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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 – glycoside in Ginseng
 to transport the molecule.
Glycosides: Definition
• Multitude of glycosides

• Glycosides are not related to
  each other botanically or
  chemically
• “Business End of a
   Glycoside is the
   Aglycone, not the sugar




           Salicin-found in White Willow Bark,Oil of Wintergreen, Meadowsweet
           First Isolated from Meadowsweet
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
                GlucosidesGlucose
                RhamnosidesRhamnose

2. AGLYCONE STRUCTURE:
The business end of the molecule; most classification systems
focus on the Aglycone
Glycosides:Classification
    Classes of Glycosides:   Examples:
•   Cardioactive glycosidesDigitalis, Convallaria
•   Anthraquinone glycosidesCascara, Senna, Aloe
•   Saponin glycosidesGlycyrrhiza
•   Cyanophore glycosides Amygdalin(laetril), Prunisin
•   Isothiocynate glycosidesWild mustard
•   Flavonoid glycosidesQuercetin
•   Alcohol glycosidesSalicin
•   Aldehyde glycosidesVanillin (Vanilla orchid)
•   Lactone glycosidesSweet & Red clover
•   Phenolic glycosidesUvaUrsi, (arbutin)
•   Tanninsglycosides polymerized by polyphenol oxidase
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
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
Glycosides:Anthraquinones
                      Laxatives
Aloe

Buckthorn
(Rhamus frangula)


Cascara sagrada
(Rhamus purshiana)

Chinese rhubarb
(Rheum palamtum)

Senna
(Senna alexandrina)               Rheum rhabarbarum
                                   NOT LAXATIVE
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.“


http://www.pueblo.gsa.gov/cic_text/health/teatime/597_tea.html
Glycosides:Anthraquinones

Senna:
Glycoside: Sennoside A

Dimeric glycoside

 two 3 UNIT Phenolic
  groups attached with
  hydrogen bonding
Glycosides:Anthraquinones
     Cascara
     Glycoside: Cascarosides

                        glucose




                               glucose
LG
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

• Pregnancydon’t use Except if labor has stalled
LINK: mechanism of action study:
http://www.ncbi.nlm.nih.gov/pubmed/2289777?dopt=Abstract
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
Glycosides:Anthraquinones
Aloe

Glycosides:
aloe-emodin and emodin- anthraquinones
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
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.
Glycosides:Anthraquinones
Senna
Glycosides: sennosides, glycosides of „dianthrones‟ -
 molecules made with two anthraquinone skeletons



      glucose




     glucose
LG
Glycosides: Saponins
„Saponins‟ 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
Glycosides: Saponins
Hydrophobic-Hydrophilic Asymmetry
lowers surface tension- causes soaplike foaming
effect
Glycosides: Saponins


Three main classes of Saponins:

  Triterpenoid glycosides ( 5 rings)

  Steroidal glycosides (4 rings)

  Steroidal alkaloid glycosides
Glycosides: Saponins
MEDICINAL EFFECTS :

•   Adaptogenic/amphoteric
•   Alterative
•   Antihelminthic
•   Antifungal
•   Antimicrobial/Immunomodulation (both humoral and cellular)
•   Anti ulcerogenic
•   Cholesterol-lowering
•   Expectorant (via reflex irritation and lowering surface tension)
•   Hemolytic
•   Hepatoprotective (Bupleurem’s saikosaponins)
•   Adrenotrophic hormone releasers (ACTH)
•   Calcium channel blockers (Panax)
•   Diuretic
•   Vascular tonics/anti-exhudativeAesculus
•   AntiinflammatoryGlycyrrhiza, Guaicum
Glycosides: Saponins

Natural surfactants, Foaming
agents-

soaps and shampoos.



Antifungal, antibacterial
inhibits cancer cell growth.

