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Tachyarrhythmia and Hypomania With Horny Goat Weed
... Partin and Pushkin have presented a case of a 66 year old man with a history of cardiovascular disease who, after two weeks of consumption of an herbal sexual enhancer containing Horny Goat Weed, was admitted to hospital with a new-onset tachyarrhythmia and hypomanic symptoms (sexual and verbal inappropriate behaviour, irritable mood, hyperverbal speech). The patient needed to undergo an electric cardioversion and to be treated with a therapy based on olanzapine and lorazepam [70]. Metz reported a case of a painful vasculitic rash in a 77-year-old man, who had started a treatment with Ginkgo Biloba and Horny Goat Weed tablets four days before. ...
... Psychological safety: As mentioned above one case has been reported with hypomanic symptoms combined with tachyarrhythmia [70]. During the online monitoring of discussion fora several cases of aggressive behaviour and irritability were noted. ...
Introduction:
The use of unlicensed food and herbal supplements to enhance sexual functions is drastically increasing. This phenomenon, combined with the availability of these products over the Internet, represents a challenge from a clinical and a public health perspective.
Methods:
A comprehensive multilingual assessment of websites, drug fora, and other online resources was carried out between February and July 2013 with exploratory qualitative searches including 203 websites. Additional searches were conducted using the Global Public Health Intelligence Network (GPHIN). Once the active constitutes of the products were identified, a comprehensive literature search was carried out using PsycInfo and PubMed.
Results:
The most common sexual enhancement products available on the Internet were identified. Their active ingredients included yohimbine, maca, horny goat weed and Ginkgo biloba. These four substances were reported with the occurrence of adverse events and the induction of psychological symptoms, such as mood changes, anxiety, and hallucinations as well as addictive behaviours.
Conclusions:
Uncontrolled availability of sexual enhancement products that contain potentially harmful substances is a major public health concern. The possible impact on population health, particularly among subjects with psychiatric disorders, usually at risk for sexual dysfunction, may be significant. This new trend needs to be extensively studied and monitored.
... The use of arnica may increase the risk of arrhythmias and reduce the efficacy of antihypertensive medications [87]. In a single case report, horny goat weed was alleged to cause arrhythmia, chest pain, and shortness of breath [88]. In naïve users, cannabis at high doses can also produce bradycardia and postural hypotension. ...
... Bibliografía: [238,247,293,294,[299][300][301][302][303][304] Tópicos en nutrición y suplementación deportiva -Dr. Heber E. Andrada pág. ...
This book is intended for anyone passionate about nutrition and
sports supplementation. It aims to introduce readers to what
regards the subject, combining areas such as nutrition, biological chemistry, the physiology of the exercise, food science and pharmacology. It is by no means intended to replace a good
book on each of these areas, just try to give a general snapshot of each of the substances that are currently being used in the world of supplementation sports, its functions, applications, benefits and doses that are usually used.
Heber E. Andrada
October 5, 2020
... In patients with cardiovascular disease, blood pressure, musculoskeletal, bipolar and other psychological disorders or in patients using antihypertensive medications [56] or in patients with immune function disorders and delayed-type hypersensitivity response, bleeding disorders or frequent nosebleeds, homocysteine disorders, hypothyroid conditions, respiratory disorders, vertigo or in patients using anticoagulant or anti-platelet medications, or monoamine oxidase inhibitors is unlikely unsafe. Due to a lack of sufficient safety data, the use of Epimedium in children, as well as pregnant and lactating women, is unlikely safe. ...
Epimedium sp. is famous for its potency as sexual enhancer and five species of Epimedium brevicornum, E. sagittatum, E. pubescens, E. koreanum, and E. wushanense were recorded as Epimedium Herba (Yin Yang Huo) in Chinese Pharmacopeia. The aim of this study was to evaluate the potential efficacy of E. brevicornum as remedy for sexual dysfunction and infertility. For preparing this manuscript, we searched in all accessible resources (PubMed, Science direct, Wiley, Springer, and Google), books, thesis, and pharmacopeia. There are different traditional prescriptions from E. brevicornum, which are used for treatment of impotence and sexual disorders. Although, there is no clinical study on efficacy and safety of E. brevicornum on sexual functions, but animal and experimental analysis exhibited that E. brevicornum is and estrogenic plant and its flavonoid glycosides are inhibitors of phosphodiesterase 5 (PDE 5) and improved the erectile dysfunction, libido, impotence, sperm quality and fertility . Due to the lack of clinical study on efficacy of E. brevicornum, designing the human clinical study on safety and efficacy of standard E. brevicornum can be the subject of future studies.
