Also Known As:

Cataire, Catmint, Catswort, Chataire, Field Balm, Hierba Gatera, Menta de Gato,

Menthe des Chats.

CAUTION: See separate listing for Schizonepeta.

Scientific Name:

Nepeta cataria.

Family: Lamiaceae/Labiatae.

People Use This For:

Catnip is used for insomnia; migraine headaches; cold; flu; swine flu; fever;

hives; and gastrointestinal (GI) upset, including indigestion, colic, cramping, and

flatulence. It is also used orally for conditions associated with anxiety, diuresis,

as a tonic, for upper respiratory tract infections, and headaches. Additionally,

catnip is also used orally for lung and uterine congestion, eradicating worms, and

for initiating menses in girls with delayed onset of menstruation.

Topically, catnip has been used for arthritis, hemorrhoids, and as a poultice to

relieve swelling.

As an inhalant, catnip is smoked for respiratory conditions and recreationally for

inducing a euphoric high.

In manufacturing, catnip is used as a pesticide and insecticide.

Safety:

POSSIBLY SAFE ...when used orally and appropriately (2,3). Significant adverse

effects have not been reported when catnip tea is used in cupful amounts (62).

POSSIBLY UNSAFE : when used orally in excessive doses. Higher doses may

be associated with significant adverse effects (62). ...when inhaled by smoking

dried leaves. Smoking the dried leaves of catnip has been associated with a

euphoric high (2), which might impair judgment; however, whether catnip can

truly produce this effect in humans remains controversial (2).

There is insufficient reliable information available about the safety of topically

applied catnip.

CHILDREN: POSSIBLY UNSAFE ...when used orally. One child developed

stomach pain and irritability followed by lethargy and hypnotic state after

ingesting catnip leaves and tea (1,5).

PREGNANCY: LIKELY UNSAFE ...when used orally. Catnip tea has been

reported to have uterine stimulant properties (3); avoid using.

LACTATION: Insufficient reliable information available; avoid using.

Effectiveness:

There is insufficient reliable information available about the effectiveness of

catnip.

Mechanism of Action:

The applicable part of catnip is the flowering tops. The pharmacological effect

that catnip is famous for is the euphoric state it induces in cats. It is thought that

the constituent cis-trans-nepetalcatone produces the characteristic stimulation

in cats only when they smell it (1). Although humans have used catnip to

induce a euphoric high, whether or not this effect actually occurs in humans

is controversial. In humans, the constituent nepetalactone is thought to be

responsible for catnip's calming effects in insomnia, anxiety, gastrointestinal (GI)

conditions, and migraine headache. Nepetalactone is the major component (80-

95%) of the volatile oil of catnip and is structurally related to the valepotriates

found in valerian. Catnip provides approximately 0.2-1% volatile oil. Catnip

reportedly also has antipyretic and diaphoretic effects, which have been

attributed to its use for colds, flu, and fever. Other reported pharmacological

effects, include diuretic and stimulation of gallbladder activity (2).

Adverse Reactions:

Report an Adverse Reaction to CATNIP

Catnip abuse may result in headache and malaise. Large amounts of tea may

cause vomiting (2). One case report exists of a nineteen-month-old child who

developed a stomachache and irritability, followed by lethargy and a hypnotic

state after ingesting raisins soaked in catnip tea and chewing on the tea bag (5).

Interactions with Herbs & Supplements:

HERBS AND SUPPLEMENTS WITH SEDATIVE PROPERTIES: Theoretically,

concomitant use of catnip with herbs that have sedative properties might

enhance therapeutic and adverse effects. Some of these supplements include

5-HTP, calamus, California poppy, catnip, hops, Jamaican dogwood, kava, St.

John's wort, skullcap, valerian, yerba mansa, and others.

Interactions with Drugs:

CNS DEPRESSANTS <<interacts with>> CATNIP

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use with drugs with sedative properties may cause

additive effects and side effects (4).

LITHIUM <<interacts with>> CATNIP

Interaction Rating = Moderate Be cautious with this combination.
Severity = Moderate • Occurrence = Probable • Level of Evidence = D

Catnip is thought to have diuretic properties. Theoretically, due to these potential
diuretic effects, catnip might reduce excretion and increase levels of lithium. The
dose of lithium might need to be decreased.

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known.

Interactions with Diseases or Conditions:

PELVIC INFLAMMATORY DISEASE (PID) and MENORRHAGIA: Because

catnip is also used to stimulate menstruation, theoretically it is contraindicated in

pelvic inflammatory disease (PID) and excessive menstrual bleeding (3).

SURGERY: Catnip has CNS depressant effects. Theoretically, catnip might

cause additive CNS depression when combined with anesthesia and other

medications during and after surgical procedures. Tell patients to discontinue

catnip at least 2 weeks before elective surgical procedures.

Dosage/Administration:

ORAL: People typically use two 380 mg capsules three times daily at meals or

prepared as a tea using 1-2 teaspoons in 6 ounces of boiling water.

Specific References: Catmint

1. Foster S, Tyler VE. Tyler's Honest Herbal: A Sensible Guide to the Use of

Herbs and Related Remedies. 3rd ed., Binghamton, NY: Haworth Herbal Press,

1993.

2. The Review of Natural Products by Facts and Comparisons. St. Louis, MO:

Wolters Kluwer Co., 1999.

3. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products

Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC

1997.

4. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR:

Eclectic Medical Publications, 1998.

5. Osterhoudt KC, Lee SK, Callahan JM, Henretig FM. Catnip and the alteration

of human consciousness. Vet Hum Toxicol 1997;39:373-5.

Also Known As:

African Bird Pepper, African Chillies, African Pepper, Aji, Bird Pepper, Capsaicin, Capsaïcine, Cayenne, Cayenne Pepper, Chili, Chili Pepper, Chilli, Chillies, Cis-capsaicin, Civamide, Garden Pepper, Goat's Pod, Grains of Paradise, Green Chili Pepper, Green Pepper, Hot Pepper, Hungarian Pepper, Ici Fructus, Katuvira, Lal Mirchi, Louisiana Long Pepper, Louisiana Sport Pepper, Mexican Chilies, Mirchi, Oleoresin Capsicum, Paprika, Paprika de Hongrie, Pili-pili, Piment de Cayenne, Piment Enragé, Piment Fort, Piment-oiseau, Pimento, Poivre de Cayenne, Poivre de Zanzibar, Poivre Rouge, Red Pepper, Sweet Pepper, Tabasco Pepper, Trans-capsaicin, Zanzibar Pepper, Zucapsaicin, Zucapsaïcine.

CAUTION: See separate listings for Grains of Paradise and Indian Long Pepper.

Scientific Name:

Capsicum frutescens; Capsicum annuum; Capsicum chinense; Capsicum baccatum; Capsicum pubescens; Capsicum minimum; and other Capsicum species.
Family: Solanaceae.

People Use This For:

Orally, capsicum is used for dyspepsia, flatulence, colic, diarrhea, cramps, toothache, poor circulation, excessive blood clotting, seasickness, swallowing dysfunction, alcoholism, malaria, fever, hyperlipidemia, and preventing heart disease.
Topically, capsicum is used for the pain of shingles, osteoarthritis, rheumatoid arthritis, post-herpetic neuralgia, trigeminal neuralgia, diabetic neuropathy, back pain, and post-surgical neuralgias. It is also used topically for prurigo nodularis, HIV-associated neuropathy, and fibromyalgia. Capsicum is also used to relieve muscle spasms, as a gargle for laryngitis, and as a deterrent to thumb-sucking or nail biting.

Intranasally, capsicum is used for allergic rhinitis, perennial rhinitis, migraine headache, cluster headache, sinonasal polyposis, and sinusitis

Safety:

LIKELY SAFE ...when used orally in amounts typically found in food. Capsicum has Generally Recognized As Safe (GRAS) status in the US (5). ...when used topically and appropriately. The active capsicum constituent capsaicin used in topical preparations is an FDA-approved over-the-counter product (1).
POSSIBLY SAFE ...when used orally and appropriately, short-term in medicinal amounts (16,17). ...when used topically and appropriately (11,12). ...when used intranasally and appropriately, short-term. Capsicum-containing nasal sprays, suspensions, and swabs seem to be safe when applied daily or every other day for up to 14 days (28,30,31 ,32, 33, 34, 35, 38, 39, 40, 41, 42, 43). No serious side effects have been reported in clinical trials, however, application of capsicum-containing products intranasally can be very painful.
POSSIBLY UNSAFE ...when used orally, long-term or in high doses. There is concern that long-term use or use of excessive doses might be linked to hepatic or renal damage (16). (
CHILDREN: POSSIBLY UNSAFE ...when used topically in children under 2 years old (1). There is insufficient reliable information available about the safety of capsicum when used orally in children.
PREGNANCY: LIKELY SAFE ...when used topically and appropriately (1). There is insufficient reliable information available about the safety of capsicum during pregnancy when used orally in medicinal amounts.
LACTATION: LIKELY SAFE ...when used topically and appropriately (1). POSSIBLY UNSAFE ...when used orally. Dermatitis can sometimes occur in breast-fed infants when mothers ingest foods heavily spiced with capsicum peppers (2).

