Medicinal plants used for locomotor diseases Analgesic herbs and drugs

Transcription

1 Medicinal plants used for locomotor diseases Analgesic herbs and drugs Györgyi Horváth PTE GYTK Department of Pharmacognosy Herbal medicines PTE GYTK Department of Pharmacognosy, 7624 Pécs, Rókus u. 2.

2 Background Source: Budapest, screening in primary schools DR. ILNA ANDRÁSSY 14% 4% 1% 27% NP GD HT 15% TS T n= és 9. osztályos tanulók 39% GYT NP: no problem, GD: spinal deformity, HT: not appropriate sitting, TS: footstep sinking, T: overweight, GYT:physiotherapy

3 Background Magyar Reumatológusok Egyesülete

4 Background Pain: - 2 groups of medicines: plant-origin - (1) major analgetics: morfin (2) non steroid anti-inflammatory drugs (NSAID): acetyl salicylic acid (CX-inhibitor) - CX-inhibitors from plants: chamomile chamazulene, -bisabolol, apigenin olive oil oleokantal - NSAID side effects: nausea, vomiting, dyspepsia, ulcer, skin problems

5 Background Chronic pain: - Phytotherapy has secondary role. - Aim: to relieve pain and inflammation - Reuma, osteoartritis: - paprika tincture, champhor-containing products, methyl salicylic acid

6 Latin name of plant 1. neuralgia Drug name Mentha canadensis Mentha x piperita Pinus mugo Pinus silvestris Pinus pinaster Capsicum annuum var. minimum, C. frutescens Menthae arvensis aetheroleum partim mentoli privum Menthae piperitae aetheroleum Pini pumilionis aetheroleum Pini silvesrtis aetheroleum Terebinthini aetheroleum ab pinum pinastrum Capsici tinctura normata

7 2. Muscle pain Latin name of plant Drug name Arnica montana Eucalyptus globulus Eucalyptus sp. Rosmarinus officinalis Arnicae flos Arnicae tinctura Eucalypti aetheroleum Rosmarini folium Rosmarini aetheroleum

8 3. Muscle cramp Latin name of plant Drug name Capsicum annuum var. minimum Capsicum frutescens 1. Capsici fructus 2. Capsici oleoresina raffinata et quantificata 3. Capsici tinctura normata

9 4. Joint pain Latin name of plant Drug name Harpagophytum procumbens, H. zeypheri Salix daphnoides Salix fragilis Harpagophyti radix Harpagophyti radix extractum siccum Salicis cortex Salicis corticis extractum siccum Salix purpurea + Arnica, paprika, eucalyptus, rosemary

10 5. Reuma Latin name of plant Drug name Betula pubescens Betulae folium Betula pendula Urtica dioica Urticae folium Urtica urens + Arnica, paprika, eucalyptus, rosemary

11 Joint pain

12 Drug: Capsici fructus (Ph. Eur.) Paprika/Capsicum Capsicum annuum L. var. minimum (Mill.) Heis; C. frutescens L. Solanaceae Paprika is native to Middle-America, Mexico, but it is also widely cultivated, e.g. in Hungary. Constituents: capsaicinoids, principally capsaicin (63-77%), dihydrocapsaicin (20-32%) and nordihydrocapsaicin; carotenoids: capsanthin, capsorubin, β-cryptoxanthin, zeaxanthin, lutein and β-carotene; flavonoids; ascorbic acid (vitamin C).

13 Constituents of Capsici fructus capsaicinoids H H CH 3 CH 3 CH 3 CH 2 NH C (CH 2 ) 4 CH CH CH CH 3 CH 3 CH 2 NH C (CH 2 ) 6 CH CH 3 capsaicin dihydrocapsaicin

14 Constituents of Capsici fructus carotenoids H ' 9' 3 5 * 1 * * 3 H capsanthin 13' 9' 6 6' capsorubin 5' H 3' * 5' * 6' H 3' * * 1' 1'

15 Use of Capsici fructus Use: The drug and its preparations are used medically for external purposes (not more than 10 days): muscle main, osteoarthritis, rheumatoid arthritis, treatment of neuralgias such as the pain following herpes zoster and painful diabetic neuropathy; pruritus (e.g. psoriasis) Special warnings and precautions for use: The drug should not be applied to mucosa or near the eyes. Interaction with other medicaments: Capsicum should not be used together with other external products, e.g. other rubefacient or pain relieving gels at the same application site. Undesirable effects: hyperaemia with marked erythema. Skin hypersensitivity reactions such as urticaria and vesiculation may occur.

