Topic: Complementary &

Alternate Medicine
Module: NS-I
Theme 2

Dr. Tanya Waseem

(Ph.D. Scholar, M.Phil., Pharm.D.)
Lecturer
Shifa College of Pharmaceutical Sciences
 Learning Objectives
By the end of this lecture, learners would be able to:
• Discuss the complementary and alternative medicine
therapies that can modulate the ANS effects or activity of
the drugs acting on ANS.
• Discuss the interactions of ANS-related drugs with
complementary and alternative medicine (CAM).
• List the natural sources from which the drugs acting on
ANS can be obtained.

2
 What is CAM?
• A working definition of complementary medicine is:
“Diagnosis, treatment and/or prevention, which complements
mainstream medicine by contributing to a common whole, by
satisfying a demand not met by orthodoxy or by diversifying the
conceptual framework of medicine” (Ernst 2004)”.
• Alternative medicine is an older term used to contrast this
approach with conventional medicine.
• As it is difficult to distinguish the two meaningfully, it is usual to
put them together as complementary and alternative medicine or
CAM.
Difference between Complementary and Alternative
Medicine
Complementary Medicine Alternative Medicine

Used together with conventional In place of conventional medicine

medicine

Also called allopathy, western, Generally incorporates a holistic

mainstream, orthodox, biomedicine approach, focus on treating whole body
and mind

Refers to using a non-mainstream Refers to using a non-mainstream

approach in addition to conventional approach instead of conventional
medicine medicine

