Lymphdiaral Drainage-Cream by Pascoe

There is insufficient reliable information available about the effectiveness of autumn crocus.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Topical calendula has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with mild to moderate acne associated with mask wearing shows that topical application of a combination of calendula 4%, licorice root extract 0.3%, and snail secretion filtrate 40% (AI complex) to the face twice daily for 12 weeks modestly reduces inflammatory, but not non-inflammatory or total, acne lesions when compared with placebo. There was no difference in overall treatment success, defined as at least almost clear skin or a large improvement (110322). It is unclear if any benefits are due to calendula, other ingredients, or the combination.
• Bacterial vaginosis. It is unclear if topical calendula is beneficial for improving bacterial vaginosis. Details: A small clinical study in patients with bacterial vaginosis shows that applying 5 grams of vaginal cream containing calendula flower extract before bed for one week improves vaginal burning, odor, painful urination, and painful intercourse when compared to baseline (96649). The validity of these findings is limited by the lack of a comparator group.
• Burns. It is unclear if oral calendula is beneficial for burn healing. Details: A small clinical trial in patients hospitalized for second-degree burns shows that taking calendula 2 grams daily for 2 weeks has a large beneficial effect on wound healing when compared with placebo (110323).
• Chronic obstructive pulmonary disease (COPD). Oral calendula has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in males aged 40-70 years with a history of smoking and stage 2 COPD shows that taking a specific combination of calendula flowers 165 mg, elderberry 165 mg, and heart's ease herb 165 mg (Inflaminat, INAT-Farma), 3 capsules daily for 6 months, modestly improves symptoms, as measured on the breathlessness, cough, and sputum scale (BCSS), and mean forced expiratory volume in 1 second (FEV1) when compared to baseline. However, there was no improvement of COPD exacerbations or other pulmonary function tests (103629). The validity of this finding is limited by the lack of statistical comparison to the placebo group. Furthermore, it is unclear if these effects are due to calendula, the other ingredients, or the combination.
• Chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS). Calendula in rectal suppositories has only been evaluated in combination with turmeric extract; its effect when used alone is unclear. Details: A small clinical study in patients with CP/CPPS shows that using a rectal suppository containing turmeric extract 350 mg and calendula extract 80 mg daily for one month improves pain, peak urine flow rate, and erectile function when compared with placebo (96648). It is unclear if these effects are due to calendula, turmeric, or the combination.
• Conjunctivitis. Although there is interest in using topical calendula for conjunctivitis, there is insufficient reliable information about the clinical effects of calendula for this condition.
• Diabetic foot ulcers. It is unclear if topical calendula is beneficial for improving diabetic foot ulcers. Details: Observational research has found that applying a calendula hydroglycolic extract spray in addition to standard care and hygiene is associated with reduced bacterial colonization and improved odor in patients that have had a diabetic ulcer for over 3 months (93548).
• Diaper rash. It is unclear if topical calendula is beneficial for improving diaper rash. Details: One preliminary clinical study in children less than 3 years of age shows that topical application of calendula 1.5% ointment three times daily for 10 days improves diaper rash when compared with aloe gel (19779). However, other preliminary clinical research shows that applying calendula 1.5% cream every 4-6 hours for 3 days improves diaper rash in fewer infants when compared to treatment with bentonite 50% mineral solution (93545,93554).
• Dysmenorrhea. Although there is interest in using oral calendula for dysmenorrhea, there is insufficient reliable information about the clinical effects of calendula for this condition.
• Gingivitis. It is unclear if using a mouth rinse with calendula is beneficial for improving gingivitis. Details: Preliminary clinical research in patients with mild gingivitis and bleeding gums shows that rinsing the mouth with a tincture containing calendula 25% (Dr. Willmar Schwabe Germany Home Pharmacy Pvt. Ltd.) twice daily for 6 months decreases plaque, gingivitis, and bleeding by 10% to 18% when compared to rinsing with water (93551). Other preliminary clinical research in adults with mild to moderate gingivitis and mild plaque shows that rinsing the mouth with a combination mouthwash containing a 5% extract of calendula, rosemary, and ginger for 30 seconds twice daily after food for 2 weeks decreases plaque, gingivitis, and bleeding when compared with a placebo mouthwash. The effects of this combination mouthwash appear to be similar to chlorhexidine 0.2% mouthwash (93555). It is unclear if these effects are due to calendula, other ingredients, or the combination.
• Hemorrhoids. Although there is interest in using topical calendula for hemorrhoids, there is insufficient reliable information about the clinical effects of calendula for this purpose.
• Liver disease. Although there is interest in using oral calendula for liver disease, there is insufficient reliable information about the clinical effects of calendula for this condition.
• Mosquito repellent. It is unclear if topical calendula essential oil helps to repel mosquitos. Details: Preliminary clinical research shows that applying calendula 50% essential oil to the skin does not repel mosquitos as effectively as applying DEET. Mean repellency time was about 2 hours for patients applying calendula, which was shorter than the 6 hour repellency with DEET (93562).
