Transcript Chapter 16 Cholinesterase Inhibitors

Chapter 107
Dietary Supplements
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Dietary Supplements
FDA definition:
“vitamins, minerals, herbs or other botanicals,
amino acids, and substances such as
enzymes, organ tissues, glandulars, and
metabolites” intended to supplement the diet
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Regulation of Dietary Supplements
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The Dietary Supplement Health and
Education Act (DSHEA) of 1994
Package labeling
Adverse effects
Impurities, adulterants, and variability
National Center for Complementary and
Alternative Medicine
Promotional materials
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Regulation of Dietary Supplements
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Dietary Supplement and Nonprescription
Drug Consumer Protection Act of 2006
FDA Current Good Manufacturing Practices
(CGMPs) ruling, 2007
Quality certification programs
Standardization of dietary supplements
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Common Herbal Remedies
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Black cohosh
Coenzyme Q-10
Cranberry juice
Echinacea
Feverfew
Flaxseed
Garlic
Ginger root
Ginkgo biloba
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Common Herbal Remedies
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Glucosamine
Green tea
Probiotics
Saw palmetto
Soy
St. John’s wort
Valerian
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Harmful Supplements to Avoid
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Comfrey
Kava
Ma huang (ephedra)
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Black Cohosh
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Cimicifuga racemosa
Used to treat symptoms of menopause
MOA unknown
Effectiveness
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Some studies have shown it to be as effective as
estrogen
Has not been evaluated for long-term use
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Black Cohosh
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Drug interactions
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May potentiate antihypertensives and the
hypoglycemic effect of oral agents and insulin
Adverse effects
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Safe for routine use
GI are most common side effects
Also rash, headache, dizziness, weight gain, and
cramps
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Coenzyme Q-10
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Potent antioxidant in the body; participates in
production of ATP at the mitochondrial level
Therapeutic uses
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Mitochondrial encephalomyopathies, CHF, and
myopathies due to HMG-CoA reductase inhibitors
(statins)
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Coenzyme Q-10
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Adverse effects
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Well tolerated, may have GI symptoms
Drug interactions
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CoQ-10 is structurally similar to vitamin K2 and
may antagonize the effects of warfarin
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Cranberry Juice
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Therapeutic use
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Effectiveness
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Prevents UTI
The proanthocyanidins it contains interfere with
bacterial adhesion to the urinary tract
Daily intake helps prevent UTIs in women in their
teens or 20s and elderly women – not older adults
or young girls
Contradictory evidence that cranberry juice
may increase INR of warfarin patients
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Echinacea
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Echinacea angustifolia, E. purpurea,
E. pallida
Used orally and topically
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Produces antiviral, anti-inflammatory, and
immunostimulant effects
Widely taken, but effectiveness is highly
questionable
Interactions
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May interfere with immunosuppressant drugs
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Feverfew
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Used primarily for prophylaxis of migraine
MOA not well understood
Has shown to be effective
Adverse effects
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Well tolerated, no serious effects
Mild GI reactions
Long-term safety studies are lacking
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Flaxseed
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Used to treat dyslipidemia and constipation
Soluble plant fiber
Seems to decrease total cholesterol and LDL,
similar to other fiber products
Adverse effects are GI-related (bloating,
cramping, etc.)
Should be taken 1 hour before or 2 hours
after other medications
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Garlic
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Used primarily for cardiovascular system
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To reduce levels of TG and LDL and raise HDL
Also used to reduce blood pressure,
suppress platelet aggregation, increase
arterial elasticity, and decrease formation of
atherosclerotic plaque; antimicrobial and
anticancer effects
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Garlic
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Can have favorable effects on blood pressure
and plasma lipids
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Must be raw, not cooked (allicin and allinase)
1-2 cloves twice daily for effect
Only 5 of 18 common garlic products contain
allicin in effective amounts
Generally well tolerated except for unpleasant
taste and bad breath
Has significant antiplatelet effects
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Ginger Root
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Primary uses
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To treat vertigo
To suppress nausea and vomiting caused by
motion sickness or morning sickness; to suppress
post-op nausea and vomiting
For cancer chemotherapy
Can suppress platelet aggregation
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Additional Supplements
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Ginkgo
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Glucosamine
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Generally well tolerated
Use with caution in patients with shellfish allergy
Increased risk for bleeding
Green tea
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Overconsumption leads to caffeine overdose
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Additional Supplements
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Probiotics
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Saw palmetto
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Generally well tolerated – some GI effects
Conflicting results in treatment of BPH
May have antiplatelet effects
Soy
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Should not be used with antiestrogenic
medications (tamoxifen)
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St. John’s Wort
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Widely used to treat depression
Limited clinical studies show St. John’s wort
is useful for mild to moderate depression –
not severe depression
No prescription needed in United States
Interacts adversely with many drugs
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Induction of cytochrome P450 enzymes
 Induction of P-glycoprotein
 Intensification of serotonin effects
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Additional Supplements
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Valerian
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Generally well tolerated
Does not seem to potentiate CNS depressant
effects of alcohol, but this may occur
Used as a tranquilizer in World War II
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Harmful Supplements
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Comfrey
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Kava
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Contains pyrrolizidine alkaloids that are
associated with veno-occlusive disease
Can result in severe hepatic damage
Ma huang (ephedra)
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Can elevate BP and stimulate the heart and CNS
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