When CAM therapies are used in CAM therapies when used alone
combination with other referred as alternative therapies
conventional therapies referred as
complementary therapies
CAM Cholinergic Agonist & Antagonist
CAM THERAPIES
1) Deadly nightshade
2) Duboisia leaves
3) Scopolia
4) Mandrake
5) Jaborandi leaf
6) Calabar beans
7) Stramonium leaf
8) Henbane
1. DEADLY NIGHTSHADE
CAM THERAPIES
Biological source: Atropa belladonna
Family: Solanaceae
Part used: dried leaves
Chemical constituents: Hyoscyamine, Atropine, scopolamine
Clinical uses: Scopolamine reduce bodily discharge, helpful in reducing
stomach acids, controlling heart rate and relaxing muscles. Atropine also have same uses
but not as effective as scopolamine. Atropine is used to dilate the eyes. Belladonna leaves
are mainly used for internal preparations which are used as sedatives and to check
secretion. Preparations of the root are mainly used externally.
Dose: Herb 50 mg, Root 30 mg TDS
 CAM THERAPIES
Adverse effects: Belladonna is likely unsafe. It contains chemicals that can be poisonous even at
low doses. Serious side effects might include blurred vision, fever, fast heartbeat, inability to
urinate or sweat, hallucinations, spasms, mental problems, convulsions, coma, and others.
Moderate Interaction Be cautious with this combination
Drying medications (Anticholinergic drugs) interacts with BELLADONNA Belladonna can block a
chemical in the body called acetylcholine, which has many important functions. Some
medications, called anticholinergic drugs, also block acetylcholine. There is some concern that
taking them together might increase the risk for confusion, blurred vision, increased sweating,
and increased heart rate.
Cisapride (Propulsid) interacts with BELLADONNA Atropine can reduce the effects of cisapride.
Taking belladonna with cisapride might reduce the effects of cisapride.
 CAM THERAPIES
2. CORKWOOD TREE
Biological source: Duboisia hopwoodii, Duboisia leichhardtii,
Duboisia myoporoides
Family: Solanaceae Part used: Leaves
Chemical constituents: Nicotine, hyoscine (scopolamine) and hyoscyamine
Clinical uses: The chemicals in corkwood tree can affect the CNS & cause serious side
effects. The cured and rolled leaves (quid’s) are sometimes chewed. People use corkwood
tree quid's for hunger, pain, tiredness, and other conditions, but there is no good scientific
evidence to support these uses. It might also be unsafe.
 CAM THERAPIES
Dose: There are no recent clinical studies of corkwood to provide a basis for dosing
recommendations. Corkwood should be used with caution because of its high
anticholinergic alkaloid content.
Adverse effects: Even small doses may cause CNS disturbances; corkwood leaves have
demonstrated CNS stimulant and hallucinogenic properties.
Moderate Interaction: Be cautious with this combination
Drying medications (Anticholinergic drugs) interacts with CORKWOOD TREE
Corkwood tree can block a chemical in the body called acetylcholine, which
has many important functions. There is some concern that taking them together might
increase the risk for confusion, blurred vision, decreased sweating, and increased HR.
 CAM THERAPIES
3. SCOPOLIA
Biological source: Scopolia carniolica , S. caucasia, S. lurida and S. tangutica
Family: Solanaceae Part used: Leaves
Chemical constituents: Hyoscyamine and hyoscine , pseudo-tropine, tropine.
Clinical uses: GIT, bronchial, Genitourinary, Ophthalmic, CNS Activity, Anxiety, trouble sleeping.
Dose: Consult your pharmacist or physician before using.
Adverse effects: Early symptoms of scopolia poisoning include reddened skin and dry mouth.
Other symptoms include high body temperature, vision problems, difficulty urinating,
and constipation.
Taking large amounts of scopolia can cause restlessness, compulsive speech, and hallucinations,
followed by breathing problems and death.
 CAM THERAPIES
Major Interaction: Do not take this combination
Drying medications (Anticholinergic drugs) interacts with SCOPOLIA
● Taking scopolia and drying medications together might cause side effects including dry skin,
dizziness, low blood pressure, fast heartbeat, and other serious side effects.
● Some of these drying medications include atropine, scopolamine, and some medications used
for allergies (antihistamines), and for depression (antidepressants).
Medications for depression (Tricyclic Antidepressants) interacts with SCOPOLIA
● Taking scopolia might increase the side effects of some medications used for depression.
● Some of these medicines used for depression include amitriptyline (Elavil), imipramine
(Tofranil), and others.
Quinidine interacts with SCOPOLIA Taking quinidine along with scopolia might cause serious heart
problems.
4. MANDRAKE
CAM THERAPIES
Biological source: Mandragora officinalis
Family: Solanaceae
Part used: Leaves and Roots
Chemical constituents: Scopolamine
Clinical uses: Preoperative sedative and analgesic, hallucinogenic preparations
Dose: Consult your pharmacist or physician or other healthcare professional before using.
Adverse effects: It can cause many side effects, including confusion, drowsiness, dry
mouth, heart problems, vision problems, overheating, problems with urination, and
hallucinations. Large doses can be fatal.
 CAM THERAPIES
Drug interactions: Be cautious with this combination
Drying medications (Anticholinergic drugs) interacts with EUROPEAN MANDRAKE
● Taking European mandrake and drying medications together might cause side effects including dry
skin, dizziness, low blood pressure, fast heartbeat, and other serious side effects.
● Some of these drying medications include atropine, scopolamine, and some medications used for
allergies (antihistamines), and for depression (antidepressants).
Medications taken by mouth (Oral drugs) interacts with EUROPEAN MANDRAKE
● European mandrake seems to slow down the bowels.
● Taking European mandrake along with medications taken by mouth might increase how much
medicine your body absorbs.
● Increasing how much medicine your body absorbs can increase the effects and side effects of your
medicines.
