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Herbs for increasing breast-milk production

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Abstract

Subjective perception of insufficient milk supply is one of the most common problems of nursing mothers. For centuries, herbs have been used to increase lactation and remain popular even today. There is only a limited number of studies proving their safety and effectivity, so their use is based primarily on previous experience. The use of certain herbs has shown that they could be effective and safe, but further research is needed to define terms of use. This paper describes preliminary findings on the mechanism of action, adverse effects and possible interactions observed in some herbs frequently used to promote lactation.Key words: phytotherapy lactation herbal galactagogue.

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Background: Many women express concern about their ability to produce enough milk, and insufficient milk is frequently cited as the reason for supplementation and early termination of breastfeeding. When addressing this concern, it is important first to consider the influence of maternal and neonatal health, infant suck, proper latch, and feeding frequency on milk production, and that steps be taken to correct or compensate for any contributing issues. Oral galactagogues are substances that stimulate milk production. They may be pharmacological or non-pharmacological (natural). Natural galactagogues are usually botanical or other food agents. The choice between pharmacological or natural galactagogues is often influenced by familiarity and local customs. Evidence for the possible benefits and harms of galactagogues is important for making an informed decision on their use. Objectives: To assess the effect of oral galactagogues for increasing milk production in non-hospitalised breastfeeding mother-term infant pairs. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Health Research and Development Network - Phillippines (HERDIN), Natural Products Alert (Napralert), the personal reference collection of author LM, and reference lists of retrieved studies (4 November 2019). Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs (including published abstracts) comparing oral galactagogues with placebo, no treatment, or another oral galactagogue in mothers breastfeeding healthy term infants. We also included cluster-randomised trials but excluded cross-over trials. Data collection and analysis: We used standard Cochrane Pregnancy and Childbirth methods for data collection and analysis. Two to four review authors independently selected the studies, assessed the risk of bias, extracted data for analysis and checked accuracy. Where necessary, we contacted the study authors for clarification. Main results: Forty-one RCTs involving 3005 mothers and 3006 infants from at least 17 countries met the inclusion criteria. Studies were conducted either in hospitals immediately postpartum or in the community. There was considerable variation in mothers, particularly in parity and whether or not they had lactation insufficiency. Infants' ages at commencement of the studies ranged from newborn to 6 months. The overall certainty of evidence was low to very low because of high risk of biases (mainly due to lack of blinding), substantial clinical and statistical heterogeneity, and imprecision of measurements. Pharmacological galactagogues Nine studies compared a pharmacological galactagogue (domperidone, metoclopramide, sulpiride, thyrotropin-releasing hormone) with placebo or no treatment. The primary outcome of proportion of mothers who continued breastfeeding at 3, 4 and 6 months was not reported. Only one study (metoclopramide) reported on the outcome of infant weight, finding little or no difference (mean difference (MD) 23.0 grams, 95% confidence interval (CI) -47.71 to 93.71; 1 study, 20 participants; low-certainty evidence). Three studies (metoclopramide, domperidone, sulpiride) reported on milk volume, finding pharmacological galactagogues may increase milk volume (MD 63.82 mL, 95% CI 25.91 to 101.72; I² = 34%; 3 studies, 151 participants; low-certainty evidence). Subgroup analysis indicates there may be increased milk volume with each drug, but with varying CIs. There was limited reporting of adverse effects, none of which could be meta-analysed. Where reported, they were limited to minor complaints, such as tiredness, nausea, headache and dry mouth (very low-certainty evidence). No adverse effects were reported for infants. Natural galactagogues Twenty-seven studies compared natural oral galactagogues (banana flower, fennel, fenugreek, ginger, ixbut, levant cotton, moringa, palm dates, pork knuckle, shatavari, silymarin, torbangun leaves or other natural mixtures) with placebo or no treatment. One study (Mother's Milk Tea) reported breastfeeding rates at six months with a concluding statement of "no significant difference" (no data and no measure of significance provided, 60 participants, very low-certainty evidence). Three studies (fennel, fenugreek, moringa, mixed botanical tea) reported infant weight but could not be meta-analysed due to substantial clinical and statistical heterogeneity (I2 = 60%, 275 participants, very low-certainty evidence). Subgroup analysis shows we are very uncertain whether fennel or fenugreek improves infant weight, whereas moringa and mixed botanical tea may increase infant weight compared to placebo. Thirteen studies (Bu Xue Sheng Ru, Chanbao, Cui Ru, banana flower, fenugreek, ginger, moringa, fenugreek, ginger and turmeric mix, ixbut, mixed botanical tea, Sheng Ru He Ji, silymarin, Xian Tong Ru, palm dates; 962 participants) reported on milk volume, but meta-analysis was not possible due to substantial