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St. John’s Wort (Hypericum perforatum)

Uses More than 3% of presurgical pts report using St. John’s wort. Taken mainly for depression, although pts may take it for a variety of reasons including anxiety, viral and bacterial infections, menstrual cramps, HIV, cancer, chest congestion, hemorrhoids, skin wounds, and burns. Efficacy in treating depression is controversial. Most integrative medical specialists will use every other alternative first because of drug interactions; this is at…

Saw Palmetto

Uses BPH Urinary tract inflammation (prostatitis) Underactive bladder Male- and female-pattern baldness Aphrodisiac Breast augmentation Perioperative Risks No established interactions with anesthetic agents Worry About Saw palmetto has been implicated in hepatitis, cholecystitis, bleeding diatheses, conduction defects, and erectile dysfunction. No studies confirm these effects. Unsubstantiated pharmacologic effects such as increasing the action of benzodiazepines You’re Reading a Preview Become a Clinical Tree membership for Full…

S-Adenosyl- l-Methionine

Uses As an antiaging, antidisease therapeutic agent. May protect against the hepatotoxic effect of certain drugs (e.g., alcohol, acetaminophen, phenobarbital, and steroids). Depression, mild to moderate and adolescent. Anxiety, PMS. Heart disease. Liver disease, cirrhosis, intrahepatic cholestasis, disorders of porphyrin, and bilirubin metabolism. Osteoarthritis, tendinitis, bursitis, chronic low back pain. Dementia, Alzheimer disease, Parkinson disease. MS, migraine, seizure, spinal cord injury. Chronic lead poisoning. Disorder of…

Red Yeast Rice (Cholestin)

Uses Chinese traditional medicine for therapy of pts with cardiovascular diseases Hypercholesterolemia Prevention of coronary events, stroke, and TIA Treatment of dyslipidemia in statin-intolerant pts Prostate and colon cancer Possible diabetes treatment Perioperative Risks Obtain adequate Hx to determine indication for taking red yeast rice. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are…

Phytosterols

Uses Naturally occurring in human diet. Used as supplements, especially in margarines, to reduce cholesterol levels. May also possess anti-inflammatory, antipyretic, antineoplastic, and immune-modulating properties. Some recent evidence questions the beneficial effect of phytosterols and the potential for increased CV risk. Perioperative Risks None known You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are…

Nutraceuticals

Risk Approx 64% of pts have taken or are taking a nutraceutical agent. Incidence in USA: More than 50% take dietary supplements; a study of over 1000 outpatients found that approx 33% were using herbals at the time of surgery or pain procedures. 31% use herbal drugs in combination with prescriptions. 48% use them with OTC drugs. Up to 70% of pts do not inform the…

Melatonin ( N -Acetyl-5-Methoxytryptamine, Bevitamel, Vitamist, Melatonex)

Uses Regulates sleep-wake cycles. Prescribed for jet lag, shift work, depression. Use as antineoplastic, antidelirium, and anticonvulsant is under investigation. Questionable benefit in treating breast cancer and migraines. Categorized as a nutraceutical (unregulated). Risks Not controlled by FDA; therefore quality and potency may vary. May interact with other CNS-acting medications such as hypnotics, sedatives, or psychotropics. Not recommended in children or pregnant/breastfeeding women owing to insufficient…

Licorice (Glycyrrhiza glabra)

Uses One of the top 10 herbal medications utilized in USA. Historically used to improve immune function and treat a variety of conditions including PUD, duodenal ulcers, cough and/or bronchitis, atherosclerosis, chronic fatigue syndrome, various cancers, AIDS, and Addison disease. Most recently a study has demonstrated its effectiveness in relieving postop sore throat. Perioperative Risks Unknown. Theoretical problems in pts with impaired renal function, Htn, chronic…

Kava

Uses Treatment of anxiety, stress, nervousness Treatment of insomnia Treatment of muscular aches and pains Traditionally used in the South Pacific during religious and cultural ceremonies to achieve relaxation and for medicinal purposes Perioperative Risks No data exist to quantify risk of adverse effects ASA recommends stopping herbal supplements as long as 2 wk prior to elective procedures. Worry About Risk of hepatotoxicity, especially when combined…

Glycine

Uses Inhibitory neurotransmitter in the brain stem and spinal cord. Glycine and GABA receptors may mediate the effects of inhaled anesthetics. A nonessential amino acid sold as a natural sugar substitute, a sedative, and an antacid; used to promote muscle growth and decrease Sx of BPH; also as a polyphenol and an antipsychotic. Glycine 1.5% used as a nonhemolytic irrigation solution during TURP. Antagonists of glycine…

