For Herbal Medicines

PDR

for Herbal Medicines"

SCIENTIFIC EDITORS Joerg Gruenwald, PhD Thomas Brendler, BA Christof Jaenicke, MD

PHARMACEUTICAL DIRECTOR Mukesh Mehta, RPh

CHIEF EDITOR Thomas Fleming, RPh

ASSISTANT EDITORS Maria Deutsch, MS, RPh, CDE Lori Murray Christine Wyble, PharmD

ASSOCIATE EDITORS Mohammed Hamid, MS, RPh Joseph Nathan, RPh Kavitha Pareddy, MS, RPh Joyce Case Potter Kathleen Rodgers, RPh

PRODUCTION MANAGER Lydia F. Biagioli

DATA MANAGER Jeffrey D. Schaefer

INDEX EDITOR Johanna M. Mazur

SENIOR PRODUCTION COORDINATOR Amy B. Brooks

ELECTRONIC PUBLISHING DESIGNER Livio Udina

PRODUCTION EDITOR Donna Tapellini

PRODUCTION COORDINATOR Arlene M. Phayre DATABASE MANAGER Thomas Dougherty DESIGN DIRECTOR Robert Hartman PUBLISHING STAFF Senior Vice President, Directory Services: Paul Walsh Director of Product Management: Mark A. Friedman

Product Manager: Bill Shaughnessy Senior Business Manager: Mark S. Ritchin Financial Analyst: Wayne M. Soltis Director of Sales: Dikran N. Barsamian National Sales Manager, Medical Economics Trade Sales: Bill Gaffney Director of Direct Marketing: Michael Bennett Direct Mail Manager: Lorraine M. Loening Senior Marketing Analyst: Dina A. Maeder New Business Development Manager: Jeffrey D. Dubin Editor, Directory Services: David W. Sifton Assistant Editor: Gwynned L. Kelly Director of Production: Carrie Williams Manager of Production: Kimberly H. Vivas Index Editor: Robert N. Woerner Senior Digital Imaging Coordinator: Shawn W. Cahill Digital Imaging Coordinator: FrankJ.McElroy.in Fulfillment Managers: Stephanie DeNardi, Louis Bolcik

Copyright ? 2000 and published by Medical Economics Company, Inc. at Montvale, NJ 07645-1742. Ail rights reserved. None of the content of this publication may be reproduced, stored in a retrieval system, resold, redistributed, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written permission of the publisher. PHYSICIANS' DESK REFERENCE?, PDR?, PDR For Ophthalmology?, Pocket PDR?, and The PDR? Family Guide to Prescription Drugs? are registered trademarks used herein under license. PDR For Nonprescription.Drugs and Dietary SupplementsTM, PDRCompanion GuideTM, PDR for Herbal MedicinesTM, PDR? Medical DictionaryTM, PDR? Nurse's Drug HandbookTM, PDR? Nurse's DictionaryTM, The PDR? Family Guide Encyclopedia of Medical CareTM, The PDR? Family Guide to Natural Medicines and Healing TherapiesTM, The PDR?Family Guide to Common AilmentsTM, The PDR?Family Guide to Over-the-Counter DrugsTM, and PDR?Electronic LibraryTM are trademarks used herein under license.

OFFICERS OF MEDICAL ECONOMICS COMPANY: President and Chief Executive Officer: Curtis B. Allen; Vice President, New Media: L. Suzanne BeDell; Vice President, Corporate Human Resources: Pamela M. Bilash; Vice President and Chief Information Officer: Steven M. Bressler, Chief Financial Officer: Christopher Caridi; Vice President and Controller: Barry Gray; Vice President, New Business Planning: Linda G. Hope; Vice President, Finance: Donna Santarpia; Senior Vice President, Directory Services: Paul Walsh; Senior Vice President, Operations: John R. Ware; Senior Vice President, Internet Strategies: Raymond Zoeller

ISBN: 1-56363-361-2

Contents

Foreword

Alphabetical Index Lists all scientific, common, and brand names found in the herbal monographs.

