HERBAL MEDICINES AFFECTING THE CARDIOVASCULAR SYSTEM 1. MEDICINAL PLANTS AND DRUGS AFFECTING THE HEART

1.1. Cardiotonic agents, plants and drugs for heart insufficiency

1.1.1. Cardiotonics with cardiac glycosides

Cardenolides, bufadienolides

digitoxigenin (cardenolide)

scillarenin (bufadienolide)

Digitalis purpureae folium – Digitalis leaf

© Papp

© Papp

Digitalis purpurea L. (Scrophulariaceae) Ph.Hg. VIII.

Digitalis lanatae folium

© Papp

© Papp

Digitalis lanata – woolly foxglove (Scrophulariaceae)

Digitalis lanatae folium

Ph. Hg. VIII.: Digitoxinum (Digitoxin)  Digitalis purpureae folium Digoxinum (Digoxin)  Digitalis lanatae folium

Strophanti semen – Strophantus seed

Strophantus gratus Wall. et Hook Franch. (Apocynaceae)

Strophanthi semen

Strophantus kombe: k-strophantidine strophantidol

periplogenin

Nerii folium – Oleander leaf

Nerium oleander L. – oleander leaf (Apocynaceae)

Nerii folium

AC: cardenolic glycosides (oleandrin) Therapy: cardiovascular problems, heart insufficiency in the elderly

Convallariae herba Convallaria majalis L. lily of the valley (Convallariaceae)

• mild heart insufficiency, associated with oedema • cardenolide glycosides similar to Strophanthus, oral administration – absorption is not satisfactory, but they do not accumulate • accompanied with strong diuretic effect

Adonidis herba AC: cardenolic glycosides Therapy:

• neurotic heart complaints, angina pectoris, hyperthyreosis • A.C. variable – not as home remedy!!!

Adonis vernalis L. – spring pheasant’s eye (Ranunculaceae)

• as a tincture – standardized for flavonoid content

Leonuri cardiacae herba - Motherwort

Leonurus cardiaca L. - motherwort (Lamiaceae) Ph.Hg. VIII.

Leonuri cardiacae herba - Motherwort

Ph. Hg. VIII.

Leonuri cardiacae herba Motherwort AC: bufadienolide glycosides, flavonoids

Iridoids:

Therapy:

mild heart insufficiency, neurotic heart problems, ”elderly heart”

ajugol

Scillae bulbus Sea onion

Urginea/Scilla maritima L. sea squill (Liliaceae/Hyacinthaceae)

Scillae bulbus

bufadienolide mixture (scillaren A, proscillaridin A) - per os - „elderly heart”

Hellebori radix / rhizoma Hellebore root / rhizome

Helleborus niger L. – black hellebore (Ranunculaceae)

Hellebori radix / rhizoma  Hatvani

 Hatvani

Helleborus odorus W. et K. (Ranunculaceae)

Hellebori radix / rhizoma Hellebore root / rhizome

AC: bufadienolide (hellebrin) Therapy: similar to Strophanthus cardenolides; veterinary: immunostimulant – stimulus therapy

115. …. contains bufadienolide glycosides: 1. 2. 3. 4. 5.

Scillae bulbus Convallariae herba Hellebori rhizoma et radix Oleandri folium Digitalis lanatae folium

106. Choose the drugs that do NOT contain cardiotonic substances! 1. 2. 3. 4. 5.

Digitalis purpureae folium Allii bulbus Oleandri folium Stramonii semen Convallariae herba

1.1. Cardiotonics, medicinal plants and drugs for heart insufficiency 1.1.2. Cardiotonics with flavonoids and procyanidins

Crataegi folium cum flore Hawthorn leaf and flower Crataegus laevigata woodland hawthorn DC. (Rosaceae)

Crataegus monogyna common hawthorn Jacq. (Rosaceae)

Ph.Hg.VIII.

Crataegi folium cum flore Hawthorn leaf and flower C. pentagyna (small-flowered black hawthorn)

C. nigra (Hungarian hawthorn)

C. azarolus (azarole)

Ph.Hg.VIII.

Ph. Hg. VIII. Ph. Hg. VII.

Crataegi folium cum flore

Ph. Hg. VIII.

Crataegi folii cum flore extractum siccum Hawthorn leaf and flower dry extract

Aqueous extract: min. 2.5% flavonoid (hyperoside) Hydroalcoholic extract: min. 6% flavonoid (hyperoside)

Ph. Hg. VIII.

