2 What is Hyperlipidemia What is Hyperlipidemia ? Hyperlipidemia is an excess of fatty substances called lipids, largely cholesterol and triglycerides, in the blood.
3 Cholesterol is required to build and maintain cell membranes It is the major precursor for the synthesis of vitamin D and of the various steroid hormonesCholesterol is primarily synthesized from acetyl CoA through the HMG-CoA reductase pathway in many cells and tissues.
4 Alfalfa Family :fabaceae/leguminosae Species: medicago sativa Part used: herbHerbal use :treatment arthritis ,high cholesterol ,diabetes and peptic ulcerIt has bactericidal ,cardiotonic ,diuretic &emeticIt is source of vitamins A,C,E,K &mineral ca ,k,phosphorus and iron
5 Constituent Acids: lauric acid, malic acid, malonic acid … Alkaloids: pyrrolidine type ,pyridine type in the seeds onlyAmino acids :arginine ,asparagines, cystine ….the non protein toxic Amino acids canavanine is present in leaves ,stem and seedsCoumarins: medicagolIsoflavonoid:coumestrol,biochaninA,daidzein….Saponins: 2-3%hydrolsis yield aglycone ,medicagenic acid ,soyasapogenolsA-F and hedragenin .sugar chain component include arabinose galactose …SteroidsOther consisteunts:Carbohydrates ,vitamin ,pectin methylestrase pigments, protein and trace element
6 Pharmacological action Saponins is decrease plasma cholesterol concentration without change in (HDL)decrease intestinal absorption of cholesterol and increase excretion of neutral steroids and bile acids .stimulate lipolytic activity of a mixture of porcine pancreatic enzymes including lipase ,amylase and proteasesClinical studyreduced plasma cholesterol concentration by less than 5% in (LDL)
7 Side effect /toxicity : It induce asystemic lupus erthematosus like syndrome because there is canavanine which is toxic due to it is structure analogue of arginine and may interfere with the binding of this amino acid to enzymes and its incorporation into proteinContra indication &warningshould be avoided it with (SLE) .Not take with oral contraceptive &hormonal replacement therapy because the potential oestrogenic &anticoagulant activityPregnancy and lactation:The safety not established .
8 Preparation& dosage: Tablet ,capsule and teas Dried herbs Liquidextract
9 Artichoke Family asteraceae /compositae Species cynara scolymus L Part used leavesHerbal use :treatment hyperlipidemia , hyperlipoprotinaemia condition require an increase in choleresis and non-ulcer dyspepsiaIt has choleretic,hypocholesterlamic,hypolipidaemic ,diuretic and hepatostimulating properties
10 Pharmacological action Inhibition of cholesterol biosynthesis by 65% .The hypolipidemic effect well document for globe aritichoke leaf extract and the Constituent: cynarinLuteolin the most important constituent for this effect by indirect inhibition of hydroxymethylglutrayl-COA reductase(HMG-COA)Clinical study :It is reported cynarin tobe effective in lowering serum concentration of cholesterol and triglyceride when taken daily dose ranging from 60mg to 1500mg
11 Side effect /toxicity : 1- No series adverse effect were reported2- Non- specific gastrointestinal complaints: dyspepsia& constipation gastric irritation3- Allergic contact dermatitisContra indication &warningglobe aritichoke yields cynaropicirin potentially allergenicPregnancy and lactation:The safety not established .
13 Fenugreek Family: Leguminosae Species: Trigonella foenum –graecum Part used : seedHerbal use :It possess as mucilaginous demulcent,laxative,nutritive ,expectorant .Traditionally ,use for treatment of anorexia ,dyspepsia ,gastritistopically for myalgia,lymphadenitis ,gout wounds and leg ulcers .
14 Constituent Alkaloids: pyridine type. Protein :23%-25% Flavonoids: flavone glycosides including orintin and vitexin,quercetin(flavonol)Saponins: %.glycosides yeilding steroidal sapogenins diosgenin and yamogenin (major)Other constituent:coumarin,lipid,mucilaginous,fibre,vitamins and minerals
15 Pharmacological action Hypocholesterolaemic activity due to fibre and saponin fractionIt has Hypocholesterolaemic activity and lowering triglyceride concentration but without change (LDL)& (HDL)Clinical study :A significant reduction in serum cholesterol concentration in diabetic patients was also noted
16 Side effect /toxicity : No reportedContra indication &warning:It has hypoglycemic activity so it is interfere hypoglycemic therapyCation is advisable in patients receiving monoamine oxidase inhibitor ,hormonal or anticoagulant therapiesPregnancy and lactation:It is reputed to be uterine stimulant activity .