heterogeneity (I2 = 99%). The subgroup analysis for each intervention suggested either benefit or little or no difference (very low-certainty evidence). There was limited reporting of adverse effects, none of which could be meta-analysed. Where reported, they were limited to minor complaints such as mothers with urine that smelled like maple syrup and urticaria in infants (very low-certainty evidence). Galactagogue versus galactagogue Eight studies (Chanbao; Bue Xue Sheng Ru, domperidone, moringa, fenugreek, palm dates, torbangun, moloco, Mu Er Wu You, Kun Yuan Tong Ru) compared one oral galactagogue with another. We were unable to perform meta-analysis because there was only one small study for each match-up, so we do not know if one galactagogue is better than another for any outcome. Authors' conclusions: Due to extremely limited, very low certainty evidence, we do not know whether galactagogues have any effect on proportion of mothers who continued breastfeeding at 3, 4 and 6 months. There is low-certainty evidence that pharmacological galactagogues may increase milk volume. There is some evidence from subgroup analyses that natural galactagogues may benefit infant weight and milk volume in mothers with healthy, term infants, but due to substantial heterogeneity of the studies, imprecision of measurements and incomplete reporting, we are very uncertain about the magnitude of the effect. We are also uncertain if one galactagogue performs better than another. With limited data on adverse effects, we are uncertain if there are any concerning adverse effects with any particular galactagogue; those reported were minor complaints. High-quality RCTs on the efficacy and safety of galactagogues are urgently needed. A set of core outcomes to standardise infant weight and milk volume measurement is also needed, as well as a strong basis for the dose and dosage form used.
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An increase in the marketing and use of herbal galactagogues among breastfeeding mothers in the US has raised the issue of how best to provide support and information on the use of these products, particularly in light of limited availability of certified lactation counselors and continued suboptimal rates of breastfeeding globally. Currently, no cross-sectional data are available on the experiences and attitudes of mothers regarding the use of herbal and pharmaceutical galactagogues for lactation in the US. The findings of an online survey of 188 breastfeeding mothers on experiences with and sources of information on galactagogues are presented. Most mothers (76%) reported that while breastfeeding, they felt as though they were not making enough milk to meet the needs of their child, and yet 54% also indicated that they had not supplemented with formula. A large proportion of respondents reported utilizing galactagogues to increase lactation and finding them useful. The results indicated that most women learned about galactagogues from the Internet or by word of mouth through friends. Lactation consultants were the third-most reported sources of information on these products. While many respondents reported perceiving galactagogues as innocuous, more evidence on safety and efficacy is needed to support women properly who seek out and use them. Large-scale studies of the prevalence of galactagogue use in the US and rigorous evaluation of use globally are needed to ensure that mothers who choose to breastfeed may safely avail themselves of all options when counseling support is insufficient.
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Background: Therapeutic approaches to addressing insufficient lactation are available but remain poorly understood. Current trends in maternal health, such as increasing rates of obesity, delayed age at childbearing, and high rates of cesarean section, may be associated with physiological challenges for lactation that cannot be managed by counseling alone. Women who have not had success with counseling alone, including adoptive mothers seeking to induce lactation, may use galactagogues (pharmaceutical and herbal compounds used to increase lactation). We present a review of selected studies of galactagogues and data indicating popular demand for such products. Methods: A systematic search was conducted for published studies on the use of galactagogues for breast-feeding. The following databases were searched: MEDLINE (PubMed), EBSCO (Academic Search Complete), and EMBASE. The search was conducted between July 15, 2015, and August 18, 2015; only English language articles were included, and we imposed no restrictions on publication date. Two authors independently reviewed the studies and extracted data. Results: Blinded, placebo-controlled clinical trials of 2 pharmaceutical galactagogues (domperidone and metoclopramide) and 5 popular herbal galactagogues (shatavari, fenugreek, silymarin, garlic, and malunggay) were identified. All of the studies identified for domperidone showed a significant difference in milk production between the treatment and placebo groups. Of the 6 trials of metoclopramide, only 1 study showed a significant difference in milk production compared to placebo. Results of the clinical trials on herbal galactagogues were mixed. Our review of the evidence for the efficacy of popular pharmaceutical and herbal galactagogues revealed a dearth of high-quality clinical trials and mixed results. Conclusion: Health providers face the challenge of prescribing or recommending galactagogues without the benefit of robust evidence. Given the suboptimal rates of exclusive breast-feeding worldwide and the availability and demand for medical and herbal lactation therapies, controlled trials and analyses investigating these medicines are urgently warranted.
