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Development of a Genus-Universal Nucleotide Signature for the Identification and Supervision of Ephedra-Containing Products. Molecules 2022; 27:molecules27072342. [PMID: 35408741 PMCID: PMC9000813 DOI: 10.3390/molecules27072342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 12/02/2022] Open
Abstract
Ephedra plants generally contain ephedrine alkaloids, which are the critical precursor compounds of methamphetamine (METH). METH could cause serious physical and mental damage, and therefore Ephedra materials are strictly in supervision internationally. However, unlawful utilization of Ephedra herbs and its products still exist. Thus, it is imperative to establish a universal method for monitoring Ephedra ingredients in complex mixtures and processed products. In this study, 224 ITS2 sequences representing 59 taxa within Ephedra were collected, and a 23-bp genus-level nucleotide signature (GTCCGGTCCGCCTCGGCGGTGCG) was developed for the identification of the whole genus. The specific primers MH-1F/1R were designed, and 125 individuals of twelve Ephedra species/varieties were gathered for applicability verification of the nucleotide signature. Additionally, seven batches of Chinese patent medicines containing Ephedra herbs were used to test the application of the nucleotide signature in complex and highly processed materials. The results demonstrated that the 23-bp molecular marker was unique to Ephedra and conserved within the genus. It can be successfully utilized for the detection of Ephedra components in complex preparations and processed products with severe DNA degradation. The method developed in this study could undoubtedly serve as a strong support for the supervision of illegal circulation of Ephedra-containing products.
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Wu J, Sun B, Hou L, Guan F, Wang L, Cheng P, Scobell S, Cheng YC, Lam W. Prospective: Evolution of Chinese Medicine to Treat COVID-19 Patients in China. Front Pharmacol 2021; 11:615287. [PMID: 33716728 PMCID: PMC7947616 DOI: 10.3389/fphar.2020.615287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022] Open
Abstract
During the outbreak of the novel coronavirus disease (COVID-19), the Chinese government took a series of public health measures to tackle the outbreak and recommended six traditional Chinese medicine (TCM) evolved formulas, collectively referred to as "3-drugs-3-formulas", for the treatment. In this prospective article, we will discuss how these six formulas evolved from TCM and what their underlying mechanisms of actions may be by evaluating the historical usage of the component formulas, the potential targeted pathways for the individual herbs used by STAR (signal transduction activity response) database from our laboratory, and the pathogenesis of COVID-19. Five of the six recommended formulas are administered orally, while the sixth is taken as an injection. Five classic categories of herbs in the six formulas including "Qing-Re", "Qu-Shi", "Huo-Xue", "Bu-Yi" and "Xing-Qi" herbs are used based on different stages of disease. All five oral formulas build upon the core formula Maxingshigan Decoction (MD) which has anti-inflammatory and perhaps antiviral actions. While MD can have some desired effects, it may not be sufficient to treat COVID-19 on its own; consequently, complementary classic formulas and/or herbs have been added to potentiate each recommended formula's anti-inflammatory, and perhaps anti-renin-angiotensin system (RAS)-mediated bradykinin storm (RBS) and antiviral effects to address the unique medical needs for different stages of COVID-19. The key actions of these formulas are likely to control systemic inflammation and/or RBS. The usage of Chinese medicine in the six formulas is consistent with the pathogenesis of COVID-19. Thus, an integrative systems biology approach-combining botanical treatments of conventional antiviral, anti-inflammatory or anti-RBS drugs to treat COVID-19 and its complications - should be explored.
