Ingredients | Amount Per Serving |
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Proprietary Blend Extract
|
1500 mg |
Ilex Pubescens Root Extract
(Ilex pubescens )
(root)
(Mao dong qing)
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(Pueraria lobata )
(root)
(Ge gen)
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(Verbena officinalis )
(herb)
(ma bian cao)
|
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(Isatis indigotica )
(root)
(Ban lan gen)
|
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(Artemisia annua )
(herb)
(Qing hao)
|
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Gypsum fibrosum Mineral Extract
(Shi gao)
|
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Notopterygium incisum Extract
(Notopterygium incisum Rhizome Extract, Notopterygium incisum Root Extract)
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Microcrystalline Cellulose, Sodium Starch Glyconate, Hypromellose, Polyethylene Glycol, Magnesium Stearate
Below is general information about the effectiveness of the known ingredients contained in the product Zhong Gan Ling. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
Below is general information about the safety of the known ingredients contained in the product Zhong Gan Ling. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
POSSIBLY SAFE ...when used topically and appropriately, short-term. A specific product containing indigo naturalis, an isatis leaf extract, in olive oil (Lindioil), applied topically in doses of 0.05-0.1 mL to the skin around the fingernails twice daily, has been used with apparent safety for 24 weeks (88276,108089). There is insufficient reliable information available about the safety of isatis when used orally.
PREGNANCY AND LACTATION:
Insufficient reliable information is available; avoid using.
POSSIBLY SAFE ...when used orally and appropriately. Kudzu appears to be safe for up to 4 months (10386,11386,92257). ...when used intravaginally and appropriately. Kudzu 5% to 6% gel has been used with apparent safety for up to 12 weeks (96740,105521,110702).
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
POSSIBLY SAFE ...when used orally and appropriately, short-term. Sweet Annie 300 mg daily has been used with apparent safety in studies lasting up to 9 months (11055,94520,94521). Sweet Annie tea, prepared from dried leaves and twigs and consumed in divided doses daily, has been used with apparent safety for up to 7 days (11055,11058). While rare, there is some concern that Sweet Annie might cause liver damage (16895,103254,103255).
POSSIBLY SAFE ...when used sublingually and appropriately, short-term. Sweet Annie up to 2400 biological units daily as sublingual immunotherapy has been used with apparent safety in studies lasting up to 16 months (106441,112392,112393,112394). There is insufficient reliable information available about the safety of Sweet Annie when used topically.
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when used orally in amounts commonly found in foods. Verbena has Generally Recognized As Safe status (GRAS) for use in foods in the US (4912). There is insufficient reliable information available about the safety of verbena when used orally or topically in medicinal amounts.
PREGNANCY AND LACTATION:
There is insufficient reliable information available about the safety of verbena in medicinal amounts during pregnancy and lactation; avoid using.
Below is general information about the interactions of the known ingredients contained in the product Zhong Gan Ling. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
Theoretically, kudzu may increase the risk of bleeding if used with antiplatelet or anticoagulant drugs.
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Theoretically, taking kudzu with antidiabetes drugs might increase the risk of hypoglycemia.
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Theoretically, taking kudzu with caffeine might increase levels of caffeine.
Details
In healthy males injected with the kudzu constituent puerarin, caffeine clearance and metabolism is inhibited (23583). This effect has been attributed to inhibition of cytochrome P450 1A2 (CYP1A2) enzyme, which is involved in caffeine metabolism. It is unclear if taking kudzu orally would have this same effect.
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Theoretically, kudzu might alter the effects of estrogen therapy.
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Theoretically, concomitant use might have additive hepatotoxic effects.
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Theoretically, taking kudzu with methotrexate might increase the risk of methotrexate toxicity.
Details
Preclinical research suggests that kudzu extract greatly reduces the elimination and increases the toxicity of methotrexate. Kudzu might inhibit organic anion transporters (OATs) that are responsible for hepatobiliary and renal excretion of anions, similar to the interaction between methotrexate and non-steroidal anti-inflammatory drugs (NSAIDs) (13296).
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Theoretically, kudzu might interfere with tamoxifen activity.
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Sweet Annie may alter plasma levels and clinical effects of drugs metabolized by CYP2B6.
Details
In vitro research shows that the Sweet Annie constituent artemisinin induces CYP2B6, possibly increasing CYP2B6 activity by 1.6-fold (92501,109316). However, Sweet Annie extract seems to inhibit the activity of CYP2B6 in vitro, suggesting that other constituents of Sweet Annie play a role in its effects on the overall activity of this enzyme (109316). More information is needed to determine whether taking Sweet Annie extract affects the metabolism of CYP2B6 substrates.
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Sweet Annie may alter plasma levels and clinical effects of drugs metabolized by CYP3A4.
Details
In vitro research shows that the Sweet Annie constituent artemisinin induces CYP3A4, possibly increasing CYP3A4 activity by 1.9-fold (92501). However, Sweet Annie extract seems to inhibit the activity of CYP3A4 in vitro, suggesting that other constituents of Sweet Annie play a role in its effects on the overall activity of this enzyme (109316). More information is needed to determine whether taking Sweet Annie extract affects the metabolism of CYP3A4 substrates.
