2 g/

day

of d

ried

leaf

).109

Dia

zepa

m: C

linic

al tr

ial i

n he

alth

y vo

lunt

eers

foun

d no

effe

ct (

Gin

kgo

50:1

ext

ract

: 240

mg/

day,

eq

uiva

lent

to 1

2 g/

day

of d

ried

leaf

).110

Mid

azol

am: C

linic

al tr

ials

in h

ealth

y vo

lunt

eers

foun

d co

nflic

ting

resu

lts o

n dr

ug le

vels

: inc

reas

ed

(defi

ned

as a

wea

k in

tera

ctio

nE ; G

inkg

o 50

:1 e

xtra

ct: 3

60 m

g/da

y, e

quiv

alen

t to

18 g

/day

of d

ried

leaf

),111 d

ecre

ased

(G

inkg

o 50

:1 e

xtra

ct: 2

40 m

g/da

y, e

quiv

alen

t to

12 g

/day

of d

ried

leaf

)112 a

nd n

o ef

fect

(G

inkg

o 50

:1 e

xtra

ct: 2

40 m

g/da

y, e

quiv

alen

t to

12 g

/day

of d

ried

leaf

).113

Mon

itor

(low

leve

l of r

isk)

.

Hyp

ogly

caem

ic d

rugs

Glip

izid

e: M

ay c

ause

hy

pogl

ycae

mia

.O

bser

vatio

n fro

m a

bort

ed tr

ial:

hypo

glyc

aem

ia o

ccur

red

in v

olun

teer

s w

ith n

orm

al g

luco

se to

lera

nce

with

in 6

0 m

inut

es.11

4 Gin

kgo

50:1

ext

ract

was

adm

inis

tere

d as

a s

ingl

e do

se o

f 120

mg,

equ

ival

ent t

o 6

g of

drie

d le

af.11

5

Mon

itor

(low

leve

l of r

isk)

.

Met

form

in: M

ay e

nhan

ce

effe

ctiv

enes

s of

dru

g.Cl

inic

al tr

ial:

elim

inat

ion

half-

life

was

incr

ease

d at

dos

es o

f met

form

in 8

50 m

g, th

ree

times

a d

ay.

Effe

ct n

ot s

igni

fican

t at d

oses

to 5

00 m

g, tw

ice

a da

y. G

inkg

o 50

:1 e

xtra

ct w

as a

dmin

iste

red

as a

si

ngle

dos

e of

120

mg,

equ

ival

ent t

o 6

g of

drie

d le

af.11

4

Mon

itor

at d

oses

of m

etfo

rmin

>

1 g/

day

(med

ium

leve

l of

risk)

. Red

uce

drug

if n

eces

sary

in

conj

unct

ion

with

pre

scrib

ing

phys

icia

n.

Piog

litaz

one:

May

incr

ease

dr

ug le

vel.

Clin

ical

tria

l with

hea

lthy

volu

ntee

rs (

Gin

kgo

50:1

ext

ract

: 120

mg/

day,

equ

ival

ent t

o 6

g/da

y of

drie

d le

af).11

6

Mon

itor

(low

leve

l of r

isk)

.

Tolb

utam

ide:

May

dec

reas

e ef

fect

iven

ess

of d

rug.

Clin

ical

tria

ls w

ith h

ealth

y vo

lunt

eers

: non

sign

ifica

nt re

duct

ion

in g

luco

se-lo

wer

ing

effe

ct o

f dru

g (G

inkg

o 50

:1 e

xtra

ct: 3

60 m

g/da

y, e

quiv

alen

t to

18 g

/day

of d

ried

leaf

);111 p

harm

acok

inet

ics

not

alte

red

(Gin

kgo

50:1

ext

ract

: 240

and

360

mg/

day)

.111,

113

Mon

itor

(low

leve

l of r

isk)

.

Nife

dipi

neM

ay in

crea

se d

rug

leve

ls o

r si

de e

ffect

s.Cl

inic

al s

tudi

es: m

ixed

resu

lts fo

und

for m

ean

plas

ma

drug

leve

l – in

crea

se (

120

mg/

day,

equ

ival

ent

to 6

g/d

ay o

f drie

d le

af)11

7 and

no

effe

ct (

240

mg/

day,

equ

ival

ent t

o 12

g/d

ay o

f drie

d le

af).11

8 H

owev

er, a

t the

hig

her d

ose,

max

imal

pla

sma

drug

leve

l and

hea

rt ra

te w

as in

crea

sed

with

adv

erse

dr

ug re

actio

ns fo

r par

ticip

ants

with

hig

hest

pla

sma

drug

leve

ls (

head

ache

, diz

zine

ss, h

ot fl

ushe

s).11

8

Mon

itor

at d

oses

< 2

40 m

g/da

y,

equi

vale

nt to

< 1

2 g/

day

of d

ried

le

af (

med

ium

leve

l of r

isk)

. Co

ntra

indi

cate

d fo

r hig

her d

oses

.

Om

epra

zole

May

dec

reas

e dr

ug le

vels

.Cl

inic

al tr

ials

with

hea

lthy

volu

ntee

rs fo

und

confl

ictin

g re

sults

on

drug

leve

ls: d

ecre

ased

(G

inkg

o 50

:1 e

xtra

ct: 2

80 m

g/da

y, e

quiv

alen

t to

14 g

/day

of d

ried

leaf

);119 a

nd n

o ef

fect

(G

inkg

o 50

:1 e

xtra

ct: 2

40 m

g/da

y, e

quiv

alen

t to

12 g

/day

of d

ried

leaf

).113

Mon

itor

(low

leve

l of r

isk)

.

Stat

in d

rugs

M

ay d

ecre

ase

drug

leve

ls.

Ator

vast

atin

: Clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

(G

inkg

o 50

:1 e

xtra

ct: 3

60 m

g/da

y, e

quiv

alen

t to

18

g/da

y of

drie

d le

af).

No

phar

mac

odyn

amic

effe

ct w

as o

bser

ved.

120

Sim

vast

atin

: Clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

(G

inkg

o 50

:1 e

xtra

ct: 2

40 m

g/da

y, e

quiv

alen

t to

12

g/da

y of

drie

d le

af)

– dr

ug le

vels

dec

reas

ed, b

ut a

ctiv

e m

etab

olite

dru

g le

vels

not

affe

cted

. Ph

arm

acod

ynam

ics

(cho

lest

erol

low

erin

g) o

f the

dru

g no

t sig

nific

antly

affe

cted

, alth

ough

tren

d to

war

ds lo

wer

ing

of L

DL-

chol

este

rol e

ffica

cy o

bser

ved.

121

Mon

itor

(low

leve

l of r

isk)

.

Talin

olol

May

incr

ease

dru

g le

vels

.Cl

inic

al tr

ial w

ith h

ealth

y vo

lunt

eers

.122

Mon

itor

(low

leve

l of r

isk)

.

HD

I Cha

rt

Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Gol

den

Seal

C H

ydra

stis

can

aden

sis

Dru

gs w

hich

dis

plac

e th

e pr

otei

n bi

ndin

g of

bili

rubi

n

eg p

heny

lbut

azon

e

May

pot

entia

te e

ffect

of d

rug

on

disp

laci

ng b

iliru

bin.

Her

b A

lone

Theo

retic

al c

once

rn b

ased

on

in v

itro

data

(di

spla

ced

bilir

ubin

from

alb

umin

) an

d in

ani

mal

s w

ith h

igh

dose

of b

erbe

rine

by in

ject

ion

(red

uced

bili

rubi

n se

rum

pro

tein

bin

ding

).3

Mon

itor

(low

leve

l of r

isk)

.

Mid

azol

amM

ay in

crea

se d

rug

leve

l.Cl

inic

al tr

ial (

defin

ed a

s a

wea

k in

tera

ctio

nE ).12

3M

onito

r (lo

w le

vel o

f ris

k).

Gre

en T

ea C

amel

lia s

inen

sis

(Se

e al

so P

olyp

heno

l-con

tain

ing

herb

s an

d Ta

nnin

-con

tain

ing

herb

s)

Boro

nic

acid

-bas

ed p

rote

ase

inhi

bito

rs e

g bo

rtez

omib

May

dec

reas

e ef

ficac

y of

dru

g.Th

eore

tical

con

cern

bas

ed o

n in

itial

in v

itro

data

and

in v

ivo

anim

al s

tudy

(gr

een

tea

cons

titue

nt: E

GCG

re

duce

d tu

mou

r cel

l dea

th in

duce

d by

dru

g).12

4 How

ever

, a fu

rthe

r in

vivo

ani

mal

stu

dy fo

und

EGCG

w

as n

ot a

ntag

onis

tic to

the

activ

ity o

f the

dru

g.12

5 See

not

e N

.

Cont

rain

dica

ted

at h

igh

dose

s (a

roun

d 60

0 m

g/da

y EG

CG o

r 1 g

/day

gr

een

tea

cate

chin

s).P

Mor

e in

form

atio

n re

quire

d fo

r dos

es

belo

w th

is le

vel.

Fola

teM

ay d

ecre

ase

abso

rptio

n.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs.12

6 Clin

ical

sig

nific

ance

unc

lear

, as

was

a o

ne-d

ay s

tudy

(ie

not

on

goin

g ad

min

istra

tion)

, with

50

mg

of g

reen

tea

cate

chin

s ad

min

iste

red

befo

re, d

urin

g an

d up

to

2 ho

urs

afte

r fol

ate

(for

a to

tal o

f 250

mg

of c

atec

hins

).

If ta

ken

sim

ulta

neou

sly,

may

nee

d to

incr

ease

dos

e of

fola

te. T

he e

ffect

m

ay b

e re

lativ

ely

smal

l – m

ore

info

rmat

ion

is re

quire

d.

Imm

unos

uppr

essi

ves

May

incr

ease

dru

g le

vels

.Ca

se re

port

(pa

tient

was

a C

YP3A

4 po

or m

etab

oliz

er).12

7M

onito

r (m

ediu

m le

vel o

f ris

k).

Sild

enafi

lM

ay in

crea

se b

ioav

aila

bilit

y of

dru

g.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs (

2 g,

sin

gle

dose

, gre

en te

a po

wde

r con

tain

ing

60 m

g ca

tech

ins)

. Blo

od p

ress

ure

and

elec

troc

ardi

ogra

m w

ere

unch

ange

d.12

8

Mon

itor

(low

leve

l of r

isk)

.

Stat

in d

rugs

eg

sim

vast

atin

May

incr

ease

pla

sma

leve

l and

sid

e ef

fect

of d

rug.

One

cas

e re

port

ed o

f mus

cle

pain

(si

de e

ffect

). Ph

arm

acok

inet

ic e

valu

atio

n in

dica

ted

gree

n te

a (1

cup

) in

crea

sed

the

bioa

vaila

bilit

y of

sim

vast

atin

in th

is p

atie

nt.12

9

Mon

itor

(low

leve

l of r

isk)

.

Suni

tini

bM

ay re

duce

bio

avai

labi

lity

of d

rug.

Case

repo

rt (

effe

ct a

ppea

red

dose

-dep

ende

nt).

Cons

ider

ing

the

phar

mac

okin

etic

dat

a (in

tera

ctio

n in

m

ice)

, the

aut

hors

reco

mm

ende

d av

oidi

ng g

reen

tea

inta

ke o

r lea

ving

an

inte

rval

of 4

hou

rs b

etw

een

beve

rage

and

dru

g in

take

.130

Cont

rain

dica

ted,

unl

ess

take

n at

leas

t 4

hour

s ap

art.

War

fari

nM

ay in

hibi

t effe

ct o

f dru

g:

decr

ease

d IN

R.Ca

se re

port

(br

ewed

gre

en te

a: 0

.5–1

gal

lon/

day)

.131

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

Haw

thor

n C

rata

egus

mon

ogyn

a, C

rata

egus

laev

igat

a (C

. oxy

acan

tha)

(Se

e al

so T

anni

n-co

ntai

ning

her

bs)

Dig

oxin

May

incr

ease

effe

ctiv

enes

s of

dru

g.Cl

inic

al s

tudi

es in

dica

te a

(be

nefic

ial)

syne

rgis

tic e

ffect

.132,

133 P

harm

acok

inet

ics

not a

ffect

ed in

a c

linic

al

stud

y (h

ealth

y vo

lunt

eers

).134

Mon

itor

(low

leve

l of r

isk)

.

Hyp

oten

sive

dru

gsM

ay in

crea

se e

ffect

iven

ess

of d

rug.

Cont

rolle

d tr

ials

whe

re d

rugs

kno

wn

to b

e ta

ken

by a

ll or

man

y he

art d

isea

se p

atie

nts:

blo

od p

ress

ure

decr

ease

d si

gnifi

cant

ly (

2 tr

ials

),135,

136 d

ecre

ased

non

sign

ifica

ntly

(1

tria

l)137 a

nd w

as u

ncha

nged

(1

tria

l).13

8

Sign

ifica

nt d

ecre

ase

in b

lood

pre

ssur

e ob

serv

ed in

dia

betic

s ta

king

hyp

oten

sive

dru

gs (

1 tr

ial).

139

Mon

itor

(low

leve

l of r

isk)

.



Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Hyp

ogly

caem

ic h

erbs

eg

Gym

nem

a sy

lves

tre,

goa

t’s ru

e (G

aleg

a of

ficin

alis

), fe

nugr

eek

(Trig

onel

la fo

enum

-gra

ecum

), ps

ylliu

m (

Plan

tago

ova

ta, P

. psy

llium

, P. i

ndic

a)

(See

als

o G

inkg

o, K

orea

n G

inse

ng, S

t Joh

n’s

Wor

t, St

Mar

y’s

This

tle)

Hyp

ogly

caem

ic d

rugs

in

clud

ing

insu

linM

ay p

oten

tiate

hyp

ogly

caem

ic

activ

ity o

f dru

g.In

unc

ontr

olle

d tr

ials

, hig

h do

se, l

ong-

term

adm

inis

tratio

n of

Gym

nem

a ex

tract

(eq

uiva

lent

to

10–1

3 g/

day

drie

d le

af)

redu

ced

insu

lin a

nd h

ypog

lyca

emic

dru

g re

quire

men

ts in

dia

betic

s.14

0,14

1

Hyp

ogly

caem

ic e

ffect

s of

fenu

gree

k (1

5–10

0 g/

day

drie

d an

d/or

def

atte

d se

ed)

obse

rved

in ty

pe

1 an

d ty

pe 2

dia

betic

s in

clud

ing

thos

e on

ther

apeu

tic a

nd s

ubth

erap

eutic

dos

es o

f hyp

ogly

caem

ic

drug

s.14

2-14

7 No

effe

ct o

n gl

ucos

e or

insu

lin re

spon

ses

in w

omen

with

PCO

S tr

eate

d w

ith m

etfo

rmin

an

d fe

nugr

eek

(con

cent

rate

d ex

tract

, equ

ival

ent t

o ab

out 1

0 g/

day

drie

d an

d fre

sh s

eed)

.148

Hyp

ogly

caem

ic e

ffect

s ob

serv

ed in

man

y w

ell-c

ontr

olle

d cl

inic

al tr

ials

for p

sylli

um (

10.2

–15

g/da

y,

mor

e th

an 6

wee

ks)

in ty

pe 2

dia

betic

s. D

rug

dosa

ge a

djus

tmen

ts w

ere

not r

equi

red.

149-

152 S

ee a

lso

note

Q. I

n on

e sm

all,

unco

ntro

lled

tria

l, ne

arly

70%

of t

ype

1 di

abet

ics

expe

rienc

ed h

ypog

lyca

emic

ep

isod

es. R

educ

tions

in in

sulin

dos

age

may

hav

e be

en re

quire

d ha

d th

e tr

ial b

een

of lo

nger

du

ratio

n (1

0.8

g/da

y of

hus

k, a

bout

1 w

eek)

.153 (

Ther

e is

als

o cl

inic

al e

vide

nce

that

hig

h fib

re d

iets

(1

0–60

g/d

ay)

wor

sen

cont

rol o

f typ

e 2

diab

etes

in p

atie

nts

who

are

poo

rly c

ontr

olle

d w

ith o

ral

hypo

glyc

aem

ic d

rugs

.154 )

Seve

ral t

rials

hav

e fo

und

no e

ffect

for g

arlic

on

bloo

d gl

ucos

e in

type

2 d

iabe

tes,

alth

ough

in a

do

uble

-blin

d, p

lace

bo-c

ontr

olle

d tr

ial (

usin

g en

teric

-coa

ted

tabl

ets)

, a re

duct

ion

in th

e do

sage

of o

ral

hypo

glyc

aem

ic d

rugs

was

requ

ired

(the

se p

atie

nts

had

fast

ing

bloo

d gl

ucos

e ab

ove

8.0

mm

ol/L

).155

Pres

crib

e ca

utio

usly

and

mon

itor

bloo

d su

gar r

egul

arly.

War

n pa

tient

ab

out p

ossi

ble

hypo

glyc

aem

ic

effe

cts.

Red

uce

drug

if n

eces

sary

in

conj

unct

ion

with

pre

scrib

ing

phys

icia

n.

Kava

Pip

er m

ethy

stic

um

CNS

depr

essa

nts

eg a

lcoh

ol,

barb

itura

tes,

ben

zodi

azep

ines

Pote

ntia

tion

of d

rug

effe

cts.

Theo

retic

al c

once

rn b

ased

on

delib

erat

ions

of G

erm

an C

omm

issi

on E

12 a

nd th

e an

xiol

ytic

act

ivity

of

kav

a.49

Tw

o ap

pare

nt c

ase

repo

rts

(kav

a +

benz

odia

zepi

nes

(alp

razo

lam

, flun

itraz

epam

)).15

6,15

7 Cl

inic

al tr

ials

with

hea

lthy

volu

ntee

rs: n

o ad

ditio

nal s

ide

effe

cts

obse

rved

for k

ava

(ext

ract

con

tain

ing

240

mg/

day

of k

ava

lact

ones

) +

benz

odia

zepi

ne (

brom

azep

am),15

0 and

kav

a (e

xtra

ct c

onta

inin

g 21

0 m

g/da

y of

kav

a la

cton

es)

+ al

coho

l.159 C

linic

al s

tudy

with

hea

lthy

volu

ntee

rs: n

o ef

fect

on

phar

mac

okin

etic

par

amet

ers

of m

idaz

olam

(ex

tract

pro

vide

d 25

3 m

g/da

y of

kav

a la

cton

es).12

3

Mon

itor

(low

leve

l of r

isk)

.

L-do

pa a

nd o

ther

Par

kins

on’s

di

seas

e tr

eatm

ents

Poss

ible

dop

amin

e an

tago

nist

effe

cts.

Case

repo

rts.

160,

161 A

lthou

gh, k

ava

is u

nlik

ely

to b

e re

spon

sibl

e fo

r cen

tral d

opam

iner

gic

anta

goni

sm

(exp

erim

enta

l mod

el)16

2 and

kav

a re

duce

d pa

rkin

soni

sm in

duce

d by

neu

role

ptic

dru

gs (

obse

rvat

iona

l st

udy,

psy

chia

tric

pat

ient

s).16

3

Cont

rain

dica

ted

unle

ss u

nder

clo

se

supe

rvis

ion.

Kore

an G

inse

ng P

anax

gin

seng

Ant

ihyp

erte

nsiv

e m

edic

atio

ns

incl

udin

g ni

fedi

pine

Gen

eral

: May

dec

reas

e ef

fect

iven

ess

of d

rug.

Theo

retic

al c

once

rn s

ince

hyp

erte

nsio

n is

a fe

atur

e of

GA

S. C

linic

al s

igni

fican

ce u

ncle

ar.49

Ass

essm

ent o

f 316

hos

pita

l pat

ient

s fo

und

Kore

an g

inse

ng to

hav

e a

cont

rary

effe

ct o

nly

in a

ver

y sm

all p

erce

ntag

e: b

lood

pre

ssur

e in

crea

se in

5%

of h

yper

tens

ives

; inc

reas

e in

3%

and

dec

reas

e in

2%

of n

orm

oten

sive

s; d

ecre

ase

in 6

% o

f hyp

oten

sive

s.16

4 N

o in

form

atio

n on

con

curr

ent m

edic

atio

ns.

Not

e fo

r clin

ical

tria

l dat

a be

low

: Acu

te, s

ingl

e-do

se tr

ials

exc

lude

d. H

igh

dose

s us

ed in

sev

eral

tria

ls.

Her

b A

lone

Clin

ical

tria

ls: n

o si

gnifi

cant

effe

cts

foun

d in

hea

lthy

volu

ntee

rs,16

5,16

6 tho

se w

ith m

etab

olic

sy

ndro

me,

167 t

ype

2 di

abet

es16

8 or g

lauc

oma,

169 a

lthou

gh b

asel

ine

bloo

d pr

essu

re m

ay b

e a

fact

or.16

7

Her

b an

d D

rug

Clin

ical

tria

ls: d

ecre

ased

blo

od p

ress

ure

in e

ssen

tial h

yper

tens

ion,

170 a

nd c

oron

ary

arte

ry d

isea

se17

1 bu

t no

effe

ct in

whi

te c

oat h

yper

tens

ion17

0 and

ess

entia

l hyp

erte

nsio

n.17

2

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

Nife

dipi

ne: M

ay in

crea

se d

rug

leve

ls.

Clin

ical

tria

l.117

Mon

itor

(low

leve

l of r

isk)

.

HD

I Cha

rt

Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Kore

an G

inse

ng P

anax

gin

seng

(co

ntin

ued)

Ant

ipla

tele

t an

d an

tico

agul

ant

drug

sG

ener

al: M

ay p

oten

tiate

effe

cts

of d

rug.

Her

b A

lone

Two

epid

emio

logi

cal s

tudi

es in

Kor

ea: l

ong-

term

inta

ke (

3–5

year

s) p

rolo

nged

pla

sma

clot

ting

times

(A

PTT)

,173,

174 a

nd d

ecre

ased

pla

tele

t agg

rega

tion.

173 (

Dos

age

in K

orea

is g

ener

ally

hig

h.)

Clin

ical

tria

l (he

alth

y vo

lunt

eers

): in

hibi

ted

plat

elet

agg

rega

tion,

but

no

effe

ct o

n co

agul

atio

n (P

T, AP

TT).17

5

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

War

farin

: May

dec

reas

e ef

fect

iven

ess

of d

rug.

Her

b an

d D

rug

One

cas

e re

port

ed (

decr

ease

d IN

R)17

6 but

clin

ical

sig

nific

ance

unc

lear

. No

effe

ct d

emon

stra

ted

in th

ree

clin

ical

tria

ls (

heal

thy

volu

ntee

rs a

nd p

atie

nts)

for I

NR,

pro

thro

mbi

n tim

e an

d pl

atel

et

aggr

egat

ion.

177-

179 A

lthou

gh th

e de

sign

of t

he tr

ials

has

bee

n cr

itici

sed.

Se

e no

te R

.180

Mon

itor

(low

leve

l of r

isk)

.

Canc

er c

hem

othe

rape

utic

dru

gs

eg im

atin

ibM

ay p

oten

tiate

adv

erse

effe

ct

poss

ibly

by

alte

red

met

abol

ism

.Ca

se re

port

(he

pato

toxi

city

; pro

babl

e ca

usal

ity).18

1M

onito

r (lo

w le

vel o

f ris

k).

CNS

stim

ulan

tsM

ay p

oten

tiate

effe

cts

of d

rug.

49Th

eore

tical

con

cern

sin

ce C

NS

stim

ulat

ion

is a

feat

ure

of G

AS.

Clin

ical

sig

nific

ance

unc

lear

.M

onito

r (lo

w le

vel o

f ris

k).

HIV

inte

gras

e in

hibi

tors

eg

ralte

grav

irM

ay p

oten

tiate

adv

erse

effe

ct

poss

ibly

by

alte

red

met

abol

ism

.Ca

se re

port

(el

evat

ed li

ver e

nzym

es: p

roba

ble

caus

ality

, dos

age

unkn

own)

.182

Mon

itor

(low

leve

l of r

isk)

.

Hyp

ogly

caem

ic d

rugs

in

clud

ing

insu

linM

ay p

oten

tiate

hyp

ogly

caem

ic

activ

ity o

f dru

g.50

Theo

retic

al c

once

rn b

ased

on

clin

ical

ly o

bser

ved

hypo

glyc

aem

ic a

ctiv

ity o

f gin

seng

in n

ewly

di

agno

sed

type

2 d

iabe

tics.