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Affiliation(s)
- Jieya Wu
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT, United States
- Department of Oncology and Hematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Baoguo Sun
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT, United States
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Li Hou
- Department of Oncology and Hematology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fulan Guan
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT, United States
| | - Liyuan Wang
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT, United States
- Institute of TCM and Health Development, Jiangxi University of Traditional Chinese Medicine, Jiangxi, China
| | - Peikwen Cheng
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT, United States
- Yiviva, Inc., New York, NY, United States
| | - Sophia Scobell
- Department of Biology, Wesleyan University, Middletown, CT, United States
| | - Yung-Chi Cheng
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT, United States
| | - Wing Lam
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT, United States
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Miao SM, Zhang Q, Bi XB, Cui JL, Wang ML. A review of the phytochemistry and pharmacological activities of Ephedra herb. Chin J Nat Med 2020; 18:321-344. [PMID: 32451091 DOI: 10.1016/s1875-5364(20)30040-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 12/22/2022]
Abstract
Ephedra herb is a traditional Chinese medicine with a long history. Conventionally, it was used as a folk phytomedicine in many ancient medical books and traditional prescriptions. Up to date, a variety of specific ingredients have been found in Ephedra herb, mainly including alkaloids, flavonoids, tannins, polysaccharides, organic acids, volatile oils, and many other active compounds. These components from Ephedra herb account for its use as the accurate treatment of cold, cough, cardiovascular and immune system disease, cancer, microbial infection, and other diseases. Moreover, with the fast development of novel chemistry and medicine technology, new chemical constituents and pharmacological effects of Ephedra herb are increasingly identified, demonstrating their great potential for various diseases treatment. Therefore, further detailed understanding and investigation of this ancient herb will offer new opportunities to develop novel therapeutics. This study systematically reviews its progress of phytochemistry, traditional and modern pharmacology based on research data that have been reported, aiming at providing useful insight for commercial exploitation, further study and precision medication of Ephedra herb in future.
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Affiliation(s)
- Shuang-Man Miao
- Institute of Applied Chemistry, Shanxi University, Taiyuan 030006, China; Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China
| | - Qi Zhang
- Institute of Applied Chemistry, Shanxi University, Taiyuan 030006, China; Modern Research Center for Traditional Chinese Medicine, Shanxi University, Taiyuan 030006, China
| | - Xiao-Bao Bi
- Centre for Biomimetic Sensor Science (CBSS), School of Materials Science & Engineering, Nanyang Technological University, Singapore 637553, Singapore
| | - Jin-Long Cui
- Institute of Applied Chemistry, Shanxi University, Taiyuan 030006, China.
| | - Meng-Liang Wang
- Institute of Applied Chemistry, Shanxi University, Taiyuan 030006, China
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Gurley BJ, Steelman SC, Thomas SL. Multi-ingredient, Caffeine-containing Dietary Supplements: History, Safety, and Efficacy. Clin Ther 2015; 37:275-301. [DOI: 10.1016/j.clinthera.2014.08.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/19/2014] [Accepted: 08/23/2014] [Indexed: 02/07/2023]
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Brown CE, Trauth SE, Grippo RS, Gurley BJ, Grippo AA. Combined Effects of Ephedrine-Containing Dietary Supplements, Caffeine, and Nicotine on Morphology and Ultrastructure of Rat Hearts. JOURNAL OF CAFFEINE RESEARCH 2012; 2:123-132. [PMID: 24761270 DOI: 10.1089/jcr.2012.0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cigarette smokers have an increased risk for coronary artery disease. Nicotine present in cigarettes can adversely affect the cardiovascular system via stimulation of both sympathetic and parasympathetic neurons. Caffeine, another cardiovascular and central nervous system (CNS) stimulant, is commonly found in Ephedra and Ephedra-free dietary supplements. These caffeine-containing supplements also have been linked to cardiovascular toxicities. Although no longer on the U.S market, Ephedra-containing supplements are another source of cardiovascular and CNS stimulants, namely the ephedrine alkaloids. Together caffeine, nicotine, and ephedrine can individually stress the cardiovascular system, and an overlap of these agents is predicted in smokers and dieters. To understand the collective effects of these stimulants on the heart morphology and ultrastructure, rats were exposed to synthetic combinations of nicotine (0.2 mg/kg/day), ephedrine (0-30 mg/kg/day), and/or caffeine (0-24 mg/kg/day) as well as an extract from a caffeine-containing Ephedra supplement (Metabolife 356). After exposure for 3 days, the hearts were removed and examined for hypersensitivity myocarditis and myocardial necrosis. None of the drugs tested alone affected heart tissue morphology, nor were atypical cardiac cells observed. However, in combination, significant interactions were found between caffeine and ephedrine; the interventricular septum was most susceptible, with a significant increase in atypical cardiac cells observed. Nicotine pretreatment caused greater susceptibility to cardiotoxicity associated with combinations of caffeine + ephedrine or Metabolife, particularly in the left ventricle wall. These results indicate that sympathomimetic combinations present in Ephedra supplements may have produced cardiotoxicity reported in consumers of these products. Moreover, the presence of nicotine exacerbates these toxic effects.
