ALT AND COMP MED
ALT AND COMP MED MEDCH 420
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This 25 page Class Notes was uploaded by Madelyn Rodriguez on Wednesday September 9, 2015. The Class Notes belongs to MEDCH 420 at University of Washington taught by Gary Elmer in Fall. Since its upload, it has received 17 views. For similar materials see /class/192629/medch-420-university-of-washington in Medicinal Chemistry at University of Washington.
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Date Created: 09/09/15
Homeopathic Products Principle of analogy or Law of Similars Small or infinitesimal closes 3X3OC Avogadro s number6x1023 23X Succussion and potentization see httpwwwboironcomenhtm02 medi homeo Dreoa medihtm Ultrahigh dilution effects Final product World Market USA Evidence In vitro studies Animal studies Human studies Metaanalyses of human studies Implausibility entrenched skeptics and overenthusiastic zealots Inhibition H 75 50 25 Diluuons 0 10c 20c 30c 40c 50c 59c Dilutions FIG 8 Inhibition of basophil degranulation by successive dilutions of histamine An oscillation of inhibititory ac tivity across the series of histamine dilutions is notable The results are expressed in mean percentages of inhibition SEM on 10 experiments 77 lt 005 Mp lt 001 p lt 0001 In SainteLaudy et al 199 Permission to reproduce this figure has been kindly granted by Taylor amp Francis In Vallance AK J Alt Compl Med 1998424976 Reilly et a1 Lancet 1994344160106 asthma Dany mean change from baseme VAS mm u 39 39 n Harem Hammapamy Ense ne lmpmvbment Pllnci pal 0 5 D Ea el5ne New 5 715 2o 25 Improvement Conlirmatm EESPI at lmpmvarllnn 1 7 14 21 28 Days after randomisanon odds ratio 95 CH 9 45 i7 05 9 93 All males as 0 Sensitivity analyses 1 Highqualiiy smdies 5 155 ii 319 as 1 0 on e i em 3 1931151 47 4 Doubie bi nmng siaiea 81 2 17 1 3312 5 7 1 0 Aaeuua e uiiaw up 25 3 18 i2 144 a i MEDL Erliste sludles 23 1 7 1 3112 20 1 Predefined mam ouicume 21 1 701113117 2 I o Carranza im puhiicalion bias 39 148111531310 w r so scenaiio 5 197 104 375 Sungmun an I High mienci I 1 3313 7 0 Highmedium pozences 51 2 7712093 67 i 0 Classical homo my 13 2 91157 5 37 1 0 Clinical nbmneapalhy 49 20011501 251 lsunamy 5 04 1224 11 32 Cumniex humozupamy 20 19412121 may ltgt 01 1 10 Odds ratio Linde et al Lancet 1997 Sep 20350908183443 ABLE 2 Results in three studies of homeopathy for Childhood diarrhea and combined results with all children completing 5day followup Variable Treatment Control P Nicaragua 1990 n 17 Duration of diarrhea 30 i 16 028 No of stoolsday 35 1 14 057 Nicaragua 1991 n 41 Duration of diarrhea 38 t 17 0048 No of stoolsday 29 t 20 007 epal n 52 Duration ofdiarrhea 4 t 9 006 No of stoolsday 3 i 0 003 Combined 10 Duration of diarrhea 3 9 0008 No of stoolsday 3 0 0004 Mean SD Jacobs et al Pediatr Infect Dis J 200322229334 V TABLE 1 COMMON Homeowmnc REMEDIFS FOR ACUTE DIARRHEA AND Tim INDICATIONS Arsenicum album arsenic tn39oxide Mind reat anxiety and restlessness Tossing about in bed Fearful doesn39t want to be alone General Frustration Worse after midni t B 39 heat with thirst for small amounts Chilly better being covered cold sweats Vomiting immediately after eating or g Stools Acrid burning excoriating Diarrhea worse at night after 39dnight Putn39d bloody odor of rotton e 39 Chamomilla German 39 e Mind Capricious irritable quarrelsome nothing pleases Asks for something then rejects it striking on sensitive 0 pain moaning frerm ed Better being carried General One cheek red otha39 pale hot worse from heat better from cold drinks Worse evening until L nudrugh Stools Green slimy offmsive like chopped grass Diarrhea during teething Smelling like rotten eggs co 39 wi 39 hea better after stool Calmrea mrlmm cu