183

Clin

ical

sig

nific

ance

unc

lear

. No

effe

ct o

n in

sulin

sen

sitiv

ity o

r bet

a-ce

ll fu

nctio

n af

ter v

ery

high

dos

es

in n

ewly

dia

gnos

ed ty

pe 2

dia

betic

s or

thos

e w

ith im

paire

d gl

ucos

e to

lera

nce.

184 K

orea

n re

d gi

nsen

g (2

.7 g

/day

) re

duce

d th

e re

quire

men

t for

insu

lin in

abo

ut

40%

of d

iabe

tics

in a

sm

all u

ncon

trol

led

tria

l.185 N

o ad

vers

e ef

fect

s in

thre

e tr

ials

of t

ype

2 di

abet

ics

wel

l con

trol

led

with

die

t and

/or o

ral h

ypog

lyca

emic

dru

gs.16

8,18

6,18

7

Mon

itor

(low

leve

l of r

isk)

.

MA

O in

hibi

tors

eg

phen

elzi

neM

ay c

ause

sid

e ef

fect

s su

ch a

s he

adac

he, s

leep

less

ness

, tre

mor

.Ca

se re

port

s.18

8-19

0Co

ntra

indi

cate

d.

Mid

azol

amM

ay d

ecre

ase

drug

leve

l.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs (

extra

ct p

rovi

ding

abo

ut 4

5 m

g/da

y of

gin

seno

side

s).19

1M

onito

r (lo

w le

vel o

f ris

k).

Sild

enafi

lPo

tent

iatio

n of

dru

g po

ssib

le.

Theo

retic

al c

once

rn b

ased

on

in v

itro

stud

ies

whi

ch s

how

gin

seng

incr

ease

s ni

tric

oxi

de re

leas

e fro

m

corp

us c

aver

nosu

m ti

ssue

.192,

193

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

Laxa

tive

(an

thra

quin

one-

cont

aini

ng)

herb

s e

g al

oe re

sin

(Alo

e ba

rbad

ensi

s, A

loe

fero

x), s

enna

(Ca

ssia

spp

.), c

asca

ra (

Fran

gula

pur

shia

na, R

ham

nus

purs

hian

us),

ye

llow

doc

k (R

umex

cris

pus)

Ant

iarr

hyth

mic

age

nts

May

affe

ct a

ctiv

ity if

pot

assi

um

defic

ienc

y re

sulti

ng fr

om lo

ng-t

erm

la

xativ

e ab

use

is p

rese

nt.

Ger

man

Com

mis

sion

E a

nd E

SCO

P re

com

men

datio

n.12

,194

Avoi

d ex

cess

ive

dose

s of

laxa

tives

. M

aint

ain

patie

nts

on a

hig

h po

tass

ium

di

et.

Card

iac

glyc

osid

esM

ay p

oten

tiate

act

ivity

, if

pota

ssiu

m d

efici

ency

resu

lting

from

lo

ng-t

erm

laxa

tive

abus

e is

pre

sent

.

Ger

man

Com

mis

sion

E a

nd E

SCO

P re

com

men

datio

n.12

,194

Mon

itor

(low

leve

l of r

isk

at n

orm

al

dose

s).

Pota

ssiu

m-d

eple

ting

age

nts

eg

thia

zide

diu

retic

s, c

ortic

oste

roid

s,

licor

ice

root

(G

lycy

rrhi

za g

labr

a)

May

incr

ease

pot

assi

um d

eple

tion.

Ger

man

Com

mis

sion

E a

nd E

SCO

P re

com

men

datio

n.12

,194

Avoi

d ex

cess

ive

dose

s of

laxa

tives

. M

aint

ain

patie

nts

on a

hig

h po

tass

ium

di

et.



Her

b-D

rug

Inte

ract

ion

Char

t: G

ener

al P

resc

ribi

ng G

uide

lines

� Ex

erci

se g

reat

cau

tion

whe

n pr

escr

ibin

g he

rbs

for p

atie

nts

taki

ng d

rugs

with

a n

arro

w th

erap

eutic

win

dow

. Th

ese

drug

s m

ay b

ecom

e da

nger

ousl

y to

xic

or in

effe

ctiv

e w

ith o

nly

rela

tivel

y sm

all c

hang

es in

thei

r blo

od

conc

entra

tions

. Exa

mpl

es in

clud

e di

goxi

n, w

arfa

rin, a

ntire

ject

ion

(imm

unos

uppr

essi

ve)

drug

s, m

any

anti-

HIV

dr

ugs,

theo

phyl

line,

phe

nyto

in a

nd p

heno

barb

ital.

Thes

e pa

tient

s ne

ed to

be

mon

itore

d on

a fr

eque

nt,

regu

lar b

asis

.

� Ex

erci

se g

reat

cau

tion

whe

n pr

escr

ibin

g he

rbs

for p

atie

nts

taki

ng d

rugs

:

–

if he

art,

liver

, or k

idne

y fu

nctio

n is

impa

ired,

–

in e

lder

ly p

atie

nts,

–

in p

regn

ant w

omen

,

–

in th

ose

who

hav

e re

ceiv

ed a

n or

gan

trans

plan

t,

–

in th

ose

with

a g

enet

ic d

isor

der t

hat d

istu

rbs

norm

al b

ioch

emic

al fu

nctio

ns.

Thes

e pa

tient

s ne

ed to

be

mon

itore

d on

a fr

eque

nt, r

egul

ar b

asis

.

� Ca

re s

houl

d be

exe

rcis

ed w

ith p

atie

nts

who

exh

ibit

long

-ter

m u

se o

f lax

ativ

e he

rbs

or p

otas

sium

-lo

sing

diu

retic

s.

� Cr

itica

l dru

gs s

houl

d be

take

n at

diff

eren

t tim

es o

f the

day

from

her

bs (

and

food

) to

redu

ce c

hem

ical

or

phar

mac

okin

etic

inte

ract

ions

. The

y sh

ould

be

sepa

rate

d by

at l

east

1 h

our,

pref

erab

ly m

ore.

� St

op a

ll he

rbs

appr

oxim

atel

y 1

wee

k be

fore

sur

gery

. St M

ary’

s th

istle

may

hel

p re

duce

the

toxi

c af

ter-

effe

cts

of a

naes

thet

ic d

rugs

, so

it ca

n be

take

n up

to th

e da

y be

fore

, and

then

aga

in, a

fter s

urge

ry.

� Ca

refu

lly m

onito

r the

effe

cts

of d

rugs

suc

h as

ant

ihyp

erte

nsiv

es a

nd a

ntid

iabe

tic d

rugs

whe

n co

mbi

ning

w

ith h

erba

l rem

edie

s. T

he h

erbs

may

mak

e th

em m

ore

or le

ss e

ffect

ive.

In th

e id

eal s

ituat

ion

the

dose

of

the

drug

cou

ld b

e ad

just

ed.

� In

tera

ctio

ns m

ay b

e do

se re

late

d fo

r the

her

b an

d th

e dr

ug, f

or e

xam

ple,

St J

ohn’

s w

ort a

nd d

igox

in.

Refe

renc

e an

d fu

rthe

r re

adin

g: M

ills

S, B

one

K (e

ds).

The

Esse

ntia

l Gui

de to

Her

bal S

afet

y. C

hurc

hill

Livi

ngst

one,

USA

, 200

5.

Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Lico

rice

Gly

cyrr

hiza

gla

bra

Ant

ihyp

erte

nsiv

e m

edic

atio

ns

othe

r tha

n di

uret

ics

Gen

eral

: May

dec

reas

e ef

fect

iven

ess

of d

rug.

Whe

n co

nsum

ed in

hig

h do

ses,

lico

rice

can

caus

e ps

eudo

aldo

ster

onis

m a

nd h

igh

bloo

d pr

essu

re.

Her

b or

Con

stitu

ent

Alo

ne

Hyp

erte

nsio

n de

mon

stra

ted

in c

ase

repo

rts,

usu

ally

from

long

-ter

m in

take

and

/or v

ery

high

dos

e.19

5 H

ypok

alae

mic

par

alys

is re

port

ed (

184

mg/

day

of g

lycy

rrhi

zin

for 2

mon

ths)

, alth

ough

hyp

erte

nsio

n w

as m

ild, p

ossi

bly

due

to c

oexi

stin

g so

dium

was

ting

rela

ted

to u

ropa

thy

from

pro

stat

e ca

ncer

.196

Clin

ical

stu

dies

(up

to 2

00 g

/day

of l

icor

ice)

: dos

e-de

pend

ent r

elat

ions

hip

foun

d be

twee

n lic

oric

e an

d in

crea

se in

blo

od p

ress

ure,

mor

e pr

onou

nced

effe

ct in

hyp

erte

nsiv

e pa

tient

s th

an in

nor

mot

ensi

ve

volu

ntee

rs, a

dver

se e

ffect

gre

ater

in w

omen

, and

effe

ct s

how

n fo

r dos

e as

low

as

50 g

/day

of

licor

ice

(75

mg/

day

of g

lycy

rrhe

tinic

aci

d =

130

mg/

day

of g

lycy

rrhi

zinS )

take

n fo

r 2 w

eeks

.197-

199

Oth

er s

tudi

es s

how

var

iatio

n of

effe

cts

on b

lood

pre

ssur

e (s

ee n

ote

T) –

rena

l fun

ctio

n m

ay b

e a

fact

or.20

0 The

incr

ease

in b

lood

pre

ssur

e af

ter t

akin

g gl

ycyr

rhet

inic

aci

d (8

74 m

g/da

y of

gly

cyrr

hizi

n)

was

mor

e pr

onou

nced

in s

alt-

sens

itive

than

sal

t-res

ista

nt v

olun

teer

s.20

1 Clin

ical

stu

dy to

est

ablis

h a

no-e

ffect

leve

l for

gly

cyrr

hizi

n (h

ealth

y fe

mal

e vo

lunt

eers

): si

gnifi

cant

resu

lts (

e.g.

blo

od

pres

sure

, ser

um p

otas

sium

and

ald

oste

rone

) co

mpa

red

to c

ontr

ols

foun

d fo

r dai

ly d

ose

of 4

mg/

kg

(220

–332

mg/

day)

take

n fo

r 8 w

eeks

, but

no

effe

ct a

t low

er d

oses

of 1

–2 m

g/kg

(55

–166

mg/

day)

of

gly

cyrr

hizi

n.20

2

Her

b an

d D

rug

Case

repo

rts

(lico

rice

tea,

3 L

/day

; pat

ient

stil

l hyp

erte

nsiv

e de

spite

trea

tmen

t with

dru

gs;20

3 de

coct

ion

of C

hine

se h

erbs

con

tain

ing

5 g

licor

ice,

take

n fo

r 14

days

).204

Avoi

d lo

ng-t

erm

use

at d

oses

>

100

mg/

day

glyc

yrrh

izin

unl

ess

unde

r clo

se s

uper

visi

on.R P

lace

pa

tient

s on

a h

igh

pota

ssiu

m d

iet.

ACE-

inhi

bito

r: M

ay m

ask

the

deve

lopm

ent o

f pse

udoa

ldos

tero

nism

.Ca

se re

port

(pa

tient

con

sum

ed li

coric

e he

rbal

med

icin

e (2

00–2

40 m

g/da

y gl

ycyr

rhiz

in))

. Dru

g do

sage

w

as re

duce

d, le

adin

g to

pse

udoa

ldos

tero

nism

.205 S

ee n

ote

V.Av

oid

long

-ter

m u

se a

t dos

es

> 10

0 m

g/da

y gl

ycyr

rhiz

in u

nles

s un

der c

lose

sup

ervi

sion

.U Pl

ace

patie

nts

on a

hig

h po

tass

ium

die

t.

Cilo

staz

olM

ay c

ause

hyp

okal

aem

ia,

whi

ch c

an p

oten

tiate

the

toxi

city

of

the

drug

.

Case

repo

rt (

patie

nt ta

king

150

mg/

day

of g

lycy

rrhi

zin)

. Ser

um p

otas

sium

leve

ls w

ere

stab

le p

rior

to a

dmin

istra

tion

of d

rug.

206

Mon

itor

(med

ium

leve

l of r

isk)

. Pla

ce

patie

nts

on a

hig

h po

tass

ium

die

t.

HD

I Cha

rt

Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Lico

rice

Gly

cyrr

hiza

gla

bra

(con

tinue

d)

Cort

icos

tero

ids

Cort

isol

: May

pot

entia

te th

e ac

tion

(r

athe

r tha

n in

crea

se le

vel o

f dru

g).

Inhi

bitio

n of

the

enzy

me

11be

ta-H

SD2

by g

lycy

rrhi

zin

lead

s to

an

incr

ease

d le

vel o

f cor

tisol

in th

e ki

dney

. Thi

s do

es n

ot h

appe

n in

the

liver

.

The

plas

ma

half-

life

of c

ortis

ol m

ay b

e pr

olon

ged

whe

n he

rb a

nd d

rug

are

coad

min

iste

red,

but

dr

ug c

once

ntra

tions

rem

ain

norm

al, p

ossi

bly

beca

use

of a

con

com

itant

fall

in c

ortis

ol p

rodu

ctio

n.20

7 Pr

olon

ged

half-

life

of c

ortis

ol m

ay s

ugge

st th

e po

tent

ial f

or li

coric

e to

pro

long

cle

aran

ce (

and

henc

e,

activ

ity)

of th

e dr

ug.

(Stu

dies

invo

lvin

g pa

tient

s w

ith A

ddis

on’s

dis

ease

or o

n ha

emod

ialy

sis

are

not l

iste

d he

re.)

Her

b or

Con

stitu

ent

Alo

ne

Clin

ical

stu

dies

with

hea

lthy

volu

ntee

rs19

8,20

0,20

8-21

4 and

pat

ient

s w

ith e

ssen

tial h

yper

tens

ion19

8 (on

goin

g or

al a

dmin

istra

tion)

: inc

reas

e in

urin

ary

excr

etio

n of

cor

tisol

, but

no

sign

ifica

nt c

hang

e in

pla

sma

cort

isol

198,

200,

208-

214 (

alth

ough

pla

sma

cort

ison

e de

crea

sed)

208,

209,

215 a

nd d

iurn

al v

aria

tion

of p

lasm

a co

rtis

ol w

as u

naffe

cted

.211 D

osag

e w

as h

igh:

100

–200

g/d

ay o

f lic

oric

e ca

ndy

(con

tain

ing

glyc

yrrh

izin

or

gly

cyrr

hetin

ic a

cid

equi

vale

nt to

262

–244

0 m

g/da

y of

gly

cyrr

hizi

nS ),19

8,21

0,21

1,21

4 3.5

g/d

ay o

f lic

oric

e ta

blet

s (c

onta

inin

g 26

6 m

g/da

y of

gly

cyrr

hizi

n),21

2 4.8

g/d

ay o

f lic

oric

e ex

tract

(co

ntai

ning

gl

ycyr

rhet

inic

aci

d =

587

mg/

day

of g

lycy

rrhi

zin)

,213 2

25 m

g/da

y gl

ycyr

rhiz

in,20

8 gly

cyrr

hetin

ic a

cid

(= 2

27–8

74 m

g/da

y gl

ycyr

rhiz

in).20

0,20

9

Clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

and

hyp

erte

nsiv

e pa

tient

s (s

ingl

e do

se, p

lace

bo-c

ontr

olle

d; o

ral

adm

inis

tratio

n of

gly

cyrr

hetin

ic a

cid

equi

vale

nt to

874

mg/

day

of g

lycy

rrhi

zinS )

: inc

reas

ed p

lasm

a co

rtis

ol/c

ortis

one

ratio

(du

e m

ostly

to a

dec

reas

e in

pla

sma

cort

ison

e); s

aliv

ary

cort

isol

incr

ease

d.21

6

Clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

(to

pica

l app

licat

ion

of a

cre

am c

onta

inin

g gl

ycyr

rhet

inic

aci

d):

no e

ffect

on

plas

ma

cort

isol

.217

Her

b or

Con

stitu

ent

and

Dru

g

Clin

ical

stu

dies

: inc

reas

ed p

lasm

a ha

lf-lif

e of

cor

tisol

(or

al a

dmin

istra

tion

of li

coric

e ca

ndy

(200

g d

ay,

cont

aini

ng 5

80 m

g/da

y gl

ycyr

rhiz

in)

+ in

trave

nous

cor

tisol

to 7

hea

lthy

volu

ntee

rs;21

0 ora

l ad

min

istra

tion

of g

lycy

rrhe

tinic

aci

d =

227

mg/

day

of g

lycy

rrhi

zinS +

ora

l cor

tisol

to 2

vol

unte

ers)

.218,

219

See

also

Not

e W

.

Ex v

ivo

stud

y (s

kin

sam

ples

from

hea

lthy

volu

ntee

rs a

nd p

atie

nts

with

pso

riasi

s an

d ec

zem

a;

glyc

yrrh

etin

ic a

cid

and

drug

topi

cally

app

lied)

: act

ivity

of h

ydro

cort

ison

e po

tent

iate

d by

gl

ycyr

rhet

inic

aci

d.22

0

Mon

itor

(ver

y lo

w le

vel o

f ris

k at

no

rmal

dos

es).

Pred

niso

lone

: May

pot

entia

te th

e ac

tion

or in

crea

se le

vel o

f dru

g.H

erba

l Con

stitu

ent

and

Dru

g

Two

clin

ical

stu

dies

with

hea

lthy

volu

ntee

rs (

oral

adm

inis

tratio

n of

gly

cyrr

hizi

n or

gly

cyrr

hetin

ic

acid

;S pre

dnis

olon

e ad

min

iste

red

intra

veno

usly

): in

crea

sed

drug

leve

l221 a

nd in

crea

sed

pred

niso

lone

/pr

edni

sone

ratio

X in

urin

e an

d pl

asm

a.22

2 Dos

age

was

hig

h: 2

00 m

g/da

y gl

ycyr

rhiz

in,22

1 and

400

mg/

day

glyc

yrrh

etin

ic a

cid

(= 7

00 m

g/da

y gl

ycyr

rhiz

in).22

2

Mon

itor

(low

leve

l of r

isk

at n

orm

al

dose

s) w

hen

drug

adm

inis

tere

d in

trave

nous

ly.

Dig

oxin

May

cau

se h

ypok

alae

mia

whi

ch

can

pote

ntia

te th

e to

xici

ty o

f the

dr

ug.

Her

b A

lone

Hyp

okal

aem

ia d

emon

stra

ted

in c

ase

repo

rts

and

clin

ical

stu

dies

, usu

ally

from

long

-ter

m in

take

and

/or

ver

y hi

gh d

ose,

how

ever

effe

ct h

as b

een

dem

onst

rate

d in

sen

sitiv

e in

divi

dual

s at

low

dos

es

(lico

rice

cont

aini

ng 1

00 m

g/da

y of

gly

cyrr

hizi

n). S

ide

effe

cts

wou

ld b

e co

mm

on a

t 400

mg/

day

of g

lycy

rrhi

zin.

195,

223,

224

Her

b an

d D

rug

Case

repo

rt (

patie

nt ta

king

her

bal l

axat

ive

cont

aini

ng li

coric

e (1

.2 g

/day

) an

d rh

ubar

b (R

heum

spp

., 4.

8 g/

day)

). In

add

ition

to d

igox

in, p

atie

nt w

as a

lso

taki

ng a

pot

assi

um-d

eple

ting

diur

etic

.225

Avoi

d lo

ng-t

erm

use

at d

oses

>

100

mg/

day

glyc

yrrh

izin

unl

ess

unde

r clo

se s

uper

visi

on.U

Plac

e pa

tient

s on

a h

igh

pota

ssiu

m d

iet.



Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Lico

rice

Gly

cyrr

hiza

gla

bra

(con

tinue

d)

Diu

reti

csSp

irono

lact

one

(pot

assi

um-s

parin

g di

uret

ic):

Redu

ce s

ide

effe

cts

of d

rug.

Clin

ical

stu

dy: i

n w

omen

with

PCO

S ad

ditio

n of

lico

rice

extra

ct (

cont

aini

ng a

bout

463

mg/

day

glyc

yrrh

izin

) re

duce

d si

de e

ffect

s re

late

d to

the

diur

etic

act

ivity

of d

rug.

226

Mon

itor

(low

leve

l of r

isk

at n

orm

al

dose

s).

Thia

zide

and

loop

(po

tass

ium

-de

plet

ing)

diu

retic

s: T

he c

ombi

ned

effe

ct o

f lic

oric

e an

d th

e dr

ug c

ould

re

sult

in e

xces

sive

pot

assi

um lo

ss.12

Her

b or

Con

stitu

ent

Alo

ne

Hyp

okal

aem

ia d

emon

stra

ted

in c

ase

repo

rts

and

clin

ical

stu

dies

, usu

ally

from

long

-ter

m in

take

and

/or

ver

y hi

gh d

ose,

195,

223,

224 h

owev

er e

ffect

has

bee

n de

mon

stra

ted

in p

atie

nts

for o

ngoi

ng tr

eatm

ent

with

her

bal m

edic

ines

con

tain

ing

glyc

yrrh

izin

at d

oses

of 8

0–24

0 m

g/da

y.22

7

Her

b an

d D

rug

Case

repo

rts,

usu

ally

from

long

-ter

m in

take

and

/or v

ery

high

dos

e,20

3,22

3,22

8-23

4 how

ever

effe

ct h

as

been

dem

onst

rate

d fo

r ong

oing

trea

tmen

t of g

lycy

rrhi

zin

as lo

w a

s 80

mg/

day.

227 C

linic

al tr

ial (

cand

y co

ntai

ning

40

mg/

day

of g

lycy

rrhi

zin)

: dec

reas

ed p

lasm

a po

tass

ium

, with

20%

of h

ealth

y vo

lunt

eers

hy

poka

laem

ic in

the

first

wee

k.23

5

Cont

rain

dica

ted

unle

ss u

nder

clo

se

supe

rvis

ion

at d

oses

> 4

0 m

g/da

y gl

ycyr

rhiz

in.

Imm

unos

uppr

essi

ves

eg s

irolim

usM

ay d

ecre

ase

drug

cle

aran

ce.

Popu

latio

n ph

arm

acok

inet

ic s

tudy

with

112

Chi

nese

adu

lt re

nal t

rans

plan

t rec

ipie

nts:

cle

aran

ce o

f si

rolim

us d

ecre

ased

in th

ose

patie

nts

with

abn

orm

al A

LT v

alue

s w

ho w

ere

taki

ng h

erba

l for

mul

atio

ns

cont

aini

ng g

lycy

rrhi

zin

(rou

te a

nd d

osag

e un

know

n).23

6

Mon

itor

(med

ium

leve

l of r

isk)

in

hepa

tical

ly-im

paire

d pa

tient

s.

Mid

azol

amM

ay d

ecre

ase

drug

leve

l.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs (

pota

ssiu

m s

alt o

f gly

cyrr

hizi

n, e

quiv

alen

t to

287

mg/

day

of g

lycy

rrhi

zin)

.237

Mon

itor

(low

leve

l of r

isk

at n

orm

al

dose

s).

Om

epra

zole

May

dec

reas

e dr

ug le

vel.

Clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

(po

tass

ium

sal

t of g

lycy

rrhi

zin,

equ

ival

ent t

o 28

7 m

g/da

y of

gly

cyrr

hizi

n).23

8

Mon

itor

(low

leve

l of r

isk

at n

orm

al

dose

s).

Pota

ssiu

m-d

eple

ting

dru

gs o

ther

than

th

iazi

de a

nd lo

op d

iure

tics

eg

cor

ticos

tero

ids,

stim

ulan

t lax

ativ

es

May

resu

lt in

exc

essi

ve

pota

ssiu

m lo

ss.

Her

b A

lone

Hyp

okal

aem

ia d

emon

stra

ted

in c

ase

repo

rts

and

clin

ical

stu

dies

, usu

ally

from

can

dy in

take

(hi

gh

dose

), ho

wev

er e

ffect

has

bee

n de

mon

stra

ted

in s

ensi

tive

indi

vidu

als

at lo

w d

oses

(lic

oric

e co

ntai

ning

10

0 m

g/da

y of

gly

cyrr

hizi

n). S

ide

effe

cts

wou

ld b

e co

mm

on a

t 400

mg/

day

of g

lycy

rrhi

zin.