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Affiliation(s)
- Christopher E Brown
- Department of Biological Sciences, Arkansas State University , State University, Arkansas
| | - Stanley E Trauth
- Department of Biological Sciences, Arkansas State University , State University, Arkansas
| | - Richard S Grippo
- Department of Biological Sciences, Arkansas State University , State University, Arkansas
| | - Bill J Gurley
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences , College of Pharmacy, Little Rock, Arkansas
| | - Anne A Grippo
- Department of Biological Sciences, Arkansas State University , State University, Arkansas
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Acute effects of ephedra on autonomic nervous modulation in healthy young adults. Clin Pharmacol Ther 2010; 88:39-44. [PMID: 20520603 DOI: 10.1038/clpt.2010.66] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this study was to assess the acute effects of ephedra on autonomic nervous modulation by means of heart rate variability (HRV) analysis, using a randomized, double-blind, placebo-controlled, crossover design. On three separate days, 20 healthy subjects took capsules containing either 1 or 2 g of ephedra dry extract or a placebo, and the sequential percentage changes in HRV measures were compared. After the subjects took ephedra, the normalized low-frequency component (LF) and the ratio of LF to high-frequency component (HF) increased significantly in a dose-dependent manner, whereas the normalized HF (HF%) decreased significantly. We conclude that ingestion of ephedra tilts the sympathovagal balance dose-dependently toward increased sympathetic activity and impairs parasympathetic activity.
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Nazeri A, Massumi A, Wilson JM, Frank CM, Bensler M, Cheng J, Saeed M, Rasekh A, Razavi M. Arrhythmogenicity of weight-loss supplements marketed on the Internet. Heart Rhythm 2009; 6:658-62. [DOI: 10.1016/j.hrthm.2009.02.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 02/10/2009] [Indexed: 10/21/2022]
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Grippo AA, Capps K, Rougeau B, Gurley BJ. Analysis of flavonoid phytoestrogens in botanical and ephedra-containing dietary supplements. Ann Pharmacother 2007; 41:1375-82. [PMID: 17698891 DOI: 10.1345/aph.1h497] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Plant-derived botanical and dietary supplements are widely self-prescribed in the US and considered natural, safe, and beneficial. However, because they are not strictly regulated by the Food and Drug Administration (FDA), their ingredients are not always known and they may contain unexpected agents. Among the myriad plant-produced molecules are flavonoids, which reportedly have various human health effects, including anticancer, antioxidant, and estrogenic properties. Several flavonoids (eg, isoflavones) are known as phytoestrogens, based on their ability to mimic estrogen in mammals. Because botanical and dietary supplements are plant products and need not be processed or purified due to their FDA classification as foods, they may contain unexpected phytoestrogens, such as flavonoids. OBJECTIVE To analyze 8 botanical and 11 ephedra-containing dietary supplements for the presence and concentration of 5 flavonoids (biochanin A, daidzein, formononetin, genistein, quercetin), which may deliver unexpected estrogenic activity. METHOD Randomly selected tablets from single bottles of 19 botanical and dietary supplements purchased locally were pooled. Flavonoids were extracted into ethanolic solution and analyzed by high-performance liquid chromatography. RESULTS Flavonoids were detected in all supplements tested, with the largest number (4) found in Kava Kava. Almost all supplements contained measurable amounts of genistein and/or daidzein, known estrogenic agents, at up to 22 mg/day of isoflavone, per recommended daily dosage of supplement. CONCLUSIONS These results suggest that single-component botanical and multi-ingredient dietary supplements could contain unexpected estrogenic agents, which may impact the health of consumers.