16 Drugs containing iridoids Harpagophytum procumbens (Burch.) DC. Devil s claw Dried, secondary roots

17 Drugs containing iridoids Devil s claw root Harpagophytum procumbens (Burch.) DC., H. zeyheri (Pedaliaceae) Drug: Harpagophyti radix (Ph. Eur. 4.) Native to: Southern and Eastern Africa. Collected in regions bordering on the Kalahari desert. Constituents: 1-3 % iridoid glycosides (harpagoside, harpagide, procumbide), triterpenes, flavonoids, phenolic acids, stachyose (trisaccharide) H H glu harpagoside (harpagide s cinnamoyl ester) H H H harpagide glu H H glu procumbide (epoxyiridoid glycoside)

18 Drugs containing iridoids Use: anti-inflammatory and analgesic effect rheumatic disease, inflammation of tendons, painful osteoarthritis and low back pain; cholagogue, loss of appetite Phytotherapy: 4-5 g daily dose in rheumatic diseases, 1-3 g gastrointestinal problems, infusion Contra-indications: As with other drugs containing bitter substances, patients with gastric ulcers should consult their doctor before use. Human studies: water-extracts Rheuma and back pain. In treated group: dosis of NSAID could be reduced.

19 Arnica Arnica montana is endemic to Europe, from southern Iberia to southern Scandinavia and the Carpathians. Arnica montana L. Asteraceae In Hungary: protected Can be replaced with A. chamissonis (native to North America) A. chamissonis

20 Arnica Drugs: Arnicae flos (Arnica flower, Ph. Eur.) Arnicae tinctura (Arnica tinture, Ph. Eur.)

21 Arnica Constituents: % sesquiterpene lactones: - helenalin, dihydrohelenalin flavonoids % essential oil H helenalin H 11,13-dihydrohelenalin

22 Arnica Uses (only for external purposes): The drug is used to treat bruises, sprains, inflammation caused by insect bites and rheumatic complaints. The best herbal medicine for treatment of wounds and injuries. Dosage: intments, creams, gels or compresses made with tinctures or fluid extracts or a decoction of 2.0 g of dried arnica flower in 100 ml of water. Not to be used on open wounds.

23 Arnica Side-effects, Contra-indications: Internal use: toxicity (symptoms: headache, gastrointestinal pain, disturbance in respiration) Skin irritation has been reported. Contact dermatitis may develop in susceptible individuals. Allergy to Arnica or other members of the Asteraceae may occur. Sesquiterpene lactones: inhibit the activity of transcription factors, no inflammatory mediators nly few number of human studies.

24 Drugs containing monoterpenes Eucalypti folium (Eucalyptus leaf) Eucalyptus globulus Labill. Eucalyptus

25 Drugs containing monoterpenes Eucalyptus leaf and oil Eucalyptus globulus Labill. (Myrtaceae) Drugs: Eucalypti folium (Ph. Eur. 4.), Eucalypti aetheroleum (Ph. Eur. 4.) Native to: Australia, cultivated world-wide. il is produced: S-Africa, Spain, China, Brazil, Australia, India and Paraguay Constituents: % essential oil (1,8-cineol), tannins, flavonoids Uses: expectorant (bronchitis), antiseptic, nasopharyngeal infection, coughs It is taken internally in the form of mixtures, inhalation, lozenges and pastilles, applied externally as ointments. Do not use under 4 years.