Effectiveness:

LIKELY EFFECTIVE

Pain. Several clinical studies show that applying 0.25% to 0.75% capsaicin cream topically temporarily relieves chronic pain from rheumatoid arthritis, osteoarthritis, psoriasis, and neuralgias including shingles and diabetic neuropathy (13, 47). The active capsicum constituent capsaicin, used in topical preparations, is FDA-approved for these uses (1).
For neuropathic pain, the number needed to treat using capsaicin 0.075% for eight weeks is 5.7 (13).  (12401).
For musculoskeletal pain, for every 8.1 patients treated with 0.025% capsaicin, one would achieve at least a 50% reduction in pain (13). In a study using 0.05% capsaicin (Finalgon CPD Warmecreme) applied three times daily for 21 days, there was a 49% reduction in pain compared to placebo in patients with chronic soft tissue pain (47).

POSSIBLY EFFECTIVE

Back pain. Some evidence shows that applying a capsicum-containing plaster to back can significantly reduce low-back pain compared to placebo (44, 45. 46).
Cluster headache. Some evidence shows that using capsaicin intranasally might reduce the frequency of episodic or chronic cluster headache attacks (29, 33, 34, 40). Intranasal application of capsaicin 0.025% (Zostrix, Rodlen Laboratories) might also decrease symptom severity during an acute cluster headache attack. Daily treatment for 7 days seems to decrease symptom severity over the following week (35). Ipsilateral, or same side, nostril application of capsaicin appears to be more effective than contralateral application (33).
Fibromyalgia. Applying cream containing 0.025% of the active capsicum constituent capsaicin 4 times daily to tender points for 4 weeks seems to reduce tenderness in patients with fibromyalgia (11).
Perennial rhinitis. Some evidence suggests that intranasal treatment with capsaicin solution can significantly decrease symptoms of non-allergic, non-infectious perennial rhinitis symptoms ( 34, 39, 43) A decrease of symptoms has been observed for 6-9 months following intranasal capsaicin treatment (34, 39) 

Prurigo nodularis. Applying a cream containing 0.025% to 0.3% of the active capsicum constituent capsaicin 4-6 times daily seems to relieve burning sensations, erythema, pruritus, and healing of skin lesions over a period of 2 weeks to 33 months. Symptoms, however, may return after discontinuation of therapy (48).

POSSIBLY INEFFECTIVE

HIV-associated peripheral neuropathy. Applying capsaicin topically does not seem to relieve symptoms of HIV-associated peripheral neuropathy (4).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Allergic rhinitis. Preliminary research suggests that intranasal treatment with cotton wads soaked in capsaicin applied for 15 minutes and repeated over two days might reduce the severity of experimentally induced allergic rhinitis. Severity of symptoms seems to be decreased for up to two months after capsaicin treatment (30). However, contradictory evidence suggests that patients with allergic rhinitis caused by house dust mites do not have significantly improved symptoms after using a capsaicin solution providing 0.15 mg/dose for up to 7 doses over a 14-day period (42).
Dyspepsia. Preliminary evidence suggests that red pepper powder in capsules taken before meals 3 times daily reduces symptoms of functional dyspepsia. In some patients, there seems to be a worsening of symptoms before improvement (22). (12410).
Irritable bowel syndrome (IBS). Preliminary evidence suggests that capsicum fruit taken orally doesn't help symptoms of IBS (15).
Migraine headache. Anecdotal evidence suggests that intranasal application of capsaicin 0.075% might help abort a migraine headache (35).
Peptic ulcers. There is preliminary evidence that suggests people who eat capsicum fruit (chili) an average of 24 times per month appear to be less likely to have an ulcer than people who eat chili an average of 8 times per month. This applies to chili in the form of chili powder, chili sauce, curry powder, and other chili-containing foods (12).  
Sinonasal polyposis. Preliminary evidence suggests that intranasal application of capsaicin can cause significant subjective improvement in symptoms as well as objective improvement in nose/sinus air volume and endoscopy scores in patients with severe sinonasal polyposis; however, capsaicin does not seem to significantly affect eosinophil cationic protein levels (41). 

Swallowing dysfunction. Preliminary evidence suggests that elderly patients at risk for aspiration pneumonia due to swallowing dysfunction have improved swallowing reflexes after dissolving a capsaicin-containing lozenge in their mouth before each meal (27).
More evidence is needed to rate capsicum for these uses.

Mechanism of Action:

The applicable part of capsicum is the fruit. Capsicum contains the constituent capsaicin, which makes it taste hot.
Naturally-occurring capsaicin exists only in the trans-stereoisomer form. However, the cis-isomer, known as civamide, also has pharmacological activity. Some evidence suggests that civamide is more potent and causes less irritation than naturally occurring capsaicin. (29).
When used topically, capsaicin binds to nociceptors in the skin, initially causing neuronal excitation and heightened sensitivity. This is felt as itching, pricking, or burning. Capsaicin also causes cutaneous vasodilation. The mechanism for these effects is thought to be the result of selective stimulation of afferent C fibers, which act as thermoreceptors and nociceptors, and release of substance P, a sensory neurotransmitter that mediates pain. This is followed by a refractory period with reduced sensitivity. After repeated applications, persistent desensitization occurs, possibly the result of substance P depletion. Pain relief may also be caused by degeneration of epidermal nerve fibers (13, 16, 22).
Capsaicin also stimulates the unmyelinated slow C-fibers of the sensory nervous system, which can induce cough, dyspnea, nasal congestion, and eye irritation after inhalation (6).
Some research with inhaled capsaicin suggests that severity of ACE inhibitor cough correlates with sensitivity to inhaled capsaicin (23, 24, 25,26).
In people with swallowing dysfunction, capsaicin is thought to provide sensory stimulation that increases the swallowing reflex (27).
For allergic and perennial rhinitis, it is not clear how capsaicin nasal spray might work. Like for pain syndromes, capsaicin likely depletes substance P, resulting in desensitization of the nasal mucosa to antigens (30, 36). Some research suggests that capsaicin does not cause significant changes in nasal neuronal tissue. Capsaicin is thought to possibly have anti-inflammatory effects. But some research suggests that capsaicin does not affect inflammatory cell density in the nasal mucosa (28, 30). Or concentrations of inflammatory mediators such as leukotrienes or prostaglandins (34).  Other research in animal models of nasal hypersensitivity suggests that intranasal capsaicin decreases substance P and tyrosine hydroxylase-like immunoreactive nerve fibers (37).
For migraine and other headaches, capsaicin is thought to cause a desensitizing effect by relieving both peripheral and central pain by decreasing release of neuropeptides, such as substance P, from nerve terminals. When applied intranasally, capsaicin is also thought to decrease intranasal and central blood vessel neurotransmitters, cause vasodilation, and histamine or serotonin release (29). In animal models, intranasal capsaicin also seems to deplete nerve fibers that are immunoreactive to the neuropeptides substance P or calcitonin gene-related peptide (CGRP) (34).
Some researchers theorize that the capsaicin constituent might also have gastroprotective effects. Preliminary evidence suggests that capsicum protects against alcohol and non-steroidal anti-inflammatory drug (NSAID) damage to the GI mucosa. This has also led to the hypothesis that capsaicin might decrease the risk of peptic ulcer disease (12). However, with heavy ingestion, capsaicin has been associated with necrosis, ulceration, and carcinogenesis (16).
Capsaicin seems to have antiplatelet effects (18, 19). Some evidence shows capsicum extract has antibacterial properties (14).
Capsaicin is thought to be metabolized by the cytochrome P450 (CYP450) system to active metabolites. Whether these substances can cause cancer or protect against cancer by altering carcinogen metabolism is an area of active research (14). 

Capsicum powder has been reported to prevent radiation-induced damage to bacterial DNA and thereby protect certain bacteria (Escherichia coli, Bacillus megaterium, and Bacillus pumilus spores) from gamma irradiation, which is used to preserve some foods (6).

Adverse Reactions:

Orally, capsicum can cause upper abdominal discomfort including fullness, gas, bloating, nausea, epigastric pain and burning, diarrhea, and belching (12, 22). Sweating and flushing of the head and neck, lacrimation, headache, faintness, and rhinorrhea have also been reported (8, 22). Excessive amounts of capsaicin can lead to gastroenteritis and hepatic necrosis (13). There are also reports of dermatitis in breast-fed infants whose mothers' food is heavily spiced with capsicum (2). Capsicum can also decrease blood coagulation (9).
Topically, capsicum can cause burning, stinging, and erythema. About one in 10 patients who use capsaicin topically discontinue treatment because of adverse effects. Side effects tend to diminish with continued use (10). Exacerbation of ACE-inhibitor cough has been reported in patients using topical capsaicin and taking ACE-inhibitors (26). Skin contact with fresh capsicum fruit can cause irritation or contact dermatitis (20)
Intranasally, capsaicin can cause nasal burning and pain in most patients. It also often causes lacrimation, sneezing, and excessive nasal secretion (29, 35, 40): however, these side effects appear to diminish with repeat applications. In some cases, the burning sensation disappears after 5-8 applications (33, 40). In some cases, patients are pretreated with intranasal lidocaine to decrease the pain of intranasal capsaicin treatment. However, even with lidocaine pretreatment, patients seem to experience significant pain (30).
Inhalation of capsicum can cause cough, dyspnea, nasal congestion, eye irritation, and allergic alveolitis (6).
Capsicum can be extremely irritating to the eyes and mucous membranes. 