Therapeutic Category Index Groups herbs by therapeutic or medicinal category. Listings are alphabetical by category and accepted common name. Herbs deemed effective by Commission E are flagged for quick recognition.

Indications Index Lists herbs by their primary indications. Entries are alphabetical by indication and accepted common name. Herbs deemed effective by Commission E are specially flagged.

Homeopathic Indications Index Catalogs herbal applications in homeopathy. Entries are alphabetical by indication and scientific name.

Asian Indications Index Groups herbs by their therapeutic uses in Chinese and Indian medicine. Listings are alphabetical by indication and accepted common name.

Side Effects Index Groups herbs by the adverse reactions with which they have been associated. Listings are alphabetical by reaction and accepted common name.

Drug/Herb Interactions Guide Lists problem combinations alphabetically by the name of the drug and the name of the interacting herb, and provides a brief description of each combination's potential effect.

Safety Guide Lists herbs that must be avoided while pregnant or nursing, and herbs that should be used only under professional supervision. Includes all scientific, common, and brand names.

Manufacturers Index Provides contact information for each supplier whose products appear in the monographs.

Herb Identification Guide Permits rapid, positive identification of unknown botanicals. Includes nearly 400 full-color photos.

Product Identification Guide Present photos of a representative group of popular commercial formulations.

Herbal Monographs Profiles of 700 medicinal herbs, including trade names, description, actions, indications, contraindications, precautions, adverse effects, overdosage, dosage, and literature citations. Organized alphabetically by accepted common name, and cross-referenced by scientific name.

Glossary A key to the specialized botanical nomenclature and other unfamiliar terminology employed in the herbal monographs.

Poison Control Centers

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IV

Foreword

PDR FOR HERBAL MEDICINES

With 150,000 copies of its first edition in print, PDR for Herbal Medicines has almost instantly become one of the nation's leading pharmacological references. The reasons for its phenomenal reception are evident. Hundreds of herbal remedies now fill the shelves in virtually every supermarket and pharmacy, and the popularity of self-medication with "natural" supplements continues to rise, making the benefits--and risks--of these preparations an ever more compelling concern.

Now, to better address the host of questions that still surround most herbal remedies. Physicians' Desk Reference? is proud to present this completely revised and updated second edition of PDR for Herbal Medicines. Significantly enhanced and expanded, this new edition extends both the range and depth of the original volume. Among the many improvements you'll find:

ing--the findings of the German Regulatory Authority's herbal watchdog agency, commonly called "Commission E." This agency has conducted an intensive assessment of the peer-reviewed literature on some 300 common botanicals, weighing the quality of the clinical evidence and identifying the uses for which the herb can reasonably be considered effective. Its conclusions represent the best expert consensus on medicinal herbs currently available.

For the herbs not considered by Commission E, PDR for Herbal Medicines provides the results of an exhaustive literature review conducted by the respected PhytoPharm U.S. Institute of Phytopharmaceuticals under the direction of noted botanist, Dr. Joerg Gruenwald. These additional monographs, now some 400 in number, provide a detailed introduction to an array of exotic botanicals that you'll be hard pressed to find in any other source.

? Broader Coverage: With some 100 new entries, the book now covers a total of 700 botanicals, including a wide selection of popular Chinese herbs. ? More Research Data: Hundreds of entries have been augmented with additional information on safety and efficacy. ? Additional Adverse Effects: The entries include new information on drug/herb interactions. The Side Effects and Interactions indices have been enriched and expanded ? Available Formulations: Whenever applicable, the herbal monographs now list the names and suppliers of popular commercial preparations. ? New Indices: The index section has been enhanced with four additional indices: -- Homeopathic Indications Index -- Asian Indications Index -- Safety Guide -- Manufacturers Index ? Better Organization: In this edition, remedies appear under their more familiar common name, instead of their botanical designation. All monographs are cross-referenced by scientific name.

