Metagenics
Adaptan
Resilience in times of stress
Adaptan contains herbs that have been clinically trialled for their ability to increase resistance to environmental stress, whilst balancing the body and improving physical functioning and cognitive processing.
- Improves Physical and Mental Performance Under Stress
- Reduces Nervous Exhaustion and Mental Fatigue
- Restores balance within the body
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BENEFITS
CLINICALLY PROVEN;
Reduces Anxiety
Alleviates Nervous Exhaustion
Improves Energy
ADAPTOGENIC
Rehmannia and American ginseng
Rehmannia and American ginseng are adaptogenic herbs that have demonstrated the ability to increase mental work capacity in times of stress and fatigue, enhancing tolerance to mental exhaustion. Research supports both rehmannia and American ginseng’s neuroprotective, anti-fatigue, anxiolytic, nootropic and CNS stimulating actions, based on animal and cell line studies.[11] American ginseng has been used for millennia in TCM as an adaptogen and is highly regarded for its ability to enhance physical performance, promote vitality and increase resistance to stress. The adaptogenic properties of ginseng are believed to be due to the effects upon the HPA axis.[12] Empirical studies have attributed these effects to the action of a group of ginseng-specific saponins known as ginsenosides.[13] Recent pharmacological studies of a number of adaptogens such as rehmannia and American ginseng have further supported the impact these herbs have through HPA axis regulation, reduction of oxidative stress and the attenuation of cortisol production.[14]
It may be concluded that the use of adaptogens could increase the body’s ability to cope with stress, meanwhile decreasing the sensitivity to internal and external stressors. Instead of exhaustion, a higher level of equilibrium is attained. The greater the ability to cope, the better the therapeutic adaptation to stress.
ANXIOLYTIC
American ginseng
The anxiolytic effects of American ginseng have been attributed to the interaction between ginsenosides and gamma-aminobutyric acid (GABAA)receptors, as suggested via animal studies.[15] Supporting this interaction, in vitro studies demonstrate that ginsenosides modulate nerve transmission by decreasing the availability of neurotransmitters, GABAA, glutamate, dopamine, noradrenalin, and serotonin in the brain.[16] Accumulating evidence has shown that ginsenoside Rg3, the most active ginsenoside, interacts with and regulates voltage and ligand-gated ion channel activity through the interaction with specific amino acids at channel entryways or channel pore regions that are associated with ion influx or efflux.[17] This activity modulates nerve activity and supports brain channel regulation. This evidence highlights the potential of American ginseng as a preventative and/or supportive therapy for a variety of nervous system disorders.[18]
Ginsenosides, found within American Ginseng are believed to act on the CNS and possess cortisol-modulating effects.
Wild oats
Wild oats extracts and tinctures have a long history of medicinal use encompassing a number of psychotropic indications, including the alleviation of anxiety and inducing a state of calmness. Oats contain structural groups of phytochemicals, which include numerous compounds that have been shown to exert wide ranging cellular and physiological effects that modulate brain function and cognitive performance in human subjects.[19] Notably, wild green oats extracts have demonstrated the capability to inhibit the enzymes, monoamine oxidase-B (MAO-B) and phosphodiesterase 4 (PDE 4).[20] The inhibition of the degradation of monoamine neurotransmitters and the cellular second messenger, cyclic adenosine monophosphate (cAMP), suggest a wider range of potential functional effects within the brain relevant to enhanced cognitive function and mood.[21]
Lavender
Lavendar has long history of use as an anxiolytic, sedative and calming agent.[22] The use of lavender oil as an anxiolytic has been demonstrated in various research fields relating to anxiety, sleep and mood disorders.[23] The mechanism of action is not completely understood, however lavender has been proposed to modulate GABA similarly to benzodiazepines and possibly cause serotonin modulation, in a similar way to SSRI/SNRIs,[24] without the potential for addiction.[25] The chemical constituents in lavender, specifically linalool and linalyl acetate, have been proposed to act upon GABAA binding receptors in the CNS inducing a relaxed state.[26] Furthermore, research has demonstrated that lavender has the capacity to non-selectively reduce calcium influx through several different types of voltage operated calcium channels (VOCCs) such as N-type, P/Q-type and T-type VOCCs.[27] It has been speculated that under pathological conditions, (e.g. in anxiety or stress disorders), an enhanced calcium (Ca2þ) influx through N-type and P/Q-type VOCCs may increase the release of neurotransmitters such as glutamate and norepinephrine, which are involved in the pathogenesis of these conditions.[28] By inhibiting VOCCs, lavender may have a normalising effect on hyperactive nerve cells and counteract symptomatic expressions, such as anxious moods and spinning thoughts.[29]
