What is Hyperlipidemia ? Hyperlipidemia is an excess of fatty substances called lipids, largely...

What is Hyperlipidemia ?Hyperlipidemia is an excess of fatty substances

called lipids ,largely cholesterol and triglycerides, in the

blood .

• Cholesterol is required to build and maintain cell membranes

• It is the major precursor for the synthesis of vitamin D and of the various steroid hormones

• Cholesterol is primarily synthesized from

acetyl CoA through the HMG-CoA reductase pathway in many cells and tissues.

Alfalfa Family :fabaceae/leguminosaeSpecies: medicago sativa Part used: herb Herbal use :treatment arthritis ,high cholesterol ,diabetes

and peptic ulcer It has bactericidal ,cardiotonic ,diuretic

&emeticIt is source of vitamins A,C,E,K &mineral

ca ,k,phosphorus and iron

ConstituentAcids: lauric acid, malic acid, malonic acid …Alkaloids: pyrrolidine type ,pyridine type in the seeds

onlyAmino acids :arginine ,asparagines, cystine ….the non protein toxic Amino acids canavanine is

present in leaves ,stem and seeds Coumarins: medicagol Isoflavonoid:coumestrol,biochaninA,daidzein….Saponins: 2-3%hydrolsis yield aglycone ,medicagenic

acid ,soyasapogenolsA-F and hedragenin .sugar chain component include arabinose galactose …SteroidsOther consisteunts: Carbohydrates ,vitamin ,pectin methylestrase

pigments, protein and trace element

Pharmacological actionSaponins is decrease plasma cholesterol

concentration without change in (HDL)decrease intestinal absorption of cholesterol and

increase excretion of neutral steroids and bile acids .

stimulate lipolytic activity of a mixture of porcine pancreatic enzymes including lipase ,amylase and proteases

Clinical study reduced plasma cholesterol concentration by less

than 5% in (LDL)

Side effect /toxicity :It induce asystemic lupus erthematosus like

syndrome because there is canavanine which is toxic due to it is structure analogue of arginine and may interfere with the binding of this amino acid to enzymes and its incorporation into protein

Contra indication &warning should be avoided it with (SLE) . Not take with oral contraceptive &hormonal

replacement therapy because the potential oestrogenic &anticoagulant activity

Pregnancy and lactation:The safety not established .

Preparation& dosage:

Tablet ,capsule and teas Dried herbsLiquidextract

Artichoke Family asteraceae /compositae Species cynara scolymus LPart used leavesHerbal use :treatment hyperlipidemia ,

hyperlipoprotinaemia condition require an increase in choleresis and non-ulcer dyspepsia

It has choleretic,hypocholesterlamic,hypolipidaemic ,diuretic and hepatostimulating properties

Pharmacological actionInhibition of cholesterol biosynthesis by 65% .The hypolipidemic effect well document for globe

aritichoke leaf extract and the Constituent: cynarin Luteolin the most important constituent for this

effect by indirect inhibition of hydroxymethylglutrayl-COA reductase(HMG-COA)

Clinical study :It is reported cynarin tobe effective in lowering

serum concentration of cholesterol and triglyceride when taken daily dose ranging from 60mg to 1500mg

Side effect /toxicity :1- No series adverse effect were reported 2- Non- specific gastrointestinal complaints:

dyspepsia& constipation gastric irritation 3- Allergic contact dermatitis Contra indication &warning globe aritichoke yields cynaropicirin potentially

allergenic Pregnancy and lactation:The safety not established .

Preparation& dosageLeaf extract Liquid extract

A teabag containing artichoke tea

Fenugreek

Family: Leguminosae Species: Trigonella foenum –graecum Part used : seedHerbal use :It possess as mucilaginous

demulcent,laxative,nutritive ,expectorant .Traditionally ,use for treatment of

anorexia ,dyspepsia ,gastritis topically for myalgia,lymphadenitis ,gout

wounds and leg ulcers .

ConstituentAlkaloids: pyridine type. Protein :23%-25%Flavonoids: flavone glycosides including

orintin and vitexin,quercetin(flavonol)Saponins: 0.6-1.7%.glycosides yeilding

steroidal sapogenins diosgenin and yamogenin (major)

Other constituent:coumarin,lipid,mucilaginous,fibre,vitamins

and minerals

Pharmacological action

Hypocholesterolaemic activity due to fibre and saponin fraction

It has Hypocholesterolaemic activity and lowering triglyceride concentration but without change (LDL)& (HDL)

Clinical study : A significant reduction in serum cholesterol

concentration in diabetic patients was also noted

Side effect /toxicity :No reported Contra indication &warning: It has hypoglycemic activity so it is interfere

hypoglycemic therapy Cation is advisable in patients receiving

monoamine oxidase inhibitor ,hormonal or anticoagulant therapies

Pregnancy and lactation:It is reputed to be uterine stimulant activity .