195,

223

Avoi

d lo

ng-t

erm

use

at d

oses

>

100

mg/

day

glyc

yrrh

izin

unl

ess

unde

r clo

se s

uper

visi

on.U

Plac

e pa

tient

s on

a h

igh

pota

ssiu

m d

iet.

Mar

shm

allo

w R

oot

Alth

aea

offic

inal

is

Pres

crib

ed m

edic

atio

nM

ay s

low

or r

educ

e ab

sorp

tion

of

dru

gs.

Theo

retic

al c

once

rn b

ased

on

abso

rben

t pro

pert

ies

of m

arsh

mal

low

root

.Ta

ke a

t lea

st 2

hou

rs a

way

from

m

edic

atio

n.

Mea

dow

swee

t F

ilipe

ndul

a ul

mar

ia (

See

also

Tan

nin-

cont

aini

ng h

erbs

)

War

fari

nM

ay p

oten

tiate

effe

cts

of d

rug.

Theo

retic

al c

once

rn b

ased

on

in v

ivo

anim

al s

tudy

dem

onst

ratin

g an

ticoa

gula

nt a

ctiv

ity

(dos

age

unav

aila

ble)

.239

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

Pepp

erm

int

Men

tha

x pi

perit

a (

See

also

Tan

nin-

cont

aini

ng h

erbs

)

War

fari

nM

ay in

hibi

t effe

ct o

f dru

g:

decr

ease

d IN

R.Tw

o ca

se re

port

s (m

enth

ol c

ough

dro

ps: 8

–10

per d

ay;24

0 6 p

er d

ay.)24

1 Ass

umin

g th

e co

ugh

drop

s co

ntai

ned

5–10

mg

of m

enth

ol, t

his

is a

dos

age

of a

bout

30–

100

mg/

day

of m

enth

ol.

Mon

itor

(low

leve

l of r

isk

at n

orm

al

dose

s of

her

b).

Phel

lode

ndro

nC Ph

ello

dend

ron

amur

ense

Dru

gs t

hat

disp

lace

the

pro

tein

bi

ndin

g of

bili

rubi

n eg

phe

nylb

utaz

one

May

pot

entia

te e

ffect

of d

rug

on

disp

laci

ng b

iliru

bin.

Her

b A

lone

Theo

retic

al c

once

rn b

ased

on

in v

itro

data

(di

spla

ced

bilir

ubin

from

alb

umin

) an

d in

ani

mal

s w

ith h

igh

dose

of b

erbe

rine

by in

ject

ion

(red

uced

bili

rubi

n se

rum

pro

tein

bin

ding

).3

Mon

itor

(low

leve

l of r

isk)

.

HD

I Cha

rt

Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Poly

phen

ol-c

onta

inin

gY or

Flav

onoi

d-co

ntai

ning

her

bs e

spec

ially

cay

enne

(Ca

psic

um a

nnuu

m),

cham

omile

(M

atric

aria

cha

mom

illa)

, coc

oa, g

reen

tea

(Cam

ellia

sin

ensi

s),

lime

flow

ers

(Tili

a co

rdat

a), r

osem

ary

(Ros

mar

inus

offi

cina

lis),

St M

ary’

s th

istle

(Si

lybu

m m

aria

num

), ve

rvai

n (V

erbe

na

offic

inal

is)

(Se

e al

so T

anni

n-co

ntai

ning

her

bs)

Imm

unos

uppr

essi

ves

eg c

yclo

spor

inD

ecre

ases

dru

g le

vels

, due

to

impa

ired

abso

rptio

n or

incr

ease

d m

etab

olis

m.

Thre

e ca

se re

port

s, in

tran

spla

nt p

atie

nts

(2 L

/day

of h

erba

l tea

; 1-1

.5 L

/day

of c

ham

omile

tea;

‘lar

ge

quan

titie

s’ o

f fru

it te

a co

ntai

ning

hib

iscu

s ex

tract

, and

a d

rink

cont

aini

ng b

lack

tea)

. Con

firm

ed b

y re

chal

leng

e in

one

cas

e, b

ut n

o si

gns

of re

ject

ion.

242

Mon

itor

(med

ium

leve

l of r

isk)

. Als

o ad

visa

ble

not t

o ta

ke s

imul

tane

ousl

y.

Iron

Inhi

bitio

n of

non

-hae

m

ironZ a

bsor

ptio

n.Cl

inic

al s

tudy

(in

clud

ed h

erb

teas

(G

erm

an c

ham

omile

, ver

vain

, lim

e flo

wer

, pep

perm

int;

all

3 g/

300

mL)

, bev

erag

es (

eg b

lack

tea,

cof

fee,

coc

oa))

: effe

ct d

epen

dent

on

poly

phen

ol c

onte

nt

(per

ser

ving

: 20-

400

mg)

.243 S

ee a

lso

note

AA.

Tim

ing

of in

take

may

be

impo

rtan

t. Se

e al

so n

ote

BB.

Epid

emio

logi

cal s

tudy

(Un

ited

Stat

es):

1 cu

p/w

eek

of c

offe

e as

soci

ated

with

1%

low

er s

erum

ferr

itin

in th

e el

derly

.244 E

pide

mio

logi

cal s

tudy

(Ch

ina)

: effe

ct fo

r eat

ing

chill

i on

seru

m fe

rriti

n in

wom

en

not s

igni

fican

t.245

Mix

ed re

sults

in o

ther

stu

dies

(he

alth

y vo

lunt

eers

): ro

sem

ary

(32.

7 m

g of

pol

yphe

nols

)246 a

nd c

ayen

ne

(hig

h do

se: 1

4.2

g, fr

esh

wei

ght,CC

con

tain

ing

25 m

g po

lyph

enol

s)24

7 cau

sed

inhi

bitio

n; c

ham

omile

248

and

turm

eric

(2.

8 g,

fres

h w

eigh

t, co

ntai

ning

50

mg

poly

phen

ols)

247 d

id n

ot. S

ee a

lso

note

DD.

Resu

lts fo

r gre

en te

a ha

ve b

een

confl

ictin

g: tw

o st

udie

s fo

und

no e

ffect

(he

alth

y vo

lunt

eers

and

th

ose

with

ana

emia

),249,

250 t

wo

stud

ies

(hea

lthy

volu

ntee

rs)

foun

d an

effe

ct.24

6,25

1 Drin

king

gre

en

tea

(1:1

00, 1

L/d

ay)

low

ered

ser

um fe

rriti

n in

wom

en w

ith lo

w le

vels

of f

errit

in (

< 25

mcg

/L)

at

base

line.

No

effe

ct in

oth

er w

omen

or m

en (

vege

taria

ns a

nd o

mni

vore

s), a

nd n

o ef

fect

on

iron

stat

us

para

met

ers.

252 T

wo

epid

emio

logi

cal s

tudi

es (

Fren

ch a

nd Ja

pane

se p

opul

atio

ns)

foun

d m

ixed

resu

lts fo

r se

rum

ferr

itin

and

haem

oglo

bin,

alth

ough

risk

of i

ron

depl

etio

n or

ana

emia

was

not

incr

ease

d.25

3,25

4 Cl

inic

al s

tudy

(15

0–30

0 m

g/da

y EG

CG):

decr

ease

d ab

sorp

tion

in h

ealth

y w

omen

with

low

iron

sto

res

adm

inis

tere

d to

geth

er w

ith ir

on. R

esul

ts s

igni

fican

t onl

y at

hig

her d

osag

e.25

5

Conc

entra

ted

extra

ct o

f St M

ary’

s th

istle

redu

ced

iron

abso

rptio

n in

hae

moc

hrom

atos

is p

atie

nts.

256

In a

naem

ia a

nd w

here

iron

su

pple

men

tatio

n is

requ

ired,

do

not

take

sim

ulta

neou

sly

with

mea

ls o

r iro

n su

pple

men

ts.

Psyl

lium

Pla

ntag

o ov

ata,

Pla

ntag

o ps

ylliu

m, P

lant

ago

indi

ca (

See

also

Hyp

ogly

caem

ic h

erbs

)

Carb

amaz

epin

eD

ecre

ases

pla

sma

drug

leve

l.Cl

inic

al s

tudy

(ps

ylliu

m h

usk)

,257 a

lthou

gh n

o ad

vers

e ef

fect

obs

erve

d in

one

cas

e re

port

.258

Take

at l

east

2 h

ours

aw

ay fr

om

med

icat

ion.

Dig

oxin

May

dec

reas

e ab

sorp

tion

of d

rug.

Dec

reas

ed b

ioav

aila

bilit

y fo

und

for d

igox

in a

nd ‘c

rude

’ (un

defin

ed)

diet

ary

fibre

,259 b

ut n

o ef

fect

was

fo

und

on d

igox

in le

vels

in tw

o cl

inic

al s

tudi

es (

psyl

lium

hus

k).26

0,26

1 Slig

ht d

ecre

ase

in a

bsor

ptio

n (1

5%)

foun

d in

hea

lthy

volu

ntee

rs w

hen

psyl

lium

hus

kEE (

15 g

) an

d di

goxi

n ta

ken

conc

omita

ntly

but

w

hen

give

n 30

min

utes

apa

rt th

e de

crea

se w

as m

uch

smal

ler (

3%).26

2

Take

at l

east

2 h

ours

aw

ay fr

om

med

icat

ion.

Iron

Inhi

bitio

n of

non

-hae

m ir

on

abso

rptio

n.Iro

n fr

om T

est

Mea

l

Clin

ical

stu

dies

: abs

orpt

ion

decr

ease

d by

8%

(5

g/da

y fo

r 2 m

eals

, psy

llium

und

efine

d) in

hea

lthy

volu

ntee

rs;26

3 no

effe

ct o

vera

ll in

type

2 d

iabe

tics,

alth

ough

sig

nific

ant d

iffer

ence

s am

ong

part

icip

ants

(1

4 g/

day,

for 6

wee

ks, p

sylli

um u

ndefi

ned)

.264

Iron

from

Die

t

Clin

ical

stu

dies

: no

chan

ge in

ser

um ir

on in

two

tria

ls w

ith p

atie

nts

(6 g

/day

, for

4-5

wee

ks, p

sylli

um

unde

fined

;265 m

axim

um to

lera

ted

dose

, gen

eral

ly le

ss th

an 2

5 g/

day,

for 4

mon

ths,

psy

llium

hus

k);26

6 iro

n ab

sorp

tion

decr

ease

d in

non

-ana

emic

ado

lesc

ent g

irls,

but

iron

bal

ance

was

pos

itive

(25

g/d

ay,

for 3

wee

ks, p

sylli

um h

usk)

;267 s

light

dec

reas

e in

pla

sma

iron

in o

bese

pat

ient

s w

ithou

t effe

cts

on

othe

r iro

n pa

ram

eter

s du

ring

first

per

iod

of tr

eatm

ent (

30 d

ays)

, with

out f

urth

er m

odifi

catio

n on

long

-te

rm tr

eatm

ent o

f 6 m

onth

s (6

g/d

ay, p

sylli

um u

ndefi

ned)

.268

In a

naem

ia a

nd w

here

iron

su

pple

men

tatio

n is

requ

ired,

do

not

take

sim

ulta

neou

sly

with

mea

ls o

r iro

n su

pple

men

ts.

Lith

ium

May

dec

reas

e ab

sorp

tion

of d

rug.

Case

repo

rt (

psyl

lium

hus

k),26

9 and

clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

(ps

ylliu

m h

usk)

.270

Hyd

roph

ilic

psyl

lium

may

pre

vent

lith

ium

from

ioni

sing

.Ta

ke a

t lea

st 2

hou

rs a

way

from

m

edic

atio

n.



Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Psyl

lium

Pla

ntag

o ov

ata,

Pla

ntag

o ps

ylliu

m, P

lant

ago

indi

ca (

See

also

Hyp

ogly

caem

ic h

erbs

) (c

ontin

ued)

Pres

crib

ed m

edic

atio

nM

ay s

low

or r

educ

e ab

sorp

tion

of d

rugs

.Th

eore

tical

con

cern

bas

ed o

n ab

sorb

ent p

rope

rtie

s of

psy

llium

.

No

effe

ct fo

und

on a

bsor

ptio

n or

pro

thro

mbi

n tim

e in

hea

lthy

volu

ntee

rs w

hen

psyl

lium

hus

k (1

4 g)

an

d w

arfa

rin w

ere

take

n co

ncom

itant

ly.27

1

Case

repo

rt (

adre

nal c

risis

in s

tabl

e pa

tient

with

adr

enal

insu

ffici

ency

; psy

llium

coa

dmin

iste

red

with

st

eroi

d dr

ugs)

.272

In a

cro

ssov

er tr

ial,

psyl

lium

hus

k (6

g)

was

adm

inis

tere

d w

ith o

rlist

atFF th

ree

times

a d

ay a

nd fo

und

to re

duce

the

subs

eque

nt s

ide

effe

cts.

Sin

gle

dose

of p

sylli

um (

12 g

) at

bed

time

was

als

o ef

fect

ive

in re

duci

ng th

e si

de e

ffect

s.27

3

Take

at l

east

2 h

ours

aw

ay fr

om

med

icat

ion,

GG e

xcep

t for

orli

stat

whi

ch

may

be

take

n at

the

sam

e tim

e.

Thyr

oxin

eM

ay d

ecre

ase

effic

acy

of d

rug.

Clin

ical

stu

dy: d

ecre

ased

effi

cacy

foun

d in

12

hypo

thyr

oid

patie

nts

cons

umin

g di

etar

y fib

re (

one

patie

nt: w

hole

gra

in c

erea

l + p

sylli

um la

xativ

e); s

ome

patie

nts

stab

ilise

d by

dec

reas

ing

or re

mov

ing

the

fibre

from

thei

r die

t.274 C

linic

al s

tudy

(he

alth

y vo

lunt

eers

, 3.4

g/d

ay, f

or 4

day

s, p

sylli

um h

usk)

: de

crea

se in

abs

orpt

ion

not s

igni

fican

t.275

Take

as

man

y ho

urs

apar

t as

pos

sibl

e.

May

requ

ire d

ose

redu

ctio

n or

ce

ssat

ion

of h

erb.

Saw

Pal

met

to S

eren

oa re

pens

Ant

ipla

tele

t an

d an

tico

agul

ant

drug

sM

ay p

oten

tiate

effe

ct o

f dru

g.H

erb

Alo

ne

Case

repo

rt (

haem

orrh

age

durin

g su

rger

y).27

6

Clin

ical

tria

ls: r

educ

ed in

traop

erat

ive

blee

ding

from

tran

sure

thra

l res

ectio

n of

the

pros

tate

pro

cedu

re

with

pre

oper

ativ

e us

e of

lipo

ster

olic

ext

ract

(2

tria

ls);

bloo

d lo

ss n

ot d

iffer

ent w

hen

com

pare

d w

ith

drug

trea

tmen

t (1

tria

l).27

7

Her

b an

d D

rug

Case

repo

rts

(2):

incr

ease

d IN

R (w

arfa

rin +

sim

vast

atin

,278 a

spiri

n +

clop

idog

rel;27

9 – in

the

first

cas

e,

the

inte

ract

ion

may

hav

e be

en d

ue to

the

vita

min

E a

lso

pres

ent i

n th

e pr

epar

atio

n;27

8 in

the

seco

nd

case

, six

tim

es th

e us

ual d

ose

of e

xtra

ct w

as ta

ken)

.

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

Schi

sand

ra S

chis

andr

a ch

inen

sis

Imm

unos

uppr

essi

ves

May

incr

ease

dru

g le

vels

.Si

rolim

us: O

bser

vatio

ns in

som

e liv

er tr

ansp

lant

ed re

cipi

ents

. Clin

ical

stu

dy: m

arke

dly

incr

ease

d dr

ug le

vels

in h

ealth

y vo

lunt

eers

280 g

iven

S. s

phen

anth

era

extra

ct, p

rovi

ding

67.

5 m

g/da

y of

de

oxys

chis

andr

inH

H.

Tacr

olim

us: O

bser

vatio

ns in

som

e re

nal a

nd li

ver t

rans

plan

ted

reci

pien

ts. C

linic

al s

tudi

es: m

arke

dly

incr

ease

d dr

ug le

vels

in h

ealth

y vo

lunt

eers

281 a

nd tr

ansp

lant

reci

pien

ts,28

2,28

3 giv

en S

. sph

enan

ther

a ex

tract

, pro

vidi

ng 6

7.5

mg/

day

of d

eoxy

schi

sand

rinH

H.

Mon

itor

(low

leve

l of r

isk

at

norm

al d

oses

).

Mid

azol

amM

ay in

crea

se d

rug

leve

ls.

Incr

ease

d dr

ug le

vel (

defin

ed a

s a

mod

erat

e in

tera

ctio

nE ), i

ncre

ase

in s

leep

ing

time

and

incr

ease

in

mild

to m

oder

ate

adve

rse

effe

cts

foun

d in

hea

lthy

volu

ntee

rs, g

iven

S. c

hine

nsis

ext

ract

, pro

vidi

ng

22.5

mg/

day

of d

eoxy

schi

sand

rinH

H.28

4

Mon

itor

(med

ium

leve

l of r

isk

at

norm

al d

oses

).

Pres

crib

ed m

edic

atio

nM

ay a

ccel

erat

e cl

eara

nce

from

th

e bo

dy.

Theo

retic

al c

once

rn b

ased

on

in v

ivo

anim

al s

tudi

es d

emon

stra

ting

enha

nced

pha

se I/

II he

patic

met

abol

ism

.285,

286

Mon

itor

(med

ium

leve

l of r

isk)

.

Talin

olol

May

incr

ease

dru

g le

vels

.In

crea

sed

drug

leve

l and

dec

reas

ed c

lear

ance

foun

d in

hea

lthy

volu

ntee

rs, g

iven

S. c

hine

nsis

ext

ract

, pr

ovid

ing

33.7

5 m

g/da

y of

deo

xysc

hisa

ndrin

HH.12

2

Mon

itor

(low

leve

l of r

isk

at

norm

al d

oses

).

Sibe

rian

Gin

seng

Ele

uthe

roco

ccus

sen

ticos

us

Dig

oxin

May

incr

ease

pla

sma

drug

leve

ls.

Case

repo

rt: a

ppar

ent i

ncre

ase

in p

lasm

a le

vel,

but h

erb

prob

ably

inte

rfere

d w

ith d

igox

in a

ssay

JJ (p

atie

nt h

ad u

ncha

nged

ECG

des

pite

app

aren

t dig

oxin

con

cent

ratio

n of

5.2

nm

ol/L

).287 I

n a

late

r cl

inic

al tr

ial n

o ef

fect

obs

erve

d on

pla

sma

conc

entra

tion.

288

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

HD

I Cha

rt

Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Slip

pery

Elm

Bar

k U

lmus

rubr

a

Pres

crib

ed m

edic

atio

nM

ay s

low

or r

educ

e ab

sorp

tion

of d

rugs

.Th

eore

tical

con

cern

bas

ed o

n ab

sorb

ent p

rope

rtie

s of

slip

pery

elm

.Ta

ke a

t lea

st 2

hou

rs a

way

from

m

edic

atio

n.

St Jo

hn’s

Wor

tKK H

yper

icum

per

fora

tum

(Se

e al

so T

anni

n-co

ntai

ning

her

bs)

Am

itri

ptyl

ine

Dec

reas

es d

rug

leve

ls.28

9Cl

inic

al s

tudy

.M

onito

r (m

ediu

m le

vel o

f ris

k).

Ant

icon

vuls

ants

eg

carb

amaz

epin

e,

mep

heny

toin

, phe

noba

rbito

ne,

phen

ytoi

n

May

dec

reas

e dr

ug le

vels

via

CYP

in

duct

ion.

290-

292

Theo

retic

al c

once

rn. A

n op

en c

linic

al tr

ial d

emon

stra

ted

no e

ffect

on

carb

amaz

epin

e ph

arm

acok

inet

ics

in h

ealth

y vo

lunt

eers

.293 C

ase

repo

rt: i

ncre

ase

in s

eizu

res

in p

atie

nt ta

king

sev

eral

ant

iepi

lept

ic d

rugs

, tw

o of

whi

ch a

re n

ot m

etab

olis

ed b

y cy

toch

rom

e P4

50.29

4 Clin

ical

stu

dy (

heal

thy

volu

ntee

rs; c

linic

al

sign

ifica

nce

uncl

ear)

: inc

reas

ed e

xcre

tion

of a

mep

heny

toin

met

abol

ite in

ext

ensi

ve m

etab

oliz

ers,

but

no

t in

poor

met

abol

izer

s.29

5 See

not

e LL

.

Mon

itor

(low

leve

l of r

isk)

.

Ant

ihis

tam

ine

eg fe

xofe

nadi

neD

ecre

ases

dru

g le

vels

.Cl

inic

al s

tudi

es.29

6,29

7M

onito

r (m

ediu

m le

vel o

f ris

k).

Ant

ipla

tele

t an

d an

tico

agul

ant

drug

sCl

opid

ogre

l: M

ay p

oten

tiate

effe

cts

of d

rug.

Clin

ical

stu

dies

: inc

reas

ed re

spon

sive

ness

(de

crea

sed

plat

elet

agg

rega

tion

or im

prov

ed re

sidu

al

plat

elet

reac

tivity

) in

hyp

ores

pons

ive

volu

ntee

rs a

nd p

atie

nts,

298-

301 p

ossi

bly

via

the

form

atio

n of

the

activ

e m

etab

olite

(CY

P3A4

act

ivity

was

incr

ease

d), t

hus

prov

idin

g a

bene

ficia

l effe

ct

in th

ese

patie

nts.

Thi

s is

a c

ompl

ex s

ituat

ion,

with

the

mea

ning

of c

lopi

dogr

el re

sist

ance

/hy

pore

spon

sive

ness

deb

ated

.298,

302

In p

atie

nts

with

kno

wn

clop

idog

rel r

esis

tanc

e:

Mon

itor

(med

ium

leve

l of r

isk)

.

In o

ther

pat

ient

s:

Mon

itor

(ris

k is

unk

now

n).

Phen

proc

oum

on: D

ecre

ases

pla

sma

drug

leve

ls.

Clin

ical

stu

dy.30

3Co

ntra

indi

cate

d.

War

farin

: Dec

reas

es d

rug

leve

ls

and

INR.

Case

repo

rts

(dec

reas

ed IN

R (n

ine

case

s), i

ncre

ased

INR

(thr

ee c

ases

)).30

4-30

6 Clin

ical

stu

dy w

ith

heal

thy

volu

ntee

rs (

decr

ease

d dr

ug le

vel a

nd IN

R).17

7

Cont

rain

dica

ted.

Benz

odia

zepi

nes

Dec

reas

es d

rug

leve

ls, a

nd is

pr

obab

ly d

epen

dent

upo

n th

e hy

perfo

rin c

onte

nt.30

7

Alpr

azol

am: M

ixed

resu

lts fo

r dru

g le

vels

in tw

o cl

inic

al s

tudi

es (

sim

ilarly

low

am

ount

of h

yper

forin

, ~4

mg/

day)

– n

o ef

fect

(dr

ied

herb

equ

ival

ent:

1.1

g/da

y)30

8 and

dec

reas

e.30

9

Mon

itor

(med

ium

leve

l of r

isk)

.

Mid

azol

am: C

linic

al s

tudi

es, e

ffect

not

rega

rded

as

clin

ical

ly re

leva

nt fo

r low

(<

1 m

g/da

y)

hype

rforin

ext

ract

s.29

7,30

7,31

0,31

1

Hyp

erfo

rin-r

ich

extra

cts:

M

onito

r (m

ediu

m le

vel o

f ris

k).

Low

-hyp

erfo

rin e

xtra

cts:

M

onito

r (lo

w le

vel o

f ris

k).

Qua

zepa

m: D

ecre

ased

dru

g le

vels

, but

no

effe

ct o

n ph

arm

acod

ynam

ics

(sed

atio

n).31

2M

onito

r (lo

w le

vel o

f ris

k).

Calc

ium

cha

nnel

ant

agon

ists

D

ecre

ases

dru

g le

vels

.N

ifedi

pine

: Clin

ical

stu

dies

.117,

313

Vera

pam

il: C

linic

al s

tudy

.314

Cont

rain

dica

ted.

Canc

er c

hem

othe

rape

utic

dru

gs

eg ir

inot

ecan

, im

atin

ibD

ecre

ases

dru

g le

vels

.Cl

inic

al s

tudi

es.31

5-31

8Co

ntra

indi

cate

d.