FATIGUE
American Ginseng
Traditionally, herbalists consider American ginseng to be an adaptogen that helps restore balance to the body,[30] with fatigue reduction being one of the most well-known benefits of this herb. The active ginsenosides found within American ginseng are believed to act on the CNS and possess cortisol-modulating effects, impacting the HPA axis to improve energy, physical and emotional health, and wellbeing.[31]
Rehmannia:
Rehmannia has been shown to possess anti-fatigue properties, as confirmed via research conducted in animal models.[32] It has been noted that an increase in exercise endurance is a powerful representation of rehmannia’s anti-fatigue effect.[33] The anti-fatigue effects are associated with the ability of rehmannia to reduce the levels of blood lactic acid (BLA) and serum urea nitrogen (SUN), two biochemical markers related to fatigue.[34] Further research has pointed to the polysaccharide content of rehmannia as the main chemical components related to the anti-fatigue properties.[35]
NERVOUS EXHAUSTION / MENTAL FATIGUE
American Ginseng
For decades extracts of ginseng have been prized for their effects on the CNS. American ginseng has shown promise in preclinical studies assessing its impacts on human cognition and mood stabilisation. One clinical trial has shown significant benefit for the use of American ginseng for neurocognitive function and related acute mood state.[36] In this randomised, double-blind, placebo-controlled, crossover trial 32 healthy young adults aged 18–40 years were assessed for acute mood (calmness), neurocognitive and glycaemic effects upon consuming one of three doses (100, 200, or 400 mg) of American ginseng (standardised to 10.65% ginsenosides). Participants' mood, cognitive function and blood glucose were measured at baseline and 1, 3 and 6 hours following administration. Results demonstrated a significant improvement in working memory (WM) performance associated with American ginseng intake (at all doses), with self-rated calmness increasing following 100 mg of American ginseng at 3 and 6 hours post treatment.[37] This preliminary study identified American ginseng’s treatment-related improvements in neurocognitive performance and association of increased calmness in healthy young adults.[38]
One clinical trial has shown significant benefits for the use of American ginseng for neurocognitive function and related acute mood state.
A follow-up study aimed to partially replicate the aforementioned double-blind, placebo-controlled, balanced, cross-over design, evaluated American ginseng‘s impact upon mood and WM.[39] This study aimed to investigate whether the beneficial effects of American ginseng extended to healthy middle-aged individuals. Fifty-two healthy volunteers aged 40-60 years received either 200 mg of American ginseng or placebo to evaluate cognitive performance and impact on mood.[40] A noted improvement in WM performance and mood stabilisation was yet again achieved. It was noted that as cognitive improvements are most consistently found in WM measures, a plausible explanation could relate to a ginsenoside-mediated augmentation of the dopaminergic neurotransmitter system.[41] Therefore, American ginseng has the ability to improve cognitive performance on WM and stabilise mood, which may assist in areas of mental fatigue and support nervous exhaustion.
Wild oats extract contains a range of bioactive components that have been shown to enhance and improve cognitive performance in humans’.
Wild Oats
Wild oats extract contains a range of bioactive components that have been shown to enhance and improve cognitive performance in humans.[42] The effects of a single dose green oat extract (GOE) were assessed in a double-blind, placebo-controlled, counterbalanced cross-over study. Healthy adults aged 40–65 years who self-reported their memory had declined with age received a single dose of either 800 or 1600 mg GOE or placebo, with the treatments repeated twice for each participant. Cognitive function was assessed with a range of computerised tasks measuring attention, spatial/working/episodic memory, and executive function at baseline and at 1, 2.5, 4, and 6 hours post-dose.[43] The results showed that 800 mg GOE increased the speed of performance across post-dose assessments on a global measure including data from all of the timed tasks. Performance improved in a variety of mental tasks with decreased thinking time and overall completion time.[44] These results confirm the beneficial effects of GOE on cognitive performance.
