immunostimulating activity. Elderberry stimulates production of cytokines, including interleukin and tumor necrosis factor (Barak, Halperin, & Kalickman, 2001). Immunosuppressant drugs include glucocorticoids, which may be administered or prescribed by OHCPs to help reduce pain, swelling, and trismus related to a dental procedure. Although this herbal-drug interaction may be only theoretical, it is based on a high level of medical evidence (“B”). From a dental perspective, then, when treating immunosuppressed patients (e.g., patients with inflammatory arthropathies such as rheumatoid arthritis or systemic lupus erythematosus, drug- or radiation- induced immunosuppression, malignancy, malnourishment, hemophilia, HIV infection, or insulin-dependent diabetes), if a glucocorticoid is intended to be used, patients should not suddenly start taking this herbal medication before the dental procedure, and if they do consume elderberry routinely, they should stop the supplement for 24 hours before the dental procedure and for at least 24 hours after the last dose of the glucocorticoid. However, OHCPs may choose to avoid glucocorticoids altogether in these high-risk immunosuppressed patients, regardless of whether they take elderberry supplementation. & Ruberto, 2012; Herrera-Arellano, Aguilar-Santamaria, García-Hernández, Nicasio-Torres, & Tortoriello, 2004; Rodriguez Villanueva & Martin Esteban, 2016). Theoretically, horehound may have additive effects when used by patients taking antidiabetic drugs and the dose of diabetes medications might need to be adjusted if patients routinely consume these supplements. From a dental perspective, be aware of diabetic patients who may consume horehound- containing supplements, and request that they do not take these supplements at least 24 hours before the dental procedure. As with all patients with diabetes, routine blood glucose monitoring is paramount, dental appointments should be kept relatively short, and patients should maintain their normal nutritional routine. In patients with controlled diabetes, this potential herbal-drug interaction can be easily avoided. Turmeric can inhibit CYP3A4 causing increased blood levels of concomitant medications such as clarithromycin, clindamycin, erythromycin, dexamethasone, hydrocodone, lidocaine, alprazolam, diazepam, midazolam, and triazolam. If any of these medications are to be used during the dental appointment, patients should stop taking turmeric at least 24 hours before the procedure to avoid a potential herbal-drug interaction. Alternatively, medications that are not listed as having an interaction with turmeric could be substituted (e.g., azithromycin as an antibiotic, articaine as a local anesthetic, or lorazepam as a sedative agent). In vitro, turmeric has been shown to have antiplatelet effects, however, results from human research are inconsistent (Shivalingu, B. R., Vivek, H. K., Nafeesa, Z., Priya, B. S., & Swamy, S. N., 2015). Until more is known, turmeric should be used cautiously in combination with anticoagulant and antiplatelet drugs as concomitant use might increase the risk of bleeding due to decreased platelet aggregation. Some of these drugs include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others. On a dental note, a recent clinical trial evaluated the efficacy of turmeric gel as an anti-plaque and anti-gingivitis agent compared to chlorhexidine gel (Kandwal, A., Mamgain, R. K., & Mamgain, P., 2015). Both study groups
diaphoretic. Although there is insufficient evidence in the medical literature to support its effectiveness in most of these situations, there is medical evidence in support of this herbal supplement’s possible effectiveness in treating influenza. Clinical research shows that some elderberry extracts might reduce flu-like symptoms. Fifteen milliliters (1 tablespoon) of a specific syrup formulation of elderberry fruit extract administered orally four times daily seems to reduce the symptoms and duration of influenza infection when given within 48 hours of initial symptoms (Kinoshita, Hayashi, Katayama, Hayashi, & Obata, 2012; Zakay-Rones et al., 1995; Zakay-Rones, Thom, Wollan, & Wadstein, 2004). Significant symptom relief seems to occur within 2 to 4 days of treatment for most patients. On average, this elderberry extract reduces the duration of symptoms by about 56% (Zakay-Rones et al., 2004). In another preliminary clinical study, an elderberry extract lozenge taken four times daily for 2 days, starting within 24 hours of initial symptoms, significantly improved flu-like symptoms compared with placebo. Substantial symptom relief occurred within 48 Horehound In manufacturing, the extracts of white horehound are used as flavoring in foods and beverages and as an expectorant in cough syrups and lozenges. Patients may be unaware that they are consuming this herbal medication as the primary ingredient in many throat lozenges, and this lack of awareness may be problematic specifically in the diabetic population (adding to the problem that many of these dosage forms also contain a significant amount of sugar; Donaldson, Goodchild, & Epstein, 2015). Evidence from animal research suggests that horehound might lower blood glucose (Roman, Alarcon-Aguilar, Lara-Lemus, & Flores- Saenz, 1992; Novaes et al., 2001 – although preliminary clinical research suggests that horehound only slightly lowers blood glucose when taken in combination with antidiabetic agents, suggesting that the effect may not be clinically significant (Boudjelal, Henchiri, Siracusa, Sari, hours for most treated patients (Kong, 2009). Theoretically, elderberry might interfere with immunosuppressant therapy because of its Turmeric Turmeric is possibly effective when given orally to treat allergic rhinitis (hay fever), depression, hyperlipidemia, nonalcoholic fatty liver disease, osteoarthritis, and pruritis. Topically, turmeric is used for analgesia, ringworm, sprains and swellings, bruising, leech bites, eye infections, acne, inflammatory skin conditions, skin lesions, psoriasis, inflammation of the oral mucosa, periodontitis, infected wounds, and gingivitis. As an enema, turmeric is used for ulcerative colitis. Clinical research has also suggested that the turmeric constituent, curcumin, may lower blood glucose levels and glycosylated hemoglobin (HbA1C) in patients with diabetes (Azhdari, M., Karandish, M., & Mansoori, A. 2019; Kato, M, et al, 2017). Theoretically, taking a combination of turmeric and antidiabetes drugs might have an additive effect and increase the risk of hypoglycemia. From a dental perspective, be aware of patients with diabetes who may routinely consume turmeric and request that they do not suddenly start or stop taking this supplement before the dental procedure; OHCPs will want patients to be as stable as possible when they are seen in the office. As with all patients with diabetes, routine blood glucose monitoring is paramount, dental appointments should be kept relatively short, and patients should maintain their normal nutritional routine. In patients with controlled diabetes, this potential herbal-drug interaction can be easily managed.
EliteLearning.com/Dental
Page 91
Powered by FlippingBook