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Glycosides by Ellen Kamhi PhD RN, The Natural Nurse
1. Glycosides: Definition
SUGAR + AGLYCONE= GLYCOSIDE
- Myriad of Sugars
- Huge variety of Aglycones
Sugar molecule:
enhances absorption
and bioavailability of aglycone.
Plants will make glycosides
by adding a sugar molecule
to an aglycone in order to
enhance solubility in water GINSENOSIDE â glycoside in Ginseng
to transport the molecule.
2. Glycosides: Definition
⢠Multitude of glycosides
⢠Glycosides are not related to
each other botanically or
chemically
⢠âBusiness End of a
Glycoside is the
Aglycone, not the sugar
Salicin-found in White Willow Bark,Oil of Wintergreen, Meadowsweet
First Isolated from Meadowsweet
3. Glycosides:Classification
Glycosides may be classified by the number of sugar units , or the
specific aglycone structure that it contains.
1. SUGAR UNIT:
Many glycosides are 5 carbon (pentose sugars )
or 6 carbon (hexose sugars)
However the sugar may be a mono, di, or oligosaccharide
Glucosidesď Glucose
Rhamnosidesď Rhamnose
2. AGLYCONE STRUCTURE:
The business end of the molecule; most classification systems
focus on the Aglycone
5. Glycosides:Anthraquinones
⢠Many are found in laxative plants
⢠Strong cathartic action
⢠May damage epithelial cells, leading to changes in
absorption,secretion and motility
⢠Damaged cells are found as apoptotic bodies in
dark pigmented mucosa- pseudomelanosis coli, can
be caused by laxative abuse
Video of Pseudomelanosis:
http://daveproject.org/viewfilms.cfm?film_id=882
6. Glycosides:Anthraquinones
⢠Red-orange pigments
⢠Water/alcohol soluble
⢠Function as stimulants/
laxatives/purgatives
⢠Excessive use can cause
pathological changes in
colon
⢠Anthraquinones are
characterized by two
aromatic rings fused to Aloe, Buckthorn, Cascara
the central ketone-bearing Sagrada, Rhubarb, Senna
ring
LG
8. FDA LAXATIVE WARNING
"NOTICE (or WARNING): Contains herbs (insert name of herbs)
that can act as stimulant laxatives. Prolonged steeping time can
increase the risk of adverse laxative effects, including: nausea,
vomiting, abdominal cramps, and diarrhea. Chronic use of laxatives
can impair colon function. Use of laxatives may be hazardous in
the presence of abdominal pain, nausea, vomiting, or rectal bleeding.
Laxative-induced diarrhea does not significantly reduce absorption
of food calories. Acute or chronic diarrhea may result in serious
injury or death.â
http://www.pueblo.gsa.gov/cic_text/health/teatime/597_tea.html
11. Glycosides:Anthraquinones
Cascara (Rhamnus purshiana)
⢠The bark of the tree
⢠Grows in Washington and BC,Canada
⢠Collected in May
⢠Dried for one year to oxidize glycosides to give them a
milder action
⢠Never use in UC, Crohns , IBS
⢠Pregnancyď donât use Except if labor has stalled
LINK: mechanism of action study:
http://www.ncbi.nlm.nih.gov/pubmed/2289777?dopt=Abstract
12. Glycosides:Anthraquinones
Cascara
⢠Aged bark is a mild stimulant laxative
⢠Cascarosides are one of many anthraquinone
glycosides; some of these are also anticarcinogenic
⢠Excessive use can cause pathological changes in
colon mucosa glucose
glucose
Cascaroside A
LG
14. Glycosides:Anthraquinones
⢠Aloe gel does not contain
anthraquinones
⢠Aloe resin: aloe-emodin &
its glycosides, aloin
(barbaloin), aloinoside
⢠Aloe-emodin is anti-
carcinogenic; also found in
Turkey Rhubarb(Rheum palmatum)
ingredient in Essiac formula
Link to study:
http://www.ncbi.nlm.nih.gov/pubmed/12445860?dopt=Abstract
LG
15. Glycosides:Anthraquinones
Chinese Rhubarb( also called
Turkey Rhubarb):
Glycoside:
Glucorhein
Rhein ( aglycone)
Favorite Chinese cathartic
Root of plant is used
Prevents kidney damage
Li X, Wang H. Chinese herbal
medicine in the treatment of
chronic kidney disease. Adv
Chronic Kidney Dis.
