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Com/therapy
| Question | Answer |
|---|---|
| Black Cohosh Uses (with or without evidence) (5) | Arthritis Pain (C) Breast Cancer (C) **Menopausal Symptoms(C)- hot flashes estrogen like activity Migraines (C) Labor induction (no evidence) |
| Black Cohosh Dosing | 40-200 mg of dried rhizome daily in divided doses Usual dose: 20-40 mg BID |
| Black Cohosh Side effects (11) | Headache Constipation, GI discomfort, Nausea / Vomiting Hypotension, dizziness Heaviness in the legs Vaginal bleeding Liver toxicity / failure (german black box warning) Thromboembolic disorders Siezures |
| Black Cohosh Warnings and Cautions (5) | Do not confuse with BLUE COHOSH Avoid if allergic to Ranunculaceae (buttercup) and salicylates Caution use in patients with Liver disease, hormone-dependent cancers, or history of blood clots Avoid in pregnancy and lactation Do not use beyond 6 months |
| Black Cohosh Interactions (5) | Antihypertensives (risk of hypotension) Antiplatelet agents Hepatotoxic drugs CYP P450 2D6 substrates (amitriptyline, codeine, metoprolol, paroxetine) Drugs with estrogenic or anti-estrogenic effects (HRT, tamoxifen) |
| Chamomile Uses (with or without evidence) (10) | Cardiovascular conditions (C) **Colic (C) Common cold (C) Dermatitis (C) Diarrhea in children (C) Eczema (C) **GI Conditions (C) Hemorrhoids (C) Mucositis from Chemotherapy (C) **Sleep aid / Sedation (C) |
| Chamomile Dosing | Capsules / Tablets: 400-1600 mg daily in divided dosages Liquid extract (1:1 in 45% alcohol) 1-4 mL TID Tincture (1:5 in alcohol): 15 mL TID Tea: 1-4 cups daily Topical: no standard dose In general there is no set dosage |
| Chamomile Side Effects (4) | Atopic dermatitis Conjunctivitis Drowsiness / Sedation Increased risk of bleeding (an occasional cup should not cause any problems) |
| Chamomile Warnings and Cautions (3) | Many products contain impurities Serious allergic reactions have occurred Avoid in patients allergic to Asteraceae family (aster, chrysanthemum, marigolds, ragweed) |
| Chamomile Interactions (4) | Benzodiazepines (additive effect)- drowsiness CNS Depressants Contraceptive Drugs / Hormone Replacement (large doses compete with estrogen) Warfarin |
| Cinnamon Uses (with or without evidence) (6) | **Diabetes Type 2 (C) Allergic rhinitis (C) Candidiasis (C) H.pylori infection (C) Cancer (C) GI disorders (nausea, vomiting, diarrhea, flatulence, spasms) (no evidence) |
| Cinnamon Dosing | Diabetes: 1 to 6 grams daily for up to 4 months 1 teaspoon = 4.75 grams |
| Cinnamon Side Effects (2) | Well tolerated when used in recommended dosages and durations Allergic reactions may occur |
| Cinnamon Warnings and Cautions (1) | Hepatotoxicity (large doses) more than 7 grams |
| Cinnamon Interactions (2) | Additive hypoglycemia Increased risk of bleeding |
| Coenzyme Q10 Dosing | Standard: 100-200 mg 2 to 3 times a day Up to 1200 mg a day has been taken Dosages over 100 mg should be divided into multiple daily doses >100mg at a time increased GI side effects |
| Coenzyme Q10 Side Effects (5) | Nausea, vomiting Diarrhea Appetite suppression Heartburn |
| Coenzyme Q10 Warnings and Cautions (3) | May lower blood glucose levels Hypotension Increased liver enzymes |
| Coenzyme Q10 Interactions (4) | Antihypertensive medications Warfarin – reduced anticoagulation HMG CoA Reductase Inhibitors Levothyroxine |
| Coenzyme Q10 Uses (with or without evidence) (9) | CoQ10 deficiency (A) **Hypertension (B) **Congestive heart failure (C) Huntington’s disease (D) Parkinson’s disease (C) Athletic performance (C) **Statin-induced myopathy (C) **Hypercholesterolemia (C) antioxident -value unestablished |
| Cranberry Uses (with or without evidence) (5) | H.pylori infection (B) **Prevention of UTI (B)(keeps ecoli from binding to binding to bladder wall) **Treatment of UTI (C) Reduction of odor from incontinence (C) Antioxidant (C) |
| Cranberry Dosing | Prevention: 90-480 mL of cranberry juice cocktail BID OR 15-30 mL of 100% cranberry juice daily Cranberry juice cocktail contains about 30% PURE cranberry juice 300-400 mg cranberry capsules BID |
| Cranberry Side Effects (3) | Hyperglycemia (dont recommend the juice because of suger) GI upset, diarrhea Increase risk of kidney stones (capsule and tablet- avoid use in patients with kidney dysfunction or stones) |
| Cranberry Warnings and Cautions (2) | Avoid if allergic to Vaccinium species (cranberry and blueberry) Large doses may trigger a reaction in patients with a salicylic acid allergy |