Lowers blood cholesterol by binding with bile acids
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
Glycosides: Saponins
Licorice Root (Glycyrrhiza glabra)

 Glycosides:

 Glycyrrhizin (glycyrrhizinic acid)

 Liquiritin
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 malaria…
• Butein, isoliquiritigenin : stops growth of
  melanoma cells in vitro


LG
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
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
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
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.
Glycosides: Saponins

• Cortisone          • Glycyrrhitinic acid
Glycosides: Saponins
 Steroidal Saponins

• Cholesterol:
  example of solid sterol
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!)
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)
STEROIDAL SKELETON:
•   Sourcehttp://www2.odn.ne.jp/~had26900/constituents/cardiac_steroid_skeleton.gif:
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
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
Glycosides: Cardiac
Actions:
 •   Increase strength of systolic contractions-
     decrease length of systole- increase length of
     diastole

 •   Increases the heart‟s resting tone


 •   Improves cardiac output


 •   Improves renal flow

 •   Decreases edema- Pulmonary and Systemic
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
  – Safer, but requires more frequent dosing
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,
   – slowing down conduction
Glycosides: Cardiac




http://www.personal.psu.edu/mjm5267/blogs/202c/heart%202.jpg
Glycosides: Cardiac

        Dr. William Withering published
        Use of Digitalis to Treat Dropsy
        1785
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)
Glycosides: Cardiac
     Digitalis for Dropsy
• William Withering (a
  prominent physician in his
  time) is credited with
  „discovering‟ digitalis as a cure
  for dropsy in 1775
• In reality, he learned it from a
  local „gypsy‟ or „old woman‟
  who was curing cases of heart
  failure with a formula including
  Foxglove … an „old family
  recipe‟
LG
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
• „Purified‟ glycosides currently used in medicine;
  whole leaf previously used




LG
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
Glycoside:Cardiac
     • Isolated digitoxin is used in
       contemporary pharmacy
     • Cardiac glycoside, extracted from
       Foxglove (Digitalis purpurea or D.
       lanata)
Glycosides: Cardiac
 DIGITALIS
• INDICATIONS: CHF, supra-ventricular tachycardia, atrial flutter,
  atrial fibrillation

• USUAL DOSE:
    1-2 grams USP crude drug 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
    – less polar,
    – less water soluble
    – (MORE LIPOPHILIC) and have a longer half life
Glycosides:Cardiac
Lilly of the Valley(Convallaria spp.)
Glycosides:Cardiac
Convalleria

Used for cardiac irregularities with mechanical impediments
   –   Mitral valve insufficiency
   –   Feeble circulation with low arterial tension
   –   Dropsy of cardiac origin
   –   Palpitation with arrhythmias and vehement (violent) heart
       action
   –   Dyspnea
   –   Feeble quickened pulse
   –   Used with Crateagus, it is valuable in BRADYCARDIA
   –   Use before digitalis, which is more applicable in SEVERE
       CHF
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
Convalleria
                     Glycosides:Cardiac
• Contains anthraquinones-excessive doses cause diarrhea 1st- before
  toxicity ensues

• Contains highly water soluble ‘safer’ 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
Hawthorn
• Hyperin, a glycoside of quercetin, is
  the main flavonoid in Hawthorn
• Also contains OPC‟s
• 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
Variability: Developmental Stage




OPC levels in Hawthorn flowers are ~ 4x higher
in the bud stage than in open flowers
Cardiovascular Drugs
Herbal Support: Hawthorne


                   Hawthorne
 (Crataegus: laevigata, oxyacantha, monogyna, spp.)




                                                      53
                                                           53
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
„doctrine of signatures‟ which proposes that plants give „cosmic clues‟
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
Cardiovascular Drugs
      Nutrient Depletion: Hawthorne


Crataegus spp.
 Hawthorne
 Oligomeric
  procyanidins,vitexin,vitexin
  4’-O-rhamnoside,quercetin,
  Rutin
 Leaves and flowers have
  highest flaonide
  content,esp. OPC
 Also, increases strength of
  collagen 20 fold
 Use in OA a.w.a.CV Dz
                                      55
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
Cardiovascular Drugs
     Herbal Support: Hawthorne


Recommended Dosage:
Standardized Extract (18.75% oligomeric procyanidins)
    60 mg 3 X/day or or 80 mg 2 X per day.
Standardized ( 2.2 % flavonoids )
    100 – 300 mg 3 X per day
 Tincture: 300-900 mg/ day in divided doses
 Capsules Standardized (2% vitexin-2"-0- rhamnoside)
     300-1000 mg/ day in divided doses



                                                         57
Cardiovascular Drugs
   Herbal Support: Hawthorne

Product Examples
 Hawthorn leaf capsules, 325 mg Standardized (2% vitexin-2"-0-
rhamnoside)
http://www.iherb.com/Nature-s-Answer-Hawthorn-Leaf-Extract-60-Veggie-
Caps/8143?at=0