calcium carbonate 39 Slow lethargic fears the dark and being alone General Profuse perspiration on the head during sleep Sour smell to perspiration Strong desire for milk eggs and indigestibles pica Plump children who get sick frequently and have swollen glan Stools Sour odor to the stools Diarrhea during teething Watery with bits of undigested food Padaphyllum May apple Mind Diarrhea after mental excitement Figety and restless Genera Gagging or empty retching Violent cramps of the feet calves and Head sweats during ep Thirst for large quantities of cold water 39 Stools Profuse frequent gushing painless watery Bloody with green mucus very offensive Rectal prolapse Exhaustion after stool Diarrhea during teething after fruit Sulphur owers of sulphur Irritable indifferent weeping C EL In General old sweat on face and feet Blue circles under eyes weakness Thirsty for cold drinks little ap elite Stools Diarrhea worse at night after milk involuntary sudden expulsion Worse 500 am Red ring around anus Offensive acrid stools Painless sour thin wateryi Odor of rotten eggs Bold type indicates the most important symptoms for each medicine Sources Bell 1888 Boeriake 1971 1 Jacobs et al J Alt Compl Med 20006z131139 n126 in Nepal TABLE 1 Indications for common homeopathic medicines for acute otitis medial9 Pulsatilla wind ower Mind Generals Ears Chamnmilla German chamomile Mind Generals Ear Sulf 39elemeutal salrnrl Generals Ear Calmreu calbonich calcium carbonate Mind Generals Ear Weepy clingy whiney Wants tn be held and carried Changeable moods Needs attentian and reassurance wann mom better from fresh air Thiretless omes on in middle of t e ni t xtenial ear and nieatas is red Decreased hearing Earaehe fcllewing a celrl Worse in a Earache c 39 39 39 39 nnthin at a some 39 5 then rejects it striking out sensitive to pain moaning frenzied Better hein e One che k red ether pale hct thirsty fur cald drinks Worse evening until midnight ight ewe Unbearable pain screaming from pain Ears feel stepped inetienally irritable and sluggish arse from heat Fever with sweating and shivering estless sleep Doesn t wan to wash or a re hirsty for cold drinks little appetite Worse 5 am harp pains worse on the left eduess of extemal ear Enlarged cervical lymph nades arache with painful ringing 39 in the ears Irritable stnliliorn complaining Fearful at night Sweaty head and back of the neck especially at night Sour odor to sweat steals breath Sensitive to cold Thro ing pn sating ear pain decreased hearing Enlarged cervical lymph nodes Jacobs et a1 Pediatr Infec Dis 200120177183 N75 9 8 a 2 E 9 o E a g 5 Control Treatment 0 I I I 39 l I I I I l I O 8 16 24 32 4O 48 56 64 72 Observation Time hours plt05 Jacobs et al Pediatr Infec Dis 200120177183 N75 Shang et a1 Lancet 2005366726 732 Sample size Median range Mean SD Median year of publication range Type of publication quot I 39 ulnl n110 6539510quot1573l 117211 1992 19662003 r n110 d trials 65 124367 133 226 1994 1974 2002 In English 58 53 94 85 Journal article 94 85 110 100 MEDLINEltindexedjournal 45 41 95 86 Type of outcome Overall assessment of response 54 49 49 45 Occurrence or duration of disorder 26 24 26 24 Assessment of symptoms 21 19 26 24 Measurement offunction or state 6 5 6 5 Assessment of clinical signs 3 3 3 3 Trial quality Described as doubleblind 101 92 96 87 Adequate generation of allocation sequence 27 25 30 27 Adequate concealment of allocation 49 45 21 19 Analysis by intention to treat 33 30 40 36 Higherqualityquot 21 19 9 8 wr 1 39L l 4 LI kl A L A I j t H J J I ofallocation Table 2 Characteristics of placebocontrolled trials of homoeopathy and conventional medicine Shang et al Lancet 2005366726732 Odds ratio for large high quality trials the lower the value the