Cloz

apin

eD

ecre

ases

dru

g le

vels

.Ca

se re

port

.319

Cont

rain

dica

ted.

Dig

oxin

Dec

reas

es d

rug

leve

ls.

Clin

ical

stu

dies

(se

vera

l stu

dies

sho

wed

dec

reas

e, o

ne s

tudy

sho

wed

no

effe

ct)30

8,32

0-32

2 but

effe

ct is

de

pend

ent u

pon

dose

of h

erb

and

the

hype

rforin

con

tent

.322

Cont

rain

dica

ted

at d

oses

equ

ival

ent

to >

1 g

/day

drie

d he

rb, e

spec

ially

for

high

-hyp

erfo

rin e

xtra

cts.

Doc

etax

el (

intra

veno

us)

May

dec

reas

e ef

fect

iven

ess

of d

rug.

Clin

ical

stu

dy w

ith c

ance

r pat

ient

s:32

3 effe

ct o

n ph

arm

acok

inet

ics

prob

ably

not

clin

ical

ly re

leva

nt (

eg

plas

ma

leve

ls d

ecre

ased

by

only

6%

); dr

ug-in

duce

d si

de e

ffect

s w

ere

also

redu

ced.

See

als

o N

ote

MM

.Co

ntra

indi

cate

d.

Fina

ster

ide

May

dec

reas

e dr

ug le

vels

.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs.32

4 Cas

e re

port

: PSA

leve

l ele

vate

d (d

ue to

dec

reas

ed e

ffica

cy o

f dr

ug?)

in p

atie

nt w

ith b

enig

n pr

osta

tic h

yper

plas

ia.32

5

Cont

rain

dica

ted.



Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

St Jo

hn’s

Wor

tKK H

yper

icum

per

fora

tum

(Se

e al

so T

anni

n-co

ntai

ning

her

bs)

(con

tinue

d)

HIV

non

-nuc

leos

ide

tran

scri

ptas

e in

hibi

tors

eg

nevi

rapi

neD

ecre

ases

dru

g le

vels

.Ca

se re

port

.326

Cont

rain

dica

ted.

HIV

pro

teas

e in

hibi

tors

eg

indi

navi

rD

ecre

ases

dru

g le

vels

.Cl

inic

al s

tudy

.327

Cont

rain

dica

ted.

Hyp

ogly

caem

ic d

rugs

Glic

lazi

de: M

ay re

duce

effi

cacy

of

drug

by

incr

ease

d cl

eara

nce.

Clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

, but

glu

cose

and

insu

lin re

spon

se to

glu

cose

load

ing

wer

e un

chan

ged.

329

Mon

itor

(low

leve

l of r

isk)

.

Repa

glin

ide:

May

alte

r met

abol

ism

of

dru

g.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs: n

o ef

fect

, and

glu

cose

and

insu

lin re

spon

se to

glu

cose

load

ing

wer

e un

chan

ged.

329

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

Tolb

utam

ide:

May

affe

ct b

lood

gl

ucos

e.Tw

o cl

inic

al s

tudi

es (

heal

thy

volu

ntee

rs):

no e

ffect

on

phar

mac

okin

etic

s,30

8,31

0 but

ther

e w

as a

n in

crea

sed

inci

denc

e of

hyp

ogly

caem

ia in

the

tria

l usi

ng h

yper

forin

-ric

h ex

tract

(33

mg/

day)

.310

Mon

itor

(low

leve

l of r

isk)

.

Imm

unos

uppr

essi

ves

Dec

reas

es d

rug

leve

ls.

Cycl

ospo

rin: C

ase

repo

rts,

330-

338 c

ase

serie

s,33

9,34

0 clin

ical

stu

dies

.297,

341 I

nter

actio

n is

dep

ende

nt u

pon

the

hype

rforin

con

tent

.333,

341

Tacr

olim

us: C

ase

repo

rt a

nd c

linic

al s

tudi

es.34

2-34

4

Cont

rain

dica

ted

espe

cial

ly fo

r hig

h-hy

perfo

rin e

xtra

cts.

Ivab

radi

neM

ay d

ecre

ase

drug

leve

ls.

Clin

ical

tria

l with

hea

lthy

volu

ntee

rs. N

o ph

arm

acod

ynam

ic e

ffect

was

obs

erve

d.34

5M

onito

r (m

ediu

m le

vel o

f ris

k).

S-Ke

tam

ine

(ora

l)M

ay d

ecre

ase

drug

leve

ls.

Clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

. No

phar

mac

odyn

amic

effe

ct w

as o

bser

ved

(eg

anal

gesi

c ef

fect

no

t alte

red)

.346

Mon

itor

(med

ium

leve

l of r

isk)

.

Met

hado

neD

ecre

ases

dru

g le

vels

, pos

sibl

y in

duci

ng w

ithdr

awal

sym

ptom

s.Ca

se re

port

s.34

7Co

ntra

indi

cate

d.

Met

hylp

heni

date

May

dec

reas

e ef

ficac

y.Ca

se re

port

,348 b

ut c

linic

al s

igni

fican

ce u

ncle

ar.

Mon

itor

(low

leve

l of r

isk)

.

Mor

phin

e (o

ral)

May

pot

entia

te e

ffect

s of

dru

g.Cl

inic

al s

tudy

(he

alth

y vo

lunt

eers

):349 p

ain

scor

es w

ere

decr

ease

d w

hen

mor

phin

e co

-adm

inis

tere

d w

ith s

tand

ardi

sed

extra

ct a

t a d

ose

of h

erb

belo

w th

ose

used

to o

btai

n an

ant

idep

ress

ant o

r ana

lges

ic

effe

ct. T

he e

ffect

was

dep

ende

nt h

yper

icin

con

tent

, but

not

hyp

erfo

rin. T

he a

utho

rs s

ugge

st th

e he

rb

may

be

able

to d

ecre

ase

the

dose

of m

orph

ine

whi

le o

btai

ning

the

sam

e an

alge

sic

effe

ct.

Mon

itor

(med

ium

leve

l of r

isk)

.

Om

epra

zole

May

dec

reas

e dr

ug le

vels

.Cl

inic

al tr

ial.35

0M

onito

r (lo

w le

vel o

f ris

k).

Ora

l con

trac

epti

ves

May

incr

ease

met

abol

ism

and

re

duce

effe

ctiv

enes

s of

dru

g.Br

eakt

hrou

gh b

leed

ing

repo

rted

whi

ch w

as a

ttrib

uted

to in

crea

sed

met

abol

ism

of d

rug.

304,

330 C

linic

al

sign

ifica

nce

uncl

ear.

Case

s of

unw

ante

d pr

egna

ncie

s ha

ve b

een

repo

rted

.351-

353 C

ontra

dict

ory

resu

lts fo

r ef

fect

on

bioa

vaila

bilit

y, h

orm

one

leve

ls a

nd o

vula

tion

dem

onst

rate

d in

thre

e cl

inic

al s

tudi

es, a

lthou

gh

som

e br

eakt

hrou

gh b

leed

ing

occu

rred

.354-

356 I

n on

e cl

inic

al tr

ial a

n ex

tract

low

in h

yper

forin

did

not

af

fect

pla

sma

cont

race

ptiv

e dr

ug le

vels

or c

ause

bre

akth

roug

h bl

eedi

ng.35

7 Clin

ical

tria

l: cl

eara

nce

of

levo

norg

estr

el a

t em

erge

ncy

cont

race

ptiv

e do

ses

incr

ease

d (n

ot s

tatis

tical

ly s

igni

fican

t).35

8 Clin

ical

st

udy:

ant

iand

roge

nic

effe

ct o

f con

trace

ptiv

e no

t affe

cted

.359

Hyp

erfo

rin-r

ich

extra

cts:

M

onito

r (m

ediu

m le

vel o

f ris

k).

Low

-hyp

erfo

rin e

xtra

cts:

M

onito

r (v

ery

low

leve

l of r

isk)

.

Oxy

codo

neD

ecre

ases

dru

g le

vels

.Cl

inic

al tr

ial w

ith h

ealth

y vo

lunt

eers

.360

Mon

itor

(med

ium

leve

l of r

isk)

.

SSRI

s eg

par

oxet

ine,

traz

odon

e,

sert

ralin

e an

d ot

her

sero

tone

rgic

ag

ents

eg

nefa

zodo

ne, v

enla

faxi

ne

Pote

ntia

tion

effe

cts

poss

ible

in

rega

rd to

ser

oton

in le

vels

.Ca

se re

port

s: c

linic

al s

igni

fican

ce u

ncle

ar.36

1-36

6M

onito

r (v

ery

low

leve

l of r

isk)

.

HD

I Cha

rt

Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

St Jo

hn’s

Wor

tKK H

yper

icum

per

fora

tum

(Se

e al

so T

anni

n-co

ntai

ning

her

bs)

(con

tinue

d)

Stat

in d

rugs

May

dec

reas

e ef

fect

and

/or

drug

leve

ls.

Ator

vast

atin

: Clin

ical

stu

dy, s

erum

LD

L-ch

oles

tero

l inc

reas

ed b

y 0.

32 m

mol

/L w

hich

cor

resp

onds

to

a de

crea

se in

effe

ct o

f dru

g in

pat

ient

s by

abo

ut 3

0%. S

erum

tota

l cho

lest

erol

was

als

o in

crea

sed.

367

Prav

asta

tin: C

linic

al s

tudy

, no

effe

ct o

n pl

asm

a le

vel i

n he

alth

y vo

lunt

eers

.368

Rosu

vast

atin

: Cas

e re

port

.369

Sim

vast

atin

: Tw

o cl

inic

al s

tudi

es, d

ecre

ase

in d

rug

leve

ls in

hea

lthy

volu

ntee

rs,36

8 and

sm

all i

ncre

ases

in

ser

um to

tal c

hole

ster

ol a

nd L

DL-

chol

este

rol i

n pa

tient

s.37

0

Mon

itor

bloo

d ch

oles

tero

l reg

ular

ly

(med

ium

leve

l of r

isk)

.

Talin

olol

May

dec

reas

e dr

ug le

vels

.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs.37

1M

onito

r (m

ediu

m le

vel o

f ris

k).

Theo

phyl

line

May

dec

reas

e dr

ug le

vels

.Ca

se re

port

.372 N

o ef

fect

obs

erve

d in

clin

ical

stu

dy.37

3M

onito

r (lo

w le

vel o

f ris

k).

Vori

cona

zole

Dec

reas

es d

rug

leve

ls.

Clin

ical

stu

dy.37

4M

onito

r (m

ediu

m le

vel o

f ris

k).

Zolp

idem

May

dec

reas

e dr

ug le

vels

(bu

t with

w

ide

inte

rindi

vidu

al v

aria

bilit

y).N

N

Clin

ical

stu

dy (

heal

thy

volu

ntee

rs).37

5M

onito

r (lo

w le

vel o

f ris

k).

St M

ary’

s Th

istl

eK S

ilybu

m m

aria

num

(Se

e al

so P

olyp

heno

l-con

tain

ing

herb

s)

Hyp

ogly

caem

ic d

rugs

incl

udin

g in

sulin

May

impr

ove

insu

lin s

ensi

tivity

.Co

ntro

lled

tria

ls: i

mpr

oved

gly

caem

ic c

ontr

ol a

nd re

duce

d in

sulin

requ

irem

ents

in p

atie

nts

with

ty

pe 2

dia

bete

s an

d ci

rrho

sis

(sily

mar

in: 6

00 m

g/da

y),37

6 alth

ough

insu

lin re

quire

men

ts u

ncha

nged

in

ano

ther

tria

l (si

lym

arin

: 200

mg/

day)

;377 i

mpr

oved

gly

caem

ic c

ontr

ol in

dia

betic

s tr

eate

d w

ith

hypo

glyc

aem

ic d

rugs

(si

lym

arin

: 200

and

600

mg/

day)

,378,

379 i

mpr

oved

blo

od g

luco

se, b

lood

insu

lin

and

insu

lin re

sist

ance

in P

COS

patie

nts

trea

ted

with

met

form

in (

sily

mar

in: 7

50 m

g/da

y);38

0 but

no

effe

ct o

n gl

ucos

e m

etab

olis

m in

NAF

LD p

atie

nts

incl

udin

g th

ose

with

insu

lin re

sist

ance

(si

lym

arin

: 28

0 an

d 60

0 m

g/da

y).38

1,38

2

Pres

crib

e ca

utio

usly

and

mon

itor

bloo

d su

gar r

egul

arly.

War

n pa

tient

ab

out p

ossi

ble

hypo

glyc

aem

ic

effe

cts.

Red

uce

drug

if n

eces

sary

in

conj

unct

ion

with

pre

scrib

ing

phys

icia

n.

Imm

unos

uppr

essi

ves

eg s

irolim

usM

ay d

ecre

ase

drug

cle

aran

ce.

Popu

latio

n ph

arm

acok

inet

ic s

tudy

with

112

Chi

nese

adu

lt re

nal t

rans

plan

t rec

ipie

nts:

cle

aran

ce

of s

irolim

us d

ecre

ased

in th

ose

patie

nts

with

abn

orm

al A

LT v

alue

s w

ho w

ere

taki

ng s

ilym

arin

fo

rmul

atio

ns (

rout

e an

d do

sage

unk

now

n).23

6

Mon

itor

(med

ium

leve

l of r

isk)

in

hepa

tical

ly-im

paire

d pa

tient

s.

Losa

rtan

May

redu

ce e

ffica

cy o

f dru

g by

in

hibi

ting

met

abol

ism

.Cl

inic

al s

tudy

(he

alth

y vo

lunt

eers

; clin

ical

sig

nific

ance

unc

lear

): in

hibi

ted

met

abol

ism

of d

rug;

th

e in

hibi

tion

was

gre

ater

in th

ose

of a

par

ticul

ar C

YP2C

9 ge

noty

pe (

sily

mar

in: 4

20 m

g/da

y).38

3 Se

e no

te P

P.

Mon

itor

(low

leve

l of r

isk)

.

Met

roni

dazo

leM

ay d

ecre

ase

abso

rptio

n of

dru

g,

by in

crea

sing

cle

aran

ce.

Clin

ical

stu

dy w

ith h

ealth

y vo

lunt

eers

(si

lym

arin

: 140

mg/

day)

.384

Mon

itor

(med

ium

leve

l of r

isk)

.

Nife

dipi

neM

ay d

elay

the

abso

rptio

n ra

te o

f dru

g.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs (

sily

mar

in: 2

80 m

g/da

y), b

ut b

ioav

aila

bilit

y un

chan

ged.

385

Mon

itor

(low

leve

l of r

isk)

.

Orn

idaz

ole

May

incr

ease

dru

g le

vels

.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs (

sily

mar

in: 1

40 m

g/da

y).38

6M

onito

r (m

ediu

m le

vel o

f ris

k).

Talin

olol

May

incr

ease

dru

g le

vels

.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs (

sily

mar

in: 4

20 m

g/da

y).38

7M

onito

r (lo

w le

vel o

f ris

k).



Dru

gPo

tent

ial I

nter

acti

onB

asis

of

Conc

ern

Reco

mm

ende

d A

ctio

n

Tann

in-c

onta

inin

g or

OPC

-con

tain

ing

herb

s e

g ag

rimon

y (A

grim

onia

eup

ator

ia),

bear

berr

y (A

rcto

stap

hylo

s uv

a-ur

si),

grap

e se

ed e

xtra

ct (

Vitis

vin

ifera

), gr

een

tea

(Cam

ellia

si

nens

is),

haw

thor

n (C

rata

egus

spp

.), le

mon

bal

m (

Mel

issa

offi

cina

lis),

mea

dow

swee

t (Fi

lipen

dula

ulm

aria

), pe

pper

min

t (M

enth

a x

pipe

rita)

, Pel

argo

nium

(Pe

larg

oniu

m s

idoi

des)

, pin

e ba

rk (

Pinu

s m

asso

nian

a), r

aspb

erry

leaf

(Ru

bus

idae

us),

sage

(Sa

lvia

fr

utic

osa)

, St J

ohn’

s w

ort (

Hyp

eric

um p

erfo

ratu

m),

will

ow b

ark

(Sal

ix s

pp.),

will

ow h

erb

(Epi

lobi

um p

arvi

floru

m)

(Se

e al

so

Poly

phen

ol-c

onta

inin

g he

rbs)

Min

eral

s, e

spec

ially

iron

Iron:

May

redu

ce a

bsor

ptio

n of

non

-ha

em ir

onZ f

rom

food

.Cl

inic

al s

tudi

es in

hea

lthy

volu

ntee

rs, a

dmin

istra

tion

durin

g or

imm

edia

tely

follo

win

g th

e m

eal24

3,38

8-

395 (

blac

k te

a, ty

pica

l str

engt

h: 0

.8–3

.3 g

/100

mL;

243,

388-

394 s

orgh

umQ

Q (

0.15

% ta

nnin

s)39

3 ), a

nd in

w

omen

with

iron

defi

cien

cy a

naem

ia39

6 (bl

ack

tea:

1–2

x 1

50 m

L of

1:1

00 in

fusi

on c

onta

inin

g 78

mg

of ta

nnin

s pe

r 150

mL)

.396 I

ron

abso

rptio

n re

duce

d to

a g

reat

er e

xten

t in

thos

e w

ith ir

on d

efici

ency

an

aem

ia (

IDA)

.396 H

owev

er, t

he re

sults

from

sin

gle

test

mea

ls m

ay e

xagg

erat

e th

e ef

fect

of i

ron

inhi

bito

rs a

nd e

nhan

cers

.397 E

ffect

s w

ere

not s

igni

fican

t in

a 14

-day

stu

dy.25

1 Cas

es o

f IDA

resi

stan

t to

trea

tmen

t: he

avy

blac

k te

a dr

inke

rs (

2 ca

ses,

1.5

–2 L

/day

).398,

399

Epid

emio

logi

cal s

tudi

es (

12, t

o 20

02)

foun

d m

ixed

resu

lts, b

ut s

ome

evid

ence

of a

n as

soci

atio

n be

twee

n dr

inki

ng b

lack

tea

and

poor

iron

sta

tus.

397

Clin

ical

stu

dy in

pat

ient

s w

ith h

aem

ochr

omat

osis

(bl

ack

tea:

250

mL

with

mea

l).40

0

Take

at l

east

2 h

ours

aw

ay fr

om fo

od

or m

edic

atio

n.

Zinc

: May

redu

ce a

bsor

ptio

n

from

food

.Cl

inic

al s

tudi

es w

ith h

ealth

y vo

lunt

eers

: res

ults

con

flict

ing

for e

ffect

on

zinc

(un

defin

ed te

a,40

1 bla

ck

tea25

1 con

sum

ed a

t or i

mm

edia

tely

afte

r foo

d).

Take

at l

east

2 h

ours

aw

ay fr

om fo

od

or m

edic

atio

n.

Turm

eric

C Cu

rcum

a lo

nga

Talin

olol

May

dec

reas

e dr

ug le

vels

.Cl

inic

al s

tudy

with

hea

lthy

volu

ntee

rs (

300

mg/

day

of c

urcu

min

oids

).402

Mon

itor

at h

igh

dose

s (≥

300

mg/

day

curc

umin

, low

leve

l of r

isk)

.

Vale

rian

s M

exic

an V

aler

ian

(Val

eria

na e

dulis

), Va

leria

n (V

aler

iana

offi

cina

lis)

CNS

depr

essa

nts

or a

lcoh

olM

ay p

oten

tiate

effe

cts

of d

rug.

Theo

retic

al c

once

rn e

xpre

ssed

by

US P

harm

acop

eial

Con

vent

ion.

403 H

owev

er a

clin

ical

stu

dy fo

und

no

pote

ntia

tion

with

alc

ohol

.404 C

ase

repo

rt o

f adv

erse

effe

ct w

ith b

enzo

diaz

epin

e dr

ug (

lora

zepa

m)40

5 –

herb

dos

age

unde

fined

but

like

ly h

igh

(tab

let c

onta

ined

val

eria

n an

d pa

ssio

nflow

er (

Pass

iflor

a in

carn

ata)

). Al

praz

olam

: Clin

ical

stu

dy in

hea

lthy

volu

ntee

rs fo

und

no e

ffect

on

drug

leve

ls (

extra

ct

prov

ided

11

mg/

day

tota

l val

eren

ic a

cids

).406

Mon

itor

(ver

y lo

w le

vel o

f ris

k).

Will

ow B

ark

Sal

ix a

lba,

Sal

ix d

aphn

oide

s, S

alix

pur

pure

a, S

alix

frag

ilis

(Se

e al

so T

anni

n-co

ntai

ning

her

bs)

War

fari

nM

ay p

oten

tiate

effe

cts

of d

rug.

Her

b A

lone

Clin

ical

stu

dy o

bser

ved

very

mild

but

sta

tistic

ally

sig

nific

ant a

ntip

late

let a

ctiv

ity (

extra

ct c

onta

inin

g 24

0 m

g/da

y of

sal

icin

).407

Mon

itor

(low

leve

l of r

isk)

.

COD

E FO

R RE

COM

MEN

DED

ACT

ION

Cont

rain

dica

ted:

Do

not p

resc

ribe

the

indi

cate

d he

rb.

Mon

itor:

Can

pre

scrib

e th

e in

dica

ted

herb

but

mai

ntai

n cl

ose

cont

act a

nd re

view

the

patie

nt’s

sta

tus

on a

regu

lar b

asis

. Not

e th

at w

here

the

risk

is a

sses

sed

as m

ediu

m, s

elf-p

resc

riptio

n of

the

herb

in c

onju

nctio

n w

ith th

e dr

ug

is n

ot a

dvis

able

.

ABB

REVI

ATIO

NS

ACE

: ang

iote

nsin

-con

vert

ing

enzy

me;

ALT

: ala

nine

tran

sam

inas

e, a

lso

know

n as

glu

tam

ic p

yruv

ic tr

ansa

min

ase

(GPT

); A

MP:

ade

nosi

ne m

onop

hosp

hate

; APT

T: a

ctiv

ated

par

tial t

hrom

bopl

astin

tim

e; A

UC:

are

a un

der t

he p

lasm

a/se

rum

con

cent

ratio

n-tim

e cu

rve

(mea

sure

s ex

tent

of a

bsor

ptio

n); C

NS:

cen

tral n

ervo

us s

yste

m; C

YP: c

ytoc

hrom

e P4

50; E

CG: e

lect

roca

rdio

gram

/gra

ph; E

GCG

: epi

gallo

cate

chin

gal

late

; GA

S: g

inse

ng a

buse

syn

drom

e; H

IV: h

uman

im

mun

odefi

cien

cy v

irus;

11b

eta-

HSD

2: 1

1bet

a-hy

drox

yste

roid

deh

ydro

gena

se ty

pe 2

; ID

A: i

ron

defic

ienc

y an

aem

ia; I

NR

: int

erna

tiona

l nor

mal

ised

ratio

; LD

L: lo

w d

ensi

ty li

popr

otei

n; N

AFL

D: n

onal

coho

lic fa

tty

liver

dis

ease

; O

PC: o

ligom

eric

pro

cyan

idin

; PCO

S: p

olyc

ystic

ova

ry s

yndr

ome;

PSA

: pro

stat

e sp

ecifi

c an

tigen

; PT:

pro

thro

mbi

n tim

e; S

SRI:

sele

ctiv

e se

roto

nin

reup

take

inhi

bito

rs; t

ds: t

hree

tim

es p

er d

ay; >

: gre

ater

than

; ≥: g

reat

er th

an o

r eq

ual t

o; <

: les

s th

an.

HD

I Cha

rt

NO

TES

* Th

is ch

art c

onta

ins

info

rmat

ion

the

auth

ors

belie

ve to

be

relia

ble

or w

hich

ha

s re

ceiv

ed c

onsid

erab

le a

ttent

ion

as p

oten

tial i

ssue

s. Ho

wev

er, m

any

theo

retic

al c

once

rns

expr

esse

d by

oth

er a

utho

rs h

ave

not b

een

incl

uded

. Du

e to

the

focu

s on

saf

ety,

pos

itive

inte

ract

ions

bet

wee

n he

rbs

and

drug

s, an

d th

e ef

fect

of d

rugs

on

the

bioa

vaila

bilit

y of

her

bs a

re g

ener

ally

no

t inc

lude

d.

