Triple Bee Complex by Y S Organic Bee Farms

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Two capsules contain: Royal Jelly (3.5 concentrate equivalant to 700 mg fresh royal jelly) 200 mg • Bee Pollen (multi-floral) 400 mg • Bee Propolis (2 x equivalent to 400 mg natural state) 200 mg • Korean Ginseng root 200 mg. Other Ingredients: Gelatin, Magnesium Stearate, Carob.

Brand name products often contain multiple ingredients. To read detailed information about each ingredient, click on the link for the individual ingredient shown above.

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Effectiveness view details

Below is general information about the effectiveness of the known ingredients contained in the product Triple Bee Complex. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

BEE POLLEN

POSSIBLY INEFFECTIVE

Athletic performance. Small clinical studies suggest that oral bee pollen may not improve athletic performance. Details: Clinical research in athletes shows that taking bee pollen supplements orally does not seem to improve athletic performance or stamina (7062,7063,33973).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Aging. Although there has been interest in using oral bee pollen for aging, there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Allergic rhinitis (hay fever). Although there has been interest in using oral bee pollen for allergic rhinitis (hay fever), there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Amenorrhea. Although there has been interest in using oral bee pollen for amenorrhea, there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Atopic dermatitis (eczema). Although there has been interest in using topical bee pollen for atopic dermatitis (eczema), there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Benign prostatic hyperplasia (BPH). Although there has been interest in using oral bee pollen for BPH, there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Bleeding. Although there has been interest in using oral bee pollen for bleeding, including intracranial hemorrhage, there is insufficient reliable information about the clinical effects of bee pollen for these conditions.
Breast cancer-related hot flashes. It is unclear if oral bee pollen is beneficial for the treatment of menopause-like symptoms in breast cancer patients. Details: Preliminary clinical research in breast cancer patients suggests that taking a combination of bee pollen and honey does not reduce hot flashes or other menopause-like symptoms when compared with honey alone (91983).
Constipation. Although there has been interest in using oral bee pollen for constipation, there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Diarrhea. Although there has been interest in using oral bee pollen for diarrhea, there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Diaper rash. Although there has been interest in using topical bee pollen for diaper rash, there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Dysmenorrhea. Although there has been interest in using oral bee pollen for dysmenorrhea, there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Obesity. Although there has been interest in using oral bee pollen for obesity, there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Oral mucositis. Although there has been interest in using oral bee pollen for oral mucositis, there is insufficient reliable information about the clinical effects of bee pollen for this purpose.
Premenstrual syndrome (PMS). Oral bee pollen has only been studied in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking two tablets twice daily of a specific combination product (Female, Natumin Pharma) containing royal jelly 6 mg, bee pollen extract 36 mg, and bee pollen with pistil extract 120 mg per tablet over a period of 2 menstrual cycles seems to decrease some symptoms of PMS, including irritability, weight gain, and edema, when compared with placebo (12008). More evidence is needed to rate bee pollen for these uses.

(Read more about BEE POLLEN)

PANAX GINSENG (Korean Ginseng)

POSSIBLY EFFECTIVE

Cognitive function. In middle-aged individuals, but not young adults, oral Panax ginseng seems to improve abstract thinking, attention, arithmetic skills, and reaction time. Any benefit to memory seems to be dependent on the inclusion of ginkgo. Details: Some clinical evidence shows that taking Panax ginseng orally can improve abstract thinking, attention, mental arithmetic skills, and reaction times in healthy, middle-aged people; however, Panax ginseng does not seem to improve these outcomes in young adults (2064,23596,23599,23608,23609,54374). While Panax ginseng alone does not seem to improve memory (2064), there is some evidence that a combination of Panax ginseng (G115) and ginkgo leaf (GK501) extract 80-320 mg daily for 12 weeks can improve memory in otherwise healthy people or people with neurasthenia 38-66 years of age (8591,9759,87984,88046). In clinical trials, various doses have been used. These include a specific Panax ginseng extract (G115, Pharmaton SA, Lugano) 200-400 mg once daily or in two divided doses for up to 12 weeks, or 200-960 mg administered as a single dose (8591,23596,23599,23608,23609,54374,88046). Another extract (Gerimax Ginseng Extract; Dansk Droge A/S Ishoj) 400 mg daily for 8 weeks has also been used (2064).
Erectile dysfunction (ED). Oral Panax ginseng seems to improve sexual function in people with ED. Details: Taking Panax ginseng orally for 8 weeks seems to improve sexual function in adults with ED (8813,23637,23638,89747). Doses used in clinical research have included extract from the juice and pulp of 4 year-old Panax ginseng berry 700 mg twice daily (89747), tissue-cultured mountain ginseng extract 1000 mg twice daily (23638), and Korean red ginseng, a type of Panax ginseng, 1000-2700 mg daily (8813,112840). Panax ginseng has also been studied in adults with symptoms of ED that are associated with an enlarged prostate. A small clinical study in adult males with moderate lower urinary tract symptoms shows that taking a specific extract of Korean red ginseng (RXGIN, Jung Kwan Jang), a type of Panax ginseng, 1000 mg daily for 12 weeks improves symptoms of sexual dysfunction including erectile function, sexual desire, orgasmic function, and intercourse satisfaction when compared with placebo. However, there was no improvement reported in overall satisfaction. Most symptoms of ED except sexual desire had not significantly improved by 6 weeks, suggesting that longer durations of at least 12 weeks may be needed for Panax ginseng to significantly improve ED symptoms (112840). Additionally, Panax ginseng has been evaluated in combination with other ingredients. A moderate-sized, open-label clinical study in adults with mild-to-moderate ED shows that taking a specific combination supplement (Icarifil, Anvest Health S.p.A) containing Panax ginseng 150 mg, L-carnitine, L-citrulline, tribulus, and other ingredients daily for 3 months improves patient-reported erectile function when compared to baseline. Additionally, taking the supplement with tadalafil improves some, but not all, patient-reported assessments of erectile function when compared with taking tadalafil alone (114989). It is unclear if this effect is due to Panax ginseng, other ingredients, or the combination. Additionally, the interpretation of these results is limited by poor methodology, including the use of per-protocol analysis and lack of a placebo group.
Influenza. Oral Panax ginseng seems to modestly reduce the risk of developing influenza. However, it might not reduce the severity or duration of symptoms. Details: Some preliminary clinical research shows that taking a specific Panax ginseng extract (G115) 200 mg daily, beginning 4 weeks prior to influenza vaccination and continuing for 8 weeks thereafter, can decrease the relative risk of getting the flu or common cold by 65% when compared with placebo (589). Also, clinical research in healthy adults shows that taking Panax ginseng extract 1 gram three times daily for 12 weeks reduces the relative risk of developing an acute influenza infection by 45% when compared with placebo. However, taking Panax ginseng does not seem to affect symptom duration or severity (89746).
Multiple sclerosis-related fatigue. Oral Panax ginseng seems to reduce fatigue and improve quality of life in patients with multiple sclerosis. Details: Clinical research shows that taking Panax ginseng 250 mg twice daily for 3 months improves symptoms of fatigue and quality of life when compared with placebo in female patients with relapsing-remitting multiple sclerosis (RRMS). Females taking Panax ginseng experienced a 75% reduction in fatigue, compared with no change in the placebo group; quality of life was increased by 19.9 points in the Panax ginseng group, compared with only 4.2 in the placebo group (89745).
Sexual arousal. Oral Panax ginseng, alone or in combination with other ingredients, seems to improve sexual arousal in postmenopausal adults or females with sexual dysfunction. Details: Taking Korean red ginseng, a specific form of Panax ginseng, 3 grams daily for 8 weeks seems to improve sexual arousal and satisfaction when compared with placebo in postmenopausal adults (23630). Also, other preliminary clinical research shows that taking a specific combination product (ArginMax for Women, Daily Wellness Company) containing ginkgo leaf extract, Panax ginseng root extract, damiana leaf extract, L-arginine, multivitamins, and minerals for 4 weeks can improve sexual satisfaction when compared with placebo in females who are self-reported to have sexual dysfunction (23635,46933). It is unclear if this effect is due to Panax ginseng, other ingredients, or the combination.