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Theoretically, concomitant use might have additive adverse hepatotoxic effects.
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In vitro research suggests that beta-myrcene, a terpene constituents of verbena, can significantly inhibit cytochrome P450 2B1 (CYP2B1) enzyme activity (82024). Theoretically, verbena might increase levels of drugs metabolized by this enzyme. However, this interaction has not been reported in humans.
Details
Some substrates of CYP2B1 include cyclophosphamide, ifosfamide, barbiturates, bromobenzene, and others.
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Below is general information about the adverse effects of the known ingredients contained in the product Zhong Gan Ling. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
General ...Orally and topically, no adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.
General
...Orally and intravaginally, kudzu seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Elevated liver transaminases.
Cardiovascular ...Orally, side effects of kudzu reported in clinical trials have included palpitations and chest discomfort; however, these effects did not occur more frequently than with placebo (57924,57927).
Dermatologic ...Orally, a side effect of kudzu reported in one clinical trial has included urticaria; however, this effect did not occur more frequently than with placebo (57924). There is one case report of allergic reaction following use of a combination herbal product (Kakkonto) containing kudzu involving a maculopapular eruption starting on the thighs and spreading over the entire body (13111,57886).
Gastrointestinal ...Orally, some side effects of kudzu reported in clinical trials have included nausea, dyspepsia, and bloating; however, these effects did not occur more frequently than with placebo (57927,57942).
Genitourinary ...Intravaginally, irritation of the vulva has been reported with kudzu gel. These cases were generally mild and transient (110702).
Hematologic ...Intravenously, the kudzu derivative, puerarin, has caused intravascular hemolysis (13298,15025,57947).
Hepatic ...Orally, there are several cases reports of liver injury following use of kudzu involving elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels (88777,92260).
Neurologic/CNS ...Orally, a side effect of kudzu reported in one clinical trial has included dizziness; however, this effect did not occur more frequently than with placebo (57924).
Other ...Orally, a side effect of kudzu reported in one clinical trial has included mastodynia; however, this effect did not occur more frequently than with placebo (57942).
General
...Orally, Sweet Annie is generally well-tolerated.
Most Common Adverse Effects:
Orally: Nausea and vomiting.
Serious Adverse Effects (Rare):
Orally: Hepatotoxicity.
Gastrointestinal ...Orally, Sweet Annie might cause gastrointestinal upset including nausea and vomiting in some patients (11058,112393).
Hepatic
...Orally, Sweet Annie might cause hepatic adverse effects (16895,103254,103255).
In one case, a 52-year-old patient developed hepatitis after taking the Sweet Annie constituent artemisinin 200 mg three times daily for 10 days. The patient developed abdominal pain and dark urine and was found to have elevated liver enzymes consistent with hepatitis. Symptoms resolved within 2 weeks of discontinuing use. Although it is possible this supplement caused liver disease in this patient, it is not certain. In clinical trials evaluating artemisinin, elevated liver enzymes have only been reported in around 0.9% of patients. However, the dose of artemisinin in this case was substantially higher than a typical dose (16895). A case of severe acute cholestatic hepatitis has also been reported in a 51-year-old male who drank Sweet Annie tea daily, prepared using 1.25 grams of Sweet Annie powder, for malaria prophylaxis during a 4-week trip to Ethiopia. Three weeks after his return, he presented with malaise, abdominal discomfort, jaundice, elevated liver enzymes, and markers of cholestasis. The patient was treated with corticosteroids and ursodeoxycholic acid and ultimately recovered (103255).
A series of cases linking the use of a supercritical carbon dioxide extract of Sweet Annie to hepatoxicity has also been reported. Of the 29 reports of adverse hepatic reactions to this extract, 19 patients noted symptoms within 12 weeks of starting the extract, 16 patients experienced jaundice, and 9 patients required hospitalization. Other common symptoms of hepatotoxicity included abdominal pain, vomiting, nausea, fever, headache, anorexia, malaise, fatigue, and lethargy. All but one case involved doses below or up to the extract's recommended dose of 300 mg daily. Upon discontinuation, symptoms resolved completely or were improved in nearly all cases (103254).
Immunologic ...One case of a mild allergic reaction to Sweet Annie tea has been reported. The reaction was characterized by a rash and cough that resolved quickly and did not require treatment (11059). When low doses are taken sublingually by individuals allergic to Sweet Annie, numbness of the tongue and throat itching have been reported (109315,112392,112393,112394).
General
...Orally, verbena is well tolerated when used orally in amounts commonly found in foods (4912).
When used in medicinal amounts and in combination with other herbs, adverse effects have included gastrointestinal adverse effects and allergic skin reactions (374,379).
Topically, verbena can cause contact dermatitis (13431).
Gastrointestinal ...Orally, verbena in combination with other herbs can cause gastrointestinal adverse effects (374,379).
Immunologic ...Orally, verbena in combination with other herbs can cause allergic skin reactions (374,379). Topically, verbena can cause contact dermatitis (13431).