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Assi H, Najera C, Aboudawoud O, Nadella S, Bies JJ, Hassan M, Roongsritong C. Tejocote Root's Role in Symptomatic Mobitz Type 1 Heart Block: A Compelling Case Report. Cureus 2023; 15:e45228. [PMID: 37842399 PMCID: PMC10576468 DOI: 10.7759/cureus.45228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
The clinical presentation and diagnosis of Tejocote root toxicity causing Mobitz Type 1 remains a scarcely clinical phenomenon, often resulting in delayed diagnosis and treatment. This case report highlights a 30-year-old female presenting with a constellation of symptoms, including fatigue, dizziness, chest pressure, myalgias, nausea, vomiting, and peripheral tingling. Significantly, the patient had been using Tejocote root as an over-the-counter laxative acquired from Mexico. Laboratory findings revealed detectable Digoxin levels in her bloodstream, while an electrocardiogram (EKG) indicated sinus bradycardia with Mobitz Type 1 heart block. The patient was treated with a single dose of atropine 0.5 mg IV push. A repeat EKG before discharge showed resolution of the Mobitz type 1. This case underscores the potential cardiovascular repercussions of Tejocote root consumption and emphasizes the importance of heightened clinical awareness, especially in regions where such herbal supplement usage is prevalent.
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Affiliation(s)
- Heabah Assi
- Internal Medicine, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
| | - Carolina Najera
- Internal Medicine, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
| | - Omar Aboudawoud
- Internal Medicine, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
| | - Sahithi Nadella
- Internal Medicine, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
| | - Jared J Bies
- Internal Medicine, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
| | - Mariam Hassan
- Internal Medicine, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
| | - Chanwit Roongsritong
- Cardiology, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
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Kumar G, Dey SK, Kundu S. Herbs and their bioactive ingredients in cardio-protection: Underlying molecular mechanisms and evidences from clinical studies. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 92:153753. [PMID: 34610528 DOI: 10.1016/j.phymed.2021.153753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Medicinal plants or herbs produce a bounty of bioactive phytochemicals. These phytochemicals can influence a variety of physiological events related to cardiovascular health through multiple underlying mechanisms, such as their role as antioxidative, anti-ischemic, anti-proliferative, hypotensive, anti-thrombotic, and anti-hypercholesterolemic agents. PURPOSE The purpose of this review is to summarize and connect evidences supporting the use of phytotherapy in the management of some of the most common cardiovascular impairments, molecular mechanisms underlying cardio-protection mediated by herbs, and clinical studies which are positively linked with the use of herbs in cardiovascular biology. Additionally, we also describe several adverse effects associated with some of the herbal plants and their products to provide a balanced set of studies in favor or against phytotherapy in cardiovascular health that may help global discourses on this matter. METHODS Studies relating to the use of medicinal plants were mined by strategically searching scientific databases including Google Scholar, PubMed and Science Direct. Investigations involving approximately 175 articles including reviews, research articles, meta-analyses, and cross-sectional and observational studies were retrieved and analyzed in line with the stated purpose of this study. RESULTS A positive correlation between the use of medicinal plants and cardiovascular health was observed. While maintaining cardiovascular physiology, medicinal plants and their derivatives seem to govern a variety of cellular mechanisms involved in vasoconstriction and vasorelaxation, which in turn, are important aspects of cardiovascular homeostasis. Furthermore, a variety of studies including clinical trials, cross-sectional studies, and meta-analyses have also supported the anti-hypertensive and thus, cardio-protective effects, of medicinal plants. Apart from this, evidence is also available for the potential drawbacks of several herbs and their products indicating that the unsupervised use of many herbs may lead to severe health issues. CONCLUSIONS The cardio-protective outcomes of medicinal plants and their derivatives are supported by ever-increasing studies, while evidences exist for the potential drawbacks of some of the herbs. A balanced view about the use of medicinal plants and their derivative in cardiovascular biology thus needs to be outlined by researchers and the medical community. The novelty and exhaustiveness of the present manuscript is reflected by the detailed outline of the molecular basis of "herbal cardio-protection", active involvement of several herbs in ameliorating the cardiovascular status, adverse effects of medicinal plants, and the clinical studies considering the use of phytotherapy, all on a single platform.