POSSIBLY INEFFECTIVE

Athletic performance. Most research shows that oral Panax ginseng does not improve athletic performance. Details: Taking Panax ginseng 0.4 to 3 grams daily orally for up to 8 weeks, or as a single dose 200 mg one hour prior to exercise, does not improve aerobic exercise capacity (1427,4230,4231,23646,23647,89737,114981). Higher doses of Panax ginseng also do not seem to improve athletic performance. A small study in young athletes shows that taking Panax ginseng 100 mg/kg (about 5-7 grams, standardized to 10% ginsenosides) daily in three divided doses for 8 days does not improve squat exercise performance, although it might modestly improve perceived exertion, when compared with placebo (103045). Similarly, a small clinical study in adult male recreational athletes shows that taking Panax ginseng extract 500 mg daily for 14 days does not improve 10-kilometer running times when compared with placebo (114981).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Aging. Although there has been interest in using oral Panax ginseng for aging, there is insufficient reliable information about the clinical effects of Panax ginseng for this condition.
Anthracycline cardiotoxicity. It is unclear if oral Panax ginseng protects against anthracycline cardiotoxicity. Details: A very small clinical study in adults with non-metastatic HER-2 negative breast cancer being treated with anthracycline-based chemotherapy in Iran shows that taking Panax ginseng rhizome powder 1000 mg daily starting on the first day of doxorubicin administration until one week after completion of the eighth doxorubicin cycle improves left ventricular ejection fraction (LVEF) by 1% when compared with placebo, which was associated with a 7% reduction in LVEF. Treatment with Panax ginseng also reduces the incidence of chemotherapy-related cardiac dysfunction when compared with placebo, an effect that endured over a 6-month follow up period. However, Panax ginseng did not improve the cardiac biomarker high-sensitive cardiac troponin I or transthoracic echocardiographic measurements of left atrium diameter, left ventricular end-systolic diameter, or left ventricular end-diastolic diameter when compared with placebo (112817).
Attention deficit-hyperactivity disorder (ADHD). Oral Panax ginseng has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small low-quality study in children with ADHD aged 6-12 years shows that taking Panax ginseng extract 3 mg with omega-3 fatty acids 500 mg daily for 12 weeks improves overall symptoms, reduces errors of commission, and improves reaction time when compared with baseline (103049). The validity of this study was limited by the lack of a comparator group. Also, it is unclear if these changes are due to Panax ginseng, omega-3 fatty acids, or the combination.
Age-related cognitive decline. It is unclear if oral Panax ginseng is beneficial in age-related cognitive decline. Details: Clinical research in patients over 50 years of age with memory impairments shows that taking standardized ginseng extract (G115) in combination with vitamins, minerals, and dimethylaminoethanol bitartrate may improve memory when compared to baseline (23600). The validity of this finding is limited by the lack of a comparator group. Also, it is unclear if these changes are due to Panax ginseng, other ingredients, or the combination.
Allergic rhinitis (hay fever). It is unclear if oral Panax ginseng is beneficial in allergic rhinitis. Details: A small clinical study in adults with allergic rhinitis shows that taking Panax ginseng (Korean Ginseng Corporation) 3 mg/kg daily for 4 weeks improves rhinorrhea, nasal itch, and eye itch when compared to baseline (103047). The validity of this study is limited because it did not report statistical comparisons between the treatment and control groups.
Alzheimer disease. Some preliminary clinical studies suggest that oral Panax ginseng might improve cognitive performance in patients with this condition. Details: Clinical research shows that taking Panax ginseng root 4.5 to 9 grams daily for 12 weeks can improve cognitive performance in patients with Alzheimer disease when compared with control (23611,23612). The validity of this finding is limited by the lack of patient and caregiver blinding.
Androgenic alopecia. Topical Panax ginseng has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with androgenic alopecia shows that applying 1 mL of a topical combination product (Hirsuit hair tonic, Dermcor Pharmaceutical) containing Panax ginseng extract, biochanin A (from red clover), acetyl tetrapeptide-3, Salvia officinalis oil, and other ingredients, twice daily for 24 weeks, is similarly effective to minoxidil 3% solution for increasing hair count and mass (105672). It is unclear if the benefit is due to Panax ginseng, other ingredients, or the combination.
Anxiety. Although there has been interest in using oral Panax ginseng for anxiety, there is insufficient reliable information about the clinical effects of Panax ginseng for this condition.
Aplastic anemia. Although there has been interest in using oral Panax ginseng for aplastic anemia, there is insufficient reliable information about the clinical effects of Panax ginseng for this condition.
Asthma. Although there has been interest in using oral Panax ginseng for asthma, there is insufficient reliable information about the clinical effects of Panax ginseng for this condition.
Benign prostatic hyperplasia (BPH). It is unclear if oral Panax ginseng is beneficial for treating lower urinary tract symptoms. Details: A small clinical study in adults with moderate lower urinary tract symptoms shows that taking a specific extract of Korean red ginseng (RXGIN, Jung Kwan Jang), a type of Panax ginseng, 1000 mg daily for 12 weeks reduces serum prostate-specific antigen (PSA) and improves most prostate symptoms including residual urine sensation, frequency, intermittency, urgency, weak stream, straining, and nocturia after 6 and 12 weeks when compared with placebo. However, there was no improvement in maximum urinary flow rate or post-void residual volume when compared with placebo (112840).
Breast cancer. It is unclear if oral Panax ginseng is beneficial in breast cancer. Details: Observational research in Chinese patients with breast cancer suggests that regular use of ginseng, including either Panax ginseng or American ginseng, is associated with higher quality of life scores and a lower risk of overall mortality, breast cancer-related mortality, and breast cancer recurrence when compared with patients who do not take ginseng (14466). However, ginseng users were also significantly more likely to have been treated with tamoxifen. Another small clinical study in adults with non-metastatic breast cancer undergoing anthracycline-based chemotherapy in Iran shows that taking Panax ginseng 1 gram daily starting on the first day of chemotherapy until 1 week after completion of the final cycle at 7 or 10 weeks improves social, emotional, and functional measures of health-related quality of life but does not improve physical well-being when compared with placebo (112823).
Bronchitis. It is unclear if oral Panax ginseng is beneficial in bronchitis. Details: One small clinical study shows that taking a specific Panax ginseng extract (G115) 100 mg twice daily for 9 days might be beneficial when used adjunctively for treating acute exacerbations of chronic bronchitis. Panax ginseng, combined with antibiotic therapy, might reduce bronchial bacterial counts more than antibiotic therapy alone (8814).
Cancer. It is unclear if oral Panax ginseng is beneficial in preventing cancer. However, it might increase quality of life in some cancer patients. Details: Observational research has found that taking ginseng orally might decrease the incidence of cancer, specifically breast, stomach, lung, liver, ovarian, and skin cancer (2063,3122). But evidence from large-scale clinical research shows that taking Panax ginseng 1 gram once weekly for 3 years does not reduce the risk of cancer development (23622). However, some clinical research suggests that Panax ginseng may slow cancer progression or improve quality of life in patients already diagnosed with cancer. One clinical study shows that taking sun ginseng, a form of Panax ginseng that has been heat treated, 3000 mg daily orally for 12 weeks can improve quality of life for cancer patients (23643). Evidence from a case series suggests that giving Panax ginseng (also called Cultivated Wild Ginseng Pharmacopuncture) 20 mL daily by intravenous infusion for up to 13 cycles lasting 2-4 weeks each may attenuate the progression of advanced non-small cell lung cancer in some patients (23619,23620).
Cancer-related fatigue. It is unclear if oral Panax ginseng is beneficial in cancer-related fatigue. Details: Preliminary clinical research shows that taking Panax ginseng 400 mg twice daily for 4 weeks reduces fatigue in 63% of adults with cancer-related fatigue when compared to baseline. Panax ginseng also reduces pain and improves appetite and overall quality of life when compared to baseline. The lack of a control group limits the validity of these findings (96217). Another clinical study in patients with colorectal cancer receiving the mFOLFOX-6 chemotherapy regimen shows that taking Panax ginseng 2000 mg daily for 16 weeks improves fatigue as measured on the brief fatigue inventory (BFI) when compared with placebo. However, when evaluated on the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale, no benefit was seen (103048).
Chronic fatigue syndrome (CFS). It is unclear if oral Panax ginseng is beneficial in patients with severe CFS. Details: A nonblinded, observational study in patients with severe CFS, most of whom also have fibromyalgia, shows that taking Panax ginseng daily for one month improves patient reports of energy, overall wellbeing, mental clarity, sleep, pain, and stamina when compared with baseline. Patients took Panax ginseng either as capsules (Terry Naturally HRG80 Red Ginseng Energy capsules; EuroPharma, Inc) 200-400 mg daily or chewable tablets (Terry Naturally HRG80 Red Ginseng Energy chewable tablets; EuroPharma, Inc) 100-200 mg daily. There were no dose- or formulation-dependent differences between groups (107746). The validity of these findings is limited by the lack of randomization and placebo-control; additionally, the majority (89%) of patients included in this study were female.
Chronic kidney disease (CKD). It is unclear if oral Panax ginseng prevents CKD. Details: A cross-sectional study in Korea suggests that supplemental Panax ginseng or American ginseng use is associated with a higher prevalence of CKD when compared with no supplemental ginseng use. However, no association was found when adjusting the results for potential confounders (112810). The applicability of these results is limited by a lack of subgroup analysis on the type of supplemental ginseng.
Cognitive impairment. It is unclear if oral Panax ginseng is beneficial for the prevention or treatment of cognitive impairment. Most research has evaluated Panax ginseng in combination with other ingredients. Details: Preliminary clinical research in elderly patients with mild cognitive impairment shows that taking a specific combination product (Memo, Pharco Pharmaceuticals), which contains natural lyophilized royal jelly 750 mg, standardized ginkgo leaf extract 120 mg, and standardized Panax ginseng root extract 150 mg, orally for 4 weeks improves memory when compared with placebo (89712). It is unclear if these benefits are due to Panax ginseng, other ingredients, or the combination. A moderate-sized clinical study in older adults with subjective memory impairment shows that taking a specific Panax ginseng sprout extract (ThinkGIN, BTC Corporation) 450 mg daily for 12 weeks improves performance on some verbal and visual memory tests and cognitive function as measured with MoCA-Korean version when compared with placebo (114983).
Common cold. It is unclear if oral Panax ginseng is beneficial in preventing the common cold. Details: Preliminary clinical research shows that taking a specific Panax ginseng extract (G115) 200 mg daily orally beginning 4 weeks prior to influenza vaccination and continuing for 8 weeks thereafter can decrease the relative risk of getting the flu or common cold by 65% when compared with placebo (589).
Congestive heart failure (CHF). It is unclear if oral Panax ginseng is beneficial in CHF. Details: A small clinical study in adults with CHF shows that Panax ginseng 2 grams daily, with or without digoxin 0.25 mg once daily for 15 days, seems to improve heart function according to New York Heart Association (NYHA) classification when compared to baseline. Ginseng might also improve hemodynamics and may work synergistically with digoxin (4243). The validity of these findings is limited by the lack of a comparator group.
