K - 42 Traditional Medicine (Farmakologi)

7/27/2019 K - 42 Traditional Medicine (Farmakologi)

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Traditional MedicineTri Widyawati


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New drug(release process)

Screening

Mechanism

Component efficacy

System effectiveness

Safety

Utilisation

Safety

System effectiveness

Component efficacy

Mechanism

Traditional drug(in widespread use)


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Herbal medicines are naturalmedicines which made fromplantor

plants part

Most of traditional medicines are

herbal, although some of it are

animal-origin

The knowledge of traditional

medicines are handed down

from generation to generation

over centuries in differentcommunities


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Good examples: vincristine and vinblastine for

cancer, morphin for pain, digitalisfor heart failure,

colchicine for acute attacks of gout, and artemisinin

for drug-resistant malaria.

Good prospects: finding some herbal formulations

forlife-threatening diseases such as cancer and

HIV.

Herbal Medicine: therapeutic agents

Digitalis, the heart stimulant, is found in the leaves of the European foxgloves (Digitalis purpurea)
http://rds.yahoo.com/_ylt=A0Je5xUI0KNEK_MAwIWJzbkF;_ylu=X3oDMTBjb3ZrYjNkBHBvcwM0BHNlYwNzcg--/SIG=1fb4ovi4b/EXP=1151672712/**http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dfoxglove%252C%2Bdigitalis%2B%26ei%3DUTF-8%26fr%3Dsfp%26x%3Dwrt&w=1050&h=1191&imgurl=www.genrichs.com%2Fimages%2FDIGITALIS%2520FOXGLOVE.jpg&rurl=http%3A%2F%2Fwww.genrichs.com%2Ftoc.htm&size=1.4MB&name=DIGITALIS+FOXGLOVE.jpg&p=foxglove%2C+digitalis&type=jpeg&no=4&tt=2,363&ei=UTF-8


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Why people use traditional medicine ?

Health care

Esthetic

Alternatif

Economi

Easy to obtained, prescription (-)

Pegagan


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1.Jamu

(Empirical based herbal medicine)

seluruh bahan tanaman

5-10 plants

Empiric.

Handed down from generation togeneration : safety and efficacy

Indonesian Schemes of Herbal Medicines


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2.Obat Herbal Terstandar

(Scientific based herbal medicine)

extract formulation

complex tools, skills

pre klinik


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Ex.

Extract Conc. Indication

Arvensis Curcuma (temulawak)

(Curcuma xanthorrhiza)

> 17.50% Curcumin Hepatoprotector

Appetice Enhancer

Arvensis Turmeric (kunyit)

(Curcuma domestica)

> 30% Curcumin Antioxidant

Anti Dyspepsia

Immunomodulator

Arvensis Green Tea (teh)

(Camellia sinensis)

> 70% Polyphenols Anti-inflamatory

Anti Oxidant

Arvensis Retropiper (cabe jawa)

(Piper retrofractum)

> 40% Piperin Aphrodisiac

Tonicum

Arvensis Orthosiphon (kumis

kucing) (Orthosiphon stamineus)

> 0.20% Sinensetin Diuretic

Anti Hypertension

Arvensis ginger (jahe)

(Zingiber purpureum Roxb.)

> 0.05% Essential Oil Analgesic

Cardiotonic

Arvensis galanga (kencur)

(Kaempferia galanga)

> 5.60% Essential Oil Anti Dyspepsia

Appetite Stimulant


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3. Phytopharmaca

(Clinical based herbal medicine)

= modern medicine

Standard

Clinical study


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Jamu to Phytopharmaca

Plant

Kurkuminoid

Kurkuminoid Minyak Atsiri

Extracum Curcuma

Curcuma Rhizoma

Curcuma Xanthorriza Roxb

Allo-AromandenrenAr-CurcumenXanthorizol

KurkuminSenyawa Murni

Kelompok Senyawa Bioaktif

Campuran Senyawa Bioaktif

Extract

Part of plant

Minyak Atsiri


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How do herbs work ?

For most herbs, the specific ingredientthat cause a therapeutic effect is notknown

Whole herbs contain many ingredients(alkaloids, terpenoid, saponin, flavonoids, phenols, volatile oils, etc)

that work together to produce the

desired medicinal effect


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Modernpharmacology

Herbalism

Isolated One active ingredients

One effect that measurable & repeatable

Holistic Whole plants

Synergistic effect of itscomponents

Table 1. Comparism of modern pharmacologyand herbalism


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Pharmacology characteristics ofmedicinal plants

Have a broadtherapeutics range

Onset of actionoccurred after alatent period (weeks or months)

The action have usually been observed

empiricallyin human patient treatedwith the herbs


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Pharmacology characteristic(continued)

Accuratepharmacokinetic datafor extractsthat have a complex composition is difficultto obtain

Subjective assessmentsby the patients orphysician used to evaluate efficacy


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Phytomedicines that have undergone pharmacology testing

Herb extract Pharmacological action uses

Ginkgo bilobaLeaf extracts

Anti ischemic Anti hemorrheologic

anti PAF

Cerebralinsufficiency

Peripheral vascular

disease

Garlic cloves

(Allum sativum)

hypolipidemic

Antithrombotic

fibrinolytic

Hypotensive

Dyslipidemia

CV-disorders

Hawthorn extract

(Cratageus monogyna)

positive inotropic

anti arrythmic coronary vasodilatation

mild heart failure

(St. II NYHA)
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Potential Interactionbetween Herbal and Conventional Drugs

Herb Conventional drugs problem echinacea > 8 week anabolic steroids,

methotrexate, amiodarone,ketoconazole

immunosuppresants

hepatotoxicity

antagonist effect

garlic, ginger, ginkgo warfarin altered bleeding

time

ginseng warfarin

estrogens, corticosteroids

altered bleeding

time additive effects

valerian barbiturates additive effects(exessive sedation)


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Many things must take into account

when prescribing herbs, i.e :

Varietyof plantThe plants habitat

How it was stored & processed

Whether or not there are contaminants


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Traditional Medicine Development

Active constituents : Stabil

Market ???

Malaria and filariasis not profitable

Benefit Risk Ratio :Tapak dara (Catharanthus roseus)

antidiabetic & antileukemia


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Morphology ?- Curcuma zedoaria ( kunyit putih, kunir putih)

Vs Curcuma mangga ( temu mangga)

Dosage?

- Kunyit (Curcuma domestica) :

low dose : maag, high dose induce maag

- Mentimun (Cucumis sativus) BP

The Rasionalitation


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When ?- Jamu Kunir asem abortivum

- Jamu cabe puyeng uterus contraction

How?

- Kecubung (Datura metel)

oral: mabuk kecubung midriasis

The Rasionalitation


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Safety ?- Daun tapak dara ( Catharanthus ro seus)leukosit - Keji beling (Sericocalyx crispus) diuretik renal

damage

Biji kapas (Gossypium sp.) gossypol spermicidebut libido

Avoid misuse:

- Jamu masuk angin : asetosal

bleeding


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SOPin Formal health servicesHISTORY

TREATMENT

EXAMINATION

with

drugs

without

drugs

Standard diagnostic Standard treatment

EBM ?

DIAGNOSE


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Evaluating Web Sites

Accuracy

Authority

BiasCurrency

Coverage


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Documents

K - 42 Traditional Medicine (Farmakologi)