PHARMACOLOGY

M.13 DIETARY SUPPLEMENTS & HERBAL MEDICATIONS

Dr. Buñag | April 04, 2018

CASE
A 63 y/o male with a history of coronary artery disease, high cholesterol, type 2 diabetes & HPN
presents with a question about a dietary supplement. His LDL is still slightly above the set goal. Tsaang
Medications: He is taking includes simvastatin, metformin, benazepril & aspirin. He regularly takes a Gubat
vitamin B complex supplement & coenzyme Q10. He asks whether a garlic supplement can bring can
bring down his LDL cholesterol. What benefit can be derived from coenzyme Q10?

DIETARY OR NUTRITIONAL SUPPLEMENTS

Dietary Supplement Health and Education Act (DSHEA) of 1994 definition: A dietary
supplement is a product taken by mouth that contains a “dietary ingredient” intended to Ampalaya
supplement the diet. Examples include: Vitamins, minerals, herbs or other botanicals, amino
acids, substances such as enzymes and metabolites, weight loss products

HERBALISM
Herbalism (“herbology” or “herbal medicine”)
- use of plants for medical purposes, and the study of such use
Lagundi
Plants have been the basis for medical treatments through much of human history, and such
traditional medicine is still widely practiced today.

The WHO (World Health Organization) estimates that 80% of the population of some Asian and
African countries presently use herbal medicine for some aspect of primary health care. Ulasimang
Bato
As part of primary health care and because of the increasing cost of drugs, the use of locally
available medicinal plants and herbs in the Philippine backyard and field have been found to be
effective in the treatment of common ailments as attested to by the National Science Development
Board, other government agencies / persons engaged in research.
Bawang
The DOH is advocating the use of the following ten herbal plants.

Sambong
Bayabas

Akapulko

Yerba
Buena

Niyog-
Niyogan

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 PHARMACOLOGY

TOP 10 HERBAL MEDICINES APPROVED BY THE DOH

MEDICINAL SCIENTIFIC NAME PLANT PART / ACTIVE CONTRAINDICATION (CI)
INDICATIONS MOA
PLANT PLANT NAMES FEATURES CONSTITUENT ADRs
Blumea balsamifera Leaves 1. Diuretic Chemolysis of Calcium- Precaution to those with Hypersensitivity reaction
2. Dissolution of kidney containing stones with ragweed plant
Aromatic shrub stones ! severe pruritus
Sambong Ngai camphor 3. NKTI: for patients ! skin irritation
Blumea camphor with CKD ! delay or
Ragweed plant avert dialysis or
kidney transplant
Cassia alata Leaves Chrysophanic acid 1. Tinea infection CI: Patients under:
(Fungicidal activity) 2. Eczema • Anticoagulant therapy:
Legume shrub 3. Scabies Akapulko contains Vit, K! procoagulant!
Akapulko antagonism
Dosage forms: • Tx for autoimmune disease:
soap, cream, shampoo, Akapulko contains CANAVANINE (amino acid)!
lotion worsen symptoms of SLE
Quisqualis indica Flowers: varied colors 1. Ascariasis ADR: GI symptoms
Fruits • Diarrhea,
Niyog-
Climbing woody shrub Dried seeds ! Cure rate: • Abdominal pain,
niyogan
Yesterday, Today, expulse intestinal Niyog-niyogan: 85% • Distention,
Tomorrow worms Pyrantel pamoate: 90% • Hiccups
Carmona retusa Leaves mixture of titerpenes: 1. Stomach ache
1. Rosmarinic acid 2. Antihistamine for Like Nedocromil / Cromolyn
Tsaang Philippine tea 2. Microphyllon allergic skin rxns Na (mast cell stabilizer)
gubat may also be used as (51% analgesic
an ornamental plant activity)
Yellow fruit
Momordica charantia Whole Fruit Extract Alterative tx for 1. " insulin secretion Precaution:
DM Type 2 2. # intestinal glucose Patients already receiving oral hypoglycemic drugs !
Ampalaya Bitter melon Leaves Momordicin uptake aggravate hypoglycemia
Climbing vine (hypoglycemic 3. " in peripheral uptake
activity) & utilization of glucose
Vitex negundo Leaves n-hexadecanoic acid Asthma 1. Inhibits PDE No ADR: OTC (Over-The-Counter) preparation
(potent (like Papaverine &
5-pointed leaves bronchodilator) Methylxanthine:
appears as a tree / Lavender flowers, Theophylline)
Lagundi shrub ovoid fruits 2. Calcium-blocking effect
(like Diltiazem); induces
smooth muscle
relaxation (cGMP) !
bronchodilation
Peperomia pellucida 1. Analgesia ADR: Allergic reactions
2. Anti- inflammatory
Pansit-pansitan 3. Lower blood uric acid
Ulasimang
(used as a food item) (like Allopurinol)
Bato
Shallow rooted herb Ulasimang Bato: 44%
Allopurinol: 66%