ANXIETY
Lavender
Lavender’s anxiolytic properties have been postulated to have a positive effect on generalised anxiety disorder (GAD). A controlled clinical study was performed to evaluate the efficiency of 6 weeks’ intake of an oral lavender capsule preparation, compared with Lorazepam (benzodiazepine) in adults with GAD. The primary target variable was the change in the Hamilton Anxiety Rating Scale (HAM-A) as an objective measurement of the severity of anxiety between baseline at week 6. During the active treatment period, the mean HAM-A total score decreased clearly and to a similar extent in both groups (by 11.3 + 6.7 points (45%) in the lavender group and by 11.6 + 6.6 points (46%) in the Lorazepam group), from a baseline of 25 + 4 points in both groups. The HAM-A subscores for somatic anxiety and psychic anxiety also decreased clearly and to a similar extent in both groups. The results note that oral lavender effectively ameliorates generalised anxiety, comparable to Lorazepam.[45] This research indicates that lavender may deliver a gentle, yet effective treatment option as an alternative to conventional anxiolytic drugs.
Lavender has also been demonstrated to be efficacious in sub-syndromal and syndromal anxiety disorders and concommitant depressive symptoms.[46] In this study, 318 adult out-patients with mixed anxiety and depressive disorder (MADD) according to international classification of disease (ICD-10) criteria (a total score ≥18 points on the HAM-A, and at least moderately severe anxious and depressed mood), were randomised and received 80 mg/d lavender or placebo for a scheduled period of 70 days. Primary outcomes measured were total score changes in the HAM-A and Montgomery Åsberg Depression Rating Scale (MADRS) between baseline and treatment end. The HAM-A total score decreased by 10.8 ± 9.6 points for patients in the lavender group compared with 8.4 ± 8.9 points for placebo (treatment group difference: p<0.01). Total score decreases of 9.2 ± 9.9 and 6.1 ± 7.6 points respectively, were observed for the MADRS (p<0.001).[47] Compared to placebo, the patients treated with lavender had better overall clinical outcomes for anxiety and depressive symptoms, and showed more pronounced improvements of impaired daily living skills and health related quality of life.[48] This study strengthens the use of lavender as efficacious and safe in the treatment of mixed anxiety and depression symptoms.
INGREDIENTS
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DIRECTIONS
Adult Maximum Dose:
Take 2 tablets twice daily with food
EVIDENCE
References
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[2] Raabe FJ, Spengler D. Epigenetic Risk Factors in PTSD and Depression. Front Psychiatry. 2013 Aug 7;4:80.
[3] Medibank, Medibank livebetter [Internet]. Medibank, Australia; 2017 [updated 2017 December 28; cited 2018 October 23]. Available from: https://www.medibank.com.au/livebetter/health-brief/health-insights/was-2017-australias-most-stressful-year/.
[4] Medibank, Medibank livebetter [Internet]. Medibank, Australia; 2017 [updated 2017 December 28; cited 2018 October 23]. Available from: https://www.medibank.com.au/livebetter/health-brief/health-insights/was-2017-australias-most-stressful-year/.
[5] Doerr JM, Ditzen B, Strahler J, Linnemann A, Ziemek J, Skoluda N, et al. Reciprocal relationship between acute stress and acute fatigue in everyday life in a sample of university students. Biological psychology. 2015 Sep 1;110:42-9.
[6] Doerr JM, Ditzen B, Strahler J, Linnemann A, Ziemek J, Skoluda N, et al. Reciprocal relationship between acute stress and acute fatigue in everyday life in a sample of university students. Biological psychology. 2015 Sep 1;110:42-9.
[7] Edwards LD, Heyman AH, Swidan S. Hypocortisolism: An evidence-based review. Integrative Medicine. 2011;10(4):26-33.
[8] McEwen BS. Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008 Apr 7;583(2-3):174-85. doi: 10.1016/j.ejphar.2007.11.071
[9] McEwen BS. Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008 Apr 7;583(2-3):174-85. doi: 10.1016/j.ejphar.2007.11.071
[10] Guilliams TG. The role of stress and the HPA axis in chronic disease management. Stevens Point, WI: Point Institute; 2015 p. 21.