Constipation. It is unclear if oral fermented Panax ginseng is beneficial for constipation. Details: An observational study in healthy postmenopausal adults aged 50 years and older in Korea suggests that taking fermented red ginseng 20 mL before meals daily for 3 weeks normalizes stool consistency and increases the frequency of bowel movements when compared to baseline (112837). The validity of these effects is limited by the observational study design, lack of a comparator group, and insufficient blinding.
Chronic obstructive pulmonary disease (COPD). Oral Panax ginseng has primarily been evaluated in combination with other ingredients for improving symptoms of COPD; its effect when used alone is unclear. Taking Panax ginseng doesn't seem to prevent exacerbations. Details: A meta-analysis of clinical trials in patients with stable COPD shows that taking Panax ginseng, usually in combination with other ingredients as part of TCM formulations, significantly improves pulmonary function tests and quality of life when compared with placebo after 3-6 months of treatment. These formulations improve COPD symptoms by approximately 53% when compared with placebo. However, they only modestly improve forced expiratory volume in one second (FEV1) (17736). In contrast, Panax ginseng might not reduce the risk of COPD exacerbations. A clinical study in patients with moderate to very severe COPD shows that taking Panax ginseng 200 mg does not reduce the rate of acute COPD exacerbations over 12 months (103044).
Depression. It is unclear if Panax ginseng is beneficial in depression. Details: In adults with treatment-resistant major depressive disorder, a small clinical study shows that taking Panax ginseng 2 grams daily in addition to current antidepressant medications for 6 weeks produces remission in 39% of patients and decreases scores on the Montgomery-Asberg Depression Rating Scale by a mean of 44% when compared with baseline (104954). The reliability of these findings is limited by the lack of a control group, randomization, blinding, and an intention-to-treat analysis, as well as a high drop-out rate.
Diabetes. Research on the use of oral Panax ginseng for improving glycemic control in patients with diabetes is inconclusive and conflicting. Details: A meta-analysis of 6 small clinical trials in patients with type 2 diabetes using Panax ginseng for 4-24 weeks and 3 small trials using American or unidentified ginseng for 4-8 weeks, shows that taking these ingredients modestly reduces fasting blood glucose, but does not affect glycated hemoglobin (HbA1c) or insulin levels, when compared with control (105689). This analysis is limited by publication bias, as well as the heterogeneity and imprecision of the included trials. Another meta-analysis of 5 clinical studies in healthy adults and adults with a variety of metabolic disorders including diabetes and prediabetes shows that taking Panax ginseng 200 mg up to 8 grams daily for 4 to 24 weeks does not improve fasting blood glucose, 2-hour postprandial blood glucose, HbA1c, or insulin levels when compared with placebo. However, Panax ginseng might improve glucose AUC in these individuals. Subgroup analysis further suggests that the beneficial effect of Panax ginseng on glucose AUC is greater in adults with diabetes than those with prediabetes (112838). Individual small studies have shown modest glycemic benefit with fermented Panax ginseng 2.7 grams daily for 4 weeks or non-fermented Panax ginseng 6 grams daily for 8-12 weeks (23627,89740), and other studies have shown no benefit with Korean red ginseng extract or Korean black ginseng 2-8 grams daily for 4-6 weeks (17734,112839). It is unclear if the effects of Panax ginseng may be dose- or product-dependent. Panax ginseng has also shown some glycemic benefit when used in combination with other ingredients. Panax ginseng extract 750 mg (standardized to 30% ginsenosides) has been used in combination with American ginseng extract 1500 mg (standardized to 10% ginsenosides), viscous fiber 10 grams, and ground white chia seeds 60 grams daily for 24 weeks (105673). It is unclear if this benefit is due to Panax ginseng, other ingredients, or the combination.
Diabetic neuropathy. It is unclear if oral Panax ginseng is beneficial in diabetic neuropathy. Details: A small clinical study in patients with diabetic neuropathy shows that taking Panax ginseng extract powder 1 gram daily for 24 weeks seems to improve sensory perception of electric currents, a marker for severity of diabetic neuropathy, when compared with baseline (103051). The validity of this study was limited by the lack of statistical comparison between treatment and placebo groups.
Exercise-induced muscle damage. Although there has been interest in using oral Panax ginseng for exercise-induced muscle damage, there is insufficient reliable information about the clinical effects of Panax ginseng for this condition.
Fatigue. Most clinical research shows that oral Panax ginseng can reduce fatigue in adults with idiopathic chronic fatigue. However, not all research agrees. Details: Some clinical research in patients with idiopathic chronic fatigue or self-reported fatigue shows that taking Panax ginseng improves self-reported fatigue when compared with baseline or placebo (89743,23623,106665). A small clinical study in patients with idiopathic chronic fatigue shows that taking an ethanolic extract of Panax ginseng 1 gram twice daily for 4 weeks reduces self-reported fatigue by 66% and mental fatigue by 50% when compared with placebo (89743). Another clinical study in adults with chronic fatigue also shows that taking a specific combination product containing Panax ginseng (G115) 80 mg, vitamins, and minerals daily for 7 weeks alleviates fatigue symptoms in 20% more patients when compared with placebo (23623). However, not all research has been positive. A small clinical study in middle-aged patients with idiopathic chronic fatigue shows that taking Panax ginseng, steamed and aged for six years, 3 grams daily for 6 weeks is no different than placebo for reducing fatigue (103052). Notably, this clinical trial had a robust placebo effect.
Fibromyalgia. It is unclear if oral Panax ginseng is beneficial for fibromyalgia. Details: Clinical research shows that taking Panax ginseng root extract 100 mg daily orally for 12 weeks does not improve pain, fatigue, sleep quality, anxiety, tender point count, or quality of life when compared with placebo in patients with fibromyalgia (89744). A nonblinded, observational study in patients with fibromyalgia, most of whom also have severe chronic fatigue syndrome (CFS), shows that taking Panax ginseng daily for one month improves patient reports of energy, overall wellbeing, mental clarity, sleep, pain, and stamina when compared with baseline. Patients took Panax ginseng, either as a capsule (Terry Naturally HRG80 Red Ginseng Energy capsules; EuroPharma, Inc) 200-400 mg daily, or chewable tablet (Terry Naturally HRG80 Red Ginseng Energy chewable tablets; EuroPharma, Inc) 100-200 mg daily. There were no dose- or formulation-dependent differences between groups (107746). The validity of these findings is limited by the lack of randomization and placebo-control; additionally, the majority (89%) of patients included in this study were female.
Gallbladder disease. It is unclear if oral Panax ginseng is beneficial for gallbladder disease. Details: Clinical research shows that taking Panax ginseng 7.5 grams as an adjuvant to the bile acids chenodeoxycholic acid (CDCA) 500 mg daily plus ursodeoxycholic acid (UDCA) 500 mg daily, divided into three doses daily for 24 weeks, does not decrease the total volume of gallstones or increase gallstone dissolution when compared to use of bile acids alone (89748).
Gastritis. Although there has been interest in using oral Panax ginseng for gastritis, there is insufficient reliable information about the clinical effects of Panax ginseng for this condition.
Glaucoma. It is unclear if oral Panax ginseng is beneficial for glaucoma. Details: A clinical crossover study in patients with glaucoma shows that taking oral Panax ginseng 1 gram three times daily for 4 weeks improves dry eye severity, daytime visual function, and eye pain when compared with placebo. In a sub-group of patients with early or moderate glaucoma, nighttime visual function was also improved (107744). The validity of this study is limited due to short duration of treatment.
Halitosis. It is unclear if oral Panax ginseng is beneficial for halitosis. Details: Preliminary clinical research shows that taking Korean red ginseng, a type of Panax ginseng, 2.7 grams daily for 10 weeks helps reduce bad breath when compared with baseline, particularly in patients with bad breath caused by Helicobacter pylori (H. pylori) infection (23624). The validity of this finding is limited by the lack of a comparator group.
Hangover. It is unclear if oral Panax ginseng is beneficial for hangover. Details: One small clinical study shows that drinking 100 mL of a drink containing Panax ginseng extract 0.321 mg/mL within 5 minutes of drinking 100 mL blended Scotch whiskey with 40% alcohol and eating a piece of cheese may reduce hangover symptoms by approximately 66% when compared with placebo in healthy males. Levels of alcohol in the blood also appear to be reduced (89742).
Hearing loss. It is unclear if oral Panax ginseng is beneficial for hearing loss. Details: Preliminary clinical research in male textile workers exposed to continuous noise shows that taking Korean red ginseng, a type of Panax ginseng, 200 mg daily for 14 days reduces temporary hearing loss caused by noises at frequencies of 4, 6, or 16 kHz when compared with control. However, Panax ginseng may be slightly less effective than N-acetyl cysteine at preventing temporary hearing loss caused by noise at 4 kHz frequency (89739).
HIV/AIDS. It is unclear if oral Panax ginseng is beneficial for this condition. Details: Preliminary clinical research in adults with HIV shows that taking Korean red ginseng, a particular form of Panax ginseng, along with highly active antiretroviral therapy (HAART) modestly increases CD4 count, but does not affect viral load, when compared with HAART alone (23625).
Hyperlipidemia. It is unclear if oral Panax ginseng is beneficial for hyperlipidemia. Details: A meta-analysis of clinical studies in healthy adults and adults with a variety of metabolic disorders shows that taking Panax ginseng 200 mg to 8 grams daily for 4 to 24 weeks reduces total cholesterol by 7 mg/dL and low-density lipoprotein (LDL) cholesterol by 9 mg/dL but does not reduce triglycerides or increase high-density lipoprotein (HDL) cholesterol when compared with placebo (112838). However, a meta-analysis of up to 28 clinical studies in healthy adults and adults with a variety of metabolic disorders shows that taking Panax ginseng 300 mg to 6 grams daily for 3 to 32 weeks does not reduce total or LDL cholesterol or triglycerides or increase HDL cholesterol when compared with placebo (114985).
Hypertension. It is unclear if oral Panax ginseng is beneficial for hypertension. Details: A meta-analysis of clinical studies in healthy adults and adults with a variety of metabolic disorders shows that taking Panax ginseng 200 mg to 8 grams daily for 4 to 24 weeks does not reduce systolic (SBP) or diastolic (DBP) blood pressure when compared with placebo. However, subgroup analysis suggests that Panax ginseng might modestly reduce SBP in people with prehypertension, hypertension, or metabolic syndrome (112838). Smaller individual studies of various forms of Panax ginseng have been evaluated in patients with mild to severe hypertension with conflicting results. Some preliminary clinical research in patients with essential hypertension shows that taking Panax ginseng 4.5 grams daily in three divided doses, alone or with a beta-blocker or calcium channel blocker for 8 weeks, moderately decreases 24-hour SBP (23632). However, in patients with prehypertension or mild hypertension, taking protopanaxatriol-enriched Panax ginseng (Ginseol K-g1) 100 mg or 300 mg daily for 8 weeks does not reduce seated SBP or DBP when compared with placebo (89741). Panax ginseng has also been evaluated in combination with American ginseng. Clinical studies in patients with hypertension with or without type 2 diabetes show that taking Panax ginseng 0.75 grams and American ginseng 1.5-2.25 grams enriched to contain 30% total ginsenosides daily for 12 weeks reduces central SBP by about 5 mmHg and 24-hour SBP by about 4 mmHg, but does not impact DBP, when compared with placebo or a control of wheat-bran (103046,107745). Patients receiving this combination also have greater reductions in daytime SBP, glycated hemoglobin, total cholesterol levels, and triglyceride levels when compared with control (107745). It is unclear if these effects are due to Panax ginseng, American ginseng, or the combination; additionally, it is unclear if enrichment with ginsenosides alters clinical effects.