 Hawthorn extract (leaf, flower) tablets, 80 mg (18.75% Oligomeric
Procyanidins)
http://www.iherb.com/Nature-s-Way-HeartCare-Hawthorn-Extract-120-Tablets/1987?at=0

 Hawthorn Berry Veggie Caps, 500 mg
http://www.iherb.com/Nature-s-Answer-Hawthorn-Berry-120-Veggie-Caps/8115?at=0




                                                                                58
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.
“AUTHORS' 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.”
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
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
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
 – 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
 – 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
 – These drugs include digoxin.
 Note: all interactions are supported by studies unless noted by potential/theoretical



                                                                                             61
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
 – 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
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
     – 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
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 – 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
Isoflavones: Aglycones




LG
Isoflavones: Glycosides




     Most isoflavones actually occur as the glucose
     conjugates; aglycones are present in the plants, but
LG
     only in small amounts
Anthraquinones in Yellow Dock
     • Emodin, chrysophanol,
       rhein & related
       glycosides
     • Contribute to aperient
       activity




LG
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
Quinones: Naphthoquinones
  Drosera (Sundew) contains plumbagin:
  antibacterial, antispasmodic (for cough),
  immunostimulant




LGPhoto Š Richard Bailey 2003 The Carnivorous Plant Society www.thecarnivorousplantsociety.org
Anthraquinones in Hypericum
 • St. Johnswort contains a complex
   anthraquinone relative, hypericin
    (a „bianthraquinone‟)
 • Aka a „naphthodianthrone‟
 • Occurs with pseudohypericin
 • Colors the oil red
 • Contributes to antiviral & antidepressant
   activities
 • Responsible for photoreactivity
 • Synergistic with the flavonoids, xanthones,
   & hyperforin
LG
Cardiac Glycosides in Milkweeds




     • Found in all species of Asclepias
     • Components of the milky latex
LG   • Toxic to vertebrates, but not to butterflies
Isoflavones: Glycosides




Most isoflavones actually occur as the glucose
conjugates; aglycones are present in the plants, but
only in small amounts