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Aim . There is evidence that Anethum graveolens (AG) has been used for centuries in Asian traditional medicine, and its constituents have useful effects on the control and management of diabetes and cardiovascular disorders. AG has many useful effects, including hypolipidemic and hypoglycemic effects, and it has been reported to reduce the incidence of diabetic complications. It acts mainly by affecting antioxidant capacity and change in some genes in glucose and lipid pathways. The aim of the present paper was to summarize pharmacological effects of AG in the management of diabetes. Methods . To prepare this review, a pharmacological and phytochemical literature survey was performed using Scopus, PubMed, and Web of Science. Also, some historical and ethnopharmacological literature sources were used. Results . This review plans to provide readers with an assessment of the pharmacological effects of AG, especially in diabetes. Conclusion . The paper highlights the therapeutic effects of AG which would aid in supporting their safe use in the management of diabetes and cardiovascular diseases.
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One concept used in traditional Persian medicine (TPM) for multidrug therapy is that of the convoy drug (Mobadregh). According to TPM texts, convoy drugs are substances (or drugs), which facilitate the access of drugs or foods to the whole body or to specific organs. This study reviewed some convoy drugs presented in TPM, their biological effects, and their probable interactions with main drugs, considering the increased absorption through inhibition of P-glycoprotein (P-gp) efflux function, bioavailability-enhancing effects, and decreased metabolism of the main drug using electronic databases including PubMed, Scopus, ScienceDirect, and Google Scholar in November and December, 2013. Recent studies have proven the beneficial effects of Crocus sativus L. (saffron) and camphor on the heart and brain, the cerebral therapeutic effects of Asarum europaeum (hazelwort), the hepatoprotective effects of Cichorium intybus (chicory), and Apium graveolens (celery) seeds, and the diuretic effects of Cinnamomum zeylanicum (cinnamon), and Cucumis melo (melon) seeds. The effects of vinegar in targeting the liver and brain have also been demonstrated. An evaluation of the results demonstrated that the suggested convoy drugs, including Piper nigrum (black pepper), Piper longum (long pepper), red wine, Camellia sinensis (tea), hazelwort, Mentha longifolia (pennyroyal), Anethum graveolens (dill), Foeniculum vulgare (fennel), cinnamon, and Sassafras albidum (sassafras) can increase the bioavailability of coadministered drugs by inhibition of P-gp or cytochrome P450s (CYP450s) or both of them. This evidence could be a good basis for the use of these agents as convoys in TPM.
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Pimpinella anisum (anise) , belonging to Umbelliferae family, is an aromatic plant which has been used In Iranian traditional medicine (especially its fruits) as carminative, aromatic, disinfectant, and galactagogue. Because the wide traditional usage of Pimpinella anisum for treatment of diseases, in this review published scientific reports about the composition and pharmacological properties of this plant were collected with electronic literature search of GoogleScholar, PubMed, Sciencedirect, Scopus, and SID from 1970 to 2011. So far, different studies were performed on aniseeds and various properties such as antimicrobial, antifungal, antiviral, antioxidant, muscle relaxant, analgesic and anticonvulsant activity as well as different effects on gastrointestinal system have been reported of aniseeds. It can also reduce morphine dependence and has beneficial effects on dysmenorrhea and menopausal hot flashes in women. In diabetic patients, aniseeds showed hypoglycemic and hypolipidemic effect and reduce lipid peroxidation. The most important compounds of aniseeds essential oil were trans-anetole, estragole, γ -hymachalen, para-anisaldehyde and methyl cavicol. Due to broad spectrum of pharmacological effects, and very few clinical studies of Pimpinella anisum , more clinical trials are recommended to evaluate the beneficial effects of this plant in human models and synthesis of new drugs from the active ingredients of this plant in future.
