Kava-kava (Piper methysticum)

1. Kava-kava (Piper methysticum) Parts used : roots, rhizomes Properties: bitter, pungent, warming herb, diuretic, relieves pain, relaxes spasm, stimulant effect on circulatory and nervous system Constituents: kava lactones / pyrones, kavain, dihydro-kavain methysticin, yangonine, Medicinal use: nervous anxiety, stress, restlessness, insomnia The sedative effect of kava-pyrones might be mediated via the GABA-A receptor.

2. Precautions and dosage: Patients should not use kava without first obtaining medical advice, and doses should not exceed 300 mg/day. In one clinical trial using WS 1490, the occurrence of adverse effects was rare. Only two reports (stomach upset in both cases) were rated as “possibly related.” The most commonly reported adverse effect of kava usage is kava dermopathy—a yellow, scaly, leprosy-like eruption of the skin and inflammation of the eyes. The drug contraindicated during pregnancy or nursing. It is also contraindicated in patients with endogenous depression because it increases the danger of suicide. Daily dose: equivalent of 60 to 120 mg kava lactones.

3. Possible interaction between kava-lactones and pharmaceutical drugs. The drug may enhances the effectiveness of barbiturates and other psychopharmacological agents. Kava lactons inhibit Cytochrome P-450 Drug clearance is slowing down, extended effect or toxicity Deficiency of CYP2D6 (7-9% of Caucasian population) People should avoid kava predisposed to liver problem or already taking drugs that have adverse effect on the liver.

4. Valerian (Valeriana officinalis) • Actions: Anxiolytic, mild sedative, hypnotic, spasmolytic • Medicinal Uses: insomnia, nervous unrest, stress and neuralgia, depression and anxiety • Side effects:low • Doses: 400-500 mg liquid ext capsules of 100, 250, 380, 400, 445, 475, 500, 1000 mg tablets 160 mg 550 mg

5. Chemistry, Functions, Toxicity • Sesquiterpenes (volatile oils) and valepotriates (iridoid triesters). • Acts via a central adenosine mechanism(partialagonist) • Inhibits cAMP accumulations • No clearly identified toxicities in humans • Possible adverse reactions: CNS: headache, morning drowsiness, restlessness. CV: cardiac disturbances GI: GI complaints Withdrawal symptoms

6. Drug-herb Interaction • No drug interactions have been reported in humans • Potential reaction with barbiturates and benzodiazepines • Contraindicated while undergoing treatment with barbiturates • May be helpful in easing withdrawal from benzodiazepines.

7. Passion flower (Passioflora incarnata) • Actions: Nervine, sedative, hypnotic, anticonvulsive, hypotensive • Medicinal Uses: insomnia, nervous agitation, stress and neuralgia, anxiety, asthma • Side effects: mild • Doses: up to500 mg liquid ext capsules of 150-300 mg tablets 200-300 mg

8. Chemistry, Functions, Toxicity • Alkaloids(indol alkaloids, harmine ,harmol, harmaline, passaflorine) and flavonoids (apeginin various glycosides). • Exact mechanism is unknown : CNS stimulation via MAO inhibition • Inhibits metabolism of serotonin and noradrenalin • No clearly identified toxicities in humans • Possible adverse reactions: CNS: headache, morning drowsiness. CV: tachycardia, hypotension GI: nausea

9. Drug-herb Interaction • Potential reaction with hexabarbital • Contraindicated while undergoing treatment with barbiturates • Isocarboxazid, phenelzine, selegiline, tanylcypromine, Action may be potentiated.

10. Hops (Humulus lupus) • Actions: Sedative, hypnotic, antispasmodic, anti-microbial, bitter • Medicinal Uses: insomnia, restlessness, neuralgia, anxiety, indigestion • Side effects: mild • Doses: 0.50-1.0g or 1-3ml tincture , 2 tsp 1 cup water tee.

11. Chemistry, Functions, Toxicity • Bitter substances(volatile oils mainly humulene) and flavonols (kaempherol, quercetin) diterpene alcohols (maruciol, sclareol). • Beta –bitters may have estrogenic activity, humulene inhibit gram-positive bacterial growth • The volatile hemiterpene 2-methyl-3-buten- 2-ol sedative hypnotic • Possible adverse reactions: CNS: sedation. Respiratory: bronchial irritation Skin : irritation, deramatitis

12. Drug-herb Interaction • CNS depressant: possible additive effect • Phenothizine –type antipsychotics: possible additive effect • Contraindicated to use with small children. • Patient with estrogenic dependent tumors should avoid.

13. Lemon balm (Melissa officinalis) • Actions: sedative, carminative anti-viral, anti-thyroid (inhibits TSH synth) • Medicinal Uses: insomnia, anxiety, chronic bronchial cataract, migrane, HBP, topically: rheumatism, nerve pain, • Side effects: low • Doses: 1.5g for tea, 1-5 drop essential oil inhalation, topical cream.

14. Chemistry, Functions, Toxicity • Volatile oils : citral (geranial, limone flavonoids, tannins, caffeic , ursolic ,pomolic acids • Anti bacterial agent , Anti-viral, (herpes simplex), mosquito repellent • Cautions: • Patient with glaucoma, hypertension, thyroid disorders, BPH allergic to lemon citrus scent should not use.

15. Drug-herb Interaction • No direct herb drug interaction reported. • Avoid alcohol use. • Direct oral use of essential oil should be avoided.