Crataegi fructus – Hawthorn berries

Crataegus sp. characteristic compounds procyanidines

flavonoidglycosides

Active compounds and effect of hawthorn drugs • vitexin (flavonoid): widens the coronary arteries • procyanidines: – positive inotropic (force of heart contractions), – positive chronotropic (heart rate )

• indirectly normalizes BP – combined with drugs for lowering BP Medical uses: • „elderly” heart • high BP • cardiomyopathy (after infectious diseases) • heart arrhythmia

1.2. Medicinal plants and drugs against arrhythmia

Cinchona pubescens - red cinchona / quina

Active compounds: alkaloids: • quinine  malaria • quinidine: antiarrhythmic

Sarothamni scoparii herba

Sarothamnus scoparius (L.) Wimm. common broom (Fabaceae)

sparteine: antiarrhythmic, blood pressure , diuretic

1.3. Medicinal plants and drugs for lowering blood pressure

Visci herba / stipes

Viscum album L. – common mistletoe (Loranthaceae)

Visci herba / stipes

AC.: viscotoxin (mixture of proteins with low molecular mass) lectins (glycoproteins with high molecular weight – specific sugar binding capacity) Use: antihypertensive, cardiotonic – not justified!; anti-cancer

Herbal products affecting the cardiovascular system

– garlic – mistletoe – hawthorn – old age-related heart disorders, prevention of atherosclerosis, hypertension – complementing drug therapy

Visci stipes – antihypertensive? • herbal products: combined preparations, mistletoe only in small proportion • phosphodiesterize enzyme inhibiting effect – not proven • excitation of vasomotor centre ↓ – only hypothesis • slight diuretic effect – only open studies • the active ingredient responsible for the effect is not known • only animal studies • known effects of viscotoxin: dose-dependent hyper- or hypotension, bradycardy, negative inotrope effect (nondesirable adverse effects!) • → usage as antihypertensive cannot be justified according to our current knowledge! Kéry Á.: Gyógyszerként alkalmazott fehérjék drogismereti és fitoterápiai vonatkozásai. „Klasszikus gyógyszerészeti tudományok újabb eredményei 2009.” Pécs, 2009. okt. 17-18.

Ribis nigri folium – black currant leaf • Ribes nigrum L. black currant (Grossulariaceae) • AC: flavonoids, essential oil, procyanidines, ascorbic acid • Therapy: diuretic, antihypertensive • Folk medicine: joint disorders, cough

1.4. Herbal products for lowering blood cholesterol level

2. MEDICINAL PLANTS AND DRUGS AFFECTING CEREBRAL AND PERIPHERAL BLOOD SUPPLY 2.1. Medicinal plants and drugs affecting the blood supply to the brain

Vincae minoris herba

Vinca minor L. – lesser periwinkle (Apocynaceae)

Vincae minoris herba

vincamine: blood pressure  , sedative, antisclerotic, against migraine

vincamine

vinpocetine

Ginkgo biloba (Ginkgoaceae)

♀

Ph. Hg. VIII.

Ginkgo folium – Ginkgo leaf

Ginkgo biloba active substances

Drugs with ginkgo extract

2.2. Medicinal plants and drugs against oedema

Hippocastani semen Horse chestnut seed

Therapy: leg ulcer, haemorrhoids, varicose veins

2.3. Medicinal plants and drugs improving peripheral circulation 2.3.1. Plants and herbal products with coumarin

Galium odoratum – sweet woodruff (Rubiaceae) • AC: coumarin

Melilotus officinalis sweetclover

Melilotus albus

2.3. Medicinal plants and drugs improving peripheral circulation 2.3.2. Medicinal plants and drugs containing rutin and related compounds

Fagopyrum esculentum – buckwheat (Polygonaceae) • Rutin content: 6-8% • pharm. industry: rutin  fagorutin

Ruta graveolens – garden rue (Rutaceae)

Active coumpund: rutin (flavonoid-glycoside): 0.15 %

Sambucus nigra L. black elder (Caprifoliaceae)

Ph. Hg. VIII.

Sambuci flos – Elder flower

Ph. Hg. VIII.

Sambuci flos – Elder flower

chlorogenic acid

diaphoretic, immunostimulant

Sophorae flos – pagoda tree flower

Sophora japonica L. pagoda tree (Fabaceae)

Ph.Hg.VIII.

Verbasci flos

Verbascum phlomoides L. – woolly mullein (Scrophulariaceae)

Viola tricolor – heart’s ease (Violaceae)

Rutin content • > 4%

Citrus bioflavonoids

Citrus bioflavonoids

Bioflavonoids: hesperidin, eryodictiol (citrin) antihemorrhagic, antisclerotic

2.3. Medicinal plants and drugs improving peripheral circulation 2.3.3. Other medicinal plants and drugs used in the treatment of varicose veins

Ruscus aculeatus – butcher’s broom (Ruscaceae) Active compunds: • rhizome: steroid saponins Medical use: • treatment of varicose veins (usually combined with rutin-containing drugs)

Centellae asiaticae herba Centella Centella asiatica (L.) Urban (Apiaceae) centella AC: triterpene-saponins, asiatic acid glycosides Therapy: antibacterial, externally antimycotic, treatment of skin diseases, eczema, increases the flexibility of veins Ph.Hg.VIII.

Myrtilli fructus recens, Myrtilli fructus siccus Bilberry fruit, fresh/dry

Vaccinium myrtillus L. (Ericaceae)

Ph. Hg. VIII.

AC: catechin, proanthocyanidins, phenolcarboxylic acids, iridoid, invert sugar, pectin Therapy: antidiarrhoeic (enteritis), retinopathy: flexibility of capillaries, antioxidant, free radical scavenging Homeopathy (fresh fruit)

Vitis vinifera – grape (Vitaceae)

Berry skin: • procyanidines