Lobelia and Calamus Combination Powder by TerraVita Premium Collection

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Anorexia nervosa. Although there has been interest in using oral calamus for anorexia nervosa, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Asthma. Although there has been interest in using oral calamus for asthma, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Bronchitis. Although there has been interest in using oral calamus for bronchitis, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Cancer. Although there has been interest in using oral calamus for cancer, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Colic. Although there has been interest in using oral calamus for colic, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Depression. Although there has been interest in using oral calamus for depression, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Diabetes. Although there has been interest in using oral calamus for diabetes, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Diarrhea. Although there has been interest in using oral calamus for diarrhea, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Dyspepsia. Although there has been interest in using oral calamus for dyspepsia, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Flatulence. Although there has been interest in using oral calamus for flatulence, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Gastritis. Although there has been interest in using oral calamus for gastritis, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Headache. Although there has been interest in using oral calamus for headache, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Hemorrhoids. Although there has been interest in using topical calamus for hemorrhoids, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Memory. Although there has been interest in using oral calamus for memory, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Obesity. Although there has been interest in using oral calamus for obesity, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Peptic ulcers. Although there has been interest in using oral calamus for peptic ulcers, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Rheumatoid arthritis (RA). Although there has been interest in using oral calamus for rheumatoid arthritis, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Seizures. Although there has been interest in using oral calamus for seizures, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Stroke. Although there has been interest in using oral calamus for stroke, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Tinnitus. Although there has been interest in using topical calamus for tinnitus, there is insufficient reliable information about the clinical effects of calamus for this condition.
• Toothache. Although there has been interest in using oral calamus for toothache, there is insufficient reliable information about the clinical effects of calamus for this condition. More evidence is needed to rate calamus for these uses.

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POSSIBLY INEFFECTIVE

• Smoking cessation. Some small clinical studies have evaluated the use of lobeline, a constituent of lobelia, for smoking cessation and stopping use of smokeless tobacco over a 48-hour period. These studies show inconsistent effects of lobelia on tobacco use, with many finding no benefit. The validity of these findings is limited by low study quality and the short duration of use (16413,16414,59987). There is insufficient reliable information available about the effectiveness of lobelia for its other uses.

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LIKELY UNSAFE ...when used orally. The FDA prohibits calamus use in food products due to evidence of carcinogenic effects in animals receiving high doses of a calamus strain high in beta-asarone (93978,94727,94728). However, the beta-asarone content can vary widely among species from 0% to 96% (6); some products may be safer than others. There is insufficient reliable information available about the safety of calamus when used topically.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally; avoid using (4,500).

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LIKELY UNSAFE ...when used orally (3,11). Lobelia leaf can be toxic in doses of 600-1000 mg; 4000 mg of the leaf may be fatal (18). There is insufficient reliable information available about the safety of lobelia when used topically.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally due to its emetic effects (4,12). There is insufficient reliable information available about the safety of lobelia when used topically during pregnancy and lactation.

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ANTACIDS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking calamus might reduce the effectiveness of antacids.  Details Some research suggests that calamus lowers gastric pH (19).

ANTICHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concurrent use of anticholinergic drugs and calamus might decrease the effectiveness of the anticholinergic drug.  Details In vitro evidence shows that calamus can inhibit acetylcholinesterase (AChE) (38418).

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking calamus with other antihypertensive medications might increase the risk of hypotension.  Details Animal research shows that calamus decreases the rate and strength of the heartbeat, which might lower blood pressure (38444). use with caution.

CHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concurrent use of cholinergic drugs and calamus might have an additive effect and increase the risk of cholinergic effects.  Details In vitro evidence shows that calamus can inhibit acetylcholinesterase (AChE) (38418).

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concurrent use of CNS depressants and calamus might have an additive effect and increase the risk of sedative effects.  Details Animal research shows that calamus is a CNS depressant and increases gamma-aminobutyric acid levels (4,38400,38444).

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking calamus with drugs metabolized by CYP2D6 might increase drug levels and potentially increase the risk of adverse effects.  Details In vitro research shows that calamus extract inhibits CYP2D6 enzyme (93975).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking calamus with drugs metabolized by CYP3A4 might increase drug levels and potentially increase the risk of adverse effects.  Details In vitro research shows that calamus extract inhibits CYP3A4 enzyme (93975).

H2-BLOCKERS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking calamus might reduce the effectiveness of H2-blockers.  Details Some research suggests that calamus lowers gastric pH (19).

MONOAMINE OXIDASE INHIBITORS (MAOIs) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, calamus might potentiate the effects and adverse effects of MAOIs.  Details Some reports suggest that calamus increases the effects of MAOIs (4).

PROTON PUMP INHIBITORS (PPIs) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking calamus might reduce the effectiveness of PPIs.  Details Some research suggests that calamus lowers gastric pH (19).

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General ...There is currently a limited amount of information on the adverse effects of calamus. Calamus is likely unsafe for use because it may cause cancer.
Most Common Adverse Effects:
Orally: Nausea, vomiting.
Serious Adverse Effects (Rare):
Orally: Cancer, intestinal paralysis.
Orally, nausea, vomiting, and intestinal paralysis have been reported with calamus use (33310,38458,93980). Tachycardia has also been reported (93980).

Cardiovascular ...Tachycardia has been reported as a toxic effect related to oral use of calamus oil (93980).

Gastrointestinal ...A case of gastrointestinal toxicity has been reported in a 19-year-old male who appeared to use calamus root for its euphoric effects. The man ingested a large amount of the root with water and later presented at the emergency department with continuous vomiting, paleness, and sweating. He was treated intravenously with saline and promethazine (38458). Both nausea and vomiting have been reported in patients using calamus oil orally (93980). Intestinal paralysis has also been reported with calamus use in children (33310).

Oncologic ...Beta-asarone, a constituent of calamus, increases the risk of cancer (93978,94727,94728).

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General ...Orally, lobelia can cause nausea, vomiting, diarrhea, coughing, dizziness, tremors, and throat irritation. These adverse effects have been reported with doses as low as 50 mg (4,16414). Lobelia leaf can cause toxicity when taken in doses of 600 mg or higher. Symptoms of lobelia toxicity include sweating, tachycardia, convulsions, hypothermia, hypotension, coma, and death (4,11).

Cardiovascular ...Orally, high doses of lobelia leaf can cause toxicity. Symptoms of lobelia toxicity include tachycardia, hypotension, and death (4,11).

Gastrointestinal ...Orally, lobelia can cause nausea, vomiting, diarrhea, and throat irritation (4,16414).

Neurologic/CNS ...Orally, lobelia can cause dizziness and tremors. High doses of lobelia leaf can cause toxicity. Symptoms of lobelia toxicity include convulsions, coma, and death (4,11).

Pulmonary/Respiratory ...Orally, lobelia can cause coughing and throat irritation (4,16414).

Other ...Orally, high doses of lobelia leaf can cause toxicity resulting in death. Toxicity has been reported to occur at doses as low as 600 mg, with doses of 4000 mg or more considered to be fatal (4,11).

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