2005;12:276-81.
17. Glycosides: Saponins
âSaponinsâ come from the word saponify
soap-like
Water soluble sugars attached to either a
lipophilic steroid(C 27) or triterpenoid (C 30)
Wide array of diverse plants contain saponins
Common Characteristics:
Bitter taste
Hemolytic activity
Form stable foam in water upon shaking
21. Glycosides: Saponins
Natural surfactants, Foaming
agents-
soaps and shampoos.
Antifungal, antibacterial
inhibits cancer cell growth.
Lowers blood cholesterol by binding with bile acids
22. Glycosides: Saponins
Thousands of herbs contain saponins:
Eleuthero
Smilax
Licorice
Astragalus
Panax spp.
Calendula
Phytolacca
Codonopsis
Dandelion
Dioscoria
Mullein
Legumes -soy, alfalfa Also Many Vegetables
24. Glycosides: Saponins
Licorice Root
⢠Isoliquiritigenin :
- inhibits aldose reductase : may reduce
diabetic neuropathy
- inhibits MAO (Monoamine oxidase): may
support mood balance
⢠Licochalcones: anti-parasitic: eg. Leishmania
has been used for malariaâŚ
⢠Butein, isoliquiritigenin : stops growth of
melanoma cells in vitro
LG
25. Glycosides: Saponins
Licorice Root
⢠Liquiritigenin (a flavonoid) & its
glycoside, liquiritin, contribute to the
anti-inflammatory & antispasmodic
action of Licorice
⢠May also be involved in
ulcer-healing properties
⢠Antimicrobial
⢠MAO inhibitor
LG
26. Glycosides: Saponins
Licorice Root
⢠Glycyrrhizin (glycyrrhizinic acid): main
triterpenoid saponin in root
⢠Anti-inflammatory (synergistic with the
flavonoids)
⢠Inhibits secretion of stomach acid
⢠Inhibits deactivation of cortisol
⢠Responsible for raising blood pressure w/excess
ingestion ( sodium & water retention, potassium
excretion, diuresis)
⢠Immunostimulating, antihepatotoxic, antiviral
LG
27. Glycosides: Saponins
Licorice Root
Glycyrrhetinic acid
⢠antitussive
⢠flavoring agent-
masks bitter taste,
used in Chinese
formulas for this
purpose
⢠anti-inflammatory
⢠relieves peptic ulcers-
inhibits gastric
secretion but
stimulates pancreatic
and mucous secretion
28. Glycosides: Saponins
Licorice Root
⢠The structure of glycyrrhetinic acid is
similar to that of cortisone.
⢠Both molecules are flat and similar at
position 3 and 11.
⢠This might be the basis for licorice's
anti-inflammatory action.
31. Glycosides: Cardiac
Steroidal Saponins
Highly specific- powerful action on cardiac tissue.
Sugars are attached to the 3 position of the steroid
nucleus
Two broad categories of Cardiac glycosides:
Cardenolides, C 23, more prevalent in nature
Bufadienolides (Buf-adi-eno-lides) (derived from the skin
of toads (sounds like witches brew!)
32. Glycosides: Cardiac
⢠Cardiac steroids: strongest heart
regulators, but most toxic ( eg. Digitalis)
⢠Phosphodiesterase inhibitors: indirectly
raise cAMP, nontoxic and extremely
useful for CHF ( congestive heart failure)
(eg. Hawthorne (Crataegus spp.)
⢠Direct adenylate cyclase stimulants :can
also be useful (eg. Forskolin)
34. Glycosides: Cardiac
Actions:
⢠actions include both beneficial and toxic effects on the
heart.
⢠Documented since 1500 B.C. as poisons, arrow poisons,
emetics, diuretics, and heart tonics.