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Affiliation(s)
- Gaurav Kumar
- Dr. B. R. Ambedkar Center for Biomedical Research (ACBR), University of Delhi, Delhi-110007, India; Department of Biochemistry, University of Delhi South Campus, New Delhi 110021, India
| | - Sanjay Kumar Dey
- Dr. B. R. Ambedkar Center for Biomedical Research (ACBR), University of Delhi, Delhi-110007, India; Department of Biochemistry, University of Delhi South Campus, New Delhi 110021, India
| | - Suman Kundu
- Dr. B. R. Ambedkar Center for Biomedical Research (ACBR), University of Delhi, Delhi-110007, India; Department of Biochemistry, University of Delhi South Campus, New Delhi 110021, India.
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Naveed M, Majeed F, Taleb A, Zubair HM, Shumzaid M, Farooq MA, Baig MMFA, Abbas M, Saeed M, Changxing L. A Review of Medicinal Plants in Cardiovascular Disorders: Benefits and Risks. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2020; 48:259-286. [PMID: 32345058 DOI: 10.1142/s0192415x20500147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Many cultivated and wild plants are used for the management of various diseases, specifically renal and hepatic diseases and those of the immune and cardiovascular systems. In China, medicinal plants from ancient to modern history have been used in patients with angina pectoris, congestive heart failure (CHF), systolic hypertension, arrhythmia, and venous insufficiency for centuries. The latest increase in the fame of natural products and alternative medicine has revived interest in conventional remedies that have been consumed in the management of CVD. The cardio-protective properties of the various herbs are possibly due to their anti-oxidative, antihypercholesterolemic, anti-ischemic activities, and inhibition of platelet aggregation that reduce the risk of CVD. Ethno-pharmacological and biological properties of these plants are explored, based upon published scientific literature. Although a majority of medicinal plants having a biological mechanism that linked with CVD management, to date, published literature pertaining to their promising scientific properties are still poorly understood. Compared with synthetic medicines, alternative medicines do not need scientific studies before their formal approval from the government sector and due to this purpose; their safety, as well as efficacy, still remain elusive. Taken together, we addressed all accessible evidence on alternative medicines commonly consumed in CVD management. Our comprehensive analysis of the scientific literature indicated that many TCMs are available and valuable herbal medication would be the best alternative for the management of CVD as a complementary therapy. Furthermore, practitioners should always discuss possible benefits-risks of alternative medicines with patients so that they are aware of the consumption of alternative medications.
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Affiliation(s)
- Muhammad Naveed
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Jiangsu Province, Nanjing 211166, P. R. China
| | - Fatima Majeed
- Department of Nutrition and Food Hygiene, School of Public Health, Nanjing Medical University, Jiangsu Province, Nanjing 211166, P. R. China
| | - Abdoh Taleb
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Jiangsu Province, Nanjing 211166, P. R. China
| | - Hafiz Muhammad Zubair
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Jiangsu Province, Nanjing 211166, P. R. China
| | - Muhammad Shumzaid
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Punjab Province, Lahore 54770, Pakistan
| | - Muhammad Asim Farooq
- Department of Pharmacy, School of Pharmacy, China Pharmaceutical University, Jiangsu Province, Nanjing 211198, P. R. China
| | - Mirza Muhammad Faran Ashraf Baig
- State Key Laboratory of Analytical Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Jiangsu Province, Nanjing 210093, P. R. China
| | - Muhammad Abbas
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Jiangsu Province, Nanjing 210093, P. R. China
| | - Muhammad Saeed
- Faculty of Animal Production and Technology, The Cholistan University of Veterinary and Animal Sciences, Bahawalpur 6300, Pakistan
| | - Li Changxing
- Department of Human Anatomy, Medical College of Qinghai University, Xining 810000, Qinghai Province, P. R. China