• Oral leukoplakia. It is unclear if topical calendula is beneficial for improving oral leukoplakia. Details: Preliminary clinical research in patients with oral leukoplakia shows that applying a gel containing calendula flower extract 0.2% three times daily for one month reduces lesion size by about 2 cm when compared to baseline (96650). The validity of this finding is limited by the lack of a comparator group.
• Oral mucositis. Calendula as a mouth rinse has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with head and neck cancer receiving chemotherapy and radiotherapy shows that rinsing with 7 mL of a specific product (Faringel, Cadigroup) containing calendula powder extract 2%, propolis, aloe vera, and chamomile three times daily for 6 weeks does not prevent oral mucositis when compared with placebo (95879).
• Otitis media. Topical calendula has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in children with otitis media shows that applying a specific combination product containing calendula, mullein, garlic, and St. John's wort in olive oil (Otikon Otic Solution, Healthy-On Ltd, Petach-Tikva, Israel), five drops into the affected ear three times daily for 3 days, may reduce ear pain when compared with baseline (39500,39552). It is unclear if this effect is due to calendula, other ingredients, or the combination. Furthermore, due to the lack of an adequate control group, it is unclear whether the pain reduction was due to the resolution of otitis media.
• Peptic ulcers. Although there is interest in using oral calendula for peptic ulcers, there is insufficient reliable information about the clinical effects of calendula for this condition.
• Pressure ulcers. It is unclear if topical calendula is beneficial for improving pressure ulcers. Details: Observational research has found that the application of a specific calendula product (Plenusdermax) twice daily is associated with improved healing in patients with pressure ulcers that have not changed in size for at least 3 months (93549). Preliminary clinical research in hospice patients with symptomatic pressure ulcers and other wounds shows that applying a homeopathic powder (RGN107) containing calendula 0.1% and arnica 0.01% to wounds for 4 weeks is rated by the patients and caregivers to be acceptable for controlling pain, odor, and exudate when compared with baseline (96647). The validity of this finding is limited by the lack of a control group.
• Radiation dermatitis. It is unclear if topical calendula reduces radiation dermatitis symptoms. Details: A meta-analysis of three preliminary clinical trials in patients with breast cancer shows that topical calendula does not affect the development of radiation dermatitis or the incidence of moderate to severe symptoms when compared to control (110325). In addition, a meta-analysis of two studies (39503,93560) shows that topical calendula does not reduce the incidence of treatment interruptions due to severe symptoms of radiation dermatitis (110325). In one of the included studies, a specific calendula petroleum jelly ointment (Pommade au Calendula par Digestion, Boiron Ltd.) used twice daily during radiation therapy was found to reduce acute radiation dermatitis occurrence when compared with topical trolamine (Biafine) (39503). However, it is unclear if the benefit was due to calendula or petroleum jelly. Another clinical study used a specific calendula 10% cream in wool fat and sesame oil (Calendula Weleda, Weleda AG) twice daily during radiation therapy. This product was found to be no better than aqueous petroleum jelly cream (Essex, Schering-Plough) for reducing acute skin reactions and dermatitis symptoms of pain, burning, itching, pulling, and tenderness (93560).
• Vaginal atrophy. Topical calendula has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in menopausal patients with vaginal atrophy shows that use of a specific vaginal gel containing calendula, Lactobacillus sporogenes, isoflavones, and lactic acid (Estromineral Gel, Rottapharm-Madaus) daily for 4 weeks reduces vaginal itching, burning, dryness, and painful intercourse when compared with no topical treatment. Both groups also received oral isoflavones (39534). It is unclear if these effects are due to calendula, other ingredients, or the combination.
• Vaginal candidiasis. One small clinical study suggest that topical calendula is not beneficial for the treatment of vaginal candidiasis. Details: Preliminary clinical research shows that applying 5 grams of calendula 1% cream intravaginally once daily for 7 days effectively treats vaginal candidiasis in 34% fewer patients when compared with using clotrimazole 1% cream (93559).
• Venous leg ulcers. It is unclear if topical calendula is beneficial for improving venous leg ulcers. Details: Preliminary clinical research shows that applying a calendula 7.5% ointment twice daily for 3 weeks to venous leg ulcers accelerates healing when compared with applying saline solution dressing (39509).
• Wound healing. It is unclear if topical calendula is beneficial for improving the healing of small wounds. Details: Two small clinical trials in postpartum patients show that applying calendula ointment (formulation unspecified) to the episiotomy wound every 8 hours for 5-10 days modestly reduces pain, and seems to speed up the resolution of redness, edema, and ecchymosis, when compared with standard care, such as application of betadine solution (93550,105087). Another small clinical study in adults with wounds smaller than 10 cm² on the hands and fingers shows that applying calendula flower extract 2% to the wound twice daily may modestly improve healing and epithelialization time when compared with mineral oil (107806). More evidence is needed to rate calendula for these uses.