Capsicum oleoresin, an oily extract in pepper self-defense sprays, causes intense eye pain. It can also cause erythema, blepharospasm, tearing, shortness of breath, and blurred vision. In rare cases, corneal abrasions have occurred (20, 21).

Interactions with Herbs & Supplements:

ANTICOAGULANT/ANTIPLATELET HERBS AND SUPPLEMENTS: Concomitant use of herbs and supplements that affect platelet aggregation could theoretically increase the risk of bleeding in some people. Some of these herbs include angelica, clove, danshen, garlic, ginger, ginkgo, Panax ginseng, and others.
COCA: Theoretically, concomitant use of capsicum (including exposure to the capsicum in pepper spray) and coca might increase the effects and risk of adverse effects of the cocaine in coca (3).

Interactions with Drugs:

ACE INHIBITORS (ACEIs) <<interacts with>> CAPSICUM

Interaction Rating = Minor Be watchful with this combination.

Severity = Mild • Occurrence = Unlikely • Level of Evidence = D

There is one case report of a topically applied cream containing capsaicin contributing to the cough reflex in a patient using an ACE-inhibitor (26). (12414). But it is unclear if this interaction is clinically significant.

ANTICOAGULANT/ANTIPLATELET DRUGS <<interacts with>> CAPSICUM

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, capsicum might increase the effects and adverse effects of antiplatelet drugs (15, 16). 

COCAINE <<interacts with>> CAPSICUM

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use of capsicum (including exposure to the capsicum in pepper spray) and cocaine might increase cocaine effects and the risk of adverse effects, including death (3).

THEOPHYLLINE <<interacts with>> CAPSICUM

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, oral administration of capsicum before or at the same time as theophylline might enhance theophylline absorption (14).

Interactions with Foods:

None known.

Interactions with Lab Tests:

BLEEDING TIME: Capsicum has led to increased fibrinolytic activity and may lead to prolonged times in coagulation studies (9).

Interactions with Diseases or Conditions:

DAMAGED SKIN: Capsicum is contraindicated in situations involving injured skin. Do not apply capsicum if the skin is open.
SURGERY: Capsicum has antiplatelet effects. Capsicum might cause excessive bleeding if used perioperatively. Tell patients to discontinue capsicum at least 2 weeks before elective surgical procedures.

Dosage/Administration:

ORAL: For swallowing dysfunction in the elderly, 1 lozenge containing 1.5 mcg of capsaicin is dissolved in the mouth before each meal (27).

SourceURL:file://localhost/Users/ruthruane/Downloads/Herbal%20Medicine-Newest.doc TOPICAL: For pain syndromes, including rheumatoid and osteoarthritis, neuropathy, and fibromyalgia, creams contain the active capsicum constituent capsaicin and are typically applied 3-4 times daily. It can take up to 14 days for the full analgesic effect. Most creams contain 0.025% to 0.075% capsaicin concentrations. Higher potency preparations may be used for diabetic neuropathy (1, 13). For back pain, capsicum-containing plasters providing 11 mg capsaicin/plaster or 22 mcg/cm2 of plaster applied have been used. The plaster is applied once daily in the morning and left in place for 4-8 hours (44, 45, 46).
For prurigo nodularis, 0.025% to 0.3% of the active capsicum constituent capsaicin 4-6 times daily has been used (48). Tell patients to make sure they wash their hands after applying capsaicin cream. Tell patients they can use a diluted vinegar solution to remove capsicum cream. The active constituent, capsaicin is not water washable. Warn against using capsicum preparations near the eyes or on sensitive skin (21).
INTRANASAL: For cluster headache, 0.1 mL of a 10 mM capsaicin suspension, providing 300 mcg/day of capsaicin, applied to the ipsilateral nostril, has been used. Applications of the suspension continued once daily until a burning sensation was no longer experienced (23, 43). A capsaicin 0.025% cream (Zostrix, Rodlen Laboratories) applied daily for 7 days has been used to treat acute cluster headache attacks (25). For migraine headache, application of capsaicin 0.075% to the nasal mucosa has been used (35).
For allergic rhinitis, a cotton wad soaked in 30 microM capsaicin solution applied for 15 minutes and repeated over 2 days has been used (30).
For perennial rhinitis, intranasal application of capsaicin solution providing 0.15 mg/dose for up to 7 doses over a 14-day period has been used (34). A capsaicin nasal spray 0.0033 mol once weekly for 5 weeks has also been used (42). A capsaicin nasal spray containing 15 mcg/mcL, 2 sprays applied 3 times daily for 3 days has also been used (44).
For sinonasal polyposis, 0.5 mL of a 30 mmol/L capsaicin solution applied to each nostril for 3 days followed by 0.5 mL of a 100 mmol/L capsaicin solution for 2 days has been used (41).

Due to severe pain associated with intranasal capsaicin administration, pretreatment with intranasal local anesthetic is usually used.

Editor's Comments:

In nature, capsaicin occurs only as a trans-stereoisomer. However, the cis-isomer called civamide also has activity. Some evidence suggests that civamide is more potent and causes less irritation than trans-capsaicin. Civamide is currently an investigational drug for migraine, osteoarthritis, and other pain-related conditions (29).
Products labeled capsaicin sometimes include nonivamide which is an adulterant or pelargonic acid vanillylamide, referred to as "synthetic capsaicin" (10).

Specific References: Cayenne

• Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.

• Cooper RL, Cooper MM. Red pepper-induced dermatitis in breast-fed infants. Dermatol 1996;93:61-2.

• Mendelson J, Tolliver B, Delucchi K, Berger P. Capsaicin increases the lethality of cocaine. Clin Pharmacol Ther 1998;65abstract PII-27).

• Paice JA, Ferrans CE, Lashley FR, et al. Topical capsaicin in the management of HIV-associated peripheral neuropathy. J Pain Symptom Manage 2000;19:45-52.

• Electronic Code of Federal Regulations. Title 21. Part 182 -- Substances Generally Recognized As Safe. Available at: http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid= 786bafc6f6343634fbf79fcdca7061e1&rgn=div5&view= text&node=21:3.0.1.1.13&idno=21

• Millqvist E. Cough provocation with capsaicin is an objective way to test sensory hyperreactivity in patients with asthma-like symptoms. Allergy 2000;55:546-50.

• Sharma A, Gautam S, Jadhav SS. Spice extracts as dose-modifying factors in radiation inactivation of bacteria. J Agric Food Chem 2000;48:1340-4

• Locock RA. Capsicum. Can Pharm J 1985;118:517-9.

• Visudhiphan S, Poolsuppasit S, Piboonnukarintr O, Timliang S. The relationship between high fibrinolytic activity and daily capsicum ingestion in Thais. Am J Clin Nutr 1982;35:1452-8.

• Cordell GA, Araujo OE. Capsaicin: identification, nomenclature, and pharmacotherapy. Ann Pharmacother 1993;27:330-6.

• McCarty DJ, Csuka M, McCarthy G, et al. Treatment of pain due to fibromyalgia with topical capsaicin: A pilot study. Semin Arthr Rheum 1994;23:41-7.

• Kang JY, Yeoh KG, Chia HP, et al. Chili - protective factor against peptic ulcer? Dig Dis Sciences 1995;40:576-9.

• Mason L, Moore RA, Derry S, et al. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ 2004;328:991.

• Cichewicz RH, Thorpe PA. The antimicrobial properties of chile peppers (Capsicum species) and their uses in Mayan medicine. J Ethnopharmacol 1996;52:61-70.

• Schmulson MJ, Valdovinos MA, Milke P. Chili pepper and rectal hyperalgesia in irritable bowel syndrome. Am J Gastroenterol 2003;98:1214-5.  

• Surh YJ, Lee SS. Capsaicin in hot chili pepper: carcinogen, co-carcinogen or anticarcinogen? Food Chem Toxicol 1996;34:313-6.

• Bouraoui A, Brazier JL, Zouaghi H, Rousseau M. Theophylline pharmacokinetics and metabolism in rabbits following single and repeated administration of Capsicum fruit. Eur J Drug Metab Pharmacokinet 1995;20:173-8.

• Hogaboam CM, Wallace JL. Inhibition of platelet aggregation by capsaicin. An effect unrelated to actions on sensory afferent neurons. Eur J Pharmacol 1991;202:129-31.

• Wang JP, Hsu MF, Teng CM. Antiplatelet effect of capsaicin. Thromb Res 1984;36:497-507.