... Partin and Pushkin, who reported a case of hypomania associated with horny goat weed (Epimedium grandiflorum) proposed that this may have been due to the addition of other unidentified herbs and pharmaceuticals (50). However, these were not explicitly tested for. ...
Background: DSM-5 introduced the diagnostic category of substance/medication-induced bipolar and related disorder. This systematic review examines published reports linking mania with the consumption of herbal medicines (HM), excluding cannabis. Putative pathophysiological mechanisms that may account for the reported HM being associated with mania are discussed.
Methods: A systematic search of EMBASE, CINAHL, Health Source, PsychINFO, and PubMed. The quality of case reports meeting inclusion criteria was assessed using the modified Quality Assessment Scale by Agbabiaka.
Results: Nineteen single and seven multiple-case reports met inclusion criteria. These yielded a study sample of 35 case reports, 28 of herbal medicine associated mania, 5 of hypomania, and two mixed states, in 17 females [age in years M(SD) = 43.1(13.2)] and 18 males [40.7(18.1)]. A total of 11 herbal medicines were implicated. Case reports by herbal medicine (number of reports) comprised: St John's wort (Hypericum perforatum) (14); Ginseng (Panax ginseng) (5); brindleberry (Garcinia cambogia) (4); ma-huang (Ephedra sinica) (3); “herbal slimming pills” (2); Herbalife products (2); Hydroxycut (1); horny goat weed (Epimedium grandiflorum) (1); “herbal body tonic” (1); celery root (Apium graveolans) (1), and a “herbal mixture” (1). All case reports were associated with use rather than withdrawal of herbal medicines. Only one case report was rated for probability of association using a standardized algorithm. Laboratory assays to confirm composition of the herbal preparation were reported in only one article describing two cases and indicating admixture of a likely causal pharmaceutical in the herbal preparation.
Conclusions: Causal attributions are problematic given the limited number of reports, antidepressant co-prescribing in 7 cases, insufficient data regarding pattern and type of herbal medicine use, and lack of a reference frequency for spontaneous mania.The quality assessment scores across the 26 papers (35 case reports) were as follows: low quality (0), lower-medium quality (9), upper-medium quality (10) and high quality (7). Putative pathophysiological mechanisms were postulated for nine of the 11 herbal medicines and centered on HPA-axis activation and increased monoamine activity. Systematic study of the association between herbal medicines and the course of bipolar disorder may contribute to defining targets for pathophysiological research.
... A case was reported of a 66-year-old man who developed heart arrhythmia and hypomania after taking a herbal sexual enhancement product containing epimedium. As it was a multi-ingredient preparation, and the man was predisposed to heart disease and possible mood disorder, it is unclear if this was caused by epimedium or another ingredient (Partin and Pushkin 2004). ...
This chapter presents indications, clinical evidence, pre-clinical evidence, mechanisms of action, interactions, and contraindications of Horny Goat Weed (Epimedium spp.). Horny Goat Weed is used to treat sexual dysfunction, particularly impotence in men and lack of libido in women. In traditional Chinese medicine, it is also used widely for osteoporosis. Epimedium species are used to treat a number of other conditions including rheumatic arthritis, menopausal symptoms and memory loss. Adverse effects, dosage, and general plant information are included in the chapter. According to a Chinese legend, a goat herder first noticed the qualities of the plant after he observed far more sexual activity in his goats after they ate it; hence the common name.
... As a clinically based discipline, CLP has tended to give rise to fascinating case reports of limited everyday utility (a personal favourite during the period under review was 'tachyarrhythmia and hypomania with horny goat weed' [13]) or descriptions of services, and relatively few articles on pathogenesis, classification or treatment trials. This is well illustrated in a recent meta-review of interventions in three key areas of CLP (psychological effects of illness or treatment, somatoform disorders and self-harm) which concluded that '. . . ...
Consultation-liaison psychiatry deals with patients who manifest both psychological and somatic symptoms and involves a close and collaborative interaction with other medical specialities. While it is a clinically rich area, resource constraints and service requirements have meant that it has perhaps contributed a little below its weight in academic terms. This review, although far from exhaustive, seeks to present some themes of recent research in this fascinating discipline.