Preparation& dosageSeed 1-6g or equivalent three times daily

Garlic

Family :Amaryllidaceae /liliaceae Species :Allium sativum L . Part :used bulbHerbal use : expectorant ,antispasmodic, antiseptic ,bacteriostatic

,antiviral,hypotensive and anthelmintic properties Traditionally :it used to treat chronic

bronchitis ,recurrent colds ,bronchitic asthma and influenza .

Modern use :antihypertensive ,antiartherogenic ,antithrombotic,anti

microbial ,cancer preventive and lipid lowering effects .

ConstituentEnzyme :allinase ,peroxidases,myrosinase and

others Volatile oils:0.1-0.36% .sulfur containing

compound including alliin , compound produced enzymetically from alliin including allicin,S-allylmercaptocysteine and S-methylmercaptocysteine ;terpenes

Other constituents :Protein ,amino acids ,minerals, vitamins, trace

element ,lipid and prostaglandins

Pharmacological actionSulfur-containing constituent inhibit cholesterol biosynthesis including :

Inhibition (HMG-COA)reductaseReduction in triacylglycerol biosynthesis Increase in hydrolysis of triacylglycerols via

increased lipase activity and inctivation of enzymes ivolved in lipid synthesis

inhibit triglyceride biosynthesis in part by decreasing de novo fatty acid synthesis via inhibition of fatty acid synthase.

garlic significantly reduced total serum cholesterol concentration by about 9%

Side effect :Non toxic Burning sensation in the mouth and

gastrointestinal tractGarlic breath &body odourThe allergenic potential due to allergen

as:diallyl disulfide ,allylpropyl sulifide and allicin

Contra indication &warning: Interfere with hypoglycemic and

anticoagulant therapies It potentiate the antithrombotic effects of

anti-inflammatory drugs such as aspirin Gastrointestinal irritation may occur Pregnancy and lactation:There is no experimental or clinical reports

Preparation& dosageDried bulb TinctureOilJuice of garlic Syrup of garlic Garlic powder tablets

Milk ThistleSpecies: silybum marianumSynonym: carduus marianusPart used: fruits, herb.Legal category: milk thistle is not

included in the GSL.Constituents: Fruit:

flavolignans,flavonoids,lipids,sterols.Leaves: flavonoids

Food use: it is not used in foods.Herbal use:✭Milk thistle fruits have been used for

disorder of liver,spleen and gall bladder.✭Also used for nursing mothers for

stimulating milk production,as abitter tonic for haemorrhoids.

✭The leaves have also been used for the treatment of liver, spleen and gall bladder disorders and as an antimalarial and for uterine complaints.

Pharmacological actions:As well as inhibition of lipid peroxidation,

stimulation of protein biosynthesis and acceleration of liver regeneration.

Mechanism of Action? *Found a dose dependent decrease in HMG-

CoA reductase in the liver with increasing silymarin concentration .

*A decrease in HMG-CoA reductase leads to a decrease in synthesis of cholesterol.

Sid-effects, toxicity:Sever sweating, abdominal cramping,

nausea,vomiting, diarrhoea,anaphylactic shock in a 54-year-old man with immediate type allergy to kiwi fruit.

Contra-indications, warning s:✭It is conta-indication for individuals with

hypersensitivity to species of asteraceae.✭Pregnancy and lactation should be avoided.

Pharmaceutical prepration:

Extract milk thistle capsules 

HawthornSpecies: crataegus laevigata (rosaceae)Synonym: whitethornPart used: fruitLegal category: it is not included in the GSL.Constituents:Amine,flavonoids(flavonol,flavones), tannins.Food used:It is not common used in food.Herbal use:✭It is stated to possess cardiotoinc,coronary

vasodilator and hypotensiveproperties,hypertension

Pharmacological action:An inhibition of lipid peroxidation which can

be caused by highly reactive free radicals was also documented.

Mechanism of Action:The mechanism of action of hawthorn

remains unknown.

Side-effect,toxicity:Nausea,fatigue,sweating,rash on the hand. Contra-indications,warnings:✭Cardiovascular disorder such as

hypertention, hypotention and cardiac disorders.

pregnancy and lactation should be avoided.✭

Pharmaceutical prepration:

Capsule liquid

✰GingerSpecies: Z. officinaleSynonym: zoingiberPart used: rhizomeLegal category: GSLConstituents:Carbohydarates starch, lipids, oleo-resin

gingerol homologues, volatile oils.Food used:It is the natural source of food flavouring,and

used widely in foods as a spice. 

Herbal use:✭Ginger is stated to possess carminative,

diaphoretic and antispasmodic properties.✭Also used for colic, flatulent dyspepsia and

used to prevention of nausea and vomiting.Pharmacological actions:✭Anti-atheroscleroticGinger (dried ginger)oleo-resin by intragastric

administration has been reported to inhibit elevation in serum and hepatic cholesterol concentration in rats by impairing cholesterol absorption and those with existing hypercholesterolamai.

✭Fresh ginger not effect on serum cholesterol.