• Williams SR, Clark RF, Dunford JV. Contact dermatitis associated with capsaicin: Hunan hand syndrome. Ann Emerg Med 1995;25:713-5.

• Zollman TM, Bragg RM, Harrison DA. Clinical effects of oleoresin capsicum (pepper spray) on the human cornea and conjunctiva. Ophthalmology 2000;107:2186-9.

• Bortolotti M, Coccia G, Grossi G, Miglioli M. The treatment of functional dyspepsia with red pepper. Aliment Pharmacol Ther 2002;16:1075-82.

• Yeo WW, Chadwick IG, Kraskiewicz M, et al. Resolution of ACE inhibitor cough: changes in subjective cough and responses to inhaled capsaicin, intradermal bradykinin and substance-P. Br J Clin Pharmacol 1995;40:423-9.

• Yeo WW, Higgins KS, Foster G et al. Effect of dose adjustment on enalapril-induced cough and the response to inhaled capsaicin. J Clin Pharmacol 1995;39:271-6.

• O'Connell F, Thomas VE, Pride NB, Fuller RW. Capsaicin cough sensitivity decreases with successful treatment of chronic cough. Am J Respir Crit Care Med 1994;150:374-80.

• Hakas JF Jr. Topical capsaicin induces cough in patient receiving ACE inhibitor. Ann Allergy 1990;65:322-3.

• Ebihara T, Takahashi H, Ebihara S, et al. Capsaicin troche for swallowing dysfunction in older people. J Am Geriatr Soc 2005;53:824-8.

• Blom HM, Severijnen LA, Van Rijswijk JB, et al. The long-term effects of capsaicin aqueous spray on the nasal mucosa. Clin Exp Allergy 1998;28:1351-8.

• Rapoport AM, Bigal ME, Tepper SJ, Sheftell FD. Intranasal medications for the treatment of migraine and cluster headache. CNS Drugs 2004;18:671-85.

• Stjarne P, Rinder J, Heden-Blomquist E, et al. Capsaicin desensitization of the nasal mucosa reduces symptoms upon allergen challenge in patients with allergic rhinitis. Acta Otolaryngol 1998;118:235-9.

• Blom HM, Van Rijswijk JB, Garrelds IM, et al. Intranasal capsaicin is efficacious in non-allergic, non-infectious perennial rhinitis. A placebo-controlled study. Clin Exp Allergy 1997;27:796-801.

• Levy RL. Intranasal capsaicin for acute abortive treatment of migraine without aura. Headache 1995;35:277.

• Fusco BM, Marabini S, Maggi CA, et al. Preventative effect of repeated nasal applications of capsaicin in cluster headache. Pain 1994;59:321-5.

• Fusco BM, Fiore G, Gallo F, et al. "Capsaicin-sensitive" sensory neurons in cluster headache: pathophysiological aspects and therapeutic indication. Headache 1994;34:132-7.

• Marks DR, Rapoport A, Padla D, et al. A double-blind placebo-controlled trial of intranasal capsaicin for cluster headache. Cephalalgia 1993;13:114-6.

• Geppetti P, Tramontana M, Del Bianco E, Fusco BM. Capsaicin-desensitization to the human nasal mucosa selectively reduces pain evoked by citric acid. Br J Clin Pharmacol 1993;35:178-83.

• Kitajiri M, Kubo N, Ikeda H, et al. Effects of topical capsaicin on autonomic nerves in experimentally-induced nasal hypersensitivity. An immunocytochemical study. Acta Otolaryngol Suppl 1993;500:88-91.

• Bascom R, Kagey-Sobotka A, Proud D. Effect of intranasal capsaicin on symptoms and mediator release. J Pharmacol Exp Ther 1991;259:1323-7.

• Lacroix JS, Buvelot JM, Polla BS, Lundberg JM. Improvement of symptoms of non-allergic chronic rhinitis by local treatment with capsaicin. Clin Exp Allergy 1991;21:595-600.

• Sicuteri F, Fusco BM, Marabini S, et al. Beneficial effect of capsaicin application to the nasal mucosa in cluster headache. Clin J Pain 1989;5:49-53.

• Baudoin T, Kalogjera L, Hat J. Capsaicin significantly reduces sinonasal polyps. Acta Otolaryngol 2000;120:307-11.

• Gerth Van Wijk R, Terreehorst IT, Mulder PG, et al. Intranasal capsaicin is lacking therapeutic effect in perennial allergic rhinitis to house dust mite. A placebo-controlled study. Clin Exp Allergy 2000;30:1792-8.

• Marabini S, Ciabatti PG, Polli G, et al. Beneficial effects of intranasal applications of capsaicin in patients with vasomotor rhinitis. Eur Arch Otorhinolaryngol 1991;248:191-4.

• Gagnier JJ, van Tulder MW, Berman B, Bombardier C. Herbal medicine for low back pain. A Cochrane review. Spine 2007;32:82-92.

• Frerick H, Keitel W, Kuhn U, et al. Topical treatment of chronic low back pain with a capsicum plaster. Pain 2003;106:59-64.

• Keitel W, Frerick H, Kuhn U, et al. Capsicum pain plaster in chronic non-specific low back pain. Arzneimittelforschung 2001;51:896-903.

• Chrubasik S, Weiser W, Beime B. Effectiveness and safety of topical capsaicin cream in the treatment of chronic soft tissue pain. Phytother Res 2010;24:1877-85.

• Stander S, Luger T, Metze D. Treatment of prurigo nodularis with topical capsaicin. J Am Acad Dermatol 2001;44:471-8.

Also Known As:

Blue Chamomile, Camomilla, Camomille, Camomille Allemande, Chamomilla, Echte Kamille, Feldkamille, Fleur de Camomile, Hungarian Chamomile, Kamillen, Kleine Kamille, Manzanilla, Manzanilla Alemana, Matricaire, Matricariae Flos, Pin Heads, Sweet False Chamomile, True Chamomile, Wild Chamomile.

Scientific Name:

Matricaria recutita, synonyms Chamomilla recutita, Matricaria chamomilla.

Family: Asteraceae/Compositae. 

People Use This For:

Orally, German chamomile is used for flatulence, travel sickness, nasal mucous membrane inflammation, allergic rhinitis, nervous diarrhea, attention deficit hyperactivity disorder (ADHD), fibromyalgia, restlessness, and insomnia. It is also used for gastrointestinal (GI) spasms, colic, inflammatory diseases of the GI tract, GI ulcers associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol consumption, and as an antispasmodic for menstrual cramps. 

Topically, German chamomile is used for hemorrhoids; mastitis; leg ulcers; skin, anogenital, and mucous membrane inflammation; and bacterial skin diseases, including those of the mouth and gums. It is also used topically for treating or preventing chemotherapy- or radiation-induced oral mucositis.

As an inhalant, German chamomile is used to treat inflammation and irritation of the respiratory tract. 

In foods and beverages, German chamomile is used as flavor components.

In manufacturing, German chamomile is used in cosmetics, soaps, and mouthwashes.

Safety:

No concerns regarding safety, available studies validate this statement, when used orally in amounts commonly found in foods. German chamomile has Generally Recognized as Safe (GRAS) status in the US.¹

No concerns regarding safetywhen used orally, short-term. There is some evidence that German chamomile can be used safely for up to 8 weeks.^2,3,4 The long-term safety of German chamomile in medicinal doses is unknown, when used topically; avoid applying it near the eyes.⁵

Children: No concerns regarding safety when used orally and appropriately, short-term. Preliminary clinical research also suggests that a specific multi-ingredient product containing fennel 164 mg, lemon balm 97 mg, and German SourceURL:file://localhost/Users/ruthruane/Downloads/Herbal%20Medicine-Newest.doc

chamomile 178 mg (ColiMil, Milte Italia SPA) is safe in infants when used for up to a week.⁶

Pregnancy and Lactation: Insufficient reliable information available; avoid using. 