Impaired glucose tolerance (prediabetes). It is unclear if oral Panax ginseng is beneficial for impaired glucose tolerance. Details: In overweight adults with prediabetes, a small clinical study shows that taking hydrolyzed Panax ginseng extract, 320 mg three times daily before meals for 6 months, does not improve fasting blood glucose levels. However, compliance in this study was only 49% (104953). Additionally, a large, cross-over, clinical study in patients with prediabetes initiating a lifestyle intervention shows that taking a Chinese herbal medicine preparation containing Panax ginseng providing ginseng berry saponins 50 mg three times daily for 4 weeks improves 2-hour post-prandial glucose, but not fasting blood glucose, when compared with placebo (114980). Panax ginseng has also been studied in combination with other ingredients. One clinical study shows that taking a combination of Korean red ginseng, a type of Panax ginseng, and cheonggukjang, a type of fermented soybean paste, 20 grams daily for 8 weeks can decrease fasting blood glucose levels by 17% in patients with prediabetes (23640). Also, taking fermented Panax ginseng 2.7 grams daily for 4 weeks reduces 2-hour postprandial glucose by about 17% and increases 2-hour postprandial insulin levels by about 44% when compared to baseline; when compared with placebo, these changes are significant (89740). It is unclear if these effects are due to Panax ginseng, other ingredients, or the combinations.
Inflammatory bowel disease (IBD). Although there has been interest in using oral Panax ginseng for Crohn disease and ulcerative colitis, there is insufficient reliable information about the clinical effects of Panax ginseng for these conditions.
Insomnia. Although there has been interest in using oral Panax ginseng for insomnia, there is insufficient reliable information about the clinical effects of Panax ginseng for this condition.
Liver disease. Although there has been interest in using oral Panax ginseng for liver diseases, there is insufficient reliable information about the clinical effects of Panax ginseng for these conditions.
Male infertility. It is unclear if oral Panax ginseng is beneficial for male infertility. Details: Chronic prostatitis due to Chlamydia trachomatis infection is associated with reduced male fertility due to decreased sperm concentration and motility. Preliminary clinical research in adults with this condition shows that taking 25 mL of a specific product containing L-arginine 1660 mg, L-carnitine 150 mg, acetyl-L-carnitine 50 mg, and Panax ginseng 200 mg (Fertimev) along with prulifloxacin 600 mg daily for 6 months improves sperm concentration and sperm motility when compared to treatment with prulifloxacin alone (59006). It is unclear if this effect is due to Panax ginseng, other ingredients, or the combination.
Menopausal symptoms. Research on oral Panax ginseng for menopausal symptoms has yielded conflicting results. Details: One clinical study in postmenopausal adults shows that taking Panax ginseng extract (G115) 200 mg daily orally for 16 weeks does not improve psychological well-being or reduce vasomotor symptoms such as hot flashes when compared with placebo (10981). However, several smaller clinical studies in postmenopausal adults demonstrate beneficial effects with higher doses of Panax ginseng. One study shows that taking Panax ginseng 1 gram (containing 30 mg ginsenosides) three times daily for 12 weeks reduces hot flashes and other symptoms, as measured by the Kupperman index and the Menopause Rating Scale (MRS), when compared with placebo (89749). Another study shows that taking an extract of Korean red ginseng, a specific form of Panax ginseng, 500 mg 4 times daily for 8 weeks improves fatigue severity scores by 21%, compared with 3% in those receiving placebo (106666). In premenopausal adults with menopausal symptoms following surgery for gynecologic cancer, taking Panax ginseng 1 gram three times daily for 12 weeks reduces the total symptom score on the MRS when compared with baseline. However, there was also a robust response in the placebo group, with no significant difference in symptom reduction between groups (104596). Panax ginseng has also been evaluated for improving genitourinary syndrome and cognition after menopause. A small clinical trial in postmenopausal adults with genitourinary syndrome shows that taking a specific Panax ginseng supplement (Ruginseng, Ghaem Daru Pharmaceutical) 500 mg twice daily for 4 weeks does not affect vaginal maturation index or pH, but seems to improve patient-rated symptoms such as vaginal itching and burning, when compared with a lactose placebo (105670). This study was funded by the supplement manufacturer. In another clinical study, taking a specific combination product (Gincosan) containing Panax ginseng 200 mg and ginkgo 120 mg daily for 6-12 weeks does not improve cognition, memory, mood, anxiety, or sleep when compared with placebo (87767).
Metabolic syndrome. It is unclear if oral Panax ginseng is beneficial for metabolic syndrome. Details: A meta-analysis of 23 clinical studies in healthy adults, menopausal adults, and adults with a variety of metabolic disorders shows that taking Panax ginseng 200 mg to 8 grams daily for 4 to 24 weeks reduces glucose area under the plasma concentration-time curve (AUC), total cholesterol, and high-density lipoprotein cholesterol, but does not improve other measures of blood glucose, insulin resistance, blood pressure, lipids, or anthropometric measures when compared with placebo (112838). Additionally, a small clinical study in adults with metabolic syndrome shows that taking Korean red ginseng, a specific form of Panax ginseng, 6 grams daily for 8 weeks modestly reduces systolic blood pressure from baseline, but not when compared with placebo. Additionally, Panax ginseng has no effect on anthropometric measurements, biochemical markers, or other vital signs when compared with placebo (106667).
Nausea and vomiting. Although there has been interest in using oral Panax ginseng for nausea and vomiting, there is insufficient reliable information about the clinical effects of Panax ginseng for these conditions.
Neuropathic pain. Although there has been interest in using oral Panax ginseng for neuropathic pain, there is insufficient reliable information about the clinical effects of Panax ginseng for this condition.
Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral Panax ginseng is beneficial for NAFLD. Details: A small clinical study in adults with NAFLD shows that taking Panax ginseng 2 grams (containing ginsenosides 4.5 mg/gram) daily for 30 days modestly reduces fatigue and plasma levels of alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) when compared with placebo. All patients were also given milk thistle dried extract 450 mg (Legalon, Bukwang Pharmaceutical) daily and asked to exercise daily for at least 30 minutes (105671).
Oral cancer. It is unclear if topical Panax ginseng is beneficial for oral health in patients with oral cancer. Details: A small clinical study in patients with oral cancer and poor oral hygiene shows that rinsing with a specific herbal mouthwash (Dr. Dental care liquid, Jangin Pharm Co., Ltd.) containing Panax ginseng 8 mL for 1 minute twice daily for 14 days reduces oral bacterial load and improves oral hygiene and gingival indices when compared with chlorhexidine or saline rinses (114987).
Osteoarthritis. It is unclear if oral Panax ginseng is beneficial for osteoarthritis of the hand. Details: A small clinical study in postmenopausal adults with degenerative osteoarthritis of the hand shows that taking oral Korean red ginseng, a type of Panax ginseng, 1 gram three times daily for 12 weeks improves pain scores at rest, during daily activity, and at work or sport, and also improves disabilities of the arm, shoulder, and hand (DASH) score when compared with placebo (107747). The validity of this trial is limited due to the lack of objective outcome measures.
Pneumonia. Injectable Panax ginseng has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Oral Panax ginseng has not been evaluated for this use. Details: A meta-analysis of 20 small, low-quality randomized and non-randomized studies in older Chinese adults with severe pneumonia shows that administering an injection containing Panax ginseng extract 0.8 mg/mL and aconite extract 0.1 mg/mL in addition to standard treatment leads to improvement in symptoms such as fever, cough, and chest tightness in 77% of patients as compared with 61% of those who received standard treatment alone. This combination injection may also modestly reduce disease severity and the risk of mortality when compared with standard treatment alone. However, these outcomes were not evaluated in all studies, and dosing regimens were heterogenous (110472). Additionally, it is unclear whether these effects are due to Panax ginseng, aconite, or the combination.
Premature ejaculation. Oral Panax ginseng has primarily been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Applying a multi-ingredient cream preparation containing Panax ginseng, angelica root, Cistanches deserticola, Zanthoxyl species, torlidis seed, clove flower, asiasari root, cinnamon bark, and toad venom (SS Cream) to the glans penis one hour prior to intercourse and washing off immediately before intercourse seems to improve ejaculatory latency in adults with premature ejaculation when compared with placebo (2537). It is unclear if this effect is due to Panax ginseng, other ingredients, or the combination.
Quality of life. It is unclear if oral Panax ginseng is beneficial for quality of life. Details: While some research suggests that Panax ginseng might improve self-rated quality of life (6254,23644), other studies show no benefit (8601,10314). In studies showing benefit for quality of life, doses have included one capsule daily of a specific Panax ginseng extract (Pharmaton Capsules, Pharmaton Natural Health Products) for 12 weeks (6254) and Panax ginseng extract (G115) 40 mg twice daily for 12 weeks (23644).
Rheumatoid arthritis (RA). It is unclear if oral Panax ginseng is beneficial for improving symptoms of RA. Details: A moderate-sized clinical study in patients with RA, Sjogren syndrome, or both shows that taking Panax ginseng 2000 mg daily for 3 months does not improve fatigue scores when compared with placebo (114984).
Sjogren syndrome. It is unclear if oral Panax ginseng is beneficial in patients with Sjogren syndrome. Details: A moderate-sized clinical study in patients with RA, Sjogren syndrome, or both shows that taking Panax ginseng 2000 mg daily for 3 months does not improve fatigue scores when compared with placebo (114984).
Stress. It is unclear if oral Panax ginseng is beneficial for stress. Details: A small clinical study in healthy patients with occupational stress shows that taking a specific Panax ginseng root preparation (HRG80) high in ginsenosides daily for 14 days modestly reduces perceived stress and improves attention and memory when compared with placebo. However, taking a standard Panax ginseng preparation with a lower quantity of ginsenosides was no better than placebo (103050). However, a moderate-sized clinical study in adult males shows that taking Panax ginseng 2000 mg daily for 8 weeks does not improve self-reported stress response when compared with placebo (114988).
Stroke. It is unclear if oral Panax ginseng prevents stroke. Details: A small clinical study in adults with severe atherosclerosis in major intracranial arteries or extracranial carotid arteries at high risk for ischemic stroke shows that taking an extract of Korean red ginseng, a type of Panax ginseng, 1000 mg twice daily for 12 months does not prevent transient ischemic attack or ischemic stroke and does not improve neurological disability, cerebral blood flow, or the incidence of new ischemic brain lesions when compared with placebo (112835).
Traumatic brain injury (TBI). It is unclear if oral Panax ginseng is beneficial for asthenic syndrome due to TBI. Details: A small study in adults with asthenic syndrome secondary to mild combat TBI shows that taking Panax ginseng improves autonomic nervous system functioning and asthenic symptoms when compared to baseline (112834). The validity of these effects is limited by a lack of a comparator group.
Vascular dementia. Oral Panax ginseng has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients aged 60 years or older with vascular dementia shows that taking a supplement containing extracts of Panax ginseng, ginkgo, and saffron three times daily for 16 weeks modestly improves some cognitive function scores, caregiver assessed activities of daily living, and patient-reported quality of life when compared with placebo. However, these effects were not maintained after patients stopped taking the supplement (111336). Additionally, it is unclear if these effects are due to Panax ginseng, other ingredients, or the combination.
Wrinkled skin. It is unclear if oral Panax ginseng is beneficial for wrinkled skin. Details: Preliminary clinical research shows that taking 3 grams of a combination of Korean red ginseng root with Torilus fructus and Corni fructus daily for 24 weeks may reduce wrinkles when compared with placebo. However, it does not seem to affect skin elasticity, moisture, thickness, or color (23645). It is unclear if this benefit is due to Panax ginseng, other ingredients, or the combination. More evidence is needed to rate Panax ginseng for these uses.