One important aspect of the first edition does, however, remain constant. Because it is still extremely hard to come by reliable information on the swarm of unregulated "dietary supplements" in today's marketplace, this new edition continues to provide you with the closest available analog to FDA-approved label-

To make the information in the monographs as useful and accessible as possible, PDR? has echoed the structure of standard U.S. product labeling. Each monograph contains up to ten standard sections, covering considerations ranging from description to dosage. Here's a closer look at what you will find:

? Title: Each monograph begins with the herb's generally accepted common name, followed by its scientific name. In addition, all monographs are crossreferenced by their botanical designation.

? Trade Names: Listed here are common commercial preparations of the herb.

? Description: This section provides a detailed botanical overview of the herb, including information on its medicinal parts; flower and fruit; leaves, stem, and root; unique characteristics, habitat, production, related plants, and additional common names and synonyms.

? Actions and Pharmacology: Here you'll find data on the active compounds or heterogeneous mixtures found in the plant, followed by a summary of the herb's clinical effects. If various parts of the plant possess different pharmacological activity, the parts are discussed individually, here and throughout the remainder of the monograph.

FOREWORD

V

? Indications and Usage: Information on the uses of the herb is listed under five categories, as applicable: -- Approved by Commission E -- Unproven Uses -- Chinese Medicine -- Indian Medicine -- Homeopathic Approved uses are presented in list fashion. Other uses are described with provisos as necessary regarding route and form of administration.

? Contraindications: Although most natural remedies can be used under all medical circumstances, a few pharmacologically potent herbs must be avoided in the presence of certain medical conditions. If any such contraindications exist, they are summarized here.

? Precautions and Adverse Reactions: Found in this section are any cautions or special considerations regarding safe use of the herb, including any restrictions on use in pregnancy or childhood. Although most herbal remedies are notably free of known side effects, any reported in the available literature are noted here.

? Overdosage: As we all know, "natural" is not synonymous with "benign," and an overdose of many "healing" herbs can have serious--even fatal--consequences. Whenever adverse effects of overdose have been found in the literature, they are reported here, along with the appropriate medical interventions to be undertaken when an overdose occurs.

? Dosage: Listed here are common modes of administration, forms and strengths of available commercial preparations, methods for preparing the natural herb, and representative dosage recommendations drawn from the literature. Note, however, that dosage recommendations can be used only as a general guide. The potency of individual preparations and extracts is subject to substantial variation, so the manufacturer's directions should be consulted whenever available.

? Literature: This section provides you with a unique bibliography of the technical literature. Because German researchers have been particularly active in the herbal arena, you will find an unusual number of German-language citations. However, work in the English literature is included as well.

To assist you in quickly locating the information you require, the monographs have been indexed by name, therapeutic category, general indications, homeopathic indications, Asian indications, and side effects. To aid you in evaluating potential risk, a drug/herb interaction guide and a safety guide are also included. An index of manufacturers completes the set. Here's an overview of what each index provides: .

? Alphabetical Index: This index includes all scientific, common, and brand names found in the herbal monographs, together with appropriate page numbers.

? Therapeutic Category Index: This index lists the monographs and their page numbers, alphabetically by accepted common name, under appropriate therapeutic category headings. Herbs deemed effective by Commission E are flagged with a (?) symbol at their left. To facilitate comparison with prescription and nonprescription drugs, PDR's standard therapeutic categories are used throughout.

? Indications Index: This index lists herbs and their page numbers, alphabetically by accepted common name, under their various indications. Herbs deemed effective for the indication by Commission E are flagged with a (?) symbol at their left. To help you quickly identify conventional alternatives, the indication headings match those found in PDR's Indications Index, which appears in the PDR Companion GuideTM and the PDR Electronic Library TM CD-ROM.