higher the bene t Homeopath N8 ORO88 Conventional N6 ORO58 Conclusions clinical effects of homeopathy are placebo effects Critique how about giving the OR for all included studies and also the OR for the higher quality studies n21 for homeopathy and n9 for conventional The selection of clinical topics for study seem to favor conventional drugs e g respiratory infections Editorial s SCUWmILi await ergo 705 ccumment page691 get Articles page 725 The end of homoeopathy That homoeopathy fares poorly when compared with allopathy in Aijing Shang and colleagues39 systematic evaluation is unsurprising Of greater interest is the fact tha li39s debate continues despite 150 years of unfavourable ndings The more dilute the evidence for homceupathy becomes the greaterseems its popularity For too long a politically correct laissezrfaire attitude has existed towards liomoeopatiiy but there are now signs oi enlightenment from unlikely sources The UK Parlia enta Sel ct o n e Technolo y issued a report about complementary and alternative medicine in 2000 It recommended any thera ythat makesspeci c claimsrer being abletotreat speci c conditions should have evidence of being able to 39 e and beyond the placebo effectquot Going one step further the Swiss Government aftera Sryear trial 39 mrnittee Sci nce and has now withdrawn verage re and tour complementary treatments because they did not meet ef cacy and cost e ectiveness criteria insurance to lmrnoeopathy her In ent Jan Vandenbroucke gives philosophical interpretation ofShang s study One other hilosopher he might ve included is Kant who reminds us that we see things not as they are but as we are Thls observation is also true of healthcare consumers who ma see homoeapathy as a holistic alternative to a diseaserfocused technologydriven medical model it is the attitudes of patients and providers that engender alternativetherapy seeking behaviours which create a greater threat to conventional care and patients welfare t an 0 spurious arguments of putative bene ts from absurd dilutlons Surely the time has passed for selective analyses biased reports or further investment in research to perpetuate the homoeopathy versus allopathy debate Now doctors need to be bold and honest with their patients about homoeopathy s lack of bene t and with themselves about the failings of modern medicine to address patients needs for personalised care I The Lancet www tnelantetrnm Val ass August 27 mos World Report Critics slam draft WHO report on homoeopathy amnhinn than I is ni Ahemauve medwine are a man an humoenpa hnnmenpathy 5 denvcd fxam mu smmww Step The 40mg mngfarWHOmexmnslvc ymvwsaa myenmlmmmummymum Glcckwnrdshomoimtsrm arnnd Wm M drah re on on human amy ml analysrsofrepnnsnnmmmszLh pathos u c n WWW m pa t1 a and mm 39 f may law s mm 1 a mu m u n ddmen m m smst symp hnmocmmthywcpagamlm mwmwm mnnli c paws pm mmsoimsaassmnmmpmmm 7 gt r m as Rundmns a mum mm m pm 40 year hmn Harm39s say hey must also lake mm gynaem ngm 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physwianand mduding hanlmy lyszMLlyand Iw hcmws Hahmmn avgm Vhal w mpenia m evnlcnm dues nal an s s m slmcl Mlhbyshm p gt n s sa vimquot9 ymvcgmmlsbmlancc mpumm mum and now mu Thisdebcdunmwsawd byndnms humouupai y 39punar we at slulnqsubsmnwslhmprovukudmc HO hasheemn lmtud by nussm n sandsan lnmsaslhadlsr alias fa a mmamz medianequot anz 1 He sued his m2 sixwha minus sand r e39 N m mm w The m quotWM masts MM 172an5 7n u v 3 httpWWWhomeopathicpharmacyorg index htm Cytochrome P450 lsozymes Substrates Inhibitors and lnducers Philip D Hansten PharmD and John R Horn PharmD University of Washington Clozapine Clozaril Flutamide Enlexin lmipramine Tofranil Tacrine Cognex Theophylline T heoDur Ropinirole Requip Enoxacin