A.

Rese

arch

pap

er d

escr

ibes

adm

inist

ratio

n of

Scu

tella

ria ra

dix.

Tria

l aut

hors

co

nfirm

this

was

root

of B

aica

l sku

llcap

( Scu

tella

ria b

aica

lens

is).40

8

B.

Anal

ysis

of B

aica

l sku

llcap

root

sam

ples

from

Japa

n fo

und

the

baic

alin

co

nten

t var

ied

from

3.5

to 1

2%. F

or a

dos

e of

150

mg/

day

of b

aica

lin,

1.2–

4.3

g/da

y of

drie

d ro

ot w

ould

be

requ

ired.

409

C.

Info

rmat

ion

is pr

ovid

ed fo

r her

bs c

onta

inin

g st

anda

rd le

vels

of a

ctiv

e co

nstit

uent

s. Se

e el

sew

here

for i

nfor

mat

ion

on e

xtra

cts

cont

aini

ng v

ery

high

leve

ls of

act

ive

cons

titue

nts

such

as

berb

erin

e an

d cu

rcum

in.

D.

Sing

le-s

treng

th (

fresh

ly s

quee

zed,

100

%)

cran

berry

juice

is h

ighl

y ac

idic

an

d as

tring

ent,

mak

ing

it un

pala

tabl

e. F

or th

is re

ason

, cra

nber

ry ju

ice is

us

ually

dilu

ted

and

swee

tene

d (o

ften

know

n as

cra

nber

ry ju

ice d

rink)

. Cr

anbe

rry ju

ice c

ockt

ail u

sual

ly c

onta

ins

25%

cra

nber

ry ju

ice, a

lthou

gh c

an

be u

p to

35%

. Cra

nber

ry ju

ice d

rinks

con

tain

abo

ut 1

0% c

ranb

erry

juice

. Cr

anbe

rry s

auce

is a

bout

hal

f the

stre

ngth

of c

ranb

erry

juice

coc

ktai

l, ab

out

the

sam

e st

reng

th a

s ju

ice d

rinks

. Cra

nber

ry ju

ice c

an b

e co

ncen

trate

d to

a

dry

pow

der (

unsw

eete

ned

and

usua

lly u

p to

25:

1) a

nd u

sed

in ta

blet

s an

d ca

psul

es. J

uice

s ca

n be

pre

pare

d by

dilu

ting

juice

con

cent

rate

s yi

eldi

ng

a co

ncen

trate

d ju

ice (

eg d

oubl

e-st

reng

th ju

ice, a

t tw

ice th

e st

reng

th o

f sin

gle-

stre

ngth

, squ

eeze

d ju

ice).

It is

likel

y th

at u

nles

s de

fined

, cra

nber

ry

juice

refe

rred

to in

cas

e re

ports

and

clin

ical

stu

dies

is ju

ice d

rink

cont

aini

ng

arou

nd 1

0% c

ranb

erry

juice

.

E.

Refe

r to

Pres

crib

ing

Guid

elin

es &

Ass

essm

ent o

f Risk

(av

aila

ble

on

ww

w.m

edih

erb.

com

.au)

for d

efini

tion

of th

e ex

tent

of t

his

inte

ract

ion.

F. Th

e cr

anbe

rry ‘j

uice

’ adm

inist

ered

was

sim

ilar i

n co

ncen

tratio

n to

a

refe

renc

e cr

anbe

rry ‘j

uice

’ con

tain

ing

abou

t 25%

cra

nber

ry ju

ice,41

0 but

w

ith a

hig

her c

once

ntra

tion

of a

ntho

cyan

ins,

and

low

er in

cat

echi

ns a

nd

orga

nic

acid

s.

See

also

not

e D.

G N

o ef

fect

ove

rall

whe

n m

idaz

olam

was

adm

inist

ered

ora

lly: o

ral c

lear

ance

an

d ar

ea u

nder

the

drug

con

cent

ratio

n-tim

e cu

rve

wer

e un

chan

ged.

H.

Thes

e fo

ur tr

ials

used

tabl

ets

cont

aini

ng a

con

cent

rate

d, s

tand

ardi

sed

extra

ct. A

dos

age

of 9

00 m

g/da

y of

dry

ext

ract

was

equ

ival

ent t

o ab

out

2.7

g/da

y of

fres

h ga

rlic,

411 a

nd w

as s

aid

to p

rovi

de 1

2 m

g/da

y of

al

liin,

58,6

6 alth

ough

ther

e is

som

e do

ubt a

s to

the

amou

nt o

f alli

cin

rele

ased

fro

m th

is br

and

of ta

blet

from

aro

und

1995

to 2

000.

412

J. Th

ere

may

hav

e be

en v

aria

tion

in p

atie

nts’

inte

rpre

tatio

ns (

of b

leed

ing)

an

d th

e sig

nific

ant a

ssoc

iatio

n be

twee

n gi

nger

use

and

ble

edin

g w

as

base

d on

7 s

elf-r

epor

ted

even

ts in

25

user

s.413

K.

Info

rmat

ion

is pr

ovid

ed fo

r spe

cial

ised

and/

or c

once

ntra

ted

extra

ct, r

athe

r th

an g

alen

ical

form

of h

erb.

L.

Gink

goto

xin

(4’-O

-met

hylp

yrid

oxin

e) is

pre

sent

in s

ubst

antia

l am

ount

s in

Gin

kgo

seed

, and

con

vulsi

ons

arisi

ng fr

om in

gest

ion

of G

inkg

o se

ed

have

bee

n do

cum

ente

d in

Japa

n (in

fant

s ar

e pa

rticu

larly

vul

nera

ble)

. Gi

nkgo

toxi

n is

know

n to

inhi

bit v

itam

in B

6 ph

osph

oryl

atio

n, w

hich

may

le

ad to

incr

ease

d ne

uron

al e

xcita

bilit

y.414 P

oiso

ning

by

gink

goto

xin

can

be

coun

tera

cted

by

vita

min

B6,

414 in

cas

es o

f poi

soni

ng it

is a

dmin

ister

ed b

y in

trave

nous

inje

ctio

n.41

5,41

6 Gin

kgot

oxin

is p

rese

nt in

ver

y sm

all a

mou

nts

in s

tand

ardi

sed

Gink

go le

af e

xtra

cts,41

7 but

is b

elow

the

dete

ctio

n lim

its in

hu

man

pla

sma

afte

r ora

l dos

es (

240

mg

of 5

0:1

extra

ct, e

quiv

alen

t to

12

g of

drie

d le

af).41

8 Acc

ordi

ng to

the

man

ufac

ture

r, de

spite

the

exte

nsiv

e

use

of th

is sp

ecia

l ext

ract

(m

ore

than

150

mill

ion

daily

dos

es p

er y

ear f

or

mor

e th

an tw

o de

cade

s) n

o ca

ses

of e

pile

ptic

sei

zure

hav

e be

en a

ttrib

uted

to

this

extra

ct.41

8 (Gi

nkgo

pre

para

tions

ass

ocia

ted

with

the

abov

e ca

se

repo

rts w

ere

unde

fined

.) St

rictly

spe

akin

g th

is is

a po

tent

ial a

dver

se e

ffect

(r

athe

r tha

n a

herb

-dru

g in

tera

ctio

n) a

s th

ere

is no

pha

rmac

okin

etic

dat

a in

dica

ting

an in

tera

ctio

n fo

r coa

dmin

istra

tion

of G

inkg

o an

d an

ticon

vuls

ants

in

hum

ans.

An in

tera

ctio

n is

sugg

este

d th

ough

, bec

ause

Gin

kgo

has

been

fo

und

to in

duce

CYP

2C19

act

ivity

(se

e en

try fo

r om

epra

zole

), an

enz

yme

invo

lved

in th

e m

etab

olism

of s

ome

antic

onvu

lsan

ts.

M.

Anal

ysis

of o

ver 3

20 0

00 p

atie

nts

in a

Ger

man

adv

erse

dru

g re

actio

n re

porti

ng s

yste

m (

1999

-200

2) fo

und

no in

crea

se in

pre

vale

nce

of b

leed

ing

durin

g Gi

nkgo

inta

ke c

ompa

red

to p

erio

ds w

ithou

t Gin

kgo

in th

ose

taki

ng

antic

oagu

lant

or a

ntip

late

let m

edic

atio

n.41

9 In

a tri

al in

volv

ing

3069

he

alth

y vo

lunt

eers

trea

ted

for a

n av

erag

e of

6.1

yea

rs, t

here

wer

e no

st

atist

ical

ly s

igni

fican

t diff

eren

ces

betw

een

plac

ebo

and

Gink

go in

the

rate

of m

ajor

ble

edin

g or

the

inci

denc

e of

ble

edin

g in

indi

vidu

als

taki

ng

aspi

rin. (

Com

plia

nce

durin

g th

e tri

al w

as h

owev

er lo

w (

at th

e en

d of

the

trial

, abo

ut 6

0% w

ere

taki

ng G

inkg

o/pl

aceb

o).42

0 ) In

Kor

ea, G

inkg

o ex

tract

is

adm

inist

ered

with

ticl

opid

ine

for t

he p

reve

ntio

n of

isch

aem

ic s

troke

or

acut

e co

rona

ry s

yndr

ome.

421

N.

The

in v

itro

redu

ctio

n by

EGC

G w

as o

verc

ome

whe

n th

e co

ncen

tratio

n of

th

e dr

ug w

as in

crea

sed

(to a

leve

l exp

ecte

d cli

nica

lly ie

in p

lasm

a fro

m

the

stan

dard

dru

g do

se).42

2 A fu

rther

in v

ivo

stud

y fo

und

no re

duct

ion

in

the

activ

ity o

f the

dru

g (w

hen

EGCG

adm

inist

ered

by

inje

ctio

n to

ach

ieve

pl

asm

a le

vels

of 1

1–16

micr

oM).12

5

P Th

e in

vitr

o st

udy

foun

d a

pron

ounc

ed re

duct

ion

in th

e cy

toto

xic

effe

ct o

f th

e dr

ug fo

r a c

once

ntra

tion

of 2

.5–5

mic

roM

of E

GCG,

and

whe

n ap

plie

d as

gre

en te

a po

lyph

enol

s a

very

sub

stan

tial e

ffect

occ

urre

d at

a E

GCG

conc

entra

tion

of 1

mic

roM

(th

e ot

her p

olyp

heno

ls m

ay c

ontri

bute

to th

e ac

tivity

).124 A

pha

rmac

okin

etic

stu

dy w

ith h

ealth

y vo

lunt

eers

foun

d a

EGCG

pl

asm

a co

ncen

tratio

n of

0.7

mic

roM

afte

r a d

ose

of 5

80 m

g of

EGC

G, a

nd

a EG

CG p

lasm

a co

ncen

tratio

n of

0.5

mic

roM

afte

r a d

ose

of 1

g o

f gre

en

tea

poly

phen

ols.42

3

Q.

Bette

r gas

tric

tole

ranc

e to

met

form

in w

as n

oted

in th

e ps

ylliu

m g

roup

of

one

trial

.149

R.

A be

tter d

esig

n w

ould

hav

e vo

lunt

eers

take

war

farin

alo

ne fo

r a p

erio

d lo

ng e

noug

h to

allo

w th

e dr

ug to

reac

h its

max

imum

effe

ct (

abou

t 3–5

da

ys)

befo

re a

ddin

g th

e he

rb.

S.

Glyc

yrrh

etin

ic a

cid,

is th

e ag

lyco

ne o

f gly

cyrrh

izin

. Gly

cyrrh

izin

, is

the

glyc

osid

e an

d co

ntai

ns th

e ag

lyco

ne (

glyc

yrrh

etin

ic a

cid)

and

a s

ugar

uni

t.

T. N

o ef

fect

on

bloo

d pr

essu

re in

hea

lthy

volu

ntee

rs in

two

stud

ies

(130

mg/

day

of g

lycy

rrhet

inic

aci

d =

227

mg/

day

of g

lycy

rrhiz

in, f

or 1

4 da

ys;20

0 lic

orice

tabl

ets

(266

mg/

day

of g

lycy

rrhiz

in)

for 5

6 da

ys);21

2 inc

ludi

ng

whe

re p

lasm

a re

nin

leve

ls w

ere

high

(3.

1 ng

/mL/

h),21

2 but

in a

noth

er

stud

y, b

lood

pre

ssur

e in

crea

sed

in h

ealth

y vo

lunt

eers

taki

ng 5

46 m

g/da

y of

gly

cyrrh

izin

for 4

wee

ks, o

nly

for t

hose

with

pla

sma

reni

n ac

tivity

gr

eate

r tha

n 1.

5 ng

/mL/

h.42

4

U.

This

is a

guid

e, b

ased

on

a re

com

men

datio

n fro

m th

e Ge

rman

Com

miss

ion

E fo

r lon

g-te

rm c

onsu

mpt

ion

of li

coric

e as

a fl

avou

ring.

Gly

cyrrh

izin

is a

lso

know

n as

gly

cyrrh

izin

ic a

cid

and

glyc

yrrh

izic

aci

d.

V.

ACE-

inhi

bito

rs c

ause

mild

nat

riure

sis (

an in

crea

se in

sod

ium

exc

retio

n in

the

urin

e) a

nd o

ccas

iona

lly h

yper

kala

emia

. The

mec

hani

sm o

f the

in

tera

ctio

n is

not k

now

n, a

lthou

gh it

may

invo

lve

oppo

sing

effe

cts

on

11be

ta-h

ydro

xyst

eroi

d de

hydr

ogen

ase

type

2 (

glyc

yrrh

izin

inhi

bitin

g,

ACE-

inhi

bito

r pro

mot

ing)

, thu

s af

fect

ing

min

eral

ocor

ticoi

d re

cept

or a

ctiv

ity.

Redu

ctio

n of

dru

g do

sage

reve

aled

the

exist

ing

hypo

kala

emia

cau

sed

by

this

dosa

ge o

f gly

cyrrh

izin

.

W.

Max

imum

pla

sma

corti

sol (

exog

enou

s) w

as n

ot in

crea

sed

in o

ne

volu

ntee

r;219 i

n th

e ot

her,

plas

ma

(exo

geno

us)

corti

sone

/cor

tisol

ra

tio d

ecre

ased

,218 s

ugge

stin

g in

crea

sed

(exo

geno

us)

corti

sol w

hile

(e

ndog

enou

s) c

ortis

ol d

ecre

ased

(al

thou

gh s

tatis

tical

and

clin

ical

sig

nific

ance

is u

nkno

wn,

and

may

hav

e be

en w

ithin

the

norm

al ra

nge)

. In

thes

e st

udie

s iso

tope

-labe

lled

corti

sol w

as a

dmin

ister

ed, w

hich

allo

wed

ex

ogen

ous

and

endo

geno

us c

ortis

ol to

be

mea

sure

d.

X.

A hi

gher

pre

dniso

lone

/pre

dniso

ne ra

tio in

dica

tes

decr

ease

d co

nver

sion

of

pred

niso

lone

(ac

tive)

to p

redn

isone

(in

activ

e).

Y. Th

e w

ord

tann

in h

as a

long

est

ablis

hed

and

exte

nsiv

e us

age

alth

ough

it

is co

nsid

ered

in m

ore

rece

nt y

ears

to la

ck p

reci

sion.

Pol

yphe

nol i

s th

e pr

efer

red

term

whe

n co

nsid

erin

g th

e pr

oper

ties

at a

mol

ecul

ar

leve

l. Pl

ant p

olyp

heno

ls ar

e br

oadl

y di

visib

le in

to p

roan

thoc

yani

dins

(c

onde

nsed

tann

ins)

and

pol

ymer

s of

est

ers

base

d on

gal

lic a

nd/

or h

exah

ydro

xydi

phen

ic a

cid

and

thei

r der

ivat

ives

(hy

drol

yzab

le

tann

ins)

.425 T

he te

rms

‘tann

in’ a

nd ‘p

olyp

heno

l’ ar

e so

met

imes

use

d in

terc

hang

eabl

y. Fo

r exa

mpl

e, th

e re

sults

of a

clin

ical

stu

dy a

re d

escr

ibed

: “p

olyp

heno

ls pr

esen

t in

tea

and

coffe

e in

hibi

ted

iron

abso

rptio

n in

a

dose

-dep

ende

nt m

anne

r”. T

he ‘p

olyp

heno

l’ co

nten

t was

mea

sure

d us

ing

a sp

ectro

phot

omet

ric m

etho

d fo

r the

det

erm

inat

ion

of “

tann

ins

and

othe

r po

lyph

enol

ics”

.395 D

epen

ding

on

the

anal

ytic

al m

etho

d us

ed, i

t is

poss

ible

th

at th

e po

lyph

enol

con

tent

may

act

ually

be

the

cont

ent o

f tan

nins

or

tann

ins

+ po

lyph

enol

s.426 I

t is

reco

mm

ende

d th

at b

oth

sect

ions

of t

his

char

t be

cons

ider

ed: P

olyp

heno

l-con

tain

ing

or F

lavo

noid

-con

tain

ing

herb

s,

and

Tann

in-c

onta

inin

g or

OPC

-con

tain

ing

herb

s.

Z.

Haem

iron

is d

eriv

ed fr

om h

aem

oglo

bin

and

myo

glob

in m

ainl

y in

mea

t pr

oduc

ts. N

on-h

aem

iron

is d

eriv

ed m

ainl

y fro

m c

erea

ls, v

eget

able

s an

d fru

its.

AA.

At a

n id

entic

al c

once

ntra

tion

of to

tal p

olyp

heno

ls, b

lack

tea

was

mor

e in

hibi

tory

than

all

the

herb

teas

exc

ludi

ng p

eppe

rmin

t: bl

ack

tea

was

of

equa

l inh

ibiti

on to

pep

perm

int t

ea.24

3 The

type

of p

olyp

heno

ls pr

esen

t, as

w

ell a

s th

e co

ncen

tratio

n, m

ay a

ffect

iron

abs

orpt

ion.

BB.

Anot

her c

linic

al s

tudy

also

foun

d a

dose

-dep

ende

nt e

ffect

, and

the

redu

ced

abso

rptio

n w

as m

ost m

arke

d w

hen

coffe

e w

as ta

ken

with

the

mea

l or o

ne h

our l

ater

. No

decr

ease

in ir

on a

bsor

ptio

n oc

curre

d w

hen

coffe

e w

as c

onsu

med

one

hou

r bef

ore

the

mea

l.394

CC.

Adm

inist

ered

in fr

eeze

-drie

d fo

rm (

4.2

g), w

hich

wou

ld b

e ex

pect

ed

to h

ave

a lo

wer

inhi

bito

ry e

ffect

than

with

the

use

of fr

esh

chill

i, as

fre

eze

dryi

ng p

roba

bly

decr

ease

d th

e as

corb

ic a

cid

cont

ent (

asco

rbic

aci

d en

hanc

es ir

on a

bsor

ptio

n).24

7

DD.

The

diffe

rent

resu

lts fo

r cay

enne

and

turm

eric

und

er th

e sa

me

expe

rimen

tal c

ondi

tions

, sug

gest

it is

not

onl

y th

e qu

antit

y of

pol

yphe

nol

pres

ent t

hat d

eter

min

es th

e in

hibi

tion,

but

also

for e

xam

ple,

the

stru

ctur

e of

the

poly

phen

ol (

and

henc

e m

echa

nism

of i

ron

bind

ing)

.247

EE.

Plan

t par

t defi

ned

in o

ther

pub

licat

ion.

427

FF.

Orlis

tat i

nhib

its g

astri

c an

d pa

ncre

atic

lipa

ses

in th

e lu

men

of t

he s

tom

ach

and

smal

l int

estin

e w

hich

lead

s to

dec

reas

ed a

bsor

ptio

n of

die

tary

fat,

and

the

subs

eque

nt e

xcre

tion

of th

e un

abso

rbed

fats

in fa

eces

. No

syst

emic

ab

sorp

tion

is re

quire

d to

exe

rt its

ther

apeu

tic e

ffect

.

GG.

This

proc

edur

e ha

s be

en a

dopt

ed in

clin

ical

tria

ls w

here

hy

poch

oles

tero

laem

ic d

rugs

(st

atin

s) w

ere

coad

min

ister

ed.42

8,42

9

HH.

Fruc

tus

Schi

sand

ra is

defi

ned

as th

e fru

it of

Sch

isand

ra c

hine

nsis

or

Schi

sand

ra s

phen

anth

era

in tr

aditi

onal

Chi

nese

med

icin

e. T

he m

ajor

co

nstit

uent

s ar

e di

benz

ocyc

looc

tene

lign

ans.

Seve

ral f

acto

rs in

clud

ing

harv

est s

easo

n, o

rigin

of h

erb

and

extra

ctio

n so

lven

t affe

ct th

e le

vels

of

the

indi

vidu

al li

gnan

s. Aq

ueou

s or

eth

anol

ic e

xtra

cts

of S

. chi

nens

is ar

e



REFE

REN

CES

Brau

n L.

Her

b Dr

ug In

tera

ctio

n Gu

ide

for P

harm

acist

s. FH

Fau

ldin

g, A

ugus

t 200

0 Fu

gh-B

erm

an A

. Lan

cet

2000

; 355

(919

8): 1

34-1

38

1 Yi

SJ,

Cho

JY, L

im K

S et

al.

Basic

Clin

Pha

rmac

ol T

oxico

l 200

9; 1

05(4

): 24

9-25

6

2 Fa

n L,

Zha

ng W

, Guo

D e

t al.

Clin

Pha

rmac

ol T

her 2

008;

83(

3): 4

71-4

76

3 Ch

an E

. Bio

l Neo

nate

199

3; 6

3(4)

: 201

-208

4 Pu

llier

o G,

Mon

tin S

, Bet

tini V

et a

l. Fi

tote

rapi

a 19

89; 6

0(1)

: 69-

75

5 Du

terte

M, W

augh

S, T

hana

wal

a R.

Am

J Ga

stro

ente

rol 2

007;

102

(Sup

pl 2

): S3

50

6 N

eum

ann

L. K

lin M

onbl

Aug

enhe

ilkd

1973

; 163

(1):

96-1

03

7 Ak

tas

C, S

enka

l V, S

arik

aya

S et

al.

Turk

J Ge

riatr

2011

; 14(

1): 7

9-81

8 Pa

tel N

M, D

erki

ts R

M. J

Pha

rm P

ract

200

7; 2

0(4)

: 341

-346

9 de

Sm

et P

AGM

, Kel

ler K

, Han

sel R

et a

l (ed

s). A

dver

se E

ffect

s of

Her

bal D

rugs

, Vol

ume

3. S

prin

ger-

Verla

g, B

erlin

, 199

7.

10

Mill

er L

G. A

rch

Inte

rn M

ed 1

998;

158

(20)

: 220

0-22

11

11

de S

met

PAG

M, K

elle

r K, H

anse

l R e

t al (

eds)

. Adv

erse

Effe

cts

of H

erba

l Dru

gs, V

olum

e 2.

Spr

inge

r-Ve

rlag,

Ber

lin, 1

993.

12

Blum

enth

al M

et a

l (ed

s). T

he C

ompl

ete

Germ

an C

omm

issio

n E

Mon

ogra

phs:

Ther

apeu

tic G

uide

to

Herb

al M

edici

nes.

Amer

ican

Bota

nica

l Cou

ncil,

Aus

tin, 1

998.

13

Lope

z Ga

lera

RM

, Rib

era

Pasc

uet E

, Est

eban

Mur

JI e

t al.

Eur J

Clin

Pha

rmac

ol 2

008;

64(

12):

1235

-123

6

14

Haka

s JF.

Ann

Alle

rgy

1990

; 65(

4): 3

22-3

23

15

Bour

aoui

A, T

oum

A, B

ouch

ouch

a S

et a

l. Th

erap

ie 1

986;

41(

6): 4

67-4

71

16

Mos

es G

. Aus

tralia

n Pr

escr

iber

200

1; 2

4(1)

: 6

17

de S

ouza

NJ.

J Eth

noph

arm

acol

199

3; 3

8(2-

3): 1

77-1

80

18

Yoko

tani

K, C

hiba

T, S

ato

Y et

al.

J Pha

rm P

harm

acol

201

2; 6

4(12

): 17

93-1

801

19

de S

ouza

NJ,

Doha

dwal

la A

N, R

eden

J. M

ed R

es R

ev 1

983;

3(2

): 20

1-21

9

20

Dube

y M

P, Sr

imal

RC,

Nity

anan

d S

et a

l. J E

thno

phar

mac

ol 1

981;

3(1

): 1-

13

21

Sabi

nsa

Corp

orat

ion.