Side-effect,toxicity:Non toxicContr0indication,warnings:✭Effect to blood pressure✭Pregnancy and lactation should be avoided.Pharmaceutical prepration:

Oleo-resin cream

IspaghulaSpecies: Plantago ovata Forsk.Family: PlantaginaceaeSynonym: Blond psyllium Indian

plantago,Ispagol, Pale psyllium,SpogelPart used: seed, husk

Herbal use:Ispaghula is started to posses demulcent and

laxative properties.

Traditional use:in the treatment of the: chronic constipation. dysentery diarrhea.cystitis.The German commission A approved use for

chronic constipation and disorder in which bowel movement with loose stool are desirable.

Active constituent:1 -Alkaloids Monoterpene-type. Plantagonin

and indicainin.2 -Mucilages 10-30% mucopolysaccharide

consisiting mainly of ahighly branched arabinoxylan with a xylan backbone and branches of arabinose, xylose and 2-O-

galacturonic-rhamnose moites .3- Other constituents: Aucubin sugars (fructose, glucose, sucrose). protein. steroils .triterpenes .fatty acid .tnnins.

Pharmacological actionIn clinical studies:

• Hypocholesterolaemic effects:

26 men with mild to moderate hypercholesterolemia (serum cholesterol concentration: 4.86- 8.12 mmol/L)

received isphagula 3.4 g for eight weeks , and the end of study , serum cholesterol concentration were reduced by 14.8 %

and LDL cholesterol by 20.2% and ratio of LDL to HDL cholesterol by 14.8 %.• Laxative effect.

• Antidiarrhoeal effect.

• Hypoglycemic effect.

Mechanism of actin: IN CHOLESTEROL CONTROL :

The content has cellulose fiber, which is responsible for decreasing the absorption of cholesterol into the blood stream.

Dosage:Seeds/ 5-10g (3g in children ) three times daily, seed should be soaked in worm water for several hr before taking.

Liquid extract/ 2-4 ml (1:1 in 25% alcohol) three times daily.

. Ispaghula Husk 225 Capsules

Ispaghula Husk (300g

Side effects, toxicity:Increase flatulence and abdominal distention,

and may be cause intestinal obstructionIf swllowed dry ,may cause oesphageal

obstruction. Contra-indictions, warnings:Not given to patints with intestinal obstruction.

Should be taken fluid to avoid oesphageal obstruction.

Interaction with other medicinal products and other form of interaction:

Absorption of minerals ( calcium, iron, lithium, zinc), vitamins (B12), cardiac glycoside and coumarine derivatives may be delayed .for this reason the product should not be taken 0.5-1 hr before or after intake of other drugs.

If the product is taken together with meals in the case of insulin-dependent diabetics it may be necessary to reduce the insulin dose .

Pregnancy and lactation:Ispaghula may be used during pregnancy and

lactation

Gugulipid(Gum Guggul, Guggulu )

Species : Commiphora mukul Local Name : Bdellium Gum, Guggulipid, Gum Gugal, Salaitree Gugulipid, gum guggulu. Parts Used : Gum resin extract. Origin:

The mukul myrrh (Commiphora mukul) tree is a small, thorny plant distributed throughout India.

Traditional use:guggul lipid has been used to treat arthritis, rheumatism, haemorrhids, urinary disorder, obesity, skin diseases and high cholesterol. It has been claimed to be widely used for over 2,000 years.

active constituents: Ketone fraction that is extracted from the resin

contains the most potent cholesterol lowering components. This is composed of C21 or C27 steroids, with the

major components being Z- and E-guggulsterone.

Guggul contains resin, volatile oils, and gum. The extract isolates ketonic steroid compounds

known as guggulsterones. These compounds have been

shown to provide the lipid-lowering actions noted for guggul.

Dosage:A common intake of guggulsterones is 25 mg three times per day. Most extracts contain 5-10% guggulsterones. For a 5 percent guggulsterone extract, this translates to an effective dose of 500 milligrams three times per day.

Pharmacology: lowers serum triglycerides and cholesterol as

well as LDL and VLDL cholesterols (the "bad" cholesterols). At the same time, it raises levels of HDL cholesterol (the "good" cholesterol).

inhibits platelet aggregation, stimulation of the thyroid, potentially resulting

in weight loss., deposits of waste or toxic material in the body A direct anti-inflammatory effect reduce the stickiness of platelets.thate lowers the risk of coronary artery disease.

mechanism of action:Guggul works on the liver by increasing the

metabolism (or break down) of the bad cholesterol known as LDL Cholesterol.

After taking the product for 4 to 12 weeks, total cholesterol levels can drop, triglyceride levels can drop and an increase in HDL (the good cholesterol) of approximately 16% can occur.

Guggul can lower blood cholesterol by 14-27% and can lower triglycerides by 22-30%

Advers effect: Gugulipid is a fairly nontoxic product

there may be mild skin rashes or GI upset/diarrhea.

It is safe to use during pregnancy and does not adversely affect liver or kidney function,

Pharmaceutical prepration:Guggul - Pure extract (250 mg capsule)