Penetrex Ethinyl Estradiol Fluvoxamine Luvox Norethindrone Tacrine Cognex Zileuton Zy o lsozyme Substrates Inhibitors lnducers Caffeine Olanzapine Zypyrexa R Warfarin Coumadin Cimetidine Tagamet lsoniazid INH Charcoalbroiled meat Clomipramine Anafranil Ondansatron Zofran Zileuton Zy o Cipro oxacin CiprO Mexiletine Mexitil Smoking CYP2C9 CYP2CI9 Celecoxib Celebrex Diclofenac Voltaren Dronabinol Marinol Flurbiprofen Ansaid Fluvastatin Lescol Glimepiride Glipizide Glucotrol Glibenclamide Amitriptyline Elavil Carisoprodol Soma Citalopram Celexa Clomipramine Anafranil Diazepam Valiumquot lmiprarnine T2franil39 ibuprofen Motrin 39 lndomethacin lndocin Losartan Cozaar Monlelukast Singulair Naproxen Naprosyn Phenytoin Dilantin Piroxicam Feldene Tolbutamide Orinase Lansoprazole Prevacid Mephenytoin Pant bprazole Protgnix Olanz39apine Zypyrex39a Omeprazole Prilosec Pentamidine Pentam Torsemide Demadex SWarfarin Coumadin Za rlukast Accolate Phenytoin minor pathway Proguanii Rabeprazole Aciphex RWarfarin Coumadin 39 J C J Cimetidine Tagamet Clopidogrei Plavix Cotrimoxazole Bactrim Disul ram Antabuse Efavirenz Sustiva Fluconazole Diflucan Fluvastatin Lescol Efavirenz Sustiva Felbamate Felbatol Fluconazole Di ucan Fluoxetine Prozacquot Fluvoxamine Luvox r r 39 Luvox lsoniazid INH ltraconazole Sporanox Ketoconazole Nizoral Metronidazole Flagyl Sul npyrazone Anturane Ticlopidine Ticlid Za rlukast Accolate Omeprazole Prilosec Ticlopidine T iclid Aminoglutethimide Cytandren Barbiturates Carbamazepine T egretol Griseofulvin Fulvicin Nafcillin Unipen Phenytoin Diiantin Primidone Mysoline Rifampin Rimactane CYPZDG CYP3A4 Amitriptyline Elavilquot Carvedilol Coreg Clomipramine Anafranil Codeine 9 Morphine Desipramine Norpramin Dexfen uramine Redux Dextromethorphan Dihydrocodeinequot Efavirenz Sustiva Encainide Flecainide Tambocor Alfentanil Alfenta Alprazolam Xanax Amlodipine Norvasc Amiodarone Cordarone Astemizole Atorvastatin Lipitor Bepridil Vascor Bromocriptine Parlodel Buspirone Buspar Carbamazepine l39egretol Cisapride Propulsid Citalopram Celexa Clarithromycin Biaxin Cyclophosphamide Cyciosporine Neoral O Dapsone Delavirdine Rescriptor DexamethasoneO Diazepam Valium Diltiazem Cardizem C9 Disopyramide Norpace Doxorubicin Adriamycin Eiavirenz Sustiva Ergotamine Ergomar Erythromycin EMycin Fluoxetine Prozatl Fluvoxamine Luvox Haloperidol Haldol Hydrocodone39 lmipramine 39l39ofranil v Maprotiline Methamphetamine Metoprolol Lopressor Mexiletine Mexitil Nortriptyline Pamelor Oxycodone Percocet Ethinyl Estradiol Etoposide Vepesid 9 Felodipiqe Plendil FentanleSublimaze Finasteride Proscar Flutarnide Eulexin lfosfamide lfex lndinavir Crixivan Isradipine DynaCirc ltraconazole Sporanox Ketoconazole Nizoral Lidocaine Loratadine Claritin Losartan Cozaar Lovastatin Mevacor Methadone Melhylprednisolone Mibefradil Posicor VMiconazole Monistat Midazolam Versed Nefazodone Serzone Nicardipine Cardene O Nifedipine Adalat O Nimodipine Nimotop Nisoldipine Sular Paroxetine Paxil Perohenazine Trilafon Propafenone Rhythmol Propranolol lnderal Risperidone Risperdal39 Thioridazine Mellaril Timolol Blocadren Tolterodine Detrol Tramadol Ultram Trazodone Desyrel Venlafaxine Effexor Nitrendipine Paclitaxel Taxoi 9 Pimozode Orap Prednisolone Quetiapine Seroquel Quinidine Quinidex Quinine 39 Rifabutin Mycobutin Ritonavir Norvir Saquinavir lnvirase Sertraline Zoloft Sibutramine Meridia Sildenafil Viagra Simvastatin Zocor Sirolimus Rapamune Tacrolimus Prograf O Tamoxifen Nolvadex Terfenadinequot Testosterone Theophylline minor pathway Triazolam Halcion Verapamil Calan O Vinblastine Velban O Vincristine Oncovin G RWarfarin Coumadin Zolpidem Ambien Amiodarone Cordarone Chloroquine Aralen Cimetidine Taga met Diphenhydramine Benadryl Fluoxetine Prozac