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There is insufficient reliable information available about the effectiveness of hemlock.

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UNSAFE ...when consumed orally as a food or medicine. Autumn crocus is associated with significant and potentially fatal adverse effects (33947,99056,99057,99058,99059,99060,99061,111190). Accidental poisoning has occurred when the autumn crocus plant is mistaken for onions, wild garlic, or wild leeks (99057,99060).

PREGNANCY AND LACTATION: UNSAFE
when used orally. Autumn crocus is a potential mutagen and is associated with significant and potentially fatal adverse effects (500,33947,99056,99057,99058,99059,99060,99061); avoid using.

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LIKELY SAFE ...when the flower preparations are used orally or topically and appropriately (4,19779,36931,39503,93552,93557,96647,105088).

PREGNANCY: LIKELY UNSAFE
when used orally; contraindicated due to spermatocide, antiblastocyst, and abortifacient effects. There is insufficient reliable information available about the safety of calendula when used topically during pregnancy (4).

LACTATION:
Insufficient reliable information available; avoid using.

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UNSAFE ...when used orally (6338). All parts of hemlock including seeds, flowers, and fruits are considered poisonous (6338,6339). Death has resulted after ingestion of hemlock (6340,54711). Damage to the tubule cells of the kidneys (acute tubular necrosis), rapid breakdown of muscle tissue and release of muscle tissue byproducts into the blood (rhabdomyolysis), and subsequent kidney failure, as well as respiratory arrest, have also been reported following ingestion of hemlock (54709,54716,54718,54727). Prompt medical attention is advised after ingestion of hemlock (6341).

CHILDREN: UNSAFE
when used orally (6340). Acute, sometimes lethal poisoning has resulted after ingestion of leaf material (6340) or when hollow stems are used as peashooters, flutes, or whistles (6338).