⢠Used in modern treatment of congestive heart failure ,
atrial fibrillation and flutter
⢠Toxicity issues must be kept in mind
35. Glycosides: Cardiac
Actions:
Positive inotropic activity- increases contraction of heart muscle-
important in heart failure
Inhibits NA+, K+ , ATPase, increasing intracellular NA+,
which then increases intracellular Ca+, which leads to
enhanced contraction of the cardiac muscle fibers
http://www.sbirc.ed.ac.uk/cyril/gfx/cp_neurophysio2_NaK-pump.jpg
36. Glycosides: Cardiac
Actions:
⢠Increase strength of systolic contractions-
decrease length of systole- increase length of
diastole
⢠Increases the heartâs resting tone
⢠Improves cardiac output
⢠Improves renal flow
⢠Decreases edema- Pulmonary and Systemic
37. Glycosides: Cardiac
⢠The sugar portion of the molecule confers
solubility and distribution
⢠The more OH groups on the cardiac glycoside
molecule, the more:
Rapid action
Water soluble
Easily excreted
â Safer, but requires more frequent dosing
38. Glycosides: Cardiac
Cautions:
⢠Avoid electrolyte depletion and other sources of calcium
⢠Some are (+) ionotrophic (increased force of contraction)
but negatively (-)chronotrophic (decreases beats, slows
heart)
⢠Also affect vascular smooth muscle, REDUCING
AFTERLOAD on heart muscle
⢠Reduce sympathetic tone
⢠Effect purkinje fibers and Bundle of HIS,
â slowing down conduction
40. Glycosides: Cardiac
Dr. William Withering published
Use of Digitalis to Treat Dropsy
1785
41. Glycosides: Cardiac
'Dropsy' : swelling of the body, often occurs
with congestive heart disease, when heart does not pump
sufficiently, which causes accumulation of fluid
Main symptoms: swelling of the whole body especially legs
gastrointestinal symptoms
tingling sensation in the skin
tenderness in the calf muscles
increased intra-ocular pressure (glaucoma)
42. Glycosides: Cardiac
Digitalis for Dropsy
⢠William Withering (a
prominent physician in his
time) is credited with
âdiscoveringâ digitalis as a cure
for dropsy in 1775
⢠In reality, he learned it from a
local âgypsyâ or âold womanâ
who was curing cases of heart
failure with a formula including
Foxglove ⌠an âold family
recipeâ
LG
43. Glycosides: Cardiac
⢠Foxglove has ~ 30 different cardenolides including
digitoxin/digitalin, gitoxin, & gitaloxin
⢠Powerful cardiac agents that increases contractility of
heart muscle, cardiac output, cardiac work
capacity, heart rate, arterial resistance; narrow
range of safety
⢠âPurifiedâ glycosides currently used in medicine;
whole leaf previously used
LG
44. Glycosides:Cardiac
⢠Small doses used clinically for controlling congestive
heart failure
⢠Larger doses are cardiac poisons
⢠Native peoples use/d them as arrow poisons
⢠Steroidal glycosides with an extra lactone ring
attached
LG
45. Glycoside:Cardiac
⢠Isolated digitoxin is used in
contemporary pharmacy
⢠Cardiac glycoside, extracted from
Foxglove (Digitalis purpurea or D.