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Palmer KG, Lebin JA, Cronin MT, Mazor SS, Burns RA. Crataegus mexicana (Tejocote) Exposure Associated with Cardiotoxicity and a Falsely Elevated Digoxin Level. J Med Toxicol 2019; 15:295-298. [PMID: 31407210 DOI: 10.1007/s13181-019-00727-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION A species of hawthorn, Crataegus mexicana (tejocote), has been marketed as a weight-loss supplement that is readily available for purchase online. While several hawthorn species have shown clinical benefit in the treatment of heart failure owing to their positive inotropic effects, little is known about hawthorn, and tejocote in particular, when consumed in excess. We describe a case of tejocote exposure from a weight-loss supplement resulting in severe cardiotoxicity. CASE REPORT A healthy 16-year-old girl presented to an emergency department after ingesting eight pieces of her mother's tejocote root weight-loss supplement. At arrival, she was drowsy, had active vomiting and diarrhea, and had a heart rate of 57 with normal respirations. Her initial blood chemistries were unremarkable, except for an elevated digoxin assay of 0.7 ng/mL (therapeutic range 0.5-2.0 ng/mL). All other drug screens were negative. She later developed severe bradycardia and multiple episodes of hypopnea that prompted a transfer to our institution, a tertiary pediatric hospital. Her ECG demonstrated a heart rate of 38 and Mobitz type 1 second-degree heart block. She was subsequently given two vials of Digoxin Immune Fab due to severe bradycardia in the setting of suspected digoxin-like cardiotoxicity after discussion with the regional poison control center. No clinical improvement was observed. Approximately 29 hours after ingestion, subsequent ECGs demonstrated a return to normal sinus rhythm, and her symptoms resolved. DISCUSSION Tejocote root toxicity may cause dysrhythmias and respiratory depression. Similar to other species of hawthorn, tejocote root may cross-react with some commercial digoxin assays, resulting in a falsely elevated level.
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Affiliation(s)
- Katherine G Palmer
- Department of Emergency Medicine, University of Washington, 325 9th Avenue, Box 359702, Seattle, WA, 98104, USA.
| | - Jacob A Lebin
- Department of Emergency Medicine, University of Washington, 325 9th Avenue, Box 359702, Seattle, WA, 98104, USA
| | - Michael T Cronin
- Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, Mailstop: FA.2.112, Seattle, WA, 98105, USA
| | - Suzan S Mazor
- Division of Emergency Medicine, Seattle Children's Hospital, University of Washington, MB.7.520 - Emergency Medicine , 4800 Sand Point Way NE, Seattle, WA, 98105, USA
- Washington Poison Center, Seattle, WA, USA
| | - Rebekah A Burns
- Division of Emergency Medicine, Seattle Children's Hospital, University of Washington, MB.7.520 - Emergency Medicine , 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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Deguigne M, Brunet M, Abbara C, Turcant A, Le Roux G, Lelièvre B. Enzalutamide and analytical interferences in digoxin assays. Clin Toxicol (Phila) 2018; 56:1150-1154. [DOI: 10.1080/15563650.2018.1469758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marie Deguigne
- Centre Antipoison-Toxicovigilance Grand Ouest, CHU Angers, Angers, France
| | - Marion Brunet
- Centre Antipoison-Toxicovigilance Grand Ouest, CHU Angers, Angers, France
| | - Chadi Abbara
- Laboratoire de Pharmacologie-Toxicologie, CHU Angers, Angers, France
| | - Alain Turcant
- Laboratoire de Pharmacologie-Toxicologie, CHU Angers, Angers, France
| | - Gaël Le Roux
- Centre Antipoison-Toxicovigilance Grand Ouest, CHU Angers, Angers, France
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Abstract
Cardiovascular disease (CVD) is traditionally treated through medications and lifestyle modifications, yet adherence to these treatments is often poor. The use of complementary therapies is increasing, and it is vital for physicians to be aware of the risks and benefits of these options. This article summarizes the current evidence base on integrative therapies for the prevention and treatment of CVD, including hypertension, hyperlipidemia, coronary artery disease, heart failure, and arrhythmias. Where applicable, recommendations are included for therapies that may be used as an adjunct to traditional medical care to improve cardiovascular health and quality of life.