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Affiliation(s)
- Anne A Grippo
- Department of Biological Sciences, Arkansas State University, State University, AR 72467, USA.
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247-346. [PMID: 16949478 DOI: 10.1016/j.jacc.2006.07.010] [Citation(s) in RCA: 863] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rakovec P, Kozak M, Sebestjen M. Ventricular tachycardia induced by abuse of ephedrine in a young healthy woman. Wien Klin Wochenschr 2006; 118:558-61. [PMID: 17009070 DOI: 10.1007/s00508-006-0655-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Accepted: 06/20/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Ephedrine or ephedra herbal products have occasionally been used to enhance sports performance and energy or to aid weight loss. The most serious side effects are those on cardiovascular function, including acute myocardial infarction, severe hypertension, myocarditis and lethal cardiac arrhythmias. CASE REPORT A 19-year-old woman was taking ephedrine to enhance her sports performance. After 10 days of this medication she developed hemodynamically unstable ventricular tachycardia resistant to cardioversion and amiodarone treatment. She converted to sinus rhythm 60 hours later, presumably when the plasma ephedrine level had sufficiently decreased. In an electrophysiological study the ventricular tachycardia could be induced and successfully ablated. There were no recurrences during follow-up of more than a year. The use of ephedrine carries a risk of development of life-threatening arrhythmias. DISCUSSION Ephedrine alone cannot be considered as the ultimate cause of tachycardia in our patient; however, it is highly probable that ephedrine triggered the tachycardic attack. The proarrhythmic effect most likely occurred because of underlying idiopathic left ventricular tachycardia. Although the patient could have developed her first attack of ventricular tachycardia at any time in her life, it is highly improbable that the attack following the ephedrine abuse was purely coincidental. CONCLUSION Our experience with the reported patient shows that ephedrine alone, or in combination with substances that increase its effects on the cardiovascular system, may also trigger paroxysms of non-ischemic ventricular tachycardia. The use of ephedrine carries a risk of development of life-threatening arrhythmias and should be discouraged.
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Affiliation(s)
- Peter Rakovec
- Department of Cardiology, University Medical Center, Ljubljana, Slovenia.
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e385-484. [PMID: 16935995 DOI: 10.1161/circulationaha.106.178233] [Citation(s) in RCA: 807] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Grippo AA, Hamilton B, Hannigan R, Gurley BJ. Metal content of ephedra-containing dietary supplements and select botanicals. Am J Health Syst Pharm 2006; 63:635-44. [PMID: 16554287 DOI: 10.2146/ajhp050270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The metal content of dietary supplements, including 13 ephedra-containing supplements, was studied. METHODS Samples of botanicals (black cohosh, echinacea, goldenseal, kava kava, milk thistle, saw palmetto, Synephrine, and valerian root), ephedra-containing dietary supplements (Amp II, EPH 833, Ephedra, Ephedra 1000, Hydroxycut, Metabolife 356, Metabolift, Ripped Fuel, Ripped Fuel Extreme, Ripped Fuel [ma huang-free], Stacker 2 [two lots], Super Stinger, Virgin Earth, Xenadrine RFA-1 [two lots], Yellow Jacket), and nonprescription reference agents (NoDoz and Primatene) were digested in acid, reacidified, and then spiked with internal standards. Metals were quantified using Environmental Protection Agency quality assurance and quality-control standards 6020 and 200.8. Forty-seven metals were analyzed by inductively coupled plasma-mass spectrometry, with subpart-per-trillion detection limits. RESULTS All metals detected were in concentrations below toxic levels or physiological limit levels for the daily doses specified by the products' labeling. Metals found in highest concentrations among all the supplements sampled were sodium, magnesium, calcium, potassium, aluminum, iron, titanium, mercury, strontium, lead, barium, and silver. Of the 27 supplements analyzed, those with the lowest metal concentrations were mostly single-ingredient botanical supplements, while multiple-component, ephedra-containing dietary supplements generally had higher metal concentrations. Significant lot-to-lot variations were found for two ephedra-containing dietary supplements. CONCLUSION None of 47 metals was found in highly toxic amounts in 23 brands of dietary supplements and two nonprescription reference preparations.