For

sLea

n® P

rodu

ct In

form

atio

n. A

vaila

ble

from

ww

w.fo

rsle

an.co

m. A

cces

sed

Nov

embe

r 200

4.

22

Hend

erso

n S,

Mag

u B,

Ras

mus

sen

C et

al.

J Int

Soc

Spo

rts N

utr 2

005;

2(2

): 54

-62

23

Seam

on K

B, D

aly

JW. J

Cyc

lic N

ucle

otid

e Re

s 19

81; 7

(4):

201-

224

24

Ngo

N, Y

an Z

, Gra

f TN

et a

l. Dr

ug M

etab

Disp

os 2

009;

37(

3): 5

14-5

22

25

Lilja

JJ, B

ackm

an JT

, Neu

vone

n PJ

. Clin

Pha

rmac

ol T

her 2

007;

81(

6): 8

33-8

39

26

Gold

enbe

rg G

, Kha

n R,

Bha

rath

an T.

Clin

Ger

iatri

cs 2

012;

20(

8): 3

8-42

27

Med

icine

s an

d He

alth

care

Pro

duct

s Re

gula

tory

Age

ncy,

Com

mitt

ee o

n Sa

fety

of M

edici

nes.

Curre

nt

Prob

lem

s in

Pha

rmac

ovig

ilanc

e, V

ol 3

0, O

ctob

er 2

004,

p 1

0.

28

Rind

one

JP, M

urph

y TW

. Am

J Th

er 2

006;

13(

3): 2

83-2

84

29

Sylv

an L

, Jus

tice

NP.

Am F

am P

hysic

ian

2005

; 72(

6): 1

000

30

Paen

g CH

, Spr

ague

M, J

acke

viciu

s CA

. Clin

The

r 200

7; 2

9(8)

: 173

0-17

35

31

Wel

ch JM

, For

ster

K. J

Pha

rm T

echn

ol 2

007;

23(

2): 1

04-1

07

32

Mer

genh

agen

KA,

She

rman

O. A

m J

Heal

th S

yst P

harm

200

8; 6

5(22

): 21

13-2

116

33

Griff

iths

AP, B

edda

ll A,

Peg

ler S

. J R

Soc

Pro

mot

Hea

lth 2

008;

128

(6):

324-

326

34

Ham

ann

GL, C

ampb

ell J

D, G

eorg

e CM

. Ann

Pha

rmac

othe

r 201

1; 4

5(3)

: e17

35

Habe

r SL,

Cau

thon

KA,

Ran

ey E

C. C

onsu

lt Ph

arm

201

2; 2

7(1)

: 58-

65

36

Li Z,

See

ram

NP,

Carp

ente

r CL

et a

l. J A

m D

iet A

ssoc

200

6; 1

06(1

2): 2

057-

2061

37

Anse

ll J,

McD

onou

gh M

, Zha

o Y

et a

l. J C

lin P

harm

acol

200

9; 4

9(7)

: 824

-830

38

Moh

amm

ed A

bdul

MI,

Jiang

X, W

illia

ms

KM e

t al.

Br J

Phar

mac

ol 2

008;

154

(8):

1691

-170

0

39

Mel

len

CK, F

ord

M, R

indo

ne JP

. Br J

Clin

Pha

rmac

ol 2

010;

70(

1): 1

39-1

42

40

Qiu

F, W

ang

J, Zh

ang

R et

al.

Brit

J Clin

Pha

rmac

ol 2

010;

69(

6): 6

56-6

62

41

Tam

LS,

Cha

n TY

K, L

eung

WK

et a

l. Au

st N

Z J M

ed 1

995;

25(

3): 2

58

42

Yu C

M, C

han

JCN

, San

ders

on JE

. J In

tern

Med

199

7; 2

41(4

): 33

7-33

9

43

Izzat

MB,

Yim

APC

, El-Z

ufar

i MH.

Ann

Tho

rac

Surg

199

8; 6

6(3)

: 941

-942

44

Shaw

D, L

eon

C, K

olev

S e

t al.

Drug

Saf

199

7; 1

7(5)

: 342

-356

45

Page

RL,

Law

renc

e JD

. Pha

rmac

othe

rapy

199

9; 1

9(7)

: 870

-876

46

Ellis

GR,

Ste

phen

s M

R. B

MJ 1

999;

319

(721

0): 6

50

47

Mol

tó J,

Val

le M

, Mira

nda

C et

al.

Antim

icrob

Age

nts

Chem

othe

r 201

2; 5

6(10

): 53

28-5

331

48

Mol

tó J,

Val

le M

, Mira

nda

C et

al.

Antim

icrob

Age

nts

Chem

othe

r 201

1; 5

5(1)

: 326

-330

49

Mill

s S,

Bon

e K.

Prin

ciple

s an

d Pr

actic

e of

Phy

toth

erap

y: M

oder

n He

rbal

Med

icine

. Chu

rchi

ll Liv

ings

tone

, Edi

nbur

gh, 2

000.

50

New

all C

A, A

nder

son

LA, P

hilli

pson

JD. H

erba

l Med

icine

s –

A Gu

ide

for H

ealth

-Car

e Pr

ofes

siona

ls.

Phar

mac

eutic

al P

ress

, Lon

don,

199

6.

51

Gors

ki JC

, Hua

ng S

M, P

into

A e

t al.

Clin

Pha

rmac

ol T

her 2

004;

75(

1): 8

9-10

0

52

Mill

s S,

Bon

e K.

The

Ess

entia

l Gui

de to

Her

bal S

afet

y. C

hurc

hill

Livin

gsto

ne, U

SA, 2

005.

53

Rose

KD,

Cro

issan

t PD,

Par

liam

ent C

F et

al.

Neu

rosu

rger

y 19

90; 2

6(5)

: 880

-882

54

Burn

ham

BE.

Pla

st R

econ

str S

urg

1995

; 95(

1): 2

13

55

Germ

an K

, Kum

ar U

, Bla

ckfo

rd H

N. B

r J U

rol 1

995;

76(

4): 5

18

56

Card

en S

M, G

ood

WV,

Card

en P

A et

al.

Clin

Exp

erim

ent O

phth

alm

ol 2

002;

30(

4): 3

03-3

04

57

Man

ohar

an A

, Gem

mel

l R, H

artw

ell T

. Am

J He

mat

ol 2

006;

81(

9): 6

76-6

83

58

Legn

ani C

, Fra

scar

o M

, Gua

zzal

oca

G et

al.

Arzn

eim

For

sch

1993

; 43(

2): 1

19-1

22

59

Kies

ewet

ter H

, Jun

g F,

Jung

EM

et a

l. Eu

r J C

lin P

harm

acol

199

3; 4

5(4)

: 333

-336

60

Kies

ewet

ter H

, Jun

g F,

Jung

EM

et a

l. Cl

in In

vest

ig 1

993;

71(

5): 3

83-3

86

61

Hare

nber

g J,

Gies

e C,

Zim

mer

man

n R.

Ath

eros

clero

sis 1

988;

74(

3): 2

47-2

49

62

Ali M

, Tho

mso

n M

. Pro

stag

land

ins

Leuk

ot E

ssen

t Fat

ty A

cids

1995

; 53(

3): 2

11-2

12

63

Lule

y C,

Leh

man

n-Le

o W

, Mol

ler B

et a

l. Ar

znei

m F

orsc

h 19

86; 3

6(4)

: 766

-768

64

Scha

rber

t G, K

alb

ML,

Dur

is M

et a

l. An

esth

Ana

lg 2

007;

105

(5):

1214

-121

8

65

Jain

RC.

Am

J Cl

in N

utr 1

977;

30(

9): 1

380-

1381

66

Law

son

LD. F

ASEB

J 20

07; 2

1(6)

: A11

26

67

Gadk

ari J

V, Jo

shi V

D. J

Post

grad

Med

199

1; 3

7(3)

: 128

-131

68

Sunt

er W

. Pha

rm J

1991

; 246

: 722

69

Pisc

itelli

SC,

Bur

stei

n AH

, Wel

den

N e

t al.

Clin

Infe

ct D

is 20

02; 3

4(2)

: 234

-238

70

Hajd

a J,

Rent

sch

KM, G

uble

r C e

t al.

Eur J

Pha

rm S

ci 20

10; 4

1(5)

: 729

-735

71

Dunc

an A

, Mill

s J.

AIDS

201

3; 2

7(8)

: 136

1-13

62

72

Krut

h P,

Bros

i E, F

ux R

et a

l. An

n Ph

arm

acot

her 2

004;

38(

2): 2

57-2

60

73

Verm

a SK

, Sin

gh J,

Kha

mes

ra R

et a

l. In

dian

J M

ed R

es 1

993;

98:

240

-242

74

Bord

ia A

, Ver

ma

SK, S

rivas

tava

KC.

Pro

stag

land

ins

Leuk

ot E

ssen

t Fat

ty A

cids

1997

; 56(

5): 3

79-3

84

75

Lum

b AB

. Thr

omb

Haem

ost 1

994;

71(

1): 1

10-1

11

76

Sriv

asta

va K

C. P

rost

agla

ndin

s Le

ukot

Ess

ent F

atty

Acid

s 19

89; 3

5(3)

: 183

-185

77

Lesh

o EP

, Sau

llo L

, Udv

ari-N

agy

S. C

leve

Clin

J M

ed 2

004;

71(

8): 6

51-6

56

78

Jiang

X, W

illia

ms

KM, L

iauw

WS

et a

l. Br

J Cl

in P

harm

acol

200

5; 5

9(4)

: 425

-432

79

Shal

ansk

y S,

Lyn

d L,

Rich

ards

on K

et a

l. Ph

arm

acot

hera

py 2

007;

27(

9): 1

237-

1247

80

Youn

g HY

, Lia

o JC

, Cha

ng Y

S et

al.

Am J

Chin

Med

200

6; 3

4(4)

: 545

-551

81

Gran

ger A

S. A

ge A

gein

g 20

01; 3

0(6)

: 523

-525

82

Greg

ory

PJ. A

nn In

tern

Med

200

1; 1

34(4

): 34

4

83

Kupi

ec T,

Raj

V. J

Ana

l Tox

icol 2

005;

29(

7): 7

55-7

58

84

Bruh

n JG

. Phy

tom

edici

ne 2

003;

10(

4): 3

58

85

Chan

AL,

Leu

ng H

W, W

u JW

et a

l. J A

ltern

Com

plem

ent M

ed 2

011;

17(

6): 5

13-5

17

86

Bent

S, G

oldb

erg

H, P

adul

a A

et a

l. J G

en In

tern

Med

200

5; 2

0(7)

: 657

-661

87

Griff

iths

J, Jo

rdon

S, P

ilon

K. C

anad

ian

Adve

rse

Reac

tion

New

slette

r 200

4; 1

4(1)

: 2-3

88

Pedr

oso

JL, H

enriq

ues

Aqui

no C

C, E

scór

cio B

ezer

ra M

L et

al.

Neu

rolo

gist

201

1; 1

7(2)

: 89-

90

89

Kelle

rman

n AJ

, Klo

ft C.

Pha

rmac

othe

rapy

201

1; 3

1(5)

: 490

-502

90

Vella

s B,

Col

ey N

, Ous

set P

J et a

l. La

ncet

Neu

rol 2

012;

11(

10):

851-

859

91

Schu

bert

SR. C

onsu

ltant

201

3; 5

3(6)

: 420

-426

92

DeLo

ughe

ry T

G, K

aye

JA, M

orris

CD

et a

l. Bl

ood

2002

; 100

(11)

: Abs

tract

#38

09

93

Gard

ner C

D, Z

ehnd

er JL

, Rig

by A

J et a

l. Bl

ood

Coag

ul F

ibrin

olys

is 20

07; 1

8(8)

: 787

-793

94

Wol

f HR.

Dru

gs R

D 2

006,

7(3

): 16

3-17

2

95

Arun

a D,

Nai

du M

U. B

r J C

lin P

harm

acol

200

7; 6

3(3)

: 333

-338

96

Kim

HS,

Kim

GY,

Yeo

CW e

t al.

Br J

Clin

Pha

rmac

ol 2

014;

77(

5): 8

21-8

30

97

Darn

boro

ugh

S. M

enop

ause

Int 2

012;

18(

3): 1

16-1

17

98

Kim

BH,

Kim

KP,

Lim K

S et

al.

Clin

The

r 201

0; 3

2(2)

: 380

-390

99

Lu W

J, Hu

ang

JD, L

ai M

L. J

Clin

Pha

rmac

ol 2

006;

46(

6): 6

28-6

34

100

Hong

JM, S

hin

DH, L

im Y

A et

al.

Thro

mb

Res

2013

; 131

(4):

e147

-e15

3

101

Enge

lsen

J, N

ielse

n JD

, Win

ther

K. T

hrom

b Ha

emos

t 200

2; 8

7(6)

: 107

5-10

76

102

Lai C

F, Ch

ang

CC, F

u CH

et a

l. Ph

arm

acot

hera

py 2

002;

22(

10):

1326

103

Zhan

g XY

, Zho

u DF

, Su

JM e

t al.

J Clin

Psy

chop

harm

acol

200

1; 2

1(1)

: 85-

88

104

Zhan

g XY

, Zho

u DF

, Zha

ng P

Y et

al.

J Clin

Psy

chia

try 2

001;

62(

11):

878-

883

105

Atm

aca

M, T

ezca

n E,

Kul

oglu

M e

t al.

Psyc

hiat

ry C

lin N

euro

sci 2

005;

59(

6): 6

52-6

56

106

Doru

k A,

Uzu

n O,

Ozs

ahin

A. I

nt C

lin P

sych

opha

rmac

ol 2

008;

23(

4): 2

23-2

37

107

Blon

k M

, Col

bers

A, P

oirte

rs A

et a

l. An

timicr

ob A

gent

s Ch

emot

her 2

012;

56(

10):

5070

-507

5

108

Wie

gman

DJ,

Brin

kman

K, F

rans

sen

EJ. A

IDS

2009

; 23(

9): 1

184-

1185

109

Mar

kow

itz JS

, Don

ovan

JL, L

inds

ay D

eVan

e C

et a

l. J C

lin P

sych

opha

rmac

ol 2

003;

23(

6): 5

76-5

81

110

Zuo

XC, Z

hang

BK,

Jia

SJ e

t al.

Eur J

Clin

Pha

rmac

ol 2

010;

66(

5): 5

03-5

09

111

Uchi

da S

, Yam

ada

H, L

i XD

et a

l. J C

lin P

harm

acol

200

6; 4

6(11

): 12

90-1

298

112

Robe

rtson

SM

, Dav

ey R

T, Vo

ell J

et a

l. Cu

rr M

ed R

es O

pin

2008

; 24(

2): 5

91-5

99

113

Zado

yan

G, R

okitt

a D,

Kle

men

t S e

t al.

Eur J

Clin

Pha

rmac

ol 2

012;

68(

5): 5

53-5

60

114

Kudo

lo G

B, W

ang

W, J

avor

s M

et a

l. Cl

in N

utr 2

006;

25(

4): 6

06-6

16

115

Pers

onal

com

mun

icatio

n fro

m tr

ial a

utho

r Kud

olo

GB, 2

9 Fe

brua

ry 2

008.

116

Wan

g W

, Jav

ors

M, B

lodg

ett J

et a

l. Di

abet

es 2

007;

56(

Supp

l 1):

A560

117

Smith

M, L

in K

M, Z

heng

MD.

Clin

Pha

rmac

ol T

her 2

001;

69(

2): P

86, A

bstra

ct #

PIII-

89

118

Yosh

ioka

M, O

hnish

i N, K

oish

i T e

t al.

Biol

Pha

rm B

ull 2

004;

27(

12):

2006

-200

9

119

Yin

OQ, T

omlin

son

B, W

aye

MM

et a

l. Ph

arm

acog

enet

ics 2

004;

14(

12):

841-

850

120

Guo

CX, P

ei Q

, Yin

JY e

t al.

Xeno

biot

ica 2

012;

42(

8): 7

84-7

90

121

Dai L

L, F

an L

, Wu

HZ e

t al.

Xeno

biot

ica 2

013;

43(

10):

862-

867

122

Fan

L, M

ao X

Q, Ta

o GY

et a

l. Xe

nobi

otica

200

9; 3

9(3)

: 249

-254

123

Gurle

y BJ

, Sw

ain

A, H

ubba

rd M

A et

al.

Clin

Pha

rmac

ol T

her 2

008;

83(

1): 6

1-69

124

Gold

en E

B, L

am P

Y, Ka

rdos

h A

et a

l. Bl

ood

2009

; 113

(23)

: 592

7-59

37

125

Bann

erm

an B

, Xu

L, Jo

nes

M e

t al.

Canc

er C

hem

othe

r Pha

rmac

ol 2

011;

68(

5): 1

145-

1154

126

Alem

daro

glu

NC,

Die

tz U

, Wol

ffram

S e

t al.

Biop

harm

Dru

g Di

spos

200

8; 2

9(6)

: 335

-348

not l

ikel

y to

con

tain

mor

e th

an 2

.5 m

g/g

of d

eoxy

schi

sand

rin.43

0,43

1 A

max

imum

dos

e of

S. c

hine

nsis

extra

ct e

quiv

alen

t to

4 g/

day,

wou

ld

prov

ide

10 m

g/da

y of

deo

xysc

hisa

ndrin

.

JJ El

euth

eros

ides

(fro

m S

iber

ian

gins

eng)

and

gin

seno

sides

(fro

m K

orea

n gi

nsen

g) h

ave

som

e st

ruct

ural

sim

ilarit

y w

ith d

igox

in. B

ecau

se o

f thi

s sim

ilarit

y in

terfe

renc

e w

ith s

erum

dig

oxin

mea

sure

men

ts is

pos

sible

, as

confi

rmed

whe

n m

ice fe

d th

ese

herb

s de

mon

stra

ted

digo

xin

activ

ity in

th

eir s

erum

. Mor

e sp

ecifi

c as

says

are

abl

e to

neg

ate

the

inte

rfere

nce.

432

KK.

As n

oted

for s

ever

al d

rugs

, the

hyp

erfo

rin c

onte

nt o

f the

St J

ohn’

s w

ort

prep

arat

ion,

as

wel

l as

the

dosa

ge o

f her

b, a

ffect

s th

e ex

tent

of t

he

inte

ract

ion.

All

type

s of

pre

para

tions

can

con

tain

hyp

erfo

rin, i

nclu

ding

dry

ex

tract

s us

ed in

tabl

ets

and

caps

ules

. Hyp

erfo

rin is

how

ever

, uns

tabl

e –

parti

cula

rly w

hen

in s

olut

ion.

433 T

inct

ures

and

liqu

id e

xtra

cts

mad

e us

ing

a st

anda

rd e

than

ol c

onte

nt (

45%

) co

ntai

n ne

glig

ible

am

ount

s of

hyp

erfo

rin.

Liqui

d ex

tract

s us

ing

a hi

gher

eth

anol

con

tent

(su

ch a

s 60

%)

will

con

tain

a

high

er in

itial

am

ount

of h

yper

forin

than

sta

ndar

d liq

uid

extra

cts.

Over

tim

e th

e hy

perfo

rin c

onte

nt is

sub

stan

tially

redu

ced

and

afte

r a fe

w m

onth

s tin

ctur

es a

nd li

quid

ext

ract

s co

ntai

n no

hyp

erfo

rin.43

4

LL.

Gene

tic p

olym

orph

isms

are

impo

rtant

in d

eter

min

ing

diffe

renc

es in

the

resp

onse

to d

rugs

, and

may

influ

ence

inte

ract

ions

. The

re a

re m

any

gene

tic

varia

nts

of th

e CY

P ge

nes,

incl

udin

g th

e CY

P2C1

9 ge

ne. P

heno

type

s of

CY

P2C1

9 ha

ve b

een

clas

sified

func

tiona

lly a

s ex

tens

ive

met

abol

izers

and

po

or m

etab

olize

rs, t

he la

tter h

avin

g a

defic

ienc

y of

CYP

2C19

act

ivity

.238,

435

MM

. Tw

o of

the

10 p

atie

nts

with

the

high

est h

yper

forin

leve

ls pr

ior t

o dr

ug

adm

inist

ratio

n sh

owed

the

grea

test

dec

reas

e in

the

AUC ∞

of d

ocet

axel

, for

th

e ot

her p

atie

nts,

no a

ppar

ent c

orre

latio

n be

twee

n hy

perfo

rin le

vels

and

the

doce

taxe

l AUC

∞ w

as o

bser

ved.

NN

. Of

the

14 v

olun

teer

s, in

thre

e, a

sm

all i

ncre

ase

in A

UC w

as o

bser

ved

afte

r ad

min

istra

tion

of S

t Joh

n’s

wor

t.

PP.

Seve

ral v

aria

nts

of C

YP2C

9 ha

ve b

een

iden

tified

in h

uman

s: th

e m

ost

impo

rtant

mut

atio

ns a

re C

YP2C

9*2

and

CYP2

C9*3

. The

CYP

2C9*

3 va

riant

sh

ows

decr

ease

d m

etab

olic

act

ivity

for m

any

drug

s m

etab

olise

d by

CY

P2C9

. CYP

2C9

is th

e m

ain

enzy

me

resp

onsib

le fo

r tra

nsfo

rmin

g lo

sarta

n to

its

activ

e m

etab

olite

.

QQ.

Sorg

hum

also

con

tain

s ph

ytat

e. B

oth

phyt

ate

and

poly

phen

ol in

hibi

t nu

trien

ts s

uch

as ir

on.43

6,43

7

HD

I Cha

rt

127

Visc

hini

G, N

iscol

a P,

Stef

oni A

et a

l. Am

J Ki

dney

Dis

2011

; 58(

2): 3

29

128

Hega

zy S

K. B

r J P

harm

Res

201

4; 4

(3):

289-

300

129

Wer

ba JP

, Giro

li M

, Cav

alca

V e

t al.

Ann

Inte

rn M

ed 2

008;

149

(4):

286-

287

130

Ge J,

Tan

BX, C

hen

Y et

al.

J Mol

Med

201

1; 8

9(6)

: 595

-602

131

Tayl

or JR

, Wilt

VM

. Ann

Pha

rmac

othe

r 199

9; 3

3(4)

: 426

-428

132

Wol

kers

torfe

r H. M

MW

196

6; 1

08(8

): 43

8-44

1

133

Jaur

sch

U, L

ande

rs E

, Sch

mid

t R e

t al.

Med

Wel

t 196

9; 2

7: 1

547-

1552

134

Tank

anow

R, T

amer

HR,

Stre

etm

an D

S et

al.

J Clin

Pha

rmac

ol 2

003;

43(

6): 6

37-6

42

135

Iwam

oto

M, I

shiza

ki T,

Sat

o T.

Plan

ta M

ed 1

981;

42(

1): 1

-16

136

Schm

idt U

, Kuh

n U,

Plo

ch M

et a

l. Ph

ytom

edici

ne 1

994;

1(1

): 17

-24

137

Zick

SM, V

auta

w B

M, G

illes

pie

B et

al.

Eur J

Hea

rt Fa

il 20

09; 1

1(10

): 99

0-99

9

138

Dalli

E, C

olom

er E

, Tor

mos

MC

et a

l. Ph

ytom

edici

ne 2

011;

18(

8-9)

: 769

-775

139

Wal

ker A

F, M

arak

is G,

Sim

pson

E. B

r J G

en P

ract

200

6; 5

6(52

7): 4

37-4

43

140

Shan

mug

asun

dara

m E

R, R

ajes

war

i G, B

aska

ran

K et

al.

J Eth

noph

arm

acol

199

0; 3

0(3)

: 281

-294

141

Bask

aran

K, K

izar A

ham

ath

B, R

adha

Sha

nmug

asun

dara

m K

et a

l. J E

thno

phar

mac

ol 1

990;

30(

3):

295-

300

142

Shar

ma

RD, R

aghu

ram

TC,

Rao

NS.

Eur

J Cl

in N

utr 1

990;

44(

4): 3

01-3

06

143

Shar

ma

RD, R

aghu

ram

TC.