17 Preparation& dosageSeed 1-6g or equivalent three times daily
18 Garlic Family :Amaryllidaceae /liliaceae Species :Allium sativum L . Part :used bulbHerbal use :expectorant ,antispasmodic, antiseptic ,bacteriostatic ,antiviral,hypotensive and anthelmintic propertiesTraditionally :it used to treat chronic bronchitis ,recurrent colds ,bronchitic asthma and influenza .Modern use :antihypertensive ,antiartherogenic ,antithrombotic,antimicrobial ,cancer preventive and lipid lowering effects .
19 Constituent Enzyme :allinase ,peroxidases,myrosinase and others Volatile oils: % .sulfur containing compound including alliin , compound produced enzymetically from alliin including allicin,S-allylmercaptocysteine and S-methylmercaptocysteine ;terpenesOther constituents :Protein ,amino acids ,minerals, vitamins, trace element ,lipid and prostaglandins
20 Pharmacological action Sulfur-containing constituent inhibit cholesterol biosynthesis including :Inhibition (HMG-COA)reductaseReduction in triacylglycerol biosynthesisIncrease in hydrolysis of triacylglycerols via increased lipase activity and inctivation of enzymes ivolved in lipid synthesisinhibit triglyceride biosynthesis in part by decreasing de novo fatty acid synthesis via inhibition of fatty acid synthase.garlic significantly reduced total serum cholesterol concentration by about 9%
21 Side effect :Non toxicBurning sensation in the mouth and gastrointestinal tractGarlic breath &body odourThe allergenic potential due to allergen as:diallyl disulfide ,allylpropyl sulifide and allicinContra indication &warning:Interfere with hypoglycemic and anticoagulant therapiesIt potentiate the antithrombotic effects of anti-inflammatory drugs such as aspirinGastrointestinal irritation may occurPregnancy and lactation:There is no experimental or clinical reports
22 Preparation& dosage Dried bulb Tincture Oil Juice of garlic Syrup of garlicGarlic powder tablets
23 Milk Thistle Species: silybum marianum Synonym: carduus marianus Part used: fruits, herb.Legal category: milk thistle is not included in the GSL.Constituents:Fruit: flavolignans,flavonoids,lipids,sterols.Leaves: flavonoids
24 Food use: it is not used in foods. Herbal use:✭Milk thistle fruits have been used for disorder of liver,spleen and gall bladder.✭Also used for nursing mothers for stimulating milk production,as abitter tonic for haemorrhoids.✭The leaves have also been used for the treatment of liver, spleen and gall bladder disorders and as an antimalarial and for uterine complaints.
25 Pharmacological actions: As well as inhibition of lipid peroxidation, stimulation of protein biosynthesis and acceleration of liver regeneration.Mechanism of Action?*Found a dose dependent decrease in HMG-CoA reductase in the liver with increasing silymarin concentration .*A decrease in HMG-CoA reductase leads to a decrease in synthesis of cholesterol.
26 Sid-effects, toxicity: Sever sweating, abdominal cramping, nausea,vomiting, diarrhoea,anaphylactic shock in a 54-year-old man with immediate type allergy to kiwi fruit.Contra-indications, warning s:✭It is conta-indication for individuals with hypersensitivity to species of asteraceae.✭Pregnancy and lactation should be avoided.
28 Hawthorn Species: crataegus laevigata (rosaceae) Synonym: whitethorn Part used: fruitLegal category: it is not included in the GSL.Constituents:Amine,flavonoids(flavonol,flavones), tannins.Food used:It is not common used in food.Herbal use:✭It is stated to possess cardiotoinc,coronary vasodilator and hypotensiveproperties,hypertension
29 Pharmacological action: An inhibition of lipid peroxidation which can be caused by highly reactive free radicals was also documented.Mechanism of Action:The mechanism of action of hawthorn remains unknown.
30 Side-effect,toxicity: Nausea,fatigue,sweating,rash on the hand.Contra-indications,warnings:✭Cardiovascular disorder such as hypertention, hypotention and cardiac disorders. ✭pregnancy and lactation should be avoided.
32 ✰GingerSpecies: Z. officinaleSynonym: zoingiberPart used: rhizomeLegal category: GSLConstituents:Carbohydarates starch, lipids, oleo-resin gingerol homologues, volatile oils.Food used:It is the natural source of food flavouring,and used widely in foods as a spice.
33 Herbal use:✭Ginger is stated to possess carminative, diaphoretic and antispasmodic properties.✭Also used for colic, flatulent dyspepsia and used to prevention of nausea and vomiting.Pharmacological actions:✭Anti-atheroscleroticGinger (dried ginger)oleo-resin by intragastric administration has been reported to inhibit elevation in serum and hepatic cholesterol concentration in rats by impairing cholesterol absorption and those with existing hypercholesterolamai.✭Fresh ginger not effect on serum cholesterol.
