Congestive Heart Failure

Guarana is recommended as a cardiac stimulant.  The primary active ingredient is caffeine, which of course would stimulate the heart.  This is potentially dangerous (as any high level of caffeine intake would be).  The use of guarana is not recommended.

Broom (hogweed, bannal)

Touted Uses -- arrhythmias, cathartic, diuretic, emetic, to promote relaxation and euphoria

Source -- Cytisus scoparius Link (Sarothamnus scoparius L.), a 3-5 feet high plant with straight branches and alternate, oblate leaves.  Active plant parts include twigs, flowers, and ærial portions.

Chemical Constituents

Alkaloids -- Sparteine
Flavone glycosides -- scoparoside, spiræoside, genitoside
Others -- isoquercetin, kæmpferol, lectins (phytohæmagglutinins)

Mechanism(s) of action (in vitro studies) -- Blocks sodium and potassium channels

Pharmacodynamic effects -- animal studies

Negative inotropy and chronotropy
Uterine contractile effects
diuresis (scoparoside)

Human Clinical Trials -- NONE PERFORMED

Dose recommended -- 1 to 1.5 G of active drug in aqueous or ehtanolic extracts once daily

Side Effects -- Arrhythmias, Headache, Spontaneous abortion, Fungal pneumonia (from smoking contaminated broom top cigarettes)

Overdose Toxicity (broom constituents are metabolised by CYP 2D6 pathway -- inhibitors will increase the toxicity of broom) -- Shock, Tachycardia, Behavioural changes, Vertigo, Nausea, Diarrhœa

Contraindications -- Pregnancy, Hypertension, Congestive Heart Failure, Pacemaker implants

Drug Interactions

Antihypertensives (may increase or decrease their effects)
Beta adrenergic and calcium channel antagonists (additive negative inotropy)
TCAs (additive arrhythmogenic actions)
MAOIs (hypertensive crisis)

Clinical Considerations -- Observe for drug interactions

Analysis -- Sparteine and other constituents may prove to be useful models for future anti-arrhythmics.  However, the lack of scientific and clinical data, coupled with the known severe toxicity profile, strongly discourage its recommendation.  Although the German Commission E has approved broom for functional heart and circulatory disorders, the FDA considers it a herb unsafe for use.

Motherwort -- this herb contains cardenolides that have been suggested as anti-arrhythmics.  There is no research to indicate benefit.

Garlic

Touted Uses

Currently, hyperlipidæmia and hypertenstion -- less promoted for AIDS, asthma, diabetes, inflammation, heavy metal poisoning, constipation, athlete's foot

Historically, blood disorders, promote wound healing, treat infections, ward off evil spirits

Source -- Allium sativum L. -- a member of the monocotyledenous lily family (lilies and onion)

Chemical Constituents

Alliin -- this component is converted via the enzyme alliinase to allicin.  Allicin is thought to be responsible for the majority of garlic's beneficial effects.  It also imparts the characteristic odour of garlic.

Ajoene is another metabolic product that also possesses pharmacologic activity.

Other constituents -- methylallyltrisulphide, Vitamins A, B, and C, trace minerals

Mechanisms of Action -- Not Known

Pharmacodynamic Effects -- Garlic has been shown to

decrease total cholesterol, triglycerides, LDL and to increase HDL (animals and humans)

decrease blood pressure (animal and human -- significant reductions in diastolic pressure, no significant changes in systolic pressure)

possess anti-infective activity (in vivo and in vitro)

inhibit platelet aggregation (methylallyltrisulphide and ajoene)

anti-carcinogenic activity (mice)

decrease GI motility (rodents)

Human Clinical Trials -- Garlic has been tested in human subjects with the following results

Lower total cholesterol, no better than the HMG-CoA reductase inhibitors (mortality and morbidity tests have not been performed)

Lowered diastolic, but not systolic, blood pressure

Reduce morbidity in AIDS patients (very preliminary and few patients)

Dose -- Antihyperlipidæmic -- 600-900 mg daily (4 G fresh garlic, 8 mg garlic oil)

Side Effects -- Contact Dermatitis, Diaphoresis, Dizziness, Garlic odour, Hypothyroidism, Irritation of mouth, œsophagus, stomach; Nausea and vomiting

Contraindications -- Hypersensitivity, Peptic ulcer disease, GERD, Pregnancy

Drug Interactions -- Anti-coagulants and anti-platelet drugs -- additive effects

Clinical Considerations

Monitor for side effects and drug interactions
Obtain baseline and periodic lipid profiles
"Odourless" garlic is probably not effective

Analysis -- Scientific and clinical evidence supports some therapeutic benefits from garlic in lowering lipids and blood pressure and reasonable doses.  Other reported effects only occur at potentially dangerous doses or have no basis for efficacy.