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Affiliation(s)
- Monica Aggarwal
- Division of Cardiology, University of Florida, 1600 Southwest Archer Road, PO Box 100288, Gainesville, FL 32610, USA.
| | - Brooke Aggarwal
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, 51 Audubon Avenue, Suite 505, New York, NY 10032, USA
| | - Jyothi Rao
- Shakthi Health and Wellness Center, 2702 Back Acre Circle Suite 290C, Mt. Airy, MD 21771, USA
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Liperoti R, Vetrano DL, Bernabei R, Onder G. Herbal Medications in Cardiovascular Medicine. J Am Coll Cardiol 2017; 69:1188-1199. [PMID: 28254182 DOI: 10.1016/j.jacc.2016.11.078] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/11/2016] [Accepted: 11/07/2016] [Indexed: 01/01/2023]
Abstract
Herbal medications are commonly used for clinical purposes, including the treatment of cardiovascular conditions. Compared with conventional medications, herbal medications do not require clinical studies before their marketing or formal approval from regulatory agencies, and for this reason their efficacy and safety are rarely proven. In this review, we summarize available evidence on herbal medications mostly used in cardiovascular medicine. We show that the use of these medications for the treatment of cardiovascular diseases is often not supported by scientific evidence. Despite most of these herbs showing an effect on biological mechanisms related to the cardiovascular system, data on their clinical effects are lacking. Potential relevant side effects, including increased risk of drug interactions, are described, and the possibility of contamination or substitution with other medications represents a concern. Physicians should always assess the use of herbal medications with patients and discuss the possible benefits and side effects with them.
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Affiliation(s)
- Rosa Liperoti
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide L Vetrano
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
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8
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Phyto-anesthetics: A mini-review on herb–anesthesia drug interactions. Biomed Pharmacother 2016; 84:1885-1890. [DOI: 10.1016/j.biopha.2016.10.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 02/06/2023] Open
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Choi JG, Eom SM, Kim J, Kim SH, Huh E, Kim H, Lee Y, Lee H, Oh MS. A Comprehensive Review of Recent Studies on Herb-Drug Interaction: A Focus on Pharmacodynamic Interaction. J Altern Complement Med 2016; 22:262-79. [PMID: 27003511 DOI: 10.1089/acm.2015.0235] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The concomitant use of herbal and conventional drugs accelerates the possibility of clinically significant herb-drug interactions (HDIs). This paper aims to analyze the current status of HDI studies worldwide and to review studies on HDI-induced pharmacodynamic (PD) interactions. METHODS HDI studies published from 2000 to 2014 and indexed in PubMed were categorized according to publication year, area/country, study methods and objectives, and disease categories. The reviewed studies focused on HDI-induced PD; each PD interaction with concurrent use of approximately 100 herbal drugs and 70 conventional drugs was summarized. All PD-related articles were categorized according to four characteristics: herbal drugs, conventional drugs, types of PD interaction, and type of study. Among them, 17 well-designed clinical studies were evaluated by using the Jadad Quality Assessment Scale. RESULTS The number of HDI reports has gradually increased since 2000, with a primary focus on neoplasms and diseases of the circulatory system. Most of these investigated pharmacokinetic reactions, such as cytochrome P450 enzyme metabolism, with fewer reports investigating PD. Most PD interaction studies investigated warfarin, ginkgo leaves, and St. John's wort. An evaluation of 17 studies revealed a generally positive view of PD effects involving synergism or reduced toxicity and a high average quality score (>3 points on a 0-5 scale). CONCLUSIONS These results demonstrate that most HDI studies so far have examined PK interactions and have been limited to very few conventional drugs and herbal drugs. This suggests that more studies focusing on PD are necessary to understand interactions between commonly used herbal and conventional drugs.