(Read more about PANAX GINSENG)

PROPOLIS (Bee Propolis)

POSSIBLY EFFECTIVE

Diabetes. Oral propolis seems to improve glycemic control in patients with type 2 diabetes; however, some conflicting evidence exists. Details: A meta-analysis of six clinical trials including 374 patients with type 2 diabetes shows that taking propolis for 8 weeks to 6 months reduces glycated hemoglobin (HbA1c) by 0.5% and fasting plasma glucose by 14 mg/dL when compared with placebo. However, significant improvements in insulin levels or measures of insulin resistance were lacking (102520). While this pooled analysis suggests that propolis is modestly effective for improving glycemic control, individual study results are mixed. Three of the trials in the analysis failed to demonstrate significant improvements in HbA1c or glucose levels; however, all of these studies were small and likely underpowered to detect meaningful improvements in glycemic control (102523,102524,102525). Other studies showed positive results, with reductions in HbA1c ranging from 0.9% to 1.1% and reductions in fasting plasma glucose ranging from 21 mg/dL to 26 mg/dL. The doses and durations of propolis therapy in these studies included 400 mg daily for 6 months (99173), 900 mg daily for 12 weeks (95883), and 500 mg three times daily for 8 weeks (102521).
Herpes labialis (cold sores). Topical propolis ointment or cream, applied five times daily, may improve lesion healing and reduce symptoms in patients with cold sores. Details: One small clinical study in patients with cold sores shows that applying a specific propolis 3% ointment (Herstat or ColdSore-FX by Afexa), five times daily at the start of symptoms, reduces cold sore duration by about 3-4 days and may reduce cold sore-related pain when compared with placebo (17664,17665). Larger clinical studies in patients with cold sores in the papular or vesicular stages show that applying a lip cream containing a specific propolis extract (GH2002) 0.5% five times daily for 5-10 days reduces the time to complete encrustation/epithelialization by about 1 day and improves symptoms of pain, burning, itching, tension, and swelling when compared with acyclovir 5% cream (95875,102519).
Oral mucositis. Most clinical research shows that oral propolis or propolis-containing mouthwash can reduce the risk for severe, chemotherapy-induced oral mucositis. Details: A meta-analysis of five clinical trials including 209 patients shows that using mouthwash containing propolis reduces the odds of severe chemotherapy-induced oral mucositis by 65% when compared with placebo in cancer patients (99171). Rinsing with 5-10 mL of a propolis mouth rinse for 1 minute three times daily, alone or in addition to chlorhexidine mouthwash and fluconazole for 7-14 days, improves mucositis and redness when compared to control in patients receiving chemotherapy (92793,95877). A small clinical study in patients receiving chemotherapy for breast cancer also shows that taking tablets of propolis (Natur Farma S.A.S.) 80 mg two or three times daily for 3 weeks, in addition to rinsing with sodium bicarbonate solution, decreases the development of mucositis when compared with only rinsing with sodium bicarbonate solution (95882). However, at least one high quality clinical study shows that rinsing with 7 mL of a specific product (Faringel, Cadigroup) containing propolis extract 6% and other ingredients three times daily for 6 weeks does not prevent the development of mucositis due to chemotherapy when compared with placebo in patients with head and neck cancer (95879).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Athletic performance. It is unclear if oral propolis is beneficial for improving athletic performance. Details: A small clinical study in healthy male military cadets shows that taking propolis 450 mg twice daily for 4 weeks does not improve measures of aerobic or anaerobic performance during exercise testing when compared with placebo (108519).
Atopic disease. It is unclear if oral propolis can prevent atopic disease in lactating adults or their infants. Details: A small clinical study in lactating adults shows that taking propolis 300 mg daily for 4-10 months does not appear to reduce the risk for developing atopic disease in either the mothers or their infants when compared with placebo (102518). However, due to the small sample size, this study may have been inadequately powered to detect a difference between groups.
Breast cancer. It is unclear if oral propolis is beneficial in patients with breast cancer. Details: A small clinical study in patients with stage II or III breast cancer receiving chemotherapy shows that taking propolis 250 mg twice daily for 3 months improves quality of life and nutritional status when compared with placebo (108518). It is unknown if propolis can increase the likelihood of survival or remission in patients with breast cancer.
Burns. It is unclear if topical propolis is beneficial in patients with minor burns. Details: One small clinical study in patients with minor burns shows that application of propolis cream to burn wounds every 3 days improves healing and reduces inflammation when compared with silver sulfadiazine. Propolis cream seems to be as effective for preventing infection as silver sulfadiazine in these patients (8663).
Canker sores. It is unclear if oral propolis is beneficial in patients with canker sores. Details: A very small clinical study in patients with recurrent canker sores shows that taking propolis 500 mg daily for 6-13 months significantly reduces canker sore outbreaks and improves quality of life when compared with placebo. A 50% or greater reduction in cold sore outbreaks was reported in 60% and 11% of patients taking propolis or placebo, respectively (17629).
Catheter-related infections. It is unclear if topical propolis is beneficial for the prevention of catheter-related infections. Details: One small clinical study in patients with peritoneal dialysis catheters shows that cleaning the exit site after dialysis with a normal saline wash and propolis 10% ointment for 6 months does not reduce the rate of catheter site infections when compared with using normal saline wash plus mupirocin 2% ointment or normal saline wash alone (109985).
Chronic kidney disease (CKD). It is unclear if oral propolis is beneficial in patients with CKD. Details: A small clinical study in patients with CKD shows that taking Brazilian green propolis extract (EPP-AF) 250 mg twice daily for 12 months reduces proteinuria, but does not increase estimated glomerular filtration rate (eGFR), when compared with placebo (105785).
Chronic obstructive pulmonary disease (COPD). Oral propolis has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with frequent exacerbations of COPD shows that taking a combination of N-acetylcysteine (NAC) 1200 mg and propolis 160 mg orally once daily for 3 months reduces the incidence of acute exacerbations during 1 year of follow-up when compared with placebo or a lower dose combination of NAC 600mg and propolis 80 mg (109984). Further research shows that using the higher dose combination for 6 months reduces acute exacerbations, cough, and overall COPD severity, and increases dyspnea-free walking distance, when compared with placebo or the lower dose combination (109986).
Common cold. It is unclear if oral propolis is beneficial in patients with the common cold. Details: One small clinical study in patients with rhinovirus infection shows that taking propolis (dose and duration unknown) might decrease the duration of cold symptoms 2.5-fold when compared with placebo (6602).
Coronavirus disease 2019 (COVID-19). It is unclear if oral propolis is beneficial for the prevention or treatment of COVID-19. Details: A small observational study in healthcare professionals working in an emergency department shows that taking a 30% Anatolian propolis solution as 20 drops twice daily for one month reduces the occurrence of COVID-19 positivity to 2 of 102 subjects, compared with 14 of 102 in an untreated control group (109983). The validity of this study is limited by the lack of blinding and randomization. A small, open-label clinical study in hospitalized adults with COVID-19 shows that taking a standardized green propolis extract (EPP-AF) 100 mg or 200 mg four times daily for 7 days, along with conventional therapy, reduces length of hospital stay by around 5-6 days, but does not affect the need for supplemental oxygen, odds of intubation, or admission to the intensive care unit, when compared with conventional therapy alone (108514).
Dengue fever. It is unclear if oral propolis is beneficial in patients with dengue fever. Details: A small clinical study in patients with dengue hemorrhagic fever shows that taking propolis extract (Propoelix) 400 mg three times daily for 7 days reduces the length of hospital stay by about 18 hours when compared with placebo. This was based on being deemed technically fit for discharge because of a recovery of platelet counts. The effect of propolis on other symptoms of dengue fever was not investigated in this study (99168).
Dental caries. It is unclear if topical propolis, used either as a chewing gum or mouthwash, can prevent dental caries in children. Details: One small clinical trial in children 6-8 years of age at high risk of dental caries shows that chewing propolis gum twice daily for 20 minutes or rinsing with 10 mL of propolis 2% mouthwash for 1 minute twice daily for 2 weeks reduces plaque and Streptococcus mutans count when compared to baseline. There were no differences between the two propolis formulations; however, children preferred the chewing gum over the mouthwash (105790). The validity of these findings is limited by a lack of control group.
Denture stomatitis. Small clinical studies suggest that topical propolis may speed recovery in patients with denture stomatitis. Details: One very small clinical study in denture-bearing patients with prosthesis stomatitis candidiasis shows that applying Brazilian green propolis 20% ethanol extract topically four times daily for 7 days can cause regression of candidiasis lesions. After 7 days, 58% of patients treated with propolis and 67% of patients treated with nystatin had total lesion remission. After 15 days, all patients in both groups saw total lesion remission (70070). Also, two small clinical studies in patients with denture-induced oral mucositis show that applying propolis 2% to 3% gel (EPP-AF) to dentures three to four times daily for 7-14 days improves the cure rate and reduces erythema. In these studies, propolis appeared to be comparable to applying miconazole to dentures (95881,95884).
Depression. It is unclear if oral propolis is beneficial as adjunct therapy in patients with depression. Details: A small clinical study in patients with moderate to severe depression inadequately managed with selective serotonin reuptake inhibitors (SSRIs) shows that taking propolis 1000 mg daily for 6 weeks, in addition to SSRI therapy, reduces symptoms of depression, as measured on the 17-item Hamilton Depression Scale (HAMD-17) and Beck Depression Inventory (BDI), when compared with placebo (108523).
Diabetic foot ulcers. It is unclear if topical propolis is beneficial in patients with diabetic foot ulcers. Details: A small clinical study in patients with diabetic foot ulcers shows that topical application of propolis 5% ointment in addition to routine care for 4 weeks reduces ulcer size about 2.5-fold more than routine care alone (99172).
Genital herpes. It is unclear if topical propolis is beneficial in patients with genital herpes. Details: A small clinical study in patients with recurrent genital herpes caused by herpes simplex virus type 2 (HSV-2) shows that applying propolis 3% ointment (Herstat or ColdSore-FX by Afexa) four times daily for 10 days reduces healing time and increases the relative rate of complete healing by 1.7- and 2-fold when compared with acyclovir 5% ointment and placebo, respectively (1926).
Gingivitis. Small clinical studies suggest that topical propolis may modestly improve symptoms in patients with gingivitis. Details: A small clinical study shows that rinsing with a propolis 2% solution 20 mL twice daily for 21 days is as effective as a rinse containing sodium fluoride 0.05% plus cetylpyridinium chloride 0.05% for the prevention of induced gingival redness and bleeding (99169). Another small clinical study in patients with gingivitis shows that rinsing with a propolis solution twice daily for 4 weeks reduces gingival bleeding, but does not improve plaque index, when compared with placebo (108513). Propolis has also been evaluated in combination with other ingredients. One small clinical study in patients with plaque-induced gingivitis shows that adjuvant therapy with a topical gel containing propolis and other ingredients (Oralsan NBF gel, IDS SpA) for 15 days following scaling and root planing is as effective as a chlorhexidine-based gel for improving bleeding, plaque, and probing depth (99170). Another small clinical study in patients with generalized or localized gingivitis or stage I periodontitis shows that taking 194 mg of a product containing propolis and mangosteen improves the modified gingival index by 31% or 40% at weeks 4 or 8, respectively, compared with 16% or 25% in those receiving placebo. No changes in probing depth, clinical attachment, plaque index, bleeding, or gingival recession were observed (106789).
Helicobacter pylori. It is unclear if oral propolis is beneficial in patients with H. pylori infection. Details: One very small, uncontrolled clinical study in patients with H. pylori infection shows that taking 60 drops of an alcoholic preparation of Brazilian green propolis daily for 7 days does not reduce H. pylori infection when compared to baseline (70107).
HIV/AIDS. Although there has been interest in using oral propolis as an adjunct to antiretroviral therapy for HIV/AIDS, there is insufficient reliable information about the clinical effects of propolis for this purpose.
Intestinal parasite infection. It is unclear if oral propolis is beneficial in patients with giardiasis. Details: One small clinical study in adults with giardia infection shows that taking a specific propolis 30% extract (Propolisina, Apis Flora) for 5 days increases cure rates when compared with tinidazole. The cure rate was 60% with propolis extract, compared to only 40% with tinidazole. In children with giardiasis, taking propolis 10% extract showed a 52% cure rate; however, the rate of cure with tinidazole was not available (70121).
Malnutrition. It is unclear if oral red propolis is beneficial in malnourished children with frequent respiratory tract infections. Details: A small clinical study in children aged 1-5 years with frequent respiratory tract infections and growth failure associated with malnutrition shows that giving 3% red propolis in 8 mL (10 grams) of honey once daily in addition to adequate nutrition does not improve weight gain or reduce the frequency of respiratory infections when compared with honey plus adequate nutrition (109987).
Muscle fatigue. It is unclear if oral propolis is beneficial for speeding recovery from muscle fatigue. Details: One small study in young, healthy males shows that taking Brazilian green propolis 1575 mg before meals three times daily for one week, followed by exercise to induce muscle fatigue, reduces the time to regain maximal contraction torque after stopping when compared with placebo or a 100-mg dose of propolis. There was no difference in average peak power between the groups (109989).
Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral propolis is beneficial in patients with NAFLD. Details: One small clinical study in patients with NAFLD shows that taking propolis extract 250 mg twice daily for 4 months improves markers of hepatic steatosis and fibrosis, but does not improve liver function, when compared with placebo (105786). Another small study in adults with obesity and NAFLD shows that taking propolis 510 mg daily for 8 weeks with a calorie-restricted diet reduces liver fibrosis, fasting blood glucose levels, serum insulin levels, and homeostasis model assessment of insulin resistance (HOMA-IR) when compared with placebo. However, it does not affect the severity of fatty liver, anthropometric measurements, lipid profile, or levels of inflammatory markers (109988).
Peptic ulcers. Although there has been interest in using oral propolis for peptic ulcers, there is insufficient reliable information about the clinical effects of propolis for this purpose.
Periodontitis. It is unclear if oral propolis or propolis extract rinse is beneficial in patients with periodontitis. Details: One small clinical study in patients with type 2 diabetes and chronic periodontitis also receiving scaling and root planing shows that taking propolis 400 mg daily for 6 months reduces probing depth and improves clinical attachment by a small amount when compared with scaling and planing alone. There was no additional benefit with propolis on measures of gingivitis, plaque, or bleeding when compared with scaling and planing alone (99173). Another very small clinical study in patients with chronic periodontitis shows that irrigation of the gums with an ethanol solution containing propolis extract 20% twice weekly for 2 weeks reduces gum bleeding when compared with irrigation with ethanol 14% solution (95876). Propolis has also been evaluated in combination with other ingredients. A small clinical study in patients with generalized or localized gingivitis or stage I periodontitis shows that taking 194 mg of a product containing propolis and mangosteen improves the modified gingival index by 31% or 40% at weeks 4 or 8, respectively, compared with 16% or 25% in those receiving placebo. No changes in probing depth, clinical attachment, plaque index, bleeding, or gingival recession were observed (106789).
Rheumatoid arthritis (RA). It is unclear if oral propolis is beneficial in patients with RA. Details: A small clinical study in females with RA shows that taking Brazilian propolis 508.5 mg daily for 24 weeks does not improve measures of disease activity, quality of life, or activities of daily living when compared with placebo (108515).
Sepsis. It is unclear if oral propolis is beneficial in patients with sepsis. Details: A small clinical study in patients with pneumosepsis shows that taking propolis 1000 mg daily along with conventional therapy does not improve survival rates or disease severity, as measured using APACHE II and SOFA scores, when compared with placebo. The combination of propolis 1000 mg plus melatonin 20 mg daily did improve disease severity scores but had no effect on survival (108524).
Tinea pedis. It is unclear if topical propolis is beneficial in patients with tinea pedis. Details: A case series involving students with athlete's foot found that topical treatment with a 100 mg/mL ethanolic extract of Brazilian green propolis results in less skin itching, peeling, and redness when compared with petroleum jelly placebo, but not when compared with miconazole (95880).
Tuberculosis. Although there has been interest in using oral propolis for tuberculosis, there is insufficient reliable information about the clinical effects of propolis for this purpose.
Upper respiratory tract infection (URTI). It is unclear if oral propolis spray is beneficial in patients with URTI. Details: One small clinical study in patients reporting mild URTI symptoms shows that use of a propolis oral spray (M.E.D. Propolis, B Natural srl), 2-4 sprays daily, providing 6 mg of polyphenols per spray, for 5 days reduces the time to complete resolution of symptoms by 2 days when compared with placebo (105787). Propolis has also been evaluated in combination with other ingredients. A large clinical study in children 1-5 years of age shows that taking 5-7.5 mL of a specific combination product (Chizukit, Hadas Corp Ltd.) containing propolis 50 mg/mL, echinacea extract 50 mg/mL, and vitamin C 10 mg/mL for 12 weeks reduces the number of children who experience one or more upper respiratory tract illnesses, as well as the number and duration of illnesses, when compared with placebo (48551). It is unclear if these findings are due to propolis, other ingredients, or the combination.
Urinary tract infections (UTIs). Oral propolis has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of 3 small clinical studies in adults with uncomplicated UTIs shows that taking combination products containing propolis, Hibiscus sabdariffa, and gelatin or xyloglucan daily for 5-10 days, then daily for two weeks each month for two months, reduces the odds of UTI recurrence by 87% when compared with control (108520). One of these studies used a specific product (Utipro Plus, Noventure) containing propolis 100 mg, xyloglucan extract 100 mg, Hibiscus sabdariffa extract 100 mg, and gelatin 50 mg once daily for 15 consecutive days each month for 6 months (101734). A small clinical study in females with recurrent UTIs shows that taking two capsules of a specific combination product (DUAB, Nutrivercell) containing propolis, cranberry, and zinc daily for 6 months reduces the number of recurrent UTIs by around 0.8 and delays the time to first recurrent UTI by around 26 days when compared with placebo (102522).
Vaginitis. It is unclear if topical propolis is beneficial in patients with vaginitis. Details: A small clinical study in patients with chronic vaginitis shows that applying 50 mL of a specific aqueous solution containing propolis 5% (Melprotect, Melbrosin International) to the vagina for 7 days can reduce symptoms and improve quality of life when compared to baseline (70068). The validity of these findings is limited by a lack of control group.
Warts. It is unclear if oral propolis is beneficial in patients with warts. Details: One small clinical study in adults and children with common and plane warts shows that taking propolis (Bee Propolis, Pollen) 500 mg orally daily for up to 3 months increases wart cure rates when compared with echinacea or placebo. Common warts were cured in 73% of patients taking propolis, compared to 20% taking echinacea and 8% taking placebo. Plane warts were cured in 75% of patients taking propolis, compared with 36% taking echinacea and 21% taking placebo. Neither propolis nor echinacea were effective for treating plantar warts (92800).
Wound healing. It is unclear if topical propolis or propolis mouth rinse improves wound healing. Details: One small clinical study shows that using an aqueous alcohol mouth rinse containing propolis 5% five times daily for 1 week following sulcoplasty improves healing and reduces pain and inflammation (799). Another small clinical study in males recovering from surgery for sacrococcygeal pilonidal disease shows that using 1 mL of propolis 15% solution on the wound dressing daily for 28 days accelerates wound healing when compared with normal saline (108516) However, another small clinical trial in patients undergoing dental surgery shows that using a propolis 20% solution in a dressing is no more effective than the dressing alone for improving wound healing and reducing pain associated with the wound (99167). More evidence is needed to rate propolis for these uses.

(Read more about PROPOLIS)

ROYAL JELLY

POSSIBLY EFFECTIVE

Menopausal symptoms. Several clinical studies suggest that oral royal jelly, taken alone or in combination with other ingredients, modestly improves menopausal symptoms. It is unclear if topical royal jelly is beneficial for this use. Details: One clinical study in postmenopausal patients shows that taking royal jelly 1000 mg daily for 8 weeks reduces menopausal symptom scores by around 30% when compared with placebo (102527). Other small clinical studies show that taking one to two capsules of a specific combination product containing royal jelly and flower pollen (Melbrosia) daily for 12 weeks reduces menopausal symptoms and improves feelings of well-being when compared with baseline or placebo (18064,71956,72005). Another clinical trial in postmenopausal patients shows that taking two capsules of a specific combination product containing royal jelly, evening primrose oil, damiana, and ginseng (Lady 4) daily for 4 weeks decreases self-rated menopausal symptoms when compared with placebo (21003). Topical royal jelly has also been evaluated. A small clinical study in postmenopausal adults shows that applying vaginal cream containing royal jelly 15% daily for 12 weeks improves quality of life, sexual problems, and urinary problems similarly to vaginal estrogen cream 0.625 mg. However, estrogen cream improves vaginal atrophy better than royal jelly (92884).