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Affiliation(s)
- Anne A Grippo
- Department of Chemistry and Physics, Arkansas State University, PO Box 599, State University, AR 72467, USA.
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Kuczkowski KM. Labor analgesia for the parturient with herbal medicines use: what does an obstetrician need to know? Arch Gynecol Obstet 2006; 274:233-9. [PMID: 16534580 DOI: 10.1007/s00404-006-0136-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 01/31/2006] [Indexed: 11/29/2022]
Abstract
The use of herbal medicines in the developed world is widespread, and increasing. Herbal medicines, which include a wide spectrum of substances ranging from home-made teas to the national regulatory bodies-approved medicinal substances, are defined as plant-derived products that are used for medicinal and/or nutritional purposes. The use of herbal self-therapy is common in pregnancy, with many parturients consuming more than one agent at a time. Despite widespread use there has been surprisingly little research into the outcomes or the potential risks of using herbal therapies during pregnancy. As epidural analgesia is the most popular form of pain relief in labor, the potential for herbal remedies-related alterations in maternal hemodynamics (e.g., hypertension, tachycardia), and increased bleeding tendencies (e.g., spinal-epidural hematoma) remain a significant concern. Obstetricians and obstetric anesthesiologists must be familiar with the effects of herbal medicines and should specifically inquire about the use of herbal medicines during prenatal/preanesthetic assessment. This review article attempts to summarize current data on special considerations for labor analgesia in parturients with herbal medicines use.
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Affiliation(s)
- Krzysztof M Kuczkowski
- Department of Anesthesiology, University of California San Diego Medical Center, 200 W. Arbor Drive, San Diego, CA 92103-8770, USA.
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Affiliation(s)
- Richard B Libman
- Department of Neurology, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA.
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Woolf AD, Watson WA, Smolinske S, Litovitz T. The severity of toxic reactions to ephedra: comparisons to other botanical products and national trends from 1993-2002. Clin Toxicol (Phila) 2005; 43:347-55. [PMID: 16235509 DOI: 10.1081/clt-200066075] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Ephedra is a botanical product widely used to enhance alertness, as a weight loss aide, and as a decongestant. Its reported adverse effects led the Food and Drug Administration (FDA) to ban ephedra-containing products in the United States in 2004. This study's purpose was to compare toxicity from botanical products containing ephedra to nonephedra products. METHODS The Toxic Exposure Surveillance System (TESS), a national poison center database, was utilized to determine the number and outcomes of cases involving botanical products reported from 1993-2002. Cases listing both a botanical product and any other drugs or chemicals were excluded a priori. Ten-year hazard rates (moderate outcomes + major outcomes + deaths per 1000 exposures) were used to compare botanical product categories. RESULTS There were 21,533 toxic exposures with definitive medical outcomes reported over the 10 yrs where a botanical product was the only substance involved. Of these, 4306 (19.9%) had moderate or major medical outcomes and there were two deaths, for an overall hazard score of 200 per 1000 exposures. The number of ephedra reports to poison centers increased 150-fold over the 10-yr period. The hazard rate for products that contained only ephedra was 250 per 1000 exposures and 267 per 1000 exposures for products that contained ephedra and additional ingredients; whereas the hazard score for only nonephedra botanical products was 96 per 1000 exposures. The rate ratios for multibotanical products with ephedra (RR 1.33; 95% C.I. 1.27-1.40) and for single-ingredient ephedra products (RR 1.25; 95% C.I. 1.11-1.40) were both two to six times higher than those of other common botanical products. Yohimbe-containing products had the highest hazard score (417) and rate ratio (2.08; 95% C.I. 1.59-2.80). CONCLUSION Ephedra-containing botanical products accounted for a significant number of toxic exposures with severe medical outcomes reported to poison centers. Hazard rate analysis suggests poison center-reported events involving ephedra-containing botanical products were much more likely to result in severe medical outcomes than those involving nonephedra-containing botanical products. These data support recommendations by policymakers that the sale of ephedra should be prohibited to protect consumers. Our data suggest that the botanical product, yohimbe, may also be associated with unacceptably high risks of toxicity and should receive close scrutiny from health policymakers.