Effectiveness:

POSSIBLY EFFECTIVE

Colic. A clinical trial shows that breast-fed infants with colic who are given a specific multi-ingredient product containing fennel 164 mg, lemon balm 97 mg, and German chamomile 178 mg (ColiMil, Milte Italia SPA) twice daily for a week have reduced crying times compared to placebo.⁶

Dyspepsia. A specific combination product containing German chamomile (Iberogast, Medical Futures, Inc) seems to improve symptoms of dyspepsia. The combination includes German chamomile plus peppermint leaf, clown's mustard plant, caraway, licorice, milk thistle, celandine, angelica, and lemon balm.^7,3 A meta-analysis of studies using this combination product suggests that taking 1 mL orally three times daily over a period of 4 weeks significantly reduces severity of acid reflux, epigastric pain, cramping, nausea, and vomiting compared to placebo.⁸

Oral mucositis. Using a German chamomile oral rinse (Kamillosan Liquidum) might help prevent or treat mucositis induced by radiation therapy and some types of chemotherapy.² German chamomile oral rinse seems to prevent or treat mucositis secondary to radiation therapy and some types of chemotherapy including asparaginase (Elspar), cisplatin (CDDP, Platinol-AQ), cyclophosphamide (Cytoxan, Neosar), daunorubicin (DaunoXome), doxorubicin (Adriamycin, Rubex), etoposide (VP-16, Etopophos, VePesid, Toposar), hydroxyurea (Hydrea), mercaptopurine (6-MP, Purinethol), methotrexate (MTX, Rheumatrex), procarbazine (MIH, Mutlane), and vincristine (VCR, Oncovin, Vincasar) (2). However, the rinse doesn't seem to be better than placebo for preventing fluorouracil (5-FU)-induced oral mucositis.⁹

POSSIBLY INEFFECTIVE

Dermatitis. Applying German chamomile cream topically does not seem to prevent dermatitis induced by cancer radiation therapy.¹⁰

Mechanism of Action:

The applicable part of German chamomile is the flowerhead. Active constituents of German chamomile include quercetin, apigenin, and coumarins, and the essential oils.⁵

German chamomile might have anti-inflammatory effects. Preliminary research suggests it can inhibit the pro inflammatory enzymes. Other constituents may inhibit histamine related to allergies,^5,4

The constituent(s) responsible for the sedative activity of German chamomile are unclear. Preliminary research suggests that extracts of German chamomile might inhibit morphine dependence and withdrawal.¹¹ Other preliminary research suggests that German chamomile flower extract taken orally might have an antipruritic effect.¹² Preliminary research suggests that German chamomile blocks slow wave activity in the small intestine, which could slow peristaltic movement.¹³

Adverse Reactions:

Orally, German chamomile tea can cause allergic reactions including severe reactions in some patients.¹⁴

Interactions with Herbs & Supplements:

HERBS AND SUPPLEMENTS WITH SEDATIVE PROPERTIES: Theoretically, concomitant use with herbs that have sedative properties might have additive effects which needs to be taken into account.^5,16

Interactions with Drugs:

Benzodiazepines: Consult a Medical Herbalist

CNS Depressants: Consult a Medical Herbalist

Warfarin (Coumadin): Consult a Medical Herbalist

Interactions with Foods:

None known. 

Interactions with Lab Tests:

Creatinine: Chronic ingestion of German chamomile for two 2 weeks can reduce urinary creatinine output. This effect may be prolonged for up to two weeks after discontinuing German chamomile. The mechanism for this effect is unclear.⁴

Interactions with Diseases or Conditions:

Surgery: Avoid from 2 weeks prior to elective surgery.

Dosage/Administration:

Oral: For dyspepsia, a specific combination product containing German chamomile (Iberogast, Medical Futures, Inc) and several other herbs has been used in a dose of 1 mL three times daily.^7,3,8

For colic in infants, a specific multi-ingredient product containing fennel 164 mg, lemon balm 97 mg, and German chamomile 178 mg (ColiMil, Milte Italia SPA) twice daily for a week has been used.⁶ 

Topical: For chemotherapy- or radiation-induced oral mucositis, an oral rinse made with 10-15 drops of German chamomile liquid extract in 100 mL warm water has been used three times daily.²

Comments:

German chamomile is an annual herb found throughout Europe and in portions of Asia. German chamomile has a mild apple-like scent. The name "chamomile" is Greek for "Earth apple." 

Specific References: CHAMOMILE

1.   FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

2.   Carl W, Emrich LS. Management of oral mucositis during local radiation and systemic chemotherapy: a study of 98 patients. J Prosthet Dent 1991;66:361-9.

3.   Madisch A, Holtmann G, Mayr G, et al. Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Digestion 2004;69:45-52.

4.   Wang Y, Tang H, Nicholson JK, et al. A metabonomic strategy for the detection of the metabolic effects of chamomile (Matricaria recutita L.) ingestion. J Agric Food Chem 2005;53:191-6.

5.   Hormann HP, Korting HC. Evidence for the efficacy and safety of topical herbal drugs in dermatology: part I: anti-inflammatory agents. Phytomedicine 1994;1:161-71.

6.   Savino F, Cresi F, Castagno E, et al. A randomized double-blind placebo-controlled trial of a standardized extract of Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil) in the treatment of breastfed colicky infants. Phytother Res 2005;19:335-40.

7.   Holtmann G, Madisch A, Juergen H, et al. A double-blind, randomized, placebo-controlled trial on the effects of an herbal preparation in patients with functional dyspepsia [Abstract]. Ann Mtg Digestive Disease Week 1999 May.

8.   Melzer J, Rosch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004;20:1279-87.

9.   Fidler P, Loprinzi CL, O'Fallon JR, et al. Prospective evaluation of a chamomile mouthwash for prevention of 5-FU-induced oral mucositis. Cancer 1996;77:522-5.

10.  Maiche AG, Grohn P, Maki-Hokkonen H. Effect of chamomile cream and almond ointment on acute radiation skin reaction. Acta Oncol 1991;30:395-6.

11.  Gomaa A, Hashem T, Mohamed M, Ashry E. Matricaria chamomilla extract inhibits both development of morphine dependence and expression of abstinence syndrome in rats. J Pharmacol Sci 2003;92:50-5.

12.  Kobayashi Y, Nakano Y, Inayama K, et al. Dietary intake of the flower extracts of German chamomile (Matricaria recutita L.) inhibited compound 48/80-induced itch-scratch responses in mice. Phytomedicine 2003;10:657-64.

13.  Storr M, Sibaev A, Weiser D, et al. Herbal extracts modulate the amplitude and frequency of slow waves in circular smooth muscle of mouse small intestine. Digestion 2004;70:257-64.

14.  Subiza J, Subiza JL, Hinojosa M, et al. Anaphylactic reaction after the ingestion of chamomile tea; a study of cross-reactivity with other composite pollens. J Allergy Clin Immunol 1989;84:353-8.

15.  Viola H, Wasowski C, Levi de Stein M, et al. Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects. Planta Med 1995;61:213-6.

16.  Avallone R, Zanoli P, Puia G, et al. Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla. Biochem Pharmacol 2000;59:1387-94.

Also Known As:

Cassia Cinnamon, Canela de Cassia, Canela Molida, Canelle, Cannelle
Bâtarde, Cannelle Cassia, Cannelle de Ceylan, Cannelle de Chine, Cannelle de
Cochinchine, Cannelle de Padang, Cannelle de Saigon, Cannelier Casse, Canton
Cassia, Casse, Casse Odorante, Cassia, Cassia Aromaticum, Cassia Bark, Bastard Cinnamon, Cassia Lignea, Chinese Cinnamon, Cinnamomi Cassiae Cortex, Cinnamomum,
Cinnamon, Cinnamon Essential Oil, Cinnamon Flos, Cinnamoni Cortex,
Cinnamonomi Cortex, Cortex Cinnamomi, Écorce de Cassia, False Cinnamon,
Fausse Cannelle, Gui Zhi, Huile Essentielle de Cannelle, Keishi, Laurier des
Indes, Nees, Ramulus Cinnamomi, Rou Gui, Sthula Tvak, Taja, Zimbluten.

Scientific Name:

Cinnamomum aromaticum, synonyms Cinnamomum cassia, and Cinnamomum
ramulus.
Family: Lauraceae.

People Use This For:

Orally, cassia cinnamon is used for type 2 diabetes, gas (flatulence), muscle and
gastrointestinal spasms, preventing nausea and vomiting, diarrhea, infections,
the common cold, and loss of appetite. It is also used for impotence, enuresis,
rheumatic conditions, testicle hernia, menopausal symptoms, amenorrhea, and as
an abortifacient. Cassia cinnamon is also used orally for angina, kidney disorders,
hypertension, cramps, cancer, and as a blood purifier.
Topically, cassia cinnamon is used in suntan lotions, nasal sprays, mouthwashes,
gargles, toothpaste, and as a counterirritant in liniments.
In food and beverages, cassia cinnamon is used as a flavoring agent.

Safety:

LIKELY SAFE ...when used orally and appropriately. Cassia cinnamon has been
safely used in clinical trials lasting up to 4 months (8, 13, 20). Cassia cinnamon
has Generally Recognized as Safe (GRAS) status in the US (1).
POSSIBLY UNSAFE ...when used orally in high doses, long-term. Some cassia
cinnamon products contain high levels of coumarin. Coumarin can cause
hepatotoxicity in animal models (14). In humans, very high doses of coumarin
from 50-7000 mg/day can result in hepatotoxicity that resolves when coumarin
is discontinued (17). In most cases, ingestion of cassia cinnamon won't provide
a high enough amount of coumarin to cause significant toxicity; however, in
especially sensitive people, such as those with liver disease, prolonged ingestion
of large amounts of cassia cinnamon might exacerbate the condition.
PREGNANCY AND LACTATION: There is insufficient reliable information
available about the safety of cassia cinnamon when used in medicinal amounts
during pregnancy and breast-feeding; avoid using.