POSSIBLY INEFFECTIVE

Allergic rhinitis (hay fever). Oral royal jelly does not appear to prevent or treat symptoms of allergic rhinitis in children. Details: A clinical trial in children 5-16 years of age with allergic rhinitis shows that taking a specific royal jelly product (Bidro) 150 mg twice daily for 3-6 months before and during pollen season does not prevent or treat nasal congestion, sneezing, or eye discomfort when compared with placebo (71968).
Diabetes. Oral royal jelly does not appear to improve glycemic control in patients with type 2 diabetes. Details: Most clinical research in patients with type 2 diabetes, along with a meta-analysis of five small clinical trials including patients with or without type 2 diabetes, shows that taking royal jelly 0.5-6 grams daily for 4-8 weeks does not improve markers of glycemic control such as fasting plasma glucose and glycated hemoglobin (HbA1c) (92879,92880,92881,102529).
Physical performance. Oral royal jelly does not appear to improve physical performance in elderly nursing home residents. Details: A clinical trial in elderly nursing home residents shows that taking royal jelly 1.2 grams or 4.8 grams daily for one year does not improve hand grip strength, walking, or ability to stand on one leg when compared with placebo (95870).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Androgenic alopecia. Although there has been interest in using topical royal jelly for androgenic alopecia, there is insufficient reliable information about the clinical effects of royal jelly for this purpose.
Atherosclerosis. Although there has been interest in using oral royal jelly for atherosclerosis, there is insufficient reliable information about the clinical effects of royal jelly for this purpose.
Athletic performance. Oral royal jelly has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Two small clinical trials in elite male swimmers and runners show that taking royal jelly 400 mg and coenzyme Q10 60 mg daily for 10 days does not improve high-intensity interval training performance when compared with placebo (109992,109993). These studies were small and may not have been adequately powered to detect a difference between groups.
Cancer-related fatigue. It is unclear if oral royal jelly is beneficial for improving cancer-related fatigue. Details: A small clinical study in patients with solid (nonhematologic) malignancies shows that taking 5 mL of processed honey and royal jelly twice daily for 4 weeks reduces fatigue when compared with 5 mL of honey alone (92877).
Chemotherapy-induced acral erythema. It is unclear if oral royal jelly is beneficial for preventing acral erythema from tyrosine kinase inhibitors (TKIs). Details: One small clinical trial in patients receiving TKI therapy for renal cell carcinoma shows that taking royal jelly 900 mg four times daily for 3 months does not reduce the risk of acral erythema when compared with placebo (105773). However, this study may have been inadequately powered to detect a difference between groups.
Chemotherapy-induced hepatotoxicity. It is unclear if oral royal jelly is beneficial for preventing hepatotoxicity from tyrosine kinase inhibitors (TKIs). Details: One small clinical trial in patients receiving TKI therapy for renal cell carcinoma shows that taking royal jelly 900 mg four times daily for 3 months does not reduce the risk of hepatotoxicity when compared with placebo (105773). However, this study may have been inadequately powered to detect a difference between groups.
Chemotherapy-induced nephrotoxicity. It is unclear if oral royal jelly is beneficial for preventing chemotherapy-induced nephrotoxicity. Details: A small clinical study in patients receiving two cycles of cisplatin therapy shows that taking royal jelly capsules daily may attenuate increases in serum creatinine and urea levels when compared with placebo. However, it is unclear if this effect is clinically significant; the increased levels that occurred in the placebo group were still within normal limits (95871). The validity of these results is also limited by the short study duration and lack of statistical comparison between groups. Another small clinical trial in patients receiving tyrosine kinase inhibitor therapy for renal cell carcinoma shows that taking royal jelly 900 mg four times daily for 3 months does not reduce the risk of kidney dysfunction when compared with placebo (105773). However, this study may have been inadequately powered to detect a difference between groups.
Chemotherapy-related fatigue. It is unclear if oral royal jelly is beneficial for preventing fatigue from tyrosine kinase inhibitors (TKIs). Details: One small clinical trial in patients receiving TKI therapy for renal cell carcinoma shows that taking royal jelly 900 mg four times daily for 3 months reduces the frequency of chemotherapy-related fatigue when compared with placebo (105773,105774).
Cognitive impairment. Oral royal jelly has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical trial in elderly patients with mild cognitive impairment shows that taking a specific combination product (Memo, Pharco Pharmaceuticals), which contains natural lyophilized royal jelly 750 mg, ginkgo leaf extract 120 mg, and Panax ginseng root extract 150 mg, daily for 4 weeks improves cognitive ability when compared with placebo (89712).
Coronavirus disease 2019 (COVID-19). Oral royal jelly has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A moderate-sized clinical study in adults without diabetes in Iran hospitalized with moderately severe COVID-19 receiving corticosteroids shows that taking a specific combination supplement (Tang Forte, HealthAid) containing royal jelly extract 350 mg and vitamin E 2 mg daily for 7 days does not improve markers of the clinical course of COVID-19, such as oxygen saturation or length of hospital stay, when compared with placebo (114535). However, this study may not have been adequately powered to detect a difference between groups. It is unclear if this effect is due to royal jelly, other ingredients, or the combination.
Diabetic foot ulcers. Small clinical studies suggest that topical application of royal jelly plus panthenol may improve healing of diabetic foot ulcers. It is unclear if topical royal jelly alone is beneficial for this use. Details: One small clinical study shows that applying royal jelly 5% to a wound after conventional cleansing and debriding three times weekly for 3 months does not improve the healing of diabetic foot ulcers when compared with placebo (92882). However, other small clinical studies show that applying 1-3 grams of a specific combination ointment (Pedyphar) containing royal jelly and panthenol after conventional cleansing and debriding procedures twice weekly for up to 6 months may improve the healing of diabetic foot ulcers (71980,102526). In one of these studies, the rate of complete healing of life-threatening ulcers was 2.7-fold greater with this combination ointment when compared with panthenol alone (102526). Possible reasons for these discrepancies include the use of combination versus single ingredient ointments and the duration of treatment.
Dry eye. It is unclear if oral royal jelly is beneficial in patients with dry eye. Details: A small clinical trial in Japanese patients with dry eye shows that taking enzyme-treated royal jelly 2.4 grams daily for 8 weeks does not improve tear stability or dry eye symptoms when compared with placebo (95869).
Fractures. Although there has been interest in using oral royal jelly for healing of fractures, there is insufficient reliable information about the clinical effects of royal jelly for this purpose.
Hepatitis. Although there has been interest in using oral royal jelly for hepatitis, there is insufficient reliable information about the clinical effects of royal jelly for this purpose.
Male infertility. Intravaginal application of royal jelly has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in couples experiencing infertility due to asthenozoospermia shows that applying a saline solution containing royal jelly 3 grams, Egyptian bee honey 100 grams, and bee bread 1 teaspoon intravaginally before or after intercourse, starting one day after menstruation and continuing for 2 weeks, can increase the rate of pregnancy when compared with intrauterine insemination (55131). It is unclear if this effect is due to royal jelly, other ingredients, or the combination.
Obesity. It is unclear if oral royal jelly is beneficial for reducing body weight in patients who are overweight or obese. Details: One small clinical study in overweight patients with type 2 diabetes shows that taking fresh royal jelly 1 gram daily for 8 weeks reduces body weight by around 2 kg and body mass index (BMI) by around 0.7 kg/m², as well as carbohydrate and total energy intake, when compared with placebo. However, the improvement is modest and may not be clinically significant (92878). Another small clinical study in overweight adults shows that taking royal jelly 1000 mg daily for 8 weeks does not reduce body weight, BMI, or appetite when compared with placebo (102528). However, this study may have been inadequately powered to detect a difference in these outcomes.
Oral mucositis. It is unclear if oral royal jelly is beneficial for preventing or treating oral mucositis in patients receiving radiotherapy and/or chemotherapy. Details: One small clinical trial in patients receiving chemotherapy and radiotherapy shows that swishing and swallowing royal jelly 1 gram in two divided doses daily, in addition to standard rinses with benzydamine and nystatin, improves healing time of mild or moderate oral mucositis when compared with standard rinses alone (95867).
Osteoporosis. It is unclear if oral royal jelly is beneficial in patients with osteoporosis. Details: A small clinical trial in postmenopausal adults shows that taking royal jelly powder 1000 mg, equivalent to 3000 mg of fresh royal jelly, daily for 6 months maintains bone mineral density (BMD) in the proximal femur and lumbar spine, while patients taking placebo saw significant reductions in lumbar spine BMD. Also, markers of bone turnover were significantly reduced with placebo, while significant changes in these markers were lacking in patients taking royal jelly (105775). It is unclear whether these findings can be generalized to patients with documented osteoporosis.
Peptic ulcers. Although there has been interest in using oral royal jelly for peptic ulcers, there is insufficient reliable information about the clinical effects of royal jelly for this purpose.
Premenstrual syndrome (PMS). It is unclear if oral royal jelly, taken alone or in combination with other ingredients, is beneficial in patients with PMS. Details: A small clinical study in healthy college students shows that taking royal jelly 1 gram daily starting on the first day of menstruation and continuing for two consecutive menstrual cycles improves PMS symptoms when compared with placebo (95873). However, methodological flaws associated with the study limit the validity of these results. A small clinical study shows that taking a specific combination product (Femal, Natumin Pharma), providing royal jelly 12 mg, bee pollen extract 72 mg, and bee pollen plus pistil extract 240 mg, twice daily over 2 menstrual cycles seems to decrease some symptoms of PMS including irritability, weight increases, and edema (12008). It is unclear if these effects are due to royal jelly, other ingredients, or the combination.
Renal cell carcinoma. It is unclear if oral royal jelly is beneficial in patients with renal cell carcinoma. Details: One small clinical trial in patients receiving tyrosine kinase inhibitor (TKI) therapy for renal cell carcinoma shows that taking royal jelly 900 mg four times daily for 3 months reduces tumor size, improves chemotherapy-related fatigue and anorexia, and reduces the need for dose reduction or the discontinuation of therapy when compared with placebo (105773,105774). Royal jelly does not seem to reduce other TKI-related adverse effects, including gastrointestinal symptoms, oral mucositis, acral erythema, anemia, hepatotoxicity, or nephrotoxicity, when compared with placebo (105773). However, this study may have been inadequately powered to detect a difference in these outcomes. More evidence is needed to rate royal jelly for these uses.

(Read more about ROYAL JELLY)

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Safety view details

Below is general information about the safety of the known ingredients contained in the product Triple Bee Complex. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

BEE POLLEN

POSSIBLY SAFE ...when used orally and appropriately, short-term. Bee pollen has been safely used in clinical trials lasting up to 30 days (7062,7063,12008,33973). There is also preliminary evidence that taking 2 tablets twice daily of a specific combination product containing royal jelly 6 mg, bee pollen extract 36 mg, and bee pollen plus pistil extract 120 mg (Femal, Natumin Pharma) per tablet for up to 2 months seems to be safe (12008).

PREGNANCY: POSSIBLY UNSAFE
when used orally. There is some concern that bee pollen might have uterine stimulant effects (5,6,11); avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about BEE POLLEN)

PANAX GINSENG (Korean Ginseng)

LIKELY SAFE ...when used orally and appropriately, short-term. Panax ginseng seems to be safe when used for up to 6 months (8813,8814,17736,89741,89743,89745,89746,89747,89748,103044)(103477,114980,114981,114984,114985). Panax ginseng sprout extract has also been used with apparent safety in doses up to 450 mg daily for up to 12 weeks (114983).

POSSIBLY UNSAFE ...when used orally, long-term. There is some concern about the long-term safety due to potential hormone-like effects, which might cause adverse effects with prolonged use (12537). Tell patients to limit continuous use to less than 6 months. There is insufficient reliable information available about the safety of Panax ginseng when used topically.

CHILDREN: LIKELY UNSAFE
when used orally in infants. Use of Panax ginseng in newborns is associated with intoxication that can lead to death (12). There is limited reliable information available about use in older children (24109,103049); avoid using.

PREGNANCY: POSSIBLY UNSAFE
when used orally. Ginsenoside Rb1, an active constituent of Panax ginseng, has teratogenic effects in animal models (10447,24106,24107); avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about PANAX GINSENG)

PROPOLIS (Bee Propolis)

POSSIBLY SAFE ...when used orally and appropriately. Propolis has been used with apparent safety in clinical research at doses of up to 1500 mg daily (95883,99173,102520,102521). ...when used topically. Propolis as a 3% or 10% ointment, 0.5% cream, 30% mouth rinse, or 15% solution has been used with apparent safety in small clinical studies (799,1926,6602,8663,17629,17664,17665,92793,92800,95882)(99171,99173,102519,102521,105785,105786,108516,108523,109985).

PREGNANCY:
Insufficient reliable information available; avoid using.

LACTATION: POSSIBLY SAFE
when used orally and appropriately during lactation. Propolis 300 mg daily has been used for 4-10 months in one clinical study with no apparent adverse effects to nursing infants (102518).

(Read more about PROPOLIS)

ROYAL JELLY

POSSIBLY SAFE ...when used orally and appropriately, short-term. Royal jelly 1-4.8 grams daily for up to 1 year has been used in clinical research without reported adverse effects (95869,95870,102527,102528,105773,105774)....when used topically and appropriately for up to 6 months (71980,102526).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately for up to 6 months. A specific royal jelly product (Bidro) 150 mg twice daily has been used with apparent safety for 3-6 months in children 5-16 years of age (71968).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about ROYAL JELLY)

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Interactions with Drugs view details

Below is general information about the interactions of the known ingredients contained in the product Triple Bee Complex. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

BEE POLLEN

WARFARIN (Coumadin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

There is some concern that bee pollen might interact with warfarin and increase the risk of bleeding.

Details

In one case report, a patient on warfarin had a stable international normalized ratio (INR) of 1.9-3.3 for 9 months. The patient's INR was found to be 7.1 after starting bee pollen granules one teaspoon twice daily for approximately one month. The patient's warfarin dose was decreased by approximately 11% in order to return the INR to the therapeutic range while continuing the bee pollen supplement (18063).