The need to demonstrate the utility, and ensure the funding, of a service that is all too often regarded as 'non-core' by both mental health services and general hospitals remains constant. Useful work is being done in streamlining data collection, accurately measuring disability and improving outcomes for these complex and resource-intensive patients. Recent reviews have helped to clarify our understanding of medication-induced depression, the treatment options in self-harm, the place of psychosocial interventions in oncology, and the relationship between depression and heart disease among other areas.
Consultation-liaison psychiatry is a fascinating and underresearched field. Important work remains to be done in service delivery, diagnosis, treatment and outcome, as well as medical ethics and systems research. Although our knowledge is progressing, many existing studies are underpowered and multisite collaborations are necessary. Our patients carry an enormous burden of ill health and require the services of skilled clinicians, advocates and treatment brokers.
In this alphabetically arranged chapter, supplements from hawthorn through lysine are discussed in detail. For each supplement, this chapter defines what it is and how it works in the body. Further, this chapter discusses the supplement’s recommended dosage as well as the evidence for or against its different usages. Safety concerns, side effects, and precautions are next discussed as well as any potential interactions with other medications. References are provided for the data provided. The goal is for the healthcare provider to be able to reference each supplement and come away with a full, balanced, evidence-based understanding of these topics
Infertility affects 8-12% of couples globally, with male factors contributing to around 40% of cases. Common male infertility issues include erectile dysfunction (ED) and low sperm count or quality, which account for over 90% of cases. These problems often result from anatomical, hormonal, or genetic abnormalities. This review focuses on natural aphrodisiac herbs commonly used to address ED, providing detailed information on their botanical characteristics, metabolic pathways, recommended dosages, phytochemical properties, side effects, origins, and traditional uses. It also reviews recent studies on medicinal herbs that boost sexual desire and treat urological conditions. By compiling reliable findings from the past decade, the study aims to serve as a comprehensive resource for individuals dealing with sexual health issues. Through careful evaluation of each herb, it offers insights into their effectiveness and limitations, emphasizing the potential of natural treatments as complementary alternatives to conventional therapies for male infertility and related conditions. HIGHLIGHTS • Anatomy, hormone abnormalities and genetic flaws may contribute to male infertility. • The most popular natural aphrodisiac herbs used in the treatment of infertility were revised. • Unique and reliable references to sexual desire and urological problems were provided. • Safe aphrodisiac herbs including phytochemical products were emphasized. • Plants were investigated for their potential as aphrodisiacs and fertility enhancers ARTICLE HISTORY
Men of all ages frequently experience erectile dysfunction (ED) or impotence, and it is a difficult health issue that adversely affects the quality of life of those who experience it. There are multiple types of treatment strategies for ED available, depending on the origin and severity of ED, as well as any underlying medical issues. However, these therapeutics are known to have a number of negative health effects. In contrast, plant-based treatments are more effective for managing diseases due to their ability to modulate biological processes like inflammation, oxidative stress, and cell signaling molecules. Many medicinal plants have been reported to be quite helpful in the improvement of ED. In this review, ED and its causes, diagnostic methods, treatment strategies, and some of the most potent plant-based interventions against ED are discussed in greater detail, along with a description of their mechanisms of action and a brief discussion of approaches to increase their efficacy, with a focus on the management of ED using herbal interventions as complementary and alternative medicines. While there is hope that medicinal plants could provide lead substances for erectile dysfunction medications, additional investigation is necessary to ascertain the efficacy and security of these prospective treatments.