 CAM THERAPIES
5. JABORANDI LEAF
Biological source: Pilocarcus jaborandi spp. / Pilocarpus microphyllus
Family: Rutaceae Part used: Leaves
Chemical constituents: Pilocarpine, iso-pilocarpine, pilosine and iso-pilosine
Clinical uses: Ophthalmic practice, antagonistic to that of atropine, glaucoma
Treatment. A study in the USA involving 207 patients suffering from dry mouth resulting
from radiation treatment for head or neck cancer indicated that oral pilocarpine can
possibly offer relief.
Dose: As dried root with herb, 3 to 4 g as a decoction or 4 to 10 g as an infusion up to 3
times a day, dry extract, up to 600 mg a day.
 CAM THERAPIES
Precautions:
● Jaborandi should not be taken during pregnancy or while breastfeeding.
● Both jaborandi and pilocarpine may cause headaches and can irritate the
stomach and cause vomiting and nausea.
● An overdose may cause such symptoms as flushing, profuse sweating and
salivation, urinary frequency nausea, rapid pulse, contracted pupils, diarrhea or
fatal pulmonary edema.
● The plant may induce bradycardia.
● Those with cardiac or circulatory conditions should not take jaborandi.
 CAM THERAPIES
6. CALABAR BEANS
Biological source: Physostigma venenosum
Family: Leguminosae
Part used: dried ripe seeds
Chemical constituents: Calabar beans contain a parasympathomimetic alkaloid, which is a
reversible cholinesterase inhibitor known as Physostigmine or eserine, eseramine,
isophysostigmine, physovenine, geneserine, N-8-norphysostigmine, calabatine and calabacine.
Clinical uses: Calabar bean contains a chemical that affects signals between muscles and nerves.
This chemical affects many parts of the body. It is antidote to atropine and It may also treat eye
problems, Alzheimer’s disease, cholera, tetanus infection, epilepsy and constipation. It has also
been investigated as an intravenous injection for reversing the effects of a number of sedatives.
 CAM THERAPIES
Dose:
● Keep in mind that natural products are not always necessarily safe and dosages can be
important.
● Be sure to follow relevant directions on product labels and consult your pharmacist or
physician or other healthcare professional before using.
Minor Interaction: Be watchful with this combination
Drying medications (Anticholinergic drugs) interacts with CALABAR BEAN
Calabar bean can increase a chemical in the body called acetylcholine. Some medications,
called anticholinergic drugs, block the effects of acetylcholine in the body.
Taking calabar bean might decrease the effects of anticholinergic drugs.
 CAM THERAPIES
7. STRAMONIUM LEAF
Biological source: Datura stramonium L
Family: Solanaceae
Part used: Leaves
Chemical constituents: All the parts of Datura contain dangerous levels of
poison like tropane alkaloids atropine, hyoscyamine, scopolamine, which are considered
deliriants or anticholinergics.
Clinical uses: Atropine has a stimulant action on the central nervous system and depresses
the nerve endings to the secretory glands and plain muscle.
● Hyoscine lacks the central stimulant action of atropine; its sedative properties enable it
to be used in the control of motion sickness.
 CAM THERAPIES
● Hyoscine hydrobromide is employed in preoperative medication, usually with papaveretum,
some 30–60 min before the induction of anesthesia.
● Atropine and hyoscine are used to a large extent in ophthalmic practice to dilate the pupil of
the eye
Dose: 60mg to 125mg
Moderate Interaction
Drying medications (Anticholinergic drugs) interacts with JIMSON WEED
Jimson weed can block a chemical in the body called acetylcholine, which has many important
functions. Anticholinergic drugs, also block acetylcholine. There is some concern that taking them
together might increase the risk for confusion, blurred vision, decreased sweating, and increased
heart rate.
 CAM THERAPIES
8. HENBANE
Biological source: Hyoscyamus niger
Family: Solanaceae Part used: Leaves
Chemical constituents: Hyoscyamine and hyoscine
Clinical uses: The higher relative proportion of hyoscine in the alkaloid mixture
makes it less likely to give rise to cerebral excitement than does belladonna. Often
used to relieve spasm of the urinary tract and with strong purgatives to prevent
griping.
Dose: Consult your pharmacist or physician before using.
 CAM THERAPIES
Major Interaction
Do not take this combination
Drying medications (Anticholinergic drugs) interacts with HENBANE
● Henbane contains chemicals that cause a drying effect. It also affects the brain and
heart. Anticholinergic drugs can also cause these effects.
● Taking henbane and drying medications together might cause side effects including
dry skin, dizziness, low blood pressure, fast heartbeat, and other serious side
effects.
● Some of these drying medications include atropine, scopolamine, and some
medications used for allergies (antihistamines), and for depression.
CAM Adrenergic Agonist & Antagonist
CAM THERAPIES
1) Coca leaf
2) Nut meg
3) Khat or Abyssinian tea
4) Ephedra
5) Rauwolfia
1. COCA LEAF
CAM THERAPIES
Biological source: Erythroxylum coca Lam, E. novogranatense
Family: Erythroxylaceae
Part used: Leaves
Chemical constituents: cocaine, cinnamyl-cocaine and α-truxilline
Clinical uses: Cocaine and its salts were the earliest of the modern local anesthetics but, because
of their toxic and addictive properties, their use is now almost entirely confined to ophthalmic,
ear, nose and throat surgery.
Dose: The appropriate dose of coca depends on several factors such as the user's age, health,
and several other conditions. Not enough scientific information to determine an appropriate
range of doses for coca. Keep in mind that natural products are not always necessarily safe and
dosages can be important.
 CAM THERAPIES
Major Interaction
Alcohol (Ethanol) interacts with COCA
Coca contains cocaine. Cocaine can affect your thinking. Alcohol can also affect
your thinking. Taking cocaine and alcohol together can cause serious effects on
thinking.
Nifedipine (Procardia) interacts with COCA
Coca contains cocaine. Taking cocaine with nifedipine increases the risk of serious