(Read more about BEE POLLEN)

PANAX GINSENG (Korean Ginseng)

ANTICOAGULANT/ANTIPLATELET DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Unlikely • Level of Evidence = B

Although Panax ginseng has shown antiplatelet effects in the laboratory, it is unlikely to increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.

Details

In vitro evidence suggests that ginsenoside constituents in Panax ginseng might decrease platelet aggregation (1522,11891). However, research in humans suggests that ginseng does not affect platelet aggregation (11890). Animal research indicates low oral bioavailability of Rb1 and rapid elimination of Rg1, which might explain the discrepancy between in vitro and human research (11153). Until more is known, use with caution in patients concurrently taking anticoagulant or antiplatelet drugs.

ANTIDIABETES DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = B

Theoretically, taking Panax ginseng with antidiabetes drugs might increase the risk of hypoglycemia.

Details

Clinical research suggests that Panax ginseng might decrease blood glucose levels (89740). Monitor blood glucose levels closely.

CAFFEINE

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = B

Theoretically, taking Panax ginseng with caffeine might increase the risk of adverse stimulant effects.

Details

Panax ginseng has been shown to have stimulant effects (589,594). Theoretically, caffeine might have an additive effect on the stimulant effects of Panax ginseng.

CYTOCHROME P450 1A1 (CYP1A1) SUBSTRATES

Interaction Rating = Minor Be watchful with this combination.

Severity = Mild • Occurrence = Possible • Level of Evidence = D

Theoretically, Panax ginseng might decrease levels of drugs metabolized by CYP1A1.

Details

In vitro research shows that Panax ginseng can induce the CYP1A1 enzyme (24104).

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Theoretically, Panax ginseng might increase levels of drugs metabolized by CYP2D6. However, research is conflicting.

Details

There is some evidence that Panax ginseng can inhibit the CYP2D6 enzyme by approximately 6% (1303,51331). In addition, in animal research, Panax ginseng inhibits the metabolism of dextromethorphan, a drug metabolized by CYP2D6, by a small amount (103478). However, contradictory research suggests Panax ginseng might not inhibit CYP2D6 (10847). Until more is known, use Panax ginseng cautiously in patients taking drugs metabolized by these enzymes.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Theoretically, Panax ginseng might increase or decrease levels of drugs metabolized by CYP3A4.

Details

Panax ginseng may affect the clearance of drugs metabolized by CYP3A4. One such drug is imatinib. Inhibition of CYP3A4 was believed to be responsible for a case of imatinib-induced hepatotoxicity (89764). In contrast, Panax ginseng has been shown to increase the clearance of midazolam, another drug metabolized by CYP3A4 (89734,103478). Clinical research shows that Panax ginseng can reduce midazolam area under the curve by 44%, maximum plasma concentration by 26%, and time to reach maximum plasma concentration by 29% (89734). Midazolam metabolism was also increased in animals given Panax ginseng (103478). Until more is known, use Panax ginseng cautiously in combination with CYP3A4 substrates.

ESTROGENS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use of large amounts of Panax ginseng might interfere with hormone replacement therapy.

Details

Laboratory research and some case reports suggest that Panax ginseng can have estrogenic effects due to competition for estrogen receptors (590,591,592,6180,10982,10983,10984). The estrogenic activity is attributed to the ginsenoside constituents of Panax ginseng (10984).

FEXOFENADINE (Allegra)

Interaction Rating = Minor Be watchful with this combination.

Severity = Mild • Occurrence = Possible • Level of Evidence = D

Theoretically, Panax ginseng might decrease blood levels of oral or intravenous fexofenadine.

Details

Animal research suggests that taking Panax ginseng in combination with oral or intravenous fexofenadine may reduce the bioavailability of fexofenadine. Some scientists have attributed this effect to the ability of Panax ginseng to increase the expression of P-glycoprotein (24101).

FUROSEMIDE (Lasix)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, Panax ginseng might reduce the effects of furosemide.

Details

There is some concern that Panax ginseng might contribute to furosemide resistance. There is one case of resistance to furosemide diuresis in a patient taking a germanium-containing ginseng product (770).

IMATINIB (Gleevec)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, Panax ginseng might increase the effects and adverse effects of imatinib.

Details

A case of imatinib-induced hepatotoxicity has been reported for a 26-year-old male with chronic myelogenous leukemia stabilized on imatinib for 7 years. The patient took imatinib 400 mg along with a Panax ginseng-containing energy drink daily for 3 months. Since imatinib-associated hepatotoxicity typically occurs within 2 years of initiating therapy, it is believed that Panax ginseng affected imatinib toxicity though inhibition of cytochrome P450 3A4. CYP3A4 is the primary enzyme involved in imatinib metabolism (89764).

IMMUNOSUPPRESSANTS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = B

Theoretically, Panax ginseng use might interfere with immunosuppressive therapy.

Details

Panax ginseng might have immune system stimulating properties (3122).

INSULIN

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = B

Theoretically, taking Panax ginseng with insulin might increase the risk of hypoglycemia.

Details

Clinical research suggests that Panax ginseng might decrease blood glucose levels (89740). Insulin dose adjustments might be necessary in patients taking Panax ginseng; use with caution.

LOPINAVIR/RITONAVIR (Kaletra)

Interaction Rating = Minor Be watchful with this combination.

Severity = Insignificant • Occurrence = Unlikely • Level of Evidence = B

Although Panax ginseng has demonstrated variable effects on cytochrome P450 3A4 (CYP3A4), which metabolizes lopinavir, Panax ginseng is unlikely to alter levels of lopinavir/ritonavir.

Details

Lopinavir is metabolized by CYP3A4 and is administered with the CYP3A4 inhibitor ritonavir to increase its plasma concentrations. Panax ginseng has shown variable effects on CYP3A4 activity in humans (89734,89764). However, taking Panax ginseng (Vitamer Laboratories) 500 mg twice daily for 14 days did not alter the pharmacokinetics of lopinavir/ritonavir in 12 healthy volunteers (93578).

MIDAZOLAM (Versed)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = B

Theoretically, Panax ginseng may increase the clearance of midazolam.

Details

Midazolam is metabolized by cytochrome P450 3A4 (CYP3A4). Clinical research suggests that Panax ginseng can reduce midazolam area under the curve by 44%, maximum plasma concentration by 26%, and time to reach maximum plasma concentration by 29% (89734). Midazolam metabolism was also increased in animals given Panax ginseng (103478).

MONOAMINE OXIDASE INHIBITORS (MAOIs)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = D

Theoretically, Panax ginseng can interfere with MAOI therapy.

Details

Concomitant use of Panax ginseng with phenelzine (Nardil) is associated with insomnia, headache, tremors (617), and hypomania (618,23650).

NIFEDIPINE (Procardia)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Theoretically, taking Panax ginseng with nifedipine might increase serum levels of nifedipine and the risk of hypotension.

Details

Preliminary clinical research shows that concomitant use can increase serum levels of nifedipine in healthy volunteers (22423). This might cause the blood pressure lowering effects of nifedipine to be increased when taken concomitantly with Panax ginseng.

QT INTERVAL-PROLONGING DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = B

Theoretically, Panax ginseng has an additive effect with drugs that prolong the QT interval and potentially increase the risk of ventricular arrhythmias. However, research is conflicting.

Details

Clinical research shows that short-term use of Panax ginseng can increase the QT interval (4322,96218). However, no changes in QT interval have been identified with prolonged use (4322).

RALTEGRAVIR (Isentress)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, taking Panax ginseng with raltegravir might increase the risk of liver toxicity.

Details

A case report suggests that concomitant use of Panax ginseng with raltegravir can increase serum levels of raltegravir, resulting in elevated liver enzymes levels (23621).

SELEGILINE (Eldepryl)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, Panax ginseng might increase or decrease levels of selegiline, possibly altering the effects and side effects of selegiline.

Details

Animal research shows that taking selegiline with a low dose of Panax ginseng extract (1 gram/kg) reduces selegiline bioavailability, while taking a high dose of Panax ginseng extract (3 grams/kg) increases selegiline bioavailability (103053). More research is needed to confirm these effects.

STIMULANT DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, taking Panax ginseng with stimulant drugs might increase the risk of adverse stimulant effects.

Details

Panax ginseng has been shown to have stimulant effects (589,594).

WARFARIN (Coumadin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Unlikely • Level of Evidence = B

Panax ginseng might affect the clearance of warfarin. However, this interaction appears to be unlikely.

Details

There has been a single case report of decreased effectiveness of warfarin in a patient who also took Panax ginseng (619). However, it is questionable whether Panax ginseng was the cause of this decrease in warfarin effectiveness. Some research in humans and animals suggests that Panax ginseng does not affect the pharmacokinetics of warfarin (2531,11890,17204,24105). However, other research in humans suggests that Panax ginseng might modestly increase the clearance of the S-warfarin isomer (15176). More evidence is needed to determine whether Panax ginseng causes a significant interaction with warfarin.

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PROPOLIS (Bee Propolis)

ANTICOAGULANT/ANTIPLATELET DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, propolis might increase the risk of bleeding when taken with antiplatelet or anticoagulant drugs.

Details

In vitro research shows that propolis water extract and the propolis constituent, caffeic acid phenethyl ester, can inhibit platelet aggregation (50794,95885). Additionally, evidence from an animal model shows that taking propolis in addition to warfarin decreases INR, suggesting that propolis can decrease the effectiveness of warfarin (95874).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, high doses of propolis might increase blood levels of drugs metabolized by CYP1A2.

Details

In vitro research shows that propolis extract can inhibit CYP1A2 (92797,92799). However, animal research shows that propolis extract does not significantly affect CYP1A2 activity when administered to rats at doses up to 250 mg/kg. It is postulated that the constituents of propolis that inhibit CYP1A2 in vitro do not have significant effects in vivo due to low bioavailability and hepatic first-pass effect (92797). This effect has not been reported in humans.

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, high doses of propolis might increase blood levels of drugs metabolized by CYP2C19.

Details

In vitro research shows that propolis extract can inhibit CYP2C19 (92797,92799). However, animal research shows that propolis extract does not significantly affect CYP2C19 activity when administered to rats at doses up to 250 mg/kg. It is postulated that the constituents of propolis that inhibit CYP2C19 in vitro do not have significant effects in vivo due to low bioavailability and hepatic first-pass effect (92797). This effect has not been reported in humans.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, high doses of propolis might increase blood levels of drugs metabolized by CYP2C9.

Details

In vitro research shows that propolis extract can inhibit CYP2C9 (92797,92799). However, animal research shows that propolis extract does not significantly affect CYP2C9 activity when administered to rats at doses up to 250 mg/kg. It is postulated that the constituents of propolis that inhibit CYP2C9 in vitro do not have significant effects in vivo due to low bioavailability and hepatic first-pass effect (92797). This effect has not been reported in humans.

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, high doses of propolis might increase blood levels of drugs metabolized by CYP2D6.

Details

In vitro research shows that propolis extract can inhibit CYP2D6 (92797,92799). However, animal research shows that propolis extract does not significantly affect CYP2D6 activity when administered to rats at doses up to 250 mg/kg. It is postulated that the constituents of propolis that inhibit CYP2D6 in vitro do not have significant effects in vivo due to low bioavailability and hepatic first-pass effect (92797). This effect has not been reported in humans.

CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, propolis might increase levels of drugs metabolized by CYP2E1.

Details

In vitro research shows that propolis can inhibit CYP2E1 (92799). This effect has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, high doses of propolis might increase blood levels of drugs metabolized by CYP3A4.

Details

Some in vitro research shows that propolis extract can inhibit CYP3A4 (92797); however, other in vitro research shows that propolis has no effect on CYP3A4 activity (92799). Furthermore, animal research shows that propolis extract does not significantly affect CYP3A4 activity when administered to rats at doses up to 250 mg/kg. It is postulated that the constituents of propolis that might in inhibit CYP3A4 in vitro do not have significant effects in vivo due to low bioavailability and hepatic first-pass effect (92797). This effect has not been reported in humans.

WARFARIN (Coumadin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, propolis might decrease the effectiveness of warfarin.

Details

Animal research shows that taking propolis in addition to warfarin decreases the international normalized ratio (INR) (95874). This effect has not been reported in humans.

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ROYAL JELLY

ANTIHYPERTENSIVE DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, royal jelly might increase the risk of hypotension when taken with antihypertensive drugs.

Details

Animal research suggests that royal jelly might lower blood pressure (71982,71963).

WARFARIN (Coumadin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Royal jelly might increase the risk of bleeding when taken with warfarin.

Details

In one case, an 87-year-old male who was previously stabilized on warfarin developed hematuria and was found to have an INR of 7.29 after taking a royal jelly supplement for one week (14303).