| Cranberry Interactions (2) | May inhibit CYP P450 2C9 May increase INR |
| Echinacea Uses (with or without evidence) (6) | **Prevention of Upper Respiratory Tract Infections (B) **Treatment of Upper Respiratory Tract Infections (Adults – B; children – D) Cancer (C) Immune System Stimulation (C) Genital Herpes (D) Vaginal Candidiasis (C) |
| Echinacea Dosing | No standard dose 300-1000 mg daily have been used Capsules, juice, extract, tincture, and tea IV administration not recommended |
| Echinacea Side effects (11) | Allergic reactions, rash Nausea/vomiting, abdominal pain, diarrhea Fever, heartburn, unpleasant taste, dry mouth, mouth ulcers Elevated liver enzymes, kidney failure |
| Echinacea Warnings and Cautions (4) | Children Immunocompromised patients Patients with autoimmune disorders Patients with allergy to Asteracea family or asthma |
| Echinacea Interactions (4) | Hepatotoxic medications (>1000mg daily for long term) Immunosuppressants Echinacea tinctures and metronidazole/disulfiram Caffeine- CYP P450 1A2 Inhibitor – amitriptyline, diazepam, olanzapine, warfarin, etc. |
| Fish Oil Uses (with or without evidence) (7) | High blood pressure (A) **Hypertriglyceridemia (A) **CV Disease Prevention (B) Rheumatoid Arthritis (B) **Artherosclerosis (C) Congestive heart failure (no rating) **Dyslipidemia (D) |
| Fish Oil Dosing | 1-4 grams/day in divided dosages Hypertriglyceridemia: 4 grams/day Heart failure: 1 gram/day – EPA:DHA ratio of 1:1.2 Consume fatty fish at least twice a week |
| Fish Oil Side Effects (3) | GI upset – diarrhea, burping, reflux, indigestion, “fishy burp” Decreased blood pressure Hyperlipidemia |
| Fish Oil Warnings and Cautions (5) | Avoid in patients with fish/seafood allergy Doses > 4 grams may increase bleeding risk May cause manic episode Increased risk of vitamin A, D, E toxicity Risk of methylmercury toxicity |
| Fish Oil Interactions (3) | Medications that increase the risk of bleeding Antihypertensives Antihyperlipidemics |
| Garlic Interactions (4) | Medications that increase risk of bleeding Antidiabetic medications Antihypertensives CYP P450 3A4 substrates (contraceptive drugs, calcium channel blockers, antifungals, saquinavir) |
| Garlic Uses (with or without evidence) | **Hyperlipidemia (B) Antifungal (C) **Atherosclerosis (C) Cancer (C) **Hypertension (C) Peripheral Vascular Disease (C) Diabetes (D) |
| Garlic Dosing | 600-1200 mg daily in divided doses of dry garlic powder Higher doses for hyperlipidemia Standardized to contain allicin 3-5 mg of allicin daily = 2-5 grams fresh garlic; 0.4-1.2 grams dried powder |
| Garlic Side Effects (5) | Bad breath, body odor Allergic reactions Bleeding GI upset: indigestion, belching, N/V, heartburn, diarrhea |
| Garlic Warnings and Cautions (2) | May cause rash/burns if applied topically Contaminated products have been reported |
| Ginkgo Alternative names (9) | Ginkgo biloba; Fossil tree; adiantifolia; EGb; EGb 761; GBE; gincosan; ginkgo balm; oriental plum tree |
| Ginkgo Dosing | 80-240 mg per day divided in 2-3 doses of ginkgo leaf extract Several weeks up to 6 years Standardized to contain 25% ginkgo flavones glycosides and 6% terpine lactones Teas: 3-6mL three times a day (40mg/mL extract) |
| Ginkgo Side Effects (4) | Headache, nausea, intestinal complaints Bleeding |
| Ginkgo Warnings and Cautions (5) | May alter insulin secretion Avoid consumption of ginkgo seeds Do not use in pregnant or breastfeeding females May cause seizures May cause hypomania |
| Ginkgo Interactions (7) | Alprazolam Anticoagulants Antidiabetic medication May inhibit CYP1A2, CYP2C9, CYP2D6, and CYP3A4 May induce CYP2C1 9 Efavirenz (Sustiva) HCTZ |
| Ginseng Uses (with or without evidence) (12) | Diabetes (B) Immune system stimulant (B) Athletic performance (C) Cancer prevention/chemotherapy (C) Coronary heart disease (C) Hypercholesterolemia (C) Hypertension (C) Dementia (C) COPD (C) ADHD (C) Mental performance (C) Respiratory Infectio |
| Ginseng Dosing | No standard dosing |
| Ginseng Side Effects (15) | GI: diarrhea, n/V, loss of appetite, heartburn Rash (spots), itching, Stevens-Johnson syndrome Anxiety, depression, insomnia Headache, fever, dizziness Changes in menstruation, breast tenderness Alterations in blood pressure Hypoglycemia Bleeding |
| Ginseng Warnings and Cautions (3) | Not the same as Siberian ginseng (Eleutherococcus senticosus) Ginseng abuse syndrome possible May have estrogen-like effects |
| Ginseng Interactions (4) | Antidiabetic medications Anticoagulants MAOIs Antihypertensives |
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