Nut

r Res

199

0; 1

0(7)

: 731

-739

144

Shar

ma

RD, S

arka

r A, H

azra

DK

et a

l. N

utr R

es 1

996;

16(

8): 1

331-

1339

145

Mad

ar Z

, Abe

l R, S

amish

S e

t al.

Eur J

Clin

Nut

r 198

8; 4

2(1)

: 51-

54

146

Ragh

uram

TC,

Sha

rma

RD, S

ivak

umar

B e

t al.

Phyt

othe

r Res

199

4; 8

: 83-

86

147

Kass

aian

N, A

zadb

akht

L, F

orgh

ani B

et a

l. In

t J V

itam

Nut

r Res

200

9; 7

9(1)

: 34-

39

148

Hass

anza

deh

Bash

tian

M, E

mam

i SA,

Mou

savi

far N

et a

l. Ira

n J P

harm

Res

201

3; 1

2(2)

: 475

-481

149

Ziai S

A, L

arija

ni B

, Akh

oond

zade

h S

et a

l. J E

thno

phar

mac

ol 2

005;

102

(2):

202-

207

150

Sarto

re G

, Rei

tano

R, B

ariso

n A

et a

l. Eu

r J C

lin N

utr 2

009;

63(

10):

1269

-127

1

151

Ande

rson

JW, A

llgoo

d LD

, Tur

ner J

et a

l. Am

J Cl

in N

utr 1

999;

70(

4): 4

66-4

73

152

Rodr

igue

z-M

oran

M, G

uerre

ro-R

omer

o F,

Lazc

ano-

Burc

iaga

G. J

Dia

bete

s Co

mpl

icatio

ns 1

998;

12(

5):

273-

278

153

Flor

holm

en J,

Arv

idss

on-L

enne

r R, J

orde

R e

t al.

Acta

Med

Sca

nd 1

982;

212

(4):

237-

239

154

Scot

t AR,

Atte

nbor

ough

Y, P

eaco

ck I

et a

l. BM

J 198

8; 2

97(6

650)

: 707

-710

155

Sobe

nin

IA, N

edos

ugov

a LV

, Fila

tova

LV e

t al.

Acta

Dia

beto

l 200

8; 4

5(1)

: 1-6

156

Alm

eida

JC, G

rimsle

y EW

. Ann

Inte

rn M

ed 1

996;

125

(11)

: 940

-941

157

Cartl

edge

A, R

uthe

rford

J. R

apid

resp

onse

(ele

ctro

nic

lette

r), B

MJ 1

2 Fe

b 20

01. A

vaila

ble

from

bm

j.co

m/c

gi/e

lette

rs/3

22/7

279/

139#

1264

3, d

ownl

oade

d 21

/2/0

2.

158

Herb

erg

KW, W

inte

r U. 2

nd In

tern

atio

nal C

ongr

ess

on P

hyto

med

icine

, Mun

ich, S

epte

mbe

r 11-

14,

1996

, Abs

tract

P-7

7.

159

Herb

erg

KW. B

luta

lkoh

ol 1

993;

30(

2): 9

6-10

5

160

Sche

losk

y L,

Raf

fauf

C, J

endr

oska

K e

t al.

J Neu

rol N

euro

surg

Psy

chia

try 1

995;

58(

5): 6

39-6

40

161

Mes

egue

r E, T

aboa

da R

, San

chez

V e

t al.

Mov

Diso

rd 2

002;

17(

1): 1

95-1

96

162

Nol

dner

M, C

hatte

rjee

SS. P

hyto

med

icine

199

9; 6

(4):

285-

286

163

Boer

ner R

J, Kl

emen

t S. W

ien

Med

Woc

hens

chr 2

004;

154

(21-

22):

508-

510

164

Yam

amot

o M

, Tam

ura

Y, Ku

ashi

ma

K et

al.

Cite

d in

: Han

KH,

Cho

e SC

, Kim

HS

et a

l. Am

J Ch

in M

ed

1998

; 26(

2): 1

99-2

09

165

Caro

n M

F, Ho

tsko

AL,

Rob

erts

on S

et a

l. An

n Ph

arm

acot

her 2

002;

36(

5): 7

58-7

63

166

Cher

drun

gsi P

, Run

groe

ng K

. Cite

d in

: Bue

ttner

C, Y

eh G

Y, Ph

illip

s RS

et a

l. An

n Ph

arm

acot

her 2

006;

40

(1):

83-9

5

167

Park

BJ,

Lee

YJ, L

ee H

R et

al.

Kore

an J

Fam

Med

201

2; 3

3(4)

: 190

-196

168

Vuks

an V

, Sun

g M

K, S

ieve

npip

er JL

et a

l. N

utr M

etab

Car

diov

asc

Dis

2008

; 18(

1): 4

6-56

169

Kim

NR,

Kim

JH, K

im C

Y. J G

inse

ng R

es 2

010;

34(

3): 2

37-2

45

170

Han

KH, C

hoe

SC, K

im H

S et

al.

Am J

Chin

Med

199

8; 2

6(2)

: 199

-209

171

Chun

g IM

, Lim

JW, P

yun

WB

et a

l. J G

inse

ng R

es 2

010;

34(

3): 2

12-2

18

172

Rhee

MY,

Kim

YS,

Bae

JH e

t al.

J Alte

rn C

ompl

emen

t Med

201

1; 1

7(1)

: 45-

49

173

Lee

JH, P

ark

HJ. J

Gin

seng

Res

199

8; 2

2(3)

: 173

-180

174

Lee

JH, K

im S

H. K

orea

n J N

utr 1

995;

28(

9): 8

62-8

71

175

Shin

KS,

Lee

JJ, K

im Y

I et a

l. J G

inse

ng R

es 2

007;

31(

2): 1

09-1

16

176

Jane

tzky

K, M

orre

ale

AP. A

m J

Heal

th S

yst P

harm

199

7; 5

4(6)

: 692

-693

177

Jiang

X, W

illia

ms

KM, L

iauw

WS

et a

l. Br

J Cl

in P

harm

acol

200

4; 5

7(5)

: 592

-599

178

Lee

SH, A

hn Y

M, A

hn S

Y et

al.

J Alte

rn C

ompl

emen

t Med

200

8; 1

4(6)

: 715

-721

179

Lee

YH, L

ee B

K, C

hoi Y

J et a

l. In

t J C

ardi

ol 2

010;

145

(2):

275-

276

180

Shao

J, Ji

a L.

Tre

nds

Phar

mac

ol S

ci 20

13; 3

4(2)

: 85-

86

181

Bilg

i N, B

ell K

, Ana

ntha

krish

nan

AN e

t al.

Ann

Phar

mac

othe

r 201

0; 4

4(5)

: 926

-928

182

Mat

eo-C

arra

sco

H, G

álve

z-Co

ntre

ras

MC,

Fer

nánd

ez-G

inés

FD

et a

l. Dr

ug M

etab

ol D

rug

Inte

ract

20

12; 2

7(3)

: 171

-175

183

Sota

niem

i EA,

Haa

pako

ski E

, Rau

tio A

. Dia

bete

s Ca

re 1

995;

18(

10):

1373

-137

5

184

Reed

s DN

, Pat

ters

on B

W, O

kuna

de A

et a

l. Di

abet

es C

are

2011

; 34(

5): 1

071-

1076

185

Okud

a H,

Yos

hida

R. P

roce

edin

gs o

f the

Thi

rd In

tern

atio

nal G

inse

ng S

ympo

sium

. Seo

ul, K

orea

. Kor

ea

Gins

eng

Rese

arch

Inst

itute

, Sep

tem

ber 8

-10,

198

0, p

p 53

-57.

186

Ma

SW, B

enzie

IF, C

hu T

T et

al.

Diab

etes

Obe

s M

etab

200

8; 1

0(11

): 11

25-1

127

187

Tets

utan

i T, Y

amam

ura

M, Y

amag

uchi

T e

t al.

Gins

eng

Rev

2000

; 28:

44-

47

188

Jone

s BD

, Run

ikis

AM. J

Clin

Psy

chop

harm

acol

198

7; 7

(3):

201-

202

189

Shad

er R

I, Gr

eenb

latt

DJ. J

Clin

Psy

chop

harm

acol

198

8; 8

(4):

235

190

Shad

er R

I, Gr

eenb

latt

DJ. J

Clin

Psy

chop

harm

acol

198

5; 5

(2):

65

191

Mal

ati C

Y, Ro

berts

on S

M, H

unt J

D et

al.

J Clin

Pha

rmac

ol 2

012;

52(

6): 9

32-9

39

192

Gilli

s CN

. Bio

chem

Pha

rmac

ol 1

997;

54(

1): 1

-8

193

Kim

HJ,

Woo

DS,

Lee

G e

t al.

Br J

Urol

199

8; 8

2(5)

: 744

-748

194

ESCO

P M

onog

raph

s: Th

e Sc

ient

ific

Foun

datio

n fo

r Her

bal M

edici

nal P

rodu

cts,

2nd

Edn.

ESC

OP,

Euro

pean

Scie

ntifi

c Co

oper

ativ

e on

Phy

toth

erap

y, Ex

eter

, 200

3.

195

Stor

mer

FC,

Rei

stad

R, A

lexa

nder

J. F

ood

Chem

Tox

icol 1

993;

31(

4): 3

03-3

12

196

Chen

g CJ

, Che

n YH

, Cha

u T

et a

l. Su

ppor

t Car

e Ca

ncer

200

4; 1

2(11

): 81

0-81

2

197

Sigu

rjons

dotti

r HA,

Fra

nzso

n L,

Man

hem

K e

t al.

J Hum

Hyp

erte

ns 2

001;

15(

8): 5

49-5

52

198

Sigu

rjons

dotti

r HA,

Man

hem

K, A

xelso

n M

et a

l. J H

um H

yper

tens

200

3; 1

7(2)

: 125

-131

199

Sigu

rjons

dotti

r HA,

Rag

nars

son

J, Fr

anzs

on L

et a

l. J H

um H

yper

tens

199

5; 9

(5):

345-

348

200

Sobi

eszc

zyk

P, Bo

rlaug

BA,

Gor

nik

HL e

t al.

Clin

Sci

2010

; 119

(10)

: 437

-442

201

Ferra

ri P,

Sans

onne

ns A

, Dick

B e

t al.

Hype

rtens

ion

2001

; 38(

6): 1

330-

1336

202

van

Geld

eren

CE,

Bijl

sma

JA, v

an D

okku

m W

et a

l. Hu

m E

xp T

oxico

l 200

0; 1

9(8)

: 434

-439

203

Brou

wer

s AJ

, van

der

Meu

len

J. N

ed T

ijdsc

hr G

enee

skd

2001

; 145

(15)

: 744

-747

204

Yosh

ino

T, Ya

naga

wa

T, W

atan

abe

K. J

Alte

rn C

ompl

emen

t Med

201

4; 2

0(6)

: 516

-520

205

Iida

R, O

tsuk

a Y,

Mat

sum

oto

K et

al.

Clin

Exp

Nep

hrol

200

6; 1

0(2)

: 131

-135

206

Mae

da Y

, Ina

ba N

, Aoy

agi M

et a

l. In

tern

Med

200

8; 4

7(14

): 13

45-1

348

207

Stew

art P

M, B

urra

P, S

hack

leto

n CH

et a

l. J C

lin E

ndoc

rinol

Met

ab 1

993;

76(

3): 7

48-7

51

208

Kage

yam

a Y,

Suzu

ki H

, Sar

uta

T. J E

ndoc

rinol

199

2; 1

35(1

): 14

7-15

2

209

Mac

Kenz

ie M

A, H

oefn

agel

s W

H, Ja

nsen

RW

et a

l. J C

lin E

ndoc

rinol

Met

ab 1

990;

70(

6): 1

637-

1643

210

Stew

art P

M, W

alla

ce A

M, V

alen

tino

R et

al.

Lanc

et 1

987;

330

(856

3): 8

21-8

24

211

Epst

ein

MT,

Espi

ner E

A, D

onal

d RA

et a

l. J C

lin E

ndoc

rinol

Met

ab 1

978;

47(

2): 3

97-4

00

212

Mat

tare

llo M

J, Be

nedi

ni S

, Fio

re C

et a

l. St

eroi

ds 2

006;

71(

5): 4

03-4

08

213

Bigl

ieri

EG. S

tero

ids

1995

; 60(

1): 5

2-58

214

Fors

lund

T, F

yhrq

uist

F, F

røse

th B

et a

l. J I

nter

n M

ed 1

989;

225

(2):

95-9

9

215

Stew

art P

M, W

alla

ce A

M, A

ther

den

SM e

t al.

Clin

Sci

1990

; 78(

1): 4

9-54

216

van

Uum

SH,

Wal

ker B

R, H

erm

us A

R et

al.

Clin

Sci

2002

; 102

(2):

203-

211

217

Arm

anin

i D, N

acam

ulli

D, F

ranc

ini-P

esen

ti F

et a

l. St

eroi

ds 2

005;

70(

8): 5

38-5

42

218

Kasu

ya Y

, Yok

okaw

a A,

Taka

shim

a S

et a

l. St

eroi

ds 2

005;

70(

2): 1

17-1

25

219

Kasu

ya Y

, Yok

okaw

a A,

Ham

ura

K et

al.

Ster

oids

200

5; 7

0(12

): 81

1-81

6

220

Teel

ucks

ingh

S, M

acki

e AD

, Bur

t D e

t al.

Lanc

et 1

990;

335

(869

7): 1

060-

1063

221

Chen

MF,

Shim

ada

F, Ka

to H

et a

l. En

docr

inol

Jpn

1991

; 38(

2): 1

67-1

74

222

Cont

i M, F

rey

FJ, E

sche

r G e

t al.

Nep

hrol

Dia

l Tra

nspl

ant 1

994;

9(1

1): 1

622-

1628

223

Shin

tani

S, M

uras

e H,

Tsu

kago

shi H

et a

l. Eu

r Neu

rol 1

992;

32(

1): 4

4-51

224

Bern

ardi

M, d

-Intim

o PE

, Tre

visa

ni F

et a

l. Lif

e Sc

i 199

4; 5

5(11

): 86

3-87

2

225

Hara

da T,

Oht

aki E

, Misu

K e

t al.

Card

iolo

gy 2

002;

98(

4): 2

18

226

Arm

anin

i D, C

aste

llo R

, Sca

roni

C e

t al.

Eur J

Obs

tet G

ynec

ol R

epro

d Bi

ol 2

007;

131

(1):

61-6

7

227

Kuris

u S,

Inou

e I,

Kaw

agoe

T e

t al.

J Am

Ger

iatr

Soc

2008

; 56(

8): 1

579-

1581

228

Heid

eman

n HT

, Kre

uzfe

lder

E. K

lin W

oche

nsch

r 198

3; 6

1(6)

: 303

-305

229

Chat

away

SJ,

Mum

ford

CJ,

Irons

ide

JW. P

ostg

rad

Med

J 19

97; 7

3(86

3): 5

93-5

94

230

Folk

erse

n L,

Knu

dsen

NA,

Teg

lbja

erg

PS. U

gesk

r Lae

ger 1

996;

158

(51)

: 742

0-74

21

231

Fam

ular

o G,

Cor

si FM

, Gia

cane

lli M

. Aca

d Em

erg

Med

199

9; 6

(9):

960-

964

232

Nie

lsen

I, Pe

ders

en R

S. L

ance

t 198

4; 3

23(8

389)

: 130

5

233

Conn

JW, R

ovne

r DR,

Coh

en E

L. JA

MA

1968

; 205

(7):

492-

496

234

Sont

ia B

, Moo

ney

J, Ga

udet

L e

t al.

J Clin

Hyp

erte

ns 2

008;

10(

2): 1

53-1

57

235

Hukk

anen

J, U

kkol

a O,

Sav

olai

nen

MJ.

Bloo

d Pr

ess

2009

; 18(

4): 1

92-1

95

236

Jiao

Z, S

hi X

J, Li

ZD e

t al.

Br J

Clin

Pha

rmac

ol 2

009;

68(

1): 4

7-60

237

Tu JH

, He

YJ, C

hen

Y et

al.

Eur J

Clin

Pha

rmac

ol 2

010;

66(

8): 8

05-8

10

238

Tu JH

, Hu

DL, D

ai L

L et

al.

Xeno

biot

ica 2

010;

40(

6): 3

93-3

99

239

Liapi

na L

A, K

oval

’chu

k GA

. Izv

Aka

d N

auk

Ser B

iol 1

993;

(4):

625-

628

240

Code

rre K

, Far

ia C

, Dye

r E. P

harm

acot

hera

py 2

010;

30(

1): 5

0e-5

2e

241

Kass

ebau

m P

J, Sh

aw D

L, T

omich

DJ.

Ann

Phar

mac

othe

r 200

5; 3

9(2)

: 365

-367

242

Now

ack

R, N

owak

B. N

ephr

ol D

ial T

rans

plan

t 200

5; 2

0(11

): 25

54-2

556

243

Hurre

ll RF

, Red

dy M

, Coo

k JD

. Br J

Nut

r 199

9; 8

1(4)

: 289

-295

244

Flem

ing

DJ, J

acqu

es P

F, Da

llal G

E et

al.

Am J

Clin

Nut

r 199

8; 6

7(4)

: 722

-733

245

Li J,

Wan

g R,

Xia

o C.

J M

ed F

ood

2014

; 17(

4): 4

72-4

78

246

Sam

man

S, S

ands

trom

B, T

oft M

B et

al.

Am J

Clin

Nut

r 200

1; 7

3(3)

: 607

-612

247

Tunt

ipop

ipat

S, J

udpr

ason

g K,

Zed

er C

et a

l. J N

utr 2

006;

136

(12)

: 297

0-29

74

248

Oliv

ares

M, P

izarro

F, H

ertra

mpf

E e

t al.

Nut

ritio

n 20

07; 2

3(4)

: 296

-300

249

Kubo

ta K

, Sak

urai

T, N

akaz

ato

K et

al.

Nip

pon

Rone

n Ig

akka

i Zas

shi 1

990;

27(

5): 5

55-5

58

250

Mita

mur

a T,

Kita

zono

M, Y

oshi

mur

a O

et a

l. N

ippo

n Sa

nka

Fujin

ka G

akka

ai Z

assh

i 198

9; 4

1(6)

: 68

8-69

4

251

Prys

tai E

A, K

ies

CV, D

riske

ll JA

. Nut

r Res

199

9; 1

9(2)

: 167

-177

252

Schl

esie

r K, K

uhn

B, K

iehn

topf

M e

t al.

Food

Res

Int 2

012;

46(

2): 5

22-5

27

253

Men

nen

L, H

irvon

en T,

Arn

ault

N e

t al.

Eur J

Clin

Nut

r 200

7; 6

1(10

): 11

74-1

179

254

Imai

K, N

akac

hi K

. BM

J 199

5; 3

10(6

981)

: 693

-696

255

Ullm

ann

U, H

alle

r J, B

akke

r GC

et a

l. Ph

ytom

edici

ne 2

005;

12(

6-7)

: 410

-415

256

Hutc

hins

on C

, Bom

ford

A, G

eiss

ler C

A. E

ur J

Clin

Nut

r 201

0; 6

4(10

): 12

39-1

241

257

Etm

an M

A. D

rug

Dev

Indu

st P

harm

199

5; 2

1(16

): 19

01-1

906

258

Ettin

ger A

B, S

hinn

ar S

, Sin

nett

MJ e

t al.

J Epi

leps

y 19

92; 5

(3):

191-

193

259

Brow

n DD

, Juh

l RP,

War

ner S

L. A

m J

Card

iol 1

977;

39(

2): 2

97

260

Nor

dstro

m M

, Mel

ande

r A, R

ober

tsso

n E

et a

l. Dr

ug N

utr I

nter

act 1

987;

5(2

): 67

-69

261

Wal

an A

, Ber

gdah

l B, S

koog

M-L

. Sca

nd J

Gast

roen

tero

l 197

7; 1

2(Su

pp 4

5): 1

11

262

Reiss

ell P

, Man

nine

n V.

Acta

Med

Sca

nd S

uppl

198

2; 6

68: 8

8-90

263

Ross

ande

r L. S

cand

J Ga

stro

ente

rol S

uppl

198

7; 1

29: 6

8-72

264

Sier

ra M

, Gar

cía JJ

, Fer

nánd

ez N

et a

l. Eu

r J C

lin N

utr 2

002;

56(

9): 8

30-8

42

265

Denn

ison

BA, L

evin

e DM

. J P

edia

tr 19

93; 1

23(1

): 24

-29

266

Burto

n R,

Man

nine

n V.

Acta

Med

Sca

nd S

uppl

198

2; 6

68: 9

1-94

267

Kaw

atra

A, B

hat C

M, A

rora

A. E

ur J

Clin

Nut

r 199

3; 4

7(4)

: 297

-300

268

Enzi

G, In

elm

en E

M, C

repa

ldi G

. Pha

rmat

hera

peut

ica 1

980;

2(7

): 42

1-42

8

269

Perlm

an B

B. L

ance

t 199

0; 3

35(8

686)

: 416

270

Tout

oung

i M, S

chul

z P,

Wid

mer

J et

al.

Ther

apie

199

0; 4

5(4)

: 358

-360

271

Robi

nson

DS,

Ben

jam

in D

M, M

cCor

mac

k JJ.

Clin

Pha

rmac

ol T

her 1

971;

12(

3): 4

91-4

95

272

Ahi S

, Esm

aeilz

adeh

M, K

ayva

npou

r E e

t al.

Acta

Med

Iran

201

1; 4

9(10

): 68

8-68

9

273

Cava

liere

H, F

loria

no I,

Med

eiro

s-N

eto

G. In

t J O

bes

Rela

t Met

ab D

isord

200

1; 2

5(7)

: 109

5-10

99

274

Liel Y

, Har

man

-Boe

hm I,

Sha

ny S

. J C

lin E

ndoc

rinol

Met

ab 1

996;

81(

2): 8

57-8

59

275

Chiu

AC,

She

rman

SI.

Thyr

oid

1998

; 8(8

): 66

7-67

1

276

Chee

ma

P, El

-Mef

ty O

, Jaz

ieh

AR. J

Inte

rn M

ed 2

001;

250

(2):

167-

169

277

Geav

lete

P, M

ulte

scu

R, G

eavl

ete

B. T

her A

dv U

rol 2

011;

3(4

): 19

3-19

8

278

Yue

QY, J

anss

on K

. J A

m G

eria

tr So

c 20

01; 3

10(4

): 83

8

279

Villa

nuev

a S,

Gon

zále

z J.

Bol A

soc

Med

PR

2009

; 101

(3):

48-5

0

280

Li R,

Guo

W, F

u Z

et a

l. Ca

n J P

hysio

l Pha

rmac

ol 2

012;

90(

7): 9

41-9

45

281

Xin

HW, W

u XC

, Li Q

et a

l. Br

J Cl

in P

harm

acol

200

7; 6

4(4)

: 469

-475

282

Jiang

W, W

ang

X, X

u X

et a

l. In

t J C

lin P

harm

acol

The

r 201

0; 4

8(3)

: 224

-229

283

Jiang

W, W

ang

X, K

ong

L. Im

mun

opha

rmac

ol Im

mun

otox

icol 2

010;

32(

1): 1

77-1

78

284

Xin

HW, W

u XC

, Li Q

et a

l. Br

J Cl

in P

harm

acol

200

9; 6

7(5)

: 541

-546

285

Ko K

M, I

p SP

, Poo

n M

K et

al.

Plan

ta M

ed 1

995;

61(

2): 1

34-1

37

286

Lu H

, Liu

GT.

Zhon

gguo

Yao

Li X

ue B

ao 1

990;

11(

4): 3

31-3

35

287

McR

ae S

. Can

Med

Ass

oc J

1996

; 155

(3):

293-

295

288

Cice

ro A

F, De

rosa

G, B

rilla

nte

R et

al.

Arch

Ger

onto

l Ger

iatr

Supp

l 200

4; (9

): 69

-73

289

John

e A,

Sch

mid

er J,

Bro

ckm

olle

r J e

t al.

J Clin

Psy

chop

harm

acol

200

2; 2

2(1)

: 46-

54

290

Aust

ralia

n Th

erap

eutic

Goo

ds A

dmin

istra

tion.

Med

ia R

elea

se, M

arch

200

0.

291

Brec

kenr

idge

A. M

essa

ge fr

om C

omm

ittee

on

Safe

ty o

f Med

icine

s, 29

Feb

ruar

y 20

00. M

edici

nes

Cont

rol A

genc

y, Lo

ndon

.

