|Type of paper:||Research paper|
A growing number of the world population is increasingly using herbal products for therapeutic and preventive purposes. Manufacturers of such products are not constrained to submit proof of efficacy and safety by the relevant drug and food administration agencies before marketing. For such reasons, the adverse impact and the resultant drug interactions related to herbal remedies remain mostly unknown. Ephedra is widely used for its purported medicinal effect although it has been extensively implicated for its adverse interactions (Stargrove, Treasure & McKee, 2008). Ephedrine-containing herbal products have for long been related to the seizures, adverse cardiovascular events, and deaths. Therefore, physicians need to take into consideration the drug interaction and adverse effect associated with herbal remedies, and patients should be consulted about their use and reaction to these products.
Over the years, alternative therapies, including herbal remedies are being used globally. About twenty-five percent of Americans who visit physicians on serious health concerns employ unconventional therapeutic approaches although only seventy percent of these patients include such details in the medical history. Herbal products are barely tested with the necessary rigor for prescribed drugs, and such products are not subject to the standard approval process. Therefore, herbal products cannot be promoted for the treatment, diagnosis, prevention or cure of diseases. Nonetheless, the 1994 Act, the Dietary Supplementary Health and Education permit the labeling of these products with statements enumerating their purported role in the promotion of wellbeing. These roles include pain alleviation, strengthening of human body structure and function, and mood enhancement. Analysis of the various putative effects of these products depicts that they often firmly take after the clinical efficacy for different conditions and diseases. Unlike the traditional drugs, herbal remedies are unregulated for potency and purity. Therefore, some drug interactions and adverse effects noted can be related to impurities, such as pollen, spores, and allergens or batch-to-batch variability.
Despite the role of ephedra as a medicinal extract, it is considered a banned substance in numerous jurisdictions because of safety concerns. Ephedra and Mormon tea are often confused, yet the latter is an extract of Ephedra nevadensis. Mormon with the former sourced from Ephedra sinica. Ephedra nevadensis is devoid of chemicals associated with the side effects associated with ephedra. The banned substance is mainly used for obesity and weight loss, as well as the performance enhancement, nasal decongestion, and treatment of various respiratory conditions, such as bronchitis and asthma. Notwithstanding the continued use of the substance in the treatment of the above diseases, its efficiency remains a significant concern as herbal remedies are not subject to the rigorous approval process familiar with other traditional medicines.
Pharmacologically, ephedrine and the associated alkaloids are the active moieties of the Ephedra extract. Ephedrine comprises between thirty to ninety percent of the Ephedra species alkaloids. Ephedrine and related alkaloids are the pharmacologically active moieties of the extract of Ephedra (a genus of shrubs).19 Ephedrine constitutes 30 to 90 percent of the alkaloids of Ephedra, and with some containing pseudoephedrine. Ephedra is commonly a constituent of weight-loss products, and numerous weight loss retail outlets and clinics market herbal products as Pondimin (fenfluramine) and Redux (dexfenfluramine) alternatives, the anorexiant prescription recently phased out from the US market. Further, the Herbal fen-phen products contain the St. John's wort, commonly referred to as "herbal Prozac."
Ephedrine-containing products are similarly promoted as stimulants, bronchodilators, and decongestants. Some dealers market it as performance enhancers in athletics and body-building endeavors. Promoted uses ephedrine as "herbal ecstasy" entails the heightening of sexual sensation and awareness, as well as induction euphoric state. Health agencies have advised consumers from using ephedrine associated products advertised as street drugs' alternatives. Over the past few years, scholars have examined more than eight hundred reports on adverse interactions related to over a hundred different drugs containing or thought to contain ephedra alkaloids (Stargrove, Treasure & McKee, 2008). Some of the adverse reactions reported include nervousness, insomnia, headaches, insomnia, seizers, hypertension, cardiac arrest, arrhythmias, and death. About fifty-six percent of these reported cases occurred on persons aged below forty years with twenty-five percent being people in the age between forty and forty-nine. The comparatively young age upon which severe cardiovascular events did happen is a significant concern.
Consequently, the findings of the studies on cardiovascular effects promoted the introduction of dosage limit of eight milligrams per every six hours with regards to ephedra alkaloids. The standard rule additionally stipulates the labels that advise consumers to use ephedrine-containing products for not more than seven days with directions that over-dosage can result in heart attack or death. The Food and Drug Administration (FDA) believes that serious effects can emanate from the use of ephedrine-containing products at a dosage of twenty-four milligrams. Additionally, life-threatening reactions have occurred and reported with a dosage of between one and five milligrams (dosage of four to twenty milligram per day). The agency is similarly concerned that arrival of the dosage limit is an implication that a safe dose certainly exists.
Ephedra-containing products also tend to be associated with the kidney stones condition. Ephedrine, metabolites, and pseudoephedrine comprise almost hundred percent of a radiolucent stone detached from a young bodybuilder who self-administered 12 Pro-Lift tablets on a daily basis. Of the tablets found, each contained roughly ten milligrams of ephedrine. Information from a database on kidney stone demonstrates that the above case is an isolated incident. The risks associated with the use of ephedrine-based supplements seem to outweigh the expected benefits. According to Stargrove et al. (2008), patients should be informed that they should avoid using these herbal remedies, particularly those that demonstrate sensitivity to sympathomimetic agents' effect. Such group of patients includes those diagnosed with hyperthyroidism, psychiatric conditions, hypertension, diabetes mellitus, seizures, prostate enlargement, and cardiovascular diseases. Besides, concomitant use of ephedra-containing products as an alternative stimulant should be discouraged.
Because of the growing popularity of dietary supplements, there is the need for physicians to inquire more about the use of herbal remedies in the medical history, despite the availability of herbal medicines without prescription and approval, medical guidance is vital since the adverse effects of such products and the possible drug interactions are a real concern. As a result, physicians should be well versed with the trend in the use of dietary supplements, taking into consideration that the adverse effects and the resultant drug interaction of ephedra and other common supplements are not well characterized. Additionally, the potency of these products can increase the potential of adverse effects. Because there is an increased chance of physicians encountering patients who have a history of using herbal remedies, there should be an increased level of awareness on the possible effects of these drugs. Further, they should be aware of the herbal remedies' adverse effects and the potential of harmful drug interactions.
Stargrove, M. B., Treasure, J., & McKee, D. L. (2008). Herb, nutrient, and drug interactions: Clinical implications and therapeutic strategies. St. Louis, Mo: Mosby Elsevier.
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