[11] Panossian A, Wikman G. Effects of adaptogens on the central nervous system and the molecular mechanisms associated with their stress—protective activity. Pharmaceuticals. 2010 Jan 19;3(1):188-224.
[12] Nocerino E, Amato M, Izzo AA. The aphrodisiac and adaptogenic properties of ginseng. Fitoterapia. 2000 Aug 1;71:S1-5.
[13] Scholey A, Ossoukhova A, Owen L, Ibarra A, Pipingas A, He K, et al. Effects of American ginseng (Panax quinquefolius) on neurocognitive function: an acute, randomised, double-blind, placebo-controlled, crossover study. Psychopharmacology. 2010 Oct 1;212(3):345-56.
[14] Panossian A, Wikman G. Effects of adaptogens on the central nervous system and the molecular mechanisms associated with their stress—protective activity. Pharmaceuticals. 2010 Jan 19;3(1):188-224.
[15] Attele AS, Wu JA, Yuan CS. Ginseng pharmacology: multiple constituents and multiple actions. Biochem Pharmacol. 1999 Dec 1;58(11):1685-1693.
[16] Attele AS, Wu JA, Yuan CS. Ginseng pharmacology: multiple constituents and multiple actions. Biochem Pharmacol. 1999 Dec 1;58(11):1685-1693.
[17] Attele AS, Wu JA, Yuan CS. Ginseng pharmacology: multiple constituents and multiple actions. Biochem Pharmacol. 1999 Dec 1;58(11):1685-1693.
[18] Nah SY. Ginseng ginsenoside pharmacology in the nervous system: involvement in the regulation of ion channels and receptors. Frontiers in physiology. 2014 Mar 19;5:98.
[19] Kennedy DO, Jackson PA, Forster J, Khan J, Grothe T, Perrinjaquet-Moccetti T, et al. Acute effects of a wild green-oat (Avena sativa) extract on cognitive function in middle-aged adults: A double-blind, placebo-controlled, within-subjects trial. Nutritional neuroscience. 2017 Feb 7;20(2):135-51.
[20] Kennedy DO, Jackson PA, Forster J, Khan J, Grothe T, Perrinjaquet-Moccetti T, et al. Acute effects of a wild green-oat (Avena sativa) extract on cognitive function in middle-aged adults: A double-blind, placebo-controlled, within-subjects trial. Nutritional neuroscience. 2017 Feb 7;20(2):135-51.
[21] Kennedy DO, Jackson PA, Forster J, Khan J, Grothe T, Perrinjaquet-Moccetti T, et al. Acute effects of a wild green-oat (Avena sativa) extract on cognitive function in middle-aged adults: A double-blind, placebo-controlled, within-subjects trial. Nutritional neuroscience. 2017 Feb 7;20(2):135-51.
[22] Perry R, Terry R, Watson LK, Ernst E. Is lavender an anxiolytic drug? A systematic review of randomised clinical trials. Phytomedicine. 2012 Jun 15;19(8-9):825-35.
[23] Henneman A, Axtell S, Chaudry S, Younas W. Lavender oil supplementation for the management of anxiety disorder. Med Case Rep Rev. 2018 Jun 8:1(2):1-5.
[24] Henneman A, Axtell S, Chaudry S, Younas W. Lavender oil supplementation for the management of anxiety disorder. Med Case Rep Rev. 2018 Jun 8:1(2):1-5.
[25] Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010 Feb 1;17(2):94-9.
[26] Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010 Feb 1;17(2):94-9.
[27] Kasper S, Müller WE, Volz HP, Möller HJ, Koch E, Dienel A. Silexan in anxiety disorders: clinical data and pharmacological background. World J of Biol Psychiatry. 2018 Aug 18;19(6):412-20.
[28] Kasper S, Müller WE, Volz HP, Möller HJ, Koch E, Dienel A. Silexan in anxiety disorders: clinical data and pharmacological background. World J of Biol Psychiatry. 2018 Aug 18;19(6):412-20.