side effects such as seizure.

 CAM THERAPIES
Moderate Interaction:
Medications for diabetes (Antidiabetes drugs) interacts with COCA
Coca might increase blood sugar levels. Taking coca along with diabetes
medications might reduce the effects of these medications. Monitor your blood

sugar closely.
Medications for high blood pressure (Antihypertensive drugs) interacts with
COCA
Coca might increase blood pressure. king coca might reduce the effects of blood
pressure medications. Monitor your blood pressure closely.
 CAM THERAPIES
2. NUT MEG
Biological source: Myristica fragrans
Family: Myristicaceae Part used: Seeds
Chemical constituents: phytosterin, starch, amylodextrin,
Clinical uses: Nutmeg contains chemicals that might affect the CNS. Nutmeg might also
kill bacteria and fungi.
Dose: Nutmeg is a spice that is commonly used in foods. As medicine, there isn't enough
reliable information to know what an appropriate dose of nutmeg might be. Keep in mind
that natural products are not always necessarily safe and dosages can be important.
 CAM THERAPIES
Drug interactions:
Moderate Interaction
Be cautious with this combination
Medications changed by the liver (Cytochrome P450 1A1 (CYP1A1),
Cytochrome P450 1A2 (CYP1A2), Cytochrome P450 2B1 (CYP2B1) substrates)
interacts with NUTMEG AND MACE
Some medications are changed and broken down by the liver. Nutmeg might change how
quickly the liver breaks down these medications. This could change the effects and side
effects of these medications.
 CAM THERAPIES
3. KHAT OR ABYSSINIAN TEA
Biological source: Catha edulis Forsk
Family: Celastraceae Part used: Fresh leaves
Chemical constituents: khatamine , norpseudoephedrine, phenylpropane,
(-)-α-aminopropiophenone (cathinone) ,Cathinone has pharmacological properties
Analogous to those of (+)-amphetamine
Clinical uses: The leaves and stem have been traditionally chewed by people in East
African countries as a recreational drug to elevate mood (as a euphoriant).
As a medicine, khat leaf is used for diabetes, muscle strength, to lower the need for
food and sleep, and to increase aggression.
 CAM THERAPIES
Dose: The appropriate dose of khat depends on several factors such as the user's
age, health, and several other conditions. Keep in mind that natural products are
not always necessarily safe and dosages can be important. Follow directions on
product labels and consult your pharmacist or physician.
Major Interaction
Ampicillin interacts with KHAT
Khat might reduce how much ampicillin the body absorbs. This might decrease
how well ampicillin works. Separate dose times by at least 2 hours.
 CAM THERAPIES
Moderate Interaction
● Medications for high blood pressure (Antihypertensive drugs) interacts with
KHAT
● Stimulant drugs interacts with KHAT
Medications for mental conditions (Antipsychotic drugs) interacts with KHAT
Khat may reduce the effects of antipsychotic drugs.
Warfarin (Coumadin) interacts with KHAT
Warfarin is a blood thinner. Chewing khat might decrease the effects of warfarin.
This might increase the risk for clotting.
 CAM THERAPIES
4. EPHEDRA
Biological source: Ephedra sinica, E. intermedia, E. equisetina
Family: Ephedraceae Part used: Stems
Chemical constituents: Two alkaloids ephedrine and pseudoephedrine.
Clinical uses: The ephedrine in ephedra is responsible for its therapeutic effects and
also its serious safety concerns.
● It stimulates the heart, lungs, and nervous system.
● People use ephedra for weight loss and athletic performance.
● It's also used for allergies, nasal congestion, asthma, common cold, headache, and
many other conditions.
 CAM THERAPIES
Dose: Current guidelines suggest limiting dosage of ephedrine to less than
90 mg/day