PREGNANCY AND LACTATION: UNSAFE
when used orally because ingestion can be lethal (6338); avoid using.

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CNS DEPRESSANTS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, calendula might have additive effects when used with CNS depressants, although this appears to be unlikely.  Details Although some animal research has suggested that a saponoside constituent in calendula may have sedative effects (39545,39547), calendula has been used for over 30 years without reports of sedation in humans (105088).

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General ...Autumn crocus is generally regarded as unsafe for use. Any benefits of therapy may not outweigh the risk of toxicity. Autumn crocus contains colchicine and can cause acute poisoning. Accidental poisoning has occurred after oral ingestion when autumn crocus is mistaken for onions, wild garlic, or wild leeks (99057,99060). Long-term use of prescription colchicine is associated with agranulocytosis, aplastic anemia, and peripheral neuritis (6).
Topically, handling fresh slices of autumn crocus corms can cause finger numbness (6).

Cardiovascular ...Predominant cardiovascular symptoms of oral autumn crocus poisoning include tachycardia, hypotension, and reduced cardiac output (99057,99058,99059,99060,111190). Arrhythmias can also occur, and cardiovascular collapse, refractory cardiogenic shock, or sudden asystole have been reported as causes of death within 30-72 hours after poisoning (33947,99057,99058,99059). Acute myocardial injury is associated with an elevated troponin 1 level, which can be used as a marker of severe toxicity (111190).

Dermatologic ...Alopecia has been reported during the recovery phase from acute oral autumn crocus poisoning, about 7-21 days after oral ingestion (33947,99057,99060).

Endocrine ...Predominant endocrine symptoms of autumn crocus poisoning include metabolic acidosis, hyponatremia, hypocalcemia, and hypoglycemia (99057,99058).

Gastrointestinal ...Gastrointestinal symptoms are often the first signs of autumn crocus poisoning and include burning of the mouth, vomiting, diarrhea, abdominal pain, and ileus. These symptoms typically occur within 2-12 hours after oral ingestion, with early onset indicating a poorer prognosis (33947,99056,99057,99058,99059,99060,111190). Pancreatitis has also been reported with severe autumn crocus poisoning (33947,99057). In fatal cases of poisoning, the gastrointestinal mucosa is inflamed and the intestinal villi are found to be shortened and blunted (99057,99059).

Hematologic ...Predominant hematologic symptoms of autumn crocus poisoning include pancytopenia, thrombocytopenia, leukopenia or leukocytosis, and coagulopathy (33947,99056,99058,99059,99060). Long-term use of colchicine, a constituent of autumn crocus, is associated with aplastic anemia (6).

Hepatic ...Predominant hepatic symptoms of autumn crocus poisoning include elevated liver function tests (LFTs) and liver failure with necrosis (33947,99056,99057,99058,99059).

Musculoskeletal ...Autumn crocus poisoning can cause rhabdomyolysis, with serum myoglobin and creatine kinase elevated to twice the upper limit of normal (111190).

Neurologic/CNS ...Predominant neurologic symptoms of autumn crocus poisoning include hemiparesis, encephalopathy, brain edema, coma, and death (99056,99057,99059). Peripheral neuropathy has occurred as a long-term consequence of autumn crocus poisoning (33947,111190).
Topically, handling fresh slices of autumn crocus corms can cause finger numbness (6).

Pulmonary/Respiratory ...Predominant pulmonary symptoms of autumn crocus poisoning include tachypnea, respiratory distress or failure, and pleural effusions (99057,99058,99059,33947). Some patients require mechanical ventilation or extracorporeal membrane oxygenation (ECMO) for life support (99060).

Renal ...Predominant renal symptoms of autumn crocus poisoning include acute renal failure and anuria, with elevated serum creatinine (33947,99056,99058,111190).