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The authoritative and comprehensive modern textbook on western herbal medicine - now in its second edition This long-awaited second edition of Principles and Practice of Phytotherapy covers all major aspects of herbal medicine from fundamental concepts, traditional use and scientific research through to safety, effective dosage and clinical applications. Written by herbal practitioners with active experience in clinical practice, education, manufacturing and research, the textbook is both practical and evidence based. The focus, always, is on the importance of tailoring the treatment to the individual case. New insights are given into the herbal management of approxiately 100 modern ailments, including some of the most challenging medical conditions, such as asthma, inflammatory bowel disease and other complex autoimmune and inflammatory conditions, and there is vibrant discussion around the contribution of phytotherapy in general to modern health issues, including health ageing. Fully referenced throughout, with more than 10, 000 citations, the book is a core resource for students and practitioners of phytotherapy and naturopathy and will be of value to all healthcare professionals - pharmacists, doctors, nurses - with an interest in herbal therapeutics.
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Fenugreek (Trigonella foenum graecum), used as traditional medicine and natural additive food, has been shown to exert significant antiatherogenic, antidiabetic, antianorexic, antioxidant, anti-carcinogenic, antihyperlipidemic, galactogogue and anti-inflammatory effects in several human and animal models. Besides, several medicinal pharmaceutical and nutraceutical properties, fenugreek have toxic effects as well. The aim of this review is discuss the cumulative evidence, which suggests that consumption of fenugreek induced some serious toxicological side effects. In this review, many teratogenic effects of fenugreek, from congenital malformations to death, were reported in human, rodent, rabbit, and chick. Moreover, results obtained in rats, mice and rabbits show a testicular toxicity and anti-fertility effects in male associated with oxidative stress and DNA damage, as well as anti-fertility, anti-implantation and abortifacient activity in females related to saponin compound of fenugreek which suggest that fenugreek is not recommended for use during pregnancy. Indeed, the consumption of fenugreek should be avoided for persons having peanut and chickpeas allergy because of possible cross-reactivity as well as chronic asthma. Accumulating evidence suggest also that fenugreek may have neurodevelopmental, neurobehavioral and neuropathological side effects. It is suggested that future studies would be conducted to identify molecular and cellular mechanisms underlying the fenugreek toxicological properties.
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Fenugreek (Trigonella foenum-graecum L.), plant is widely distributed throughout the world and which belongs to the family Fabacecae. The yields can be significant increase in quantity and quality through the suitable management of cultivation, irrigation and harvesting. The plant contains active constituents such as alkaloids, flavonoids, steroids, Saponins etc. It is an old medicinal plant. It has been commonly used as a traditional food and medicine. Fenugreek is known to have hypoglycemic, and hypocholesterolaemic, effects, Anti-inflammatory effects. Recent research has identified fenugreek as a valuable medicinal plant with potential for curing diseases and also as a source for preparing raw materials of pharmaceutical industry, like in steroidal hormones. Since fenugreek is a self-pollinated crop, a mutation breeding method can be used to generate mutants with a determinate growth habit. Irradiation and chemical mutagens can be used to produce point mutations in fenugreek. This review gives view mainly on the biological activities of some of the fenugreek compounds isolated, pharmacological actions of the fenugreek extracts, clinical studies and genetic, bredding and biotechnological studies.
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Asparagus racemosus (Willd.) is a widely found medicinal plant in tropical and sub-tropical parts of India. The therapeutic applications of this plant have been reported in Indian and British Pharmacopeias and in traditional system of medicine such as Ayurveda, Unani and Siddha. The crude, semi-purified and purified extracts obtained from different parts of this plant have been useful in therapeutic applications. Numerous bioactive phytochemicals mostly saponins and flavonoids have been isolated and identified from this plant which are responsible alone or in combination for various pharmacological activities. This review aims to give a comprehensive overview of traditional applications, current knowledge on the phytochemistry, pharmacology and overuse of A. racemosus.