Effectiveness:

INSUFFICIENT RELIABLE EVIDENCE to RATE

Diabetes. There is contradictory evidence about the effectiveness of cassia
cinnamon for treating type 1 or type 2 diabetes. Initial clinical research showed
that taking cassia cinnamon 1, 3, or 6 grams daily for 40 days lowered fasting
serum glucose by 18% to 29%, triglycerides by 23% to 30%, low-density
lipoprotein (LDL) cholesterol by 7% to 27%, and total cholesterol by 12% to 26%
in patients with type 2 diabetes (8). Another clinical trial shows that patients
taking a specific cinnamon product (Cinnamon 500 mg, Puritan's Pride) 1 gram
daily for 90 days significantly reduces hemoglobin A1C (HbA1C) by about 0.83%
(19). However, three other clinical studies found no significant effect on blood
glucose, HbA1C, cholesterol, or triglycerides when cassia cinnamon was used
in doses of 1-3 grams daily up to 4 months (13, 18, 20). A meta-analysis of
cassia cinnamon studies suggests that overall taking cassia cinnamon does not
significantly reduce fasting blood glucose, HbA1C, or lipid levels in patients with
type 1 or type 2 diabetes (18). More evidence is needed to rate cassia cinnamon
for this use.

Mechanism of Action:

The applicable parts of cassia cinnamon are the bark and flower.
Cinnamaldehyde is found in the volatile oil fraction of cassia cinnamon.
The volatile oil from cassia cinnamon bark contains about 67% to 83%
cinnamaldehyde (16). Cinnamaldehyde seems to have antibacterial activity (2). It
may also have immunomodulating, anti-tumor, and antioxidant activity (3, 4, 5, 7).
Polyphenolic polymers such as hydroxychalcone found in cassia cinnamon seem
to potentiate insulin action. These compounds seem to increase phosphorylation
of the insulin receptor, which increases insulin sensitivity. Increased insulin
sensitivity may improve blood glucose control and lipid levels. Cinnamon extracts
also seem to activate glycogen synthetase and increase glucose uptake (7, 8, 9,
11).
Research in animal models suggests that cassia cinnamon stimulates a
baseline insulin release, but does not seem to lower baseline glucose levels;
however, during a glucose tolerance test, cassia cinnamon seems to stimulate
insulin release and also significantly lowers blood glucose. Cassia cinnamon
does not seem to lower blood glucose levels as much as the prescription drug
glibenclamide. Cassia cinnamon (Cinnamomum cassia) does seem to have a
greater insulin-stimulating effect than cinnamon bark (Cinnamomum zeylanicum
(12).
Cassia cinnamon contains a wide range of coumarin concentrations from
0.004% to 1.2% (14, 15, 16). Cassia cinnamon contains higher concentrations of
coumarin compared to cinnamon bark (Cinnamomum zeylanicum). The presence
of coumarin and other compounds can be used to distinguish cassia cinnamon
from Cinnamomum zeylanicum (15).

Adverse Reactions:

Orally, cassia cinnamon appears to be well-tolerated. No significant side effects
have been reported in clinical trials (8, 13).
There is some concern about the safety of ingesting large amounts of cassia
cinnamon due to its coumarin content. Coumarin can cause hepatotoxicity in
animal models (14). In humans, very high doses of coumarin from 50-7000 mg/
day can result in hepatotoxicity that resolves when coumarin is discontinued (17).
In most cases, ingestion of cassia cinnamon won't provide a high enough amount
of coumarin to cause significant toxicity; however, in especially sensitive people,
such as those with liver disease, prolonged ingestion of large amounts of cassia
cinnamon might exacerbate the condition.
Topically, allergic skin reactions and stomatitis from toothpaste flavored with
cassia cinnamon have been reported (9, 10).

Interactions with Herbs & Supplements:

HEPATOTOXIC HERBS AND SUPPLEMENTS: There is some concern that
ingesting large amounts of cassia cinnamon might cause hepatotoxicity in some
people. Cassia cinnamon contains coumarin which can cause hepatotoxicity in
animal models (14). In humans, very high doses of coumarin, from 50-7000 mg/
day, can result in hepatotoxicity that resolves when coumarin is discontinued
(17). Lower amounts might also cause liver problems in susceptible people such
as those with pre-existing liver disease. Theoretically, concomitant use with
other potentially hepatotoxic products might increase the risk of developing liver
damage. Some of these products include androstenedione, chaparral, comfrey,
DHEA, germander, kava, niacin, pennyroyal oil, red yeast, and others.
HERBS AND SUPPLEMENTS WITH HYPOGLYCEMIC POTENTIAL: Cassia
cinnamon might lower blood glucose levels (8). Theoretically, it might have
additive effects when used with other herbs and supplements that also lower
glucose levels. This might increase the risk of hypoglycemia in some patients.
Some herbs and supplements with hypoglycemic effects include alpha-lipoic acid,
bitter melon, chromium, devil's claw, fenugreek, garlic, guar gum, horse chestnut,
Panax ginseng, psyllium, Siberian ginseng, and others.

Interactions with Drugs:

ANTIDIABETES DRUGS <<interacts with>> CASSIA CINNAMON

Interaction Rating = Moderate Be cautious with this combination.
Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Cassia cinnamon may lower blood glucose levels, and have additive effects in
patients treated with antidiabetic agents; use with caution (8). Dose adjustments
to diabetes medications might be necessary. Some antidiabetes drugs include
glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin,
metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), and
others.

HEPATOTOXIC DRUGS <<interacts with>> CASSIA CINNAMON

Interaction Rating = Moderate Be cautious with this combination.
Severity = High • Occurrence = Possible • Level of Evidence = D
There is some concern that ingesting large amounts of cassia cinnamon might
cause hepatotoxicity in some people. Cassia cinnamon contains coumarin which
can cause hepatotoxicity in animal models (14). In humans, very high doses of
coumarin from 50-7000 mg/day can result in hepatotoxicity that resolves when
coumarin is discontinued (17). Lower amounts might also cause liver problems in
susceptible people, such as those with pre-existing liver disease. Theoretically,
concomitant use with other potentially hepatotoxic drugs might increase the risk
of developing liver damage. Some of these drugs include acarbose (Precose,
Prandase), amiodarone (Cordarone), atorvastatin (Lipitor), azathioprine
(Imuran), carbamazepine (Tegretol), cerivastatin (Baycol), diclofenac (Voltaren),
felbamate (Felbatol), fenofibrate (Tricor), fluvastatin (Lescol), gemfibrozil (Lopid),
isoniazid, itraconazole, (Sporanox), ketoconazole (Nizoral), leflunomide (Arava),
lovastatin (Mevacor), methotrexate (Rheumatrex), nevirapine (Viramune), niacin,
nitrofurantoin (Macrodantin), pioglitazone (Actos), pravastatin (Pravachol),
pyrazinamide, rifampin (Rifadin), ritonavir (Norvir), rosiglitazone (Avandia),
simvastatin (Zocor), tacrine (Cognex), tamoxifen, terbinafine (Lamisil), valproic
acid, and zileuton (Zyflo).

Interactions with Foods:

None known.

Interactions with Lab Tests:

BLOOD GLUCOSE: Cassia cinnamon might lower blood glucose levels and test
results in some patients (8).
LIVER FUNCTION TESTS: There is some concern that ingesting large amounts
of cassia cinnamon might increase liver enzymes and cause hepatotoxicity
in some people. Cassia cinnamon contains coumarin which can cause
hepatotoxicity in animal models (14). In humans, very high doses of coumarin
from 50-7000 mg/day can result in hepatotoxicity that resolves when coumarin is
discontinued (17). Lower amounts might also cause liver problem in susceptible
people such as those with pre-existing liver disease.

Interactions with Diseases or Conditions:

DIABETES: Cassia cinnamon might lower blood glucose in patients with type
2 diabetes (8). Tell patients with diabetes to use cassia cinnamon products
cautiously and monitor blood glucose levels very closely. Dose adjustments to
diabetes medications might be necessary.
LIVER DISEASE: There is some concern that ingesting large amounts of cassia
cinnamon might cause hepatotoxicity in susceptible people. Cassia cinnamon
contains coumarin which can cause hepatotoxicity in animal models (14). In
otherwise healthy humans, very high doses of coumarin from 50-7000 mg/day
can result in hepatotoxicity that resolves when coumarin is discontinued (17).
Lower amounts cassia cinnamon might exacerbate liver function in people with
existing liver disease.
SURGERY: Cassia cinnamon might affect blood glucose levels. Theoretically,
cassia cinnamon might interfere with blood glucose control during and after
surgical procedures. Tell patients to discontinue cassia cinnamon at least 2 weeks
before elective surgical procedures.

Dosage/Administration:

ORAL: For type 1 or type 2 diabetes, 1 to 6 grams (1 teaspoon = 4.75 grams) of

cassia cinnamon daily for up to 4 months have been used. (8, 13, 18, 19).

