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RDU Update
RDU Update
National Center for Pharmaceutical Access and Management, Department of Health c/o Department of Pharmacology and Toxicology College of Medicine University of the Philippines A quarterly publication on the rational use of drugs of the
547 Pedro Gil Street, Ermita, Manila, Philippines 1000 National Center for Pharmaceutical Access and Management, Department of Health
Volume 18 No 1 Manila, Philippines 2011
Assessment of natural products used to
lower blood sugar level
There has been increasing use of natural AMPALAYA (BITTER MELON)
products by Filipinos to control their blood Ampalaya or bitter melon (Scientific name: products in addition to their conventional Momordica charantia) is registered as antidiabetic medications such as metformin dietary supplement in the Philippines as tea and the sulfonylureas. Some ‘borderline diabetics’ would use them to ‘prevent’ the capsule or tablet made from dried pulverized frank manifestations of diabetes. Still others ampalaya as a single plant ingredient or in such as banaba (Lagerstoenia speciosa), and/or luyang dilaw (Curcuma longa). consulting their physicians, having been influenced by aggressive promotion of the Traditional uses
neighbors. Information on the true worth of Ampalaya fruit is a folk remedy for diabetes. ampalaya should be made available for the Some patients would ask advice from their Dosage used in diabetes mellitus is 1/3 cup physicians before using these supplements, made from a decoction prepared by boiling so practitioners should be ready with the a 1:2 mixture of finely chopped ampalaya objective information that they should give leaves and water, to be taken 3 times daily, preparations include one small, unripe, raw In this issue of RDU Update, shall assess fruit or about 50 to 100 milliliters of the juice from the fruit pulp daily, by mouth. 100 RDU Update
preparations used by Filipinos, either as milliliters of a 1:1 aqueous (water) extract of single-plant preparation or as multiple-plant the fresh fruit daily, by mouth may also be Editorial Advisory Board: Nelia P, Cortes-Maramba, Marieta B, de Luna, Estrella B. Paje-Villar
preparation, to ‘lower blood sugar level’. Editor: Isidro C. Sia
Associate Editor: Nazarita T. Tacandong
Managing Editor: Rainier M. Galang
Contributing Editors: Celia P. Carlos, Maria Stephanie Fay S. Cagayan, Cynthia I. Valencia
Art/Circulation Manager: Anna Margarita A. Bernardo
Contributions, suggestions, inquiries, or feedback from readers are welcome. Please address all letters to: The Editor, RDU Update, The National Drug Information Center, c/o Department of Pharmacology and Toxicology, College of Medicine, University of the Philippines Manila, 547 Pedro Gil Street, Ermita, Manila, Philippines 1000 *Professor of Pharmacology, College of Medicine, University of the Philippines-Manila Telefax: (623) 5264384; E-mail: NDIC@druginfo.ph RDU Update 2011 Volume 18 Number 1 Page 2
RDU Update 2011 Volume 18 Number 1 Page 3
Chemical constituents and activity1
Assessment of efficacy as antidiabetic
Safety
Safety
agent
Adverse effect includes heightened bitter taste. No toxicity has been reported, even in high hypoglycemic effect include p-insulin, charantin, Most clinical trials of ampalaya have been in doses. The use of banaba should be avoided diabetes with small number of subjects and during pregnancy and lactation. Concurrent use various forms and extracts. These have yielded hypoglycemic patients. Concurrent use of The hypoglycemic effects of extracts taken from inconsistent results.1 Clinical trial data with ampalaya are well documented. Conflicting human subjects are limited and flawed by poor design and low statistical power. Better Assessment of efficacy as antidiabetic
mechanism of action behind these effects. designed clinical trials are needed to further Assessment of efficacy as antidiabetic
agent
Some studies support the action of several elucidate its possible therapeutic effects.4,5 agent
substances, such as p-insulin, charantin and Clinical evidence supporting the efficacy of vicine, as being effective hypoglycemic agents, There are no reviews for Momordica charantia There are limited clinical studies to warrant its banaba in the treatment of diabetes mellitus is even without help from the pancreas (after use as antidiabetic. Only small open studies very limited.10 In a small, randomized clinical pancreatectomy). Other investigators say that trial involving 56 patients with Type 2 diabetes extracts from ampalaya stimulate increased Devices) nor the World Health Organization. It mellitus, banaba extract standardized to 1% insulin secretion. Still, other investigators is, however, included in the list of 10 herbal Recommendations