lanata)
46. Glycosides: Cardiac
DIGITALIS
⢠INDICATIONS: CHF, supra-ventricular tachycardia, atrial flutter,
atrial fibrillation
⢠USUAL DOSE:
1-2 grams USP crude drugď proceed to 100-200 mg for maintenance
⢠REDUCE DOSE by 25% for the elderly or overly thin client, more for
obese
⢠ONSET OF ACTION: 2-4 hours
⢠DISSIPATION OF DRUG: 2-3 weeks
⢠Digitalis is particularly likely to cause toxicity as its cardiac
glycosides are
â less polar,
â less water soluble
â (MORE LIPOPHILIC) and have a longer half life
48. Glycosides:Cardiac
Convalleria
Used for cardiac irregularities with mechanical impediments
â Mitral valve insufficiency
â Feeble circulation with low arterial tension
â Dropsy of cardiac origin
â Palpitation with arrhythmias and vehement (violent) heart
action
â Dyspnea
â Feeble quickened pulse
â Used with Crateagus, it is valuable in BRADYCARDIA
â Use before digitalis, which is more applicable in SEVERE
CHF
49. Glycosides:Cardiac
Convalleria
⢠~ 40 different glycosides
based on several different
aglycones; variable
⢠Convallatoxin highly
active, but generally no
more than 10% of the
amount ingested can be
absorbed
⢠Positive inotropic effect;
used for mild cardiac
insufficiency
LG
50. Convalleria
Glycosides:Cardiac
⢠Contains anthraquinones-excessive doses cause diarrhea 1st- before
toxicity ensues
⢠Contains highly water soluble âsaferâ gycosides:
Convallotoxin, convalloside, convallotoxol
⢠High in Flavonoids
⢠Dose is usually 5-30 drops of 1:5 tincture per day
⢠Favorite of Dr. Bastyr, Founder of Bastyr University of Naturopathic
Medicine:
CCC Cardiac Combo
Crateagus, Cactus & Convallaria
NOTE: Cactus and Crateagus have NO CARDIAC GLYCOSIDES but
instead have flavonoids and other vasoactive amines which help weak
& feeble heart
51. Hawthorn
⢠Hyperin, a glycoside of quercetin, is
the main flavonoid in Hawthorn
⢠Also contains OPCâs
⢠Helps heart muscle to work more
efficiently, strengthens contractions,
stabilizes rhythm
⢠Enhances the utilization of oxygen in
cells
⢠Contains many antioxidants
⢠Antispasmodic, anti-inflammatory
LG
54. Cardiovascular Drugs
Herbal Support: Hawthorne
The Hawthorne is a tree/shrub in the rose family that is widely distributed
and grows in the USA, Europe, western Asia and North Africa. Many parts
of the plant are used. The berries are similar to crabapples and traditional
medicinal and edible preparations used this fruit. Since active constituents
have been isolated and extracted, many more modern medicinal
preparations use mainly the leaves and flowers.
The use of Hawthorne as a heart tonic probably originated due to the
âdoctrine of signaturesâ which proposes that plants give âcosmic cluesâ
about their potential use. Hawthorne berries have a similarity in color and
shape to the heart. By the first century AD, the Greek medicinal herbalist,
Dioscorides, reported using hawthorne as a heart tonic, among other uses.
54
54
55. Cardiovascular Drugs
Nutrient Depletion: Hawthorne
Crataegus spp.
ďą Hawthorne
ďą Oligomeric
procyanidins,vitexin,vitexin
4â-O-rhamnoside,quercetin,
Rutin
ďą Leaves and flowers have
highest flaonide
content,esp. OPC
ďą Also, increases strength of
collagen 20 fold
ďą Use in OA a.w.a.CV Dz
55
56. Cardiovascular Drugs
Herbal Support: Hawthorne
Mechanism of Action - Cardiovascular effects:
⢠Decreases blood pressure and total peripheral resistance
⢠Economizes myocardial function : reduces work loa=d on the heart
⢠Decreases cardiac preload in healthy people
⢠Inotropic effects (Inotropic: Affecting the force of muscle contraction)
⢠The inotropic effects of hawthorn may be caused by inhibition of 3',5'-
cyclic adenosine monophosphate diesterase , which in turn decreases
inflammation
⢠Anti-oxidant activity is protective to heart muscle and circulatory system
due to high flavonoid content
56
57. Cardiovascular Drugs
Herbal Support: Hawthorne
Recommended Dosage:
ďąStandardized Extract (18.75% oligomeric procyanidins)
60 mg 3 X/day or or 80 mg 2 X per day.