Dietary supplements (DSs) are used by 50% of Americans and 70% of United States military service members (SMs); some have adverse effects (AEs). This cross-sectional investigation examined AEs associated with specific DSs. A stratified random sample of SMs from the Air Force, Army, Marine Corps, and Navy was obtained. Volunteers completed a questionnaire reporting AEs for 96 generic and 62 specific DSs. The highest prevalence (≥1 AE) in specific DS categories was 35% prohormones, 33% weight loss supplements, 26% pre/post workout supplements, 14% herbal products, 12% multivitamin/multiminerals, 11% protein/amino acids, 9% muscle building supplements, 7% other DSs, 6% joint health products, and 5% individual vitamins/minerals. Specific DSs of concern (with proportion reporting AEs) included: Libido Max® (35%), Hydroxycut Hardcore® (33%), OxyElite® (33%), Roxylean® (31%), Growth Factor 9® (30%), Super HD® (29%), Hydroxycut Advanced® (29%), Lipo 6® (28%), The Ripper® (27%), Test Booster® (27%), Xenadrine Xtreme Thermogenic® (27%), C4 Extreme® (26%), and C4 Origional® (25%). Products marketed for weight loss, use before/after workout, and prohormones had the highest AE prevalence. DSs can contain substances with independent/additive AEs and/or interact with other ingredients or prescribed medications. Methods described here could provide a continuous surveillance system detecting dangerous DSs entering the market.
Erectile dysfunction (ED) is defined as an inability to achieve or maintain penile erection sufficiently enough for sexual performance. Sexual function involves an interplay between psychological, vascular, neurological, endocrine functions; thus the various etiologies of ED can be divided into psychosocial or organic causes. Current mainstays of treatment for ED are centered around enhancing levels of nitric oxide at the nerve terminal with pharmacologic agents such as phosphodiesterase inhibitors, followed by more invasive therapies such as intracavernosal injections and penile prosthesis. The market for supplements for ED has been growing in popularity and has warranted further investigation into mechanisms of action and efficacy. This chapter discusses several supplements that have been marketed as therapies for ED, their efficacies in clinical trials, as well as their mechanism of action on the biochemical level, safety profiles, and adverse effects.
Aphrodisiacs, libido or erection-enhancing supplements are widely available on the internet. The beneficial effects are controversial. Forensic toxicologists should be aware of the potential toxicities of these products because they could be given in cases of drug-facilitated sexual assault. This article presents a case report in which the defendant claimed to have administered an aphrodisiac to several women who showed strong symptoms of intoxication after consumption in an alcoholic drink. A literature research was carried out for potential substances sold in these aphrodisiac products. Synthetic substances as well as products of herbal or animal origin can be the ingredients. The main products that could cause intensive side effects and intoxication are phosphodiesterase V inhibitors (declared or undeclared on packaging), yohimbine, steroid hormones, flibanserin, gamma-hydroxybutyric acid, Tribulus terrestris, Bufo Toad, Spanish fly or Horny Goat Weed. All other products used as aphrodisiacs and described herein show less potential side effects or no studies on side effects in humans were carried out.
Erectile dysfunction (ED) is a common sexual problem affecting many men irrespective of cultures, beliefs and nationalities. While medical therapy for ED has been revolutionized by the advent of oral phosphodiesterase type 5 inhibitors and intracavernosal injection of vasoactive agents, recent technological advances such stem cell therapy, low intensity shock wave and newer generation of penile prosthesis implant offer hope to men who do not respond to conventional medical therapy. In contrast, traditional and complementary medicine (TCM) focuses on the restoration and better overall bodily regulation with the use of various herbal and animal products as well as exercises to invigorate qi (energy) in vital organs. Western medicine involves an analysis of ED symptom and underlying causes that contribute to ED, while TCM emphases the concept of holism and harmonization of body organs to achieve natural sexual life. The following article reviews our current understanding regarding the philosophical approach, and evaluates the evidence surrounding various ED therapies between mainstream Western Medicine and TCM.
The purpose of this book chapter is to better understand the role of alternative nonprescription medications and their effect on sexual function. We will also discuss the prevalence of counterfeit prescription medications and their impact on health. We will discuss where these drugs are being produced and how they are regulated by the federal government. The role of the Internet as a method of obtaining these medications also will be explored. The most common alternative medicines will be reviewed based on clinical research trials in terms of efficacy and side effects.
Dietary supplements, including vitamins, minerals, herbs, amino acids, and enzymes, have become increasingly more common and are used by approximately half of the US population. About three-fourths of supplements are obtained with no prescription from a physician, which raises medical concerns regarding safety as these products do not require US Food and Drug Administration approval. Common reasons for taking dietary supplements include improved mood, improved mental function, depression relief, anxiety reduction, and treatment of simple and migraine headaches. The use of herbs for medicinal purposes has a long-standing history among many cultures. We present the case of a 43-year-old man, who was taking dietary supplements, with a 6-month history of psychotic symptoms that increasingly caused impairment in functioning and eventually led to involuntary hospitalization. The published data with regard to supplements causing psychosis, herb-to-herb interaction, and reliability of herbal supplement manufacturers are discussed.