Haloperidol Haldol Mibefradil Posicor Paroxetine Paxil Perphenazine Trilafon Propafenone Rhythmol ProBO Ehene Darvon Quinacrine Quinidine Quinidex Quinine Ritonavir Norvir Sertraline Zoloft weak Terbina ne Lamisii Thioridazine Mellaril Note CYPZ 06 appears relatively resistant to enzyme induction Clarithromycin Biaxin Cyclosporine Neoral O Danazol Danocrine Delavirdine Rescriptor Diitiazem Cardizem G Erythromycin EJMycin Ethinyl Estradiol Fluconazole Di ucan weak Fluoxetine Prozacy weak Fluvoxamine Luvox Grapefruit juice lndinavir Crixivan lsoniazid INH ltraconazole Sporanox Ketoconazole Nizoral Metronidazole Flagyl Methylprednisolone Mibefradil Posicor Miconazole Monistat Nefazodone Serzone Nel navir Viracept Norethindrone Nor oxacin Nor ox Oxiconazole Oxistat Prednisone Quetiapine Seroquel Quinidine Quinidex Quinine Quinupristindalforpristin Synercid Ritonavir Norvir Saquinavir lnvirase Troleandomycin T A0 Verapamil Calan O Zafirlukast Accolate Zileuton Aminoglutethimide Cytandren Barbiturates carbanxazepine Tegretol Dexamethasone Efavirenz Sustiva Glutethimide Griseofulvin Fulvicin Nevirapine Viramune Phenytoin Dilanlin Primidone Mysoline Rifabutin Mycobutin Rifampin Rimactane Troglitazone Rezulin quot drugs with active metabolites O Substrate for Pglycoprotein Black Cohosh Botany Actaea Cgimicifu ga racem osa A tall perennial shrub native to Eastern USA roots and rhizomes used History USed by Native Americans for women s health problems and a variety of other uses A component of Lydia Pinkha m s elixir In Europe a special black coh osh extract Remifemin has been used since the 19505 for symptoms of menopause and PMS Chemistry Contains phytosterin salicylic acid tannins and triterpine gl39ycosidies that may be important f39o ractivi ty The triterpine glycosides include acetin 27deoxyacetin and cijmicifugoside OH H 3 C C H 33 H30 CH3 Cimicitugal Pharmacology black cohosh seems to have no effect on uterus or hormone lCVGlS ltLiskeet a1 1 Women s Health and Gender Based Med 2002 1 151613174 oMay have central effect on serotonin receptor Doeis not seem to stimulate estrogen receptor dependant tumors in animals or in Vitro tumor cell growth Humans Uses 39reduce symptoms associated with men0pause relieve symptoms of menopause associated with tamoxifen therapy dysmenorrhea shaste n childbirthng Evidence for relief of menopausal symptoms Early studies with Rem39ifemin show support for reducing hot ashes etc in menopause well designed studies indicate bene t However a recent well designed study done here see slide showed no effect but Remifemin was not the product tested Menopause Rating Scale Factor Analysis changes from baseline week 12 Factor 1 hot ushes Factor 2 quotpsyche Factor 3 atrophy MRS items 13 MRS items 4 6 MRS items 7 10 Placebo CR BNO 1055 Con Em Phoebe CR BNO 1055 Con Est Placebo CR BNO 055 Con Eur Xllllllll I m M I00218 looses E g 35 52 g 8 0043139 12 J Means adjusted for baseline and center differences I SEM Wuttke et al Maturitas 200344867877 n62 40mgd for 3 months Bone Turnover Index by BONDI906 AIR Phoshataso I Creams dangs from Malina week 12 Placebo CR BNO 1055 Con Est ramw mu mummmdmmmmmwsm Wuttke cta1 Maturita s200344867877 n62 40migd for months mean di erancas to placebo 3hr 12 weeks Mb 96 C18 CI BNO 1055 Wuttke 615211 Maturitas 200334451 67 S7 7 n62 4ingd 39er months Hot ushes Psyche Soma Atrophy Total MRS score Difference R P Qsmgrs et a1 Obspef Gynecpl 200510510748397 N30 f4 40mg extract for 12 weeks Remifemin Above are resultSin early cyli meitericlwomen Hot flushes Total MRS score Difference R F39 Osmersr39et39al Obstet Gy ecol 2070 5 1074813 N304 40mg extractrfor 12 weeks L Above are results in late climatericlwomen
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