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This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effect of oral galactagogues for increasing milk production in non-hospitalised breastfeeding mother and term-infant pairs.
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Gastrointestinal spasm is one of the most common gastrointestinal problems in infants. An herbal product is safe and effective gastrointestinal remedy to fight against various gastrointestinal problems. Polyherbal products are in use for the treatment of gastrointestinal problems since ancient time. Current era has witnessed an interest in homemade remedies. A large number of modern drugs have been developed from plants. The objective of this review is to provide a consolidated report on traditional uses and spasmolytic activities of some medicinal plants of umbelliferae family viz. Anethum graveolens, Apium graveolense, Foeniculum vulgare, Cuminum cyminum , Pimpinella anisum, Coriandrum sativum and Trachyspermum ammi have been extensively used for various gastrointestinal problems. Gastrointestinal spasm treatment is most common application of these plants oils.
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The efficacy and safety of herbal medicines are dependent upon the standards by which they are made and our knowledge base when prescribing them. Stinging nettles is a staple among Western herbalists and is widely used as a vegetable green, juice, tea, and freeze dried products, predominantly as a blood nourishing tonic and for seasonal rhinitis. The following botanical profile is excerpted from the American Herbal Pharmacopoeia (R) and Therapeutic Compendium. (c) 2012 Elsevier GmbH. All rights reserved.
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Context: The health benefits and medicinal properties of herbal food products are known since antiquity. Fenugreek [Trigonella foenum-graecum Linn. (Fabaceae)], a seed spice used to enhance flavor, color and texture of food, is employed for medicinal purposes in many traditional systems. A number of epidemiological studies and laboratory research have unraveled the biological actions of fenugreek. Objective: Research on fenugreek in recent years has identified a number of health benefits and physiological attributes in both experimental animals as well as clinical trials in humans. In this study we have reviewed the available scientific literature on fenugreek. Methods: This review article summarizes and reviews published experimental studies and scientific literature from the databases including PubMed, Google and local library searches. Results: The information available in the literature on the health benefits and pharmaceutical effects of Trigonella accounts for its known medicinal properties and adds new therapeutic effects in newer indications. Besides its known medicinal properties such as carminative, gastric stimulant, antidiabetic and galactogogue (lactation-inducer) effects, newer research has identified hypocholesterolemic, antilipidemia, antioxidant, hepatoprotective, anti-inflammatory, antibacterial, antifungal, antiulcer, antilithigenic, anticarcinogenic and other miscellaneous medicinal effects of fenugreek. Although most of these studies have used whole seed powder or different forms of extracts, some have identified active constituents from seeds and attributed them medicinal values for different indications. Conclusion: The resarch on Trigonella exhibits its health benefits and potential medicinal properties in various indications and has little or no side effects, suggesting its pharmaceutical, therapeutic and nutritional potential.
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Black elderberry, cranberry, fennel, ginger, horsetail, and raspberry leaf, herbs frequently used in pregnancy, were investigated for their in vitro CYP1A2, 2D6, and 3A4 inhibitory potential. Aqueous or ethanolic extracts were made from commercially available herbal products, and incubations were performed with recombinant cDNA-expressed human CYP enzymes in the presence of positive inhibitory controls. Metabolite formation was determined by validated LCMS/MS or HPLC methodologies. IC50 inhibition constants were estimated from CYP activity inhibition plots using non-linear regression. The most potent inhibition was shown for fennel towards CYP2D6 and 3A4 with respective IC50 constants of 23 ± 2 and 40 ± 4 µg/ml, horsetail towards CYP1A2 with an IC50 constant of 27 ± 1 µg/ml, and raspberry leaf towards CYP1A2, 2D6, and 3A4 with IC50 constants of 44 ± 2, 47 ± 8, and 81 ± 11 µg/ml, respectively. Based on the recommended dosing of the different commercial herbal products, clinically relevant systemic CYP inhibitions could be possible for fennel, horsetail, and raspberry leaf. In addition, fennel and raspberry leaf might cause a clinically relevant inhibition of intestinal CYP3A4. The in vivo inhibitory potential of these herbs towards specific CYP enzymes should be further investigated. Copyright © 2013 John Wiley & Sons, Ltd.