34 Side-effect,toxicity: Non toxicContr0indication,warnings:✭Effect to blood pressure✭Pregnancy and lactation should be avoided.Pharmaceutical prepration:Oleo-resin cream
35 Ispaghula Family: Plantaginaceae Species: Plantago ovata Forsk.Family: PlantaginaceaeSynonym: Blond psyllium Indian plantago,Ispagol, Pale psyllium,SpogelPart used: seed, husk
36 Herbal use:Ispaghula is started to posses demulcent and laxative properties.Traditional use:in the treatment of the:chronic constipation.dysentery diarrhea.cystitis.The German commission A approved use for chronic constipation and disorder in which bowel movement with loose stool are desirable.
37 Active constituent:1- Alkaloids Monoterpene-type. Plantagonin and indicainin.2- Mucilages 10-30% mucopolysaccharide consisiting mainly of ahighly branched arabinoxylan with a xylan backbone and branches of arabinose, xylose and 2-O-galacturonic-rhamnose moites.3- Other constituents:Aucubinsugars (fructose, glucose, sucrose).protein.steroils .triterpenes .fatty acid .tnnins.
38 Pharmacological action In clinical studies:Hypocholesterolaemic effects:26 men with mild to moderate hypercholesterolemia(serum cholesterol concentration: mmol/L) receivedisphagula 3.4 g for eight weeks , and the end of study ,serum cholesterol concentration were reduced by 14.8 % andLDL cholesterol by 20.2% and ratio of LDL to HDLcholesterol by 14.8 %.Laxative effect.Antidiarrhoeal effect.Hypoglycemic effect.
39 Mechanism of actin:IN CHOLESTEROL CONTROL : The content has cellulose fiber, which is responsible for decreasing the absorption of cholesterol into the blood stream.
40 Dosage: Seeds/ 5-10g (3g in children ) three times daily, seed should be soaked in worm water for several hr before taking. Liquid extract/ 2-4 ml (1:1 in 25% alcohol) three times daily. . Ispaghula Husk 225 Capsules Ispaghula Husk (300g
41 Side effects, toxicity: Increase flatulence and abdominal distention, and may be cause intestinal obstructionIf swllowed dry ,may cause oesphageal obstruction.Contra-indictions, warnings:Not given to patints with intestinal obstruction.Should be taken fluid to avoid oesphageal obstruction.
42 Interaction with other medicinal products and other form of interaction: Absorption of minerals ( calcium, iron, lithium, zinc), vitamins (B12), cardiac glycoside and coumarine derivatives may be delayed .for this reason the product should not be taken hr before or after intake of other drugs.If the product is taken together with meals in the case of insulin-dependent diabetics it may be necessary to reduce the insulin dose .
43 Pregnancy and lactation: Ispaghula may be used during pregnancy and lactation
44 Gugulipid (Gum Guggul, Guggulu ) Species : Commiphora mukulLocal Name : Bdellium Gum,Guggulipid, Gum Gugal, SalaitreeGugulipid, gum guggulu.Parts Used : Gum resin extract.Origin: The mukul myrrh (Commiphora mukul) tree is a small, thorny plant distributed throughout India.
45 Traditional use:guggul lipid has been used to treat arthritis, rheumatism, haemorrhids, urinary disorder, obesity, skin diseases and high cholesterol. It has been claimed to be widely used for over 2,000 years.
46 active constituents:Ketone fraction that is extracted from the resin containsthe most potent cholesterol lowering components.This is composed of C21 or C27 steroids, with the majorcomponents being Z- and E-guggulsterone.Guggul contains resin, volatile oils, and gum.The extract isolates ketonic steroid compounds knownas guggulsterones. These compounds have beenshown to provide the lipid-lowering actions notedfor guggul.
48 Dosage:A common intake of guggulsterones is 25 mg three times per day. Most extracts contain 5-10% guggulsterones. For a 5 percent guggulsterone extract, this translates to an effective dose of 500 milligrams three times per day.
49 Pharmacology:lowers serum triglycerides and cholesterol as well as LDL and VLDL cholesterols (the "bad" cholesterols). At the same time, it raises levels of HDL cholesterol (the "good" cholesterol).inhibits platelet aggregation,stimulation of the thyroid, potentially resulting in weight loss.,deposits of waste or toxic material in the bodyA direct anti-inflammatory effectreduce the stickiness of platelets.thatelowers the risk of coronary artery disease.
50 mechanism of action:Guggul works on the liver by increasing the metabolism (or break down) of the bad cholesterol known as LDL Cholesterol.After taking the product for 4 to 12 weeks, total cholesterol levels can drop, triglyceride levels can drop and an increase in HDL (the good cholesterol) of approximately 16% can occur.Guggul can lower blood cholesterol by 14-27% and can lower triglycerides by 22-30%
51 Advers effect:Gugulipid is a fairly nontoxic productthere may be mild skin rashes or GI upset/diarrhea.It is safe to use during pregnancy and does not adversely affect liver or kidney function,
52 Pharmaceutical prepration: Guggul - Pure extract (250 mg capsule)