26 Drugs containing monoterpenes Rosmarinus officinalis L. - Rosemary Rosmarini folium Rosemary leaf

27 Drugs containing monoterpenes Rosemary leaf and oil Rosmarinus officinalis L. (Lamiaceae) Drugs: Rosmarini folium (Ph. Eur. 4.) Rosmarini aetheroleum (Ph. Eur. 4.) Native to: Mediterranean areas, cultivated world-wide. Constituents: % essential oil (1,8-cineole, camphor), flavonoids Uses: Internal: cholagogue, impared digestion External: rheumatic pain (bath, ointment), insect repellent ther uses: spice, perfumery, liqueur camphor

28 Drug containing monoterpenes Phytotherapy: one dose: 1-2 g in 200 ml hot water, for bath: 50 g drug in 1 L water, in ointment : 1-2% E content E: may increase blood pressure Camphor: not use children under 4 years, absorb through the placenta easily.

29 Salicylates 18 th century: Edmund Stone, English priest reducing fever with willow bark instead of the expensive cinchona bark The antipyretic effect of salicylic acid is well known since acetylsalicylic acid (Aspirin) In the body: H H H glü H H salycin salicylic alcohol salicylic acid (Cyclooxygenase (CX) inhibitor)

30 Salicylates Meadowsweet (Filipendula ulmaria) (1) herb Ash (Fraxinus excelsior) (2) bark Aspen poplar (Populus tremula) (3) bark and leaf (1) (3) (2) Nowadays, they are not used as analgesics.

31 Salicis cortex Willow bark S. daphnoides Vill. violet willow Salix purpurea L. Salicaceae purple willow S. fragilis L. crack willow

32 The drug Drug: whole or fragmented dried bark of young branches or whole dried pieces of current year twigs (1) Salicis cortex (Ph. Eur 4.) willow bark (2) Salicis corticis extractum siccum (Ph. Eur. 6.) (1) The drug contains not less than 1.5 per cent of total salicylic derivatives, expressed as salicin, calculated with reference to the dried drug.

33 Characteristic and active compounds 1-10% phenolic compounds: - salicin, salicyl alcohol, salicortin 8-20% tannins: - gallotannins flavonoids CH 2 H H salicyl alcohol CH H CH 2 salicin H glu salicylic acid There are only few human evidences: steoarthritis, back pain, joint pains 1 clinical trial: compared to rofecoxib (CX-2 inhibitor)

34 Indications, Dosage Indications: - analgesic and antipyretic, antirheumatic - antibacterial Dosage: - dry and liquid extracts corresponding to mg salicin - drug: 2-4 g/dose, 6-12 g/day, for 8 hours in cold water or for 5 minutes in hot water - Standardized formulations may provide a more reliable dose of the active compounds than tea.

35 Side effects, Contraindications, Side effects, Contraindications: - pregnancy, breastfeeding Interactions - gastrointestinal disorders (tannins) - children with fever and viral illnesses (Reye s syndrome) - forbidden: patients with aspirin sensitivity, asthma, diabetes, gout, liver and kidney failures, ulcer Interactions: - with other salycilate containing medications and NSAIDs NSAID: non-steroid anti-inflammatory drug

36 Rheuma

37 STERIDS Urtica sp. (Nettle), Urticae radix

38 STERIDS URTICAE RADIX Urtica dioica L., Urtica urens L. (Urticaceae) Drug: Urticae radix (Nettle root, Ph. Eur.), Urtica dioica ad praeparationes homoeopathicas (Common stinging nettle for homoeopathic preparations, Ph. Eur.) Constituents: sterols, e.g. β-sitosterol, β-sitosterol-3--glucoside; lignans, fatty acids, polysaccharides, coumarins Use: benign prostatic hyperplasia (BPH) Dosage: - drug: 8-12 g/daily, tea - tincture: 2-6 ml (1:5 25% etanol), 3x H β-sitosterol

39 FoNo. VII. Pasta antirheumatica Spiritus capsici Spiritus menthae cum sale Unguentum contra rheumam

40 Phytoestrogens Isoflavonoids: soy, hop (8-prenyl-naringenin) Stilbens: trans-resveratrol Lignans: green tea, linseed