? Homeopathic Indications Index: Included in this index are only the uses found in homeopathy. Herbs, which homeopaths typically prescribe by scientific name, are listed here in the same manner, followed by their accepted common name in parentheses. As in the main indications index, headings are chosen to match those in the PDR Companion Guide.

? Asian Indications Index: Entries in this index are limited to uses found in Chinese and Indian medicine. (Chinese entries are signified with a "C;" Indian entries with an "I.") Herbs are listed by accepted common name. Once again, indication headings employ the nomenclature used in the PDR Companion Guide.

? Side Effects Index: In this index, you'll find a list of all herbs associated with a given adverse reaction. Herbs are listed alphabetically by accepted common name, with the scientific name and page number

VI

PDR FOR HERBAL MEDICINES

appended. Nomenclature employed in the side effect headings matches that used in PDR's Side Effects Index, another feature of the PDR Companion Guide and the PDR Electronic Library CD-ROM.

? Drug/Herb Interactions Guide: In this convenient reference, each potential interaction is listed under both the name of the drug and the name of the interacting herb. A brief description of the interaction's effect follows each item.

? Safety Guide: This section lists botanicals in three precautionary categories: -- Not for use during pregnancy -- Not for use while nursing -- For use only under supervision Here, the scientific, common, and brand names of all herbs in each category are listed alphabetically, together with the appropriate page number for further information.

? Manufacturers Index: This index provides you with contact information for each supplier whose products appear in the herbal monographs. The names of the products, together with the page number of the monograph in which they appear, are included in each manufacturer's entry.

Following the indices, just as in PDR itself, you'll find an extensive full-color identification section. The first part of the section--the Herb Identification Guide-- encompasses nearly 400 of the most widely used herbs. The second part--the Product Identification Guide--includes photos of some of the more popular commercial formulations. Together, these guides provide you with a truly unique reference unmatched in any other printed resource. We've also included a brief glossary of the unfamiliar terms found in the monographs.

PDR for Herbal Medicines is the product of one of the most thorough and inclusive examinations of the herbal literature ever undertaken. Nevertheless, it's important to remember that it merely summarizes and synthesizes key data from the underlying research reports, and of necessity includes neither every published report nor every recorded fact.

As in all scientific investigation, conclusions regarding the effectiveness of the herbs discussed in this compendium are based on the preponderance of current

evidence and cannot be considered firm or final. The publisher does not warrant that any herb will unfailingly and uniformly exhibit the properties ascribed to it by Germany's Commission E or any other scientific authority.

In the United States, herbal products are marketed under the provisions of the Dietary Supplement and Health Education Act of 1994, which prohibits their sale for the diagnosis, treatment, cure, or prevention of any disease. Enumeration of specific commercial preparations within an herbal monograph should not be construed as a claim or warranty of their efficacy for any purpose, by either the manufacturer or the publisher. Furthermore, it should be understood that, just as omission of a product does not signify rejection, inclusion of a product does not imply endorsement, and that the publisher is not advocating the use of any product or substance described herein.

Please remember, too, that dosing of herbal preparations is highly dependent on a variety of factors, such as cultivation and harvesting conditions, the specific parts of the plant to be processed, the extraction methods employed, and the dosage form chosen by the manufacturer. Since there are no official standards governing the production of herbal medicines in the United States, and the potency and the purity of herbal products are subject to substantial variation, dosage ranges set forth in the herbal monographs must be employed only as general guidelines.

In addition, the publisher does not guarantee that every possible hazard, adverse effect, contraindication, precaution, or consequence of overdose is included in the summaries presented here. The publisher has performed no independent verification of the data reported herein, and expressly disclaims responsibility for any error, whether inherent in the underlying literature or resulting from erroneous translation, transcription, or typography.

When patients approach you--as they surely will--for advice on the latest herbal "discovery" to hit the nightly news, we hope that PDR for Herbal Medicines will provide you with all the facts you need to offer sound, rational guidance firmly grounded in fact. Certainly such counseling is the aim of every dedicated health care professional. And at PDR, we fully share that goal.

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