Introduction:
Use of supplements is common among men seeking urologic evaluation for sexual health matters. With a dizzying array of formulations available and little regulation on the dosage, purity, or ingredients found in these products, the health effects of nutraceuticals are often confusing to patients and medical practitioners alike.
Aim:
In this review, we set out to concisely summarize the data on ingredients found within the top-selling nutraceutical agents marketed for men's sexual health in order to provide a clinical guide for urologists.
Methods:
We used sales data from the most popular retail provider of men's health supplements to identify the top-selling products marketed toward improvement of men's sexual health. We summarized the available information related to the ingredients, dosage, cost, and mechanism of action for these substances and performed an extensive literature search to identify and review the current evidence available for each of the most common ingredients found in these nutraceuticals.
Results:
The top-selling nutraceuticals marked for men's sexual health contain a blend of multiple supplements (up to 33 in one formulation identified), the most common being ginseng, tribulus, zinc, horny goat weed, B complex vitamins/trace minerals, fenugreek, L-arginine, maca, DHEA, ginkgo, and yohimbine. The currently available medical literature evaluating the efficacy of these substances is generally of low quality.
Conclusions:
Despite the dearth of evidence supporting nutraceutical agents in the men's health arena, these substances are still commonly used by patients. As these products can affect the health and well-being of men presenting to a urology clinic, a familiarity with commonly used agents can help the urologist appropriately counsel their patients. Cui T, Kovell RC, Brooks DC, and Terlecki RP. A urologist's guide to ingredients found in top-selling nutraceuticals for men's sexual health. J Sex Med **;**:**-**.
Evidence for herbal treatments for ED is contradictory. This could be due to differing definitions of ED, non-standardized
outcomes and different procedures used in the preparation of plant extracts. Additionally, animal studies are not accurate
because they do not allow cerebral aspects of sex to be evaluated and instead rely solely on basic mechanical or instinctive
sexual function. Preliminary research on a few drugs such as ginseng, PLC and DHEA is encouraging, but well-designed randomized
controlled clinical trials are lacking. It is likely that the use of medicinal plants will increase in popularity as men seek
subtle methods of treating themselves. However, whilst it is easy to purchase many ‘natural Viagra’-like substances over the
Internet, the safety and reliability of many of these drugs is poor, and patients should be cautious when acquiring these
products. Information about how these herbal products interact with prescribed drugs is also limited.
Recent literature regarding drug-drug, herb-drug, and food-drug interactions must not be ignored; nor can they always be taken at face value. Studies have shown that St. John's wort (SJW) (Hypericum perforatum) can reduce plasma levels of indinavir, cyclosporin, digoxin, and possibly other drugs as well. Current knowledge regarding the metabolism of these medications suggests that the cytochrome P450 (CYP) drug metabolizing enzyme systems cannot account for all these effects. It has been reported that the P-glycoprotein (Pgp) transmembrane pump is also induced by SJW. Medications that are substrates of both CYP 3A4 and Pgp are of particular concern and may pose special interaction risks when combined with certain foods or botanical products such as SJW.
ALTHOUGH the catecholamine precursor L-dopa
(L-3-4-dihydroxyphenylalanine), like most clinically effective
anti-depressant drugs, reverses reserpine-induced brain catecholamine
depletion and sedation1-3, early clinical trials using
1.5-3.0 g/day revealed no significant antidepressant
activity4-9. Recently, we gave L-dopa to eighteen depressed
patients, using the very large oral doses found to be effective in
reversing many of the symptoms of Parkinson's disease10-17.
Ginseng root extract is a widely used herbal product not devoid of side effects. This report describes the development of manic symptoms after ginseng consumption in a patient with affective disorder. Other potentially harmful side effects of ginseng are also reviewed.
A single case report.
A 56-year-old woman with previous affective disorder presented a manic episode during ginseng intake. Symptoms disappeared rapidly with low doses of neuroleptics and benzodiazepines after ginseng suppression.
Ginseng may produce manic symptoms. A special risk situation seems to be affective patients under antidepressant medication. The case emphasizes the lack of harmlessness of herbal products. Patients should be routinely asked about the use of herbal products and diet supplements.