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 PHARMACOLOGY

MEDICINAL SCIENTIFIC NAME PLANT PART / ACTIVE CONTRAINDICATION (CI)

INDICATIONS MOA
PLANT PLANT NAMES FEATURES CONSTITUENT ADRs
Allium sativum Organosulfur Pharmacologic effects: 1. Endothelium- ADR: Gastrointestinal reactions
compounds: S-allylcysteine dependent • Nausea: 6%
ALLICIN (unusual vasodilation • Hypotension: 1.3%
smell of bawang) Anti-hypertensive !BP lowering effect • Allergy: 1.1%
Anti-platelet 2. HMG coA reductase • Bleeding: rare
Precursor: ALLIIN inhibitor
! Cholesterol lowering Caution: Bleeding tendency
Bawang effect (like statins: in ! For patients taking anticoagulants and antiplatelet
Hypercholesterolemia drugs (Warfarin, ASA)
3. Significant reduction ! Strict monitoring of BP and bleeding episodes
in cholesterol and TG
but its effect in LDL and
HDL is not significant
4. Inhibit TXA2
synthesis
Psidium guajava Leaves & Fruit: fleshy mixture of: Antisepsis: wounds from ADR: Constipation
eugenol, circumcision & ulcers
Bayabas Tree / shrub tannins, Antibacterial: Bacterial
saponins diarrhea
Antioxidant: Vit. A, C
Menta arvensis Leaves menthene & Digestive disorders CI
Mentha spicata menthenone Avoid among:
Yerba Buena • pediatric patients who can’t tolerate ADRs
Peppermint • patients with GERD ! worsen symptoms

MEMORY TIPS
From Doc Buñag From Melo (Laban! Haha!) LaSa Ba’y Ampalaya TUNAY Ba?
S Sambong La Lagundi
A Akapulko Sa Sambong
N Niyog-niyogan Bay Bayabas
T Tsaang Gubat Amplaya Ampalaya
A Ampalaya T Tsaang gubat
L Lagundi U Ulasimang bato
U Ulasimang Bato N Niyog-niyogan
B Bawang A Akapulko
B Bayabas Y Yerba Buena
Y Yerba Buena Ba Bawang
Oh ha? Diba? Pwede :P

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 PHARMACOLOGY

DIETARY SUPPLEMENTS
DIETARY SCIENTIFIC NAME PLANT PART /
ACTIVE CONSTITUENT INDICATIONS MOA
SUPPLEMENT PLANT NAMES FEATURES
Ginkgo biloba Leaves Flavones, 1. Occlusive peripheral arterial diseases
Gingko
Glycosides, Terpenoids ! CV effects:
(Ginkgolides) (a) Increase in blood flow,
(b) reduction in blood viscosity,
(c) vasodilation
2. Metabolic effects
3. CNS effects:
Tx of Alzheimer’s Disease: cerebral insufficiency (significant compared to
a placebo) ! neurotransmission ! enhance release of Ach, NE, Serotonin
Ginseng Panax ginseng Fleshy Roots Triterpenoids, Saponins, 1. Immunomodulating
Glycosides 2. Enhance neurotransmission
Chinese variety (Ginsenosides) 3. Antioxidant
Korean variety 4. Adaptogen to stress: improve both mental and physicall performance

Milk Thistle Silybum marianum Fruit, Dried seeds Flavonolignans: Silymarin 1. Limits Hepatic injury due to toxins:
a. Amanita phalloides mushroom
Liveraide® b. Ethanol
c. APAP (Paracetamol)
2. Reduces lipid peroxidation
3. Scavenges free radicals
4. Enhances glutathione & superoxide dismutase (protective)

Ubiquinone From mitochondria of heart, 1. Hypertension ! lower both systolic and diastolic pressure
liver, kidney, skeletal muscle 2. Heart Failure ! improve ejection fraction
Coenzyme Q10
3. IHD ! Metabolic protection against ischemia
4. Predominant reduced form: UBIQUINOL ! antioxidant ! improvement
of muscle function
Human tissue (expensive)! 1. Knee OA
production of nutrient for ! Analgesia/ Anti-inflammatory
articular cartilage: ! " supply for the building blocks of GAG (Chondroitin sulfate)
GLYCOSAMINOGLYCANS (GAG)
Glucosamine
Commercial Preparation:
From CRABS (crustacean):
cheaper

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