292

Henn

ey JE

. JAM

A 20

00; 2

83(1

3): 1

679

293

Burs

tein

AH,

Hor

ton

RL, D

unn

T et

al.

Clin

Pha

rmac

ol T

her 2

000;

68(

6): 6

05-6

12

294

Drug

Saf

ety

Upda

te V

olum

e 1,

Issu

e 4,

Nov

embe

r 200

7, p

7. A

vaila

ble

from

ww

w.m

hra.

gov.u

k/Pu

blica

tions

/Saf

etyg

uida

nce/

Drug

Safe

tyUp

date

/ind

ex.h

tm. A

cces

sed

18 A

pril

2008

.

295

Wan

g LS

, Zhu

B, A

bd E

l-Aty

AM

et a

l. J C

lin P

harm

acol

200

4; 4

4(6)

: 577

-581

296

Wan

g Z,

Ham

man

MA,

Hua

ng S

M e

t al.

Clin

Pha

rmac

ol T

her 2

002;

71(

6): 4

14-4

20

297

Dres

ser G

K, S

chw

arz

UI, W

ilkin

son

GR e

t al.

Clin

Pha

rmac

ol T

her 2

003;

73(

1): 4

1-50

298

Lau

WC,

Gur

bel P

A, C

arvi

lle D

G et

al.

J Am

Col

l Car

diol

200

7; 4

9(9,

Sup

pl 1

): 34

3A-3

44A

299

Lau

WC,

Wel

ch T

D, S

hiel

ds T

A et

al.

J Am

Col

l Car

diol

201

0; 5

5(10

, Sup

pl 1

): A1

71.E

1600

300

Lau

WC,

Wel

ch T

D, S

hiel

ds T

et a

l. J C

ardi

ovas

c Ph

arm

acol

201

1; 5

7(1)

: 86-

93

301

Tran

a C,

Tot

h G,

Wijn

s W

et a

l. J C

ardi

ovas

c Tr

ansl

Res

2013

; 6(3

): 41

1-41

4

302

Fitz

gera

ld D

J, M

aree

A. H

emat

olog

y Am

Soc

Hem

atol

Edu

c Pr

ogra

m 2

007;

200

7: 1

14-1

20

303

Mau

rer A

, Joh

ne A

, Bau

er S

et a

l. Eu

r J C

lin P

harm

acol

199

9; 5

5(3)

: A22

304

Yue

QY, B

ergq

uist

C, G

erde

n B.

Lan

cet 2

000;

355

(920

3): 5

76-5

77



305

Barn

es J,

And

erso

n LA

, Phi

llips

on JD

. J P

harm

Pha

rmac

ol 2

001;

53(

5): 5

83-6

00

306

Uygu

r Bay

ram

ıçlı O

, Kal

kay

MN

, Osk

ay B

ozka

ya E

et a

l. Tu

rk J

Gast

roen

tero

l 201

1; 2

2(1)

: 115

307

Mue

ller S

C, M

ajch

er-P

eszy

nska

J, U

ehle

ke B

et a

l. Eu

r J C

lin P

harm

acol

200

6; 6

2(1)

: 29-

36

308

Arol

d G,

Don

ath

F, M

aure

r A e

t al.

Plan

ta M

ed 2

005;

71(

4): 3

31-3

37

309

Mar

kow

itz JS

, Don

ovan

JL, D

eVan

e CL

et a

l. JA

MA

2003

; 290

(11)

: 150

0-15

04

310

Wan

g Z,

Gor

ski J

C, H

amm

an M

A et

al.

Clin

Pha

rmac

ol T

her 2

001;

70(

4): 3

17-3

26

311

Mue

ller S

C, M

ajch

er-P

eszy

nska

J, M

undk

owsk

i RG

et a

l. Eu

r J C

lin P

harm

acol

200

9; 6

5(1)

: 81-

87

312

Kaw

aguc

hi A

, Ohm

ori M

, Tsu

ruok

a S

et a

l. Br

J Cl

in P

harm

acol

200

4; 5

8(4)

: 403

-410

313

Wan

g XD

, Li J

L, L

u Y

et a

l. J C

hrom

atog

r B A

naly

t Tec

hnol

Bio

med

Life

Sci

2007

; 852

(1-2

): 53

4-54

4

314

Tann

ergr

en C

, Eng

man

H, K

nuts

on L

et a

l. Cl

in P

harm

acol

The

r 200

4; 7

5(4)

: 298

-309

315

Mat

hijss

en R

H, V

erw

eij J

, de

Brui

jn P

et a

l. J N

atl C

ance

r Ins

t 200

2; 9

4(16

): 12

47-1

249

316

Man

sky

PJ, S

traus

SE.

J N

atl C

ance

r Ins

t 200

2; 9

4(16

): 11

87-1

188

317

Smith

PF,

Bullo

ck JM

, Boo

ker B

M e

t al.

Bloo

d 20

04; 1

04(4

): 12

29-1

230

318

Frye

RF,

Fitz

gera

ld S

M, L

agat

tuta

TF

et a

l. Cl

in P

harm

acol

The

r 200

4; 7

6(4)

: 323

-329

319

Van

Stra

ter A

C, B

oger

s JP.

Int C

lin P

sych

opha

rmac

ol 2

012;

27(

2): 1

21-1

24

320

John

e A,

Bro

ckm

olle

r J, B

auer

S e

t al.

Clin

Pha

rmac

ol T

her 1

999;

66(

4): 3

38-3

45

321

Durr

D, S

tiege

r B, K

ulla

k-Ub

lick

GA e

t al.

Clin

Pha

rmac

ol T

her 2

000;

68(

6): 5

98-6

04

322

Mue

ller S

C, U

ehle

ke B

, Woe

hlin

g H

et a

l. Cl

in P

harm

acol

The

r 200

4; 7

5(6)

: 546

-557

323

Goey

AK,

Mei

jerm

an I,

Ros

ing

H et

al.

Clin

Pha

rmac

okin

et 2

014;

53(

1): 1

03-1

10

324

Lund

ahl A

, Hed

elan

d M

, Bon

dess

on U

et a

l. Eu

r J P

harm

Sci

2009

; 36(

4-5)

: 433

-443

325

Anon

. Rea

ctio

ns W

eekl

y 20

11; 1

336:

22

326

de M

aat M

MR,

Hoe

telm

ans

RMW

, Mat

hot R

AA e

t al.

AIDS

200

1; 1

5(3)

: 420

-421

327

Pisc

itelli

SC,

Bur

stei

n AH

, Cha

itt D

et a

l. La

ncet

200

0; 3

55(9

203)

: 547

-548

328

Xu H

, Will

iam

s KM

, Lia

uw W

S et

al.

Br J

Phar

mac

ol 2

008;

153

(7):

1579

-158

6

329

Fan

L, Z

hou

G, G

uo D

et a

l. Cl

in P

harm

acok

inet

201

1; 5

0(9)

: 605

-611

330

Bon

S, H

artm

ann

K, K

uhn

M. S

chw

eiz

Apot

h 19

99; 1

6: 5

35-5

36

331

Ahm

ed S

M, B

anne

r NR,

Dub

rey

SW. J

Hea

rt Lu

ng T

rans

plan

t 200

1; 2

0(7)

: 795

332

Rusc

hitz

ka F,

Mei

er P

J, Tu

rina

M e

t al.

Lanc

et 2

000;

355

(920

3): 5

48-5

49

333

Mai

I, K

ruge

r H, B

udde

K e

t al.

Int J

Clin

Pha

rmac

ol T

her 2

000;

38(

10):

500-

502

334

Karli

ova

M, T

reich

el U

, Mal

ago

M e

t al.

J Hep

atol

200

0; 3

3(5)

: 853

-855

335

Rey

JM, W

alte

r G. M

ed J

Aust

199

8; 1

69(1

1-12

): 58

3-58

6

336

Baro

ne G

W, G

urle

y BJ

, Ket

el B

L et

al.

Tran

spla

ntat

ion

2001

; 71(

2): 2

39-2

41

337

Baro

ne G

W, G

urle

y BJ

, Ket

el B

L et

al.

Ann

Phar

mac

othe

r 200

0; 3

4(9)

: 101

3-10

16

338

Mos

chel

la C

, Jab

er B

L. A

m J

Kidn

ey D

is 20

01; 3

8(5)

: 110

5-11

07

339

Beer

AM

, Ost

erm

ann

T. M

ed K

lin 2

001;

96(

8): 4

80-4

83

340

Brei

denb

ach

T, Kl

iem

V, B

urg

M e

t al.

Tran

spla

ntat

ion

2000

; 69(

10):

2229

-223

0

341

Mai

I, B

auer

S, P

erlo

ff ES

et a

l. Cl

in P

harm

acol

The

r 200

4; 7

6(4)

: 330

-340

342

Bolle

y R,

Zul

ke C

, Kam

mer

l M e

t al.

Tran

spla

ntat

ion

2002

; 73(

6): 1

009

343

Mai

I, S

torm

er E

, Bau

er S

et a

l. N

ephr

ol D

ial T

rans

plan

t 200

3; 1

8(4)

: 819

-822

344

Hebe

rt M

F, Pa

rk JM

, Che

n YL

et a

l. J C

lin P

harm

acol

200

4; 4

4(1)

: 89-

94

345

Porto

les

A, T

erle

ira A

, Cal

vo A

et a

l. J C

lin P

harm

acol

200

6; 4

6(10

): 11

88-1

194

346

Pelto

niem

i MA,

Saa

ri TI,

Hag

elbe

rg N

M e

t al.

Fund

am C

lin P

harm

acol

201

2; 2

6(6)

: 743

-750

347

Eich

-Hoc

hli D

, Opp

liger

R, G

olay

KP

et a

l. Ph

arm

acop

sych

iatry

200

3; 3

6(1)

: 35-

37

348

Nie

derh

ofer

H. M

ed H

ypot

hese

s 20

07; 6

8(5)

: 118

9

349

Gale

otti

N, F

arza

d M

, Bia

nchi

E e

t al.

J Pha

rmac

ol S

ci 20

14; 1

24(4

): 40

9-41

7

350

Wan

g LS

, Zho

u G,

Zhu

B e

t al.

Clin

Pha

rmac

ol T

her 2

004;

75(

3): 1

91-1

97

351

Info

rmat

ion

from

the

MPA

(Med

ical P

rodu

cts

Agen

cy, S

wed

en) a

nd th

e M

CA (M

edici

nes

Cont

rol

Agen

cy, U

K), 2

000-

2002

.

352

Schw

arz

UI, B

usch

el B

, Kirc

h W

. Br J

Clin

Pha

rmac

ol 2

003;

55(

1): 1

12-1

13

353

Drug

Saf

ety

Upda

te M

arch

201

4 Vo

lum

e 7,

Issu

e 8:

A2.

Ava

ilabl

e fro

m h

ttp:/

/ww

w.m

hra.

gov.u

k/Sa

fety

info

rmat

ion/

Drug

Safe

tyUp

date

/CON

3928

69. A

cces

sed

June

201

4.

354

Mur

phy

PA, K

ern

SE, S

tanc

zyk

FZ e

t al.

Cont

race

ptio

n 20

05; 7

1(6)

: 402

-408

355

Hall

SD, W

ang

Z, H

uang

SM

et a

l. Cl

in P

harm

acol

The

r 200

3; 7

4(6)

: 525

-535

356

Pfru

nder

A, S

chie

sser

M, G

erbe

r S e

t al.

Br J

Clin

Pha

rmac

ol 2

003;

56(

6): 6

83-6

90

357

Will

-Sha

hab

L, B

auer

S, K

unte

r U e

t al.

Eur J

Clin

Pha

rmac

ol 2

009;

65(

3): 2

87-2

94

358

Mur

phy

P, Be

llow

s B,

Ker

n S.

Con

trace

ptio

n 20

10; 8

2(2)

: 191

359

Fogl

e RH

, Mur

phy

PA, W

esth

off C

L et

al.

Cont

race

ptio

n 20

06; 7

4(3)

: 245

-248

360

Nie

min

en T

H, H

agel

berg

NM

, Saa

ri TI

et a

l. Eu

r J P

ain

2010

; 14(

8): 8

54-8

59

361

Gord

on JB

. Am

Fam

Phy

s 19

98; 5

7(5)

: 950

, 953

362

Derm

ott K

. Clin

ical P

sych

iatry

New

s 19

98; 2

6(3)

: 28

363

Barb

enel

DM

, Yus

uf B

, O’S

hea

D et

al.

J Psy

chop

harm

acol

200

0; 1

4(1)

: 84-

86

364

Lant

z M

S, B

ucha

lter E

, Gia

mba

nco

V. J G

eria

tr Ps

ychi

atry

Neu

rol 1

999;

12(

1): 7

-10

365

Pros

t N, T

ichad

ou L

, Rod

or F

et a

l. Pr

esse

Med

200

0; 2

9(23

): 12

85-1

286

366

Wak

sman

JC, H

eard

K, J

ollif

f H e

t al.

Clin

Tox

icol 2

000;

38(

5): 5

21

367

Andr

en L

, And

reas

son

A, E

gger

tsen

R. E

ur J

Clin

Pha

rmac

ol 2

007;

63(

10):

913-

916

368

Sugi

mot

o K,

Ohm

ori M

, Tsu

ruok

a S

et a

l. Cl

in P

harm

acol

The

r 200

1; 7

0(6)

: 518

-524

369

Gord

on R

Y, Be

cker

DJ,

Rade

r DJ.

Am J

Med

200

9; 1

22(2

): e1

-e2

370

Egge

rtsen

R, A

ndre

asso

n A,

And

ren

L. S

cand

J Pr

im H

ealth

Car

e 20

07; 2

5(3)

: 154

-159

371

Schw

arz

UI, H

anso

H, O

erte

l R e

t al.

Clin

Pha

rmac

ol T

her 2

007;

81(

5): 6

69-6

78

372

Neb

el A

, Sch

neid

er B

J, Ba

ker R

K et

al.

Ann

Phar

mac

othe

r 199

9; 3

3(4)

: 502

373

Mor

imot

o T,

Kote

gaw

a T,

Tsut

sum

i K e

t al.

J Clin

Pha

rmac

ol 2

004;

44(

1): 9

5-10

1

374

Reng

elsh

ause

n J,

Banf

ield

M, R

iede

l KD

et a

l. Cl

in P

harm

acol

The

r 200

5; 7

8(1)

: 25-

33

375

Hojo

Y, E

chize

nya

M, O

hkub

o T

et a

l. J C

lin P

harm

The

r 201

1; 3

6(6)

: 711

-715

376

Velu

ssi M

, Cer

nigo

i AM

, de

Mon

te A

et a

l. J H

epat

ol 1

997;

26(

4): 8

71-8

79

377

Jose

MA,

Abr

aham

A, N

arm

adha

MP.

J Pha

rmac

ol P

harm

acot

her 2

011;

2(4

): 28

7-28

9

378

Huss

ain

SA. J

Med

Foo

d 20

07; 1

0(3)

: 543

-547

379

Huse

ini H

F, La

rijan

i B, H

eshm

at R

et a

l. Ph

ytot

her R

es 2

006;

20(

12):

1036

-103

9

380

Tahe

r MA,

Atia

YA,

Am

in M

K. Ir

aqi J

Pha

rm S

ci 20

10; 1

9(2)

: 11-

18

381

Hash

emi S

J, Ha

jiani

E, S

arda

bi E

H. H

ep M

on 2

009;

9(4

): 26

5-27

0

382

Deng

YQ,

Fan

XF,

Li JP.

Chi

n J I

nteg

r Med

200

5; 1

1(2)

: 117

-122

383

Han

Y, Gu

o D,

Che

n Y

et a

l. Eu

r J C

lin P

harm

acol

200

9; 6

5(6)

: 585

-591

384

Rajn

aray

ana

K, R

eddy

MS,

Vid

yasa

gar J

et a

l. Ar

znei

m F

orsc

h 20

04; 5

4(2)

: 109

-113

385

Fuhr

U, B

eckm

ann-

Knop

p S,

Jette

r A e

t al.

Plan

ta M

ed 2

007;

73(

14):

1429

-143

5

386

Repa

lle S

S, Y

amsa

ni S

K, G

annu

R e

t al.

Acta

Pha

rm S

ci 20

09; 5

1(1)

: 15-

20

387

Han

Y, Gu

o D,

Che

n Y

et a

l. Xe

nobi

otica

200

9; 3

9(9)

: 694

-699

388

Ross

ande

r L, H

allb

erg

L, B

jorn

-Ras

mus

sen

E. A

m J

Clin

Nut

r 197

9; 3

2(12

): 24

84-2

489

389

Disle

r PB,

Lyn

ch S

R, C

harlt

on R

W e

t al.

Gut 1

975;

16(

3): 1

93-2

00

390

Brun

e M

, Ros

sand

er L

, Hal

lber

g L.

Eur

J Cl

in N

utr 1

989;

43(

8): 5

47-5

57

391

Derm

an D

, Say

ers

M, L

ynch

SR

et a

l. Br

J N

utr 1

977;

38(

2): 2

61-2

69

392

Hallb

erg

L, R

ossa

nder

L. H

um N

utr A

ppl N

utr 1

982;

36(

2): 1

16-1

23

393

Chun

g KT

, Won

g TY

, Wei

CI e

t al.

Crit

Rev

Food

Sci

Nut

r 199

8; 3

8(6)

: 421

-464

394

Mor

ck T

A, L

ynch

SR,

Coo

k JD

. Am

J Cl

in N

utr 1

983;

37(

3): 4

16-4

20

395

Layr

isse

M, G

arcía

-Cas

al M

N, S

olan

o L

et a

l. J N

utr 2

000;

130

(9):

2195

-215

9. E

rratu

m in

: J N

utr

2000

; 130

(12)

: 310

6

396

Than

kach

an P,

Wal

czyk

T, M

utha

yya

S et

al.

Am J

Clin

Nut

r 200

8; 8

7(4)

: 881

-886

397

Nel

son

M, P

oulte

r J. J

Hum

Nut

r Die

t 200

4; 1

7(1)

: 43-

54

398

Gabr

ielli

GB,

De

Sand

re G

. Hae

mat

olog

ica 1

995;

80(

6): 5

18-5

20

399

Mah

lkne

cht U

, Wei

dman

n E,

Sei

pelt

G. H

aem

atol

ogica

200

1; 8

6(5)

: 559

400

Kaltw

asse

r JP,

Wer

ner E

, Sch

alk

K et

al.

Gut 1

998;

43(

5): 6

99-7

04

401

Ganj

i V, K

ies

CV. P

lant

Foo

ds H

um N

utr 1

994;

46(

3): 2

67-2

76

402

Juan

H, T

erha

ag B

, Con

g Z

et a

l. Eu

r J C

lin P

harm

acol

200

7; 6

3(7)

: 663

-668

403

USP

Drug

Info

rmat

ion,

US

Phar

mac

opei

a Pa

tient

Lea

flet,

Vale

rian

(Ora

l). R

ockv

ille:

The

Uni

ted

Stat

es

Phar

mac

opei

al C

onve

ntio

n, 1

998.

404

Herb

erg

KW. T

hera

piew

oche

199

4; 4

4(12

): 70

4-71

3

405

Carra

sco

MC,

Val

lejo

JR, P

ardo

-de-

Sant

ayan

a M

et a

l. Ph

ytot

her R

es 2

009;

23(

12):

1795

-179

6

406

Dono

van

JL, D

eVan

e CL

, Cha

vin

KD e

t al.

Drug

Met

ab D

ispos

200

4; 3

2(12

): 13

33-1

336

407

Kriv

oy N

, Pav

lotz

ky E

, Chr

ubas

ik S

et a

l. Pl

anta

Med

200

1; 6

7(3)

: 209

-212

408

Pers

onal

com

mun

icatio

n fro

m tr

ial a

utho

r Yu

KS, 2

Feb

ruar

y 20

10.

409

Mak

ino

T, Hi

shid

a A,

God

a Y

et a

l. N

at M

ed 2

008;

62(

3): 2

94-2

99

410

Prod

uct i

nfor

mat

ion

for C

ranb

erry

Cla

ssic

juice

drin

k. A

vaila

ble

from

ww

w.o

cean

spra

y.com

.au.

Ac

cess

ed N

ovem

ber 2

009.

411

War

shaf

sky

S, K

amer

RS,

Siv

ak S

L. A

nn In

tern

Med

199

3; 1

19(7

Pt 1

): 59

9-60

5

412

Law

son

LD, W

ang

ZJ, P

apad

imitr

iou

D. P

lant

a M

ed 2

001;

67(

1): 1

3-18

413

De S

met

PA,

Flo

or-S

chre

uder

ing

A, B

ouvy

ML

et a

l. Cu

rr Dr

ug M

etab

200

8; 9

(10)

: 105

5-10

62

414

Leist

ner E

, Dre

wke

C. J

Nat

Pro

d 20

10; 7

3(1)

: 86-

92

415

Kajiy

ama

Y, Fu

jii K

, Tak

euch

i H e

t al.

Pedi

atric

s 20

02; 1

09(2

): 32

5-32

7

416

Hase

gaw

a S,

Oda

Y, I

chiy

ama

T et

al.

Pedi

atr N

euro

l 200

6; 3

5(4)

: 275

-276

417

Aren

z A,

Kle

in M

, Fie

he K

et a

l. Pl

anta

Med

199

6; 6

2(6)

: 548

-551

418

Kuen

ick C

. Dts

ch A

poth

Ztg

201

0; 1

50(5

): 60

-61

419

Gaus

W, W

este

ndor

f J, D

iebo

w R

. et a

l. M

etho

ds In

f Med

200

5; 4

4(5)

: 697

-703

420

DeKo

sky

ST, W

illia

mso

n JD

, Fitz

patri

ck A

L et

al.

JAM

A 20

08; 3

00(1

9): 2

253-

2262

421

Kim

TE,

Kim

BH,

Kim

J et

al.

Clin

The

r 200

9; 3

1(10

): 22

49-2

257

422

Shah

JJ, K

uhn

DJ, O

rlow

ski R

Z. B

lood

200

9; 1

13(2

3): 5

695-

5696

423

Henn

ing

SM, N

iu Y

, Liu

Y e

t al.

J Nut

r Bio

chem

200

5; 1

6(10

): 61

0-61

6

424

Kage

yam

a Y,

Suzu

ki H

, Sar

uta

T. En

docr

inol

Jpn

1991

; 38(

1): 1

03-1

08

425

Hasla

m E

, Lill

ey T

H. C

rit R

ev F

ood

Sci N

utr 1

988;

27(

1): 1

-40

426

Price

ML,

But

ler L

G. J

Agric

Foo

d Ch

em 1

977;

25(

6): 1

268-

1273

427

Ewer

th S

, Ahl

berg

J, H

olm

stro

m B

et a

l. Ac

ta C

hir S

cand

Sup

pl 1

980;

500

: 49-

50

428

Mor

eyra

AE,

Wils

on A

C, K

oray

m A

. Arc

h In

tern

Med

200

5; 1

65(1

0): 1

161-

1166

429

Agra

wal

AR,

Tand

on M

, Sha

rma

PL. I

nt J

Clin

Pra

ct 2

007;

61(

11):

1812

-181

8

430

Halst

ead

CW, L

ee S

, Kho

o CS

et a

l. J P

harm

Bio

med

Ana

l 200

7; 4

5(1)

: 30-

37

431

Zhu

M, C

hen

XS, W

ang

KX. C

hrom

atog

raph

ia 2

007;

66(

1-2)

: 125

-128

432

Dasg

upta

A, W

u S,

Act

or J

et a

l. Am

J Cl

in P

atho

l 200

3; 1

19(2

): 29

8-30

3

433

Ang

CYW

, Hu

L, H

einz

e TM

et a

l. J A

gric

Food

Che

m 2

004;

52(

20):

6156

-616

4

434

Med

iHer

b Re

sear

ch L

abor

ator

ies,

2004

.

435

Tom

linso

n B,

Hu

M, L

ee V

W. M

ol N

utr F

ood

Res

2008

; 52(

7): 7

99-8

09

436

Lync

h SR

. Nut

r Rev

199

7; 5

5(4)

: 102

-110

437

Gillo

oly

M, B

othw

ell T

H, C

harlt

on R

W e

t al.

Br J

Nut

r 198

4; 5

1(1)

: 37-

46

HD

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rt


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