ďąStandardized ( 2.2 % flavonoids )
100 â 300 mg 3 X per day
ďą Tincture: 300-900 mg/ day in divided doses
ďą Capsules Standardized (2% vitexin-2"-0- rhamnoside)
300-1000 mg/ day in divided doses
57
59. Cardiovascular Drugs
Herbal Support: Hawthorne
Studies
Elango, C. , et. al. Hawthorn extract reduces infarct volume and improves
neurological score by reducing oxidative stress in rat brain following
middle cerebral artery occlusion. ( 2009) International Journal of
Developmental Neuroscience. 2009 Aug 25. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/19712738?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPa
nel.Pubmed_RVDocSum&ordinalpos=3
Pittler MH, et. al. , (2008) Hawthorn extract for treating chronic heart
failure, Cochrane Database of Systemic Reviews. Jan 23;(1):CD005312.
âAUTHORS' CONCLUSIONS: These results suggest that there is a
significant benefit in symptom control and physiologic outcomes from
hawthorn extract as an adjunctive treatment for chronic heart failure.â
http://www.ncbi.nlm.nih.gov/pubmed/18254076?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pub
med_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&lo
gdbfrom=pubmed
59
60. Cardiovascular Drugs
Herbal Support: Hawthorne
Adverse Effects
Proven safe for long term use in centuries of traditional use with minimum
reports of adverse effects
Allergies
Avoid if allergic to hawthorn or to members of the Crataegus genus. There
is a case report of an immediate-type hypersensitivity reaction to hawthorn
plants. It is not known if this applies to formulations taken by mouth.
Side Effects and Warnings
There are limited reports of adverse effects associated with hawthorn.
Numerous human trials, observational studies including over 4,500
patients, and case reports have noted rare adverse effects, including
abdominal discomfort, nausea, agitation, dizziness, headache, fatigue,
shortness of breath, skin rash, insomnia, sweating, and rapid heart rate.
Pregnancy and Breastfeeding
Not recommended due to lack of sufficient data. No reports of adverse
effects.
60
61. Cardiovascular Drugs
Herbal Support: Hawthorne
Drug Interactions
Antiarrhythmic medications: Laboratory studies report that constituents contained in
hawthorn have antiarrhythmic activity which may alter the effects of these medications and
possibly the dose needed for treatment. Use with caution. Potential/Theoretical Additive
Effects
â These drugs include amiodarone, bretylium tosylate, adenosine, dofetilide, propafenone,
lidocaine, tocainide, flecainide, ibutilide fumarate, moricizine, quinidine, disopyramide,
procainamide, mexiletine, verapamil, digoxin, propranolol, sotalol, esmolol, acebutolol.
ACE inhibitors: Laboratory studies report that constituents contained in hawthorn have
ACE inhibiting activity which may alter the effects of these medications and possibly the
dose needed for treatment. Use with caution. Potential/Theoretical Additive Effects
â These drugs include benazepril, captopril, enalapril, lisinopril, fosinopril,moexipril,
quinapril, ramipril, trandolapril, perindopril erbumine.
Cardiac glycosides: Laboratory studies report that constituents contained in hawthorn have
cardiac activity which may alter the effects of these medications and possibly the dose
needed for treatment. Use with caution. Potential/Theoretical Additive Effects
â These drugs include digoxin.
Note: all interactions are supported by studies unless noted by potential/theoretical
61
62. Cardiovascular Drugs
Herbal Support: Hawthorne
Drug Interactions
Antihypertensive medications: Laboratory studies report that constituents contained in
hawthorn have hyper/hypotensive activity which may alter the effects of these medications
and possibly the dose needed for treatment. Use with caution. Potential/Theoretical
Additive Effects
â These drugs include amlodipine, bepridil, diltiazem, felodipine, isradipine, nicardipine,
nifedipine, nimodipine, nisoldipine, verapamil, benazepril, captopril, enalapril,
lisinopril, fosinopril,moexipril, quinapril, ramipril, trandolapril, perindopril erbumine,
atenolol, esmolol, betaxolol, penbutolol, carteolol, bisoprolol, pindolol, metoprolol,
timolol, sotalol, acebutolol, nadolol, propranolol, labetalol, carvedilol, methyldopa,
clonidine, guanfacine, guanabenz, brimonidine tartrate, dipiprazole, levobunolol,
levobetaxolol, metipranolol, reserpine, prazosin, terazosin, doxazosin meylate,
guanadrel, guanethidine, isosorbide monohydrate, isosorbide dinitrate, nitroglycerin,
hydralazine, minoxidil, papaverine, isoxsuprine, losartan, valsartan, eprosartan
mesylate, telmisartan, candesartan cilexetil, irbesartan.