Editor's Comments:

There are a lot of different types of cinnamon. Cinnamomum verum (Ceylon
cinnamon) is the type used most commonly in the Western world. Cinnamomum
aromaticum (Cassia cinnamon or Chinese cinnamon) is also commonly used.
In many cases, the cinnamon spice purchased in food stores contains a
combination of these different types of cinnamon. So far, only cassia cinnamon
has been shown to have any effect on blood glucose in humans. However,
Cinnamomum verum also contains the hydroxychalcone polymer thought to be
responsible for lowering blood sugar (5).

Specific References: Cinnamon

1. lectronic Code of Federal Regulations. Title 21. Part 182 -
E
-
Substances
Generally
Recognized
As
Safe.
Available
at:
http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=
786bafc6f6343634fbf79fcdca7061e1&rgn=div5&view=
text&node=21:3.0.1.1.13&idno=21

2. Lee HS, Ahn YJ. Growth-Inhibiting Effects of Cinnamomum cassia Bark-
Derived Materials on Human Intestinal Bacteria. J Agric Food Chem
1998;46:8-12.

3. Koh WS, Yoon SY, Kwon BM, et al. Cinnamaldehyde inhibits lymphocyte
proliferation and modulates T-cell differentiation. Int J Immunopharmacol
1998;20:643-60.

4. Kwon BM, Lee SH, Choi SU, et al. Synthesis and in vitro cytotoxicity of
cinnamaldehydes to human solid tumor cells. Arch Pharm Res 1998;21:147-
52.

5.Anderson RA, Broadhurst CL, Polansky MM, et al. Isolation and
Characterization of Polyphenol Type-A Polymers from Cinnamon with Insulin-
like Biological Activity. J Agric Food Chem 2004;52:65-70.

6. Jarvill-Taylor KJ, Anderson RA, Graves DJ. A hydroxychalcone derived from
cinnamon functions as a mimetic for insulin in 3T3-L1 adipocytes. J Am Coll
Nutr 2001;20:327-36.

7. Imparl-Radosevich J, Deas S, Polansky MM, et al. Regulation of PTP-1 and
insulin receptor kinase by fractions from cinnamon: implications for cinnamon
regulation of insulin signalling. Horm Res 1998;50:177-82.

8. 11347 Khan A, Safdar M, Ali Khan M, et al. Cinnamon improves glucose and
lipids of people with type 2 diabetes. Diabetes Care 2003;26:3215-8.

9. De Benito V, Alzaga R. Occupational allergic contact dermatitis from cassia
(Chinese cinnamon) as a flavouring agent in coffee. Contact Dermatitis
1999;40:165.

10.Drake TE, Maibach HI. Allergic contact dermatitis and stomatitis caused by a
cinnamic aldehyde-flavored toothpaste. Arch Dermatol 1976;112:202-3.

11.Onderoglu S, Sozer S, Erbil KM, et al. The evaluation of long-term effcts
of cinnamon bark and olive leaf on toxicity induced by streptozotocin
administration to rats. J Pharm Pharmacol 1999;51:1305-12.

12. 3238
1
Verspohl EJ, Bauer K, Neddermann E. Antidiabetic effect of
Cinnamomum cassia and Cinnamomum zeylanicum in vivo and in vitro.
Phytother Res 2005;19:203-6.

13.
Vanschoonbeek K, Thomassen BJ, Senden JM, et al. Cinnamon
supplementation does not improve glycemic control in postmenopausal type 2
diabetes patients. J Nutr 2006;136:977-80.

14. ress release. Cinnamon capsules to reduce blood sugar are medicinal
P
products! Efficacy has not been scientifically proven - some products
contain high levels of coumarin. Federal Institute of Risk Assessment (BfM),
Germany, November 11, 2006. Available at: http://www.bfarm.de/nn_425226/
EN/press/press-releases/pm2006-14-en.html.

15.Miller KG, Poole CF, Pawloski TMP. Classification of the botanical origin
of cinnamon by solid-phase microextraction and gas chromatography.
Chromatographia 1996;42:639-46.

16.He ZD, Qiao CF, Han QB, et al. Authentication and quantitative analysis on
the chemical profile of cassia bark (cortex cinnamomi) by high-pressure liquid
chromatography. J Agric Food Chem 2005;53:2424-8.

17.Felter SP, Vassallo JD, Carlton BD, Daston GP. A safety assessment of
coumarin taking into account species-specificity of toxicokinetics. Food Chem
Toxicol 2006;44:462-75.

18.Baker WL, Gutierrez-Williams G, White CM, et al. Effect of cinnamon on
glucose control and lipid parameters. Diabetes Care 2008;31:41-3.

19. Crawford P. Effectiveness of cinnamon for lowering hemoglobin A1C in
patients with type 2 diabetes: a randomized, controlled trial. J Am Board Fam
Med 2009;22:507-12.

20. Blevins SM, Leyva MJ, Brown J, et al. Effect of cinnamon on glucose and lipid
levels in non insulin-dependent type 2 diabetes. Diabetes Care 2007;30:2236-
7.

Also Known As:

Bedstraw, Catchweed, Cleavers, Gallium, Goose Grass, Gosling Weed, Robin-Run-in-the-Grass, Scratchweed, Stick-a-Back, Sticky Willy. 

Scientific Name:

Galium aparine.

Family: Rubiaceae. 

People Use This For:

Clivers is used as a diuretic, a mild astringent, for dysuria, lymphadenitis, psoriasis, and specifically for enlarged lymph nodes.

Safety:

No concerns regarding safety when used orally and appropriately.¹³ There is no documented toxicity.¹⁴

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

There is insufficient scientific information available about the effectiveness of clivers.

Mechanism of Action:

The applicable parts of clivers are the dried or fresh above ground parts. Cleavers contain tannins, which are reported to have astringent properties.¹⁴

Adverse Reactions:

None reported.

Interactions with Herbs & Supplements:

None known.

Interactions with Drugs:

None known.

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known.

Dosage/Administration:

Dr Clare’s Blends: 1gm per day.

Oral: Typical doses are 2-4 grams dried above ground parts three times daily, or one cup tea (steep 2-4 grams herb in 150 mL boiling water 5-10 minutes, strain) three times daily.¹⁴ Liquid extract (1:1 in 25% alcohol) 2-4 mL three times daily.¹⁴

Spedific References: CLIVERS

13.  McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

14.  Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

• R1.   Mills, S. & Bone, K. (2000) Principles and Practice of Phytotherapy. London, Churchill Livingstone.
• R2.   Williamson, E.M. (2003) Potter’s Herbal Cyclopaedia. Essex UK, Saffron Walden, The C.W. Daniel Company Ltd.
• R3.   Harkness, R. & Bratman, S. (2002) The Mosby’s Handbook of Drug-Herb and Drug- Supplement Interactions. USA, Mosby Inc.
• R4.   Lininger, S.W., Gaby, A.R., Austin, S., Batz, F., Yarnell, E., Brown, D.J. & Constantine, G. (1999) A-Z guide to drug-herb-vitamin interactions. Roseville California, Prima Publishing. 

R5.   Grases, F., March, J. G., Ramis, M. & Costa-Bauzá, A. (1993) The influence of Zea mays on urinary risk factors for kidney stones in rats. 

• Phytotherapy Research. 7(2) March/April:146
• R6.   Leung, A.Y. (1980) Encyclopedia of Common Natural Ingredients Used in Food Drugs and Cosmetics. NY, USA, John Wiley & Sons Inc.
• R7.   Chan, H. & But, P. (Eds.) (1986) Pharmacology and Applications of Chinese materia medica. Vol 1.  Singapore, World Scientific.
• R8.   British Herbal Manufacturers Association (B.H.M.A). (1991) The British Herbal Pharmacopoeia 1983. ISBN 0-903032-07-4.
• R9.  Frohne, D. (1986) Arctostaphylos uva-ursi: Die Barentraube. Z Phytother 7(2):45
• R10.  Jahodar, L. et al. (1990) Pharmazie 45(6):446

Also Known As:

Indian Corn, Yu Mi Xiu, Zea.

Scientific Name:

Zea mays.

Family: Poaceae/Gramineae.

People Use This For:

Orally, corn silk is used for cystitis, urethritis, bedwetting, inflammation of the

prostate, acute and chronic inflammation of the urinary system.

Safety:

No concerns regading safety, available studies validate this statement, when

used orally in amounts commonly found in foods. Generally Recognized as Safe

(GRAS) status in the US.6

No concerns regarding safety when used orally and appropriately in medicinal

amounts.7

Pregnancy and Lactation: Refer to a Medical Herbalist

Effectiveness:

There is not enough scientific information available to comment about the

effectiveness of corn silk.

Mechanism of Action:

Corn silk contains tannins, which are astringent, and cryptoxanthin, which has

vitamin A activity.8 Diuretic. Demulcent (mucilagenous). Choleretic (promotes

bile flow). The diuretic and choleretic action has been demonstrated in animal

studies.R5 In China it is used for Hepato-Biliary Disease.R6,R7

Adverse Reactions:

None.

Interactions with Herbs & Supplements:

Herbs and Supplements with Hypotensive Effects: Corn silk is thought to have

hypotensive effects, may have an additive effect with blood pressure lowering

agents.

