1. Complimentary and Alternative Medicine Useless Weeds?

2. Critical Considerations  Quality of products Look for Standardize herbal products Buy single-herb products Select products that have been tested Choose brands that adhere to GMP’s *USP Verification Mark

3. Are you a Candidate?  Generally,Herbal products should not be recommended for the following: Those with chronic conditions Pregnant and lactating women Individuals taking other medications People having surgery within two weeks Children

4. St. John’s Wort  Mild to moderate depression  Dosage: 300mg TID (standardized to 3% hypericin)  Adverse rxns: photosensitivity, itching, headache, bloating  Interactions: MAOI’s, SSRI’s and other Antidepressant drugs, Indinavir, Digoxin, Theophylline,Cyclosporin

5. Echinacea  Stimulation of immune system  Dosage: various  Adverse rxns : cross-sensitivity in patients allergic to flowers (pollen) in the daisy family or sunflower seeds  Interactions : should not be administered with immunosuppressants

6. Ginkgo Biloba  Vascular insufficiency resulting in short term memory loss, vertigo, headache, tinnitus, and erectile dysfunction  Dosage: Memory or circulation; 120 mg/day in 2-3 divided doses  Adverse Rxns : breast tenderness in women, muscle spasms, cramps, bleeding, mild digestive problems  I nteractions : Aspirin, Ticlid, Plavix, Dypyridamole, and Coumadin-may augment the anticoagulant effect

7. Ginseng  Increase energy and reduces stress  Dosage : 100 – 300 mg/day  Adverse reactions: may raise BP and estrogen levels  Interactions : warfarin, Nardil, and digoxin

8. Ginger  Prevent nausea related to motion sickness, seasickness, and anesthesia  Dosage : Dried ginger 2-4 grams daily  Adverse rxns: GI discomfort with high doses ( > 6 grams) if taken on empty stomach  Interactions : Aspirin, Ticlid, Dypyridamole, and Coumadin-may augment the anticoagulant effect inhibits platelet aggregation – monitor bleeding times

9. Garlic  Lower serum cholesterol  Dosage :10 mg of alliin or a total of allicin potential of 4,000 mcg/day, or 1 clove (4 grams) of fresh garlic/day  Adverse rxns : Generally nontoxic but may cause GI irritation; odor may pervade breath and skin  Interactions : May potentiate antihypertensives; high doses may alter blood sugar levels and blood clotting

10. Saw Palmetto  Symptoms of BPH (benign prostatic hyperplasia) relieves difficult urine flow and emptying a irritable bladder  Dosage: 160 mg bid of standardized fat-soluble saw palmetto extract containing 85-95% fatty acids and sterols  Adverse Rxns : uncommon but includes headache, mild abdominal pain, nausea, dizziness  Interactions : None reported

11. Black Cohosh  Dysmenorrhea and Menopausal Symptoms  Dosage: 40mg daily up to six months  Adverse rxns : Hypotension,and stomach upset these are rare  Interactions : may potentiate antihypertensives; may interfere with hormonal medications

12. Milk Thistle  Loss of appetite, and liver and Gallbladder disorders  Dosage: 200 mg-400mg daily standardized to provide at least 70% silymarin  Adverse Rxns : Possible loose stools as result of increased bile flow typically none with proper use  Interactions: possibly, medications metabolized in the CYP3A4 pathway

13. Cayenne  Pain disorders such as shingles, muscle spasms, neuropathy, and joint pain  Dosage: 0.025% - 0.075% capsaicin preparation qid  Adverse rxns : local burning avoid additional heat application with topical use  Interactions : ACE inhibitors and theopylline

14. Kava  Anxiety,and insomnia  Dosage: Anxiolytic: 45-70 mg kavalactons tid; Sedative: 180-210 mg/day kavalactons 1 hour before bedtime  Adverse Rxns : GI discomfort  Interactions : avoid alcohol, muscle relaxants, sedatives, antianxiety agents, antidepressants, antipsycotics- may have an additive effect

15. Valerian  Sedative to treat insomnia, nervousness and anxiety  Dosage :150 – 300 mg of valerian extract 30 – 45 minutes before bedtime for sleep; 150 mg qid for anxiety  Adverse Rxns : morning drowsiness; with long- term use headache, uneasiness,and cardiac disturbances these are rare  Interactions : Additive effect with other CNS depressants

16. Feverfew  Prophylactic for migraine headache  Dosage :125 mg dry powdered leaf (parthenolide) capsules  Adverse rxns : edginess, Stomach upset, and skin rashes from herbal contact  Interactions : Aspirin, Ticlid, Dypyridamole, and Coumadin-may augment the anticoagulant effect

17. Peppermint  Headache  Dosage :Tea 1-2 teaspoonfuls dried leaves in 1 cup water; or Enteric-coated capsules: 1 – 2 tid for IBS  Adverse Rxns : Skin rash, heartburn, or muscle tremor contact dermatitis  Interactions : None known

18. Soy  Prevention:Menopausal symptoms, cancer, coronary heart disease,and osteoporosis  Source :Whole foods providing the equivalent of 50-120 mg of isoflavones/day  Adverse Rxns : None consistently reported  Interactions : May interfere with absorption of supplemental thyroid hormones, therefore stagger doses at least 2 hours apart

19. Ephedra  Weight loss  Dosage: typically,1 bid  Adverse Rxns: increases BP, which can lead to stroke, heart disease, and seizures  Interactions: caffeine, decongestants, and other stimulants