[29] Kasper S, Müller WE, Volz HP, Möller HJ, Koch E, Dienel A. Silexan in anxiety disorders: clinical data and pharmacological background. World J of Biol Psychiatry. 2018 Aug 18;19(6):412-20.
[30] Arring NM, Millstine D, Marks LA, Nail LM. Ginseng as a Treatment for Fatigue: A Systematic Review. J Altern Complement Med. 2018 Apr 6:24(7);624-633.
[31] Arring NM, Millstine D, Marks LA, Nail LM. Ginseng as a Treatment for Fatigue: A Systematic Review. J Altern Complement Med. 2018 Apr 6:24(7);624-633.
[32] Tan W, Yu KQ, Liu YY, Ouyang MZ, Yan MH, Luo R, et al. Anti-fatigue activity of polysaccharides extract from Radix Rehmanniae Preparata. Int J Biol Macromol. 2012 Jan 1;50(1):59-62.
[33] Tan W, Yu KQ, Liu YY, Ouyang MZ, Yan MH, Luo R, et al. Anti-fatigue activity of polysaccharides extract from Radix Rehmanniae Preparata. Int J Biol Macromol. 2012 Jan 1;50(1):59-62.
[34] Tan W, Yu KQ, Liu YY, Ouyang MZ, Yan MH, Luo R, et al. Anti-fatigue activity of polysaccharides extract from Radix Rehmanniae Preparata. Int J Biol Macromol. 2012 Jan 1;50(1):59-62.
[35] Tan W, Yu KQ, Liu YY, Ouyang MZ, Yan MH, Luo R, et al. Anti-fatigue activity of polysaccharides extract from Radix Rehmanniae Preparata. Int J Biol Macromol. 2012 Jan 1;50(1):59-62.
[36] Scholey A, Ossoukhova A, Owen L, Ibarra A, Pipingas A, He K, et al. Effects of American ginseng (Panax quinquefolius) on neurocognitive function: an acute, randomised, double-blind, placebo-controlled, crossover study. Psychopharmacol. 2010 Oct;212(3):345-56.
[37] Scholey A, Ossoukhova A, Owen L, Ibarra A, Pipingas A, He K, et al. Effects of American ginseng (Panax quinquefolius) on neurocognitive function: an acute, randomised, double-blind, placebo-controlled, crossover study. Psychopharmacol. 2010 Oct;212(3):345-56.
[38] Scholey A, Ossoukhova A, Owen L, Ibarra A, Pipingas A, He K, et al. Effects of American ginseng (Panax quinquefolius) on neurocognitive function: an acute, randomised, double-blind, placebo-controlled, crossover study. Psychopharmacol. 2010 Oct;212(3):345-56.
[39] Ossoukhova A, Owen L, Savage K, Meyer M, Ibarra A, Roller M, et al. Improved working memory performance following administration of a single dose of American ginseng (Panax quinquefolius L.) to healthy middle‐age adults. Hum Psychopharmacol. 2015 Mar;30(2):108-22.
[40] Ossoukhova A, Owen L, Savage K, Meyer M, Ibarra A, Roller M, et al. Improved working memory performance following administration of a single dose of American ginseng (Panax quinquefolius L.) to healthy middle‐age adults. Hum Psychopharmacol. 2015 Mar;30(2):108-22.
[41] Ossoukhova A, Owen L, Savage K, Meyer M, Ibarra A, Roller M, et al. Improved working memory performance following administration of a single dose of American ginseng (Panax quinquefolius L.) to healthy middle‐age adults. Hum Psychopharmacol. 2015 Mar;30(2):108-22.
[42] Kennedy DO, Jackson PA, Forster J, Khan J, Grothe T, Perrinjaquet-Moccetti T, et al. Acute effects of a wild green-oat (Avena sativa) extract on cognitive function in middle-aged adults: A double-blind, placebo-controlled, within-subjects trial. Nutr Neurosci. 2017 Feb 7;20(2):135-51.
[43] Kennedy DO, Jackson PA, Forster J, Khan J, Grothe T, Perrinjaquet-Moccetti T, et al. Acute effects of a wild green-oat (Avena sativa) extract on cognitive function in middle-aged adults: A double-blind, placebo-controlled, within-subjects trial. Nutr Neurosci. 2017 Feb 7;20(2):135-51.