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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 – glycoside in Ginseng to transport the molecule.
  • 2. Glycosides: Definition • Multitude of glycosides • Glycosides are not related to each other botanically or chemically • “Business 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 GlucosidesGlucose RhamnosidesRhamnose 2. AGLYCONE STRUCTURE: The business end of the molecule; most classification systems focus on the Aglycone
  • 4. Glycosides:Classification Classes of Glycosides: Examples: • Cardioactive glycosidesDigitalis, Convallaria • Anthraquinone glycosidesCascara, Senna, Aloe • Saponin glycosidesGlycyrrhiza • Cyanophore glycosides Amygdalin(laetril), Prunisin • Isothiocynate glycosidesWild mustard • Flavonoid glycosidesQuercetin • Alcohol glycosidesSalicin • Aldehyde glycosidesVanillin (Vanilla orchid) • Lactone glycosidesSweet & Red clover • Phenolic glycosidesUvaUrsi, (arbutin) • Tanninsglycosides polymerized by polyphenol oxidase
  • 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
  • 7. Glycosides:Anthraquinones Laxatives Aloe Buckthorn (Rhamus frangula) Cascara sagrada (Rhamus purshiana) Chinese rhubarb (Rheum palamtum) Senna (Senna alexandrina) Rheum rhabarbarum NOT LAXATIVE
  • 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.“ http://www.pueblo.gsa.gov/cic_text/health/teatime/597_tea.html
  • 9. Glycosides:Anthraquinones Senna: Glycoside: Sennoside A Dimeric glycoside two 3 UNIT Phenolic groups attached with hydrogen bonding
  • 10. Glycosides:Anthraquinones Cascara Glycoside: Cascarosides glucose glucose LG
  • 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 • Pregnancydon’t 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.
  • 16. Glycosides:Anthraquinones Senna Glycosides: sennosides, glycosides of „dianthrones‟ - molecules made with two anthraquinone skeletons glucose glucose LG
  • 17. Glycosides: Saponins „Saponins‟ 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
  • 18. Glycosides: Saponins Hydrophobic-Hydrophilic Asymmetry lowers surface tension- causes soaplike foaming effect
  • 19. Glycosides: Saponins Three main classes of Saponins: Triterpenoid glycosides ( 5 rings) Steroidal glycosides (4 rings) Steroidal alkaloid glycosides
  • 20. Glycosides: Saponins MEDICINAL EFFECTS : • Adaptogenic/amphoteric • Alterative • Antihelminthic • Antifungal • Antimicrobial/Immunomodulation (both humoral and cellular) • Anti ulcerogenic • Cholesterol-lowering • Expectorant (via reflex irritation and lowering surface tension) • Hemolytic • Hepatoprotective (Bupleurem’s saikosaponins) • Adrenotrophic hormone releasers (ACTH) • Calcium channel blockers (Panax) • Diuretic • Vascular tonics/anti-exhudativeAesculus • AntiinflammatoryGlycyrrhiza, Guaicum
  • 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
  • 23. Glycosides: Saponins Licorice Root (Glycyrrhiza glabra) Glycosides: Glycyrrhizin (glycyrrhizinic acid) Liquiritin
  • 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 malaria… • 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.
  • 29. Glycosides: Saponins • Cortisone • Glycyrrhitinic acid
  • 30. Glycosides: Saponins Steroidal Saponins • Cholesterol: example of solid sterol
  • 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)
  • 33. STEROIDAL SKELETON: • Sourcehttp://www2.odn.ne.jp/~had26900/constituents/cardiac_steroid_skeleton.gif:
  • 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 heart‟s 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 – 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, – 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 „discovering‟ digitalis as a cure for dropsy in 1775 • In reality, he learned it from a local „gypsy‟ or „old woman‟ who was curing cases of heart failure with a formula including Foxglove … an „old family recipe‟ 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 • „Purified‟ 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 drug 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 – less polar, – less water soluble – (MORE LIPOPHILIC) and have a longer half life
  • 47. Glycosides:Cardiac Lilly of the Valley(Convallaria spp.)
  • 48. Glycosides:Cardiac Convalleria Used for cardiac irregularities with mechanical impediments – Mitral valve insufficiency – Feeble circulation with low arterial tension – Dropsy of cardiac origin – Palpitation with arrhythmias and vehement (violent) heart action – Dyspnea – Feeble quickened pulse – Used with Crateagus, it is valuable in BRADYCARDIA – 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 ‘safer’ 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 OPC‟s • 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
  • 52. Variability: Developmental Stage OPC levels in Hawthorn flowers are ~ 4x higher in the bud stage than in open flowers
  • 53. Cardiovascular Drugs Herbal Support: Hawthorne Hawthorne (Crataegus: laevigata, oxyacantha, monogyna, spp.) 53 53
  • 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 „doctrine of signatures‟ which proposes that plants give „cosmic clues‟ 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.  Hawthorne  Oligomeric procyanidins,vitexin,vitexin 4’-O-rhamnoside,quercetin, Rutin  Leaves and flowers have highest flaonide content,esp. OPC  Also, increases strength of collagen 20 fold  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: Standardized Extract (18.75% oligomeric procyanidins) 60 mg 3 X/day or or 80 mg 2 X per day. Standardized ( 2.2 % flavonoids ) 100 – 300 mg 3 X per day  Tincture: 300-900 mg/ day in divided doses  Capsules Standardized (2% vitexin-2"-0- rhamnoside) 300-1000 mg/ day in divided doses 57
  • 58. Cardiovascular Drugs Herbal Support: Hawthorne Product Examples  Hawthorn leaf capsules, 325 mg Standardized (2% vitexin-2"-0- rhamnoside) http://www.iherb.com/Nature-s-Answer-Hawthorn-Leaf-Extract-60-Veggie- Caps/8143?at=0  Hawthorn extract (leaf, flower) tablets, 80 mg (18.75% Oligomeric Procyanidins) http://www.iherb.com/Nature-s-Way-HeartCare-Hawthorn-Extract-120-Tablets/1987?at=0  Hawthorn Berry Veggie Caps, 500 mg http://www.iherb.com/Nature-s-Answer-Hawthorn-Berry-120-Veggie-Caps/8115?at=0 58
  • 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. “AUTHORS' 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.” 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 – 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 – 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 – 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 – 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 – 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 – 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 „bianthraquinone‟) • Aka a „naphthodianthrone‟ • 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
  • 72. Isoflavones: Glycosides Most isoflavones actually occur as the glucose conjugates; aglycones are present in the plants, but only in small amounts