Complementary Medicines for the Common Cold, Flu, Sinusitis and Coughs (2.3) Flashcards
A) What are some nutritional supplements for cold + flu/ URTI
B) What are some herbal supplements for colds + flu/ URTI
A)
- Vitamin C and Zinc
B)
- Echinacea
- Andrographis
- Elderberry
- Pelargonium
- Ivy Leaf Extract
- Garlic
- Horseradish
- Olive Leaf
For vitamin C (essential dietary nutrient);
A) Can humans synthesise it, what is the dietary form of vitamin C
B) Actions?
C) Does it work for preventing a common cold?
D) Does it work for treating a common cold?
E) What are some adverse effects
F) interactions (useful and not so useful)
G) What decreases vitamin C levels?
A)
- Humans CANNOT synthesise vitamin C
- Ascorbic acid –> major dietary form of Vitamin C
B)
- Antioxidant
- Involved in many biochemical processes;
> Neurotransmitter and hormone synthesis
> Maintenance of connective tissue, immune function, adrenal function
C)
- Prevention of common cold ONLY in extreme conditions (E.g. reducing the risk of getting a cold in extreme atheletes)
- Regular prophylatic ingestion of Vitamin C does not reduce the incidence of a common cold (may reduce symptoms and duration of cold)
D)
- Inconsistent effects seen with Vitamin C as a treatment for common cold
E)
- High oral doses may cause loose stools
- Supplements should be taken in divided small oral doses at regular intervals
- Degree of absoprtion decreases as dose increases (saturation)
F)
Useful/important interactions
- Vitamin C enhances absorption of iron
- Vitamin C increases levels of paracetamol and oestrogen
Vitamin C increases side effects of
- Aluminum containing antacids esp. in renal failure patients (avoid concomitant use)
G)
Vitamin C levels decreased by;
- Corticosteroids
- Smoking
- Oral contraceptives
For Zinc;
A) What are some of the uses in the body
B) What some of its uses in the common cold?
C) Does it treat colds
D) does i tprevent colds
A)
- Co-factor for > 300 different enzymes, including: Superoxide dismutase (antioxidant pathway) + carbohydrate and protein metabolism
- Required for growth and devlopment
- Essential for normal immunological function
- Has neuro-modulatory effects
- Antioxidant
- Regulates insulin and activity and thyroid hormone
- Required for reproductive health
B)
- Inhibits viral replication
- Disrupts infection
- Modulates inflammatory cytokines and histamine release (may reduce symptoms)
C)
- Zinc (>- 75mg/day) administered within 24 hours of onset of symptoms reduces duration and severity of common cold in healthy people
- Maintain dose for duration of cold
D)
- Insufficent data
For Echinacea;
Echinacea purpurea (Purple Coneflower)
A) What are the plant parts used?
B) What are some constitutents found in them?
C) What are some therapeutic properties?
D) Any use in URT infections?
E) Treatment for URTI and common cold
F) Prevention for URTI and common cold
G) What are some complicating factors in evaluating echinacea
H) Does it treat rhinoviruses
I) Adverse effects
J) Safety concerns
A)
- Roots (E. angustifolia and E. pallida)
- Aerial parts and roots (E. purpurea)
B)
- Alkamides (Immunostimulants + anti-inflammatory)
- Polysaccharides (Immunostimulants + antiviral activity)
- Caffeine acid derivatives (Antiviral and antibacterial acitivity + potent anti-oxidant activity)
C)
- Immunostimulant / immunomodulator
- Anti-inflammatory
- Antiviral
- Anti-fungal
- Anti-oxidant
D)
- Evidence for prevention greater than for acute treatment
- Greater benefits in adults than children
- Benefits are due mainly to the plant E.purpurea –> recommend this species for URTI
E)
- Conflicting results
- Modest benefits in adults
- Improves symptoms and rate of recovery
- Commence early at first signs
- Supportive tx in URTI
F)
- Prophylatic use may result in a reduction in the incidence of colds
- Individuals with poor immune response, higher stress levels, higher susceptibility to colds –> more likely to see benefits
G)
Preparations differ greatly in
- Types (echinacea species)
- Plant parts used (herb, root, or both) of the plant are used
- Manufacturing methods
- If other herbs were added to the formulation
H)
- One Echinacea study reported that there was no clinically significant effects in treatment of rhinovirus infection but study was with wrong plant, taken with wrong dose and wrong duration
I)
- Generally well tolerated
- Individuals with asthma or atopy may be predisposed to allergic reactions
J)
- Can be used in prengancy and lactation on short term basis
- Caution in progressive, systemic disease
- Echinacea has immunostimulant actions
- Caution with if taking immunostimulant or immunosuppressive drugs
For Andrographis;
Andrographis paniculata
A) What are some key constituents
B) Main actions?
C) Treatment of URTI/common cold?
D) Prevention of URTI/common cold?
E) Adverse reactions?
F) Precautions
G) Safe to use in pregnancy in lactation?
H) Interactions?
A)
- Andrographolides (bitter diterpenoid lactones)
- Flavonoids
B)
- Immunostimulant
- Anti-microbial
- Antipyretic and anti-inflammatory
C)
- Reduces cold symptoms significant by >50 % aftter 5 days of treatment
- More effective than placebo in treating URTI
- Effective in reducing severity and duration of URTI when treatment started within 36-48 hours of symptoms
D)
- Reduction in incidence of colds compared to placebo
- Nothing for URTI
E)
- Generally well tolerated
- Vomitting, anorexia have been reported at high doses
F)
- Recommended that therapy should be discontinued 1 week prior to surgery (anticoagulant effect)
G)
- Not recommended
H)
Anti-coagulants and antiplatelet drugs
- Andrographolides shown to inhibit platelet aggregation
- Increased risk of bleeding and bruising
- No clinical effects seen when used with warfarin
- Observe in combination with antiplatelet drugs
Oral hypoglycaemic
- Additive effects theoretically possible (e.g. Metformin) as andrographis has hypoglycaemic acitvity
Immunosuppressive drugs
- Reduced drug activity theoretically possible (antagonistic effect) –> Use combination with caution
For elderberry;
Sambucus nigra
A) What are some key constituents?