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Affiliation(s)
- Jin Gyu Choi
- 1 Department of Life and Nanopharmaceutical Sciences, Graduate School, Kyung Hee University , Seoul, Korea
| | - Sang Min Eom
- 2 Department of Pharmacy, College of Pharmacy, Kyung Hee University , Seoul, Korea
| | - Jaeyoung Kim
- 2 Department of Pharmacy, College of Pharmacy, Kyung Hee University , Seoul, Korea
| | - Soon Han Kim
- 2 Department of Pharmacy, College of Pharmacy, Kyung Hee University , Seoul, Korea
| | - Eugene Huh
- 3 Department of Herbal Pharmacology, College of Korean Medicine, Kyung Hee University , Seoul, Korea
| | - Hocheol Kim
- 3 Department of Herbal Pharmacology, College of Korean Medicine, Kyung Hee University , Seoul, Korea
| | - Yunwoo Lee
- 4 College of Medicine, Hallym University , Chuncheon, Korea
| | - Hyangsook Lee
- 5 Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University , Seoul, Korea
| | - Myung Sook Oh
- 1 Department of Life and Nanopharmaceutical Sciences, Graduate School, Kyung Hee University , Seoul, Korea.,6 Department of Oriental Pharmaceutical Science, College of Pharmacy and Kyung Hee East-West Pharmaceutical Research Institute, Kyung Hee University , Seoul, Korea
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10
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Interactions between herbs and antidiabetics: an overview of the mechanisms, evidence, importance, and management. Arch Pharm Res 2014; 38:1281-98. [PMID: 25475096 DOI: 10.1007/s12272-014-0517-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 11/10/2014] [Indexed: 02/08/2023]
Abstract
Complementary and alternative therapies are quickly gaining importance because they are perceived to be free of side effects due to their natural origin. However, herbal remedies are complex mixtures of bioactive entities, which may interact with prescription drugs through pharmacokinetic or pharmacodynamic mechanisms and sometimes result in life-threatening consequences. In particular, diabetes patients are often treated with multiple medications due to different comorbidities, and such patients use antidiabetic medications for their entire lives; thus, it is important to make the public aware of herb interactions with antidiabetic drugs. In this paper, we summarize the reports available on the interaction of herbal remedies with oral hypoglycemic agents and describe mechanisms, preclinical or clinical evidence, importance, and management strategies.
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11
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Polyphenolic profile and biological activity of Chinese hawthorn (Crataegus pinnatifida BUNGE) fruits. Molecules 2012; 17:14490-509. [PMID: 23222867 PMCID: PMC6268084 DOI: 10.3390/molecules171214490] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/26/2012] [Accepted: 11/29/2012] [Indexed: 02/06/2023] Open
Abstract
Chinese hawthorn (Crataegus pinnatifida Bge.) fruits are rich in polyphenols (e.g., epicatechin, procyanidin B2, procyanidin B5, procyanidin C1, hyperoside, isoquercitrin and chlorogenic acid)—active compounds that exert beneficial effects. This review summarizes all information available on polyphenolic content and methods for their quantification in Chinese hawthorn berries and the relationships between individual polyphenolic compounds as well. The influence of species or cultivars, the locality of cultivation, the stage of maturity, and extract preparation conditions on the polyphenolic content were discussed as well. Currently, only fruits of C. pinnatifida and C. pinnatifida var. major are included in the Chinese Pharmacopoeia. Recent trials have demonstrated the efficacy of Chinese hawthorn fruit in lowering blood cholesterol and the risk of cardiovascular diseases. The fruit has also demonstrated anti-inflammatory and anti-tumour activities. This review deals mainly with the biological activity of the fruit related to its antioxidant properties.