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General ...Orally and topically, calendula is generally well tolerated.
Serious Adverse Effects (Rare):
All ROAs: Allergic reactions.

Dermatologic ...Topically, a preparation containing calendula powder 0. 1% resulted in inflammation around the wound to which it was applied (96647). Burning sensation, itching, redness, and scaling were reported rarely in patients applying a combination of calendula, licorice, and snail secretion filtrate to the face. The specific role of calendula is unclear (110322).

Immunologic ...Orally, calendula can cause allergic reactions. Topically, calendula can cause eczematous allergic reactions. Calendula-specific patch testing is recommended prior to usage to determine allergenic potential. Testing is particularly necessary in individuals sensitive to the Asteraceae/Compositae family (10691,11458,96647). Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs. A preparation containing calendula powder 0.1% resulted in hives in a patient with a ragweed allergy (96647). Despite the widespread use of calendula and the occurrence of allergies to other family members, there has been only one report of anaphylaxis (11152).

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General ...Hemlock is generally regarded as unsafe for use. Any benefits of therapy may not outweigh the risk of toxicity. Orally, hemlock can cause burning of the mouth, throat, and abdomen, nausea, vomiting, excessive urination, salivation, drowsiness, mydriasis, muscle pain, rapid muscle swelling and stiffness, rhabdomyolysis, and tachycardia followed by bradycardia. It can also cause loss of speech, paralysis, encephalopathy, unconsciousness, rapid respiration and respiratory arrest, cardiovascular collapse, renal toxicity, and death (6340,6341,54709,54711,54712,54716,54717,54718,96877,96878).

Cardiovascular ...Orally, hemlock can cause tachycardia followed by bradycardia, cardiovascular collapse, and death (6340,6341,54712,96877). In one case report, a 6-year old girl had prolonged coagulation tests after accidental ingestion of hemlock (96877). It can also cause hypertension (110410).
Intravenously, hemlock resulted in a brief cardiac arrest followed by return of spontaneous circulation in one case report (96876).

Gastrointestinal ...Orally, hemlock causes burning of the mouth, throat, and abdomen (6341,96877). It can also cause nausea, vomiting, and increased salivation (54712,96878,110410).

Genitourinary ...Orally, hemlock can cause excessive urination (54712).

Musculoskeletal ...Orally, hemlock can cause muscle pain, rapid muscle swelling and stiffness, and rhabdomyolysis (6340,6341,54712,110410). Plasma exchange effectively improved the signs of rhabdomyolysis in one case of hemlock poisoning (54727).

Neurologic/CNS ...Orally, hemlock can cause drowsiness, fatigue, lethargy, dizziness, numbness, loss of speech, tremors, paralysis, seizures, encephalopathy, unconsciousness, and death (6340,6341,10778,54711,54712,54716,96877,110410). Death from hemlock toxicity is usually due to respiratory paralysis (96879,96877).
A case report describes prolonged status epilepticus in a 41-year-old, previously healthy female who mistook hemlock root for parsnip. She developed severe vomiting and drowsiness, followed by prolonged status epilepticus which was refractory to multiple drugs. Seizures and the abnormal electroencephalogram were ultimately controlled with thiopental, gradually weaning to long-term oral treatment with lacosamide and perampanel, which returned the patient to her baseline level of functioning (110411).

Ocular/Otic ...Orally, hemlock can cause blurred vision and mydriasis (54712,110410).

Pulmonary/Respiratory ...Orally, hemlock can cause rapid respiration (54712) as well as acute respiratory arrest (54709,96878). In one case report, a 45-year old woman required mechanical ventilation after accidental ingestion of hemlock (96878). Death from hemlock toxicity is usually due to respiratory paralysis (96876,96877).

Renal ...Orally, hemlock has been reported to cause myoglobinuria, acute tubular necrosis, and acute renal failure (54716,54717,54718,54728). Plasma exchange effectively improved the signs of renal failure in one case of hemlock poisoning (54727).

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