Table e4–2 provides an overview of selected botanical medicines.
Table e4–2.Overview of selected botanical medicines (listed in alphabetical order). ||Download (.pdf) Table e4–2. Overview of selected botanical medicines (listed in alphabetical order).
| ||Leading Indications ||Dosage ||Level of Evidence1 ||Safety2 ||Interactions; Side Effects ||Comments |
|Asian ginseng (Panax ginseng) ||Immune enhancement, cognitive function ||200–600 mg once daily extract; 1–2 g crude drug ||C: multiple studies but few for any given indication ||I ||Use independently tested products || |
|Butterbur (Petasites hybridus) ||1. Migraine prevention ||50–100 mg two times daily ||1. B ||I ||Belching, dyspepsia ||Product must be certified pyrrolizidine alkaloid-free |
|2. Allergic rhinitis ||2. B |
|Echinacea (purple coneflower) ||1. Treatment of URIs ||500–1000 mg or 2.5–5 mL tincture three times daily ||1. C ||I ||None known: rash, pruritus, nausea ||Avoid in patients with autoimmune disorders; avoid use > 4 weeks |
|2. Prevention of URIs ||2. C |
|Garlic (Allium sativum) ||1. Hyperlipidemia ||200–400 mg three times daily ||1. C ||I || |
May have antiplatelet activity
|2. Hypertension ||2. B |
|3. Atherosclerosis ||3. C |
|Ginkgo biloba (EGb 761, GBE) ||1. Dementia ||60 mg three times daily ||1. B ||II ||Conflicting evidence about possible antiplatelet effect ||Avoid crude ginkgo |
|2. Claudication ||2. C |
|St. John's wort (Hypericum perforatum) ||1. Depression: mild to moderate ||300 mg three times daily ||1. A ||I ||Significantly induces cytochrome P450, leading to lower serum levels of certain drugs ||Cyclosporine, protease inhibitors, oral contraceptives, alprazolam, warfarin, digoxin levels reduced |
A. ST. JOHN'S WORT (Hypericum Perforatum)
St. John's wort is a perennial plant with a yellow flower native to Europe and naturalized to North America. Most preparations are standardized to hypericin or hyperforin. St. John's wort inhibits serotonin, norepinephrine, and dopamine reuptake in the CNS and may modulate autonomic system reactivity. Data from 35 double-blind, randomized, controlled trials (RCTs) show that dropout and adverse event rates in patients receiving Hypericum extracts were less than for tricyclic antidepressants or SSRIs. Side effects include GI upset, photosensitivity, mild headache, and restlessness. Cases of withdrawal symptoms like those that occur with pharmaceutical antidepressants have been described, so gradual tapering of dose is recommended when therapy is terminated. Patients are advised to avoid taking St. John's wort in combination with prescription antidepressants because there have been case reports of the serotonin syndrome. Importantly, St. John's wort also potently induces the cytochrome P450 system (isozyme CYP3A4), which may ...