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Adverse Effects view details

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Below is general information about the adverse effects of the known ingredients contained in the product Triple Bee Complex. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

BEE POLLEN

General ...Orally, bee pollen seems to be well tolerated in most patients.
Serious Adverse Effects (Rare):
Orally: Acute hepatitis, allergic reactions, interstitial nephritis, kidney failure.

Dermatologic ...Orally, a case of photosensitivity has been reported for a 32-year-old patient who took a dietary supplement containing ginseng, goldenseal, bee pollen, and other ingredients. Symptoms included a pruritic, erythematous rash that was localized to the sun-exposed surfaces of the neck and extremities. Following treatment with topical and subcutaneous corticosteroids and discontinuation of the supplement, the skin rash slowly resolved. It is not known if this effect was due to the bee pollen, one of the other ingredients, or their combination (33954).

Hepatic ...Orally, there have been two cases of acute hepatitis associated with bee pollen use. One case involved ingestion of two tablespoons of pure bee pollen daily for several months. Another case involved ingestion of 14 tablets per day of a combination herbal product containing bee pollen, chaparral, and 19 other herbs for 6 weeks (1351). In this case, it is not known if bee pollen or another herb might have caused the adverse event.

Immunologic ...Patients with a history of seasonal pollen allergies, particularly allergies to plants in the Asteraceae/Compositae family, including ragweed, chrysanthemums, marigolds, daisies, and many other herbs, are at risk for serious allergic reactions to oral bee pollen. Allergic reactions can include itching, swelling, shortness of breath, lightheadedness, and anaphylaxis (5,6,11,13480,33952,33965,91981,91984,109991). In one case, exercise may have contributed to the reaction. A 15-year-old male developed generalized urticaria, facial angioedema, and dyspnea 30 minutes into a vigorous exercise session and an hour after ingesting bee pollen granules. The patient experienced abdominal cramps within minutes of consuming bee pollen on 3 previous occasions and had a positive skin prick test for bee pollen after the anaphylactic reaction (109991). Allergy symptoms due to chronic intake of bee pollen include gastrointestinal and neurologic symptoms and eosinophilia (2627,33964).
A case of allergic eosinophilic gastropathy has been reported for a 5 year-old child who was given bee pollen daily to strengthen the immune system. Symptoms included abdominal pain, vomiting, and swelling of the eyelids and legs (91981).

Neurologic/CNS ...Orally, there is one report of dizziness in a patient who took a combination product containing royal jelly, bee pollen extract, and a bee pollen plus pistil extract (12008). It is not known if this effect was due to the bee pollen, another ingredient, or the combination.

Renal ...Orally, there is one report of a patient taking a bee pollen-containing supplement for greater than 5 months who developed breathing difficulties, edema with weight gain, and loss of appetite. The patient was diagnosed with interstitial nephritis and drug-induced acute kidney failure. The supplement was discontinued and the patient was started on hemodialysis. The patient improved after several sessions of hemodialysis (18068).

Other ...Although some research has shown a lack of mycotoxins in twenty samples of bee pollen, analysis of other ready-to-eat bee pollen products have revealed contamination with potential mycotoxin producing species, including Penicillium verrucosum, Aspergillus niger aggregate, Aspergillus carbonarius, Aspergillus ochraceus, Aspergillus flavus, Aspergillus parasiticus, and Alternaria spp. (33959,33961).

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PANAX GINSENG (Korean Ginseng)

General ...Orally, Panax ginseng is generally well tolerated when used for up to 6 months. There is some concern about the long-term safety due to potential hormone-like effects.
Topically, no adverse effects have been reported when ginseng is used as a single ingredient. However, a thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Insomnia.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis, arrhythmia, ischemia, Stevens-Johnson syndrome.

Cardiovascular ...Panax ginseng may cause hypertension, hypotension, and edema when used orally in high doses, long-term (3353). However, single doses of Panax ginseng up to 800 mg are not associated with changes in electrocardiogram (ECG) parameters or increases in heart rate or blood pressure (96218). There is a case report of menometrorrhagia and tachyarrhythmia in a 39-year-old female who took Panax ginseng 1000-1500 mg/day orally and also applied a facial cream topically that contained Panax ginseng. Upon evaluation for menometrorrhagia, the patient also reported a history of palpitations. It was discovered that she had sinus tachycardia on ECG. However, the patient was a habitual consumer of coffee 4-6 cups/day and at the time of evaluation was also mildly anemic. The patient was advised to discontinue taking Panax ginseng. During the 6 month period following discontinuation the patient did not have any more episodes of menometrorrhagia or tachyarrhythmia (13030). Also, a case of transient ischemic attack secondary to a hypertensive crisis has been reportedly related to oral use of Panax ginseng (89402).

Dermatologic ...Orally, Panax ginseng may cause itching or an allergic response consisting of systemic rash and pruritus (89743,89760,104953,114984,114985). Skin eruptions have also been reported with use of Panax ginseng at high dosage, long-term (3353). Uncommon side effects with oral Panax ginseng include Stevens-Johnson syndrome (596).
In one case report, a 6-year-old male with a previous diagnosis of generalized pustular psoriasis, which had been in remission for 18 months, presented with recurrent pustular lesions after consuming an unspecified dose of Panax ginseng. The patient was diagnosed with pityriasis amiantacea caused by subcorneal pustular dermatosis. Treatment with oral dapsone 25 mg daily was initiated, and symptoms resolved after 4 weeks (107748). In another case report, a 26-year-old female presented with itchy exanthem and oval erythematous lesions on the face, neck, and abdomen after consuming a decoction containing Panax ginseng, aconite, ginger, licorice, Cassia cinnamon, goldthread, and peony 400 mL twice daily for 1 week. Pityriasis rosea-like eruption was suspected, but the patient refused topical or oral antihistamines or corticosteroids. The patient continued taking the decoction but with Panax ginseng and aconite removed. After 6 days, symptoms began to resolve, and by 17 days symptom improvement was significant (114986). It is unclear if this reaction was due to Panax ginseng, aconite, the combination, or some other factor. Pityriasis rosea typically resolves spontaneously.
Topically, when a specific multi-ingredient cream preparation (SS Cream) has been applied to the glans penis, mild pain, local irritation, and burning have occurred (2537).

Endocrine ...The estrogenic effects of ginseng are controversial. Some clinical evidence suggests it doesn't have estrogen-mediated effects (10981). However, case reports of ginseng side effects such as postmenopausal vaginal bleeding suggest estrogenic activity (590,591,592,10982,10983).
In a 12-year-old Korean-Japanese male, enlargement of both breasts with tenderness in the right breast (gynecomastia) occurred after taking red ginseng extract 500 mg daily orally for one month. Following cessation of the product, there was no further growth or pain (89733). Swollen and tender breasts also occurred in a 70-year-old female using Panax ginseng orally (590).

Gastrointestinal ...Orally, Panax ginseng can cause decreased appetite (3353), constipation, diarrhea, dyspepsia (3353,89734,103477,112841,114980,114985), abdominal pain (89734,87984,112841,114985), and nausea (589,87984). However, these effects are typically associated with long-term, high-dose usage (3353). Some evidence suggests that fermented Panax ginseng is more likely to cause abdominal pain and diarrhea when compared with unfermented Panax ginseng (112841).

Genitourinary ...Amenorrhea has been reported with oral use of Panax ginseng (3353).
Topically, when a specific multi-ingredient cream preparation (SS Cream) has been applied to the glans penis, sporadic erectile dysfunction and excessively delayed ejaculation have occurred (2537). Less commonly, patients can experience vaginal bleeding (591,592,3354,23630).

Hepatic ...It is unclear if Panax ginseng is associated with adverse hepatic effects. Cholestatic hepatitis has been reported in a 65-year old male following oral use of a combination product containing Panax ginseng and other ingredients (Prostata). However, it is unclear if this adverse effect was due to Panax ginseng, other ingredients, or the combination (598). An elevation in liver enzymes has been rarely reported in clinical research (114985).

Immunologic ...A case of anaphylaxis, with symptoms of hypotension and rash, has been reported following ingestion of a small amount of Panax ginseng syrup (11971).

Neurologic/CNS ...Orally, one of the most common side effects to Panax ginseng is insomnia (589,89734,111336,114985). Headache (594,23638,112840,114985), vertigo, euphoria, and mania (594) have also been reported. Migraine and somnolence occurred in single subjects in a clinical trial (87984). In a case report of a 46-year-old female, orobuccolingual dyskinesia occurred following oral use of a preparation containing black cohosh 20 mg and Panax ginseng 50 mg twice daily for menopausal symptoms. The patient's condition improved once the product was stopped and treatment with baclofen 40 mg and clonazepam 20 mg daily was started (89735).

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PROPOLIS (Bee Propolis)

General ...Orally and topically, propolis seems to be well tolerated.
Most Common Adverse Effects:
Orally: Headache.
Topically: Contact cheilitis and contact dermatitis in sensitive individuals.
Serious Adverse Effects (Rare):
Orally: Severe allergic reactions in sensitive individuals.

Dermatologic ...Propolis can cause allergic reactions and acute oral mucositis with ulceration from the use of the propolis-containing lozenges (2632).
Topically, propolis-containing products, including some cosmetics, can cause eczematous contact dermatitis, erythema multiforme-like contact dermatitis, or allergic contact cheilitis (2632,15647,92796,92798,95878,95882,102517).
Patients allergic to bees or bee products may be more likely to experience allergic reactions to propolis.

Genitourinary ...Vulvar eczema caused by propolis sensitization after topical therapy has been reported (70067).

Hepatic ...Orally, propolis may cause an increase in liver enzymes when used long-term at high doses. In one case, a 30-year-old male presented with persistent abnormal liver enzymes for six months. With other causes ruled out, the patient disclosed using more than 10 propolis lozenges per day for several months to treat a sore throat. Upon discontinuation of the propolis lozenges, liver enzymes returned to normal (105788). Despite concerns presented in this case, analyses of small clinical studies suggest that propolis may have hepatoprotective effects when used at doses of 500-1000 mg daily for up to one year (108521,108522).

Immunologic ...In one case report, a 36-year-old female developed severe erythematous papules and patches with edema of the face, neck, arms, abdomen, and thighs after consuming propolis solution for a few weeks. After symptom resolution, a patch test showed an extreme positive reaction to propolis (106443). In another case, laryngeal edema and severe anaphylactic reaction has been reported in a patient who used topical propolis for the treatment of acute pharyngitis. The patient died due to complications of hypoxia that resulted from the allergic reaction (70063).
Topically, propolis-containing products can cause allergic contact dermatitis, including cheilitis, when used on or near the lips or mouth (15647,92796,92798,102517). Propolis-containing lozenges can cause allergic reactions as well as acute oral mucositis with ulceration (2632).
Patients allergic to bees or bee products may be more likely to experience allergic reactions to propolis.

Neurologic/CNS ...Orally, propolis may cause headache in some patients. In one clinical trial, around 7% of patients taking propolis 250 mg twice daily for 4 months reported mild headache (105786).

Renal ...In one case report, a 59-year-old male with cholangiocarcinoma developed acute kidney failure requiring hemodialysis after taking a Brazilian preparation of propolis 5 mL three times daily for 2 weeks. Renal function improved when propolis was discontinued. The patient restarted taking propolis and symptoms developed again and the patient again required hemodialysis. Symptoms of renal failure improved when propolis was finally discontinued. This product was not screened for contaminants; however, family members of this patient used the same product without apparent adverse effects (14300).

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ROYAL JELLY

General ...Orally and topically, royal jelly seems to be well tolerated.
Most Common Adverse Effects:
Orally: Dyspnea, eczema, oral allergy syndrome, pruritus, and urticaria in people with a history of asthma or atopy.
Topically: Contact dermatitis and skin irritation.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis, status asthmaticus, and death in people with a history of asthma or atopy.

Gastrointestinal ...There is one case report of hemorrhagic colitis with abdominal pain, bloody diarrhea with concomitant hemorrhagic and edematous mucosa of the sigmoid colon after ingestion of royal jelly. Symptoms resolved within 2 weeks following discontinuation of royal jelly and conservative treatment (3516).

Immunologic ...In people with a history of atopy or asthma, royal jelly taken orally appears to cause a high rate of allergic symptoms including pruritus, urticaria, eczema, eyelid and facial edema, conjunctivitis, rhinorrhea, dyspnea, oral allergy syndrome, and asthma (7314,7315,7316,10623,95872). In severe cases, royal jelly can cause status asthmaticus, anaphylaxis, and death (792,7315,7316,10623,10624,108511). Allergic symptoms are associated with IgE-mediated hypersensitivity reactions (3513,10623).
Topically, skin irritation, exacerbation of dermatitis, or contact dermatitis may occur (791).
From occupational exposure, royal jelly can cause allergic rhinoconjunctivitis and asthma (95868).

Neurologic/CNS ...There is one report of dizziness in a patient who took a combination product containing royal jelly, bee pollen extract, and a bee pollen plus pistil extract (12008).

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