Glucosamine Sulfate

Uses For pain associated with OA, particularly of the knee IBD Other inflammatory disorders, such as rheumatoid arthritis, psoriasis Possible benefits for wound healing and prevention of migraines Perioperative Risks No convincing evidence of increased periop risk owing to glucosamine therapy No known significant interactions with commonly administered anesthetic drugs You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…

Ginseng

Acknowledgment The authors would like to acknowledge the contributions of Dr. Devi Mahendran and Dr. Swaminathan Karthik to the previous edition. Uses Ginseng has been used for more than 2000 y in Chinese herbal medicine for a variety of proposed health benefits. Used as an adaptogen, it is believed to increase the body’s resistance to stress and fatigue. Known to have antistress, antifatigue, antiviral, antifungal, antineoplastic,…

Ginkgo biloba

Uses Antioxidant and polyphenol properties. Improved cognitive performance in pts with Alzheimer disease, particularly short-term visual memory and speed of cognitive processing, for 6 mo to 1 y. Improved cognitive performance in vascular dementia and may be neuroprotective in pts with preexisting cerebral ischemia. Used to improve symptoms of intermittent claudication, Raynaud phenomenon, and acrocyanosis. Evidence for effectiveness is debated. Ginkgo biloba extract (GBE) used in…

Ginger (Zingiber officinale)

Uses Ginger ranks 18th in recent herbal supplement sales. Has long been used in Ayurvedic and Chinese medicine for a wide variety of conditions including arthritis, rheumatism, constipation, indigestion, nausea, vomiting, motion sickness, and diabetes mellitus. In vivo human studies show ginger to be effective in management of N/V postop and in association with pregnancy. Clinical research demonstrates potential effectiveness of ginger for dysmenorrhea, vertigo, morning sickness,…

Garlic (Allium sativum)

Uses Administered orally and topically as a powder, oil, tablet, and raw clove. Allicin is the pharmacologically active component. Potentially beneficial to the CV system as an antihyperlipidemic (conflicting results in recent clinical trials); also useful as an antimicrobial ( Microsporum canis , sporotrichosis, tinea pedis), antiplatelet (via increased thromboxane levels), fibrinolytic, antioxidant (increased catalase and glutathione peroxidase), antidiabetic, and vasoprotective agent (i.e., antihypertensive and protective…

Fish Oil

Uses Active ingredient for brain and retinal health (more than 40% of brain and retina is structural fat and more than 50% of fat in brain and retina is DHA). Decreases arrhythmias and deaths related to coronary artery disease. Important component for cell signaling. Data from the MIDAS trial indicate that 900 mg of DHA (about 3 g of fish oil) per d in pts with…

Evening Primrose

Uses Evening primrose oil (EPO) is obtained from the seed of the plant species Oenothera biennis. EPO is also known as fever plant, huile d’onagre, king’s cureall, night willow-herb, scabish, suncups, and sundrops. EPO may be used as a food supplement for the essential fatty acids, linoleic acid (LA), and γ-linolenic acid (GLA). Infusion of the whole plant has been used for asthma, GI disorders, whooping…

Ephedra (Ma-Huang)

Uses Ephedra is a plant that contains a variety of ephedrine alkaloids, including ephedrine and pseudoephedrine. Dietary supplements containing ephedra were marketed in USA as agents that may aid in wt reduction and energy enhancement. Ephedra may be used in the manufacture of methamphetamine. In 2004, USA banned the sale of ephedra-containing supplements with a subsequent marked decrease in reported poisonings. Although banned in USA, sale…

Echinacea (American Coneflower, Purple Coneflower, E. Angustifolia, E. Purpurea, E. Pallida )

Uses Purported immunostimulation and prevention and treatment of respiratory tract infections. Adjuvant in the treatment of other bacterial, viral, or fungal infections of the urinary and respiratory tract. Anti-inflammatory when used topically for conditions such as eczema, psoriasis, and herpes simplex. Promotes wound healing when used topically (i.e., in leg ulcers and burns). Adjuvant for cancer therapy and in the treatment of chronic fatigue syndrome. Perioperative…

Dehydroepiandrosterone

Uses Proposed uses DHEA with insufficient evidence: Vasodilation, anti-inflammatory, antiatherosclerotic, antiaging Physical performance: Increase muscle mass, strength, and energy SLE, multiple sclerosis, osteoporosis, adrenal insufficiency, Crohn disease, COPD Alzheimer disease, Parkinson disease, fibromyalgia Depression, schizophrenia, chronic fatigue, anorexia nervosa, sleep disorders CV disease, diabetes, obesity, metabolic syndrome Improve menopausal symptoms, bone mineral density, and vaginal atrophy Improve erectile dysfunction in men; cervical dysplasia, atrichia pubis, sexual…