corosolic acid, administered for 2 weeks at suggest an extrapancreatic effect to explain the dosages of 32 mg and 48 mg daily, significantly The use of gynema in patients with diabetes processes that directly influence hepatic or Ampalaya, as stated in the guide published by the DOH, is indicated for use in diabetes controlled trials are warranted to further Recommendations
mellitus (mild, non-insulin dependent).2 Other constituents and activity
The use of banaba in the treatment of patients Recommendations
with diabetes mellitus is not recommended. LUYANG DILAW (TURMERIC)
Certain proteins found in ampalaya have been Further well-signed trials are needed to reported to have antiviral activity (momordica The use of ampalaya, if it is to be used as an Luyang dilaw (Scientific name: Curcuma longa) establish its place in diabetic therapy. anti-HIV protein–MAP30), antineoplastic adjunct in the treatment of Type 2 diabetes is used in combination with ampalaya and property (alpha-momorcharin, MAP30, mellitus entails the supervision of a physician in momordin I), and abortifacient activity (alpha-, determining the proper dosage for both the herbal extract and the conventional medicines Safety
REFERENCES
1Bitter melon – Alternative Medicine Evaluation. AltMedDEx®
for optimal glycemic control. Well-designed System. Micromedex® 2.0 (Healthcare Series), Electronic Version antifertility, analgesic and anti-inflammatory clinical trials are needed to further elucidate its 1974-2011 Thomson Reuters (Healthcare). 2Gabay sa Paggamit ng 10 Halamang Gamot. Philippine Institute of
anaphylaxis have been reported in clinical trials. Traditional and Alternative Health Care (PITAHC), Department of An increased risk of kidney stone formation is 3Bitter melon. POISINDEX® Managements. Micromedex® 2.0
Safety
theoretically possible in susceptible individuals. (Healthcare Series), Electronic Version 1974-2011 Thomson Emmenagogue and abortifacient effects of Adverse reactions noted with large intake of Gymnema (Scientific name: Gymnema luyang dilaw have been documented. Its use is Leung L, Birtwhistle R, Kotecha J, Hannah S, Cuthbertson S. Anti- diabetic and hypoglycaemic effects of Momordica charantia (bitter ampalaya and its extracts include stomach sylvestre) is not grown in the Philippines. It is melon): a mini review. Br J Nutr. 2009 Dec;102(12):1703-1708. pain, diarrhea, and hypoglycemia.3 It should not imported as finished product and is registered Yeh GY, Eisenberg DM, Kaptchuk TJ, Phillips RS. Systematic review of herbs and dietary supplements for glycemic control in be used in patients with hypersensitivity to Assessment of efficacy as antidiabetic
diabetes. Diabetes Care. 2003 Apr;26(4):1277-1294. ampalaya, in pregnant or lactating women, and Administration as food supplement, nut Filipinos Gymnema – Alternative Medicine Evaluation. AltMedDEx® System. Micromedex® 2.0 (Healthcare Series), Electronic Version 1974- in patients with known liver disease or those have been using it to control their blood sugar Clinical evidence supporting the efficacy of luyang dilaw in the treatment of diabetes Gymnema. Facts & Comparisons, Wolters Kluwer Health 2009. traditional use of roots, fruits and seeds as http://www.drugs.com/npp/gymnema.html. Date accessed:
The anti-sweet effects of Gymnema is being 8Nahas R, Moher M.Complementary and alternative medicine for
abortifacient effects of the seed momorcharin in exploited to entice diabetics to use Gymnema. Recommendations
the treatment of type 2 diabetes. Can Fam Physician. 2009 mice, ampalaya should not be used during 9Turmeric. Facts & Comparisons, Wolters Kluwer Health 2009.
sucrose, as well as those of sodium saccharin, The use of luyang dilaw in the treatment of cyclamate and glycine. The altered taste http://www.drugs.com/npp/turmeric.html. Date accessed:
January 20, 2011.
Ampalaya has been reported to further lower sensation may persist for 15 minutes to 24 recommended. Well-designed clinical trials are 10Banaba. Facts & Comparisons, Wolters Kluwer Health 2009.
blood sugar level when taken together with hours.6 It is available as tea, powder, tablet and chlorpropamide and might also occur if taken http://www.drugs.com/npp/banaba.html. Date accessed:
January 20, 2011.
together with other hypoglycemic agents.1 11Judy WV, Hari SP, Stogsdill WW, Judy JS, Naguib YM,
Concomitant use may lead to dangerously low Gymnema is used in traditional medicine to Passwater R. Antidiabetic activity of a standardized extract (GlucosolTM) from Lagerstroemia speciosa leaves in Type II lower blood sugar. It has also been investigated Banaba (Scientific name: Lagerstroemia diabetics. A dose-dependence study. J Ethnopharmacol. 2003 in animals for its lipid-lowering effect.7 speciosa) is being used alone or in combination with ampalaya in the treatment of diabetes.

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