[AF] Pildoras y ginseng

[Maribel Sanfeliu]

CONTRACEPTIVE COMBINATION

·       ¨     DRUG INTERACTIONS

§       §       A) Ginseng

§       1) Interaction Effect: additive estrogenic effects

§       2) Summary: Case reports suggest estrogen-like activity of ginseng 
(Greenspan, 1983a; Punnonen & Lukola, 1980a; Palmer et al, 1978a). The exact 
type of ginseng (i.e. Panax, Siberian, American, etc) was not reported. 
Concomitant use of ginseng with conjugated estrogens may result in symptoms 
of estrogen excess or interference. Avoid concomitant use if possible until 
further information characterizing this interaction is available.

§       3) Severity: moderate

§       4) Onset: delayed

§       5) Substantiation: probable

§       6) Clinical Management: Since estrogenic effects have been noted 
with topical and oral estrogen, either dosage form should be treated with 
the same caution when coadministered with ginseng. If estrogenic symptoms 
such as mastalgia and breakthrough menstrual bleeding occur, decreased the 
ginseng dosage. Because of the apparent estrogen-like effect, avoid ginseng 
in patients with breast cancer, undiagnosed abnormal genital bleeding, 
active thrombophlebitis or thromboembolic disorders, or if the woman is 
pregnant.

§       7) Probable Mechanism: saponin glycoside constituents of ginseng may 
stimulate liver RNA and protein synthesis mimicking the effect of ovarian 
steroids

§       8) Literature Reports

§       a) A 72-year-old woman ingested one tablet daily of a Swiss-Austrian 
geriatric formula which contained 200 mg of ginseng (Geriatric Pharmaton, 
Bernardgass, Austria). This resulted in vaginal bleeding and what was 
described as a "moderate estrogen effect" (Greenspan, 1983).

§       b) A 70-year-old woman experienced swollen tender breasts with 
diffuse nodularity after 3 weeks of "regular" ingestion of ginseng powder. 
The breast symptoms resolved upon discontinuation of the ginseng powder, 
although a time period is not provided. With two subsequent rechallenges, 
the symptoms reappeared. Neither dose nor time period were provided in the 
case report. Serum prolactin levels were measured both during ginseng powder 
use as well as when the patient was not using the powder; these levels were 
reported as normal although exact levels were not provided (Palmer et al, 
1978).

§       c) Five women aged 25 to 40 who had been taking ginseng for varying 
periods reported to their doctor the development of breast symptoms, 
including nipple enlargement, and an increased sexual responsiveness 
(Koriech, 1978).

§       d) A 62-year-old woman (14 years post-menopausal) had a vaginal 
smear exhibiting a strong estrogenic effect with a maturation index of 
0/65/35 (parabasal/intermediate/superficial cells) which was attributed to 
her intake of "Rumanian ginseng in an unspecified dose. The ginseng product 
was analyzed and was shown not to contain any estrogen, nor was the woman 
taking any estrogen product. Within 3 weeks of discontinuing the ginseng 
use, the vaginal smear displayed a maturation index of 9/95/5. Within 2 
weeks of ginseng rechallenge, the vaginal smear maturation index was 
0/90/10. Throughout periods of ginseng use and abstinence, the serum 
concentrations of estrone, estradiol, and estriol remained essentially 
unchanged within the normal range (0.32 nanomoles/liter (nmol/L), 0.03 
nmol/L and less than 0.01 nmol/L, respectively). The authors theorize the 
saponin content of ginseng interacts with estrogen receptor proteins in a 
manner similar to ovarian steroids (Punnonen & Lukola, 1980).



                                            Drugdex Drug Evaluations: 
Ginseng Micromedex®

                                            Healthcare Series. Vol. 143 
expires 3/2010

               Un saludo. Isabel Sanfeliu
                  CIM. MICOF Valencia

                  

----- Original Message -----
From: "Pedro del Río Pérez"
To: "Lista de correo de Atención Farmacéutica"
Sent: Thursday, March 25, 2010 10:05 AM
Subject: Re: [AF] Pildoras y ginseng