M
any dietary supplements and “natural”
remedies are used by the public for
self-treatment. These substances, many
derived from the folklore of various
cultures, commonly contain ingredients
that have been identified and that have
known therapeutic activities. Some of
these substances have unknown mecha-
nisms of action but over the years have
been reliably used to relieve specific
symptoms. There is an element of
the placebo effect in using some of
Appendix
Complementary and
alternative (CAM) therapies
F
these substances. The power of believing that some-
thing will work and that there is some control over the
problem is often beneficial in achieving relief from pain
or suffering. Some of these substances may contain
yet-unidentified ingredients that eventually may prove
useful in the modern field of pharmacology. Because
these products are not regulated or monitored, there
is always a possibility of toxic effects. Some of these
products may contain ingredients that interact with
prescription drugs. A history of the use of these alter-
native therapies may explain unexpected reactions to
some drugs.
■■
TABLE F Complementary and alternative therapies (continued)
Substance
Reported uses and possible risks
acidophilus
(probiotics)
Oral: prevention or treatment of uncomplicated diarrhoea
Decreased effectiveness of
warfarin
alfalfa
Topical: healing ointment, relief of arthritis pain
Oral: treatment of arthritis, hot flushes; strength giving; reduction of cholesterol level
Increased risk of bleeding with
warfarin
; increased photosensitivity with
chlorpromazine
;
increased risk of hypoglycaemia with
oral hypoglycaemic agents
; loss of effectiveness with
hormonal contraceptives
or
hormone replacement
allspice
Topical: anaesthetic for teeth and gums; soothes sore joints and muscles
Oral: treatment of indigestion, flatulence, diarrhoea, fatigue
Risk of seizures with excessive use; decreased
iron
absorption
aloe leaves
Topical: treatment of burns, healing of wounds
Oral: treatment of chronic constipation
Caution: oral use may cause serious hypokalaemia; risk of spontaneous abortion if used in third
trimester
androstenedione
Oral, spray: anabolic steroid to increase muscle mass and strength
Caution: may increase risk of cardiovascular disease and certain cancers
angelica
Oral: “cure all” for gynaecological problems, headaches, backaches, loss of appetite and
gastrointestinal spasms; increases circulation in the periphery
Risk of bleeding if combined with
anticoagulants
anise
Oral: relief of dry cough, treatment of flatulence
May increase
iron
absorption and cause toxicity
apple
Oral: control of blood glucose, constipation
May interfere with
oral hypoglycaemic agents
arnica
Topical: relief of pain from muscle or soft-tissue injury
Oral: immune system stimulant
May decrease effects of
antihypertensives
and increase effects of
anticoagulants
and
platelet
drugs
; very toxic to children
ashwagandha
Oral: to improve mental and physical functioning; general tonic; to protect cells during cancer
chemotherapy and radiation therapy
May increase bleeding with
anticoagulants
; may interfere with
thyroid replacement
therapy;
discourage use during pregnancy and breastfeeding
astragalus
Oral: to increase stamina, energy; to improve immune function, resistance to disease; to treat
upper respiratory tract infection, common cold
May increase effects of
antihypertensives
; caution against use during fever or acute infection