Drug interactions:
Interactions are likely to be similar to those established for synthetic ephedrine
and include monoamine oxidase inhibitors (MAOIs), the anesthetic propofol,
cholinergic agents such as tricyclic antidepressants, caffeine, theophylline, and
steroids such as dexamethasone.
 CAM THERAPIES
5. RAUVOLFIA
Biological source: Rauvolfia serpentina
Family: Apocynaceae Part used: Dried rhizome and roots
Chemical constituents: reserpine , ajmaline (rauwolfine), ajmalinine,
ajmalicine, serpentine and serpentinine
Clinical uses:
● Rauwolfia preparations and reserpine are used in the management of essential
hypertension and in certain neuropsychiatric disorders.
● Ajmaline, which has pharmacological properties similar to those of quinidine, is
marketed in Japan for the treatment of cardiac arrhythmias.
 CAM THERAPIES
Dose: There isn't enough reliable information to know what an appropriate dose of
Rauvolfia vomitoria might be. Consult a healthcare professional before using.
Major Interaction
Levodopa interacts with RAUVOLFIA VOMITORIA
Levodopa is used for Parkinson disease. Taking Rauvolfia vomitoria along with levodopa
might decrease the effects of levodopa and worsen symptoms of Parkinson disease.
Medications for depression (MAOIs) interacts with RAUVOLFIA
VOMITORIA
Rauvolfia vomitoria contains a chemical that affects the body. This chemical might increase
the side effects of some medications used for depression such as MAO inhibitors.
 CAM THERAPIES
Medications for mental conditions (Antipsychotic drugs) interacts with RAUVOLFIA
VOMITORIA
● It has same effects as medications for mental conditions. Taking Rauvolfia along with
these medications might increase the risk of side effects from these medications.
Stimulant drugs interacts with RAUVOLFIA VOMITORIA
● Stimulant drugs speed up the nervous system. By speeding up the nervous system,
stimulant medications can make you feel jittery and speed up your heartbeat.
● Rauvolfia vomitoria might also speed up the nervous system. Taking Rauvolfia along
with stimulant drugs might cause serious problems including increased heart rate and
high blood pressure. Avoid taking stimulant drugs along with Rauvolfia.
 CAM THERAPIES
Moderate Interaction
Ephedrine interacts with RAUVOLFIA VOMITORIA
● Ephedrine can speed up the nervous system and make you feel jittery.
● Rauvolfia vomitoria might speed up or slow down the nervous system.
● Taking Rauvolfia vomitoria along with ephedrine might increase or decrease the effects
of ephedrine.
Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates) interacts
with RAUVOLFIA VOMITORIA
Some medications are changed and broken down by the liver. Rauvolfia vomitoria
might change how quickly the liver breaks down these medications. This could change the
effects and side effects of these medications.
 CAM THERAPIES
Medications for diabetes (Antidiabetes drugs) interacts with RAUVOLFIA VOMITORIA
● Rauvolfia vomitoria might lower blood sugar levels. Taking Rauvolfia vomitoria along with
diabetes medications might cause blood sugar to drop too low. Monitor your blood sugar
closely.
Medications for high blood pressure (Antihypertensive drugs) interacts with RAUVOLFIA
● It might lower blood pressure. Taking it along with medications that lower blood pressure
might cause blood pressure to go too low. Monitor your blood pressure closely.
Moderate Interaction: Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
● Rauvolfia vomitoria might slow blood clotting. Taking Rauvolfia vomitoria along with
medications that also slow blood clotting might increase the risk of bruising and bleeding.
 CAM THERAPIES
Medications for depression (Tricyclic Antidepressants) interacts with RAUVOLFIA
● Taking some medications used for depression might alter the effects of
Rauvolfia vomitoria and increase the risk for side effects.
Sedative medications (CNS depressants) interacts with RAUVOLFIA VOMITORIA
● Rauvolfia vomitoria might cause sleepiness and slowed breathing. Some
medications, called sedatives, can also cause sleepiness and slowed breathing.
● Taking Rauvolfia vomitoria with sedative medications might cause breathing
problems and/or too much sleepiness.
 References

 Trease and Evans' Pharmacognosy 16th Edition

 Essentials of Medical Pharmacology 8th ed.

Edition by KD Tripathi

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