[44] Kennedy DO, Jackson PA, Forster J, Khan J, Grothe T, Perrinjaquet-Moccetti T, et al. Acute effects of a wild green-oat (Avena sativa) extract on cognitive function in middle-aged adults: A double-blind, placebo-controlled, within-subjects trial. Nutr Neurosci. 2017 Feb 7;20(2):135-51.
[45] Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010 Feb 1;17(2):94-9.
[46] Kasper S, Volz HP, Dienel A, Schläfke S. Efficacy of Silexan in mixed anxiety–depression–A randomized, placebo-controlled trial. Eur Neuropsychopharmacol. 2016 Feb;26(2):331-340.
[47] Kasper S, Volz HP, Dienel A, Schläfke S. Efficacy of Silexan in mixed anxiety–depression–A randomized, placebo-controlled trial. Eur Neuropsychopharmacol. 2016 Feb;26(2):331-340.
[48] Kasper S, Volz HP, Dienel A, Schläfke S. Efficacy of Silexan in mixed anxiety–depression–A Kasper S, Volz HP, Dienel A, Schläfke S. Efficacy of Silexan in mixed anxiety–depression–A randomized, placebo-controlled trial. Eur Neuropsychopharmacol. 2016 Feb;26(2):331-340.
[49] Mills S, Bone K. The essential guide to herbal safety. Philadelphia (PA): Elsevier/Churchill Livingstone; 2005. p. 493-4.
[50] Bensky D, Clavey S, Stoger E, Gamble A. Chinese herbal materia medica. 3rd ed. Seattle (WA): Eastland Press; 2004. p. 744-6/120-3.
[51] Bone K. A clinical guide to blending liquid herbs: herbal formulations for the individual patient. St Louis (MO): Elsevier/Churchill Livingstone; 2003. p. 386.
[52] Rehmannia. In: Natural Medicines Comprehensive Database [database on the Internet]. Stockton (CA): Therapeutic Research Faculty; 1995-2018 [updated 2015 Feb 16; cited 2018 Aug 3]. Available from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1155.
[53] American Ginseng. In. Natural Medicines Comprehensive Database [database on the Internet]. Stockton (CA): Therapeutic Research Faculty; 1995-2008 [cited 2018 Sept 7]. Available from: http://www.naturaldatabase.com. subscription required to view.
[54] Gardner Z, McGuffin M. Botanical safety handbook. 2nd ed. Botan Raton (FL): CRC Press; 2013. p. 625-6.
[55] Ulbricht CE. Natural Standard. Herb & Supplement Guide. An evidence-based reference. Mosby Elsevier. Maryland Heights (MIS). 2010. p. 466-8.
[56] Braun L, Cohen M. Herbs and natural supplements: an evidence-based guide. 4th ed. Vol 2. Sydney (AU): Elsevier/Churchill Livingstone; 2015. p. 613-23.
[57] Lavender. In: Natural Medicines Comprehensive Database [database on the Internet]. Stockton (CA): Therapeutic Research Faculty; 1995-2008 [cited 2018 Aug 31]. Available from: http://www.naturaldatabase.com. subscription required to view.
[58] Lavender. In: Natural Medicines Comprehensive Database [database on the Internet]. Stockton (CA): Therapeutic Research Faculty; 1995-2008 [cited 2018 Aug 31]. Available from: http://www.naturaldatabase.com. subscription required to view.
[59] Braun L, Cohen M. Herbs and natural supplements: an evidence-based guide. 4th ed. Vol 2. Sydney (AU): Elsevier/Churchill Livingstone; 2015. p. 613-23.
[60] Fetrow CW, Avila JR. Professionals handbook of complementary and alternative medicines. 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2004. p. 493-5.
[61] Ulbricht CE. Natural Standard. Herb & Supplement Guide. An evidence-based reference. Mosby Elsevier. Maryland Heights (MIS). 2010. p. 466-8.
[62] Rehmannia. In: Natural Medicines Comprehensive Database [database on the Internet]. Stockton (CA): Therapeutic Research Faculty; 1995-2018 [updated 2015 Feb 16; cited 2018 Aug 3]. Available from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1155. Subscription required to view.