B) Actions
C) Clinical use in influenza?
D) Safety?
A)
- Flavonoids (quercetin, isoquercetin, rutin, astragaline)
- Essential oil
- Anthocyanins
B)
- Antiviral
- antibacterial
- antioxidant
- immunostimulating
- anti-inflammatory
- diaphoretic
C)
- Evidence of benefit in influenza
- Flu symptoms improved in 93% of patients and duration of illness reduced from 6 days to 3 days
- Antimicrobial activity against influenza A and B
D)
- Well-tolerated
- Caution with immunosuppressants
- Considered safe in children, adults and elderly
- Likely safe for pregnancy/lactation
For Pelargonium;
Pelargonium sidoides
A) What is it used for (TGA registered product)
B) MOA?
C) Clinical uses?
D) Safety and practice points
A)
- Treatment of acute bronchitis
- Treatment of acute sinusitis
B)
- Increase in ciliary beat to remove mucus
- Antibacterial activity identified (appears to prevent attachment of bacteria to mucous membrane cells)
- May have immunomodulatory properties
- Antiviral properties have also been identified
C)
Clinical use in acute bronchitis –> suitable as treatment
- Shown to reduce symptoms of acute bronchitis by day 7 of Tx according to RCTs
- Benefit shown in both adults and children
Clinical use in acute sinusitis –> suitable as treatment
- May alleviate symptoms of sinusitis in adults after 10 days Tx
D)
- Well tolerated
- Caution with immunosuppressant drugs
- LIkely safe for pregnancy/lactation
- Useful for > 2 year old
For Ivy Leaf Extract;
Hedera helix
A) What is it used for?
B) Can it be used in children?
A)
- Commonly used in paediatric cough mixtures
- Shown to have expectorant and mucolytic properties
- Good evidence of benefit has been shown in one study for reduction of cough and viscous mucus.
B)
- Have become popular as an alternative to drug therapies especially in children <6 years
- Although evidence is limited, products containing ivy leaf extract are still use
For panax ginseng (korean ginseng);
A) What is it used for?
B) What is its mode of action?
A)
- Has been shown to improve immune function, especially in patients with URTI- e.g. colds and ‘flu.
- Reduced duration and symptoms of common cold
B)
- Stimulates T-cell and PMN leukocyte activity
- Improves immune response
For siberian ginseng;
A) What does it do?
Immunomodulatory effects
- Shown to enhance immune function (may increase resistance to infection).
- Antiviral activity demonstrated in vitro especially against viruses affecting the respiratory tract
- Shown to reduce the frequency of viral herpes outbreaks
For Garlic;
Allium sativum
A) What are the main active constituents? What do they do?
B) Prevention of common cold?
C) Adverse effects
D) Contraindications, warning and precautions
E) Pregnancy and lactation
F) Interactions
A) Allicin and Ajoene (pharmacological action in immne system and cancer)
Allicin; Responsible for most of immune system benefits
- Powerful bacteriostatic against a number of pathogens
- Active against gram positive and gram negative bacteria
- Antimalarial and antifungal activity demonstrated in vitro
- Activates and promotes macrophage activity
Ajoene;
- Has antioxidant, antiplatelet, antimicrobial, tumour inhibitory actions
- Apoptosis promotion (in vitro) → Anti-cancer effect (mainly prevention)
B)
- Garlic may prevent occurrences of the common cold
- Most of the antimicrobial acitvity seen with garlic is against bacteria not viruses
C)
- Allergic reactions
- Nausea and heartburn
- Abdominal discomfort, diarrhoea
- Headache, myalgia and fatigue were reported in one study
D)
- Avoid high doses of garlic in those with bleeding abnormalities (>7g/day)
- Suspend high dose supplements 1 week before surgery
- Dietary intake thought to be safe
E)
- Not recommended at doses > usual dietary intakes
F)
Anticoagulants (e.g. warfarin)
- Effects theoretically possible at high doses
- Use with caution
Antiplatelets
- Effects theoretically possible at high doses
- In excess of usual dietary intake
- Observe patients on both therapies
Antihypertensives and antihyperlipidaemics
- Theoretical potentiation (enhanced management of disease)
- Beneficial interaction
Saquinavir and ritonavir (HIV drug)
- garlic may reduce blood levels of saquinivir and ritonavir (via induction of P450 enzyme activity)
- May reduce derug efficacy
- Avoid concurrent use
For horseradish;
Armoracia rusticana
A) Clinical uses?
A)
- Horseradish is said to have antibiotic activity
- Effectiveness as a single therapy unclear
- Said to be used foor respiratory and urinary infection, renal stones, oedema, inflamed joints BUT
- The wide popularity of this herb within the general public is not supported by clinical evidence
What is Olive Leaf Extract used for?
- Anti-infective therapy
- Support immune system?
- Some activity observed against E.coli, candida and HIV-1 but no studies to support
- Not supported by data for anti-infective agent
- Other supplements are better
- Not recommended as monotherapy for colds/flu based on lack of evidence
Summarise what can be you used as cold and flu prevention in term of effectiveness
Summarise what can be you used as cold and flu treatment in term of effectiveness
Summarise what can be used as cough and bronchitis treatment in term of effectiveness