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12
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Dasgupta A, Johnson MJ, Wahed A. The new LOCI digoxin assay on the Vista 1500 analyzer is virtually free from interferences of herbal supplements hawthorn and ashwagandha (Indian ginseng). J Clin Lab Anal 2012; 26:227-31. [PMID: 22811353 DOI: 10.1002/jcla.21504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Herbal supplements hawthorn and ashwagandha (Indian ginseng) are indicated for cardiac illnesses and may be taken by patients receiving digoxin therapy. Because both hawthorn and ashwagandha are known to interfere with serum digoxin measurements using certain digoxin immunoassays, we investigated potential interference of these two herbal supplements with the new homogenous sequential chemiluminescent assay for digoxin based on the luminescent oxygen channeling technology (LOCI digoxin) for application on the Dimension and Vista platform. When aliquots of a drug-free serum pool were supplemented with various amounts of hawthorn (three different commercial preparations) or ashwagandha (two different commercial preparations) and apparent digoxin values were measured using LOCI digoxin assay on Dimension Vista 1500 analyzer we observed none-detected values except when aliquots were supplemented with very high amounts of the herbal extracts. When aliquots of a serum digoxin pool (prepared by pooling specimens from patients receiving digoxin) where further supplemented with various amounts of these supplements and digoxin concentrations were remeasured, statistically significant falsely higher digoxin values were observed only in specimens containing very high amounts of these supplements. Such interference may not be clinically significant. We conclude that new LOCI digoxin assay is virtually free from interferences of herbal supplements, hawthorn, and ashwagandha.
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Affiliation(s)
- Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, TX 77030, USA.
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Fasinu PS, Bouic PJ, Rosenkranz B. An overview of the evidence and mechanisms of herb-drug interactions. Front Pharmacol 2012; 3:69. [PMID: 22557968 PMCID: PMC3339338 DOI: 10.3389/fphar.2012.00069] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/05/2012] [Indexed: 12/22/2022] Open
Abstract
Despite the lack of sufficient information on the safety of herbal products, their use as alternative and/or complementary medicine is globally popular. There is also an increasing interest in medicinal herbs as precursor for pharmacological actives. Of serious concern is the concurrent consumption of herbal products and conventional drugs. Herb-drug interaction (HDI) is the single most important clinical consequence of this practice. Using a structured assessment procedure, the evidence of HDI presents with varying degree of clinical significance. While the potential for HDI for a number of herbal products is inferred from non-human studies, certain HDIs are well established through human studies and documented case reports. Various mechanisms of pharmacokinetic HDI have been identified and include the alteration in the gastrointestinal functions with consequent effects on drug absorption; induction and inhibition of metabolic enzymes and transport proteins; and alteration of renal excretion of drugs and their metabolites. Due to the intrinsic pharmacologic properties of phytochemicals, pharmacodynamic HDIs are also known to occur. The effects could be synergistic, additive, and/or antagonistic. Poor reporting on the part of patients and the inability to promptly identify HDI by health providers are identified as major factors limiting the extensive compilation of clinically relevant HDIs. A general overview and the significance of pharmacokinetic and pharmacodynamic HDI are provided, detailing basic mechanism, and nature of evidence available. An increased level of awareness of HDI is necessary among health professionals and drug discovery scientists. With the increasing number of plant-sourced pharmacological actives, the potential for HDI should always be assessed in the non-clinical safety assessment phase of drug development process. More clinically relevant research is also required in this area as current information on HDI is insufficient for clinical applications.
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Affiliation(s)
- Pius S. Fasinu
- Division of Pharmacology, Faculty of Health Sciences, University of StellenboschCape Town, South Africa
| | - Patrick J. Bouic
- Division of Medical Microbiology, Faculty of Health Sciences, University of StellenboschCape Town, South Africa
- Synexa Life Sciences, Montague GardensCape Town, South Africa
| | - Bernd Rosenkranz
- Division of Pharmacology, Faculty of Health Sciences, University of StellenboschCape Town, South Africa
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