[63] Rehmannia. In: Natural Medicines Comprehensive Database [database on the Internet]. Stockton (CA): Therapeutic Research Faculty; 1995-2018 [updated 2015 Feb 16; cited 2018 Aug 3]. Available from: https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1155. Subscription required to view.
[64] American Ginseng. In. Natural Medicines Comprehensive Database [database on the Internet]. Stockton (CA): Therapeutic Research Faculty; 1995-2008 [cited 2018 Sept 7]. Available from: http://www.naturaldatabase.com. subscription required to view.
[65] Gardner Z, McGuffin M. Botanical safety handbook. 2nd ed. Botan Raton (FL): CRC Press; 2013. p. 625-6.
[66] American Ginseng. In. Natural Medicines Comprehensive Database [database on the Internet]. Stockton (CA): Therapeutic Research Faculty; 1995-2008 [cited 2018 Sept 7]. Available from: http://www.naturaldatabase.com. subscription required to view.
[67] Mills S, Bone K. Principles and practice of phytotherapy: modern herbal medicine. 2nd ed. Edinburgh (UK): Elsevier/Churchill Livingstone; 2013. p. 802.
[68] Mills S, Bone K. The essential guide to herbal safety. Philadelphia (PA): Elsevier/Churchill Livingstone; 2005. p. 552.
[69] Mills S, Bone K. The essential guide to herbal safety. Philadelphia (PA): Elsevier/Churchill Livingstone; 2005. p. 553.
WARNINGS
Contraindications
Allergy or Hypersensitivity: Avoid in patients with cross-sensitivity to other members of the Labiatae family.[49]
Diarrhoea: Anecdotally, rehmannia may increase bowel frequency and is contraindicated in traditional Chinese medicine in those with abdominal upset and diarrhea,[50] therefore use with caution and consider avoiding in patients during times of diarrhoea/gastrointestinal upset.[51],[52]
Moderate Level Cautions
Warfarin: American ginseng may have anticoagulant actions. Co-administration with warfarin may lead to a decrease in the INR and a decrease in plasma levels of warfarin.[53],[54] Use with caution and monitor INR in patients if combining.
Low Level Cautions
Antidepressants: Lavender may have additive effects when used with prescription antidepressant medications.[55],[56] This may be a beneficial reaction but may require dosage adjustment. Use under medical supervision and monitor patient.
Antihypertensive drugs: Lavender may lower systolic and possibly diastolic blood pressure in some patients. Theoretically, concomitant use of lavender with antihypertensive drugs might cause additive hypotensive effects.[57] Use under medical supervision and monitor patient.
CNS depressants including benzodiazepines, barbituates (phenobarbital) and sedatives: Theoretically, lavender can potentiate the therapeutic effects and adverse effects of CNS depressants, including benzodiazepines. Evidence from animal research shows that lavender oil, given orally in combination with the CNS depressant drug pentobarbital, can increase sleeping time compared to pentobarbital alone. Theoretically, lavender may enhance the therapeutic and adverse effects of pentobarbital or other CNS depressants.[58],[59],[60],[61] This may be a beneficial reaction but may require dosage adjustment. Use under medical supervision and monitor patient.
Insulin and other hypoglycaemic medications: Individuals should exercise caution and monitor their blood glucose closely when taking this combination. Monitor symptoms in diabetic patients.Rehmannia may exert hypoglycaemic effects.[62] Concomitant use with medications such as insulin, metformin and others may, theoretically, potentiate their effect.[63]
American ginseng has blood glucose lowering effects and may have an additive effect with other hypoglycaemic medications when taken concurrently.[64],[65] This may cause hypoglycaemia, or the need to reduce hypoglycaemic medications, which may be desirable.
Immunosupressants: American ginseng may stimulate immune function and therefore might decrease the effectiveness of immunosuppressant drugs.[66] Therefore use caution and under medical supervision in patients on these medications.
Pregnancy and Breastfeeding
Pregnancy: A review did not identify any concerns for use during pregnancy, however safety has not been conclusively established in humans.
Breastfeeding: Appropriate for use.[67],[68]
Children: Appropriate for use.[69]
MGXADAS