Article
Anise (Pimpinella anisum L.; Apiaceae) and its essential oil have been widely used in folk medicine, pharmacy and food industry. Since there are some data about the impact of anise on functions of central nervous system (CNS), the issue of possible interactions with drugs acting in CNS should be considered. This survey aimed to examine the influence of aniseed essential oil (EO) intake on the effects of drugs that act in CNS. The chemical profile of essential oil determined by GC-MS revealed as the main components: trans-anethole (88.49%), γ-himachalene (3.13%), cis-isoeugenol (1.99%), and linalool (1.79%). The effects of codeine, diazepam, midazolam, pentobarbital, imipramine and fluoxetine were tested in mice after 5days of peroral pretreatment with human equivalent dose of aniseed EO (0.3mg/kg). The intake of EO led to significant increase of analgesic effect of codeine. The motor impairment caused by midazolam was enhanced in the group treated by EO. The application of diazepam decreased the number and percentage of entries in open arm in elevated maze plus test in the group pretreated with EO indicating augmented effect of drug on motor activity. EO pretreatment caused significant shortage of pentobarbital induced sleeping time when compared to control. The decrease in antidepressant effect of imipramine and fluoxetine was diminished by the pretreatment with aniseed EO. Based on the results of this study we conclude that concomitant intake of aniseed EO preparations and drugs that act on CNS should be avoided due to potential herb-drug interactions, which also need further clinical confirmation.
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The use of medicinal plant products to treat various ailments is a common practice in many developing countries. However, a lack of information on the adverse effects of these plants raises questions on their safety and possible adverse side effects. This study was undertaken to evaluate the potential toxic effects of fenugreek seeds on pregnant mice and foetal development. Lyophilized aqueous extract from fenugreek seeds (LAE-FS) was administered to mated female mice during the entire period of pregnancy, at doses of 500 and 1000 mg/kg/day. Females were examined for standard parameters of reproductive performance. Foetuses were weighed and examined for externally visible malformations. In pregnant females, there were no obvious symptoms of toxicity, LAE-FS-related deaths or macroscopic abnormalities. Developmental toxicity in offspring included an increase in the foetal death rate, a decrease in the litter size, and a reduction in the foetal body weight. In addition there was an increase in the incidence of morphological abnormalities. Based on these results, it was concluded that fenugreek seeds extract may have deleterious toxic effects on reproductive performance and potential teratogenic effects in foetuses.
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This study deals with the pharmacokinetic interaction of selected anti-TB drugs with a natural product (CC-1a) derived from caraway (Carum carvi, L.) seed. CC-1a, chemically standardized butanolic fraction, enhanced the plasma levels of rifampicin, pyrazinamide, and isoniazid in Wistar rat, resulting in increased bioavailability indices (C(max) and AUC) of the drugs. Moreover, a 40% reduced dose regimen of these drugs, which additionally contained CC-1a, was equivalent in terms of C(max) and AUC to a normal dose regimen. A permeation-enhancing property of CC-1a across small intestinal absorptive surface was found to be a contributing factor in its bioavailability enhancing profile.
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This study was conducted to evaluate the effect of fenugreek feeding on milk production in lactating goats. Twelve lactating local Saudi goats from the Zumri breed in early lactation were divided into two groups depending on lactation week and parity. Six goats were fed with 60 g day<sup>-1</SUP> of fenugreek seeds powder for seven weeks while the other six goats served as controls. Milk yield was recorded daily and blood samples were collected twice a week. Also, blood samples were taken every 15 min for 6 h during fenugreek treatment. Milk yield was found to be significantly higher (p<0.05) in the treated group (1236±38 vs. 1093±43 mL day<sup>-1</SUP>). Fenugreek fed goats exhibited significantly lower plasma levels of glucose (p<0.05) and urea (p<0.01) compared to control  group.  Mean  plasma  levels   of  growth  hormone  during  six  hours bleeding were significantly higher (p<0.05) in the fenugreek treated goats compared to control (0.27±0.09 and 0.21±0.02 ng mL<sup>-1</SUP>, respectively). It could be concluded that Fenugreek feeding increased milk production in goats and this effect might be mediated via growth hormone stimulation.