Interactions with Drugs:

Antidiabetes Drugs: Theoretically, because some evidence suggests corn

silk can reduce blood glucose levels, excessive amounts might interfere with

diabetes therapy.R1 pp.222

Diuretic Drugs: Additive Effect.R4 pp.192,204,215

Lithium: Because of Diuretic effect.

Warfarin (Coumadin): Corn silk contains vitamin K. Individuals taking

warfarin should consume a consistent daily amount to maintain consistent

anticoagulation.9

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known.

Interactions with Diseases or Conditions:

None within normal dose range.

Dosage/Administration:

Oral: 4-8 grams dried style/stigma three times daily, or one cup tea (steep 0.5

grams dried corn silk in 150 mL boiling water 5-10 minutes, strain) several times

daily.8,10 Liquid extract of maize stigmas, 4-8 mL.8 Tincture (1:5 in 25% alcohol),

5-15 mL three times daily. 8 Syrup of maize stigmas, 8-15 mL.8

Dr Clare’s Comments:

Corn silk is the silky threads that surround the ear of sweetcorn. It is one on the

few herbs that are more effective dried, probably because they have such a high

water content it would take a lot of them to make an effective fresh infusion.

It would be nice to think that Corn Silk would ‘treat’ high blood pressure/diabetes

however it is likely to be helpful in the way an extra portion of fruit or vegetables

are helpful. It will not reduce a normal blood sugar or a normal Blood Pressure in

my experience. Nor has it been reported, these are theoretical considerations.

Specific References: CORN SILK

6. FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A

food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.

7.

McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's

Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

8.

Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare

Professionals. London, UK: The Pharmaceutical Press, 1996.

9. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical

Publications, 1998.

Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset.

10.

Stuttgart: Medpharm GmbH Scientific Publishers, 1994

Also Known As:

Agropyron, Coughgrass, Cutch, Dog Grass.

Scientific Name:

Agropyron repens.

Family: Poaceae/Gramineae.

People Use This For:

It is used orally to treat cystitis, urethritis, prostatitis, benign prostatic hypertrophy

and kidney stones.

Safety:

No concerns regarding safety, available studies validate this statement, when

consumed in amounts commonly found in foods.11

Pregnancy and Lactation: Refer to a Medical Herbalist.

Effectiveness:

Not enough scientific information gather to offer a comment.

Mechanism of Action:

Diuretic.R8 pp.18,R1 pp.222

Adverse Reactions:

None known

Interactions with Herbs & Supplements:

None known.

Interactions with Drugs:

None known.

Interactions with Foods:

None known.

Interactions with Lab Tests:

None known.

Interactions with Diseases or Conditions:

None known.

Dosage/Administration:

Oral: For treating ulcerative colitis, 100 mL of wheatgrass juice daily for 1 month

has been used.12

DrClare’s Blends:

Specific References: COUCHGRASS

11. Rauma AL, Nenonen M, Helve T, et al. Effect of a strict vegan diet on energy and nutrient

intakes by Finnish rheumatoid patients. Eur J Clin Nutr 1993;47:747-9.

12. Ben-Arye E, Golden E, Wengrower D, et al. Wheat grass juice in the treatment of active

distal ulcerative colitis a randomized double-blind placebo-controlled trial. Scand J Gastroenterol

2002;4:444-9.

Cramp Bark

Also known as: Common Guelder-Rose, Cranberry Bush.

Scientific Name: Viburnum opulus.

Botanical Family: Adoxaceae/Viburnaceae (formerly known as Caprifoliaceae).

Part used: Bark and root bark.

Traditional Use.

Cramp bark has antispasmodic (relieves muscle spasms), anti-inflammatory (relieves inflammation), nervine (calms and soothes the nerves), hypotensive (lowers blood pressure), astringent (causes local contraction), emmenagogic (induces menstruation ), and sedative (reduces activity and excitement) properties.

Safety.

There are no reports of safety concerns regarding Cramp Bark.

Pregnancy: Refer to a Medical Herbalist.

Breastfeeding: Refer to a Medical Herbalist.

Constituents

Hydroquinines; arbutin, methylarbutin and traces of free hydroquinone.

Sesquiterpene dialdehyde fraction; viopudiol.

Coumarins; such as scopoletinans, esculatin.

Triterpinoids; including oleanic acid and ursolic acid derivatives.

Iridoid glysoside esters.

Scientific evidence.

No clinical research has been done.

Mechanism of action.

At least two active constituents have been identified, scopoletin and viopudial. These constituents appear to have smooth muscle antispasmodic effects in vitro. Viopudial appears to have cholinergic effects by inhibiting acetylcholinesterase. The effect opposes the dominence of the sympathetic nervous system and relaxes the tone in smooth muscles. There is evidence of anti-inflammatory effects.

One study showed that the administration of viopudial, a Viburnum opulus component, produces slowing of the heart rate, lowering of blood pressure, and some decrease in contractility of heart muscle. This action is by balancing the sympathetic and parasympathetic nervous system tone in the body. Experimental evidence indicates that viopudial's mechanism of action is partly due to its effects on cholinesterase. In vitro demonstrations of a competitive inhibitory effect on both acetylcholinesterase and butyrylcholinesterase showed viopudial to be relatively weak when compared to the known potent inhibitor, physostigmine. Additional mechanistic effects, such as a direct musculotrophic action, may also be responsible for the overall activity. ⁸

One animal study shows that proanthocyanidin constituents of Viburnum opulus exert a potent gastro-duodenoprotective effect by increasing nitrous oxide in the tissues, suppressing lipid peroxidation and mobilizing antioxidant activity and changes in the gastroduodenal mucosa of rat.⁷

Other studies show that Viburnum opulus exhibits anti-oxidant effects.⁹

Adverse reactions.

None reported.

Possible interactions with herbs and supplements.

None known.

Possible interactions with drugs.

None known.

Possible interactions with foods.

None known.

Interactions with laboratory tests.

None known.

Effects on diseases or conditions.

None known.

Dosage.

Recommended dose: 3-10mls per day 1:5 tincture 30% alcohol.

Decoction: range from ½ to 6 tsps. per day.

Powder/capsule: range from 1-4gms per day.

Raw herb: 2-4gms per day.^{R8 pp.230}

Liquid extract: 2-8ml/day.

The recommended dose of Dr Clare’s Joint Support Blend provides 3mls per day of 1:3 Tincture in 15mls daily, at a dose of 5mls three times a day.

This is equivalent to 375-750mgs per day.

References.

1. Exp Biol Med (Maywood) June 1972 vol. 140 no. 2 457-461 Viopudial, a Hypotensive and Smooth Muscle Antispasmodic from Viburnum opulus.John A. Nicholson,Thomas D. Darby, Charles H. Jarboe

2. Charles H. Jarboe , Karimullah A. Zirvi , John A. Nicholson , Charlotte M. Schmidt. Scopoletin, an Antispasmodic Component of Viburnum opulus and prunifolium

J. Med. Chem., 1967, 10 (3), pp 488–489

3. Antioxidant properties of Viburnum opulus and Viburnum lantana growing in Turkey. Dr Mehmet Levent Altun, Gülçin Saltan Çitoğlu, Betül, Sever Yilmaz and Tülay Çoban

International Journal of Food Sciences and Nutrition

2008, Vol. 59, No. 3 , Pages 175-180

4. Antinociceptive and Anti-inflammatory Activities of Viburnum lantana. Pharmaceutical Biology2007, Vol. 45, No. 3 , Pages 241-245

B. Sever Yilmaz, G Saltan Citoglu, M.L. Altun and H. Ozbek

5. Zeng LJ, Xing JB, Li P. China Journal of Chinese Materia Medica [2000, 25(3):184-188]

6. Ilkay Erdogan-Orhan, Mehmet Levent Altun, Betül Sever-Yilmaz, and Gülçin Saltan. Anti-Acetylcholinesterase and Antioxidant Assets of the Major Components (Salicin, Amentoflavone, and Chlorogenic Acid) and the Extracts of Viburnum opulus and Viburnum lantana and Their Total Phenol and Flavonoid Contents

Journal of Medicinal Food. April 2011, 14(4): 434-440.

7. Zayachkivska OS1, Gzhegotsky MR, Terletska OI, Lutsyk DA, Yaschenko AM, Dzhura OR.

Influence of Viburnum opulus proanthocyanidins on stress-induced gastrointestinal mucosal damage.

J Physiol Pharmacol. 2006 Nov;57 Suppl 5:155-67.

8. Viopudial, a hypotensive and smooth muscle antispasmodic from Viburnum opulus.

J A Nicholson, T D Darby, C H Jarboe

Proceedings of The Society for Experimental Biology and Medicine 07/1972; 140(2):457-61.

9. Andreeva T.I, Komarova E.N, Yusubov M. S,  Korotkova E.I.

Antioxidant activity of cranberry tree (Viburnum Opulus L.) bark extract.

Pharmaceutical Chemistry Journal

10-2004, Volume 38, Issue 10, pp 548-550