Vasoconstrictor medications : such as phenylephrine (Neo-SynephrineÂŽ), ephedrine or
norepinephrine. Hawthorn may have Potential/Theoretical Antagonistic Effects
Note: all interactions are supported by studies unless noted by potential/theoretical
62
63. Cardiovascular Drugs
Nutrient Depletion: Coleus
⢠Antihypertensive medications:
Laboratory data has reported that constituents contained in coleus leaf have
antihypertensive activity which may alter the effects of these medications and
possible the dose needed for treatment. Use with caution.
Potential/Theoretical
â Drugs include amlodipine, bepridil, diltiazem, felodipine, isradipine, nicardipine,
nifedipine, nimodipine, nisoldipine, verapamil, benazepril, captopril, enalapril,
lisinopril, fosinopril,moexipril, quinapril, ramipril, trandolapril, perindopril
erbumine, atenolol, esmolol, betaxolol, penbutolol, carteolol, bisoprolol, pindolol,
metoprolol, timolol, sotalol, acebutolol, nadolol, propranolol, labetalol, carvedilol,
methyldopa, clonidine, guanfacine, guanabenz, brimonidine tartrate, dipiprazole,
levobunolol, levobetaxolol, metipranolol, reserpine, prazosin, terazosin, doxazosin
meylate, guanadrel, guanethidine, isosorbide monohydrate, isosorbide dinitrate,
nitroglycerin, hydralazine, minoxidil, papaverine, isoxsuprine, losartan, valsartan,
eprosartan mesylate, telmisartan, candesartan cilexetil, irbesartan.
63
64. Glycosides: Flavonol
Quercitin
⢠More than 135 different glycosides exist in leaves,
fruits, flowers
⢠Rutin (quercetin-3-rutinoside) used for capillary
fragility & venous integrity
⢠Hyperin (hyperoside; quercetin-3-galactoside), main
flavonoid in Hawthorn; also in St. Johnswort â helps
prevent cataracts; may contribute to antidepressive
activity
⢠Quercetin inhibits mast cell degranulation
⢠Powerful anti-inflammatory
⢠Rich dietary sources: Onion, Kale, Broccoli,
Lingonberry, Cranberry, Black Currant, Tea
LG
66. Isoflavones: Glycosides
Most isoflavones actually occur as the glucose
conjugates; aglycones are present in the plants, but
LG
only in small amounts
67. Anthraquinones in Yellow Dock
⢠Emodin, chrysophanol,
rhein & related
glycosides
⢠Contribute to aperient
activity
LG
68. Chromones
⢠Related to the flavonoids
⢠Khellin (from Ammi visnaga)
⢠Cardiovascular tonic:
for angina, atherosclerosis, high
cholesterol
⢠Vasodilator
⢠Antispasmodic
⢠Also used for asthma
(bronchodilator) & is
antitussive via CNS
LG
action Photo Š Werner Arnold 2003
69. Quinones: Naphthoquinones
Drosera (Sundew) contains plumbagin:
antibacterial, antispasmodic (for cough),
immunostimulant
LGPhoto Š Richard Bailey 2003 The Carnivorous Plant Society www.thecarnivorousplantsociety.org
70. Anthraquinones in Hypericum
⢠St. Johnswort contains a complex
anthraquinone relative, hypericin
(a âbianthraquinoneâ)
⢠Aka a ânaphthodianthroneâ
⢠Occurs with pseudohypericin
⢠Colors the oil red
⢠Contributes to antiviral & antidepressant
activities
⢠Responsible for photoreactivity
⢠Synergistic with the flavonoids, xanthones,
& hyperforin
LG
71. Cardiac Glycosides in Milkweeds
⢠Found in all species of Asclepias
⢠Components of the milky latex
LG ⢠Toxic to vertebrates, but not to butterflies