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Affiliation(s)
- Alan D Woolf
- Division of General Pediatrics, Children's Hospital, Boston, Massachusetts 02115, USA.
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Frishman WH, Grattan JG, Mamtani R. Alternative and Complementary Medical Approaches in the Prevention and Treatment of Cardiovascular Disease. Curr Probl Cardiol 2005; 30:383-459. [PMID: 16021110 DOI: 10.1016/j.cpcardiol.2005.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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McBride BF, Guertin D, White CM, Kluger J. Inappropriate Implantable Cardioverter Defibrillator Discharge Following Consumption of a Dietary Weight Loss Supplement. Pacing Clin Electrophysiol 2004; 27:1317-20. [PMID: 15461726 DOI: 10.1111/j.1540-8159.2004.00627.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This report describes the clinical course of a 40-year-old female who experienced repetitive ICD firing after consuming Metabolife 356, a multicomponent dietary weight loss supplement. Following the initiation of Metabolife 356, the patient experienced four shocks over a 3 day period with two 30 J shocks being delivered sequentially. Interrogation of the device revealed atrial tachycardia with 1:1 AV conduction at a rate of 240 beats/min. Metabolife 356 was discontinued and the dosage of sotalol was increased to 120 mg twice daily without recurrence of ICD discharge.
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Affiliation(s)
- Brian F McBride
- Hartford Hospital Drug Information Center; Hartford, Connecticut 06102, USA
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Abstract
OBJECTIVE To describe opportunities and obligations for pharmacists regarding doping control in sports, and to present information and resources on drugs and dietary supplements that are popular among athletes for performance enhancement. DATA SOURCES Sports medicine journals and articles in English obtained from Medline (1966 through June 2003) using the search terms doping in sports, drugs in sports, dietary supplements, sports, amphetamine, stimulants, ephedrine, ephedra, caffeine, anabolic steroids, human growth hormone, erythropoietin, darbepoetin, androstenedione, dehydroepiandrosterone, and creatine. Information was also obtained from sports-governing agencies, such as the National Collegiate Athletic Association and the International Olympic Committee. STUDY SELECTION Studies and reports that were credible and scientifically sound that evaluated the ergogenic effects of drugs and dietary supplements. DATA EXTRACTION By the author. DATA SYNTHESIS Pharmacists can participate in doping control programs in a number of ways. Pharmacists also have an obligation when counseling, advising, and treating athletes to help them avoid banned substances. Athletes use a host of drugs for their performance-enhancing effects, many of which are banned by major sports-governing bodies. Myriad dietary supplements are marketed to athletes, claiming to have ergogenic effects. Some of these popular supplements have proven performance-enhancing effects, while others do not. Adverse effects of these drugs and dietary supplements are discussed. CONCLUSION A variety of drugs and dietary supplements have proven performance-enhancing effects in athletes. However, many of these substances have adverse effects and are banned by various sports-governing organizations. Pharmacists can play a key role in participating in doping control programs, and can prevent athletes from inadvertently consuming a banned substance.
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Affiliation(s)
- Peter J Ambrose
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, USA.
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Frishman WH, Sinatra ST, Moizuddin M. The use of herbs for treating cardiovascular disease. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.sigm.2004.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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