Ayurvedic Medicines EAPCCT Seville 2008

8/6/2019 Ayurvedic Medicines EAPCCT Seville 2008

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Clinical toxicology

of

Ayurvedic medicines

Ruben Thanacoody

NPIS (Edinburgh)



Ayurvedic medicine

� Comprehensive holistic medical system 4500BC

� ³Knowledge or science of life´

� Kayachikitsa Internal Medicine

� Shalya Tantra General Surgery

� Bhutavidya Psychiatry� Agada Tantra Toxicology

� Rasayana Tantra Nutrition, Detoxification andRejuvenation

� Kaumarabhrtya Paediatrics/Obstetrics/Gynaecology

� Vajikarana Fertility and Virility

� Shalakya Otorhinolaryngology



Ayurvedic medicines

� Individually prepared

� Based on herbs and minerals

� Classification in Caraka

Samhita (150BC-100AD) ± Elemental constituents

± Taste

± Potency

± Postdigestive effect

± Therapeutic action (50

groups)

� Commercialisation

� Increasing use

� Wider availability

± Health food stores

± Ethnic shops

± Internet retailers

� Lack of Regulation



THE MAKING OF

MADONNA

Traditional medicine

takes on the world

India drug gives

Alzheimer's hope

EXCLUSIVE:

MADONNA BABY BID

MADONNA is using old Indian

fertility remedies to try for a third

child at the age of 46.

She hopes a stash of Ayurvedic

medicines will help her conceive.

Source: BBC website



Clinical Toxicology

� Contamination/Incomplete processing/ Adulteration

± Heavy metal poisoning

� Herb-drug interactions

� Genotoxicity

� Teratogenicity



Case history

� 37 year old man admitted with weakness, dizziness andmuscle pain. He visited India and had bought several

Ayurvedic medicines.

� Hb 7.8 g/dl

� Blood lead 58 g/dl

� Urinary arsenic 24.1 g/dl/L (normal<20)

� Lead content of Ayurvedic medicine 238 g/gm .

Spriewald et al. Occup Environ Med 1999; 56: 282-283



Heavy metal content

� England 1979: 30% (11/37) samples of ³kushtay´ ± Aslam M et al.Public Health. 1979;93:274-284

� India 1988: 64% contain lead and mercury,

41% arsenic and 9% cadmium.

± McElvaine MD et al. JAMA. 1990;264:2212-2213

� Boston USA 2003: 20% (14/70) of preparations

contain toxic concentrations of lead, mercury andarsenic. ± Saper KB et al.JAMA 2004;292: 2868-2873.



Saper et al 2004



Lead poisoning and anaemia

Kales SN et al. Med Sci Monit. 2007;13: 295-8



Contaminant or incomplete processing?

� Medicinal properties

� Toxicity well-known

� Detoxification process ± Complex oxidation

processes

± Bhasmas (Ash)

� Vatsanabha (Aconitum sp.)� Detoxification of aconite

(samskaras)

� Crude aconite

± 100% mortality at adose of 2.6 mg/mouse

� Fully processed aconite

± no mortality at 8x dose

crude aconite).� Thorat S, Dahanukar S. J Postgrad

Med. 1991 ;37(3):157-9.



Adulteration/Contamination

� Fake preparations containing steroids

� Organochlorine pesticide residues ± Rai V et al. Environ Monit Assess. 2007(in press)



Herb-drug interactions

� Brahma Rasayana is beneficial for promoting mental clarity,improved memory and cognition whilst improving resilience tomentally demanding lifestyles.

Amla (Emblica officinalis), Haritaki (Terminalia chebula), Mandukaparni (Centellaasiatica), Pippali (Piper longum), Shankapushpi (Convovulus pluricalis),Plava (Cyperus scariosus), Musta (Cyperus rotundus), Chandana (Santalum album),

Agaru (Aquallaria agolcha), Yastimadhu (Glycirrhiza glabra), Haridra

(Curcuma longa), Vacha (Acorus calamus), Nagakeshar (Messua ferrea), Ela(Eletaria cardamomum), Twak (Cinnamomum zeylanicum), Bilva (Aegle marmelos), Agnimantha (Clerodendrum phlomides), Syonaka (Orroxylum indicum), Patala(Stereospermum suaveolens), Gambhari (Gmelina arborea), Shalaparni (Desmodiumgangenticum), Brihat (Solanum indicum), Prishniparni (Uraria picta), Kantakari(Solanum xanthophylum), Gokshura (Tribulus terrestris), Punarnava (Boerhaaviadiffusa), Mudga parni (Phaseolus trilobus), Mashaparni (Teramnus labialis), Bala(Sida cordifolia), Eranda (Ricinus communis), Jeevanti (Leptateniareticulate), Shatavari (Asparagus racemosus), Shara (Saccharum munja), Ikshu(Saccharum officinarum), Kasha (Saccharum spontaneum), Darbha (Desmostachyabipinnata), Kapikacchu (Mucuna pruriens), Sesame oil, Rock sugar, Honey



Pharmacodynamic interactions

� Sarpaghandha (Rauwolfia serpentina)

� Datura (Datura metal)

� Yavani (Hyoscyamus niger)

� Kapikachchha (Mucuna pruriens)



Phenytoin/Shankhapuspi Interaction

� Single dose of phenytoin and this herb did not

alter phenytoin serum levels in rats but

decreased antiepileptic activity.

� Multiple dose co-administration reduced both

antiepileptic activity and serum phenytoin levels.

� Dandekar et al. J Ethnopharmacol 1992;35: 285-288.



Ashwagandha and Digoxin Assay

� Ashwagandha

(Withania somnifera)contains withanolidesstructurally similar to

digoxin

� Interferes with both

± FPIA digoxinassay(falsely elevated)

± MEIA digoxin assays(falsely low) .

Dasgupta et al.Am J Clin Path 2005;124:229-336



Teratogenicity

� Asparagus racemosus roots ± Teratogenic in rats ± Goel RK et al.Indian J Exp Biol. 2006 ;44(7):570-3.

� Lead-containing preparations ± Congenital paralysis and sensorineural deafness



Genotoxicity

� Birthwort (Isharmul, sunanda)

± Contraceptive

± Aristolochia indica

± Carcinogen banned in Europe and US

� Salacia oblonga roots

± Weak genotoxicity in vit ro

± Flammang AM et al.Food Chem Toxicol. 2006; 44(11):1868-74.

� Arsenic-containing preparations

± Skin and haematological cancers

Gold LS. NEJM 2003;

349: 1576 (letter)



All substances are

poisons; there is

none which is not a

poison. The right dose differentiates a

poison from a

remedy.´

Paracelcus 1493-1541



Charaka samhita

� Sutra sthana 1/124-127

Type and dose of the drug as per the specification of everyindividual, if done by a physician before the use of the medicine, he

should be called a quality physician

If processed and used properly, a deadly poison can become a lifesaving medicine.

A lifesaving medicine medicine can become poison if not usedproperly

Rastogi et al. Int J Risk & Saf Med.2007;19:117-125



Conclusion

� Ayurvedic medicines contain potent biologicallyactive ingredients.

� Risk of heavy metal poisoning

� Regulation of these products desirable.

Ayurvedic Medicines EAPCCT Seville 2008

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